[Congressional Record Volume 158, Number 45 (Monday, March 19, 2012)]
[House]
[Pages H1378-H1384]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CBC HOUR: THE PATIENT PROTECTION AND AFFORDABLE CARE ACT
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 5, 2011, the gentlewoman from the Virgin Islands (Mrs.
Christensen) is recognized for 60 minutes as the designee of the
minority leader.
General Leave
Mrs. CHRISTENSEN. Mr. Speaker, I ask unanimous consent that all
Members may have 5 legislative days to revise and extend their remarks
and add extraneous material on the subject of this Special Order.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman from the Virgin Islands?
There was no objection.
Mrs. CHRISTENSEN. Mr. Speaker, tonight the Congressional Black Caucus
again thanks the Democratic leader for allowing us to have this hour to
talk about something very important.
As we approach the second anniversary of the Patient Protection and
Affordable Care Act, a truly landmark law that's bringing about health
reforms that are helping millions of Americans not only save money but
have healthier lives, we want to review some of those facts this
evening, not the myths, not the misrepresentations about this great
law, the facts.
There's so much that's being spread that is just flat-out wrong,
wrong about the facts and wrong to tell our fellow Americans things
that are just not true about this law.
At this time, I would like to begin yielding to some of my
colleagues. I will begin by yielding such time as she might consume to
the gentlelady from Cleveland, Ohio, Congresswoman Marcia Fudge.
Ms. FUDGE. Thank you so much. And I want to thank Representative
Christensen for continuing to host this hour. Thank you very much for
your leadership.
Mr. Speaker, for far too long, hardworking Americans have paid the
price for policies that handed free reign to insurance companies and
put barriers between patients and their doctors. We all want to be in
charge of our own care, and it is not too much to ask. The Affordable
Care Act forces insurance companies to be responsible, prohibiting them
from dropping your coverage if you get sick or billing you into
bankruptcy because of an annual or lifetime limit.
For the first time, under Federal law, insurance companies are
required to publicly justify their actions if they want to raise rates
by 10 percent or more. The law also bans insurance companies from
imposing lifetime dollar limits on health benefits, freeing cancer
patients and individuals suffering from other chronic diseases from
worrying about going without treatment.
The law also ensures that everyone pays their fair share and gets
affordable insurance because, when people without insurance get sick,
the costs get passed down to the rest of us. Despite other claims, you
can keep the coverage you have if you want it, or, if you like your
plan, you don't have to keep it. You can pick an affordable insurance
option so that you can take responsibility for your health and your
family's health.
Having everyone take responsibility for their own care started as a
Republican idea, but unfortunately they have abandoned it in an effort
to dismantle the new health care law. We know that the American people
strongly support what the new health care law does, even though
Republican rhetoric has encouraged many not to support the law. When
you ask about specific provisions, you get a much clearer picture.
{time} 1910
According to a poll done by the Kaiser Family Foundation, 85 percent
of people support the discount seniors will get in prescription drugs,
which began this year. Seventy-nine percent support subsidies to help
low- and moderate-income people buy insurance, which is scheduled to
start in 2014. Seventy-eight percent support tax credits to small
businesses to offer coverage to workers. The credits are available
starting this year. Seventy-one percent of people support prohibiting
insurers from denying coverage to people with preexisting conditions, a
provision that goes into effect in 2014. Sixty-six percent support
making insurers meet a threshold of spending on actual medical care as
opposed to administrative costs and profits. This provision goes into
effect this year. Sixty-five percent support the law's provision making
some preventive care services free to Medicare beneficiaries. It's now
in effect. I won't keep going, but I could, Mr. Speaker.
Americans support the provisions of the Affordable Care Act because
it gives them the reins. It gives them the ability to choose, not the
insurance companies. Americans overwhelmingly agree that the health
care system we had before was broken.
The Affordable Care Act is already helping millions of Americans as
well as small businesses. 105 million Americans have had the lifetime
limit on their coverage eliminated. Seventeen million children who have
preexisting conditions can no longer be denied coverage by insurers.
Two and a half million additional young adults now have health
insurance through their parents. 360,000 small employers used the small
business health care tax credit to help them afford health insurance
for 2 million workers in 2011. $2.1 billion is the amount that seniors
in the doughnut hole have already saved on their prescription drugs.
That's an Average of $604 per senior.
[[Page H1379]]
Another fundamental element of the law is the support it provides to
community health centers. The Affordable Care Act increases the funding
available to 179 existing community health centers in Ohio alone.
Health centers in Ohio have received over $53 million to create new
health center sites in medically underserved areas and enable health
centers to increase the numbers of patients served. The funds can be
used to expand preventive and primary health care services. And for so
many Ohioans, including my constituents, community health centers are
absolutely vital.
For many reasons, this law will improve care and make Americans more
healthy. It helps us keep costs under control, encourages prevention,
and lets American families focus on things other than whether they will
be able to get the type of care they need or go bankrupt. This bill
saves lives.
Mrs. CHRISTENSEN. Thank you, Congresswoman Fudge. And thank you for
reminding us that such a large percentage of Americans, once they
really know what's in the bill and what is being provided, support the
Patient Protection and Affordable Care Act.
At this time, I would like to yield such time as she might consume to
the Congresswoman, the gentlelady from Texas who often joins
Congresswoman Fudge and myself on these Special Orders, Congresswoman
Sheila Jackson Lee.
Ms. JACKSON LEE of Texas. I thank the gentlelady for her kindness.
As a member of the Congressional Black Caucus, the cochair and
founder of the Congressional Children's Caucus, and a member of the
Health Care Task Force, it is now time to commemorate--even to
celebrate--2 years of the Affordable Care Act, particularly coming from
an area that embraces the Texas Medical Center, where so much research
has benefited from the passage of the Affordable Care Act and the added
commitment to research for any number of diseases that we are still
confronted with. So I am baffled by the opposition to this bill and the
usage that it has seemingly come upon during the Republican
Presidential debates. For, in actuality, if they would read the bill
and look at its basic premises, they would take up the cause of saying
that it is a very important element of making Americans more healthy.
And I thank the gentlelady from the Virgin Islands for her leadership
on health care issues and, of course, for leading this Special Order
and, as well, the chairman of the Congressional Black Caucus for making
sure that we are focused on how this impacts our community.
Children, in particular, won't lose their coverage just because they
were born with preexisting conditions like asthma. And American
families are seeing how reform is saving lives and saving money.
Medicare is now stronger for seniors, and women can now get lifesaving
mammograms at no extra cost. In eliminating racial and ethnic health
disparities, which we worked on continuously and, as a caucus,
submitted this language to the Affordable Care Act, we find that it
would have reduced direct medical care expenditures by $229.4 billion
for the years 2003 to 2006. This bill was passed after that. And even
though all the language that the CBC wanted to include in that bill was
not included, large steps were made in terms of the elements of that
bill.
This bill protects and provides for the fact that if you have an
illness that is chronic, you do not have lifetime caps. Eighty-six
million Americans receive free preventative care; that means they get
lifesaving cancer screenings like mammograms and colonoscopies, and
soon women can have their contraceptives covered without paying a copay
or deductible. They are living healthier lives.
There is evidence, unfortunately, that over the years has shown that
for infant mortality rates of mothers age 20-plus, race, ethnicity, and
education makes a difference. For mothers with less than high school,
it is high among all populations, including white women. High school,
it is almost equally as high: 13.4 African Americans per 1,000 births;
9.2 American Indians per 1,000 births; 6.5 white/non-Hispanic; 5.6
Asian/Pacific Islander; and 5.3 Hispanic.
It is shameful that we lose our newborns because of lack of health
care and education. The Affordable Care Act will change that because it
will create greater opportunities for access to health care. 180
million are now protected against the worst insurance abuses, like
denying health care to the sick, excessive premium increases, and
lifetime caps. An additional 2.5 million young adults now have
insurance. That's because the Affordable Care Act allows families,
parents, to keep their children on insurance until age 26. I have
personally spoken to families who have said, Thank you. And lives have
been saved.
What is the Affordable Care Act? It is saving lives. Forty-seven
million Americans now benefit from a stronger Medicare program. The
solvency of the program has been extended by 8 years. New prescription
drug discounts have saved 3.6 million seniors on Medicare an average of
$600, and seniors understand that in just a few years to come, the
doughnut hole will be completely closed. The worst Medicare reform we
ever saw--and it was not reformed. It was actually a blight on Medicare
to have something called the prescription drug part D with a big fat
doughnut hole, which most seniors fell in and almost drowned. Thank
goodness we are ending that aspect of it.
But let me tell you why it's important to have the Affordable Care
Act. Coming from the State that I do and having experienced this past
week, over the last 10 days, as we've been fighting this--and it is
galvanizing--as Planned Parenthood has gone around the State of Texas,
and as we watch various State laws infringe upon women's health care
and access to health care--if you can imagine, a sonogram that forces a
woman to look at a sonogram along with her physician. This should be a
prayerful and private moment where laws do not intrude on a private
decision. Or the law that says that you have to tell your employer what
reason you are using contraception for. These are outrageous aspects.
Or Planned Parenthood affiliates that have nothing to do with abortion
in the State of Texas now are eliminated from receiving precious
Medicaid dollars in the State of Texas, which has the highest number of
uninsured, mostly among young women and single women with children.
{time} 1920
They are denying them access to health care because they are claiming
that affiliates are performing abortions. They know that is not true.
We're going to fight it, we're going to fight it, and we're going to
fight it. One of the reasons is because the Affordable Care Act
provides equal opportunity to access health care. It is shameful that
the State of Texas is turning away some $30 million to $40 million to
help women have access to health care. It is shameful that they've
already cut $76.9 million.
So I want to thank Representative Garnet Coleman, Representative
Sylvester Turner, Representative Alma Allen, Representative Carol
Alvarado, and a number of others who recognize that the State should
take a different position and are working with me to turn the clock
forward and not backwards in terms of health care for women in the
State of Texas. We need all the help we can get. And the Affordable
Care Act, a reasoned response to good health care, is providing that
legitimate law to say that all Americans deserve access to good health
care.
For my district, it improves employer-based coverage for 279,000
residents. That is the 18th Congressional District in the State of
Texas. It provides credits to help pay for coverage for up to 186,000
households; improves Medicare for 70,000 beneficiaries--seniors--
including closing the prescription drug doughnut hole for 5,300
seniors. It allows 16,600 small businesses to obtain affordable health
care.
If we say we care about small businesses--I hear that all the time--
then why are you condemning the Affordable Care Act that helps small
business provide tax credits to help reduce health care insurance for
up to 14,600 small businesses in the 18th Congressional District in
Texas? Multiply that by 435 districts. There are millions of small
businesses being helped.
It provides coverage for 187,000 uninsured residents. Remember, I
said Texas is the State with the highest number of uninsured persons
without
[[Page H1380]]
health care. It protects up to 500 families from bankruptcy due to
unaffordable health care costs. And when we were dealing with
bankruptcies in the Judiciary Committee, one of the single most
difficult elements of bankruptcy was catastrophic illnesses. It
provides better health care coverage for the insured. Approximately 41
percent of the district's population of 279,000 will receive coverage
from their employer.
There are many other aspects of what this insurance reform,
Affordable Care Act, good health care does for Americans. And so I am
happy to celebrate the Affordable Care Act because I believe that lives
have been saved. Children with diabetes or children with preexisting
diseases that would not have access to health care, other than the
emergency room, now can get good coverage and good care.
Finally, I would say something that we collectively supported that
has been an asset in my congressional district is that a health clinic
has received millions of dollars through the stimulus pursuant to our
commitment to community health clinics and now has 20 patient rooms,
increased jobs, and is providing good health care in that community.
Community health clinics have become first-line responders to providing
access to all people.
So I thank the gentlelady for allowing me to share these thoughts,
but in particular I thank her for helping me acknowledge the fight we
have in Texas, where women's access to health care foolishly has been
denied. And incorrectly, I believe, labeling Planned Parenthood and its
affiliates--in particular the affiliates, who have over the years
through the Bush administration when President Bush was in office--this
bill was passed in the State of Texas--but the affiliates were allowed
to continue to give good health care, and no question was ever raised
that they were mixing Federal dollars in their clinics that might have
provided for abortions. It is against the law.
Why we are denying women in the State of Texas their health care,
their lifeline, baffles all of us. But we're going to fight to the end,
and look forward to working with Health and Human Services to ensure
that we can fight for good health care for all Americans and the women
of the State of Texas.
I rise today to celebrate the 2nd anniversary of the Affordable
Health Care Act. After years of trying to ensure that all Americans
will have access to health care, we passed a measure which is a step in
the right direction to one day guaranteeing that every American will
have access to affordable care. In March 2010, we passed and President
Obama signed into law historic health care reform legislation, the
Affordable Care Act (ACA).
As the founding Member of the Children's Caucus and Active Member of
the Women's Caucus I am keenly aware that having access to affordable
health care will result in healthier families. As a Representative from
the State of Texas I realize the importance of the ACA. Texas has the
highest rate of uninsured individuals in the U.S. including the working
uninsured or under insured.
Because of the ACA millions of Americans are already benefitting from
this law: insurers are no longer allowed to discriminate against
children and others who are sick; small businesses are receiving
billions of dollars in tax credits to provide health care coverage for
their employees; and seniors are saving money on prescription drugs and
receiving free preventive care through Medicare.
In the 2 years since the President signed his health reforms into
law, millions of Americans have already experienced firsthand its
important benefits and the economic security it provides.
Medicare is now stronger for seniors, and women can now get life-
saving mammograms at no extra cost.
Children won't lose their coverage just because they were born with
pre-existing conditions like asthma--and American families are seeing
how reform is saving lives and saving money.
Since we passed reform almost 2 years ago, Americans have seen its
positive impact:
Eighty-six million Americans received free preventive care. That
means they got live-saving cancer screenings like mammograms and
colonoscopies, and soon women can have their contraception covered
without paying a co-pay or deductible. They're living healthier lives
while saving money at the same time.
One hundred eighty million are now protected against the worst
insurance abuses, like denying health care to the sick, excessive
premium increases and lifetime caps on the amount of care a patient can
receive, and soon will be protected against gender discrimination.
An additional 2.5 million young adults now have insurance. That's
because President Obama's health reform made sure they could stay on
parents' plans as they enter the workforce, until they turn 26.
Forty-seven million Americans now benefit from a stronger Medicare
program. The solvency of the program has been extended by 8 years, and
new prescription drug discounts have saved 3.6 million people with
Medicare an average of $600.
That's just the beginning. As the law continues to phase in over the
coming months, so will more of its benefits. New reforms will lower
costs and raise the quality of care. Seniors will see their Medicare
coverage continue to improve, and see the doughnut hole completely
close.
And in 2 years, every single American, regardless of their
circumstances--whether they want to change jobs, start a business or
retire early, or even if they lose their job--will have access to
affordable, quality health insurance. Presidents have been trying to
make that happen for 70 years. President Obama got it done.
Since March 23, 2010, every family with insurance has gained
important new protections, and by 2014 the law will make sure all
Americans have access to affordable health insurance.
PREVENTATIVE CARE--RACIAL DISPARITIES
It is common knowledge that preventive care can save money and save
lives, but too often people forego needed preventive services because
of cost. Millions of African Americans have not gotten the preventive
services they need.
Twenty percent of African American women are not up to date on their
Pap smear.
Thirty-two percent of African American women are not up to date on
their mammograms.
Forty-five percent of African Americans have never had a colon cancer
screening.
The Affordable Care Act takes important steps to reverse this trend
and make sure all Americans can afford the preventive care they need.
The law prohibits private insurance companies from charging a co-pay
or deductible for recommended preventive services, like mammograms,
colon cancer screenings, flu shots and other immunizations, regular
well-baby and well-child visits with a pediatrician, and soon,
contraception. In 2011, 5.5 million African-Americans with private
insurance saw their coverage for prevention expanded because of the
health care law.
The law also made preventive services available to Medicare
beneficiaries with no co-pay or deductible. In 2011, Medicare provided
2.4 million African-Americans with a free preventive service.
Altogether, more than 73 percent of those eligible received at least
one free service.
INSURANCE COMPANIES
Before the Affordable Care Act, insurance companies could arbitrarily
cap and cancel families' benefits, or refuse to cover kids just because
they were born with a pre-existing condition.
Before the law, 105 million Americans had lifetime caps on their
care, including 10.4 million African-Americans.
Up to 129 million Americans under the age of 65 have a health
condition that could make it hard to find their own insurance.
Before the health care law, some insurance companies spent as much as
40 percent of premiums on administrative overhead like marketing and
CEO bonuses.
Today, the health care law has put an end to some of the worst
insurance industry abuses. The law is making sure that families'
insurance is really there for them when they need it by keeping
insurance companies from taking advantage of consumers.
Lifetime caps have been banned for good.
Under the law, in 2014 insurance companies will be prohibited from
denying coverage or charging more because of anyone's pre-existing
condition.
Already because of the health care law, no insurance company can deny
coverage to the up to 17 million children with pre-existing conditions
like asthma and diabetes.
The health care law requires insurance companies to spend at least 80
percent of premiums on health care and quality improvement.
If an insurance company wants to raise rates by 10 percent or more,
they have to justify their actions.
MEDICARE
I believe that Medicare is an essential program that must be kept
strong for today's seniors and future generations. That's why the
health care law filled gaps and improved coverage for every single
person with Medicare, while removing wasteful subsidies for insurance
companies.
Medicare provides coverage for more than 47 million Americans,
including 4.9 million African-Americans.
[[Page H1381]]
The Affordable Care Act is closing the gap in prescription drug
coverage. In 2011 alone, 3.6 million people who hit the Medicare donut
hole saved an average of $600 each on their prescription medications
thanks to provisions of the Affordable Care Act.
By 2020, the donut hole will be closed for good.
Even as seniors gain these important new benefits, the health care
law extended the life of the Medicare Trust Fund by eight years.
UNDER 25--Can continue to have Parents
The health care law makes sure that young people who are working hard
to begin their careers can stay on their family health insurance plan
until they turn 26.
Before health reform was enacted, young adults were the age group
most likely to be uninsured.
Today, 410,000 young African-Americans who would otherwise be
uninsured have coverage because of this rule.
WOMEN'S HEALTH
Before the health care law, insurance companies were free to
discriminate against women.
Women could be charged as much as 50 percent more than men for the
same insurance coverage.
Women could be denied coverage because of a pre-existing condition
such as cancer or even having been pregnant.
Because of the health care law, within 2 years, insurance companies
will no longer be allowed to do this.
Under the Affordable Care Act, insurance companies will no longer be
able to deny coverage because of pre-existing conditions nor will they
be able to charge higher rates based on an individual's gender.
In 2014, all Americans soon will have access to the security that
health insurance provides.
Health care is a cornerstone of economic security, but too many
African-American families have gone without insurance. In fact, an
estimated 8.1 million African-Americans do not have health insurance.
18th CONGRESSIONAL DISTRICT
As I have said before it is almost hard to believe that it has only
been 2 years since the Affordable Care Act was signed into law, but
millions of Americans are already seeing lower costs and better
coverage, this includes hundreds of thousands of people living in the
18th Congressional District of the State of Texas.
Residents of my District--ranging from young adults to seniors to
children with pre-existing conditions--are all already receiving
critical benefits from this new health care law. As the new benefits of
the health care law continue to be implemented, I will continue to
fight my Republican colleagues' efforts to repeal this critical law.
Their efforts to repeal reform will put the insurance companies back in
charge and will lead to higher costs and reduced benefits for millions
of Americans across the country.
ACA FACTS FOR THE 18th DISTRICT
Improve employer-based coverage for 279,000 residents.
Provide credits to help pay for coverage for up to 186,000
households.
Improve Medicare for 70,000 beneficiaries, including closing the
prescription drug donut hole for 5,300 seniors in my District.
Allow 16,600 small businesses to obtain affordable health care
coverage and provide tax credits to help reduce health insurance costs
for up to 14,600 small businesses.
Provide coverage for 187,000 uninsured residents.
Protect up to 500 families from bankruptcy due to unaffordable health
care costs.
Reduce the cost of uncompensated care for hospitals and health care
providers by $49 million.
Better health care coverage for the insured. Approximately 41 percent
of the district's population, 279,000 residents, receives health care
coverage from their employer. Under the legislation, individuals and
families with employer-based coverage can keep the health insurance
coverage they have now, and it will get better.
As a result of the insurance reforms in the bill, there will be no
co-pays or deductibles for preventive care; no more rate increases or
coverage denials for pre-existing conditions, gender, or occupation;
and guaranteed oral, vision, and hearing benefits for children.
Affordable health care for the uninsured. Those who do not receive
health care coverage through their employer will be able to purchase
coverage at group rates through a health insurance exchange.
Individuals and families with an income of up to four times the
federal poverty level--an income of up to $88,000 for a family of
four--will receive affordability credits to help cover the cost of
coverage. Currently, there are 186,000 households in my district that
could qualify for these affordability credits if they need to purchase
their own coverage.
Coverage for individuals with pre-existing conditions. There are
27,600 individuals in the district that I represent who have pre-
existing medical conditions that could prevent them from buying
insurance. Under the ACA's insurance reforms, they will now be able to
purchase affordable coverage.
Health care and financial security. There were 500 health care-
related bankruptcies in my district in 2008, caused primarily by the
health care costs not covered by insurance. The bill caps annual out-
of-pocket costs at $5,000 for singles and $10,000 for families and
eliminates lifetime limits on insurance coverage, ensuring that no
citizen will have to face financial ruin because of high health care
costs.
Security for Seniors Improving Medicare. There are 70,000 Medicare
beneficiaries in my district. The health care reform legislation
improves Medicare by providing free preventive and wellness care,
improving primary and coordinated care, improving nursing home quality,
and strengthening the Medicare Trust Fund.
Closing the Part D donut hole. Each year, 5,300 seniors in the
district hit the donut hole and are forced to pay their full drug
costs, despite having Part D drug coverage. The legislation will
provide these seniors with immediate relief, covering the first $500 of
donut hole costs in 2010, cutting brand-name drug costs in the donut
hole by 50 percent, and completely eliminating the donut hole by 2019.
SMALL BUSINESS
Helping small businesses obtain health insurance. Under the
legislation, businesses with up to 100 employees will be able to join
the health insurance exchange, benefitting from group rates and a
greater choice of insurers. There are 16,600 small businesses in my
district that will be able to join the health insurance exchange.
Tax credits for small businesses. Small businesses with 25 employees
or less and average wages of less than $40,000 will qualify for tax
credits of up to 50 percent of the cost of providing health insurance.
There are up to 14,600 small businesses in the district that could
qualify for credits.
I yield back. I thank the gentlelady.
Mrs. CHRISTENSEN. Thank you, Congresswoman Sheila Jackson Lee.
Certainly, we know that Planned Parenthood has always followed the law.
And in this Women's History Month, thank you for raising the issue of
the unfair treatment of women by some of the laws like the one in
Texas, the one in Virginia, and also legislation that has been
attempted to be passed in the Congress of the United States.
We're also joined this evening by a Congressman from Texas,
Congressman Al Green, who often joins us here. We're representing all
of the 43 members of the Congressional Black Caucus, who know how
important this law is to our communities and, really, to communities
across this country. So we thank you for joining us.
I yield such time as he may consume.
Mr. AL GREEN of Texas. Thank you, Dr. Christensen. I especially thank
you for chairing the Health Care Task Force and for the outstanding job
that you've done through the years. You have shown a great deal of
dedication to health care for all, and I believe that those who write
history will be exceedingly kind to you when they record how you fought
so that every person could have health care as a matter of right as
opposed to as a matter of wealth. You have done your best to make sure
health care doesn't become wealth care.
I would also like to thank my colleague, Sheila Jackson Lee, who
spoke just ahead of me and you, for the hard work that she is doing
across the length and breadth of this country to help us with these
issues concerning health care for all as well.
The Affordable Care Act is called the Affordable Care Act for a
reason. In 2009, when we were embarking upon this transformation in
health care, we were spending about $2.5 trillion per year on health
care. And $2.5 trillion is a huge number. It is very difficult to grasp
$2.5 trillion. That $2.5 trillion is about $79,000 per second. That's
what we were spending in 2009. That was 17.6 percent of GDP--$79,000-
plus per second. And it was projected in 2009 that in 2018 we would be
spending $4.4 trillion per year. A big number, $4.4 trillion. How much
is it really? That's $139,000 per second, which equates to about 20.3
percent of GDP. That's $139,000 per second.
We needed the Affordable Care Act. In the State of Texas, we were
spending huge amounts of money because we had 6 million people who were
uninsured--1.1 million in my county, Harris County, uninsured. Twenty
percent of the State's children were uninsured. In 2009, we needed the
Affordable Care Act. There was a reason why it's called
[[Page H1382]]
the Affordable Care Act. Because upon passing it, it's projected still
that it will--and this is per CBO--that it will save a trillion
dollars-plus over a 20-year period.
This bill, this legislation, reduces the cost of care. It was
something that had to be done. But equally as important as reducing the
cost of care, it spreads health care, about 50 million people who, but
for this bill, probably would not receive some health care. I do
believe that it's important that we not have 45,000 people per year die
because they don't have insurance. That's a lot of folks who lose their
lives. We were losing about one person every 12 minutes, I believe.
This is an important piece of legislation to save lives. It saves
money. But equally as important as saving money--in my world, more
important--is the fact that it saves lives. It saves the lives of
children. It will cause children to have the opportunity to stay on the
insurance of their parents until they are 26 years of age.
{time} 1930
It closes the doughnut hole for senior citizens with their
pharmaceuticals. We had a system that allowed you to pay a copay and a
premium up to a certain point, and then you had to pay all of the costs
of your health care, and then at another point you would again receive
some additional assistance. This bill closes that doughnut hole for
those who are in the twilight of life when you need pharmaceuticals the
most.
By the way, the insurance companies were not eager to take on persons
in the twilight of life when there is much to be spent on health care.
They don't go out looking for people to insure in the twilight of life.
This bill covers people to make sure they get pharmaceuticals in the
twilight of life.
But it does something special for women. It is the discrimination
that exists against women who get the same coverage, the same insurance
that men get, but pay more because of their gender. There really is a
gender bias in the insurance industry, and women pay more for similar
coverage. This bill ends it. Women ought not be required to pay more
because they are women. This bill ends it.
It also helps us with persons in need of preventive care. And at some
point in life, we all need preventive care, so theoretically I suppose
it helps everyone. But preventive care is very important. Preventive
care can hold down the cost of health care. If you can treat and
prevent an illness, you don't pay that inordinate amount of money you
have to pay once a person has an illness and has to receive medical
attention.
One such area of preventive care has to do with contraception. This
is an adult conversation, and I want adults to know that men can
receive their contraceptives in their neighborhoods, bus stops and
truck stops. They can receive contraceptives. It is easy for men to
acquire contraceptives. If men can get them in their neighborhoods,
women should be able to get them at Planned Parenthood. There is no
reason why men should have easy access and women be denied access.
These are matters for families to consider and individuals to make
choices about, and I think that women ought to be able to make the same
choices that men can make when it comes to contraception.
I would add, as I close, that this bill is going to make a difference
in the lives of a lot of people. And what I regret is that many people
really don't understand the positive impact that it will have on them.
And it's very unfortunate because there are many people who will
benefit from this bill but who do not understand how it will have a
positive impact on their lives. It is unfortunate that we sometimes
don't know as much about a thing as we should so that we can speak
about it in terms of knowledge that we have as opposed to what we have
heard.
Read the Affordable Care Act. Look at the summaries of it. No one
denies--no one denies--that it allows you to keep your child on your
health insurance until your child is 26 years of age. No one denies
that it is closing the doughnut hole for senior citizens as it relates
to their pharmaceuticals. No one denies that it will allow preventive
care to take place such that people can receive treatment that will
prevent them from having to go to the hospital, to give them an
opportunity to remain healthy and not have to treat an unhealthy
person. No one denies that it will help keep people out of the
emergency rooms.
We were spending $100 billion per year in emergency rooms in '09.
People were going to emergency rooms for their pharmaceuticals and
their treatments that they could receive at a general practitioner's
office. This bill would end this.
This is a good piece of legislation that will help people in the dawn
of life when they are born with preexisting conditions and in the
twilight of life when they're in need of special attention and
treatment that the wealthy can now afford.
I do believe that in this country, if we find you to be an enemy
combatant and if we should mortally wound you in the process of taking
you into custody, if we should wound you, perhaps not kill you but we
wound you when we do capture you, if we don't mortally wound you, if we
don't kill you, we will give you aid and comfort. We give aid and
comfort to our enemy combatants, people who are trying to kill us. We
will give them aid and comfort if we wound them in battle.
In this country, if you are a bank robber and if, on the way out of
the bank we should harm you physically when we capture you, we will
give you aid and comfort. In this country, we give aid and comfort to
criminals.
In this country, if you are on death row and you are on your way to
meet your Maker next week, if you get sick this week, we will give you
aid and comfort and send you to meet your Maker next week.
If we can give aid and comfort to the enemy combatant, if we can give
aid and comfort to the criminal, if we can give aid and comfort to the
person who's on death row who's going to die next week, surely we can
give aid and comfort to hardworking American citizens who cannot afford
health care but for the Affordable Care Act, which, by the way,
mandates that every person who can afford health care acquire health
care. It does not require people to buy health care who cannot afford
health care.
This is the richest country in the world. One out of every 100
persons is a millionaire. In spite of all that you hear, we still are.
And in this, the richest country in the world, we cannot allow health
care to become wealth care.
I thank you for yielding to me, and I gladly yield back to you.
Mrs. CHRISTENSEN. Thank you, and thank you for making those points
and for making them so passionately.
I know you said we'll save $1 trillion over the next 20 years, but I
am confident that the savings will be more than that when we look back
on the good that this bill is going to be doing over those 20 years.
I just want to say a few words about the bill. Some of it will be
repetitive.
For the first time, the Patient Protection and Affordable Care Act is
finally making a significant investment in prevention. We're finally
beginning to turn what is supposed to be a health care system into a
real health care system and not a sick care system. The old adage, ``an
ounce of prevention is worth a pound of cure,'' is still true, and it's
no more true than in health care.
In my family practice, I would see patients who had difficulty
getting their preventive care, getting their mammograms, their
colonoscopy and other preventive services. That will no longer be true.
And so they would come in sicker. And some patients would come to me
after being sick for a long, long time when they had far advanced
disease. So I know that that is the same not only in my district and in
my practice, but it's the same for many low- and middle-income people
everywhere in this country, but especially for African Americans, other
people of color, of course the poor, and people who live in rural
America.
Let's talk about African Americans and preventive care. Twenty
percent of African American women are not up-to-date on their Pap
smears; 32 percent of African American women are not up-to-date on
their mammograms; and 45 percent of African Americans have never had a
colon cancer screening.
The Affordable Care Act, the Patient Protection and Affordable Care
Act, takes important steps to reverse this
[[Page H1383]]
trend, and makes sure that all Americans can afford the preventive care
that they need.
And this will reduce the premature deaths. It is said that in this
country, every year, about 88 or more thousand people die in excess
numbers that should not have died if they had received the preventive
care and the kind of health maintenance that we want them to have and
that this legislation will allow them to finally have.
Today the life expectancy for African American men is 7 years
shorter, and for women it's 5 years shorter than our white
counterparts.
There's an article I was reading on MedlinePlus. Overall, the
national life expectancy was nearly 75 for men, for white men, 68 for
black men; 80 for white women, and 74 for black women. Washington,
D.C., the Nation's Capital, has the largest life expectancy disparities
between blacks and whites: a 13.8-year disparity for men and 8.6 years
for women. New Mexico had the smallest disparities.
Let me just mention some of the States with the largest disparities.
More than 8 years for men: New Jersey, Nebraska, Wisconsin, Michigan,
Pennsylvania, and Illinois.
{time} 1940
The ones with the largest disparities for women--more than 6 years--
Illinois, Rhode Island, Kansas, Michigan, New Jersey, Wisconsin,
Minnesota, Iowa, Florida, and Nebraska.
Surely all Americans, but African Americans in particular, have a
serious stake in the Patient Protection and Affordable Care Act. It's
clear that our lives really depend on it, but not our lives alone.
It will also, as has been said, reduce health care costs. The Joint
Center for Political and Economic Studies reported about 2 years ago
that the direct and indirect costs of health disparities in this
country over just a 4-year period was $1.2 trillion. We could save that
money just by reducing health disparities in this country.
Of course, now 26-year-olds can stay on their parents' health
insurance for the very first time. I remember when my daughter turned
22 and I had to drop her from my insurance coverage, the insurance
coverage I had right here in the House of Representatives. But now, 2.2
million young people--of which 400,000 are African Americans--are being
covered on their parents' insurance.
Seventeen million children can no longer be denied because they have
a preexisting disease, just because they're sick. Children with asthma,
children with sickle cell disease, and the children who are
increasingly having diabetes, they can no longer be denied health
coverage; they have access to health care. In 2014, that will be
extended to adults, who also will not be able to be denied health
insurance because of preexisting diseases. There are up to 129 million
Americans under the age of 65 that have a health condition that could
make it hard for them to find health insurance.
Going back to African Americans again, who suffer disproportionately
from multiple chronic diseases, we need this benefit. Deaths from
cardiovascular disease were 30 percent higher in African Americans. The
prevalence of diabetes is 70 percent higher. It's also very high in the
American Indian population. African Americans represented about 55
percent of all adult AIDS cases and 65 percent of pediatric cases. And
our infant mortality is more than 2.3 times higher than our white
counterparts.
As you heard from Congressman Green, being a woman will no longer be
a preexisting disease. It's amazing, being a woman is almost like
having a preexisting disease. They don't deny us the insurance, but
they charge more. There's another article from The New York Times
written by Robert Pear, and I'm reading from it now. It says:
For a popular Blue Cross Blue Shield plan in Chicago, a 30-
year-old woman pays $375 a month, which is 31 percent more
than what a man of the same age pays for the same coverage.
In the States that have not banned gender rating--and I think there
are about 28 or so that have, 26 or so that have--but in the States
that have not banned gender rating, more than 90 percent of the best-
selling health plans charge women more than men.
So many testimonies of people that we heard from while we were having
the hearings in preparation for developing this bill, of people who
lost their coverage because they had a serious illness. I remember one
lady with breast cancer. They dropped her coverage. I remember a young
girl who had had a liver ailment in her infancy. She could not get
coverage. Her parents almost had to sell their home and become
destitute to be able to provide coverage for her. That would not happen
now under this Patient Protection and Affordable Care Act.
You can't have benefits cut because of lifetime limits anymore.
Before the law, 105 million Americans had lifetime caps on their care,
including 10.4 million African Americans. Who wants to go back to those
days again? No one wants to go back to those days. We're not going
back.
There can be no scrimping on our care to give bonuses to the CEOs, or
for fancy ads. At least 80 percent of premiums must be used to provide
health care services. Before the health care law, some insurance
companies spent as much as 40 percent of premiums on administrative
overhead, like marketing and CEO bonuses. Now that cannot be any more
than 20 percent.
I have a pet peeve about Medicare because I keep hearing especially
my Republican colleagues saying that Democrats have cut $500 billion
out of Medicare. That's not exactly what happened. I think the American
people understand savings. We found savings, $500 billion worth of
savings, and we used most of it to make Medicare stronger. I'll go to
some of the facts here:
It reduces prescription drug costs for seniors. The health care law
provides a 50 percent discount on brand-name drugs for seniors in the
Medicare part D doughnut hole; 3.6 million seniors have already
received that discount, saving a total of $2.1 billion, each senior
saving an average of $604.
It provides free coverage of key preventive services; 32.5 million
seniors--25.7 in traditional Medicare and 6.8 in Medicare Advantage--
have already received one or more free preventive services.
It provides a free annual wellness visit. It strengthens Medicare. By
providing those savings and putting them back into Medicare, we
strengthen Medicare and extend its solvency by 8 years, from 2016 to
2024. We have more work to do, but we extended it by 8 years.
It helps seniors remain at home and stay out of nursing homes, and it
provides nursing home residents with more protections from abuse.
The average premiums for Medicare Advantage enrollees are 7 percent
lower in 2012 than they were last year. Since the health care law was
enacted, those premiums have fallen by 16 percent. The Medicare part D
deductible has fallen by $22 in 2012, the first time in Medicare
history the deductible has fallen.
So we didn't hurt Medicare. We did not take money out of Medicare. We
found savings in Medicare, mostly from fraud and abuse, and also from
leveling the reimbursement to providers so that the Medicare Advantage
may have that much more reimbursement than other providers. And we made
Medicare stronger. So today, 47 million Americans are benefiting from a
stronger Medicare program.
We put Medicare on a stronger, more secure course; and we're not
going back. We're not going to vouchers where the beneficiary will take
on a lot more of the cost. We will not break our commitment to seniors
and people with disabilities.
Small businesses also. We've heard that they've done well; 360,000
small businesses used tax credits and covered 2 million employees in
2011. I know those 2 million employees and the people that employ them
don't want to lose that coverage. We don't want to go back. We will
oppose any attempt to take us back to the days when we could not
provide health care for our small businesses to provide insurance for
their employees.
As was said earlier, health care is a right. President Obama led and
we worked with him to ensure that that right is there for every
American. We also worked very hard, the Tri-Caucus did--the Black,
Hispanic and Asian Pacific American Caucus--to include
[[Page H1384]]
health equity as a part of this important law. In it, discrimination is
expressly prohibited. There are core objectives within it to reduce
health disparities and to create health equity. There is data
collection. You don't know what you don't know you don't know.
There are health profession provisions to increase not only the
overall health care workforce, but to make sure that that workforce
looks like America, that there's diversity in that workforce, and to
support institutions that train underrepresented minorities.
We created Offices of Minority Health in some agencies of the Health
and Human Services that did not have them, such as SAMHSA, the
Substance Abuse and Mental Health Services Administration. We know that
mental health issues often go unnoticed, undiagnosed, or misdiagnosed
in people of color or people of different racial and ethnic
backgrounds. We need an Office of Minority Health there. We needed one
at FDA to make sure that when medicines are approved, that they have
been tested in minorities and people with disabilities and other
comorbidities.
I've had bad experiences with CMS asking about the impact of changes
of medication in end-stage renal disease, where we know that African
Americans and some other subpopulations require more of a certain
medication. After a few years, we asked, What was the impact on this
population group? They said, well, we don't collect data that way. We
can't know what we're doing wrong or where we might have to change
things to improve people's health.
I represent a territory. Although the territories did not get State-
like treatment under this bill, we will finally be able to cover close
to 100 percent of the Federal poverty level in our territories under
Medicaid--finally.
We will have an opportunity to have an exchange. In our case, we may
only cover up to 200 percent of poverty, but we're making steps. This
bill has allowed us to make steps that will allow us to begin to
transform our health care system and open up access to care to our
constituents that they've never had before.
{time} 1950
This is in the United States Virgin Islands, in Guam, American Samoa,
the Commonwealth of the Northern Marianas, and Puerto Rico. As I said,
we have a lot more to do, but we made a good start with the Affordable
Care Act, and we'll continue to work until all Americans, no matter
where they live in this country, have equal access to health care.
And the rising costs of health care are already slowing. The best is
really yet to come. In 2014 the exchanges will help to pay premiums for
families that are at or below 400 percent of the Federal poverty level.
Small businesses will get even more help in the form of tax credits.
There will be no denial for anyone because of preexisting disease. The
doughnut hole will begin to be closed.
The research that this bill creates will improve the quality of
health care and make us safer. And the skyrocketing health care cost
increases will stop, will start going down.
I know that there are some in this country that feel that all of this
that we talk about in this bill threatens the health care that they
already have, but it doesn't. It does not. It makes the health care
coverage that you already have more secure. It cannot be taken away
just because you're sick. There will be no lifetime limits or annual
caps. And the increases in premiums are already beginning to level off,
so insurance is already becoming more affordable.
The American people ought to be thanking President Obama, and I know
that many do. More than 80 percent support the provisions of this bill,
thanking the President for this landmark law, as important as the one
that created Medicare. We ought to feel good about the fact that this
country is living up to the high ideals on which it was founded, and
that we will no longer be shamefully lagging behind so many countries
in the health of our population, not in the richest country in the
world.
I'm certain that if the Supreme Court decides on law and the
Constitution, without any political activism coming into play, as they
should, this good law will prevail, and more importantly, the people in
our Nation will prevail.
Mr. Speaker, I yield back the balance of my time.
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, as we celebrate the
anniversary of the Affordable Care Act this week, we should reflect on
the progress made in this country. It has only been two years since the
Affordable Care Act was signed into law, but millions of Americans are
already seeing lower costs and better coverage. This includes tens of
thousands of people in the 30th District of Texas.
Texans are saving more than $1.3 million in health care costs, an
average of $639.36 per beneficiary, and 210,700 Texans are directly
saving on their Medicare prescriptions. Residents of my district,
ranging from young adults to seniors to children with pre-existing
conditions, are all already receiving critical benefits. 9,100 young
adults in my district now have health insurance, and 54,000 seniors
have received Medicare preventative services without paying any co-
pays, coinsurances, or deductibles.
Mr. Speaker, as the many benefits of the health care law continue to
be implemented, I will continue to fight efforts to repeal this
critical law. Republican efforts to repeal the Affordable Care Act will
put the insurance companies back in charge and will lead to higher
costs and reduced benefits for millions of Americans across the
country.
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