[Congressional Record Volume 157, Number 176 (Thursday, November 17, 2011)]
[House]
[Pages H7811-H7817]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




GOP DOCTORS CAUCUS: THE EFFECTS OF THE AFFORDABLE CARE ACT ON AMERICA'S 
                               HOSPITALS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 5, 2011, the gentlewoman from New York (Ms. Buerkle) is 
recognized for 60 minutes as the designee of the majority leader.
  Ms. BUERKLE. Thank you, Mr. Speaker.
  Here in Washington, we are divided on many issues, but whether we are 
a Republican or a Democrat, Members of Congress recognize the essential 
role that our hospitals play in our communities.
  Hospitals provide care for the sick, and the clinics provide 
essential care to many. They are engaged in important medical research, 
and teaching hospitals are educating doctors and nurses to provide care 
for future generations. In many districts across the country, including 
mine, New York's 25th Congressional District, our hospitals are our 
major employers.

[[Page H7812]]

They're perhaps the largest single employer a congressional district 
may have.
  The health care sector constitutes nearly 18 percent of the United 
States' economy, and it is one of the more stable portions of our 
economy. American hospitals employ more than 5.4 million people; and as 
hospitals and hospital employees buy goods and services from other 
businesses, they create additional jobs. The economic impact is felt 
throughout the community. Hospitals are a vital part of our local and 
our national economy. In New York State, particularly in my home 
district, hospitals are the largest single employer.
  I want to call your attention to this chart, Mr. Speaker, with data 
provided by the Hospital Association of New York, which shows the 
importance hospitals have on my district's local economy. Five 
hospitals in my district employ over 18,000 people. Together, payroll 
and purchases in my district alone amount to over $2.4 billion. They 
generate over $100 million in State and local income sales taxes. This 
is in my district alone with regard to the economic impact of our 
hospitals.
  Looking at New York State as a whole--and I hope some of my New York 
colleagues will join me here tonight--the hospitals contribute nearly 
$108 billion to our State and our local economies. Mr. Speaker, it is 
no exaggeration to say hospitals are a mainstay of our New York State 
economy; so when our hospitals are hurting, the effects extend to the 
entire community. Our hospitals are under assault. Not only will it 
affect our local and State economies, but it will also affect access to 
health care, to some of the most basic services that our hospitals 
provide to our communities.
  I now yield to the gentleman from Georgia, Dr. Gingrey.
  Mr. GINGREY of Georgia. I thank the gentlelady from New York for 
yielding to me.
  Mr. Speaker, as I think most of my colleagues know, Congresswoman 
Buerkle is a member of the House GOP Doctors Caucus. There are 21 of 
us, all health care providers--some doctors, some nurses, some 
dentists, some psychologists. We've got a really good, diverse group 
that has--I would hate to say, Mr. Speaker, the total number of years 
of clinical experience that we all have in the aggregate, but it's 
several hundred. I have thoroughly enjoyed having Congresswoman Buerkle 
as a member of the House GOP Doctors Caucus. She is a Registered Nurse, 
who has worked for years in hospitals in the New York area.
  As she has pointed out, the four hospitals in her district are 
probably, if not the major employer, one of the major employers; and 
it's so important to her community, the 25th District of New York. That 
is so true, Mr. Speaker, across so many of our districts. I happen to 
be an OB/GYN physician, having practiced in my congressional district, 
the 11th of Georgia, for some 26 years.

  In our hospital system there, in the main town in Cobb County, 
Marietta, Georgia, where we have lived for the last 36 years, just as 
in Congresswoman Buerkle's district, the hospital system is one of the 
main drivers of the economy--that and the public school system. The 
hospital systems are employers, and we sometimes forget that.
  I think, as a physician, a lot of times I may be guilty of 
concentrating on issues that mainly affect my colleagues in the medical 
profession--the practitioners, the MDs; yet Congresswoman Buerkle is 
pointing out--and I know she has got a number of posters and slides for 
us to look at tonight--the devastating effects that the so-called 
Affordable Care Act--the unaffordable care act, indeed--has had on our 
hospitals like hers, the four hospitals in the 25th District of New 
York, and on the WellStar Health System and its, I think, six different 
facilities in the metropolitan Atlanta, Cobb County area. It is 
devastating.
  So I really appreciate the opportunity to join with her tonight, 
along with some of my other colleagues in the House GOP Doctors Caucus, 
to make sure that people understand that it's not just the doctors and 
the health providers outside of the hospitals who are suffering because 
of this unaffordable care act, but it's our hospital systems all across 
the Nation.
  I thank the gentlelady for yielding to me, and I plan to be with her 
during this next hour.
  Ms. BUERKLE. I thank the gentleman from Georgia for being here this 
evening.
  Mr. Speaker, as my colleague mentioned, the President's Patient 
Protection and Affordable Care Act, which became law in March of 2010, 
included some welcome provisions, such as allowing people to stay on 
their parents' insurance until the age of 26 and prohibiting insurers 
from denying coverage based on preexisting conditions. These positive 
provisions, which proponents quickly point to when facing criticism, 
are far outweighed by the negative consequences that the Affordable 
Care Act has on our providers and the health care system.
  These measures could have been accomplished in a much simpler manner. 
I say to you, Mr. Speaker, so many roads are paved with good 
intentions, but the unintended consequences are devastating to our 
hospitals.
  As a health care professional, my opposition to the Affordable Care 
Act has never been solely based on philosophical grounds, but on 
strategic and tactical ones. Most Americans--myself included and my 
colleagues here in Congress--recognize that health care needs to be 
reformed and that health care costs continue to rise. We need to figure 
this out. We disagree as to what the health care reform should look 
like. If I thought that the Federal Government could be the necessary 
agent of change, that would be one thing; but I don't believe the 
government can change health care.
  The Affordable Care Act affects our hospitals and our providers. This 
is not a Republican or a Democratic issue, but an American one--as 
access to health care affects every American.

                              {time}  2030

  Mr. Speaker, I yield now to the gentleman from Michigan, Dr. 
Benishek.
  Mr. BENISHEK. I thank the gentlewoman for yielding to me.
  Mr. Speaker, I have spent 28 years as a physician practicing rural 
medicine, even serving on the board of my local hospital. I am well 
aware of the great financial difficulties most rural hospitals and 
clinics experience each year.
  Today I was pleased that the State of Michigan celebrated Rural 
Health Day. On behalf of the thousands of Michiganders that call small 
towns and farming communities home, my State's Governor chose to 
recognize the hospitals and community-based centers that provide for 
the diverse and unique health care needs of these areas. Tonight I 
would like to join the State of Michigan in raising awareness about the 
importance these providers bring to the communities that I represent.
  While we recognize the importance of rural health today, I would be 
remiss if I did not mention one of the great rural health facilities in 
my district. Many of my colleagues may have visited the Straits of 
Mackinac during a summer vacation, or perhaps they've seen the Mackinac 
Island featured on a ``Pure Michigan'' ad. The Rural Health Clinic in 
St. Ignace is the single largest employer in the community, supporting 
not only the local township but, in addition, the 900,000-plus seasonal 
visitors that depend upon the hospital for services each year.
  I recently received a distressing letter from Mr. Rodney Nelson, the 
CEO of Mackinac Straits Health System. Mr. Nelson is very worried about 
the impact Medicare cuts may have on his patients, employees, and 
ultimately the ability to keep the doors to the hospital open. Mr. 
Speaker, the Mackinac Straits Health System is one of 25 hospitals in 
my district that is considered either critical access or sole community 
hospital. Of these, 56 percent are already operating in the red.
  Unlike urban areas, my constituents often do not have another option 
when seeking health care. In the case of the St. Ignace Hospital, the 
next closest clinic is 50 miles away. What you may not know, Mr. 
Speaker, is that caring for patients in rural facilities is far more 
economic than providing urban care. In fact, rural patients cost less 
to treat in eight of the nine CMS regions.
  As my colleagues and I discuss possible ways to trim the budget, I 
feel it's important to remember that without rural hospitals, many of 
my constituents would not have access to medical care. A 2 percent 
reduction in Medicare

[[Page H7813]]

spending is estimated to cost 389 jobs in my district as a direct 
result of the cuts to rural hospitals. If this number were raised to 10 
percent, the figures would only get worse. At that point, 76 percent of 
the hospitals would be operating in the red; and the total impact is 
expected to be nearly $68 million, with 1,900 jobs affected. Mr. 
Speaker, I don't need to tell anyone that northern Michigan can't 
afford to lose another 1,900 jobs.
  Mr. Speaker, if we force these cuts, not only will we lose these 
jobs, but we will lose access to many people's sole source of health 
care. We are forcing rural patients to travel longer distances to seek 
more expensive care. This just costs everyone more money.
  I urge my colleagues to exercise caution when considering reductions 
to Medicare programs, especially those specific to physicians, critical 
access, and sole community hospitals.
  Ms. BUERKLE. I thank the gentleman from Michigan.
  Mr. Speaker, we've touched upon it, and I want to continue having 
this conversation about the effect that the Affordable Care Act is 
going to have on our hospitals in our Medicare population. Now, Mr. 
Speaker, you may have heard over and over again from our colleagues 
from the other side of the aisle, demagoguing our budget proposal that 
came out in April. They say we want to kill Medicare; we want to kill 
Social Security; we don't care about our seniors.
  Tonight I stand here, Mr. Speaker, and I tell you, and I want to tell 
the American people, that the Affordable Care Act, in fact, cuts 
Medicare spending by $500 billion. Those are actual cuts that are now 
in the Affordable Care Act, or what is known as the health care law. 
One of the most negative effects is the result of reductions in 
hospital Medicare payments and the CMS code, offsetting reductions to 
hospital payment plans.
  I have a chart here, Mr. Speaker. And as I go through my notes, I 
want it to be clear that you can see 2010 and what happens to Medicare 
reimbursements, down until 2018. Our hospitals can't sustain these 
cuts. The five hospitals in my district have come to me, and they said, 
This Affordable Care Act--and many of these hospitals were big 
proponents of the Affordable Care Act because they know in our country 
we need to reform our health care system, we need to make some changes, 
so they were in support of the law.
  But what they didn't realize was this law is going to cut their 
Medicare reimbursements, which so many of them depend on. It's the 
mainstay--by 28.6 percent. I've had hospitals in my district say to me, 
We cannot sustain these cuts. We will go bankrupt. Because you see, Mr. 
Speaker, it's not only this Medicare, the reduction in these rates, but 
it also is a series of other cuts which we will get into as the evening 
proceeds.
  I yield to the gentleman from Georgia.
  Mr. GINGREY of Georgia. I thank the gentlelady for yielding to me.
  I wanted to take an opportunity, Mr. Speaker. I have an article from 
the Atlanta Journal-Constitution, Atlanta's main newspaper--this was 
several months ago--referencing one of our best hospitals, Piedmont 
Health Care. The title of the article is ``Piedmont Health Care Cutting 
5 Percent of Workforce.'' And this is what Misty Williams of the 
Atlanta Journal-Constitution says in this op-ed piece:
  ``Faced with a rising number of uninsured patients and unknown impact 
of the new health care law''--that would be the so-called Affordable 
Care Act--``Piedmont Health Care announced Thursday evening''--this was 
5 months ago--``plans to cut 464 jobs as part of an effort to save an 
estimated $68 million. Totaling roughly 5 percent of its workforce, the 
cuts include 171 positions that were vacant or altered because of 
scheduling changes. Layoffs are coming from across the board, including 
Piedmont's four hospitals, physician groups, heart institute and 
corporate division, spokeswoman Nina Day said.''
  And I quote Ms. Day: ``This is heart wrenching. This is not easy 
stuff when you're talking about people.''
  ``The move is, in part, a reaction to hurdles''--the hurdles that 
Congresswoman Buerkle and Congressman Benishek were just talking 
about--``to hurdles many hospitals are facing, including a growing 
number of uninsured patients, a new State hospital bed tax, anticipated 
cuts to Medicare reimbursements, and the Medicaid expansion in 2014.''
  The article goes on, talking more and more about how devastating this 
would be. And in conclusion--without reading the entire article--I'll 
finish up and then yield back to my colleague.
  The last paragraph of this article by Ms. Williams: ``While hospitals 
will get more insured patients as a result of the Medicaid expansion in 
2014, it's a big trade-off with Medicare cuts. State officials have 
estimated Georgia''--my State--``could add more than 600,000 enrollees 
to its Medicaid program as a result of this expansion.'' Again, under 
ObamaCare. ``It's a challenge in time just trying to navigate all of 
these changes.''
  Again, it's just so important that we're having the opportunity 
tonight on behalf of our leadership to tell our colleagues on both 
sides of the aisle--Congresswoman Buerkle moments ago said, It's not a 
Democrat or a Republican issue. It's a people issue. It's a community 
issue. And it's devastating. And it's sad news that we're bringing to 
our colleagues, but we need to do that. And the American people need to 
understand what's coming. The worst has not yet hit.
  Ms. BUERKLE. I thank the gentleman from Georgia.
  I have spent most of my professional career in the health care 
industry. I have represented a hospital for a number of years, so I 
know up close and personal how these issues have affected and will 
affect our hospitals and our providers. And despite the best intentions 
of this health care law--whether we disagree with it or we agree with 
it--despite the best intentions of this health care law, what we are 
seeing are the unintended consequences.

                              {time}  2040

  The fact that our hospitals, our health care providers, will not be 
able to proceed, will not be able to perform the services that our 
communities need and expect and have come to expect. That certainly 
wasn't the intent of the health care law, but ladies and gentlemen and 
Mr. Speaker, that's exactly what is happening.
  I would like to yield and recognize the gentlewoman from North 
Carolina.
  Mrs. ELLMERS. Thank you, Congresswoman Buerkle, for holding this 
Special Order tonight, along with my colleagues on the Doctors Caucus. 
And thank you, Mr. Speaker, for being here. We are all here because we 
are health professionals. We know the real world of health care, and we 
know the real world solutions. It's the reason I'm here in Washington 
now, that and the fact that I'm concerned about where the future of the 
country is going for our children.
  Many times in our health care practice as a nurse and in my husband's 
surgery practice as small business owners, over time we have always 
looked at these issues, whether we're talking about Medicare, whether 
we're talking about the possibility of having real, good, concrete tort 
reform, all of these different issues that we've said if we could put 
these in place, health care could have a much more solid foundation 
moving forward.
  We already know that we have the best health care in the world. But 
being in the industry, having that small business and understanding 
where Medicare and Medicaid reimbursements--which were down--were 
going, you have to ask yourself, how can this continue? How can we 
provide health care into the future? Well, of course we know that the 
health care bill was passed in the 111th Congress, and now we are 
seeing the effects of it. One of the effects, as you've pointed out, 
are to our hospitals. You know, it's important that we are able to 
articulate this to the American people, connecting the dots.
  When we talk about the importance of why ObamaCare is devastating to 
physicians, it's because it affects their ability to be reimbursed for 
their services. When Medicare will be cut--as we know in ObamaCare, it 
was cut by $500 billion. Today our seniors are saying to us, we're 
worried that you're going to cut our benefits. Well, their benefits 
will not be cut by any of us in Washington. However, because the 
dollars have been taken out in a significant amount, Medicare will have 
to say, I don't know what we'll cover. What are we going to cover?

[[Page H7814]]

  And as we know, again, in the President's health care bill, the 15-
person panel has been put in place. This 15-person panel will decide 
what Medicare will and will not pay for. That will be direct payments 
to hospitals, not just physicians but hospitals, based on the services 
that they're providing. And if they decide that a service cannot be 
paid for, there are penalties that can be assessed.
  There are solutions to this issue, and I pointed out one would be 
significant tort reform. Not only for our physicians, but again for 
hospitals. Why is that important? Sometimes I'm afraid we don't explain 
well enough to the American people why something like malpractice 
reform would help the situation.
  Well, we know that in our Nation's hospitals if you go into the 
emergency room, you're going to receive care whether you can pay for it 
out of pocket or not, whether you have an insurance card or not, 
whether you're on Medicare or Medicaid, it doesn't matter. You're going 
to receive the care. The problem is someone does have to pay for those 
services because services are rendered. You go into the emergency room, 
and many tests are ordered. Physicians order more tests out of pure 
fear for missing something. You can't go into an emergency room and get 
the good care that you need to get if you cannot identify the problem. 
So as we know, physicians and hospitals, physicians and doctor's 
offices, tend to cover all their bases rather than simply relying on 
the medical education that they have received, the ability to diagnose 
with just that--with the ability of their practice.
  So here we are. We talk about health care costs every day, and the 
escalating cost of them. A good contributor to that is another piece of 
the President's health care bill which basically puts a tax on all 
medical devices. Well, think about the cost for any hospital, any 
provider. What do we do in hospitals? We do surgery. We provide health 
care. These are medical devices. These are instruments that have made 
our lives better and help us live longer, but yet now they will be 
taxed. This is a tax that will have to be assessed. Someone will have 
to pay for it. If the effort is truly to decrease the cost of health 
care, how can we continue by increasing the cost? It doesn't make 
sense. It doesn't add up.
  So again, the importance is for us to connect the dots for the 
American people; to show that if we are able to pull back on ObamaCare, 
that we are able to remove it, repeal it, as we have already voted here 
in the House, then we can make the significant changes.
  There is one more point that I would like to touch on, and it has to 
do with the ability to pay for services. There was a consulting firm, 
Mercer Consulting Company, and they did a study that shows that 9 
percent of employers with 500 or more workers say they are likely to 
cancel health benefits in 2014 after State-run health insurance 
exchanges begin offering coverage under the health care law. There 
again, once again, it will become the government paying for it, which 
is paid for by the American taxpayers' dollars. We simply cannot 
continue on this path with health care or any other issue. It has to 
come with free-market solutions, and we have those solutions and we are 
ready to put those in place.
  I just, again, want to reassure our seniors who are receiving 
Medicare now or in the near future that we are doing everything we can 
to rescue Medicare from the President's health care bill and put those 
necessary pieces in place so that we can continue those services into 
the future that they have paid for their entire lives.
  I again thank my colleague from New York for holding this Special 
Order.
  Ms. BUERKLE. And I thank the gentlelady from North Carolina for being 
here this evening.
  I would just like to continue on because of my concern, and I know my 
colleagues have such concerns, about the health and the well-being of 
their hospitals. As I mentioned earlier, they are the largest employer 
in my district. We refer to it as ``eds and meds.'' We have a large 
university there and some colleges, but we also have five hospitals in 
my district. So our reliance for our local economy and for our State 
economy is just so very important.
  I want to talk a little more about what this health care law is going 
to do to Medicare and do to our hospitals. There is $112 billion in 
reduced market basket updates to hospitals. There is a $36 billion 
reduction to Medicare and Medicaid disproportionate share hospital 
payments.
  Now, Mr. Speaker, disproportionate share may sound a little 
confusing. I'm going to explain what that is. In a district such as 
mine, we have hospitals that have missions. And I'm sure across the 
country, many hospitals have missions. They want to make sure that the 
indigent population, folks who can't afford insurance, who are self-
pays or maybe are on Medicaid, that they have access to quality 
services. So the government says to these hospitals, we understand that 
Medicaid reimbursements or self-pay patients will not cover your 
services. So what we're going to do is, we're going to try to make you 
whole with this disproportionate share. Mr. Speaker, the health care 
law eliminates the disproportionate share for hospitals, and so 
hospitals that have a high indigent population or a high number of 
self-pay patients or those who are on Medicaid, they are not going to 
get that disproportionate share.
  The hospital in my district came down here. It is a large teaching 
institution. They made a special trip down here to tell me that 
provision of the health care law will bankrupt them. They probably 
receive somewhere around $80 million a year to make them whole because 
of their mission. And isn't that what we want? We want to make sure--
and wasn't that the original intent of the health care law?--to make 
sure that there was accessible care for all Americans. But here again 
we reached the unintended consequences, and the effect that this law is 
going to have on our hospitals.

                              {time}  2050

  There is a $7.1 billion reduction for readmissions. We will talk 
about that in a little bit.
  Hospitals, and many of the ones in my district, and I know throughout 
this country, they are heavily dependent on Medicare and Medicaid 
dollars. And with that narrow margin, Medicare and Medicaid don't even 
cover their costs. And so there's such a small margin for them to 
operate that there's really little capacity for improvements. 
Realistically, hospitals--especially teaching hospitals and hospitals 
that are treating the underserved--cannot bridge that gap, and they 
won't be able to bridge that gap because of this new health care law.
  Hospitals must be able to invest in their infrastructure. Having such 
a narrow margin and/or no margin operating in the red, they're not 
going to be able to do that. They're not going to be able to invest in 
infrastructure, systems improvements, new techniques to reduce 
hospital-acquired infections, new models of delivering health care and 
electronic health records.
  And I want to talk about electronic health records because they were 
mandated in the health care law. The Affordable Care Act mandates that 
hospitals must move to electronic health records. Now, from a patient 
safety standpoint, that's a good thing, but getting hospitals up to 
speed and getting them ready for business has very high IT costs for 
our hospitals. So, again, you've got this health care law mandating 
electronic records, and you've got these drastic cuts to our hospitals 
in their Medicaid and Medicare reimbursements.
  I yield to the gentleman from Georgia.
  Mr. GINGREY of Georgia. Mr. Speaker, I thank the gentlewoman for 
yielding once again.
  Just a few minutes ago, one of our colleagues spoke also about this 
problem with hospitals, Representative Ellmers from North Carolina, who 
knows of what she speaks. She works in an office with her husband, a 
general surgeon. They see patients every day in the office, but they 
also have a largely hospital-based practice because it's surgery and 
you just don't do that in the office. But she had listed some of the 
things in ObamaCare, in this so-called Affordable Care Act, Patient 
Protection and Affordable Care Act of 2010, when it was passed a year 
and a half ago.
  We all realized that this was a new entitlement program, Mr. Speaker, 
and the American people need to understand that it's not about 
strengthening

[[Page H7815]]

and saving Medicare for our seniors. That entitlement program is 
struggling mightily. And as Representative Buerkle mentioned, to take 
$500-plus billion out of that program to pay for a whole new 
entitlement program, ObamaCare, for in many cases the young and 
healthy, and also to put some of the burden of paying for that new 
entitlement program on the Medicaid program, the safety net program for 
the poor, it only weakens that program. So you literally gut Medicaid 
for the poor and the disabled and Medicare for our senior citizens, 
when both programs need strengthening and saving, not gutting.
  It was this whole idea of having Medicare for all, really, or 
national health care, there are all kinds of euphemisms to describe 
this, especially, not the least of which is the name of it, the 
Affordable Care Act. And as I said earlier, Mr. Speaker, and I know my 
colleague from New York would agree with this, it is the unaffordable 
care act. And both she and Representative Ellmers from North Carolina 
said, look, we know on both sides of the aisle that health care in this 
country is too expensive, and we need to go about changes that will 
lower the cost and not hurt the quality. And we can do that.
  President Obama keeps denying that there are any ideas and certainly 
didn't listen to the physicians in this body or the health care 
providers or physicians and the nurses that said, look, let us come 
over and sit down and talk with you or any of your folks in the 
Executive Office of the Presidency and let us explain, because we 
have--and I said it earlier--several hundred years of clinical 
experience. We do have some ideas, and we really believe we want to be 
part of the solution and not part of the problem.
  But my colleague who is leading the hour and doing such a great job 
of it, I know she will agree that I haven't been called, I haven't been 
invited over. I will ask my colleague and yield back to her and ask her 
the same question. And I know what the answer will be.
  Again, the important thing for our colleagues, Mr. Speaker, to 
understand, is that the creation of this new program, this new 
entitlement program so that everybody can get health care, whether they 
want to buy health insurance or not, is so detrimental to Medicare and 
Medicaid that I fear for the future of those programs. I really, really 
do.
  That's what it's all about here tonight, to take an opportunity to 
explain so people really understand the ultimate consequences of this.
  Ms. BUERKLE. I thank the gentleman from Georgia.
  Mr. Speaker, I want to just emphasize again with regards to this 
health care law and the fact that this law--and, Mr. Speaker, this is a 
law, this isn't a budget proposal, this is a law--guts Medicare by $500 
billion. It should be of concern, Mr. Speaker, to our seniors because 
this law, in fact in 2014, will begin to gut Medicare. I again would 
look at this chart and the Medicare reimbursements. There will be no 
hospitals that will be able to provide health care. If you look at what 
the trend is for Medicare reimbursements to our hospitals, they cannot 
continue to exist based on what is set forth in the Affordable Care 
Act.
  I spoke with the CEO of one of our local hospitals, Crouse Hospital 
in Syracuse, and he spoke with one of my health care staff; and he 
indicated to us today that Crouse Hospital, one hospital in the 
district, is facing a projected loss of $18 million in reimbursement 
reductions. That number goes to access to care. We can have the most 
comprehensive health care law on the books, but if we don't have 
hospitals who are able to provide that care, and we don't have 
physicians who are able to provide that care, we will have access-to-
health-care problems.
  Mr. Speaker, earlier I talked about hospital readmission penalties. 
This is another concern hospitals have to deal with. And tonight we've 
talked a lot about what the Affordable Care Act will do to hospitals, 
the effect that it will have on our hospitals, the drastic cuts in 
Medicare and Medicaid reimbursements and the disproportionate share 
being eliminated.
  But our hospitals are under assault from all sides, and that's part 
of the difficulty. Maybe they could somehow figure out how to deal with 
these cuts in the Affordable Care Act; but taken in its totality, our 
hospitals are having a very difficult time. In fact, as I mentioned 
earlier, many are concerned that they will be unable to sustain and 
unable to continue on with their services, given the whole assaults 
that are coming from all directions.
  And this actually is part of the Affordable Care Act. It establishes 
a punitive policy for our hospitals when they readmit a patient. And I 
will explain that, Mr. Speaker. Under the health care law, the 
Affordable Care Act--we call it the Affordable Care Act, we call it 
ObamaCare, we call it many things--but under this new law that is 
taking effect gradually, under this to their expected readmission 
rates, if even more than one readmission occurs--and that readmission 
means that you discharge a patient, the hospital sends a patient home 
and then for some reason they have to come back. If that happens with 
one of three diagnoses within the Medicare scheme, the hospital will be 
penalized for all of the Medicare reimbursements, not just that one 
case where there was a readmission, but all of the Medicare 
reimbursement cases. You can imagine the magnitude and how that will 
affect Medicare reimbursements.

                              {time}  2100

  The other part of this provision in the health care law is that it 
really doesn't discern between what's avoidable and what's not 
avoidable readmission. So sometimes a hospital may discharge a patient 
and it was premature, or something wasn't done and the patient needs to 
come back. And certainly that should be considered, and we should 
figure out what went wrong because readmissions are expensive, and so 
Medicare doesn't want to pay for them. And I understand that. However, 
some readmissions are unavoidable, and a hospital shouldn't be 
penalized for an unavoidable readmission; and yet the Affordable Care 
Act does exactly that.
  The Secretary of the Department of HHS, Health and Human Services, 
which has the authority now to expand what were three diagnoses, now 
has the authority to expand that list of conditions with regards to 
readmissions. Hospitals nationwide, Mr. Speaker, are projected to face 
more than $7 billion in Medicare reductions over 10 years because of 
this policy, $7 billion to our hospitals.
  We began this discussion tonight, Mr. Speaker, talking about the 
importance to our local economies, the employment numbers, what 
hospitals pay into our community with their purchases and with their 
employees, the taxes that they give back to the community; and now 
we're talking about cutting them again because of this policy.
  You know, the issue of hospital readmission is complex, and I hope I 
did a good enough job tonight of explaining it. And while health care 
providers agree there's always room for improvement across the 
continuum of care, readmissions occur for many reasons. And punitive 
action via reduced reimbursements is not only counterproductive, but 
it's also potentially harmful to our hospitals, to our patients, and to 
our communities.
  Mr. Speaker, as we work hard to make sure our seniors get the 
Medicare benefits from the system that they have paid into--and, Mr. 
Speaker, I want to emphasize that over and over again during the course 
of this hour, our seniors have paid into Medicare, into the health care 
system all of their life. And now, as they reach the Medicare 
eligibility age, they deserve to get Medicare coverage that they 
expect, that they deserve, and that they've paid into.
  But this health care law, this $500 billion cut to Medicare, is going 
to change that for our seniors. It's not the budget proposal in April 
that's going to--that was a budget proposal. And you've heard my 
friends and colleagues across the aisle demagogue our budget proposal 
in April, saying we want to cut benefits to seniors, Medicare, and 
Social Security.
  The fact is, Mr. Speaker, this health care law, passed into law in 
2009, will devastate Medicare. And our seniors, Mr. Speaker, should be 
very, very concerned about this Affordable Care Act. Not only will it 
affect our hospitals--as we've spent so much time talking about 
tonight--but it will also affect

[[Page H7816]]

the care and the access to care for our seniors.
  Hospitals, Mr. Speaker, already operate on such thin margins, and we 
talked about this earlier, that for many providers, especially 
specialized programs, treating patients struggling, say, with substance 
abuse or helping the developmentally disabled, they will be reduced or 
they will end those programs. Hospitals cannot operate on such a thin 
margin and then run the risk of all of these devastating Medicare and 
Medicaid reimbursements.
  Mr. Speaker, I also want to speak tonight a little bit about graduate 
medical education. As I mentioned earlier, I was an attorney in 
Syracuse, New York, and I represented a hospital that was a large 
teaching hospital. And so I know how much they rely on what's called 
graduate medical education. We often refer to it as GME, sort of the 
acronym for it, the initials. I'm going to explain what GME is because 
it's so important to our hospitals. And even hospitals that don't have 
a medical school attached to them, we'll talk about some of the 
reimbursements they get because medical students and residents train 
within these facilities.
  Graduate medical education is the training medical school graduates 
receive either as a fellow or an intern or a resident. Medicare is the 
largest contributor to the GME. Now, why do I even bring this up? I 
bring this up because we talked earlier about the many assaults on 
health care providers, the many assaults that hospitals are concerned 
about. This is not per se in the health care law, so I want to make 
that clear. But when it comes to cutting, when it comes to finding and 
helping this terrible national debt that we have that is now $15 
trillion, often we look to Medicare. And one of the areas in Medicare, 
the low-hanging fruit--whether it's a hospital or a physician--that 
seems to be the easiest place to go to rather than really looking at 
our health care system, making it a free market, allowing the market to 
compete, getting the government out of health care and letting folks 
buy insurance across State lines. Rather than letting the free market 
in it, we have the government involved. So Medicare is the largest 
contributor to this GME.
  GME payments, as I mentioned, have been targeted. They've become a 
target for recommended budget savings. In 2010, the President's 
Simpson-Bowles Deficit Commission recommended limiting hospitals' GME 
payments to 120 percent of the national average salary paid to 
residents in 2010, and reducing another reimbursement the hospitals 
get, the IME, the indirect medical education, by 60 percent, from 5.5 
to 2.2 percent.
  Mr. Speaker, these two changes--Medicare reimbursement to the GME, 
Medicare reimbursement to the IME--would reduce Medicare medical 
education payments by an estimated $60 billion through 2020, $60 
billion.
  Mr. Speaker, these aren't just numbers. These proposed cuts would 
endanger the ability of teaching hospitals to train physicians. We must 
face the fact that cuts to graduate education would result in fewer 
practicing physicians and ultimately reduced access to care, which is 
getting back to why there was an Affordable Care Act.
  I talked about this road paved with good intentions. And now what we 
are seeing is that our hospitals, our health care providers, and the 
training of physicians are both going to be significantly and severely 
impacted to the point where access to health care becomes a problem. 
And so seniors--not just seniors, but all Americans--will have to begin 
to deal with the fact that primary care physicians, there won't be as 
many of them. There will be fewer doctors being trained, and for a 
number of reasons.
  The GMEs and the IMEs going to hospitals, if there is any 
reimbursement reductions to those, but also the fact that as a 
physician goes through all those years of training and he goes through 
4 years of college, 4 years of medical school, an internship, 3 years 
of a residency, and then if he's a fellow because he wants to 
specialize, all of those years, and then they go into practice. And you 
see what the Affordable Care Act, you see what all these assaults are 
doing on our Medicare and Medicaid reimbursements to physicians as well 
as our hospitals.
  Hospitals that are primarily teaching hospitals face an additional 
challenge that could threaten the stability of their institutions. 
Hospitals that have residents in an approved graduate medical 
education--again, that GME program--receive an additional payment for a 
Medicare discharge to reflect the higher cost of care. Because they are 
a teaching hospital, their cost of care is higher.
  The regulations regarding the calculation of this additional 
payment--and I talked about this earlier--is the indirect medical 
education. This is all very complicated, but what I want to say and 
what I want to make clear, Mr. Speaker, is that if these cuts go 
through, it has been estimated that it will cost GME and IME 
reimbursements from Medicare $60 billion.

                              {time}  2110

  This could mean a loss of 2,600 jobs and $653 million in State and 
local revenue. And, Mr. Speaker, a $10.9 billion loss to the U.S. 
economy.
  At current graduation and training rates, the Association of American 
Medical Colleges projects that the Nation could face a shortage of as 
many as 150,000 doctors in the next 15 years--150,000 doctors.
  We talked about this, and I think whether you're on one side of the 
aisle or the other, whether you agree with the health care law, we all 
agree that we want to have, in a country as rich and as generous as 
ours, we want to have access to health care for all Americans. But if 
we don't have physicians to provide that care--and this estimate is 
150,000 doctors in the next 15 years--a shortage of that many, it will 
discourage this access to health care and will result in the longer 
waiting times for patients.
  Mr. Speaker, in closing, I want to just emphasize a few points this 
evening. And it's always an honor to be here on the House floor. It's 
always an honor to talk to the Speaker. And tonight it's been an honor 
to be able to address health care.
  As a health care professional, I spent years as a nurse and then, as 
I mentioned, as an attorney representing a hospital. I know that people 
within the health care profession are dedicated. They have a passion to 
provide the American people, to provide any people with quality health 
care, to make sure and ensure that they have quality health care.
  Mr. Speaker, the United States of America has the best health care in 
the world, and so it is so imperative that we preserve this health care 
system.
  My colleague from North Carolina mentioned earlier that we voted to 
repeal the health care law, the Affordable Care Act, because it's not 
in the best interest of good health care. And tonight you heard, Mr. 
Speaker, from several of my colleagues who are health care 
professionals who dedicated their whole lives to providing medical 
services to the people in their communities. They care about quality 
health care. They care about people, and they care that the United 
States of America has a good health care system.
  But we don't believe that good health care, access to health care, 
reasonable costs within health care, are going to result from the 
Affordable Care Act. The Affordable Care Act, I want to emphasize this 
one more time, Mr. Speaker, cuts Medicare to our seniors by $500 
billion. To our seniors, that will be a devastating blow to the 
services and the access to services that you will have.
  But beyond that, it affects how our hospitals can provide care, how 
our hospitals will be paid, how our doctors and our young doctors will 
be trained for future generations. This Affordable Care Act may have 
been the most well-intentioned law, but it is devastating for health 
care and health care delivery services in the United States of America.
  Mr. Speaker, hospitals serve us and our communities. The crafting of 
the Affordable Care Act was carried out with the good intentions of 
many, as I said. I don't want to indicate or imply that people didn't 
have good intentions with this Affordable Care Act, but they approached 
it from the wrong direction. They put the government in the middle of a 
physician and the patient, and that can never work.
  But good intentions are not enough to excuse legislation which has a 
terrible and far-reaching, albeit unintended, consequence for all 
sectors of our society, especially our patients, our doctors, and our 
hospitals.

[[Page H7817]]

  Mr. Speaker, I yield back the balance of my time.

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