[Congressional Record Volume 159, Number 63 (Tuesday, May 7, 2013)]
[House]
[Pages H2463-H2470]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      DOCTORS' CAUCUS: HEALTH CARE

  The SPEAKER pro tempore (Mr. Cramer). Under the Speaker's announced 
policy of January 3, 2013, the gentleman from Tennessee (Mr. Roe) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. ROE of Tennessee. I thank the Speaker. The hour we are going to 
spend with our Physicians' Caucus is going to be on health care today. 
I'm joined by numerous colleagues here on the House floor from the 
Doctors' Caucus to discuss this extremely important issue.
  When I was elected 4 years ago to the House, one of the burning 
issues at that time was health care reform in this country, and the 
greatest problem with health care in America was the cost. Certainly I 
could see it every day. I practiced for 31 years as an obstetrician-
gynecologist in Johnson City, Tennessee, a small town in northeast 
Tennessee. I saw where it was becoming harder and harder and harder for 
my patients to afford care. The major problem was that.
  Number two, we had a problem with access. We had working people out 
every day. Maybe one was a carpenter, maybe the wife worked at a local 
store that didn't have health insurance coverage. Together they made a 
living that was livable in northeast Tennessee, but certainly not 
enough money to pay $1,000 or $1,500 a month for a health insurance 
policy.
  Thirdly, we have a liability crisis. When I began my practice, I 
thought about it, I began in 1977. I know this is hard to believe, but 
we would take care of a woman who was pregnant for 1 year and see her 
for a 6-week checkup and stay as long with her as we needed to when she 
was in labor, and that cost was $360. And if you had a Caesarean 
section, it cost another $100. So it was very affordable. Even young 
families could come in and make payments and pay for it. The hospital 
bill was more than that, but it certainly wasn't the exorbitant prices 
that we see today.
  The malpractice premium I first paid, and obstetricians and 
neurosurgeons and others are very high risk, was about $4,000 a year. 
Five years ago when I retired from my practice to run for Congress, the 
malpractice premiums had ballooned to the mid-$70,000s, and the 
patients didn't get anything more for that. They didn't get better 
care. They just got a higher bill. It didn't improve the quality of 
their care. So we can see, number one, cost.
  I remember when we had the debate down here. I stood in the well of 
the House the night we debated that bill, in March of 2010, to vote on 
it. I was one of the last people to stand down here, and I remember the 
President's remarks: If you like your health insurance, you can keep 
it. And your costs are going to go down by $2,500.
  Now 3 years later, let's see what the reality is. Many of us here in 
the Doctors' Caucus brought decades, and I do mean decades. I look 
around, and I wish each speaker as they step up, would tell how many 
years they practiced medicine. You'll see the experience that's on the 
floor today. So what happened was the cost has gone up; it didn't go 
down. And I'm not even sure after this is all implemented that access 
is actually going to increase because as we discuss during this hour, 
you'll see that for some people there's more access, but for others it 
may be cut off; and I think it was unintended. I don't believe that 
they wrote a bill to actually do that, to actually cut access. But I 
think the reality is it's going to happen.
  Before I continue, I want to introduce one of my colleagues, Dr. Phil

[[Page H2464]]

Gingrey, who is in the well today. Dr. Gingrey and I are both OB/GYN 
doctors. He is from Georgia, and a good friend. Dr. Gingrey, I yield to 
you.
  Mr. GINGREY of Georgia. I thank the gentleman from Tennessee for 
yielding, my physician colleague and cochairman of the House GOP 
Doctors' Caucus, several of whom are here on the floor in the House on 
this Special Order hour to discuss the impending train wreck that Dr. 
Roe referenced.
  Mr. Speaker, it is not just Dr. Roe's words, but it is almost a 
direct quote from the chairman of the Senate Finance Committee, Senator 
Max Baucus. I don't know how many years Senator Baucus has served, but 
he has been chairing that committee for many years. And, of course, the 
Senate version of ObamaCare was essentially written by Senator Max 
Baucus and his senior staff of the Senate Finance Committee.
  So of those 2,700 pages in that final bill that we saw President 
Obama sign as his legacy, ObamaCare, on March 25, 3 years ago, the 
Senator knew everything that was in that bill. And just last week, 
there was a hearing on the Senate side, the Senate Finance Committee 
asked the secretary who is in charge of the rulemaking. You know, after 
a piece of legislation is passed, Mr. Speaker, then come the rules.
  Well, I don't know how high 2,700 pages stack, but the rules stacked 
7 feet tall. In fact, Senator Barrasso was doing a Special Order 
recently or a press interview, and he is 6 feet tall and he's standing 
next to these rules and regulations that came through the Department of 
Health and Human Services, led by Secretary Kathleen Sebelius, and 
they're 7 feet tall. I don't know whether it was 40,000 pages or 
400,000 pages, but it was a big number.

                              {time}  1520

  What I'd like to point out to my colleagues before yielding back to 
my good friend from Tennessee so he can yield to some of the other 
doctors who are members of the House GOP Doctors Caucus, I want to 
point out, colleagues and Mr. Speaker, this poster. And I give credit 
for this poster to Representative Kevin Brady from Texas, a senior 
member of the House Ways and Means Committee.
  I was speaking with Congressman Brady a little earlier this morning, 
and I said, Kevin, I'm going to use your poster today because we're 
doing this Special Order because of this impending train wreck--the 
words of Senator Max Baucus, Democratic Chairman of the Senate Finance 
Committee, not just Dr. Roe's words--and I said I was trying to count 
real quickly how many new bureaucracies, agencies--not number of 
people, mind you, but, literally, new agencies--of the Federal 
Government, talking about expanding the Federal Government and taking 
over one-sixth of our economy, which is health care. Pretty soon it'll 
be a fifth, and pretty soon it'll be a fourth as we continue to go 
broke.
  But Kevin told me, Representative Brady told me, 159. I didn't have 
time to count them all. But in the center, of course, my colleagues, 
you can see the Secretary of Health and Human Services, and today 
that's Ms. Sebelius. Tomorrow it could be somebody else.
  But, I mean, the whole point is it is a train wreck. And this law is 
going to be fully implemented, Mr. Speaker, on the first day of January 
2014. Well, what is that? Here we are, May. That's 7 months away.
  And all of these exchanges that you're hearing about, colleagues, 
that many of the States have said, ``We can't do this; we're not going 
to do it,'' they're not even close to being set up. And yet people, the 
general public who doesn't have health insurance, can't get it from 
their employer or can't afford it, whatever reason, they are supposed 
to be able, on October the 1st, October the 1st of this year, 2013, to 
begin signing up for health insurance through those exchanges. But this 
is why they can't.
  This is a train wreck. I mean, these lines are not railroad tracks, 
but they could be. So I thought I would, colleagues, I would point that 
out to you. I think you all are aware of it.
  The gentleman from Tennessee is generous with his time.
  Mr. ROE of Tennessee. It reminds me, Dr. Gingrey, of biochemistry in 
college. Looks like the Krebs cycle, the sugar cycle. It is incredibly 
complicated, this bill is, and I think we need to spend more time 
explaining it to the American people.
  And one of the frustrations, Dr. Gingrey, that I've had is that I've 
read the bill, as you have, as many of us have, probably all of us have 
in the Doctors Caucus.
  I went to a hearing the other day on the Veterans' Affairs Committee 
on which I serve. We spent 2 hours and 15 minutes explaining the 
effects of the Affordable Care Act on veterans with Dr. Petzel, who is 
the medical director of the VA. The IRS, the Treasury Department was 
represented. And when we walked out of that room, I don't think anybody 
could explain to you the effects of the Affordable Care Act on our 
veterans.
  Mr. GINGREY of Georgia. If the gentleman will yield back quickly.
  Mr. ROE of Tennessee. I yield to Dr. Gingrey.
  Mr. GINGREY of Georgia. My colleagues, the IRS is just right up here. 
That's 15,000 new IRS agents to make sure that the poor people have 
purchased health insurance or they're going to get taxed. Right?
  Mr. ROE of Tennessee. Correct.
  I now yield to my good friend, Dr. Andy Harris from Maryland One. And 
Dr. Harris serves on the faculty of Johns Hopkins University. He's an 
anesthesiologist.
  Dr. Harris.
  Mr. HARRIS. Thank you very much. I want to thank my colleague from 
Tennessee.
  I've practiced for 28 years before coming to the body here 2 years 
ago. Part of the reason is because of what the gentleman from Georgia 
mentions, the train wreck, to use the Senator's term, the train wreck 
that's coming upon us.
  Mr. Speaker, the people in Maryland got a little rude awakening last 
week when BlueCross Blue Shield CareFirst, which is our nonprofit 
provider in Maryland, announced their new rates in the individual 
market on these exchanges that the gentleman from Georgia mentioned.
  Now, in Maryland we're going to have an exchange October 1. You're 
just not going to be able to afford to buy the insurance on the 
exchange because that nonprofit insurer announced that their average 
increase was 25 percent--25 percent increase in the already high cost 
of health insurance. And it ranged from a small savings in a small 
number of people to--and I want you to hear this number--150 percent 
increase for healthy young people, a 150 percent increase in the 
premium to the people who are supposed to make that decision to do the 
right thing and buy insurance.
  So this is the decision someone's going to be faced with coming out 
of high school or college, getting that first job, is: Should I buy 
health insurance? Maybe my employer no longer offers it because of the 
penalties that are in this bill and the mandates, so their employer may 
not offer it. Their choice is going to be: Should I do the right thing 
and get it?
  And now they're faced with a 150 percent increase in that cost. And 
that was supposed to be--as the gentleman from Georgia said, and the 
gentleman from Tennessee, we were promised more affordable, and it was, 
you could keep it if you have it.
  Well, let me tell you something. For that employee who's going to 
lose it because their employer can no longer afford it, they're not 
going to have it; and in Maryland, they're not going to be able to 
afford it.
  So I want to thank the gentleman from Tennessee for keeping this 
issue in front of the American people because there are going to be 
many more surprises like we got in Maryland coming out across the 
United States in the next few months as this train wreck comes upon us.
  Mr. ROE of Tennessee. I thank the gentleman.
  Dr. Harris, if you would stay there just a moment so that people 
understand: How could this possibly happen? How could young people--
which I have three children, and I think it's a good idea to keep our 
under-26-year-olds on. I think there were a lot of things we could have 
all agreed upon. But the thing that we didn't explain to people is: How 
did you get this number? Why did that happen?
  Well, here's why it happened. Young healthy people are going to be 
subsidizing people who are not as healthy and older. How does that 
happen?

[[Page H2465]]

  Well, this bill does not allow you--when actuaries look at it, they 
know that I'm six times more risky than someone who is my children's 
age, who is in their twenties. In other words, I've got six times the 
actuarial risk that they have. The bill only allows an actuary to 
charge 3 to 1.
  So a healthy young person that's 25--Dr. Harris and I were laughing. 
Having a son--and I know that he has a fine-looking young son. We know 
that you insure young boys for stupidity. They're going to go out and 
trip and fall and jump off things, but illness is not it. So we're 
taking young healthy men and women, 20 to 25 years of age, sometimes 
doubling and tripling their costs so that someone else's can be a 
little less expensive.
  Now, what would a young person do if all of a sudden they were going 
to pay $80 or $90 a month for a basic health insurance policy and now 
it's $300, or they can pay the first year a $95 fine, a $95 fine and 
they have guaranteed issuance, they cannot be turned away? There can be 
no preexisting conditions, so they can get the insurance. So what do 
you think these smart young people are going to do? They're going to 
figure it out pretty quickly. They're not going to subsidize that, and 
they're going to be very upset when they look at their first paycheck 
and realize what's happened to them.
  I yield to Dr. Harris.
  Mr. HARRIS. Thank you very much for yielding.
  And the gentleman has hit the nail on the head on this one. We want 
to encourage young folks to do the right thing and buy insurance. And 
in Maryland, our insurance was affordable for the young because we did 
allow appropriate risk to be priced.
  But the Federal Government--and by the way, we also had high-risk 
pools. Anyone with a preexisting condition in Maryland could not be 
turned away by the high-risk pool that was actually run by the State of 
Maryland. So we didn't have a problem with someone not being able to 
get insurance in the State of Maryland.
  But the Federal Government came in and fixed our problem in Maryland. 
Now, we didn't have one, but the result is going to be that all that 
risk that used to be in the high-risk pool which everybody paid a 
little bit for is now all on the backs of the person, the individual 
now going into that exchange to buy insurance.

                              {time}  1530

  Again, Mr. Speaker, a 150 percent increase in the cost of that policy 
for those young people just entering the workforce. These are the 
people who have big student loans if they've gone to college. They've 
got other costs. They've got the costs of raising a young family. And 
now, thanks to the Federal Government and to the President's Affordable 
Care Act, a 150 percent increase in the cost of their insurance.
  Mr. ROE of Tennessee. I thank the gentleman for yielding.
  I would now like to yield to my friend and colleague, a new Member, 
Dr. Brad Wenstrup from Ohio, near Cincinnati. Dr. Wenstrup also has 
served in Iraq in our military. I now yield to Dr. Wenstrup.
  Mr. WENSTRUP. I thank the gentleman for yielding.
  I would like to take a little time to discuss a portion of the 
Affordable Care Act known as the Independent Payment Advisory Board. As 
you look at this chart, it's one of the agencies that has been 
developed here on this chart.
  I'd also like to point out on this chart that right down here is the 
physician, and over here is the patient. It seems to me that all we're 
really trying to do is get the patient to the physician. It behooves me 
to be able to explain why we need all this in between when we are just 
trying to get a patient to the physician. I would also like to point 
out that I think at the center of our health care in America should be 
the patient, not the Secretary of Health and Human Services.
  But let's talk for a minute about the Independent Payment Advisory 
Board. Who are they? Who are these people? Well, they're actually 15 
unelected bureaucrats appointed by the President. To date, as this law 
is being enacted, no one has been appointed yet.
  What do they do? Well, they limit options. They limit care options. 
They limit access to care. They drive a wedge between the doctor and 
the patient, and they're responsible for denials of payment for certain 
types of treatment. I contend to you that really this is a wedge that 
we cannot afford if we are to have the best health care in the world, 
which we have been known to have.
  I would like to share with you a little story that I experienced in 
my 26 years as a doctor, as a surgeon. I had a patient who came in one 
time, and she explained to me that she's had a problem for 10 years. 
For 10 years she's had a problem, and she's had multiple treatments. 
She explained to me what those were. Between cortisone shots and 
physical therapy, she's had previous X-rays, she had paddings and 
strappings, different things that might put the painful area to rest 
and make it better, but none of it got better. They were all acceptable 
treatments, but for 10 years, they failed.
  So I said, Well, your X-ray looks normal. Have you ever had an MRI? 
She said, No. So I said, I don't want to repeat all the things that 
have failed. Let's go ahead and get an MRI and take a look inside.
  Well, later that afternoon, I get a call from the insurance company 
where I have to speak to a doctor about ordering this MRI. The doctor 
says to me, Why are you ordering the MRI? I explained it. And he said, 
Well, you've only seen her one time, so I'm not going to allow it. I'm 
not going to allow this to be ordered. I said, Well, maybe I've only 
seen her one time, Doctor, but you haven't seen her at all. You've 
never seen her. And I said, And you haven't taken the 10-year history 
that I have taken, and yet you're going to be deciding the care? I 
said, How can I get this patient to come and see you? The doctor said, 
Well, you can't do that. I said, Well, what's your specialty? He said, 
I'm an emergency room doctor. I said, Okay, fair enough. You would 
probably, in the emergency room then, refer her to a specialist, which 
is where she is today, and yet you, in your specialty, are denying this 
care.
  I went back and I explained this to the patient. But not until I said 
to the doctor, I said, I hope this call is being monitored for quality 
assurance because I want someone to hear what you said to me today.
  I went back to the patient and I said, You need to talk to your 
person at your work, your H.R. person, explain to them that you are 
being denied care and have them make a call to the insurance company.
  Do you know, the next day we got approval for that MRI. I was able to 
look inside, find out what was wrong and treat this patient, and within 
3 weeks, she was better. But the advice from the person who had never 
seen the patient was, You can't have that MRI.
  This is what we are dealing with today. At least in this situation we 
had the opportunity to have her work call the insurance company and 
make a case saying, You need to take care of this patient.
  But imagine when it is a government agency. What kind of recourse do 
you think that we will have between the doctors and our patients? At 
least in this case it was a doctor. The Independent Payment Advisory 
Board will not be made up entirely of doctors, and they will not have 
people on there from every specialty with knowledge about everything 
that comes across medically.
  So do we want a third party deciding who gets care? Frankly, I don't 
think anyone should have the ability to determine someone's care unless 
they have looked the patient in the eye, they have looked and they've 
discussed the options, and the patient and the doctor decide together. 
This is a dangerous course that we're on in America and in Americans' 
health care.
  Mr. ROE of Tennessee. I thank the gentleman.
  And before you leave, Doctor, I want to ask you a question. This is 
an issue that is very near and dear to my heart. I have a bill, H.R. 
351, which is to repeal the Independent Payment Advisory Board. When I 
read that health care law, this was not in the original version of the 
House version of the bill. This version came from the Senate version. 
The House version did not. And Representative Neal from Massachusetts 
wrote a letter to then-Speaker Pelosi, which I signed in a bipartisan 
way, to not put this in. It was included in this side.

[[Page H2466]]

  So to better understand, let me sort of go over just a minute and 
we'll talk about it in just a little more detail. I know you have 
another appointment, but there are 15 people on here, and only one of 
them may be a doctor. These are health care policy people. Basically, 
all this board does is to determine how Medicare dollars are spent. 
There's a preset budget in Medicare, and if you spend more than that, 
this board is charged to give the Congress, they have to cut. If they 
don't make different cuts, they have to make the ones that this board--
and that's how it's going to affect care.

  Guess where the cuts are coming from? They come from providers. And 
if you keep cutting the providers, you will lessen access. I've seen it 
happen, and I'll go through that after you leave. But that is exactly 
what's going to happen. If you don't believe me, simply read a New 
England Journal of Medicine article in June 2011. This is an article 
that is not for it or against it. It just analyzed it. It looked at the 
formula, and they looked back 25 years. In 21 of the 25 previous years, 
this would have cut providers.
  Guess what the Congress has been able to do? The Congress has been 
able to override those cuts in the SGR, the way doctors are paid 
through Medicare now, and prevent that loss of access. Without a three-
fifths majority in the Senate, we've lost that ability; we've given up 
our constitutional right for the people to come to us and say that we 
don't believe this is the way it ought to be going. It is a huge 
mistake.
  I believe in that poster of gibberish down there that you're looking 
at. It's the single worst thing in there because it will ultimately 
deny access for our seniors. I believe that in my heart of hearts. I've 
seen it in Tennessee with our TennCare program, which I'll discuss 
later.
  I will yield back to you if you would like to make any closing 
comments.
  Mr. WENSTRUP. Just in closing, I would just like to reiterate the 
importance of decisions being able to be made between a doctor and a 
patient, because that's what we expect, and that's what Americans 
deserve in their health care system.
  Mr. ROE of Tennessee. I thank the gentleman.
  He pointed out something that's clear from his statement down there--
he is and has been a practicing physician--because each of us know 
this, Mr. Speaker, that health care decisions should be made between a 
patient, the doctor, and that patient's family. It shouldn't be made by 
insurance companies. It shouldn't be made by organizations, ACOs, the 
government, IPABs and so forth.
  When you're in need, you see the person, the doctor most capable of 
taking care of your needs, and you make a decision based upon that 
between you and that family. We're losing that in this country with the 
doctor-patient relationship, and it is a very, very, very bad thing to 
happen.
  I would now like to yield to my good friend, John Fleming, from 
Louisiana. He is also a veteran and a three-decade family practitioner.
  Dr. Fleming.
  Mr. FLEMING. I thank the gentleman from Tennessee.
  Of course, all of us here today talking are physicians of different 
specialties. Most of us were actually here during the ObamaCare debate. 
We actually began that in 2009. It actually went in to law, it was 
signed into law March 23, 2010.
  The interesting thing about this law--the Affordable Care Act, which 
I refer to as the Unaffordable Care Act, but lovingly and 
affectionately known as ObamaCare--is the fact that what it does is it 
adds 15 million more Americans on to Medicaid, which already way 
underreimburses physicians, which means most doctors don't accept that 
as payment, and it adds another 15 million Americans to a system that's 
already stressed.

                              {time}  1540

  Ultimately, what's going to happen is you're going to have more 
Americans carrying more cards that entitle them to health care, but it 
really will entitle them only to a waiting line--a waiting list--just 
as we see today with Canada and Great Britain.
  Let's talk for a moment about the promises. You know, Washington, Mr. 
Speaker, has a reputation for making promises it can't keep, and indeed 
that applies to ObamaCare.
  First of all, the President said if you like your plan, you can keep 
it. Well, we know that's not true. We know now that you're going to get 
whatever plan and mandates that go with it, and you'll have to pay the 
cost that goes with it.
  ObamaCare will not add one dime to our deficits. The CBO has now come 
back to show that the early estimates were way out of line. It's going 
to add billions of dollars to our deficit, and I think that's really an 
underestimation.
  ``No Federal dollars will be used to fund abortions, and Federal 
conscience laws will remain in place.'' Federal conscience laws have 
been totally gutted. We know that, for instance, Hobby Lobby will be 
fined to the tune of millions of dollars as a result of its 
unwillingness to pay for abortifacients--that is, pills that can cause 
an abortion--and other things that are against the conscience of those 
who are in management and ownership there.
  President Obama said, ``I will protect Medicare.'' Well, if he's 
going to protect Medicare, why did he take $716 billion out of Medicare 
to fund ObamaCare? He says that's savings. Well, if we can save that 
kind of money out of Medicare over 30 or 40 years, why didn't we do it 
once? We didn't because we can't without changing it structurally. It 
will simply be cuts to services.
  ObamaCare will not raise any of your taxes. Mr. Speaker, ObamaCare 
includes 21 new taxes. And they're not just on rich people; about half 
of them are on the middle class.
  I'll just give you an example of one very nasty tax that's coming 
your way. If you're a business owner, there is a tax--3.8 percent--on 
unearned income, which includes capital gains, dividends, rents, 
royalties and interest, which means that you're going to get hit hard 
and very hard. And then also a device tax on revenues--not on profits--
which those who make everything from tongue blades to artificial hearts 
tell us will drive them out of this country into another country. And 
we'll have to buy back those devices, killing tens of thousands--maybe 
hundreds of thousands--of American jobs.
  ObamaCare will ``lower your premiums by $2,500 per family per year.'' 
Mr. Speaker, no one has told me their premiums have gone down as a 
result of ObamaCare. In fact, in most cases, it's gone up $3,000. 
That's a net of $5,500 change, and many of them are expected to double 
and even triple as a result of ObamaCare. You can't just keep adding 
mandates to insurance and expect not to have to pay for them. That's 
just the simple truth.
  What about IPAB? We heard some discussion about the Independent 
Payment Advisory Board, and it's really straightforward what they do: 
they take out of the hands of Congress our ability to find more 
efficient ways and ways to limit costs to Medicare patients. In fact, 
it's a 15-member board that's appointed by the President--not 
necessarily health care providers--who will have more power than 
Congress itself. It will actually be able to determine what gets paid 
for, how much it gets paid for, what type of doctors/providers will be 
paid for their services to Medicare patients. Mr. Speaker, that is 
absolutely the beginning of rationing and long lines for health care.
  One other point before I yield back. Let me quote something that's 
already been referred to today in our discussion.
  Senator Finance Committee Chairman Max Baucus, who helped author 
ObamaCare, before a hearing, out of frustration, he asked Secretary 
Sebelius, he said, we've got all kind of problems, aren't you going to 
help us on this? Here's a quote from Senator Baucus--who shortly after 
this decided to retire. He said:

       I am very concerned that not enough is being done so far. 
     Very concerned. When I'm home, small businesses have no idea 
     what to do, what to expect. They don't know what 
     affordability rules are, they don't know what penalties may 
     apply.
       I just see a huge train wreck coming down. You and I have 
     discussed this many times and I don't see any results yet.

  And we've yet to hear a good answer, a reasonable answer from 
Secretary Sebelius on how this has come together. We know that much of 
this has to be implemented really by October and finished by the first 
of January of 2014, and nobody knows what's going to happen, how it's 
going to happen.

[[Page H2467]]

  Business owners today are looking at, should they have 50 employees 
or less than 50 employees? What kind of penalties are they going to 
have to pay, which is not tax deductible. There is nothing but chaos 
across America among small businesses.
  Even parts of ObamaCare have already either been repealed or just 
simply dropped. The CLASS Act, long-term care, which was unworkable and 
is not going to help fund it. A very onerous 1099 tax reporting 
requirement has been dropped. So, little by little, this bill is 
beginning to fall apart. I'll just say, finally, that this train wreck 
not only is coming down, but the wheels are falling off the train.
  So with that, I would like to yield back to the gentleman and 
certainly stick around for more discussion.
  Mr. ROE of Tennessee. I thank the gentleman for yielding. And let me 
reminisce before I yield to my friend from Indiana.
  As a young medical student in Memphis many, many years ago in the 
late 1960s, my first pediatric rotation was at St. Jude Children's 
Hospital, a remarkable place. At that point in time almost 90 percent 
of children died of their disease. I would go in and start an IV, and 
Dr. Fleming, I can still remember seeing some of those kids, I knew 
they wouldn't survive. It was very hard for me emotionally to deal with 
that.
  Fast forward today, almost 90 percent of those children live today. 
And they are treated at no cost, their families are sent there at no 
cost. I've had children of patients of mine who have gone to that 
wonderful place. I hope that we don't end up in a Middle Ages in health 
care, with device taxes and disincentives for new medications.
  You and I both remember, when I graduated from medical school there 
were five or six anti-hypertensives, three or four of them made you 
sicker than high blood pressure did. Well, today there is a plethora of 
wonderful new medications to use for people. There wasn't a day that 
went by that I went in the operating room that I didn't see somebody 
that needed surgery for a bleeding ulcer--almost every day. It's 
unheard of now because of new medications.
  I just found out today, in my own State of Tennessee--and I did not 
know this--the largest thing that we export in the State of Tennessee 
is, guess what? Medical devices. It will hurt my State dramatically in 
jobs, as you clearly point out--and I know, Dr. Bucshon, in Indiana 
you're very concerned about that.
  You mentioned the IPAB. If the President right yet has not appointed 
anyone and no one is approved, or they don't have a quorum, they don't 
have at least eight people confirmed by the Senate, guess who makes all 
those decisions at the IPAB? One person. That's the Secretary. That's 
who makes all the decisions. Not the Congress. We have given up, this 
body--even though it may look funny down here with us debating and 
contentious, that's what we're elected to do. We are turning over that 
power--could be--to one single individual. It's Secretary Sebelius 
right now; there will be a different name 4 years from now. I don't 
want that person, be it Republican or Democrat--that power should be 
here.
  I yield to the gentleman.
  Mr. FLEMING. Your experience is exactly the same as mine when it 
comes to blood disorders, blood cancers, solid tumors in children. That 
used to be a death warrant when you and I were in medical school. 
Today, the vast majority of those children survive and live a happy 
life.
  Yet, what we see today is some of the oldest chemotherapeutic agents, 
some that are 60 years old--and of course the patents have run out a 
long time ago--are in severe short supply because, again, the heavy 
boot of government on the neck of industry that can't produce these at 
a rate that can meet up with demand. So it's important that we begin to 
pull back on this now, because we're going to be in the same situation 
as Canada and Great Britain, who have government-run health care, where 
early diagnosis, early treatment and using the best chemotherapeutic 
agents shows up in their statistics. Their death rates from cancer are 
much higher than ours are.

                              {time}  1550

  Mr. ROE of Tennessee. I thank the gentleman.
  Mr. Speaker, I would now like to take the opportunity to yield to my 
good friend from Indiana, a cardiothoracic surgeon, Dr. Larry Bucshon.
  Mr. BUCSHON. Thank you, Dr. Roe, for yielding. It's great to be here 
with many members of the Doctors' Caucus and again remember the focus 
of what we are trying to do here is focusing on the patient, what's 
best for the American people and our patients.
  It's already been quoted a number of times today--I've got a couple 
other quotes. Senator Schumer also said:

       The Affordable Care Act could cause rates to go through the 
     roof.

  That's exactly what we are seeing in the private health insurance. I 
won't repeat Senator Baucus' statement about a train wreck. But Senator 
Rockefeller also said:

       It's so complicated, and if it isn't done right the first 
     time and it's not being done at all, it will just simply get 
     worse.

  What I'm going to focus on now and the rest of the time is what this 
means to employers and people that have employer-provided health 
insurance and what this law is going to do to employers.
  Let me focus on first what the city of Long Beach, California, just 
came out and said recently. They are going to be limiting most of their 
1,600 part-time employees to fewer than 27 hours a week on average. So 
these are employees that had a 40-hour workweek and now they are being 
cut to less than 40 hours to comply with the law.
  You say, Why would that happen? Well, because city officials say that 
without cutting payroll hours, new health care benefits would cost up 
to $2 million more next year and that expense would trigger layoffs and 
cutbacks in city services. This is a city in southern California. This 
isn't an isolated event.
  Regal Entertainment Group, the Nation's largest movie theater chain, 
with over 500 movie theaters operating in 38 States, recently said they 
plan to cut many nonsalaried employees back to part-time to comply with 
ObamaCare.
  In a memo to company managers, Regal stated:

       To comply with the Affordable Care Act, Regal had to 
     increase our health care budget to cover those newly deemed 
     eligible, based on the law's definition of full-time 
     employee, which is 30 hours or above. To manage this budget, 
     all other employees will be scheduled in accord with business 
     needs in a manner that will not negatively impact our health 
     care budget.

  That needs a translation. The translation is: everybody is getting 
cut back to less than 30 hours, and they are going to see their income 
dramatically drop.
  There are other examples. The State of Virginia, Palm Beach State 
College in Florida, and CKE Restaurants, among others.
  I have an example in my district. We got an email the other day. A 
constituent said she and 52 other employees at a school district in my 
district in Indiana were recently informed that their hours will be cut 
to 28 hours a week because the school can't afford to comply with the 
health care law.
  Municipal government officials are telling me, city government 
officials are telling me in my district this may hit city government, 
municipal government, county government, and school districts. This is 
just people being cut.
  Now, let's talk about people losing their health insurance. Here's a 
chart right here that says we were promised that everybody could keep 
their health insurance. Here are some, what I consider, conservative 
estimates of the number of Americans who are going to lose their health 
insurance after full implementation of the law.
  Why is that? Well, because I talk to small business owners all the 
time who have more than 50 employees. I talked to one young man who has 
been very successful in starting a business and creating jobs. He says, 
Not only will I probably not be able to afford it and have to just pay 
the penalty rather than complying with the law, but I don't know a 
small business owner that I've spoken to--this is his words--that is 
not going to pay the penalty and not going to jettison their employee-
provided health insurance.
  All of those employees are going to be forced to go to these State-
based exchanges, which aren't set up and which are going to cost more. 
The gentleman

[[Page H2468]]

from Maryland just talked about that about half an hour ago. People 
aren't even going to be able to afford it, so employer-provided health 
insurance is going out the window.
  I think estimates like this are very conservative, according to the 
people that I've talked to.
  Mr. ROE of Tennessee. Will the gentleman yield?
  Mr. BUCSHON. I yield to the gentleman from Tennessee.
  Mr. ROE of Tennessee. Here is what absolutely amazes me about--and 
I'm glad Senator Baucus mentioned this as a train wreck. I wrote an 
editorial about it 3\1/2\ years ago describing the train wreck of 
TennCare. But that's not what I want to talk about.
  What I want to talk about, Dr. Bucshon, is we have people right now 
today, for instance, in Medicaid, a system that what did we do? We 
expanded a system that was already broken.
  If you look at surgical outcomes for Medicaid patients, they're 
worse. The outcome is a huge study--eight hundred and something 
thousand patients--done by the University of Virginia. Those outcomes 
were worse than people who did not have health insurance coverage.
  Why would you expand a program that's already broken? Why don't we 
fix that first? I know Dr. Fleming has talked about this at length.
  Mr. BUCSHON. I practice in southern Indiana where I get patients from 
southern Illinois, northern Kentucky, and southern Indiana. Every year, 
the Illinois Medicaid system ran out of money before the end of the 
year, September-October. They just ran out of money. No money for their 
Medicaid population.
  This is exactly what you are talking about, Dr. Roe, is that a system 
that is already broken and we are going to expand it. And what it's 
going to do is, like Dr. Fleming said, put a card in your pocket that 
says you have health insurance, but you don't have access to health 
care providers, except guess where. Through the emergency room, which 
is one of the biggest problems we are already trying to defeat.
  Mr. ROE of Tennessee. I've always thought this: Why do our lower-
income patients deserve different care than somebody else? They don't.
  Mr. BUCSHON. They don't.
  Mr. ROE of Tennessee. And they do not. They should get the same care 
and deserve the same care that anyone else has.
  Maybe the President when he said, I'll go over this bill line by line 
with anybody who wants to, maybe he should have taken that up with us 
and gone over it with the Doctors' Caucus line by line, because we came 
here in a totally nonpartisan way.
  Health care should not be a partisan issue. Dr. Bucshon has taken 
care of numerous cardiac patients with heart attacks. He doesn't know 
whether they're Republicans or Democrats. He could care less. They are 
just patients who need care.
  I yield back to the gentleman.
  Mr. BUCSHON. I would agree with that. And let me tell you, there are 
some things that we could have agreed on that we could have made some 
advances on in health care reform. Preexisting conditions, all of us 
agree.
  I had a patient that had Hodgkin's disease when he was in his 
twenties. He worked his entire life. He is now in his fifties. He 
needed bypass surgery. He was never able to get health insurance the 
whole time because of a preexisting condition. That's just wrong.
  Mr. FLEMING. Will the gentleman yield?
  Mr. BUCSHON. I yield to the gentleman from Louisiana.
  Mr. FLEMING. I just want to expand a moment on what you were talking 
about small business is critical. I'm a small business owner myself, 
apart from my medical practice. We employ around 500 employees. Many of 
them are entry level. Businesses and business owners across America, at 
this very moment, are in a state of panic. Mr. Speaker, businesses 
across the country are, at this moment because of ObamaCare, in a state 
of panic.
  The reason is because of what you said. They're calculating if they 
have more than 50 employees, they've got to ratchet below them if they 
can. They've got to know how much of the punishment--or penalty, I 
really should say, but it's more like punishment--they can absorb for 
those employees that they can't afford to pay for their insurance. This 
is having a direct impact on our economy and on job creation. This is 
something that's critical going forward what this is doing to small 
business, which, arguably, employs about 75 percent of Americans.
  Mr. ROE of Tennessee. I just spoke to a physician today from 
Massachusetts. He said what had happened there, and what's not clearly 
understood by the public--unless you're in this line of work you 
don't--is how the payers pay.
  Medicaid, for instance, pays about 60 percent of the cost of actually 
providing the care. Let's say private insurance is a 1. Medicare would 
pay about 90 percent.
  The people they added in Massachusetts paid about the same as 
Medicaid. What happened was big insurers, big corporations with lots of 
employees could negotiate a really good price, but small business could 
not. So when the hospital had bills to pay, they shifted those costs to 
private business, forcing their premiums up and up and up and up. 
That's why you are seeing those premiums for small business escalate 
until you really force them out of business.

                              {time}  1600

  We talk about the exchange, and what absolutely frustrates me is 
that, on the 1st of October--and this is a person who works in 
Congress, who is a doctor who understands health care--I can't even 
tell the people who work for me here in the Washington office and in my 
office back in the district in Tennessee what their health care 
premiums are going to be or how they're going to get their health 
insurance coverage, and that is 90 days from now I can't tell them. You 
can imagine what other businesses are going through. I can tell them 
this: that I bet it's going to cost them a lot more money.
  Mr. BUCSHON. Let me add a few final comments.
  Again, on the things that we can agree on, many of us agree on 
children up to age 25 or 26. A lot of us agree that we need to look at 
finding ways to expand the affordability of health care. Remember, this 
was supposed to bring down the costs. There are a lot of things that 
could be done to bring down the costs. There are a lot of things we 
could have agreed on, Dr. Roe, if we would have just worked together 
and not put in, what I would consider, a near government takeover of 
the entire system.
  I've been a practicing physician for 15 years, and if I count my 
residency, it's more than that. Imagine if you're out there as a 
physician today and you have to look a patient in the eye and you have 
to tell him, Well, I'm sorry. The IPAB told me that this is not 
statistically something that we can provide because, based on 
statistics calculated in Washington, D.C., it's not cost-effective for 
the Medicare system to provide this service anymore.
  This is going to happen, and I hope we all wake up in America and 
realize that it will happen. This happens in other countries that have 
government insurance. The Canadian system could not exist if it did not 
sit next to the United States. It's two-tiered. People come to the 
United States, if they have money, to get health care in a timely 
manner. The same thing is true in England. If you have money, you get 
private health insurance. If you don't, you wait for months. So this is 
bad for patients, and it's bad for business. There are things we could 
have done. It's a shame that we didn't and that we weren't consulted.
  With that, I want to thank the gentleman from Tennessee for this hour 
to talk about this.
  Mr. ROE of Tennessee. I thank the gentleman.
  It is ultimately about the patients that we take care of. Really, 
it's not about systems and organizations and insurance--it's about 
people. That's the frustrating part to me because I think people are 
going to be harmed by this.
  I know Dr. Fleming mentioned small business. I was in North Carolina 
last Tuesday, a week ago today, holding a hearing, which I hope we have 
time to go through maybe a little later, on small businesses and how 
this is going to affect them. It's really eye opening to see businesses 
that have done everything exactly right. Mr. Horn is someone I want to 
talk about in just a minute who provided health insurance--all 
preventative services. He is

[[Page H2469]]

self-insured. He did everything right. It shouldn't have cost him a 
nickel, and yet it is going to cost his business thousands of dollars. 
So we'll go into that.
  At this point, I want to yield some time to my good friend G.T. 
Thompson from Pennsylvania, who is part of our Health Care Caucus and 
who is a health care administrator.
  Mr. THOMPSON of Pennsylvania. I thank my good friend from Tennessee.
  What an important topic. As you have been, Dr. Roe, I have been out 
in the community throughout my congressional district, listening, 
sitting with individuals and families and businesses, a lot of small 
businesses. All indications are, at the very best, costs are going up, 
and there are so many questions that people have. Most is unknown, but 
what is known is very negative. It will have a negative impact on 
individuals and families and businesses.
  I'll be careful here because, as with scope of practice, I'm with a 
bunch of physicians. I know even as a former therapist and rehab 
services manager and manager in hospitals, I know not to diagnose, but 
I can't resist. I'm going to diagnose. ObamaCare is terminal. It is. It 
is going to fail under the crushing weight of its own flawed design, 
and all evidence points to that. I'm not going to re-plow the fields 
that you all have as to what Democratic Senators are admitting and 
acknowledging in going public, but many of us have held concerns about 
this law for some time, and I'm glad that some proponents of the law 
are now really finally speaking the truth on it.
  For example, this past week, on May 3, Investors Business Daily 
reported how retailers are slashing work hours in anticipation of the 
implementation of the President's so-called Affordable Care Act.

  I quote:

       Retailers are cutting workers' hours at a rate not seen in 
     more than three decades, a sudden shift that can only be 
     explained by the onset of ObamaCare's employer mandates.

  Opponents of this law haven't been far off the mark when it comes to 
predicting the harm this law would impose on the economy, and this 
week's report from the Investors Business Daily is just the latest in a 
long list of failed promises under the Affordable Care Act. I think 
about each new tax or regulatory mandate and about the number of 
regulations that came out under HIPAA, and those of us who were working 
in health care, we saw the cost that that added to care. Now multiply 
by over 100 the new bureaucracies that there will be--so it's HIPAA on 
steroids--and what that will do to crush the availability of affordable 
health care.
  The President's so-called Affordable Care Act becomes even more 
unaffordable for individuals, families and for businesses. I had the 
opportunity and the privilege of working for almost 30 years in health 
care, serving people facing life-changing disease and disability. I 
always followed four principles during my professional work, and 
they've guided me in health care here in that whatever we did to make 
changes in health care should decrease costs, increase access and make 
sure America always remains a place of quality and innovation, and it 
should be the patient who makes decisions in consultation with his 
physician. When I read that bill, it stood out to me that the language 
of the Affordable Care Act was going to violate those four principles, 
and we've seen nothing but evidence mounting that that is occurring 
today.
  In terms of cost, we've seen what happens to premiums, and the 
American people know that because they see what those premium costs are 
that are coming to them. It's beyond what their budgets can sustain, 
and it's much more than what they were paying prior to the signing of 
that bill. The fact is that there are more than two-dozen new taxes 
that are coming. I don't care who you tax in the end, there is only one 
person who winds up paying the tax, and that's the consumer in the end. 
So that's adding to their costs.
  It has redefined full-time employment to 30 hours. I have to wonder 
as, today, we have record unemployment and underemployment. How many 
more Americans are going to be pushed into underemployment? I know it's 
an unintended consequence, but if you're underemployed, how do you 
afford the costs of those increased premiums coming your way?
  Mr. FLEMING. I just want to put an asterisk to your comment about 
employment.
  We met with Mort Zuckerman, economist and editor of U.S. News & World 
Report. He says that much of the ``growth'' in jobs reports that you 
see is actually people reentering the job market, but they're actually 
getting part-time jobs instead of full-time jobs and, in some cases, 
getting a second or third part-time job so that we're actually seeing 
an inflation of the actual number.
  So ObamaCare--and I would argue Obamanomics in general--is actually 
taking us to not only an underemployed society but to an unemployed and 
underemployed society, and much of it is from ObamaCare.
  Mr. THOMPSON of Pennsylvania. I couldn't agree with the gentleman 
more.
  We talk a lot about and we hear a lot about unemployment numbers, but 
underemployment is a terrible story in itself. This, unfortunately, 
puts the wrong types of pressure on the business community to actually 
have people working part time, which is now anything under 30 hours and 
working two and three jobs in trying to make ends meet.
  Access, I said, was the second principle. The Affordable Care Act--
ObamaCare--has violated access from many different perspectives. You 
just look at the announcement in the past 2 weeks about the preexisting 
condition fund. That was one of the two target groups under which this 
piece of legislation was shoved down the throats of the American 
people, and that fund is depleted. It was so poorly designed that now 
the President appears to have no intention of doing anything with it, 
so it's leaving out all the folks with preexisting conditions.
  I think all of us would agree, in our vision of what we're to do in 
health care, that that is a group for which we want to try to find a 
way for them to be able to purchase affordable health insurance. Just 
because you're born with or develop a disease or a disability, it 
shouldn't keep you from coverage. ObamaCare is failing on that.
  The other one I would say is the expansion of Medicaid, which Dr. 
Bucshon did a nice job of capturing. We're going to put somewhere 
between 18 and 50 million Americans on medical assistance, and they're 
all going to get this nice card that says they have medical assistance, 
and they'll have it in their wallets or they'll have it in their 
pocketbooks.

                              {time}  1610

  But the reality is most physicians today will not accept a patient on 
medical assistance. So just because you have coverage, it doesn't mean 
you have access. The folks that wrote this bill clearly were clueless 
about the approach that we need to take. There are things out there 
that we should be doing, and I think those are things that we can agree 
upon.
  Finally, quality and innovation. The excise tax is going to stymie 
innovation and quality that we've enjoyed here in this country. With 
regards to patient choice, I just come back to one thing among many, 
the Independent Payment Advisory Board. The Independent Payment 
Advisory Board is where you've got a group of bureaucrats appointed by 
the President that will make decisions about which procedures are 
approved by Medicare.
  Medicare is an area I worked very closely with. Actually, after the 
Balanced Budget Act of 1997, I was asked to serve on a technical-expert 
panel to review prospective payment for Medicare. This Independent 
Payment Advisory Board is going to determine and give a blessing of 
``yes'' for that procedure and ``no'' for that one. That's not patient 
choice. That's being dictated to by bureaucrats who are unelected and 
therefore unaccountable.
  Let me close very quickly.
  You meet a lot of people that have been impacted by this early. There 
was one woman in particular who lived her whole life planning her 
retirement and was so looking forward to it. She is a smart lady. She 
had laid her plan out. She had worked for a company. Part of her plan 
was health care, what was going to be affordable. She had her company 
plan and had invested, and

[[Page H2470]]

then it was announced that the employer was going to switch over and 
put them into the exchange with the retirees.
  This woman spent most of her adult life taking care of a brother and 
a sister who were less fortunate in life and needed a family member to 
step up and be there. This woman's retirement plan has been totally 
crushed by ObamaCare, and she's concerned now. As a smart lady, she 
went out to get some estimate of what it was going to cost her in her 
retirement now for health care compared to what it was before. It's 
completely unaffordable. So does she choose health care, or does she 
choose to still be there for her brother and her sister who have come 
to rely on her? I think there's many of those stories.
  Mr. ROE of Tennessee. I thank the gentleman.
  As we finish, I want to go over just a couple of things. One of the 
things the Secretary stated, Dr. Fleming and Mr. Thompson, is that she 
needed to use some money, and the prevention fund was one of the things 
she was going to use to help implement the exchanges. We've now had 
prevention funds used for massage therapy, kickboxing, kayaking, Zumba 
and pickleball. I didn't know what pickleball was. But that's tennis, 
badminton and ping pong. I can go on and on. It's utterly ridiculous. 
It should have been spent on health care. That's what this bill was 
supposed to be about.
  Let me finish by saying that even with this 1 hour here, we have lots 
more to talk about. We've barely scratched the surface. It's a 
complicated issue. Democrats and Republicans should have gotten 
together in a bipartisan way to work out a health care plan that does 
the principles that were pointed out here today, which is to increase 
access and quality, lower costs and to leave health care decisions in 
the hands of doctors, patients and those patients' families.
  With that, I yield back the balance of my time.

                          ____________________