[Congressional Record Volume 156, Number 65 (Tuesday, May 4, 2010)]
[House]
[Pages H3108-H3115]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       HEALTH CARE BILL REVISITED

  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 come to the floor tonight for the leadership hour on 
our side to talk more about this health care bill that we passed 6 
weeks ago, because it was a pretty sweeping piece of legislation. We 
passed it kind of quickly. A lot of people may not have understood 
everything that was contained therein or the implications of the things 
contained therein. So from time to time it is worthwhile to study a 
little bit about what we did and how we got there and maybe why it was 
done, and, if anything, a look at what is ahead over the horizon for 
the people of this country as they begin to adjust to life with this 
bill.
  Let me just say at the outset that I did not vote for this bill. I do 
not approve of this bill. The process was flawed. In fact, the process 
was absolutely toxic to this House, to the United States Congress--in 
fact, to the country at large. Never before has a piece of legislation 
this sweeping and with this sweeping in scope and its impact on the 
daily lives of the American people, never before has a bill this large 
passed with only the support of one side of the aisle. In fact, never 
has a bill like this passed that did not at least have some measure of 
popular

[[Page H3109]]

support. But the bill passed with a great deal of difficulty because it 
did lack popular support from the American people.
  Now, 6 weeks after the passage of this bill and the bill signing 
ceremony down in the East Wing of the White House, now 6 weeks later, 
if anything, opposition to this bill has hardened. For that reason, I 
believe this bill ultimately will have to be repealed, ripped out root 
and branch, and then get on about doing the things that people told us 
they wanted us to do. Had we bothered to listen during the summer town 
halls of August of 2009, perhaps we could have delivered something 
meaningful for the American people. Instead, we decided to push again 
with a very partisan agenda.
  And let's be honest, Madam Speaker, the only thing that was 
bipartisan about this bill was the opposition, because, indeed, at the 
end of the evening, when we passed this bill, you had some 35 or 36 
Democrats join 178 Republicans in voting against this bill. There was 
no bipartisan support for this bill either in the House or over in the 
other body. In fact, the bipartisan nature of this bill was the 
opposition. The American people are now subscribed to that notion as 
well.
  What is ahead for us? Well, there are some court challenges that 
attorneys general in various States--I think the last count, it was 20 
or 21 States--have said that they are going to register challenges to 
this bill. That is a significant number. I suspect there will be more 
over time. The concept of negating the bill through a Supreme Court 
challenge is one that is far from certain, but it is certainly worth 
the effort that the attorneys general across the country are putting 
forward because, again, the bill, at its very heart, is so flawed and 
so toxic.
  If you go back and look at the things that led up to the passage of 
this bill 6 weeks ago, you really have to go into last year and deep 
into last year to find where the roots of the problem lay. It almost 
goes back to a year ago last February, with the passage of the stimulus 
bill.
  The stimulus bill famously passed without any Republican support. All 
of the pundits and commentators around the town were absolutely 
astounded that not a single Republican would vote for the stimulus 
package. But it was in those negotiations, such as they were, the 
meetings that occurred down in the Cabinet Room at the White House, 
where the Minority Whip, Eric Cantor, tried to bring some ideas to the 
table about what this stimulus ought to look like and what the 
Republican position was on the stimulus bill. And it was, Wait, not so 
fast. We won. We won the election. What you all say here doesn't 
matter. It was really that comment that set the tone for balance of 
2009.
  Now, there were opportunities where both sides could have come 
together on some aspects of what ultimately was included in the health 
care reform bill. I will admit those opportunities were few and far 
between, but they did exist. Indeed, even individuals such as myself, 
so-called backbenchers, reached out to the other side, both to the 
transition team and to the Democratic leadership of my committee, and 
said, Look, health care is important to me. I didn't give up a 25-year 
medical career to sit on the sidelines while you guys did this. Let's 
talk about the areas where there perhaps can be some common ground. But 
those offers were never seriously entertained by the other side. They 
knew what they wanted in their health care bill and they wrote them 
exactly as they wanted them.
  Now, we finally got a chance to see the health care bill about the 
middle of July last year. It came over the transom late one night with 
a note attached to it that said, Read fast. We're going to mark it up 
in committee in a day or two. Indeed, that's just exactly what 
happened.

  Now, Madam Speaker, I ask you to think back to a piece of legislation 
not that many years ago, the Clean Air Act, which passed in the early 
1990s; sweeping legislation that changed things for a lot of people in 
this country. Arguably, there were good things in the bill. Arguably, 
there were things that were contentious in the bill. But there was, I'm 
told, in our committee, the Committee on Energy and Commerce, an 8-
month markup on this bill. Legitimately, members of the committee hated 
each other at the end of that markup, but it was important. It was 
important for people to see the process. It was important for people to 
understand that both sides did play a role in crafting this very, very 
complex piece of legislation, and the proof has been that, over time, 
the bill has delivered on what it was intended to do. Indeed, arguably, 
the Clean Air Act has improved the quality of air in many locations 
around the country, and the effects were significant as far as 
businesses were concerned, but not crippling, and people were able to 
make adjustments to the legislation after it was passed. And, arguably, 
it has been a difficult but good process for the American people.
  Now, that is an example of how things can work. It wasn't easy. It 
took months and months and months to do it, but ultimately it did have 
support from both sides of the aisle. Contrast that to the health care 
bill. The three committees that worked on this bill--my committee, the 
Committee on Energy and Commerce, also the Committee on Ways and Means 
and the Committee on Education and Labor, those three House committees 
worked on this bill. We actually had, by comparison, a lengthy markup 
in Energy and Commerce. We had 8 days of markup. Now, 4 of those days 
we were in recess subject to the call of the chair because the chairman 
of the committee was trying to get his Blue Dogs in line after he lost 
an amendment vote early in the process. But, nevertheless, we did have 
8 days in committee to work on the bill.

                              {time}  2045

  The other two committees had 24 hours, 24 hours to work on this bill. 
At the time it seemed like a big bill--it was 1,000 pages along. That's 
a big bill. It got bigger when it came back to the House in the fall 
and then got bigger still after it left the Senate. But, nevertheless, 
last July, the bill was 1,000 pages long. And to work through and mark 
up a 1,000-page bill probably was going to take longer than 4 working 
days--which is what we got in our committee--but it darn sure was going 
to take longer than 24 hours, which was the length of time that it was 
allotted in Ways and Means and the Committee on Education and Labor.
  The bill was amended in the committee work this summer by all three 
committees. Interestingly enough, some of those amendments were 
Republican amendments. Interestingly enough, after the bill was wrapped 
up, after the work was wrapped up in the committee process, the bill 
left the committee and went over to the Speaker's office. There it grew 
from 1,000 pages to 2,000 pages.
  But significantly, while the bill was doubling in size, it was 
shedding pages that were the past amendments that were bipartisan at 
the committee level. Most of the amendments that were passed in the 
committee never saw the light of day when the bill came to the full 
House floor last fall, even though the bill was substantially larger, 
largely because of input from folks down at the White House who worked 
hard with the Speaker's office for several months to get a compromise 
package that they could bring to the floor to get passed. But most of 
those Republican amendments were, in fact, deemed to be excessive and 
expendable and, indeed, they somehow lost out along the way.
  Now, one of the things that was really striking during the course of 
the year and several months that we worked on this bill was just about 
1 year ago. There were six groups that met down at the White House 
along with members of the administration to talk about things that they 
might do to get a health care bill passed. So in an effort to show good 
will toward the new administration, America's Health Insurance Plans, 
the Pharmaceutical Management Association, PhRMA, my AMA, the American 
Medical Association, the American Hospital Association, Medical Device 
Manufacturers, and the Service Employees International Union all met 
down at the White House and decided that there were things that they 
could bring to the table and give up as far as financing of this 
complex health care bill.
  I will never forget: They went into the Rose Garden and had a huge 
press conference where they described $2 trillion in savings that had 
been agreed to

[[Page H3110]]

by these different six groups, $2 trillion in savings over 10 years in 
things that were going to be given up, and this was going to allow the 
House to pass or the Congress to pass a health care bill because now 
everyone's on the same page and everyone's working together. There's 
just one problem: No one from the administration ever communicated to 
at least those of us in the rank-and-file on the legislative end what 
was contained within those bargains, what was contained within those 
deals. In fact, beginning in September, when I began to question and 
ask, can we see what those deals were? Can we see the copies of the 
emails that were exchanged? Can we see the notes or the minutes that 
were transcribed during those meetings when all of these agreements 
were made to produce those $2 trillion in savings? And we didn't write 
anything down. Now, Madam Speaker, I ask you, $2 trillion in savings, 
which was on the table--at least according to the President and the 
White House in May and June of last year--and no one wrote down a 
single word as to what those deals were?
  And the problem is, it kept surfacing. As we would deal with the bill 
in our committee and while they would deal with the bill over in the 
Senate, from time to time something would come up and they would say, 
oh, no, wait, you can't tax the hospitals for this because that wasn't 
part of the deal. Well, what was part of the deal? And why can't we 
know what was agreed to down at the White House so we can at least, if 
nothing else, even if we don't agree with what happened, but so we can 
at least work around the deals that were crafted down at the White 
House?
  One night it was particularly stunning. Senator McCain, over in the 
Senate, wanted to introduce an amendment that would have allowed for 
reimportation of prescription drugs. Now, that is not a concept that I 
support. I think there are real safety issues surrounding 
reimportation, but the Senator should have the right to offer his 
amendment and argue the merits of his amendment. People on the other 
side should have the ability to argue the merits of their case and then 
have the vote and make the decision. But to stop Senator McCain in the 
middle of his discussion and say, wait a minute, you can't do that 
because we had a deal, well, people recognize that's just not right, 
that's not the way things should be done.
  It was particularly galling because the President, when he was 
running, when he was campaigning for the highest office in the land, 
repeatedly said that this was going to be a different process, his 
would be a different presidency, he would bring people together. It was 
going to be the age of postpartisanship and people with good ideas 
would be welcomed and everyone would be around a table. And it would be 
transparent. It would be covered on C-SPAN so everyone would be aware 
of who was on the side of the American people and who was on the side 
of the special interests. This was the promise that was made to the 
American people during the course of a presidential campaign. And I 
recognize that sometimes things are said on the campaign trail, and I 
recognize that sometimes a promise is made that becomes very, very 
problematic or difficult to deliver, but this was such a central part 
of the argument.
  Let me quote to you from what the President said when he was a 
candidate for office. He said, quoting now, ``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.'' Well, that's exactly right.

  Remember a few minutes ago I said that part of the difficulty in 
passing this bill was it never enjoyed popular support. It's a big 
bill, there's some tough concepts contained within this bill. It's not 
something that people are just going to embrace unless you bring them 
along and educate them as part of the process. But although it was 
promised that that would happen, that, unfortunately, never came into 
being. In fact, after getting frustrated with being stonewalled by the 
White House in September and through the fall, in December I introduced 
in our committee what's called a Resolution of Inquiry. A Resolution of 
Inquiry means that after it's filed, the committee, after a certain 
number of days, is required to bring it up and have a legislative 
hearing on the resolution. If it passes, obviously the requests go down 
to the White House.
  Now, Chairman Waxman felt that, in fairness, some of the things for 
which I was asking would be protected by executive privilege, and not 
wanting to be in a protracted fight that might well have resulted in an 
affirmation of executive privilege, he still recognized that as a 
member of the committee, as a member of the legislative branch of 
government I should have access, that other committee members should 
have access to some of the things we were requesting. So about 6 of the 
11 things I requested, the chairman said that's reasonable, you should 
have those things. And he and Ranking Member Joe Barton sent a letter 
down to the White House counsel and said we would like for you to 
produce this information for the committee and for the Congressman 
who's filed the Resolution of Inquiry because we feel this is 
information that should be available.
  Now, unfortunately, while the White House may argue that they 
complied with that request, all we have ever gotten have been press 
releases and reprints of Web pages, never the depth of the documents 
that was asked for in the Resolution of Inquiry. We are continuing to 
push that, but here we are now in the early part of May--again, the 
meetings were held 1 year ago in May and June of 2009, the initial 
request went out in September, the Resolution of Inquiry was filed in 
December, it was brought up in committee at the end of January, and 
clearly this thing has moved with glacial speed. But tonight, Madam 
Speaker, I want to reassure you and Members of the House of 
Representatives--and, in fact, the White House--that I am going to be 
tenacious on this, I'm going to be relentless. We do need to see that 
information; it should be made available to the legislative body.
  And please understand, my beef here is not with the American Hospital 
Association, the American Medical Association, PhRMA, the insurance 
companies, or anyone else. Certainly, they have the right and the 
obligation to go down and negotiate and make arguments in favor of 
their position and the clients that they represent. I have no problem 
with that. Where I have the problem is this all being done in secret, 
all being done behind closed doors, no paper trail to trace and hold 
anyone accountable. And yet, when we get to the work of writing the 
legislation, not so fast, we have a deal, you can't do that, we have a 
deal. Members of the legislative body should have access to the same 
information that members of the administration had access.
  Now, this bill passed in March, but it was the bill that passed the 
Senate on Christmas Eve, not the bill we passed out of committee in 
July, not the bill that doubled in size and came back to the House in 
late October and then was passed in early November. Those aren't the 
bills that we now talk about. There were some interesting things in 
those bills--a lot of bad, a little bit of good--but those aren't the 
bills that are actually the point of discussion because when the Senate 
took up its health care bill, it decided to do something different from 
what the House had done. And that's okay, the Senate is a legislative 
body in its own right, and they certainly have the obligation and it is 
correct for them to do their work the way they see fit. And under 
normal circumstances, the House bill and the Senate bill--if in fact 
they're different--would be joined together in some type of conference 
process, and I'm sure that's what everyone over on the Senate side 
thought would happen, but in reality what occurred was the Senate 
picked up a bill that had already been passed by the House, H.R. 3590. 
If you'll remember, famously, that was the health care bill number.
  Now, that was a bill that the House passed 1 year ago in the late 
summer or early fall of 2009. It was a housing bill when we passed it 
on this side. We passed it and sent it over to the Senate to await 
further work on a housing bill. But it was picked up on the Senate 
side, the housing language was all stripped out of the bill, and the 
empty shell then became the vehicle for inserting the health care 
language. And that's exactly what occurred between Thanksgiving and 
Christmas of 2009.

[[Page H3111]]

  But the important part of this is, it was a bill that had already 
passed the House. And when it passed the Senate, all that was necessary 
to do, it didn't have to come back to a conference committee, you 
didn't have to iron out any differences, you simply could bring it back 
to the floor of the House of Representatives, ask the question as was 
asked here late in the night of March 20th, ask the question, Will the 
House now concur with the Senate amendment to H.R. 3590? And that 
amendment of course switched it from a housing bill to a major sweeping 
piece of health care legislation over 2,700 pages long. But the House 
did agree to the Senate amendment, and as a consequence, that bill left 
the House of Representatives late that Sunday night, zipped the quick 
trip down Pennsylvania Avenue and was signed into law on Tuesday, and 
could move just that quickly because of the nature of how the bill was 
constructed and how the bill came to be in the Senate and how it was 
passed in the Senate.
  This became important because, deep down inside, I don't think 
Members of the other body, as they put this health care bill together 
on Christmas Eve, I don't know that they had in the uppermost part of 
their mind, how do we get the very best health care policy written and 
included in this bill? They were more thinking about an arithmetic 
problem that faced them: How do we get a bill that will get a ``yes'' 
vote from 60 Senators so that we can cut off debate and pass this bill 
and get out of town before Christmas? And oh, by the way, a big 
snowstorm was bearing down on Washington on Christmas Eve and there was 
a lot of anxiety in the other body, a lot of reason to want to get 
things done and get things wrapped up for the end of the year and then 
come back and smooth out any rough edges and put things together 
because, after all, we always go to conference on these things. And 
even if we decided not to go to conference, we would what's called 
``preconference,'' where things would just be decided and the two bills 
put together and a finished product could then be passed by both 
bodies.
  But when Massachusetts held a special election and the Senate seat 
that had been held for years and years and years by a Democrat was now 
suddenly won by a Republican, the whole 60-vote majority thing was kind 
of called into question and it was not certain that the Senate would 
have the 60 votes necessary to cut off debate because the person who 
won that race on the Republican side in the special Senate election had 
campaigned on the notion that he would not be the 60th vote to push 
this health care bill across the finish line, this health care bill 
that many Americans had looked at and rejected. So a Senate race was 
held and won by someone who said don't count on me to be your 60th vote 
to get this thing passed.
  So now we've got an entirely different equation and an entirely 
different arithmetic problem here on Capitol Hill. You've got a Senate-
passed bill, you've got a House-passed bill.

                              {time}  2100

  They are vastly different. But the leaders on both sides said, you 
know, I just don't know that we can get this done in a conference 
committee.
  Now, it was also a big uphill climb to get Democrats on the House 
side to agree to vote in favor of the Senate health care bill. And with 
good reason. The House had worked long and hard on its health care 
product. And although I didn't agree with the policy and I didn't agree 
with the legislation as written, it was still a far better product. It 
had nowhere near the number of drafting errors, outright mistakes, and 
earmarks in it that the Senate bill did.
  So the Senate bill was thrown together quickly. And on top of that, 
it was just riddled with errors. Who wants to put their name next to a 
``yes'' vote for a product like that when we got a health care bill on 
the House side that while it might not be perfect, and certainly I 
didn't support it, still the product itself you could argue was a much 
more evolved product than what had come out of the other body.
  But the arithmetic problem was what it was. And it was felt that the 
only way to get a health care bill passed in this first session of the 
first term of President Obama was to pick up and pass the Senate bill. 
I will always remember being on a radio show the Wednesday morning 
after that special election in Massachusetts, where the question was 
posed, ``Do you think that the Democrats have enough votes on their 
side to simply pass the Senate bill?'' And I said, ``No, I do not.'' 
And someone broke into the radio show and said the Speaker of the House 
has just asserted that she does not have the votes to pass this bill on 
the House side. And I concurred. I said I think that's exactly right. 
This bill contains so many errors that no one is going to be willing to 
put their name to it.
  But over the 6 weeks that ensued since that time, there were multiple 
discussions that resulted in a number of people on the Democratic side 
of the aisle who had originally been a firm ``no'' on the Senate bill 
beginning to waver and then saying, ``well, maybe,'' and then 
ultimately they ended up being a ``yes'' vote for the bill. And just by 
the barest of margins they did get an affirmative answer to the 
question, ``Will the House now concur with the Senate amendment to H.R. 
3590?''
  Now, drafting errors. The bill H.R. 3590 is replete with drafting 
errors. We are likely going to be encountering problems in the drafting 
of this now law for years and years and years to come. Members of 
Congress were surprised to find in some of the published reports in the 
little newspapers that circulate up here in the Hill that in the days 
following the passage of the bill we had actually canceled our own 
health insurance and the health insurance for our staff because the way 
the bill was drawn, the way the bill was drafted was that Members of 
Congress and their staff will be required to buy their insurance in one 
of the State exchanges.
  The problem is that the State exchanges are not actually set up until 
2014. So as it stands right now, although a health insurance premium is 
still deducted every month, right now it's not clear, if indeed with 
the bill having been signed into law and that being one of the things 
that was going to take effect immediately, just what the practical 
effect of that is. And oh, by the way, and just a little ironic twist 
to that, members of the committee staff are exempt from that, members 
of leadership staff are exempt from that requirement that they buy 
insurance on the State exchanges, members and staff of the 
administration down at the White House are exempt from that 
requirement, as are the political appointees at the Federal agencies.
  So, again, it does seem somewhat ironic that the principal people 
involved in drafting this legislation, that would be committee staff, 
leadership staff, staff from the White House, and staff from the 
political appointee side of the Federal agencies, all of those groups, 
which were essentially the ones that wrote this legislation, exempted 
themselves from this requirement that they buy insurance in the State 
exchanges. Members of Congress and their personal staff are going to be 
required to do that.
  Again, this is something that is certainly fixable at some point. It 
is simply going to require the will to do so. You do hope that no one 
gets into trouble before that fix can occur. And of course it's very 
difficult to generate much sympathy with the American people, who feel 
that Congress probably shouldn't be covered by insurance when so many 
people are uninsured in the country anyway. And as a consequence, that 
now is a talking point that Members of Congress do have because we did 
say, ``If it's good enough for the American people, it's good enough 
for us as well.''
  Another part of the bill that's not widely known, but it is 
significant, there has been a phenomenon in recent years of what are 
known as physician-owned hospitals. And there are some Members of 
Congress who do not like the concept of a physician-owned hospital 
because they feel it is an inherent conflict of interest. On the other 
hand, I will tell you that no one knows better how a hospital ought to 
run and what a well-run hospital looks like than the physician who uses 
the hospital every day of his or her working life. And I will also tell 
you there is nothing quite like the pride of ownership in wanting to 
deliver a first class product for your patients.

  Physicians who are in an ownership position of facilities, as long as 
there

[[Page H3112]]

are some parameters that are followed, physicians who are owners of 
those facilities want their facilities to be the best in the area 
because that's the way doctors generally are. We are intensely 
competitive, and we always want to be first, and we always want to do 
things for our patients that are first class.
  But written into the bill is language that although it will allow the 
continued existence of physician-owned hospitals that were in existence 
on the day the bill was signed into law, it does not allow for the 
expansion of these facilities. So no new beds after March 20.
  But you have some situations, and I have one back in the district 
that I represent in north Texas, in fact I just went to the ribbon 
cutting on Friday for this beautiful new medical facility for the 
people in Flower Mound, Texas, and they are justifiably proud of this 
new facility that was inaugurated at the end of last week, but here is 
the problem. Although the hospital, because it was far enough along in 
the development process at the beginning of the year when all the bills 
were being written and passed, because it was far enough along, it is 
allowed to be licensed. But because of the very explicit language in 
the bill, it can be licensed for no more beds than those that were in 
operation on March 20, the day the bill was signed into law.
  Well, as the hospital was still just shy of completion on that date 
and had no operating beds, they are now stuck with a situation where 
they have a hospital which has a license and a Medicare number, but is 
licensed for zero beds because no beds were in operation on the day the 
bill was signed into law. Again, that is one of those problems that can 
be fixed. It is a technical correction. But it does require recognition 
by the Federal agency, Health and Human Services, the Center for 
Medicare and Medicaid Services, as well as tying up a good deal of 
staff time and a good deal of time on the staff of the medical company 
that operates the hospital to try to get everyone on the same page with 
this and get this problem ironed out. Because at least for right now 
they feel like they have been left with a fairly difficult position in 
that they are open and generating bills to pay, but they have no way of 
generating the income to pay those bills.

                              {time}  2110

  The actuary for the Centers for Medicare & Medicaid Services produced 
a report just after the health care bill was signed into law. We are 
all familiar with the arguments that were going on as the bill was 
being debated. The Congressional Budget Office said that the bill was 
going to cost just under $1 trillion over 10 years' time. In fact, 
there was the very often repeated line that the bill was going to save 
over $100 billion in the first 10 years of its existence because of 
savings that were going to occur from Medicare.
  Now, the Congressional Budget Office does work for the Congress of 
the United States. The actuary for the Centers for Medicare & Medicaid 
Services actually works for the Federal agency. The actuary over at the 
Centers for Medicare & Medicaid Services actually had a different read 
on the cost of this bill and on the likely savings generated from this 
bill.
  According to some news accounts, the health care report generated by 
the actuary at Health and Human Services was given to Secretary 
Sebelius more than a week before the health care vote. If that is true, 
then officials within the Obama administration, perhaps even the 
President, himself, continued to sell their plan as a cost reducer when 
they knew that costs would actually rise under the plan.
  According to the report: The reason we were given was that they did 
not want to influence the vote, said an HHS source, which is actually 
the point of having a review like this, wouldn't you think?
  Well, that is exactly right. If you've got information that 
significantly impacts the cost or the savings of a piece of legislation 
like this, yes, it does seem reasonable to make that information 
available prior to the vote because it might influence whether or not 
the vote actually was in favor or opposed. Many people were concerned 
about the cost of this bill, but they were reassured by statements by 
the Speaker of the House of Representatives, by the President, and by 
the majority leader that the bill's costs were under control and, in 
fact, that the bill was delivering a cost savings.
  Imagine the surprise when the actuary produced a report that said, in 
actuality, the bill will cost significantly more than what the 
Congressional Budget Office outlined and that, in fact, the purported 
savings in the bill will not materialize.
  Now, we have had a lot of discussion on the effect of this bill on 
both large and small businesses. Small businesses are, obviously, 
concerned about the effects of the fines that they might be required to 
pay if they either do not provide health insurance or if too many of 
their employees seek subsidies in the State exchanges, because then the 
Federal Government will come in with a fine for those businesses.
  I think of entry-level-type positions that may be affected by the 
additional cost burden put in place by putting these fines on these 
relatively small employers. I have heard from a number of small 
employers in my district. Primarily, these are people who employ 
individuals at small restaurants and at fast-food franchises. Again, we 
are talking about entry-level-type jobs that may now be reduced in 
number because of the overall increased cost that is going to come 
about as a result of the fines that might be levied if too many of 
their employees seek subsidies under the State exchanges.
  Additionally, you have the effect on large businesses. Large 
businesses may, in fact, look at this through an entirely different 
lens: Okay. We are providing health benefits to our employees now. It 
costs a lot. The costs are going up every year. The Senate and House of 
Representatives just passed this large health care bill, but it did 
nothing to contain costs. Rather, it added additional requirements to 
what type of insurance I am to provide my employees. So, in looking on 
the balance sheet at the cost of insurance, it is many, many millions 
or, perhaps, billions of dollars for a large employer, and the cost of 
the fines is significantly, significantly less than that cost of 
insurance.
  You hope that employers will do the right thing and will say, Well, 
it's still important for my employees to have this employer-sponsored 
insurance; but in order to maintain whatever sort of competitive edge 
or margin a business is required to maintain, not every employer may 
feel that way.
  One company may say, Look, I can offload a lot of cost by just simply 
paying the fine for not having insurance for my employees, which is a 
significant shift in dollars and, in fairness, a significant savings to 
the employer's bottom line. An employer can offload the cost of 
relatively expensive employer-sponsored insurance and can now just pay 
the fine and let the company's employees compete for insurance policies 
in the State exchanges as those are set up.
  This is not going to happen overnight. A lot of these things won't be 
occurring until 2013 or 2014, but it is important for people to be 
aware of the types of changes that are pending out there. Perhaps there 
will be some room for modifying some of these things. Perhaps there 
will be a way to remove some of the more onerous things that are facing 
us in this bill. Perhaps there will even be a way to remove the bill, 
itself, and to get back to fixing those things that need to be fixed in 
the first place.
  You also had members of the business community--the large employers--
telling Members of Congress and leadership on my committee, Look, be 
careful because we are going to incur some significant costs from what 
you're doing in this bill. It may be necessary, and it may affect our 
bottom line.
  You did have companies restate projected earnings shortly after the 
bill was passed. The chairman of my committee was upset by this and 
said these companies are just doing this to embarrass the President at 
the time of the bill signing, so he sent out the word that all of these 
CEOs from these companies who had restated their earnings would get the 
opportunity to come to our committee and to tell us all about why they 
thought it was necessary to restate earnings on what should have been a 
national day of exultation when the President signed the health care 
bill. Instead, they were putting out press releases about the fact that 
they were going to have to restate earnings.

[[Page H3113]]

  It turns out that the restatement of earnings was because of 
requirements from the Securities and Exchange Commission, requirements 
which primarily said, if a company is going to have a significant 
change from what it had previously published as its earnings 
projections, it is obligated to be public with those and to tell people 
what the restated earnings are and why they are restated. So, in fact, 
the heads of these companies were just simply doing what they were 
required to do under Federal law with the Securities and Exchange 
Commission.
  As a consequence, when that was explained to the committee, this 
hearing that was to occur on April 21 was postponed, and it was 
postponed indefinitely but not before the word sort of went out: Don't 
you dare cross this administration because, if you do, you may get to 
come to our Subcommittee on Oversight and Investigations on the 
Committee of Energy and Commerce and explain your actions to members of 
the committee and to the American people at large because, of course, 
these proceedings are transparent and are covered by C-SPAN.
  The health care costs are likely to go up significantly for large 
employers. Remember, there is a separate new tax on medical devices. 
Medtronic warned that new taxes on its products could result in layoffs 
of 1,000 workers. Their accounting also estimated there would be 
thousands of other layoffs and consumer cost increases in the ancillary 
businesses--perhaps in the hospitals, perhaps in the centers that 
provide those types of devices.
  Those taxes are going to be levied, but it's not likely that those 
taxes are going to come out of the CEOs' salaries. It is not likely 
they are going to come out of the lobbyists' salaries. It is more 
likely that they are going to come out of the costs to the consumers of 
those medical devices, and many of those costs will just simply have to 
be borne by the hospital or doctor's office. The way things work in the 
medical world is, if you have a contract with an insurance company to 
provide a type of service, you will not be able to go back and append, 
Oh, by the way, I've been asked to pay this 2.8 percent tax on every 
syringe I use and on every class 2 or class 3 medical device that I use 
in my office, surgery center, or hospital. That tax will likely, just 
simply, come out of the bottom line of that physician's office, of that 
hospital, or of that surgery center.
  There are a couple of things which I think are just worth talking 
about. There have been some statements, some affirmations, that have 
been made about the health care law that was signed in March of this 
year. Over and over again, we heard the assertion, If you like your 
plan, you can keep it.
  Well, I think, every day, as more and more is found out about what 
this bill actually means as it is implemented, that statement becomes 
less and less true. I rather suspect, by 2014, when the full 
implementation of this bill is occurring, that statement will be 
nothing more than a distant memory. Over and over again, we hear, To 
avoid additional costs and regulations, employers may consider exiting 
the employer health market and consider sending employees to the 
exchange, which is just as I was discussing a few minutes ago.

                              {time}  2120

  Larger companies are looking at this and saying there are going to be 
significant costs with continuing to provide this insurance. When 
Congress passed the law, they did nothing to hold down the cost of 
health care, nothing to hold down the cost of insurance, and what they 
have done instead is complicate things, and we can now get out of it by 
paying a fine, which in the long run may be a great deal cheaper to pay 
that fine or tax or whatever you want to call it and let our employees 
find their insurance in the State exchanges.
  The other affirmation that's been made that again is being found to 
be less and less accurate is that this health care law will lower 
costs. And I think we have already talked about this and I think we see 
it over and over again that employers are already likely to pass new 
costs on to their employees. Health care coverage may go up in cost due 
to shifting of increased taxes and fees from the provider and insurance 
industries to the employers' employees. So that is, again, another one 
of the cost shifts that are likely to occur under this law and gives 
lie to the statement that this law will lower health care costs. In 
fact, the only place where this law lowers costs is by rationing care 
in Medicare, and as a consequence, people are going to be less 
satisfied with the cost containment measures that have been put forth.
  There is an unelected, unaccountable body, the Independent Payment 
Advisory Board, which was created in this law, that is going to be 
convened to give recommendations to Congress as to how to hold down the 
costs of Medicare. And again these are likely to come in the form of 
pure cuts to Medicare. Congress will then have the responsibility to 
vote those packages of cuts up or down. We will not be able to modify, 
amend, or append those discussions. It will simply be an up-or-down 
vote. Historically, Congress, when given those opportunities, has 
declined to cut costs in those areas. Witness the physician fee 
schedule that comes up every--it used to be every year or two; now it 
comes up every few months. And Congress invariably stays those cuts 
that were to be enacted, and as a consequence, there is no holding down 
of health care costs. Nothing was intrinsically built into the bill 
itself or the law itself that would intrinsically work to lower costs 
other than cuts that will be forthcoming through this Independent 
Payment Advisory Board. And it's extremely problematic, number one, if 
any of those cuts will ever be, in fact, ratified by Congress, and if 
they are, I think people will find that that is something that they 
really didn't count on and really didn't plan on. And then the third 
area where the information that was put forward as the bill was being 
discussed, that this health care law would improve coverage, in fact, 
the increased taxes and regulation will lead to dropped coverage and 
benefits, and, again, we've already discussed that in some detail.
  But those are some of the things that were marketed as truths. And I 
don't remember how many times I heard, ``If you like what you have, you 
can keep it.'' But, again, I think that phrase will be found to be 
inoperative as the effects of this bill become more and more apparent.
  What's ahead? What's down the road? This was a very long bill, a very 
complicated bill. Is the work finished now that Congress has taken its 
final vote and sent it down to the White House for the signing 
ceremony? Is the work finished on this bill or are there still parts 
that have to be worked out? And the answer is the work is just 
beginning on the second chapter of this bill. And I would encourage 
people who have an interest in this, a Web site that I maintain that 
just simply deals with health care policy, healthcaucus.org. We had a 
forum today talking about what's ahead with some of the rulemaking and 
the proposed rules that are going to be coming forward out of the 
Centers for Medicare and Medicaid Services, and although today we were 
talking about those rules as it affects the health information 
technology sector, the same concepts are important as we begin to get 
further and further down the road at the agency level with this health 
care bill. Over a year ago when we passed the stimulus bill, the 
information technology language was included in the stimulus bill. They 
spent the last year writing the policy and the rules and regulations 
that will cover the rollout of the health information technology 
funding as it becomes available, and what we found in January was the 
rule that was proposed by the Centers for Medicare and Medicaid 
Services in many ways was so inflexible. All 23 benchmarks had to be 
met simultaneously, and it's just not the way the world works, and very 
few people were going to be able to do that. So for the bill to 
function as intended, that is, provide additional funding for hospitals 
and doctors' offices to get this newer technology up and running 
sooner, to sort of jump-start it, if you will, the net effect of the 
rulemaking that was released by the Centers for Medicare and Medicaid 
Services in January was that, in fact, it was so draconian that very 
few hospitals and providers were actually going to be able to take 
advantage of it. So the intent of the bill that was passed as part of 
the stimulus bill to get this information technology up and running and 
reward

[[Page H3114]]

early adopters and encourage people to come along and get these things 
set up in their offices, it's going to be so difficult to comply with 
the rule that many people will look at that and say it's just not worth 
the effort. You can keep the additional funding that you were offering, 
but I simply cannot go there with my practice or my business.

  Well, we are getting some--at least the Centers for Medicare and 
Medicaid Services is willing to listen to what we have to say. Two 
hundred and forty-eight Members of this House, both Republicans and 
Democrats, signed a letter to the Secretary of Health and Human 
Services that said, please, let's try to work on this and get a more 
flexible and workable product out there into the hands of people. And 
the reason this is important is because this is one simple little rule 
and perhaps the first one to come out of--really not the health care 
bill, because it came out of the stimulus bill, but it's kind of a 
harbinger of things to come. There is a flood of regulations, I mean a 
flood of regulations and rulemaking that is going to happen over at the 
levels of the Federal agencies. Health and Human Services to be sure. 
Its subset, the Centers for Medicare and Medicaid Services, which only 
just recently announced their designated head of that agency, has been 
without a political appointee at its head since Inauguration Day. So 
now we have a name that has been offered up by the administration, but 
that individual still has to go through the Senate confirmation 
process, and it's anyone's guess as to how soon Dr. Berwick will be 
seated as the new head, the new administrator, over at the Centers for 
Medicare and Medicaid Services. In the meantime deadlines are coming 
literally at the speed of light over at the Federal agency. Let me just 
give you an example of that.
  Part of the bill, part of the law, that was signed by the President 
was that the Secretary of Health and Human Services was required to 
publish on its Web site by last Friday a list of all of the authorities 
provided to the Secretary under the overhaul of the law, and that is 
section 1552. And what the agency did, rather than go through the bill 
and compile that list, as they were required to do by law, what it 
appears that they have done is just simply reprinted the table of 
contents from the bill, H.R. 3590. They just simply reprinted the table 
of contents from the bill. Now, you can go to the Web site of Health 
and Human Services and look at this document for yourself. It's 18 
pages of relatively small type of all of the requirements of the 
Secretary that are to be performed under this law.

                              {time}  2130

  Although at this point it does appear to be simply a reprint of the 
table of contents, it does give you a sense of how daunting this task 
is ahead for the Secretary of Health and Human Services.
  Section 1003, ensuring that consumers get values for their dollars; 
section 1002, health insurance consumer information; section 1004, the 
effective dates; section 1102, reinsurance for early retirees; section 
1103, immediate information that allows consumers to identify 
affordable coverage options; section 1105, the effective date of same.
  This thing goes on and on for 17 or 18 pages, and if anyone is 
interested, I do encourage you to go to the Web site for the Department 
of Health and Human Services and have a look at this for yourself. 
Don't just take my word for it.
  Now, an even larger and more daunting document is that prepared by 
the minority staff on the Committee on Energy and Commerce, and this is 
available at the Committee on Energy and Commerce, up on the Web site. 
You do have to click on the minority side to see this, but it is the 
health law implementation timeline.
  This document, again, relatively small font, but it is 53 pages in 
length and goes through in painstaking detail what is going to happen 
sequentially as a consequence of passing this bill and signing it into 
law 6 weeks ago.
  They start out in 2009, the events that were to occur prior to the 
date of enactment, things that affect Medicaid, Medicare, Indian Health 
Service, and then concludes way down the road in 2020, January 1, 2020, 
the Medicaid start date for States to pay 10 percent of the cost for 
providing health care coverage through Medicaid to people made newly 
eligible under the bill. The Federal taxpayer pays the remainder of the 
cost.
  A lot of information is contained therein, and for people who have an 
interest in what the implementation of this bill is going to look like, 
people who have an interest of what the timeline looks like, people who 
have special concerns about, hey, I think there is something in that 
bill to help me, but I'm not sure when it kicks in or when it starts, I 
encourage you to go to the Web site and look at the bill. If you decide 
to print it out, do bear in mind there are over 50 pages that are going 
to churn out of your printer after you click the print selection on the 
file. But I think it is important that people become familiar with 
this.
  Again, we passed that bill 6 weeks ago. That does not end our 
participation, the agency's participation, the White House's 
participation, and certainly doesn't end the impact on literally every 
American alive today and those who will be born in the generation to 
come. They will all be affected by things that are going to be 
happening, particularly things that are going to be happening at the 
agency level, Health and Human Services, Center for Medicare and 
Medicaid Services.
  The Office of Personnel Management, a very small Federal agency that 
most people have never heard about, but the Office of Personnel 
Management is essentially going to set up the public insurance, which 
is going to become the de facto public option, which many people 
thought was not even included in the Senate bill, except it turns out 
that it probably was. And it won't be called a public option, it will 
be called a nonprofit under the exchange set up at the Federal level. 
But, nevertheless, the intent and the effect is identical to what was 
being talked about last summer as the public option. Well, that is 
going to be administered through a small Federal agency, most people 
have never heard of it, the Office of Personnel Management.
  And the Internal Revenue Service, for crying out loud, is going to 
have a role to play in the implementation of this legislation. How are 
people going to be made to buy insurance? How is a mandate going to be 
enforced? Well, it will be up to the tender mercies of the Internal 
Revenue Service to figure that out.
  Now, it may not be as draconian as putting someone in jail for 
nonpayment of taxes, but it certainly could be garnishment of a refund 
check that someone thought that they were getting because they had 
overpaid their Federal income taxes during the year. But if they don't 
have proof of insurance, that may be something that the IRS will not be 
returning to them, but will be using to offset the cost of providing 
them insurance in the exchange, because we will have the individual 
mandate, unless the Supreme Court agrees with the 20 or 21 Attorneys 
General across the country and says that provision is unconstitutional.
  I think one of the big travesties in the passage of this bill, we do 
have a problem already in Medicare. We have a problem with funding 
Medicare. We do have unfunded liabilities.
  One of the big problems we have in Medicare is that patients arriving 
into Medicare, patients who are on Medicare and change location and try 
to find a physician who takes Medicare, are finding it increasingly 
difficult to get a physician to take on their care or their case.

  The problem has been historically over the years we have decided that 
one of the ways that we can save money in the Medicare system is to 
ratchet down reimbursement rates for providers. That has happened, and 
there is an automatic formula that requires that to happen every year.
  Right now, doctors are facing what is called a funding cliff of a 
little over 20 percent reduction in their reimbursement rates. That 
will kick in the end of May. We have done some stopgap things. We go 
right up to the edge and a little bit beyond, and then we do something 
at the last minute to keep them from going over the falls into the 
abyss. But right now the abyss does exist, and it is very real, and it 
is the end of May.
  There is another bill that would fix things for a little bit longer, 
to the end of October. But that is right before election day, and who 
wants their doctor to take a 20 percent reduction right before election 
day?

[[Page H3115]]

  These are things that we have historically punted, and we did when 
our side was in control as well. There was a real opportunity to fix 
this in this bill, and for whatever reason, for whatever reason, the 
Democratic leadership and indeed the American Medical Association 
decided to take a pass on that.
  There is a lot more that is contained in this bill. I will be back to 
the floor from time to time to talk about it over the coming year or 
two or three or four or five, however long it takes.
  Again, remember, the principle behind this is to kill this bill, root 
it out, rip it out, repeal the bill, and then get on to fixing the 
things we should have fixed in the first place.

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