[Congressional Record Volume 156, Number 129 (Thursday, September 23, 2010)]
[House]
[Pages H6972-H6979]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH CARE LAW 6-MONTH ANNIVERSARY
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. Madam Speaker, I come to the floor tonight to talk about
health care on this, the 6-month anniversary of the signing of the
Patient Protection and Affordable Care Act in the East Wing of the
White House, March 23 of this year. It's interesting because since the
passage and signing of that bill into law, support has actually
decreased rather than increased.
This bill came to the House in the most unusual fashion. And in fact,
our Speaker, Speaker Pelosi, was quoted as saying, ``We have to pass
this bill so that you can find out what's in it.'' Well, that sounds
pretty odd, doesn't it? It turns out the last 6 months have been just
that, pretty odd.
On August 31 of this year, Secretary Sebelius, Secretary of Health
and Human Services, said, quoting, ``Unfortunately, there is still a
great deal of confusion about what the reform law is and what it isn't.
We have a lot of reeducation to do.''
I don't know if that means they will be setting up reeducation camps
for some of us, but nevertheless you have to wonder about the
implications of that statement.
Now, it's interesting, I sit on a small little subcommittee on the
Committee on Energy and Commerce. The committee is called Oversight and
Investigations. Part of our jurisdiction is the Department of Health
and Human Services, the Center for Medicare and Medicaid Services. You
would think that our little subcommittee would perhaps have had some
curiosity to have a hearing or two to talk about the implementation of
this bill, to ask about how things are going, what's the future look
like. It's been 6 months, maybe we could sit down and have a little
talk. But we haven't done so.
[[Page H6973]]
I have sent letters to the chairman asking him to call the Secretary
in. I have sent letters directly to the Secretary. I even gave an
assistant Secretary a letter one day at one of our hearings and asked
to please deliver it to the Secretary. We need to have some interaction
with the Department of Health and Human Services in our little
committee because the bill is complicated. The bill is complex. The
bill is going to intimately touch the lives of every man, woman, and
child amongst us for the next three generations.
And yet complete silence from the side of the administration,
complete silence from the Democratic leadership of my committee, indeed
the Democratic leadership of this House as to where is our oversight
function in regards to the implementation of this bill.
This bill came about in the worst of any possible way. I don't know
if people recall last summer our committee did work on a House product,
a bill, a health care bill. It wasn't very good. I voted against it in
committee. I voted against it again here on the floor in November when
the Speaker of the House brought it up. But, nevertheless, we did at
least go through some semblance of regular order here on the House
side. Three committees of jurisdiction marked up the bill.
{time} 1950
Amendments were to some degree allowed. The bill came then from the
Speaker's office having doubled in size and came to the House floor,
was debated all day one Saturday and then at the end of that Saturday
evening passed by only one or two votes. But it's interesting. That was
the end of the story for that health care bill, all 2,200 pages of it.
It died that night shortly after it was passed.
What happened next between Thanksgiving and Christmas. The story
shifted over to the Senate. The Senate took up a bill, H.R. 3590. This
was a bill that had previously been passed by the House of
Representatives in the summer of 2009. It was not a health care bill at
the time. It was a housing bill. For the record, I voted against it;
but it did pass the House and was sent over to the Senate to await
action on a housing issue. This bill was picked up by the majority
leader in the other body, dusted off and then said, ``This will be our
health care bill.''
Now think for a minute. Why in the world would the other body decide
to rework a housing bill that had been passed by the House and turn it
into a health care bill? Well, I may have maintained from the beginning
that this bill that the President signed, this law that the President
signed in March of this year, was not anything to do with health care.
This was a tax bill. And the majority leader in the other body
recognizes full well that tax bills must originate in the House of
Representatives, so he took a House bill. It didn't have anything to do
with health care. It didn't have anything to do with health care taxes.
It had to do with housing.
So the bill was amended, stripping out the existing language and then
beginning to add in the health care language that they so dearly
sought. But part of this process between Thanksgiving and Christmas was
the cumbersome process of getting to 60 votes to cut off debate. Now it
shouldn't really be too much of a challenge because the ratio in the
other body at that time was 60 Democrats to 40 Republicans. Well,
technically 58 Democrats and two independents who vote with the
Democrats, so they had a pretty solid lock on that 60-vote majority to
pretty much do whatever they want. But, still, it was tough. And the
leader in the other body had some difficulty in getting his Members to
sign on and agree to vote ``yes'' on this now health care bill, and we
all remember the stories and they were uncomfortable. They were
uncomfortable for me to listen to these stories as they came up.
You remember at Christmastime we heard about the Cornhusker Kickback;
you remember the Louisiana Purchase; you remember Gator Aid down in
Florida. And these were all payoffs, if you will, to certain Members of
the other body to get them to agree to vote in favor of the health care
bill. And when they got to 60 votes, they brought the bill up and they
passed it in the Senate. This was accomplished on Christmas Eve and it
was done in a great hurry to get the Senators out of town because a
very large snowstorm was bearing down on Washington, D.C. and they all
wanted to get home for the holidays and not be trapped here in the city
over Christmas and New Year's. And they accomplished that goal. Now it
was a bad process and it was hard to watch and in many respects it was
very ugly in the process and many people across the country watched
that and said, This is not what we elected our legislative branch to
do. This is not the kind of work product we want to see them engaged
in.
And as a consequence in those days after the start of the new year,
people, the backlash, the pushback against what had happened in the
Senate was beginning to be felt across the country, and it was felt in
some unusual ways. It was felt in a special election in a small little
State up in the Northeast, Massachusetts, where they were replacing
Senator Kennedy; and, as a consequence, a Republican won a seat that
had not been in Republican hands since anyone could remember. This so
severe was the angst and anger of the American people when they saw
what had happened in the Senate to the process.
So now the Democrats in the other body have a real problem. Now they
only have 59 votes. How in the world are they going to get to 60 votes?
They decide they just simply cannot do it and the House will have to
pick up and pass the Senate bill, and since it originated in the House
of Representatives and the House had already passed it, albeit it was a
housing bill, not a health care bill but the House had already passed
this legislation, it's a tax bill that originated in the House, went
over to the Senate, it's being sent back to the House with the
question, will the House now agree to the Senate amendments in H.R.
3590?
I didn't think there was any way. In fact the Speaker of this House
said she didn't have a hundred votes for the Senate bill when it came
back over. I thought she was right. I took her at her word. But then
over the next 2 months they found a way to pass that bill. And late on
a Sunday night, the third week in March, by one or two votes this bill
was passed and immediately went down to the White House for a signature
and a signing ceremony and thus you have the health care bill, the
health care law, the worst of all possible worlds.
And is it any wonder with the way this legislation was drafted over
in the other body that it is full of drafting errors. There are
omissions of things, like a severability clause. At least in the House-
passed bill as bad as it was--and again I voted against it--but in the
House-passed bill we recognized that some of the things we were doing
in that bill, some of the things that Congress was doing in that bill
really skirted pretty close to being unconstitutional and if the
Supreme Court actually found that to be the case and struck down a
provision of the bill because we had a severability clause, only that
section would be struck down by the Supreme Court ruling and the rest
would be allowed to stand. The Senate bill lacks a severability clause.
We hear a lot of stories about what are happening with 20 or 21
attorneys general across the country pressing a lawsuit because of the
question of the constitutionality under the commerce clause of the
individual mandate. Well, what if this were struck down by the Supreme
Court? It is possible that the entire bill would fall because it lacked
a severability clause. Simply an oversight, simply a drafting
oversight, but at the same time a fairly significant one.
There was another oversight where physician-owned hospitals across
the country that were under construction could not expand. They were
allowed to continue construction but they could not expand beyond the
number of beds that they had in operation as of the bill's signing. I
had a hospital in my district that fell into this category, it's under
construction, it's being built, the day of the bill signing it's not
quite finished so zero beds are occupied. That hospital under a strict
interpretation of the rules would not be allowed to expand the number
of beds beyond zero. Well, that clearly was not the intent of the
people who drafted the bill, but that's the way that the legislative
language could be interpreted, and it took
[[Page H6974]]
several months working with CMS to try to get clarification. I'm not
sure that we have the final report on that even to this day, but the
hospital has been allowed to open and it has been allowed to open at
least the initial 100 beds. But this is in a very vibrant and growing
community in north Texas, and do you think the population in that area
is going to increase, such that a 100-bed hospital will be sufficient
from now and forevermore, or will perhaps someday they have to add some
additional beds to that hospital? It's surely a possibility. And under
the way the bill is drafted and drawn, the expansion of those hospital
beds will not be permitted. But at least we were able to get
clarification on the rule to allow that hospital to open.
Many people as the whole health care debate was going forward were
insistent that Members of Congress take whatever health insurance we
were forcing upon the rest of the country. Certainly a valid and
legitimate request that the American people made of their Congress. So
final passage of the Senate bill as it came over here did include the
fact that all Members of Congress and their personal staff would be
covered under the exchanges. They would have to purchase their
insurance in the exchanges after they are set up in the year 2014. It
is a little unclear what happens between now and 2014 since those
exchanges do not exist, but nevertheless the language was written so
that Members of Congress have to purchase their insurance in the
exchanges. Staff has to purchase their insurance in the exchanges.
Oh, except for a couple of exceptions. We excepted leadership staff,
so the staff of the Speaker of the House is not bound by this
requirement. The staff of the committee that drafted the bill over in
the Senate, not bound by this commitment. Staff in the White House, not
bound by this commitment. Political appointees at the Federal agencies,
not bound by this commitment. It seems like this must have been an
oversight. Well, I'm not so cynical as to believe this would have been
done on purpose. Surely this was just an oversight and surely that's
one of those things that should be corrected.
{time} 2000
Well, here we are 6 months later, the half-year anniversary of
ObamaCare, if you will. The bill was signed, and what do you know? What
Americans were promised didn't happen. And it's important that people
understand what has happened and what didn't happen.
We were told by the President early in his administration that if you
like what you have, you can keep it. How many times did you hear that
repeated? But the reality is nothing could be further from the truth.
And we actually got a glimpse of this almost on the day the bill was
signed.
There were several companies that restated or had to restate their
earnings because of some of the immediate effects of this bill as it
was signed. Now, that was a point of some contention. Now, let me just
quote a couple of paragraphs from a CNN story that was up on the
Internet. The story is from CNN Money. The title of the story is
``Documents Reveal AT&T, Verizon, Others Thought About Dropping
Employer-Sponsored Benefits.'' Digging into the story, ``In the days
after President Obama signed the bill on March 24, a number of
companies announced big write-downs due to some fiscal changes it had
ushered in.''
``The announcements greatly annoyed Representative Henry Waxman, who
accused the companies of using the big numbers to exaggerate health
care reform's burden on employers. Mr. Waxman, chairman of the House
Energy and Commerce Committee, demanded that they turn over their
confidential memos, and summoned their top executives in for hearings.
``But Chairman Waxman didn't simply request documents related to the
write-down issue. He wanted every document the companies created that
discussed what the bill would do to their'' expenses and to their
health care costs.
The result was 1,100 pages of documents from four major companies and
the realization by the chairman's staff that the write-downs were--I am
quoting here--`` `proper and in accordance with SEC rules.' The
committee also stated that the memos took a generally sunny view of the
new legislation. The documents'' . . . ``show that `the overall impact
of the health care reform on large employers could be beneficial.' ''
But nowhere--I am continuing to quote from the CNN Money article
here. ``Nowhere in the 5-page report did the majority staff mention
that not one, but all four companies, were weighing the costs and
benefits of dropping their coverage.''
I am continuing to quote from the CNN Money article from March of
this year. ``Indeed, companies are far more likely to cease providing
coverage if they predict the bill will lift rather than flatten the
cost curve.'' One company said, ``We do expect double-digit health care
increases as most Americans will now have insurance and providers try
to absorb the 15 percent uninsured into a practice.''
Well, we can begin to see, internally at least, in some of these
organizations that they were having some serious discussions. From the
final paragraphs of the article, ``if 50 percent of people covered by
company plans get dumped, the Federal health care costs will rise by
$160 billion dollars a year''--a year; not a 10-year window, but a
year--in 2016, in addition to the $93 billion in yearly subsidies
already forecast by the Congressional Budget Office.
Finally, I'm continuing to quote, ``Of course, as we've seen
throughout the health care reform process, it's impossible to know for
certain what the unintended consequences of these actions will be.''
So here we see a fairly significant disruption on what many
Americans, probably 60 to 68 percent, rely upon for their health
insurance, and that is employer-sponsored insurance. Could it go away
as a result of this bill? It doesn't have to. But to answer the
question honestly ``could it go away?'' the answer is companies will
look at that from a cost benefit analysis. And when you consider for
one of those companies the $1.8 billion a year that they would save by
letting their employees buy insurance from the government exchanges and
simply paying the fine, certainly those companies may have to make a
choice that is uncomfortable for them. But certainly if you like what
you have, it's going to be difficult to keep it.
Now, some additional things have come up since the signing of the
bill into law in regards to what is called grandfathering. And it turns
out, if a copayment increases by more than just a small amount or a
deductible increases by more than just a small amount, the
grandfathering clause will not be allowed, and those companies will not
be allowed to keep their insurance. Once again, ``if you like what you
have, you can keep it'' may become extremely problematic.
What about patients on Medicare? Over the next year, nearly 1.5
million seniors on Medicare Advantage could lose their benefits, if not
lose their plan altogether, because of changes that came about as a
result of passing this legislation. President Obama said, ``If you like
your doctor, you can keep your doctor.'' But what does that really
mean? A Houston Chronicle article, May 17, 2010, says, ``Texas Doctors
Are Opting Out of Medicare at Alarming Rate.''
`` `This new data shows that the Medicare system is beginning to
implode,' said Dr. Susan Bailey, president of the Texas Medical
Association. `If Congress doesn't fix Medicare soon, there'll be more
and more doctors dropping out and Congress' promise to provide medical
care to seniors will be broken.' ''
Just for a moment let me display an ad that was run in some of the
local papers up here on Capitol Hill. This was an ad produced by the
AMA that does a good job of showing how expensive it becomes to fix the
reductions in reimbursement to physicians under the Medicare system.
Cost to fix today, $210 billion; in 3 years, it will cost $396 billion;
in 5 years, $513 billion. These are indeed staggering sums.
There was an opportunity to fix this when the health care bill was
done. We'll talk about that more in just a moment. But this is an
important point that people need to bear in mind. There's a lot of
anxiety right now. People are calling their doctor's offices and
finding that if they are a new Medicare patient, their doctor may not
be able to see them because the doctor simply cannot afford to allow
any more Medicare patients into their practice,
[[Page H6975]]
and that is indeed a very uncomfortable position to place upon both
patients and doctors.
One of the most startling things we heard about this legislation as
it went through and this new law after it was signed that health care
reform will create 4 million jobs, 400,000 jobs almost immediately,
well, this really was one of the most hollow promises made during the
run-up to the passage of this legislation. Health care law has not
created a single job, much less 400,000; and, in fact, the growing
costs on businesses associated with the law may cause many businesses
to lay off workers.
Now, we talked just a little bit about large businesses, multi-State
corporations that provide employer-sponsored insurance. What about the
smaller business? What about franchise businesses in your community
that may have several locations and employ 100, 150, 200 people? I am
hearing from those individuals literally every day. They do not know
what to do. They do not know where to turn. They provide jobs that
might be thought of as entry-level jobs. Yes, they pay the minimum
wage. Yes, their benefits are not generous and some of them do not have
benefits. So, great. These workers now will have the ability to buy
insurance in the exchange. But if a worker purchases insurance in the
exchange, whether the employer provided the option for insurance or
not, that employer is now fined $2,000. Extrapolate that to a 100-
person workforce and a 150-person workforce, and it's not long before
you have eliminated any possibility of profitability for those
businesses.
So I have people in my office all the time talking to me, asking me
about this, talking to me about the problems that they are seeing on
the horizon, the immediate horizon. And over and over again, I hear the
same thing: I will tell you what I'm not doing right now; I'm not
expanding. Any position that comes open, I'm thinking long and hard
before I fill it. In fact, I think I will reduce my workforce
significantly.
No H.R. director in the country right now wants to be responsible for
hiring that 51st employee in a business because that triggers a whole
host of new requirements as brought about by the law.
From the White House, the health care czar, Nancy-Ann DeParle, said
the law will make health care more affordable for Americans. Is that a
fact? What's really happening? This law is causing health care
insurance prices to increase. The Wall Street Journal reported the
reform is causing rates to increase up to 20 percent, 20 percent for
some buyers. In Connecticut, rates are increasing at 18 percent for
small businesses and 14 percent for the self-employed. Early retirees
and others who buy their own coverage also see that same 14, 14\1/2\
percent increase, who are buying their own coverage as of the beginning
next month, October 1, 2010.
Further, Secretary Sebelius of the Department of Health and Human
Services actually sent out a letter detailing the fact that insurance
companies were misleading people and that they were to remain silent on
these issues of increased prices.
Now, I don't know about you, but that is disturbing. We've had the
Secretary talk about reeducation, and then we've had the Secretary talk
about you are not allowed to exercise your free speech rights when it
comes to talking about the cause for price increases in your insurance
product.
{time} 2010
The fact is nobody knows right now; and again, I would stress, we
have not had oversight hearings. Our chairman has not called oversight
hearings in our committee. I am troubled by the increases I hear people
talking about in their insurance. When I talk to groups of doctors back
home, it is no longer discussion about how am I going to be able to do
the medical treatment of my patient. Most of the questions I get even
from doctor groups now are: How am I going to keep up with the new
taxes? How am I going to provide health insurance for my employees
because of all of these new regulations, and because of the fact that
the cost is going up so fast that no company can even give me a quote
on what my insurance costs will be next year?
Now, if insurance companies are simply pricing in what they see as a
premium because they are worried about the effect of this bill in the
future, maybe we should talk about that in committee. Maybe we should
have some actual information about that. If insurance companies are
indeed increasing prices because they are having to price in some of
these new benefits that were mandated and come into effect essentially
today at the 6 month anniversary of the signing of this bill, maybe we
should have that discussion. The fact is, we don't know. No one knows.
Insurance costs are going up. There is some suspicion that they may be
inappropriate rises, but there is some suspicion that these may be
elevations in costs that are occurring because of the unintended
consequences of the new mandates that are put upon insurance companies.
Surely this is important enough for us to ask these questions on
behalf of our constituents and our families back home. And surely this
is important enough that the Secretary can spare a few moments from her
photo-op tour on the 6-month signing of this bill to come into our
committee and discuss this with us.
We had numerous hearings on how insurance companies were overcharging
for their product leading up to the run-up of the passage of this bill.
Maybe we ought to have a few of those companies in and say, well,
Congress passed a bill that was going to hold the costs down and now
the costs are going up, and we want to know why. It is a fairly simple
question to ask, and I don't understand why we have yet to ask it.
What about this one: When the President ran, when the President
talked about health care, all during last summer he said: These
negotiations will be open. They will be transparent. I will have
everyone around a big table, and we will have it on C-SPAN. You will be
able to watch it until you are sick of watching it.
What about the promise of being the most transparent administration
ever? The President said negotiations would not be performed behind
closed doors, but on camera in front of the American people on C-SPAN
for all to see. And what really happened? This law was written behind
closed doors by committee staff. Those very same committee staff who,
by the way, are exempt from the changes that were brought about in this
bill.
On May 9, 2009, there was a big, secret meeting in the White House, a
big meeting. Who was there? Well, the AMA was there. American Health
Insurance Plans, AHIP, was there. PhRMA, the big Pharmaceutical and
Research Manufacturers Association was there. The Service Employees
International Union was there. Why they were there I don't know, but
they were represented. AdvaMed, the medical device manufacturer, was
there. The American Hospital Association was there. The President
emerged from that meeting that morning, that bright May morning, and
said, All of the stakeholders have come in and around the table we have
all agreed to savings of $2 trillion in our health care system. Wow, $2
trillion, that is pretty significant.
It did raise some questions in my mind, but I am okay with that if
they can extract those kinds of savings from those various interest
groups. That is great. Let's see the data. No luck on that. I wrote to
the White House repeatedly. I wrote during the summer, and I wrote
during the fall. I asked for the information. I got nothing.
In December of 2009, I filed what is called a resolution of inquiry
in the House of Representatives asking the White House to produce
documents, emails, written notes of meetings. A resolution of inquiry
has to be heard within 15 legislative days in the committee otherwise
it proceeds directly to the floor as a privileged resolution.
Obviously, the chairman does not want that to happen, so my bill was
brought up, interestingly enough, on the same day as the President
delivered the State of the Union message this year, so that day late in
January. The resolution of inquiry was brought up, and I was informed
that my resolution was overly broad, and I really could not have those
things.
Just for a moment indulge me. I want to go back to that CNN Money
article from last spring. I want to remind this body of Chairman
Waxman's words when he thought the private companies were simply
raising their prices because they didn't like the President's health
care bill. Again, quoting from
[[Page H6976]]
the article, Chairman Waxman, chairman of the House Energy and Commerce
Committee, demanded that they turn over their confidential memos and
summon their top executives. But Chairman Waxman didn't simply request
documents related to the write-down issue; he wanted every document the
companies created that discussed what the bill would do to their most
uncontrollable expense, health care costs.
Well, our request was not even as broad as Chairman Waxman's request
was to legitimate American businesses. Yes, we asked for emails,
communications, memos, minutes of the meetings. We got nothing. At the
end of the day, Chairman Waxman, to his credit, did say of the 11
things I requested, I should receive some information on 6 of those 11.
And Chairman Waxman and Ranking Member Barton did write a letter to the
White House asking for the same. We got a couple of press releases and
we got some reprints of White House Web sites, but really no
significant documents. And I was told that there really wasn't anything
written down. There really weren't notes made of these meetings.
Well, wait a minute. You have six major stakeholders of cost drivers
in health care down at the White House, you come out and announce $2
trillion in savings, and nobody wrote anything down? Two trillion
dollars in savings, and no one scratched that number in the margin of a
big yellow legal pad and made a note of it? No one emailed a colleague
and said, We just saved $2 trillion, yea for us! I am asked to believe
nothing was written down at these meetings and that all of the
documents that I have received are all that I can expect to receive.
Well, okay, then we passed the bill, and remember, we were told that
it would save $142 billion over 10 years. President Obama himself came
to the floor of this House and said he had a plan that would result in
a net savings to the American people. And what really happened? We
passed the bill. The House passed the bill. Again, I must stress that I
voted against it, but the House passed the bill in March. And a month
later we get an amended report from the chief actuary's office at the
Center for Medicare and Medicaid Services which said, Oh, by the way,
the cost of this bill is $318 billion more than what you were told it
was going to be.
Well, that concerned me. Getting this actuarial report from the
Center for Medicare and Medicaid Services raised a question in my mind:
Did the Department of Health and Human Services know their report would
reveal higher costs? Was this information that was in fact available
when the House voted on this bill? Or were we so misled, was this House
so misled by its leadership, that it voted on a bill knowing full well
that we did not have adequate cost data in order to make this type of
determination.
{time} 2020
Remember, we are talking about restructuring almost one-fifth of the
American economy in this legislation. Is it possible that the
leadership of this House--the Speaker and the majority leader--would
have brought to the floor, in front of Members of their side and our
side, a bill for consideration when they didn't even know the cost this
was going to place on the American people?
So I asked for information. I asked for information from the
Secretary of Health and Human Services. I asked for information from
the chief actuary. I did not get a response. So, in July of this year,
I filed another resolution of inquiry, this time dealing with the
actuarial report from the Centers for Medicare and Medicaid Services.
After filing the resolution of inquiry, I finally got a response. On
August 3, Secretary Sebelius wrote to me.
It reads: ``Thank you for your letter regarding recent reports by the
Centers for Medicare and Medicaid Services' chief actuary. For your
review, I have enclosed an August 2 memorandum from CMS Chief Actuary
Richard Foster to CMS Administrator Donald Berwick about the timing and
process for the Office of the Actuary's preparation of financial
coverage and national health expenditure estimates for the Affordable
Care Act. I wanted to send it to you immediately as it addresses many
of the questions and concerns raised in your letter.''
Well, again, I did not get this response until after I had filed the
resolution of inquiry. Dr. Foster's memorandum, indeed, says that he
received the reconciliation bill for the health reform legislation when
it was publicly issued on March 18, which was 3 days before the House
vote took place on March 21. Because of the complexity of the
legislation, it was not possible to estimate the bill's financial and
other impacts before the House or the Senate voted. We began to work on
the estimates right away, but were not able to finalize them until the
afternoon of April 22.
Well, obviously, it would have been helpful to have received this
information when I had first requested it. It would have been helpful
to have received this information before filing the resolution of
inquiry, but it doesn't answer the broader question. Okay. I accept the
chief actuary's version of the events. He has got no reason to tell me
anything other than what is factual and truthful; but if what he says
is factual and truthful, the legislation was publicly issued on March
18. Three days later, the House took a vote on March 21, and he didn't
know what the cost was until April 18.
Did the Speaker of the House know that it was going to be another
month before she would actually have the cost data? Is it okay for this
body to vote on a piece of legislation that, again, is one-fifth of the
American economy and that is going to affect every man, woman and child
amongst us for the next three generations? Is it okay to do that with a
price tag that is simply a question mark? It's unknown. It's coming
next month. What's the rush? Why don't we have that information before
we vote?
I still have not received the information that I've requested. Again,
the documentation, the emails, the meeting notes, they do raise
questions because it was so hard to get this information. I'm not a
suspicious person by nature; but when no information is forthcoming, it
raises questions in my mind.
Is there something here that someone is trying to hide? What did they
know, and when did they know it? You know the scenarios. You've heard
them before. Why was it so difficult to get this information from
Secretary Sebelius and the Department of Health and Human Services? Why
did it take an act of Congress--literally, an act of Congress--to get a
simple response to a fairly straightforward request?
Then most disturbing and most importantly, why would the House
leadership, why would the Democratic leadership of this House, bring
before this body late on a Sunday night a bill, again, that is going to
affect every man, woman and child amongst us for the next three
generations, without knowing what the cost of that legislation would
be? It's shocking when you stop and think about it.
Again, I reference Chairman Waxman. He asked for every jot and tittle
of information from legitimate private companies in this country that
were doing their required SEC filings. He wanted to know everything
about how they came to their decisions, and I can't have the simplest
of documents from the Department of Health and Human Services and from
the Centers for Medicare and Medicaid Services? What is wrong with my
having that information?
Now, the resolution of inquiry came up for a vote today in my
committee. It was reported without recommendation on, basically, a
party-line vote. There were a couple of Democrats who voted with me on
that. Reporting a resolution of inquiry out without recommendation
means that it's essentially killed. That's the end of it. It's not
coming to the floor for a privileged resolution. There is no action
that must be taken by the Department of Health and Human Services or by
the Centers for Medicare and Medicaid Services.
At some point in the future, I hope the committee will have the
wherewithal to ask the Secretary and to ask the actuary, Donald
Berwick, in to talk about the troubling time around the passage of this
bill when this House voted on altering one-fifth of the economy of this
country with incomplete data, with insufficient data, to actually make
a determination.
Again, remember, one of the selling points of the Patient Protection
and
[[Page H6977]]
Affordable Care Act that was brought to us time and again was: we save
money; over the next 10 years, we're going to save $142 billion. False.
Wrong. Not true. In fact, over the next 10 years, not only is there not
a savings, but there is a net deficit; there is a net addition to the
deficit of $318 billion.
Would anybody have voted differently? I don't know the answer to
that. I was a ``no'' when it started. I was a ``no'' when it ended. If
it had cost another $318 billion, I would have been a ``no'' because
there wasn't a stronger negative vote for me to cast.
How about someone who was wavering--someone who voted ``yes'' and who
thought, I'm really not sure if I should vote ``yes,'' but everyone
tells me it's going to save money, and I want to save money, so I'll
vote ``yes''? Would that person have voted differently? I don't know. I
don't know, Mr. Speaker.
It would be interesting, as people go home during the month of
October to petition their constituents for reelection, if perhaps that
question might be asked: Would you have voted the way that you did if
you knew that this bill, in fact, cost an additional $318 billion?
This health reform legislation remains secretive, hidden, behind
closed doors. It is probably one of the most secretive things that this
Congress has ever done in its history.
We were told that this reform would make it easier for small
businesses to provide health insurance for their workers. One thing I
heard over and over again all summer long from small businesses across
my district is that complying with the new 1099 provision will be time-
consuming and costly. It's expected to cost an additional $74 an hour
to complete. And if not done correctly, guess what? That's a monetary
fine. Due to the strict compliance, only a small fraction of businesses
will be able to apply for any tax credits that are contained within the
bill. Yes, there is an expiration date on those tax credits.
The 1099s have been particularly onerous. In fact, there have been
bills introduced by both sides. Both sides have said maybe we ought to
do away with the 1099. Republicans had a motion to recommit that
contained a repeal of the 1099. Some Democrats have offered similar
legislation. I say that's fine. I'd like to see the entire bill
repealed, but you know what? If it has to be piece by piece, that would
be a good piece to start with, wouldn't it? Let's repeal that. Let's
stop putting that additional burden on our small businesses.
Today is the sixth-month anniversary. There are some new changes that
are coming about as a result of the health care law. Today, young
adults can remain on family health plans until they turn 26. No one
disputes that that's a good thing. In fact, that was taken from a piece
of Republican legislation, from a bill that was offered by the
gentleman from Missouri, from a Republican Member of Congress, to allow
youngsters to stay on their parents' plans until--I think his level was
age 25. We could have argued. We could have debated about: Is 25 or 26
the right number there?
The fact of the matter is that could have happened a year and a half
ago. It is happening today. Arguably, it's a good thing, but at the
same time, was it necessary to turn the entire health care system in
this country on its head in order to accomplish that goal?
Immunizations for kids: it's not the first time that has been brought
up, and it's not the last time. Arguably, it's a good position, but
let's face it: we could have done that without disrupting the whole
health care system in this country. We probably could have done that
without it costing $1 trillion. Why didn't we do that a year ago? Why
didn't we do that a year and a half ago?
{time} 2030
Some other things, preventive care, cholesterol screenings. But I
would stress, as great as these benefits are and as important as it is
for kids to have coverage until age 26, nothing happens in a vacuum.
This doesn't happen for free somewhere. Someone somewhere is going to
have to pay for it. Will that pay-for be some of the dollars that we
saw in the higher premiums that insurance companies are charging now?
Again, we don't know. It would be a great question to ask. It would be
a great question to ask; bring your books in, let's talk about this.
You raised your rates; was part of it because you have to cover kids up
until age 26?
Some companies that I've talked to have explained to me that that is
an additional cost that they are now taking on. Some others have told
me that perhaps we will just stop covering children altogether so we
don't get faced with that. But nevertheless, we ought to have those
oversight hearings. We ought to have people who deal with this every
day in to talk to us about how this is going. Maybe there are some ways
we can improve it. Maybe there are some ways we can keep it from
costing so much. We don't know because we don't ask.
All of the things that kick in today that are arguably good things,
any one of those could have been done without disrupting the entire
health care system and without costing $1 trillion. Many were ideas
that were introduced by Republicans over the last several years.
Existing legislation was out there, could have been picked up and
passed at any time, but the fact of the matter is it was not. The
bottom line is the bill does disrupt the health care system for
everyone in this country, and it does cost, as we know now, well north
of $1 trillion. That is going to be problematic for some time to come.
One of the other things about the implementation of this law is the
deadlines that were missed, and it is important to pay attention to
those deadlines. These were bits and pieces of legislative language
that were included in the bill, presumably for a reason, presumably for
a good reason, and for whatever reason the Department of Health and
Human Services has decided that they don't matter, so we're not going
to do them right now.
Required by April 22, shortly after the bill was signed: requiring
the Department of Health and Human Services to publish a list of its
new authorities, an action described as complying with an important
transparency-in-government provision. Well, what actually happened on
that date was the Department of Health and Human Services just simply
reproduced the table of contents from the bill; hardly, hardly
complying with the spirit or the intent of that language in the bill.
The law required, by May 7, 2010, proposing methodology and criteria
for designating what qualifies as ``medically underserved populations''
and ``health profession shortage areas.'' Again, maybe the
determination was made by Health and Human Services that this was not
important. Someone thought it was important enough to include it in the
bill. We should at least be given an explanation as to why that
deadline was allowed to expire without action.
Required by May 7, 2010: establishing a government task force to
develop a strategy to improve government health care programs in
Alaska. Again, this was important to someone and included in the bill
for some reason. Perhaps we are owed an explanation as to why that
deadline has lapsed and when we might expect to see compliance with
that.
Here is an ironic one. Required by May 22, 2010, to comply with
what's called the Early Act: establishing an advisory committee to
assist in creating and conducting an advertising campaign to educate
young women about breast cancer and breast health, including early
detection. Again, this language was important to a Member of this body,
important enough to have it added to the bill. I believe this language
was, in fact, important to a Democratic Member of this body. Why was it
not thought important enough to meet that deadline? And if the
Secretary is going to have difficulty meeting that deadline, perhaps
she owed an explanation to Congress about why that deadline was allowed
to lapse and when we might be expecting to see compliance with that
deadline.
Required by June 1, 2010: that the National Association of Insurance
Commissioners was supposed to provide technical guidance to the
Secretary to what is known as the Medical Loss Ratio, the MLR. That
didn't happen. The deadline was much too tight.
Now, this was interesting because lots of places in the bill it says
``the Secretary shall,'' which means there's going to be rulemaking
over at the Department of Health and Human Services and a new rule is
going to be introduced by the Department of Health and
[[Page H6978]]
Human Services. But this one, the rulemaking was kind of outsourced, if
you will, to the National Association of Insurance Commissioners,
certainly a fine group who have a lot of expertise and a lot of
knowledge in this area. It turned out that they said they were unable
to comply with this deadline and, as a consequence, were given an
extension on that until the end of July. I don't think we're quite
there yet, though we are getting close. And the Secretary is reviewing
the documents that were provided to her by the National Association of
Insurance Commissioners, but if she is having difficulty deciding on
the validity of the documents that they provided her, whether or not
what has been recommended is the correct course, perhaps we could have
a hearing in committee and have that evidence presented, have those
documents presented to the committee so we might understand something
about it.
I do want to just briefly mention that there will be, Madam Speaker,
a hearing--not in the hearing room. This will be a forum on the Medical
Loss Ratio conducted by the Congressional Health Care Caucus,
healthcaucus.org. This will be Tuesday of next week at 1 p.m. eastern
time. At healthcaucus.org, you will have the ability to watch a Webcast
or a simulcast of this forum. And the forum will be preserved in the
archive section of the Web site, so people who are interested in
learning about the Medical Loss Ratio, here will be an opportunity to
do so. Unfortunately, we're not going to have that in our committee,
but I thought this was important enough to bring to people's attention,
and so we will be having that discussion next Tuesday on the Health
Caucus Web site.
There certainly was some imprecision about how this bill was crafted,
some imprecision coming out of the Department of Health and Human
Services. According to The New York Times, the new high-risk pool
program is so underfunded that it will cover fewer than 10 percent of
those who are denied health insurance because of preexisting medical
conditions. Remember, that was just one of the selling points of this
legislation. The President stood right here in the well of this House
in September of last year and said never again will you be denied
insurance because of a preexisting condition. It turns out that's not
exactly true. This law provided $5 billion to help people with coverage
for preexisting conditions. It turns out, when the money is spent, the
money is spent, and until the exchanges are set up in 2014, no
additional help will be forthcoming. A good idea, an idea that was
actually talked about by Senator John McCain during his Presidential
campaign in 2008. The fact of the matter is the Congressional Budget
Office estimated that it would cost $20 billion to do that.
Former Member Nathan Deal and I introduced legislation to cover just
this situation, H.R. 4019 and H.R. 4020, that would provide for
preexisting coverage. Those bills are still available. They could have
been passed instead of turning the entire health care system on its
head, instead of spending north of $1 trillion. For $25 billion--
because we added an additional $5 billion because we weren't sure that
$20 billion would cover the number of people who needed to be covered.
For $25 billion, we could have had one of the main features that has
been promoted as to why this health care bill, why this health care law
was necessary.
Deadline after deadline has been missed, but in spite of that, the
administration has found time and the resources to send brochures to
seniors on Medicare highlighting the benefits that they will receive
and, in fact, even hiring a spokesperson in the form of Sheriff Andy
Griffith to talk about the new health care bill, the new health care
law.
Just going back for a moment to the chart that was produced by the
American Medical Association about what's called the sustainable growth
rate formula, the health care reform debate and time was the perfect
opportunity to address this. Let's be honest; there were significant
cuts in Medicare to pay for these new entitlements. The American
Medical Association was supportive of this legislation as it came
through. I would just simply offer the observation, since this
sustainable growth rate formula is so onerous and preventing patients
from having access to doctors, wouldn't it have been nice to at least
have a down payment on solving this problem with the sustainable growth
rate formula when this bill was discussed, when this bill was passed?
{time} 2040
December 1 of this year physicians across the country face a 23
percent reduction in Medicare reimbursement. An additional 6.1 percent
has been proposed by the Centers for Medicare and Medicaid Services.
Doctors face an almost 30 percent reduction in Medicare reimbursements
starting January 1 of next year.
It's even worse than it sounds. Many private insurance companies in
this country peg their reimbursement rates to Medicare. So if Medicare
is reducing 30 percent, guess what happens to some of the private
insurance companies? They reduce 30 percent their reimbursement rates
also. This is an extremely onerous burden that we've placed on our
country's physicians, physicians that we've asked to take care of some
of our most sickest and most vulnerable patients, those with multiple
medical conditions, those covered under Medicare.
Medical liability reform. We had the opportunity to do it. We didn't
do it. It needs to happen. We're asking doctors to be our partners in
this brave new world of health care. The least we could have done was
provided them a little bit of respite from some of the burdens they
face with medical liability and oh, by the way, we might be able to
reduce the cost of defensive medicine, which is one of the cost drivers
that's driving up the cost of health care.
From an oversight perspective I've called for hearings to examine the
implementation of this massive bill. My subcommittee has the
jurisdiction to call in the secretary of HHS, the administrator at the
Centers for Medicare and Medicaid Services. Chairman Waxman has refused
to do so. I don't know what will happen next year. Perhaps we will have
an opportunity to actually question some of those individuals.
In fact, the stimulus bill that this body passed in February of 2009
contains some money for helping physicians in hospitals purchase
information technology that everyone recognizes as important for going
forward in implementing any type of health care change in this country.
But the reality is that the rule that was produced in January of this
year regarding meaningful use was so difficult that most hospitals and
most doctors will not be able to live with that.
We tried to alter that. We tried to get CMS to understand some of the
difficulties that people would have in the real world dealing with
this. Some relief has been achieved, but we're still a long way from an
actual solution there.
This law, this bill, when it was passed on the floor of this House
late on a Sunday night in March of this year, 55 percent of the public
opposed this bill. Fifty-five percent of the public supported repealing
the bill on March 25, 2 days after its enactment. Six months later,
what has happened to that figure? It has increased. Over 60 percent of
the American people believe that this bill ought to be repealed.
The Department of Health and Human Services has spent millions on
television commercials featuring people like Andy Griffith and
brochures sent to Medicare beneficiaries.
The audacity of the administration to disregard the opinion of the
majority of Americans is unacceptable. Remember, we are government by
the consent of the governed. The governed did not consent to this. The
governed did not want this. The governed are now rejecting this
legislation.
There was a better way. There are dozens of bills that would lower
costs and increase access. Many of them have been covered on the health
caucus Web site that I referenced a moment ago.
The fact of the matter is, this Congress, whether we like it or not,
is faced with this massive health care law. In my opinion it should be
repealed. The law is so massive, the structure, the reordering of
structure is so onerous on our medical system that it's almost as if it
were designed to fail. It's like building a bridge to the
[[Page H6979]]
Moon. You will collapse of your own weight before you get only a
fraction of the way there.
It's hard to know whether the difficulties encountered in this bill,
this law, are the result of incompetence or malevolence, but it doesn't
matter which.
The time to repeal this bill is now. I urge the leadership of this
House to recognize the mistake. Don't wait for another Congress. Let's
do this today.
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