[Congressional Record Volume 157, Number 6 (Tuesday, January 18, 2011)]
[House]
[Pages H241-H247]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HONORING SARGENT SHRIVER AND HEALTH CARE
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 5, 2011, the gentleman from California (Mr. Garamendi) is
recognized for 60 minutes as the designee of the minority leader.
Mr. GARAMENDI. Mr. Speaker, thank you for this opportunity to discuss
health care this evening.
But before I get to health care, I was notified early this afternoon
that a unique, iconic American had died today; Sargent Shriver is no
longer with us.
This individual has had an impact on America and the world around us
that will last for centuries. He literally created the United States
Peace Corps. The idea was developed by him and his brother-in-law, JFK,
and put into effect in the first year of the Jack Kennedy
administration.
Thousands, indeed over nearly 200,000 Americans, have joined the
Peace Corps in the ensuing years. For my wife and I, it changed our
life; it changed the path upon which we have traveled. We were the
third iteration of the Peace Corps back in the 1960s. We were sent to
Ethiopia. We served in a village out in the boondocks of southwestern
Ethiopia, and it put in place in our lives the vision that we could and
should continue to serve.
We are not alone. Thousands upon thousands of Americans, those that
were in the Peace Corps and those that were affected by the Peace Corps
here in this Nation, found that same mission of being a life of
service.
In the 1990s, Sargent Shriver returned once again to assist the Peace
Corps as the Clinton administration undertook the rebuilding and
expansion of the Peace Corps. My wife was then working at the Peace
Corps as the associate director, and together they and the other staff
opened the Peace Corps to the former Soviet Union nations, Eastern
Europe and beyond and also to South Africa. It was a period of growth,
and once again it was a period in which the Shriver enthusiasm and the
Shriver determination to reach out to everyone in this world so that
they could have a better life created these opportunities.
We mourn his passage. Our prayers go out to his family and to remind
all of us that we too in any way possible should be serving our fellow
man.
Sergeant Shriver, we miss you and we know that America and millions
of people around the world that were affected by your programs will
miss you also.
Let me now turn to another issue that affects every American, their
well being, their lives, their ability to get the care that they need
when they have health care problems.
On this floor today we began the debate of the repeal of the
Affordable Health Care Act, an extraordinary law that will affect each
and every one of us in this Nation; and as it affects us, it will also
affect people around the world because this law will help America
finally join the other industrialized nations in the world and provide
health care to all of our people, not just those who are fortunate
enough to be employed by an employer who has found it useful, wise or
even correct to provide health care for their employees, but for those
individuals that are not so fortunate to be with an employer that does
not provide health care, and for those who are unemployed.
This is an extremely important debate going on here on the floor of
the House. It's a debate about all of our lives.
It was estimated before this law went into effect that some 30,000 to
40,000 Americans every year lost their lives because they did not have
health care. It was too late for them to get their blood pressure under
control. It was too late for them to deal with their diabetic situation
or their cancer had
[[Page H242]]
run its course so that it was not treatable, 30,000 to 40,000 Americans
every year.
{time} 2020
That is not the way America should be. We should be providing
insurance to all Americans.
On the floor today, the debate commenced, and I was pleased and a bit
curious to hear my colleagues on the Republican side talk about repeal
and replace. And as they talked about what they would replace, I began
to say, Excuse me. Wait a minute. What you're replacing is already the
law in America. The health care bill that became law this year deals
with every American from birth through their school years, through
their years of building a family, in their employment and through their
retirement. It deals with the entire cycle of life by providing the
opportunity for health insurance, improved health insurance, at every
stage of life.
Let me show you how that works. It's the Patient's Bill of Rights,
which apparently our Republican colleagues want to repeal. The
Patient's Bill of Rights is a fundamental reform of the insurance
industry. I was insurance commissioner for 8 years in California, and I
understand the insurance industry very, very well. And it's about
profit. All too often, the health insurance industry puts profit before
people. In doing so, they deny coverage. The Patient's Bill of Rights
goes directly to this issue of insurance companies putting profit
before people.
Let me show you where this works. Children. My very first speech here
on the floor as the health care debate came up in 2009, in November of
2009, I spoke to an individual, a friend of ours who lives here in
Washington, whose child was born with a very serious kidney problem.
The mother was covered by insurance through the pregnancy and through
the delivery. The moment it was discovered that that child had this
preexisting kidney ailment, they dropped the coverage on the child. The
family struggled and continues to struggle to provide care for that
child, limping along trying to get the money together for the next
procedure to provide the services that are necessary--the transplant.
All of those things should have been covered by insurance, but with
the insurance company putting profit before people, they denied that
child coverage. The Patient's Bill of Rights stops that and says that
every child has a right to coverage, no longer the kind of
discrimination that took place here with my friend's family.
Secondly, young adults. I happen to have had six young adults. All of
them have passed through the age 23, and that period where their
coverage stopped was the scary time for us in our family, and it is for
every other family in America. At the age of 23, insurance companies
were allowed to drop patients' coverage. And if you're a 23-year-old
and you have any kind of a preexisting condition, you're out of luck.
The Patient's Bill of Rights guarantees that that young woman or man
will be able to get coverage until the age of 26. And if they have a
preexisting condition, that can no longer be a reason to deny coverage.
The Patient's Bill of Rights would be repealed by the piece of
legislation that will be brought to this floor tomorrow.
If you are a woman, you have a preexisting condition. It is called
being a female. And routinely--and I've seen this during my tenure as
insurance commissioner. Routinely, the insurance companies would deny
coverage because you are a woman and you might get pregnant or you
might have any number of conditions. That will no longer be the case.
If you happen to have cancer, you cannot be denied coverage. The
Patient's Bill of Rights protects every single American when it comes
to getting insurance and keeping insurance.
Many other provisions are in this bill, and I find it astounding that
our colleagues on the Republican side would repeal the Patient's Bill
of Rights and literally open every single American up to the gross
discrimination that the insurance companies have foisted upon Americans
for decades putting profits before people.
There are many other parts of the Patient's Bill of Rights, but I
want to just take a moment and invite to this conversation my colleague
from the great State of New Jersey, Frank Pallone, who has been
fighting this fight for decades both as a Member of Congress and as a
concerned citizen.
Mr. Pallone, if you will join with us, share with us your thoughts
and your experiences, and we will continue on with this discussion. I
yield.
Mr. PALLONE. Thank you. I want to thank you for all that you do on
this issue. I have seen you come to the floor so many times over the
last year or more talking about the importance of the health care
reform and now, of course, pointing out how ridiculous it is to try to
repeal it, which is what the Republicans are going to try to do
tomorrow.
I just want to start out by saying that we were just home for the
Martin Luther King weekend, and so there was an opportunity to talk to
a lot of people at the various Martin Luther King events over the 3 or
4 days that we were home, and the issue is jobs. That's all people want
to talk about. Everyone comes up to me and says, What are you going to
do about the economy? What are you going to do about jobs? Nobody talks
about repealing the health reform bill.
And what I get basically from my constituents is they know the health
reform bill passed. They know that it's kicking in. A lot of the
patients' protections that you mentioned have already kicked in, and
they want to see how it goes. Even those who were not necessarily for
it in the beginning think it is a complete waste of time for us to be
rehashing the debate and talking about repeal because they want to see
what is actually going to happen with the health care reform. And to
the extent that they have seen certain things, protections, kick in,
they're happy with it. And what they say to me is, Look, if over the
next few years if certain aspects don't work out, then you can go back
and revisit it and maybe make some changes. Nobody is suggesting we
can't make changes on a bipartisan basis. But this idea of just
repealing it outright when it just went into effect a few months ago,
almost no one I talked to is in favor of that. They just don't think
that makes sense.
The other thing that I wanted to say, and I keep stressing over and
over again--I actually have this chart, and I know you pointed to it as
well--is: Who is going to actually gain from the repeal? We know that
insurance companies keep raising their prices. We know that
historically they try to discriminate by eliminating people who have
preexisting conditions or by having lifetime caps on insurance
policies. The only ones that gain from this repeal are the insurance
companies because essentially they can go back to the situation, to the
status quo where they can have double-digit premium increases. You
know, in your own State of California, it wasn't unusual to have a 30
percent increase. I think Blue Cross just announced a 50-something
percent increase. And so they make money by constantly raising premiums
and also by discrimination.
In other words, if you have a policy, a woman, for example, that has
breast cancer and then she has a recurrence, well, if she reaches the
cap on coverage for the year or the cap on coverage for a lifetime,
then she has no insurance to cover her reoccurring cancer.
Or the other thing is that sometimes they even rescind a policy. If
they can find some way to say that it didn't apply to you, they would
simply rescind it altogether, and you'd get sick and wouldn't have
insurance at all, even when you thought you had the greatest need for
it.
So I just want to stress, this chart says GOP patients' rights repeal
would put insurance companies back in charge where children with
preexisting conditions are denied coverage, young people aged 26 can't
stay on their parents' plan, pregnant women and breast and prostate
cancer patients could be thrown off insurance rolls--that's the
rescission--seniors pay more for their drugs.
The bill, as you know, has, for those in the doughnut hole, until
this bill went into effect, if you reached the doughnut hole, then you
had to pay 100 percent for your prescription drugs. You got a $250
rebate last year. As of January 1, you have a 50 percent reduction, and
that's going to eventually become zero so you will have complete
coverage under Medicare part D.
So, if you repeal it, seniors are going to pay more for their drugs.
And that's
[[Page H243]]
the other thing that is amazing. They talk about how this is going to,
I guess they're not using the term ``killing jobs'' anymore. They got
away from that.
Mr. GARAMENDI. Crush. Crush jobs.
Mr. PALLONE. What is it now? Crush jobs.
The fact of the matter is that the bill actually decreases the
deficit by $230 billion, so you'd be increasing the deficit if you
repealed the bill.
And with regard to jobs, I mean, look, if you think about what's in
the bill, because everybody gets coverage, you're going to have to have
a lot more health professionals, so that creates jobs, because premiums
will stabilize, employers won't have the double-digit inflation that
comes and makes it harder for them to hire people. So just the fact
that your premiums stabilize makes it easier for employers to hire
people.
{time} 2030
And then we have all kinds of funding for research at labs and
hospitals and institutions around the country; even the R&D creates
jobs. It creates jobs is the bottom line.
But I would really like to go back to where I started from, and, that
is, most people just say to me, ``Why are the Republicans doing this?
Let this bill kick in. Let us get to the point where everyone's
covered. Let's see how it works.''
We know the Senate's not going to pass the repeal. The President's
not going to sign the repeal. So rather than spend our time trying to
figure out ways of creating jobs, we'll just debate this for another
week for no purpose, just as a waste of time.
Mr. GARAMENDI. Thank you very much, Mr. Pallone.
If it's about jobs, then why are we doing all of this? It's
interesting to note, and I heard this debate earlier on the floor here,
that this is a job crusher, to be politically correct now, and that
businesses are going to lose jobs, when in fact since the bill became
law, over 932,000 private sector jobs have been created. So there's no
evidence in the large job market that this legislation, the health care
reform, has harmed jobs, crushed jobs. It hasn't happened. In fact
nearly a million new jobs have been created; 932,000.
In addition to that, this is an extremely important bill for small
businesses. This bill, as you said, actually subsidizes the cost of
health care for small businesses. If you have less than 50 employees,
you can get a subsidy, up to 35 percent, for buying health care for
your employees. And if you don't want to buy health care, you don't
have to if you have less than 50 employees.
I don't understand this debate about small businesses being harmed.
In fact, the Kaiser Family Foundation has shown that in the last year,
probably as a result of this bill--that's their conclusion--the number
of small businesses providing health insurance has grown from 46
percent to 59 percent.
Mr. PALLONE. If the gentleman would yield, one of the things that I
wanted to point out and I am going to certainly talk about it, I'll
talk about it more a little tonight, is my committee, the Energy and
Commerce Committee today, put out a report essentially that talks about
the impact of repealing the health care reform law in each
congressional district, district by district. I have the information on
my congressional district, the Sixth in New Jersey, that talks about
the tax credits for small businesses, and it says in this report that
the health reform law provides tax credits to small businesses worth up
to 35 percent of the cost of providing health insurance. There are up
to 18,200 small businesses in my district alone that are eligible for
the tax credit. And, of course, repeal would force these small
businesses to drop coverage or bear the full cost of coverage
themselves.
The bottom line, every small business owner I know wants to provide
coverage. It's just a question of whether they can afford it. And what
we do in the bill is make it affordable by giving them this major tax
credit. Eighteen thousand two hundred small businesses in my district
alone can benefit from it and would lose that if we repealed the bill.
Mr. GARAMENDI. That is similar in every district, Republican or
Democrat, across the Nation. The number of small businesses may vary
district to district, but the point is that every small business has an
opportunity to reduce by more than one-third the cost of health care by
simply providing health care. And that will grow to 50 percent in just
3 years. It climbs up 35 and then 50 percent in 2014. And in 2014,
every State will have an exchange, an insurance marketplace, where
small businesses, individuals, can buy health insurance on a
marketplace that talks about the quality and the cost so there is
competition.
Once again, why would you want to repeal that, where individuals can
shop for health insurance in a competitive market? We talk about
competition here. Well, let's let it happen. Right now it doesn't
really occur because many insurance companies don't compete. There are
many, many aspects of this.
I notice that our friend from the great State of Tennessee has joined
us. Mr. Cohen, if you will, what is going on in Tennessee? Do they want
to repeal this? Do they really want to do away with the patients' bill
of rights? The preventative care that seniors are able to get under
this bill? The closing of the doughnut hole? Is that what the Tennessee
folks want?
Mr. COHEN. Thank you, sir.
I don't think so. And the tide has been turning. The national polls,
which I think are reflective of Tennessee at least on a percentage
basis, have shown that it's gone from 10 points up on people that want
to repeal this bill to where it's even, as many people for it as
against it in this country. There's been a 10-point switch in the last
2 weeks as people have looked at the possibilities of the repeal of the
law and seen the benefit.
What I thought about, Mr. Garamendi, I was in New York, New York
City, about 2 weeks ago, and I went in the Time Warner Building. They
had an exhibit there of Salvador Dali; surreal, things looking out of
space. Strange, strange pictures and thoughts. It's hard to think of
this Congress and the Republican majority that's come in trying to
repeal a bill that's going to become as popular, once it gets
implemented, as Social Security and Medicaid and Medicare have over the
years, that they are so out of touch with America today and its needs
and the future. Because while this may seem to be important to the
minority, the tail wagging the dog in that party, the tea party that's
wagging the dog, saying repeal health care, the fact is down the line,
people are going to embrace this bill like they embraced the Great
Society's Medicaid and Medicare and the New Deal's Social Security.
It's going to be a short-term possible victory but a long-term defeat.
And the myopia of the other side, let alone the hypocrisy of some of
its members, is hard to fathom. But you can only see it through the
eyes of Salvador Dali, because obviously they are Salvador Dali, and
they're saying things in a surreal way.
The nonpartisan, bipartisan Congressional Budget Office says it's
going to save us $230 billion the first decade and $1.2 trillion
thereafter, and they say, ``Well, they can have their opinion.'' Those
are facts. Those are nonpartisan facts of people we hire to give us the
truth. They don't like the truth so they summarily dismiss it.
They say it's a government takeover of health care, a big lie. Just
like Goebbels; you say it enough, you repeat the lie, you repeat the
lie, you repeat the lie, and eventually people believe it. Like blood
libel. That's the same kind of thing. The Germans said enough about the
Jews and the people believed it and you had the Holocaust. You tell a
lie over and over again. And we've heard it on this floor; government
takeover of health care.
PolitiFact, nonpartisan, Pulitzer prize-winning, 2009, St. Petersburg
Times, said the biggest lie of 2010 was government takeover of health
care, because there is no government takeover. It's insurance.
I look at my Facebook regularly and I've got some people I
communicate with on different issues on Facebook. I respond to them
whether they take my side or not, obviously. And one lady has been
constantly talking negatively about health care. I responded. She keeps
going on with the line that obviously she hears and she's taken as her
mantra; and that is that this is a government takeover of health care.
Well,
[[Page H244]]
she's drunken the Kool-Aid, and that's just not true.
We heard in August 2009 that there were death panels and killing
grandmother. Everybody agrees now, that was a big lie; just like
government takeover of health care is a big lie. And it's amazing the
lies: denying the effect on the deficit, claiming it's a government
takeover, claiming there were death panels.
This lady on my Facebook page talked about the fact that it was going
to take insurance companies out and there was a public option. Well,
there is no public option. And the exchanges aren't a public option but
the exchanges are private insurance where people can come together and
get better rates that they couldn't get if they were dealing as
individuals on the open market.
People don't understand. If you read Paul Krugman today, or
yesterday--today in Memphis, we get it a day late--but yesterday in the
New York Times, he talked about the errors in arithmetic, basically the
lies that are being put out about how it will affect the budget. And
Krugman, who's only a Nobel prize winner, says it's just not true, and
what it comes down to, the bottom line, is there is a group in America
that don't feel like they have a responsibility, a social
responsibility, a moral responsibility, to those 32 million Americans
who can't afford health care and right now are seeing death panels, the
death panels that say you won't have insurance and you won't have
health care.
{time} 2040
As we are just one day beyond Dr. Martin Luther King's holiday,
America's holiday celebrating Dr. Martin Luther King, Dr. King was not
only for social justice, which everybody embraces today and talks about
kumbayah and integration, but it was also economic justice. And
economic justice involves health care, and it involves giving everybody
an opportunity to stay alive, to get educated, and to get a job.
The first priority I have always believed of government is to keep
people alive, their health care. The second is to get them educated.
And the third is to get them a job. This rhetoric on the other side of
the aisle about whatever they want to call it is not only false--read
Krugman, a Nobel Prize winner--but it is the third priority. The first
thing is keeping people alive. And you want to tell those 32 million
Americans we don't want you to have insurance, we don't care about you.
That is wrong. Dr. King wouldn't approve of it. I don't approve of it.
America won't approve of it.
And it is as I started with, surreal to think that the first thing
that this Republican Congress is doing is trying to repeal what will be
known down the years as one of the great acts ever passed by this
United States Congress. It will be to the fortune of the Democrats
because like Social Security and Medicare and Medicaid and voting
rights and civil rights, they are Democratic initiatives that brought
America forward, progressive initiatives that have been brought forth
by this side of the aisle. And the myopia of the other side is
politically welcomed, if not policy-wise sad.
Mr. GARAMENDI. Mr. Cohen, thank you very much. You pointed out the
nature of the debate taking place on the floor. I listened to much of
the debate this afternoon as it was going on, and tomorrow it is
probably going to be the same. Like you, I was surprised and in many
cases disappointed with the rhetoric that I heard. It simply wasn't
based on fact.
They talked about the government takeover of health care. You used
the word ``big lie.'' Well, in fact it is not going to happen. This is
not the government takeover of health care. There are many who said we
simply should take Medicare and expand it to all. Now that is a program
that is government collection of the money, but the services are
provided by individual doctors, hospitals, and other provider groups.
It is not a government takeover; it is a government finance program.
You mentioned the uninsured. Actually, it is about 42 million
uninsured in America. They get sick. Who pays for them when they go to
the emergency room? They don't have an insurance policy. They are
certainly not going to be able to afford the cost of an emergency room
and any procedure. Those people who are uninsured do get sick. They do
go to the emergency room, and they do get medical care. And who pays,
the taxpayer.
Mr. COHEN. Property taxes.
Mr. GARAMENDI. In Tennessee, the property tax base. In California,
the general tax base and the Federal Government. Here is the clincher:
every health insurance policy in the Nation pays for the uninsured. So
we have health care coverage. In fact, this law requires that the three
of us and all 435 Members of Congress and 100 Members of the Senate
will get the exact same kind of insurance that every American gets. We
don't get a special deal. In fact, we get to pay for part of it
ourselves. That is a fact.
So what about those people that are out there uninsured that get
sick. We get to pay for it through our health insurance policies
because that cost is shifted over to us, the taxpayer. There is no free
lunch here. The question we have is should everybody participate in
this insurance pool. I think it is only fair to say that we all
participate.
I don't know what I said, Mr. Pallone, that made you come to your
feet, but please proceed.
Mr. PALLONE. Everything you said is absolutely true. I know in my
State we estimate that every insurance policy, for those who have
insurance and are paying their premiums, there is built into it
something like $1,000 to $1,500 per year in your premium that pays for
uncompensated care for others. And I actually have a statistic in that
Energy and Commerce study that I mentioned that says in my district
alone repeal would increase the cost of uncompensated care by $54
million annually for hospitals in my district.
But what I wanted to point out was you can actually eliminate a lot
of the uncompensated care because what happens, people don't have
health insurance and so they don't see a primary care doctor on a
regular basis. And they get sicker, and their only recourse is to go to
an emergency room. I tried to get the CBO to build into this the
savings that would come about because of preventive care. In other
words, the fact that all of these people who are uninsured go to the
emergency room, don't see a doctor, and all of a sudden they see a
doctor and they stay well because they take preventive care of
themselves and they do wellness and then they don't end up getting sick
and going to the hospital. But that was never built into the system.
The CBO won't score prevention, so to speak.
But I would maintain there is huge savings. We talk about a $230
billion savings from the deficit, but in my opinion it is trillions of
dollars because not built into this is the fact that all of these
people who don't have primary care and end up in an emergency room now
will have a doctor. They won't get sick, and you won't have to pay for
all that care. So the system as a whole saves a tremendous amount of
money, which is not really calculated here, in my opinion. That is what
you made me think of.
Mr. GARAMENDI. You are quite correct. It is some very simple things
which I think all Americans understand. Blood pressure, high blood
pressure, the silent killer, people don't know that they have high
blood pressure until they get the stroke. And then if they survive,
they may very well be paralyzed or incapacitated the rest of their life
and take an enormous expenditure every day, every month, every year
caring for them in a nursing home or in an extended care situation.
That is a very simple thing to understand.
And this piece of legislation provides free preventive care for
seniors. Is that what they really want to repeal, that free preventive
care for seniors where most high blood pressure cases are found and
where most strokes are found? It is a preventive cost.
Mr. PALLONE. Exactly. As you know, on January 1 there were a whole
new set of patient protections that went into effect and one was
elimination of the 20 percent copay for seniors. They get a 1-year
wellness exam for which they don't have a copay, mammogram, all kinds
of tests for which they would have paid 20 percent copay. All of that
is out now. The reason it was done is exactly what you said: a lot of
seniors would not go and have those tests done because they
[[Page H245]]
didn't want to put up the 20 percent. Now they get it free.
The Republicans say that costs money. It doesn't. It may cost money
up front; but in the long run because the people get the wellness check
and they have the mammogram, they don't get sicker. So we actually
recoup the money because they don't get sick. I think it is a very
important point that you are making.
Mr. GARAMENDI. Mr. Cohen.
Mr. COHEN. Sir, I appreciate your leading this. You have been an
outstanding Member; and your first vote, I think, was for this bill.
You have a lot of experience of this issue. You were commissioner of
insurance, if I am correct, of the largest State in the country,
California. So you have knowledge here.
Mr. Pallone worked very hard on this bill, too, as I did; but Mr.
Pallone was in a senior position.
As I think back on the passage of this bill, I remember a lot of
criticism; and the other side and the people who were critical said we
didn't take enough time to pass the bill. We only took a year, a year
and a half to pass the bill. And they are going to take 2 days to
repeal it. Take enough time? Where are the people who think we should
take enough time for the legislative process to work, to have hearings,
to have thoughtful discussion, to have analysis of expert opinion
today? Two days and it is going to be voted on, and that's it. And the
old mantra which we heard from so many people, ``read the bill.'' And
yet so many people think it is a government takeover of health care. I
say to them: read the bill.
And people who think Congresspeople are going to get something
special, we get the same as everybody else. Read the bill.
Mr. GARAMENDI. If you will yield for a moment, there is a place where
the bill can be read, the Web site www.healthcare.gov. It gives the
bill. It gives a detailed description of every item in the bill. We
have only talked about maybe one-third of the bill here today, and
maybe we will go into some of the other parts.
{time} 2050
It also talks about the timeline in which the various elements of the
bill will go into effect. For example, the senior population: The
doughnut hole begins to close. Last year a $250 rebate check to those
seniors who are in the doughnut hole, and then, in the next 8 years,
that doughnut hole is squeezed shut. And, as Mr. Pallone said earlier,
seniors would then have all of their prescriptions covered. It also
shrinks the cost of prescription drugs.
That wasn't talked about here earlier today. And if they want to read
the bill, they can talk about the coverage options in every part of
America--in California, Tennessee, New Jersey, wherever--and specific
detail about seniors, about women, those kinds of pieces of
information: www.healthcare.gov. You want to read the bill? You want to
understand it? I would suggest that our colleagues on the other side,
the Republicans, take a look at the bill, itself, and what it does.
Please continue, Mr. Cohen.
Mr. COHEN. Well, thank you.
Today, when I came on the floor, Ms. Slaughter--one of the senior
Members of this Congress, an outstanding Member and the former
chairperson of the Rules Committee, now the ranking member--told me of
a Member on the other side, a Member in her fourth term--I guess it was
in the Rules Committee, but it might have been on the floor--who
expressed for the first time astonishment, amazement, that the
insurance provided for Members of Congress was subsidized by the
Federal Government. She had no idea it was subsidized. She hasn't read
the bill. She doesn't even know what her policy is and what her
benefits are.
The fact is people should want for others what they want for
themselves. I don't have Federal congressional insurance--I don't have
it--but nearly everybody else in this Chamber does. Yet they don't want
their constituents to have it. Now that's hypocrisy.
Mr. GARAMENDI. Last week, on this floor, many of us tried to put an
amendment on this piece of legislation that would read: If the repeal
occurs, then every Member of Congress would lose his health care,
keeping in mind that 31 million Americans will not have health
insurance if the repeal takes place.
So, 435 of us. If the bill is repealed, we should join the 31 million
Americans who will not have health insurance if the bill is repealed.
It seems to be the least we could do. If we want to harm 31 million
Americans, if we want to take away the insurance from 31 million
Americans, then, surely, 435 of us should be willing to go without
insurance also. It turns out that not one Republican voted for that
amendment. I wonder why. They want something that they are going to
deny to 31 million Americans.
Mr. COHEN. What is good for the goose should be good for the gander.
There but for the grace of God go I. You should care about your brother
and your sister.
And this is going to be repealed in the same week as Dr. King's
holiday?
I mean, I know it took a while for Dr. King's holiday to come about.
It was John Conyers' steadfastness for 15 years to make it become law,
and even then there were people in this House who voted against it, and
there were people in the Senate who voted against it, but there is
nobody who has given a better philosophy of life over 2,000 years than
Dr. King.
Mr. GARAMENDI. Mr. Pallone.
Mr. PALLONE. I was going to ask you to go over that chart about
security and stability for America's seniors because, frankly, you
know, as the gentleman from Tennessee was pointing out, there is a lot
of misinformation that the Republicans give out in terms of Medicare
and the benefits of this program.
I mean, the bottom line is that all that we have done with Medicare
is extend benefits. A lot of seniors think that somehow, you know,
Medicare is going to be negatively impacted, which is simply not true.
So, if you could go through that, I'd appreciate it.
Mr. GARAMENDI. Well, I will do my best, and along the way, if my
colleagues would join in on any one of these issues, I'd appreciate it.
Health care reform means security and stability for America's
seniors.
First of all, despite all the rhetoric on the floor, this legislation
actually improves the financial status of Medicare. It extends the
solvency of Medicare, I think, by almost a decade.
Mr. PALLONE. You know, on the first point that you have there, I
actually went before the Rules Committee--I guess it wasn't last week.
It was 2 weeks ago now because last week we had the tragedy of our
colleague from Arizona--and I had an amendment that actually said that
the repeal would not go into effect if it actually negatively impacted
solvency. It actually is 12 years. In other words, the bill, the health
care reform, added 12 years of solvency to the Medicare trust fund. In
other words, with the repeal, insolvency would begin in 2017. So this
pushes that day of reckoning back, when there is not enough money to
pay out, another 12 years.
Mr. GARAMENDI. So it pushes it back to 2023.
Mr. PALLONE. Yes. Exactly. So, I mean, that's an important point.
Again, everything that we do shores up Medicare, provides more
Medicare, provides more benefits under Medicare for seniors, expands
their benefits.
Go ahead. I didn't mean to interrupt.
Mr. GARAMENDI. Let's just continue on here.
We talked about prescription drugs. It's not only the doughnut hole,
but there are certain kinds of generic prescription drugs that would
also benefit as a result of this legislation and, of course, the
doughnut hole issue, which we've discussed here in some detail.
The doughnut hole is squeezed shut, and initially, this last year,
$250. Now, I don't imagine the repeal would force the seniors to refund
the $250 check they had. Nonetheless, that doughnut hole would remain
wide open if the repeal were to take place. We've talked about the
improvement of the quality of senior care, and both of my colleagues
here have spoken to this, I think, very correctly.
Preventative care.
Now, we talked a moment ago about high blood pressure--clearly, the
silent killer and a major problem for seniors. Okay. You're going to
get, free of charge, an annual blood pressure test. You know, it's very
simple, very cheap, and the drugs to treat high blood pressure are
cheap also, but the cost of not treating it is extraordinary.
[[Page H246]]
There is another one that affects not only seniors but others around
this Nation, and that is diabetes. This is an enormous cost. It can be
treated. It can be taken care of, but if you ignore it, you are in for
a world of harm and a very, very great expense to all of the people,
including, in this case, to the taxpayers.
This is an interesting one. Primary care doctors.
Nobody has really talked about this much on the floor, but in the
legislation, there is a significant increase in medical education
opportunities, not only for doctors but also for others in primary
care--nurse practitioners, physician assistants, and nurses. There is
an enormous increase.
This one happens to be really, really important to me. Our daughter
graduated from medical school just 3 days ago, and we go, Yes.
She says, I want to do primary care.
I'm going, Terrific. How about geriatric care?--my wife and I are
looking to the future here.
This is really important. She has an opportunity under this piece of
legislation, as do all other primary care doctors who choose to serve
in underserved areas--and she may very well decide to do that--to have
their medical loans reduced as they provide service in underserved
areas, and some of those underserved areas are in our urban
communities.
Now, that brought Mr. Cohen to his feet and Mr. Pallone, so please
share, gentlemen.
Mr. PALLONE. I'll let my colleague from Tennessee go first.
Mr. COHEN. Well, there are so many problems.
I represent an urban district in Memphis, and we do have a lack of
health care in the urban areas. We need more primary care doctors, and
we also need more community health centers. That's something else the
bill is going to provide for, more community health centers. There are
large areas in my community where there are very few doctors who are
available and where there are not community health centers. So that's
another portion. It's not just the primary care doctors who are so
important--and we've got some of the greatest in Memphis--but it's the
difficulty in not having community health centers.
Mr. GARAMENDI. That has not been discussed.
In every part of America, people need to know about the enormous
increase in the community clinics that will be available. That's in the
legislation. It costs money, but it saves money because, once again,
people will be able to get care early.
{time} 2100
Mr. PALLONE. Could I ask the gentleman to yield?
Mr. GARAMENDI. Please.
Mr. PALLONE. This is true in the health reform, that there's a lot
more money for community-based health care clinics, but we also have
that in the stimulus, the Recovery Act.
Actually, I had two clinics that were funded under the Recovery Act
that had not received Federal funds before. And just to give you an
idea of what they did, one of them is in my hometown of Long Branch.
They coordinated with the emergency room at Monmouth Medical Center so
that every time someone comes to the emergency room who's eligible for
the community health center--because they probably, many of them are
uncompensated, have no insurance--now they go back and coordinate so
that that person doesn't come back to the emergency room again--which,
of course, is a tremendous expense--and instead goes to the community
health center where they get primary care. So that is an example of
where some Federal dollars that are going to community health centers
are now being used to make it so that people don't have to go to the
emergency room because they're getting the primary care in the clinic
for probably maybe a hundredth of the cost of an emergency room.
Mr. GARAMENDI. You raised another point. And I recall a conversation
with Mr. Cohen in the past where we talked about medical technology,
which is also not only in the Affordable Health Care Act, the health
care reform, but also in the stimulus bill. And part of what you talked
about is the use of electronic medical technology to provide continuity
of care; whether you are in this clinic or that hospital, you could be
able to get that information across from one to another.
Mr. Cohen, do you want to carry on? You talked to me about this some
time ago, and you had some pretty good notions of what would happen in
Tennessee.
Mr. COHEN. Well, just the idea--and I will yield to Ms. Jackson Lee
in just a second--but the idea of having medical records on computers
rather than having them on notes. My father was a doctor. I inherited
his penmanship. I got a C in penmanship. The teacher was kind to me.
Doctors don't write real well. If you have to go from written
records, it's difficult, and they don't get transposed well. But if you
have them on computers, it's very easy to see what shots and
inoculations the patient has had in the past, what treatments they've
had. It makes it easier to render a diagnosis and not have to repeat
tests that are unnecessary and costly. It is so important. And part of
this bill is to see to it that the records are put on electronic
devices so that they're available throughout the Worldwide Web and
everywhere. That saves medical costs in the long run.
Mr. GARAMENDI. Some of this, if I might for a moment, sir, already
exists.
I've been with Kaiser for three decades. They have put all of the
records, all of my history, all of their patients, millions of
patients, on the electronic information system. I could present myself
at any Kaiser facility across this Nation in an emergency situation and
they could take my number and immediately call up my entire history so
that they don't have to start at the beginning with blood tests and all
of the other procedures that are common in today's emergency room
simply to know about the individual's health circumstances. All they
need to do is enter that number, bingo, they've got my information.
That's where the electronic medical records would be found. And it's
interesting that our Republican colleagues want to repeal that? I don't
think so.
Finally, at last we're going to hear from a woman. We need that
perspective here. Please join us. Thank you so very much for coming in.
Ms. JACKSON LEE of Texas. I thank the gentleman from California, but
more importantly I thank him for really turning the light bulb on. We
worked so hard on this legislation that we probably have forgotten to
articulate all of the nuances of this bill. It is unbelievable.
I hesitated to use the term ``frivolous'' today, but, frankly, I'm
saddened by the fact that we had to engage in a frivolous debate. So I
just wanted to say to the gentleman, some years ago under the Bush
administration I took note of the fact that we did not have enough
community health clinics, frankly, and I am so glad that our collective
research caused us to put that legislation in the bill.
Last Monday, I convened my community health clinics. It was amazing
the expanded work they do because some of them received stimulus
dollars. One of my clinics was able to open up 21 legacy, and one of my
community health clinics was able to open up 21 new patient rooms
because of stimulus dollars.
But what I want to say on that point is three things:
Community health clinics help seniors and families. And to seniors,
this gives you, in addition to the comfort of being nearby your home,
but you get, in addition, a primary home or a medical home. You can use
that clinic, that doctor to be part of your medical home. The community
health clinics can then multiply themselves or improve themselves by
having electronic records where, as a senior who has extended medical
records, can you imagine in the future what happens with seniors when
they can put all their data into electronic records to be able to track
seniors and to assure their good health? So contrary to frightening
seniors and talking about death panels, this bill provides community
clinics, a medical home, electronic records, and the inevitable closing
of the doughnut hole so that seniors do not have to choose between
paying rent and buying food and getting their brand drugs that they
need.
So I just wanted to say there's so much. And then as you mentioned
your
[[Page H247]]
daughter and the training. That's creating jobs. How do they talk about
losing jobs--which I think, by the way, again, is frivolous because we
created 1.1 million jobs.
And, frankly, I would just say to you that this is about saving
lives. Jobs are very important. We've created jobs. But even the title
of their legislation, H.R. 2, ``job-killing''? This is killing
Americans if we take this bill away, if we repeal this bill.
So I would argue that maybe my good friends--who some of them are new
and I appreciate their newness; I appreciate their desire to keep a
commitment to constituents. But when you come to the Congress, you have
to govern. You have to look at the whole of America. And therefore,
looking at the whole of America, you need to look at the crux. The crux
is saving lives.
So I thank the gentleman for bringing us to this point. I know that
we will be getting another hour that I hope maybe I will have an
opportunity to share some thoughts. But again, I will yield back my
time and just say this is about saving lives.
Mr. GARAMENDI. I thank the gentlewoman for her insight into the way
in which the bill affects her home and her community because that's
what all this is about; it's really about the community.
Mr. Pallone, if you would like to take a few moments and wrap, and
then I will provide the final wrap here as we close down this 1-hour
discussion.
Mr. PALLONE. I mentioned before how the money that was going to the
community health center in Long Branch, in my home town, was being used
to coordinate with Monmouth Medical Center so that people didn't have
to go to the emergency room. When they came once, they were put into a
computer, and it was exactly the electronic system that you talked
about.
I went to Monmouth Medical Center one day because they had expanded
their emergency room because they had so many people flooding the
emergency room. Particularly in these tough economic times, a lot of
people don't have health insurance, more and more people, so they had
actually doubled, I think, the capacity of their emergency room. But
they coordinated electronically with the community health center with
this money that came in. So they showed me how a person would come in,
and then they would be put into the system electronically with the
community health center and they wouldn't come back to the emergency
room.
One of the big issues now across the country--in fact, I just did an
opinion piece about it in my local newspaper, the Asbury Park Press--is
how emergency rooms are being flooded with more and more patients
because more and more people don't have insurance. So we have to figure
out a way to deal with that. Obviously, the health care reform does
that, because once everybody gets insurance, sees a doctor and gets
primary care, you won't have the need for as many people to go to the
emergency room.
When you expand an emergency room and add on all this additional
capacity, it's millions and millions of dollars. That money isn't
necessary if people see a primary care doctor. An emergency room should
just be for an emergency, when people are trauma or something else that
happens. It shouldn't be a place where people have to go because they
can't get a doctor.
I yield back to the gentleman.
Mr. GARAMENDI. Well, it has become just that.
I think I will wrap with where I started. The health care reform, the
Affordable Health Care Act, really is about making life better for
every American. From the moment they're born, that young baby, that
newborn baby cannot be denied insurance, from the moment they're born,
whatever their circumstance is. That's part of the Patient's Bill of
Rights, and it starts right at birth. This is where a student, when you
graduate from college, you are not only getting a diploma; you are also
likely to be losing your health care benefit that you were covered by
under your parents.
{time} 2110
So it extends coverage to the age of 26. And into a marriage, into a
family when you're building a family, you know that you'll be able to
get insurance. Thirty-one million Americans are going to be able to get
health care insurance as a result of this legislation.
And in the workplace, a lot of talk about this being a job crusher,
when in fact it actually creates jobs. And for small businesses, this
is an enormous benefit because they will get a subsidy reducing the
cost if they choose to provide insurance. If they have 50 employees or
less, they don't have to buy insurance. And then later, they'll be able
to get insurance through an exchange in 2014. California is probably
going to set one up next year.
And for seniors, I've never heard so many inaccurate statements as
concerns Medicare and the way in which this bill actually works. It
extends Medicare. As you said, Mr. Pallone, for 12 years--the financial
solvency's extended for 12 years. Otherwise, it would be just 7 years,
and it would be in financial trouble. So this really helps. And for
individual seniors, they'll be able to get preventive care; their drug
costs are going to be reduced. It is a very, very important part.
So for the circle of life--and all of us would want to go through
that circle of life--this health care reform provides a benefit at
every stage.
And I'll point out this final thing--and this is an estimate that was
made in the last year--some 30,000 to 40,000 Americans every year die
because they don't have health insurance. What is that? A stain upon
America. Every other industrialized country in the world would do it.
Our Republican friends talk about repeal and replace, but everything
I've heard on this floor about replacement is already the law in
America. It's already the law.
They talk about lifetime caps; they talk about putting in no
rescissions; they talk about no preexisting conditions. That's the law,
folks. Our Republican colleagues, read the bill. Go to healthcare.gov.
Read the bill. That is already the law. Why in the world would you
repeal what is already the law and put this whole thing back at risk?
Don't forget, Americans, the insurance industry, the health insurance
industry has dominated American health care for decades. And you think
for a moment they're going to let the Republican majority write a bill
that is not in their interest; that will force them to provide care;
that will force them to pay the bills; that will force the insurance
companies to no longer be the death panel? In fact, that's where the
death panel is--and this I know.
I was the insurance commissioner. I fought the insurance companies
for 8 years of my life when they denied coverage; when they said, You
have run out of benefits; when they said, Your policy is going to be
rescinded. I fought them. And I know the result when they won that
fight: people died.
We need the Patients' Bill of Rights. It should not be repealed.
Tomorrow, our Republican colleagues in H.R. 2--without one committee
hearing, with only 2 days of debate on this floor and no committee
hearings at all--put Americans at risk. Thirty-one million Americans
will not get coverage. That's what this is about.
I look forward to tomorrow's debate, and we will see what happens.
____________________