[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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