[Congressional Record Volume 158, Number 55 (Tuesday, April 17, 2012)]
[House]
[Pages H1905-H1911]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           GOP DOCTORS CAUCUS: HEALTH CARE'S BROKEN PROMISES

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 5, 2011, the gentleman from Louisiana (Mr. Fleming) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. FLEMING. Mr. Speaker, in this hour, I and my colleagues who will 
be joining me very shortly--other physicians who are from the GOP 
Doctors Caucus, perhaps nurses, and other health care workers as well--
in this next hour we're going to be talking about our favorite subject, 
and that is health care reform. We're going to be talking about 
specific aspects, things that have actually come to light to us that I 
think are important. We're going to have other things that in the 
coming days we're going to learn about how ObamaCare was passed, what 
things were done by the other side of the aisle to make that happen, 
things that maybe some would call sausage-making, others would say it's 
improper. But we'll certainly spend some time on that as the days come.
  I want to continue a theme that we've been discussing, and that is 
the broken promises of ObamaCare. Remember, to get ObamaCare passed, 
President Obama made a number of promises.
  I'll start with the first one that is relevant to our topic tonight, 
and that is: Under my plan, no family making less than $250,000 a year 
will see any form of tax increase. That was candidate Obama, Senator 
Obama at the time, who talked about all the number of things that were 
going to be good about ObamaCare; but in fact we see that virtually 
everything that's come up, with a few possible exceptions, has not been 
so favorable.
  I think that taxes is really a very relevant subject to speak about 
this evening because here we are and today is the tax deadline for the 
IRS, and we all have that on our minds. It's interesting, whenever I 
file my taxes, the first thing I think about doing is projecting into 
the next year what the issues are going to be for me and my taxes. And 
so I think it's only proper and the timing is excellent that we talk 
about that this evening.
  Remember, Candidate Obama pledged he would not raise any of your 
taxes and promised not to tax health benefits. His health care broke 
those promises at least 10 times. Here's just a lineup of some of the 
taxes that we're talking about.
  Fifty-two billion dollars in fines on employers who do not provide 
government-approved coverage. Remember that under ObamaCare not only is 
there a mandate date for individuals to buy health insurance. There's a 
mandate on the employers, the business owners to buy it as well. And 
upon both is the burden to buy not health insurance but government-
conceived health insurance, that is, health insurance that the 
government in its wisdom--our Federal Government--decides and deems is 
proper for us. And so you have to make two fulfillments in that 
mandate. One is to buy health care insurance and, number two, health 
care insurance that's approved by the government.
  Thirty-two billion dollars in taxes on health insurance plans. The 
actual health plans are going to be taxed as well. Now, who is going to 
pay that tax? Do you think the insurance companies are going to pay it? 
No, it's going to be passed down to you, the subscriber, as taxes on 
business always make their way down to the consumer.
  Five billion dollars in taxes from limits on over-the-counter 
medication; $15 billion in taxes from limiting the deduction on 
itemized medical expenses; $13 billion in taxes from new limits on 
flexible-spending arrangements; $60 billion in taxes on health 
insurance plans; $27 billion in taxes on pharmaceutical companies; $20 
billion in taxes on medical device companies; $3 billion in taxes on 
tanning services; $3 billion in taxes on self-insured health plans; and 
$1 billion in new penalties on health savings account distributions. 
The health care law also includes a high income tax. Because it's not 
indexed for inflation, it will eventually hit 80 percent of taxpayers.
  I draw my colleagues' attention to this slide: ``ObamaCare's Rising 
Tax Burden.'' You can see that the tax burden in 2012, the year we're 
in, is $190 for a family of four. That's $15 billion. You see that the 
burden goes up each year, and that in the out-years, 2022, it makes it 
above $150 billion. In 2032, the burden goes well above $250 billion. 
And it finally tops out at $320 billion total, and that's an average of 
$3,290 for a family of four.

                              {time}  2030

  So what am I saying? Remember that when you hear the rhetoric from 
the other side of the aisle, it talks about how we should be having 
more sacrifice from the wealthy and more sacrifice from those who make 
more. Folks, we've been down this road before.
  Remember the luxury tax that came out some years ago? What did it do? 
It killed the companies that made boats and luxury items. It created a 
lot of job losses. The people who were hurt were the working class 
people, not the wealthy. They can still buy those things anyplace they 
want to.
  We also came up with this silly idea of an alternative minimum tax to 
make the wealthy do their fair share.

[[Page H1906]]

Well, we have the AMT today, and where has it gotten us? Because that 
was never indexed for inflation, middle class people are being hit by 
the alternative minimum tax. So it's no longer a tax on wealthy. It is 
a tax on the middle class, the people that our colleagues on the other 
side of the aisle talk so fondly of.
  That's an important point, and that is that every time we come up 
with a tax on the wealthy, it always makes its way to the working class 
and the middle class.
  Now, why is this? Is this by accident or is it by grand design? Well, 
folks, we all know that inflation occurs every year at an average rate 
of about 3 percent, but it's been as high as 16 percent in our history. 
And so any time we have a tax law that affects people in a certain 
income, we know that automatically, over time, people with lower and 
lower incomes, because while their absolute dollars in value are going 
to go up, the truth is, the purchase power of those dollars goes down. 
So that pushes more and more people of lower and lower income levels 
into higher and higher tax brackets.
  So, again, our colleagues on the other side of the aisle love all of 
these taxes on the wealthy, but they can never make enough money. We've 
heard in recent days about the infamous Buffett tax, the Buffett rule 
that would require superwealthy people to pay some additional tax. And 
their own side agrees that would only add about $4 billion per year, 
not even a drop in the bucket, less than 1 percent of the annual 
deficit.
  So why is that important? It's important because if you're going to 
get more income from taxes--and I would argue that you never really get 
more income from taxes, but if you think you can, you can only do it 
when you spread it out among the middle class and the working class. 
And the way you do that, kind of the silent way, the camel nose under 
the tent, is to pass it on the wealthy first, and then, through 
inflation, it's passed down to albeit a lower income level but a much 
larger group, because you simply can't get enough tax revenue by 
putting a lot of tax on the wealthy. There just isn't enough wealthy 
people out there to do it. The way you have to do it is push it down 
where there's a lot of people, and that's the middle class and the 
working class.
  Another slide here, rhetoric versus reality on premium cost, the 
average annual cost of family health insurance premiums in the U.S.
  Here we are 2012. This is what President Obama in campaigning for 
ObamaCare said would happen, that you would follow this blue line down, 
and the costs would go down by 2,500. And what are we hearing from all 
the actuaries, the CBOs and others? Not only will it go up by $393, but 
we already have a differential of around $4,000 from where President 
Obama said we would be today and where we actually are. It hasn't gone 
down; it's actually gone up.
  Let's talk about a couple more taxes, and then I'm going to introduce 
a colleague here and give him some sharing time as well.
  The surtax on investment income, $123 billion, which begins this past 
January, the creation of a new 3.8 percent surtax on investment income 
earned in households making at least $250,000 for a couple or $200,000 
single. Now this is the homeowner real estate tax that you've heard 
about. It was, again, passed in the dead of night. Folks, this is a 
terrible tax, 3.8 percent on investment income.
  Now, when you sell your home, it may or may not be classed as 
investment income, but it can be, it just depends on the situation. But 
it's not just that. If you own any type of other property, if you own 
stocks and bonds, mutual funds, whatever, they could be easily subject 
to this, and it is not indexed to inflation.
  Again, let me reemphasize this. Yes, it's a tax on people who make 
over $200,000 a year, but if you make $50,000 a year, over time, this 
will affect you, too, because inflation will bring those dollars up in 
real terms because of inflation, and your buying power will stay at the 
$50,000 level, but you will show on paper that you're making $200,000, 
and this tax will affect you.
  So the bottom line here is that ObamaCare has many taxes, and 
certainly they are Trojan horses by any explanation; and, yes, they 
don't raise a lot of revenue at first, but down the road they raise a 
lot of revenue, but not on the wealthy folks, on the middle class. 
That's who's getting hurt by ObamaCare.
  A medicine cabinet tax, $5 billion beginning this past January, 
Americans are no longer able to use their health savings accounts and 
flexible spending accounts and all those other types of accounts on 
over-the-counter drugs. So that means if you want to use your health 
savings account to pay for your cold medicine or medicine you're taking 
for a headache like Aleve or Motrin or something like that, if you want 
to pay for it through your health savings account, you're going to have 
to go get a prescription from your doctor. And the doctor is going to 
say, Look, I'm overwhelmed with all these people wanting me to do this. 
We're going to have to charge something for that, so that means more 
cost. Ultimately, more bureaucracy, more paperwork, more cost, and up 
until now, prior to ObamaCare, that was not the case. You could write 
that off or pay for that out of your health savings account.
  An HSA withdrawal tax hike, $1.4 billion, that began in January 2011. 
It increases additional tax on nonmedical early withdrawals from an HSA 
from 10 to 20 percent, disadvantaging them relative to IRAs and other 
tax advantage accounts. So, you see, if you have an early withdrawal 
from your IRA or some other type of retirement plan, you've had a 10 
percent penalty, and that was true of HSAs. So that's been doubled. So 
ObamaCare has limited the use of health savings accounts, but at the 
same time has made the penalties even steeper for using it.

  And I can tell you, in my own case, in my own companies, apart from 
my own medical practice, we have used health savings accounts to 
tremendous benefit to our employees because it has lowered their cost 
and taken a lot of the anxiety and the fear away from their cost in 
being caught in some sort of illness that would bankrupt them 
otherwise.
  An excise tax on charitable hospitals, that's immediate, $50,000 per 
hospital if they fail to meet new community health assessment needs. 
Section 1411 increases the Medicare hospital insurance portion of the 
payroll tax, so this provision will increase the employees' portion 
from 1.45 percent to 2.35 percent for families making more than 
$250,000 a year or individuals making above 200. Combined with the 
employers' portion, the total rate will increase by 3.8 percent on 
every dollar of income over $250,000.
  And, again, I implore you, I realize, hey, I don't make $250,000, I 
don't make $200,000, but because of inflation--and trust me, with the 
monetary easing and the monetary policies that are coming out of this 
administration in half of the last 3\1/2\ years--when inflation gets 
going again, which it will quite soon, you will be driven up into those 
income levels, but your buying power will be the same as it is today. 
So, trust me, you're not getting by with anything. You're going to get 
hit with this tax just like everybody else.
  The reality is--and I'm going to be recognizing my good friend, Dr. 
Gingrey, here in a moment. The reality is ObamaCare includes tons of 
new taxes and tax hikes. Heritage has a list of them that shows an 
increase in revenue of more than $500 billion in 10 years. Two examples 
that clearly hit consumers are the 10 percent tax on indoor tanning 
services that will raise $2.7 billion between 2010 and 2019 and, 
beginning in 2013, the 2.3 percent excise tax on manufacturers and 
importers of certain medical devices that will raise $20 billion 
between 2010 and 2019.
  And I'm just going to just throw in a couple of more things.
  Remember, this discussion began with this being the April 15--April 
17 deadline for your taxes and the Internal Revenue Service.

                              {time}  2040

  Remember that under ObamaCare as many as 16,000 new IRS agents will 
be hired. Estimates vary, of course, and that many have not been hired 
yet. But there's no question about it that the IRS will be beefed up to 
the tune of billions of dollars in order to make that happen.
  So, with that, I've been joined by my colleague, my good friend, Dr. 
Phil Gingrey, an obstetrician/gynecologist

[[Page H1907]]

from Georgia, someone that I look up to very much, who's been a great 
mentor to me and a role model; who was here as a physician in days past 
when there weren't many doctors in the House of Representatives, and 
has helped facilitate, in fact helped start, the GOP Doctors Caucus, 
which is speaking here tonight, and helped grow our numbers from just a 
handful of physicians and health care workers to now over 15 MDs and 
upwards of around 20 total health care workers that we have in the 
House of Representatives that I think are making big, big differences 
in particularly health care policy overall.
  I yield to the gentleman, Dr. Gingrey.
  Mr. GINGREY of Georgia. Mr. Speaker, I thank the gentleman very much 
for yielding, and I thank him for his kind words. I'm happy to share 
the time with him tonight and plan to remain here on the House floor 
for the rest of this hour.
  I'll make some comments now and yield back to the gentleman from 
Louisiana, Dr. Fleming, and maybe he'll yield some additional time to 
me later in the hour.
  But, you know, I couldn't help but notice in the previous hour which 
was allotted to our Democratic colleagues, their leadership hour, they 
went first tonight, and they chose to talk about the SNAP program 
within the Department of Agriculture. And of course, SNAP is an acronym 
for the Supplemental Nutrition Assistance Program, which was formerly 
known, I think more people would commonly know it as the food stamp 
program. And they spent the whole hour talking about the unintended 
consequences of cutting discretionary Federal spending and reducing 
government bureaucracy and bloatedness and saying that when you do 
that, of course, you hurt the poor and the nearly poor, that they 
desperately need these programs. They made some legitimate points, of 
course.
  We're talking about health care in our hour and, specifically, about 
the passage of ObamaCare almost 2 years ago, indeed, a little more than 
2 years ago now to create a whole new entitlement program for people, 
the uninsured, not the folks that were covered under safety net 
programs like the program for children, the SCHIP program it's called, 
the health care program for the poor, Medicaid, certainly not the 
program for our seniors and our disabled Americans under Medicare, but 
for folks that were somewhere in the middle that maybe couldn't afford 
or weren't offered health insurance by their employer.
  But they never talked about the unintended consequences of what would 
happen. I'm sure our colleagues didn't intentionally pass a 2,600-page 
bill that would deliberately hurt anybody. I don't think anybody on 
either side of the aisle in any Congress would do that, any 
administration would do that.
  But we physician Members, the gentleman from Louisiana, myself, and 
others that have worked in the health care industry, all of our--most 
of our--professional lives before we got to Congress, understood far 
better and knew exactly what the unintended consequences would be of 
this legislation.
  Mr. Speaker, that's exactly what the gentleman from Louisiana's been 
talking about and pointing out in the poster presentation, the slide 
presentation that he has made. I could probably take the rest of the 
hour talking about the unintended consequences and list them. My good 
colleague and our friend on the Senate side, the chairman of the Senate 
Policy Committee, also a physician, orthopedic surgeon from Wyoming, 
Dr. Barrasso, just recently came out with a white paper on health care 
policies dated March 13, so just about a month ago. And Dr. Barrasso, 
in that paper, Mr. Speaker, lists 10 different unintended consequences.
  The gentleman from Louisiana's already mentioned a couple, gone over 
a couple; but I'd like to just take a few minutes before yielding back 
to him, a go over a few of the promises that he has not yet mentioned. 
One, and this is a quote from President Obama: ``I will protect 
Medicare.'' In a 2009 address to Congress, President Obama promised 
that he would ``protect Medicare.''
  Well, the President's health care law, however--Dr. Fleming may have 
mentioned this--takes more than $500 billion from the Medicare program 
and uses that money. Now, he said, and the Democrat majority at the 
time said, well, you know, we're strengthening Medicare. But over $500 
billion, more than a 10 percent cut per year in Medicare over a 10-year 
period of time, it took to create this new entitlement program.
  The Medicare actuary has actually written that the Medicare cuts 
cannot be simultaneously used to finance other Federal outlays such as 
the coverage expansion under this PPACA and to extend the Medicare 
trust fund.
  You can't pay for two things with the same amount of money. Indeed, I 
wish we could. Then maybe folks wouldn't have to be on food stamps, as 
an example.
  The Congressional Budget Office, on that same point, wrote, Medicare 
provisions in the President's health care plan, quote, and, again, this 
is the CBO, ``would not enhance the ability of the government to pay 
for future Medicare benefits.''
  President Obama actually admitted in an interview, you can't say that 
you are saving on Medicare and then spending the money twice. That's 
what the President said. But that's exactly what the law does. It 
spends the same money twice, undermining, unfortunately, a great 
Medicare program that needs to be strengthened and protected. That was 
one of the promises broken, promises made, but not kept, as Dr. 
Barrasso, Senator Barrasso, pointed out.
  Let me add one more. This is No. 5 of the 10 that Dr. Barrasso 
mentioned in his white paper of last month from the policy committee on 
the Senate side. Candidate Obama said there was no need for a mandate. 
This is back in 2008 in that campaign against Senator Hillary Clinton.

  Candidate Obama opposed a mandate to buy insurance, and made it one 
of the hallmarks of his primary campaign. He claimed that penalizing 
people for not buying health insurance--listen to this, Mr. Speaker--
was like, and I quote, ``solving homelessness by mandating everyone buy 
a house.'' He said, President Obama, Senator Obama at the time, 
Candidate Obama, solving homelessness by mandating everyone buy a 
house.
  Well, this is like solving the uninsured problem by mandating that 
all the rest of us pay for health insurance for a lot of people that 
could afford to buy health insurance but just simply did not want it.
  I don't know how many millions of people make more than $50,000 a 
year or $75,000 a year that really didn't want, don't want, would 
rather pay as they go. I don't recommend it. Dr. Fleming doesn't 
recommend it, Mr. Speaker. We think they ought to have some minimal 
coverage and certainly catastrophic coverage; but this is their right, 
their liberty to choose if they want to not have that coverage.
  And President Obama's health care law, as we all know now, created an 
unprecedented Federal requirement for all citizens to purchase a 
product merely because they exist, because they're living and 
breathing. And not just a product. Under this bill when it's fully 
implemented in 2014, the minimal coverage requirement, as the gentleman 
from Louisiana pointed out, wouldn't allow them to, let's say, have a 
mini-med policy, as many of the franchisees do across this country in 
the fast-food industry.

                              {time}  2050

  They all had to be granted waivers. So here again, another promise 
made and not kept.
  I have a couple more that I'll get to maybe later on in the hour, but 
just to point that out. And clearly, the Supreme Court, I think, now 
understands much of that in the testimony they heard a couple weeks 
ago. So I'll yield back to my colleague and stick with him during the 
remaining portion of the time.
  Mr. FLEMING. Well, I thank my friend and colleague. I'll certainly be 
returning back to you for some more information that's very valuable 
information.
  I want to get back to and sort of recap some of the things I talked 
about, and that is that the taxes are tremendously increased under 
ObamaCare. Well, let's talk about the financing of ObamaCare. I'm just 
going to stick with the basics. There are a lot of ways it is 
theoretically financed, but I'm going to tell you maybe the three major 
ways that it's supposedly paid for.

[[Page H1908]]

  Well, number one, you heard my friend, Dr. Gingrey, say that 
ObamaCare actually takes over $500 billion--that is, over a half-
trillion dollars--from existing Medicare and uses that to subsidize the 
middle class health plans for people below a certain income level. 
We're going to get to that in just a moment--I'm going to draw your 
attention to this chart and talk about those subsidies. But not only 
does it do that, but as my good friend says, it's used to extend the 
life of Medicare.
  So this is basically how it works. The idea of the bill is it takes 
money out of Medicare and theoretically makes Medicare last longer--
because it's running out of money--by taking the same money out of the 
middle and putting it at the end. I don't understand how that can work, 
but that's the way it works. That would be sort of like taking money 
out of your paycheck in the middle of the year and somehow living on 
nothing for about 3 months, and then going back to what you took out 
and paying at the end. It makes no sense.
  Not only that, but it takes the same $500 billion--and we've really 
honed down on this in our committees, and Secretary Sebelius had to 
admit that this was true--it takes the same $500 billion that's used to 
prolong the life of Medicare to subsidize middle class health plans. I 
don't know--where I come from in Louisiana, we can't spend the same 
dollar twice. You can spend it place A and place B. If my kids want to 
go to the movies or they want to do some entertainment, or maybe they 
need money for their education, I can give it to them, and they can 
spend it one time. They don't get to use the same dollar twice. And 
folks, neither can your Federal Government. So that is really smoke-
and-mirrors accounting. We've called them out on it, and they've really 
basically admitted that's true.
  But then another way that ObamaCare is paid for is by over $800 
billion in taxes in 10 years, which I've gone over a number of these, 
and I'm going to get back to them. It really is not paid for. And we 
know, we're getting estimates now showing that as much as 300 to $500 
billion is going to be added over the next 10 years in deficits, total 
debt in that period of time. So it is not paid for. All of these steep 
taxes, all of these smoke-and-mirror types of accounting are not going 
to work.
  Furthermore, half of the people who are going to get health care 
coverage cards that they wouldn't otherwise get are going to be on 
Medicaid. Today, Medicaid pays on average about 60 percent of what 
Medicare pays to health care providers, which is already too low. So 
what is the chance that 15 million Americans are going to come newly on 
the rolls, and they're going to carry a card around that pays less than 
what the doctor can afford to accept to even cover the cost of that 
care, or otherwise go out of business, what's the chance they're going 
to find doctors? So what we'll have is a drop in the number of 
physicians, a steep rise in the demand in health care. And so these 
people will all end up in emergency rooms.
  To my colleagues, it's one thing to have coverage in health care. 
It's another thing altogether to have access to health care. All you 
have to do is look at other countries that have socialized health 
care--Great Britain, Canada, and many others, and even go to the 
extreme steps of Cuba and North Korea--they all have coverage, and it's 
free. The problem is there's no access to it. There are shortages. 
There are waiting times, as much as 1 year, 2 years to get a CT scan. 
People are dying as a result of that, and they show up in their 
statistics.
  The death rates, for instance, from breast cancer and prostate cancer 
in the United States are much lower than they are in Canada and Great 
Britain. They have access to the same medications and the same quality 
physicians. The only difference is their health care systems 
themselves.
  So let's get back again. I want to really focus on this topic for a 
moment before I yield time to my friend. And again, back to this idea 
that many of the taxes are going to be placed upon wealthy Americans in 
order to pay for ObamaCare. And I'll just step back through them again. 
There is a 40 percent excise tax on so-called ``Cadillac'' health 
plans, which would be health plans valued in excess of $10,200 for 
individuals, $27,500 for families. Those thresholds will grow annually 
by an inflation rate of 1 percent, which is about a third or less of 
what it really is.
  So what that means is that, as ObamaCare unfolds, having an expensive 
gold-plated Cadillac health care plan, you're going to get taxed 40 
percent more for having it. Well, maybe that's justified. But remember 
that after a few years, that will not be an expensive, gold-plated 
plan; that will be an average plan, and you will again have to pay the 
same 40 percent excise--bracket creep is what they called it back some 
years ago, and I think it applies here today.
  Now, again, increases in Medicare hospital insurance. That's a 
payroll tax on people who make $200,000 a year individually, $250,000 
as a couple, again, only applying to people who are in that $200,000-
plus range. And then, of course, I told you the 3.8 percent tax on your 
investments that are sold for those who, again, make $200,000 or more.
  Again, we go back to it. Remember the alternative minimum tax. 
Remember the luxury tax. Remember the tax that was placed on oil, the 
so-called ``windfall'' taxes. Ultimately, those taxes all fell to the 
middle class and below. Those are the ones who were burdened with them 
and why most of them have been repealed. We would repeal the 
alternative minimum tax if we could find a way to actually pay for it 
now because we're spending at a level that we can't afford to repeal 
it, unfortunately.
  So here is this chart, which is very important in this whole 
discussion. Under ObamaCare, there is an income threshold for receiving 
subsidy. So if your income is just below $100,000 for a family, a 
married couple--and I believe that is a family of four total--if you 
make less than $100,000, or about $95,000 here, you'll get some kind of 
subsidy beginning in 2012, 2013. However, that subsidy, that line 
continues out all the way indefinitely, well past 2062 and before. Now, 
if you make $90,000 or less than $90,000 today, with inflation in those 
out-years--5 years, 10 years, 20 years, 30 years--you will break 
through this threshold. So you will not get the support, the subsidy in 
your health plan in those out-years. You'll get it early so that you 
think you're getting something, but ultimately that's going to 
basically go away, and you will not get that subsidy.
  Now, also, if you make $200,000 or $250,000 a year, you will be the 
one paying in for those who need this subsidy. But you see this line 
comes down because people who make $200,000 today, in 2022 they will 
still get a check that will say $250,000, but it will be more like 
$180,000 in today's dollars. With each year, it ratchets it down until 
finally you get to about 2042, or 2050, in that range. So a check today 
that says $200,000 on it will buy equivalent to something like $90,000 
in those years because inflation devalues the actual currency that you 
hold.
  So what you get is a crossover point where you see the subsidy 
threshold gets higher and higher. You've got to make more and more 
money to get that subsidy. But even though your income is the same, or 
going down, you actually drop out, and you get a crossover point. Where 
here, even though you're making $200,000 or $250,000, you're making too 
much for the subsidy, but you're not making too much to be taxed. And 
that is the problem.

                              {time}  2100

  Ultimately, over time, ObamaCare begins to take the subsidies out for 
those who are middle class and lower, and it begins to add taxes on 
those who are middle class and above. That is very destructive, my 
friends. That's the way you end up with socialized health care and with 
the kind of system that is working so poorly in many other countries.
  We still have time to discuss some of these issues further, so I 
would ask my good friend from Georgia, Dr. Gingrey, to elaborate on 
some of his points tonight.
  Mr. GINGREY of Georgia. Mr. Speaker, continuing on the line of 
reasoning that Dr. Fleming just outlined in talking about not indexing 
these benefits for inflation, in fact, another thing that needs to be 
pointed out is that under current law in creating these exchanges and 
in trying to help people

[[Page H1909]]

who are uninsured because it's not affordable to them, we, the 
taxpayers, are going to subsidize people who purchase health insurance 
on these State exchanges even if they make up to 400 percent of the 
Federal poverty level. For a family of four, that's $85,000 to $90,000 
a year. If John Q. Public knew that we were forcing them to subsidize 
the purchase of health insurance for people making up to $90,000 a 
year, they would be appalled; but that, in fact, is the case.
  In just continuing with what my friend from Louisiana was talking 
about, the other thing is that the law also expands the Medicaid 
program. Some States in past years, when times were better, were 
covering people on the Medicaid program at more than 100 percent of the 
Federal poverty level--indeed, some up to 185 percent or maybe 225 
percent of the Federal poverty level when they could afford it. Yet to 
actually say in times like these that we are going to force the States 
to cover people up to 133 percent of the Federal poverty level when 
they can barely afford to cover at the 100 percent level is an unfunded 
and, probably, unconstitutional mandate.
  Mr. Speaker, as you know and as my colleagues know on both sides of 
the aisle, this was part of the argument before the Supreme Court, as 
was that more publicized argument against requiring individuals to 
engage in commerce under the rules of the Commerce Clause. So that's a 
huge problem. As Dr. Fleming points out, it will become even more of a 
problem because it's not indexed for inflation, and you will have more 
and more people being subsidized.
  I want to get back, though, if the gentleman will allow me a little 
bit more time, to those failed promises that I discussed a little 
earlier.
  In the Republican health care policy report from orthopaedic surgeon 
and Senator John Barrasso, which he put out just last month, let me go 
straight to No. 10. We mentioned a couple. This is broken promise No. 
10. Get this, colleagues, and this is a quote from President Obama, our 
44th President: These negotiations will be on C SPAN.
  Candidate Obama promised to televise all health care negotiations on 
C SPAN. The process that created the President's health care plan was 
plagued, unfortunately--and it wasn't on C SPAN--with backroom deals 
like the Cornhusker kickback, Gator aid and the Louisiana Purchase, 
cutting special deals with Senators from certain States. You don't have 
to be a genius to figure out what those three States are.
  The President, indeed, even conceded the process--and he said--
legitimately raised concerns, not just among my opponents but also 
among supporters, that we just don't know what's going on; and it's an 
ugly process, and it looks like there are a bunch of backroom deals.
  Mr. Speaker, there were a bunch of backroom deals, and I think our 
colleagues are aware. We got a memo today from my committee, which is 
the Energy and Commerce Committee, and particularly from the 
Subcommittee on Oversight and Investigations. We have been trying for 
almost 2 years--the committee staff on Energy and Commerce and on the 
Subcommittee of Oversight and Investigations--to get information from 
the White House about all of these backroom deals that were cut, 
negotiated, during the process of getting buy-in from stakeholders that 
everybody in the country would recognize.
  Now, I'm not pointing fingers or saying that anybody necessarily did 
anything wrong; but there is our own American Medical Association, the 
American Hospital Association, America's Health Insurance Plans, AARP, 
which represents 37 to 40 million seniors, and all of these advocacy 
stakeholder groups in these back rooms. Promises were made, and there 
were policy changes in the law in exchange for something special for 
them. Again, Congressman Fleming talked about sausage-making and the 
legislative process, but the President promised that all of that would 
be out in the open. Indeed, he said it would even be televised on C 
SPAN. Here again, that's promise No. 10.
  That's all we're asking from the White House, from the Office of 
Health Care Reform--I think Deputy Chief of Staff Nancy-Ann DeParle was 
a director of that effort in the White House--and they have done 
nothing for the last 2 years but stonewall. We are going to continue to 
ask for documents of what went on behind closed doors so that we the 
people, the American people, can understand how this possibly could 
happen, what we now know are the unintended consequences.
  Dr. Fleming has pointed out in his presentation and in his slides 
with regard to the taxation and with regard to people thinking that if 
they like their health insurance they can keep it, only to find out 
that they can't. Whether they're on Medicare Advantage or whether they 
get their health insurance from an employer or whether they're working 
and paying $15 to $20 a week for a minimal coverage plan that has 
catastrophic protection without waivers, all of those plans will be 
taken away from people even though they like them.
  So, again, the problem is unbelievable, and the unintended 
consequences are unbelievable. Unfortunately, you'd better believe it, 
because it has happened.
  Mr. FLEMING. Would you touch a moment, Dr. Gingrey, on the fact that 
while we're trying to expand coverage and all of those things that 
there will actually be people who will be pushed off their coverage of 
the health care they have today, such as by their employers. Would you 
expound on that.

  Mr. GINGREY of Georgia. I thank the gentleman for pointing that out, 
because the law very specifically says, if you employ 50 or more 
people, then you are going to be required by the Federal Government to 
provide for them a health insurance policy. Again, this is not just any 
health insurance coverage, but the one that the Federal Government, the 
uncle, demands that you provide.
  By the way, we will be voting on a bill, Mr. Speaker, on Thursday on 
this House floor--we, the Republican majority. It is a bill introduced 
by House Majority Leader Eric Cantor, the gentleman from Virginia, to 
cut by 20 percent the taxes on those small businesses; and 30 percent 
of them are probably, in fact, owned and operated by women. To give 
them the opportunity to hire people and to stimulate the economy, that, 
in a way, is another subject, but in another way, it's actually the 
same subject, is it not?
  Mr. FLEMING. Yes.
  You say that the threshold is 50 employees and that they lose certain 
subsidies or certainly face more penalties or costs after 50. What is 
the chance that a small business that has 49 employees will dare hire 
another employee?

                              {time}  2110

  Mr. GINGREY of Georgia. That is exactly the point. They won't. If 
they've got 49 employees and they really need 53, they'll probably hire 
eight more--or whatever the math is--as half-time people with no 
benefits because they can't afford to cover their health insurance. It 
is a job destroyer. It's not a job creator.
  Then the other situation, of course, is for those that employ 
significantly more than 50. Maybe they've got 1,000 employees. Mr. 
Speaker, these companies are going to look at the mandated cost of 
coverage under ObamaCare, and they are going to say, You know what? Our 
bottom line will be a lot better if we just pay the darn fine.
  I think the fine is about $2,000 per year per employee that doesn't 
have health insurance coverage provided by them. And if they do provide 
the coverage under ObamaCare, as Dr. Fleming points out, Mr. Speaker, 
today that would be $12,000 a year probably for a family policy, but 10 
years from now, it could be $18,000 a year. The only groups that are 
held harmless from that in the taxation of these so-called Cadillac 
plans are guess who? The unions, organized labor.
  These are all good points that people need to understand, the 
unintended consequences of the Federal Government trying to meddle in 
the marketplace and treat health care--one-sixth of the economy--just 
like it's any other business. You can't do that. The American people 
know it and they hate it.
  Mr. FLEMING. I thank the gentleman. Again, great points.
  Estimates are as high as 20 million Americans who are on insurance 
today through their employers, happy and satisfied with the coverage 
they have,

[[Page H1910]]

that will be pushed off. Why? Because the employer, the business will 
find it at least financially reasonable and perhaps beneficial to just 
pay the fine, push the employees out into the marketplace, make them go 
into the exchanges and force them to have to deal with the realities of 
ObamaCare.
  I know that people hearing me say this would say, Well, that's 
coldhearted. If you really love your employees--and I have a small 
business and we employ considerably more than 50 employees, and I love 
my employees and I want them to have the best possible coverage. But 
look, if I have a competitor out there who can lower his cost by 
pushing his employees out and paying a penalty and then I go and do the 
right thing and pay that, then he's going to be able to sell his 
product at a lower price than me. That puts me out of business. Now not 
only do my employees not have health insurance, they don't have a job.
  Back to this 50 threshold. Any time you have a law in the United 
States that penalizes an employer for hiring above a certain level, 
that is a terrible law by itself. It is disincentivizing an employer 
who is going to say, Well, I'm not going to grow my business. If I 
can't grow it by leaps and bounds and take tremendous risk and in the 
process bring in so much money to cover that incremental cost of health 
care, I'm not even going to try it. In fact, I may just close my 
business down altogether.
  In the remaining moments we have--and I'll be happy to give Dr. 
Gingrey even further time to add some additional comments--I just 
wanted to go back again to this broken promise that was mentioned 
before both by Dr. Gingrey and myself, ``I will protect Medicare,'' 
President Barack Obama, September 2009. He promised he would protect 
Medicare.
  Where are we today? The Republicans, through the Ryan plan, a very 
good plan, a very good budget, have a solution that will make Medicare 
sustainable for an indefinite period of time. The Democrats in the 
House say, No, we're not in for that. We're not in for anything. We 
have no ideas.
  I'll remind folks in this body that the actuaries, the CBO, and all 
of the authorities tell us that Medicare runs out of money, becomes 
insolvent, becomes bankrupt in 4 to 8 years. So it's time that somebody 
comes up with a plan. We have a plan. We had one this year. We had one 
last year. We modified it a little bit to make it one that, I think, 
Democrats could accept, and they still have not signed on to it; 
although, we have one Democrat in the Senate who has, so it is 
bipartisan. But the President made the promise and the Republicans in 
the House are trying to keep it, and Democrats will not go along with 
that.
  Again, to recap: ObamaCare cuts as much as $575 billion from the 
Medicare program; $200 billion from Medicare Advantage, which is a 
private form of Medicare that many Americans enjoy and love. It forces 
over 7 million seniors out of their current Medicare plan. Fifteen 
percent of hospitals, nursing homes, and home health will close because 
of Medicare paying less under ObamaCare.
  Again, you can't cut out over $500 billion without cutting out 
reimbursements for something, and that's where it's going to be. It's 
going to be hospitals, nursing homes, home health agencies, and many 
other types of services that Medicare provides.
  The CBO estimates that Medicare prescription drug coverage premiums 
will increase by 9 percent as a result of ObamaCare. Mr. Speaker, this 
is not a tax. It's not an expense just on the wealthy. It hits the 
middle class and the poor as well.
  Finally, the CMS actuary projects the Medicare program could be 
bankrupt, as I mentioned before, as early as 2016. Medicare costs are 
projected to grow substantially from approximately 3.6 percent of the 
size of our economy, the GDP, in 2010, to 5.5 percent by 2035. That's 
the Medicare trustees.
  The physician payment formula in Medicare needs to be fixed or 
seniors may lose their doctors. It costs $316 billion. We're hearing 
all over America about physicians who are beginning to back away from 
seeing Medicare patients. Not because they don't want to, not because 
they are not willing to sacrifice, but because if they do, they go out 
of business and they can't make it. Already access is an issue because 
of money problems. Twelve percent of physicians stopped seeing Medicare 
patients due to the broken physician formula that we have and that 
cannot be resolved and our friends on the other side refuse to address.

  In our closing moments, I would be happy to yield to the gentleman, 
if he has any comments.
  Mr. GINGREY of Georgia. Mr. Speaker, I thank my colleague.
  I did want to make one other point. Actually, our colleague on the 
other side of the Capitol in the Senate, Senator Tom Coburn, OB/GYN and 
family practitioner, a great physician from Oklahoma--I hate that he's 
retiring at the end of this term. He has been a fantastic contributor 
to this debate. He has pointed out recently, Mr. Speaker, if people 
think that once the Medicare, the hospital insurance trust fund becomes 
insolvent, whether it's 2016 or 2020 or 2024, at the very latest, that 
doctors cannot be paid on their Medicare claims, their hospital part of 
Medicare, even if the Federal Government wanted to honor those claims 
because the trust fund is insolvent and pay those claims out of the 
general treasury as Dr. Coburn correctly points out, they cannot do it. 
And yet we are whistling past the graveyard, fiddling away while Rome 
is burning. That's what we're getting out of this administration.
  Mr. FLEMING. That's very important, because what I'm understanding 
you saying is that if the trust fund becomes insolvent and there are 
checks going out to physicians across America, we can't just connect a 
line over to the general budget and say we're going to cover the bills. 
No, they don't get paid. Checks will bounce. This is a problem that 
must be solved.
  So to recap in the final moments that we have--and I want to thank my 
good friend, Dr. Gingrey, for joining me this evening. We really have a 
strong group of physicians and nurses and other health care workers in 
the GOP Doctors Caucus. We hope to be joined by some more next year as 
a matter of fact. We feel like the physicians are a strong force in the 
U.S. Congress, not just because they know and understand the health 
care economy, which is very unique, but also because physicians are 
unique in a way that we want to make a diagnosis and we want to treat 
and we want to cure. We're not about kicking the can down the road. We 
want to cure the disease or solve the problem and move to the next one, 
and so the more physicians we have here, I think we will.

                              {time}  2120

  But again, I want to just reiterate for my colleagues that just 
because you have a card that says you are entitled to care in the 
United States does not mean you have access to it. I want to reiterate 
that. Just because you have a card, just because you have coverage does 
not mean that the doors will open for you, and this is where our 
colleagues, I think, are misguided on the other side.
  ObamaCare is all about giving coverage, all about giving cards to 
people, but it does not protect their access to care. Because, in fact, 
under their system, which is basically based on a socialized model, the 
only way that the government will be able to afford it, and taxpayers 
in general, will be to create long lines, create shortages, and say 
``no,'' to be traffic cops to people.
  And you know what? The parts of our health care system today that are 
government-run, already before ObamaCare, we are already seeing spot 
shortages; chemotherapeutic agents, injectable drugs, that are 
otherwise not expensive, but because of the quirks of this socialized, 
government-run, highly bureaucratic system, we're finding that the 
manufacturers can't make them because they don't get enough 
reimbursement to cover their cost.
  So what happens is they slow down, or stop making them altogether, 
and we have diseases and cancers out there today where physicians are 
scrounging around looking for the correct chemotherapeutic agent which 
would cure their disease, and it's very inexpensive and has been around 
for many years, and we have to even look to other countries to supply 
that.
  With that, I look forward to our next GOP Doctors Caucus. I always 
enjoy this. I hope that those in this Chamber

[[Page H1911]]

who listen to this find it at least somewhat informative.
  Mr. Speaker, I yield back the balance of my time.

                          ____________________