[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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