[Congressional Record Volume 159, Number 160 (Tuesday, November 12, 2013)]
[House]
[Pages H6983-H6990]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          AFFORDABLE CARE ACT

  The SPEAKER pro tempore. 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. Mr. Speaker, we are here for the next hour to 
discuss the Affordable Care Act with my colleagues and my cochair of 
the Doctors Caucus, Dr. Gingrey, a fellow OB/GYN from Georgia. I thank 
the gentleman for being here today.
  We are going to break this hour up into several segments and talk 
about, number one, how the Affordable Care Act was initiated, how it 
actually came to be. Two, the promises that were made by the President 
and the Democratic Party about what the Affordable Care Act would do. 
The failures, which I think are probably fixable of the Web site--if, 
in 1969, we put a man on the Moon with a slide rule and a handheld 
adding machine, surely we can get a Web site to work in the year 2013. 
If we cannot overcome that, we are in trouble. Number four, I want to 
discuss something very near and dear to my heart, because I 
participated in this for years, which is medical education. I will go 
into this in more detail.
  We have a huge doctor shortage in America today, and it is getting 
worse.

[[Page H6984]]

A major university in my State, Vanderbilt University, this past year, 
that university has lowered their workforce by approximately 1,300 
people--it will, by the end of this year. It is very disconcerting for 
those people who lost good-paying jobs.
  We have had hospitals close in our region. We have had layoffs in our 
area, in the health care industry, for the first time in my medical 
lifetime, which has been over 40 years as a physician now.
  Also very distressing to me as a doctor and as a faculty member of 
the College of Medicine at East Tennessee State University, the Quillen 
College of Medicine and Vanderbilt University are reducing their class 
size by 10 percent.

                              {time}  2000

  They are also reducing the number of the M.D./Ph.D.s that they have. 
These are our future researchers to find the great cures for diseases 
in the future.
  There is a pipeline out there, and we certainly know that a vast 
number of our senior doctors are considering, or have retired, as my 
own personal physician has done, due to the effects of the Affordable 
Care Act. So we will discuss that in more detail.
  I think, also, we need to discuss and focus on the new taxes, and 
also, on the effects on business.
  Then lastly, perhaps--hasn't been discussed much recently, the 
effects on Medicare, quite frankly, with $700 billion being cut from 
Medicare.
  There is one particular part, Mr. Speaker, of this bill that Dr. 
Gingrey and I have worked on closely together in the Medicare portion 
of the Affordable Care Act that is called the Independent Payment 
Advisory Board. It hasn't gotten a lot of press because it hasn't 
affected any seniors yet.
  It's a board, an independent board, independent of Congress, that 
will determine how Medicare dollars are spent, and we will go into that 
if we have time in more detail toward the end of the hour.
  I think that is one of the most egregious parts of this bill when it 
comes to our seniors, and we are adding 10,000 new seniors per day, 
each and every day, over 3 million per year, with a decreasing number 
of physicians and less money in that very-needed program that needs 
reform.
  Let's go back, Dr. Gingrey, approximately, 4 years when we were here 
on the House floor debating this bill--and the premise of the 
Affordable Care Act I completely agree with, which is to lower costs 
and increase access to care. That is a noble, noble goal to have, and I 
still share that goal to this day.
  There were three committees of jurisdiction in the House of 
Representatives that looked at the Affordable Care Act: the Ways and 
Means Committee; Energy and Commerce; and the committee I serve on, 
Education and the Workforce.
  Those committees had a bill brought forth by the House of 
Representatives. It was voted on, debated in the various committees, 
brought to the House floor, and was voted on in a straight party-line 
vote. That particular bill did not include the IPAB and some other 
things that are in the permanent bill, the so-called ObamaCare, or the 
Affordable Care Act.
  The Senate then voted on Christmas Eve, I believe it was 2009, 
brought a bill back over here the following month. We debated it again 
on the House floor for a very short time and, famously, our then-
Speaker said we had to read the bill to find out what was in it.
  Well, guess what I did?
  It is a 2,600, 2,700-page bill, but I felt that a bill that affected 
ever American citizen in a very personal way deserved my attention, so 
I read that bill, and the surprises that you are seeing now I have been 
talking about now for 3\1/2\ years, as have my colleagues on the 
Doctors Caucus and others on our side of the aisle, and many, quite 
frankly, recently, in a bipartisan way.
  The only thing bipartisan about the Affordable Care Act was its 
opposition. I think some 32 Democrats voted against that bill.
  So it comes as no surprise to me when the President says--and we will 
go over the broken promises in a minute--it comes as no surprise to me 
when the President says, if you like your health insurance, you can 
keep it. That wasn't going to happen.
  Why did I know that?
  Let's go over the promises that were made. Number one was universal 
coverage. I quote. This is the President saying this. He wasn't the 
President then, but this was in June of 2007.

       I will sign a universal health care bill into law by the 
     end of my first term as President that will cover every 
     American.

  Well, that is a promise that hasn't been fulfilled. It does increase 
access by a massive expansion of Medicaid, and we will go through the 
Medicaid expansion in just a minute, about why some States chose to do 
it and why our State of Tennessee has chosen not to. And there are very 
good reasons why these Governors have chosen not to.
  There are a host of unintended consequences of this bill that we are 
dealing with today. The decreased payments to our hospitals have forced 
some of our rural hospitals and, certainly, where I live in rural 
America, has put great strain on these hospitals.
  Even in the more major medical center areas, as I pointed out, at 
Vanderbilt University, and many others, I have talked to colleagues 
today in Indiana who have experienced the same scenario.
  So the promises that were promised, there would be no new taxes on 
the middle class--here is the President's quote:

       I can make a firm pledge under my plan: no family making 
     less than $250,000 a year will see any form of tax increase; 
     not your income tax, not your payroll tax, not your capital 
     gains tax, not any of your taxes.

  That was September 12, 2008.
  The third promise, and this is one that anybody who has studied 
health insurance and has dealt with it in private business, as I have, 
knew was not going to be possible, was the outrageous claim that, by 
the end of his first term, that premiums would decrease by $2,500 a 
family. I mean, anybody would know better than that that has ever run a 
business.
  This is the quote:

       We will lower premiums up to $2,500 for a typical family 
     per year. We will do it by the end of my first term as 
     President of the United States.

  That was June 5, 2008.
  The next promise was there would be no increase in the deficit. No 
increase in the deficit. Here is the President's promise:

       I will not sign a plan that adds one dime to our deficits.

  That was Promise Number Four.
  And the last one, Promise Number Five, is, you can keep your plan if 
you like it, and here is the quote:
  ``If you like your doctor''--which, by the way, I like my doctor a 
lot; I went to medical school with him--``you will be able to keep your 
doctor, period. If you like your health care plan, you will be able to 
keep your health plan, period.''
  Well, let me point out at the end of that period, that people who 
work for me now in this congressional office have lost their plan, so 
that is not true:
  No one will take it away, no matter what.
  Well, I certainly don't see that as being true. The failure of the 
Web site rollout, we will get into that a little later. I think that, 
as I said, certainly, if we can't correct a Web site, if we can't build 
a Web site, I have no faith that this plan will ever be workable.
  I would now like to yield some time to my good friend and colleague 
from Georgia. We have been joined by Dr. Paul Broun, also from Georgia, 
a family practitioner, but I would like to turn it over now to Dr. Phil 
Gingrey from Georgia.
  Mr. GINGREY of Georgia. Mr. Speaker, I thank the gentleman from 
Tennessee, Dr. Roe, for yielding time to me.
  It is incredibly concerning that the Obama administration has 
continued full speed ahead on a rollout of a system, even after 
numerous warnings from vendors and from Congress.
  The Web site has led to confusion in the insurance marketplace, as 
well as put consumers' personal information at risk to lax security 
protocols.
  Even after the Web site is technically fixed, Mr. Speaker, as Dr. Roe 
mentioned, and it probably will be, consumers will still face higher 
premiums and the likelihood that they will be unable to see the doctors 
to which they have grown accustomed.
  Mr. Speaker, I have heard from a number of my constituents in the 
past few weeks about the disastrous effects of the President's health 
care law. I will take a little time this evening to

[[Page H6985]]

share with my colleagues a few of the observations from good, solid 
Georgians.
  Tom, a Georgia Blue Cross customer, told me his ``Blue Cross policy 
went up originally by about $50 due to the Affordable Care Act. About 2 
weeks ago I got a note that said my old policy no longer exists, and my 
new policy will now cost $100 more.'' That is a quote from Tom.
  Dottie, from metro Atlanta, told me that her husband's employer was 
forced to drop their family plan and would, instead, offer them only 
two more costly options. Either plan would increase their premium by at 
least $160 a week, Mr. Speaker.
  A mother in my district told me that her young daughter's Humana plan 
was canceled only 2 weeks after being promised that the price of the 
new plan would be locked down for a full year.
  Mr. Speaker, the President kept telling the American people, and this 
is the quote, if they ``liked their insurance they could keep it, 
period''--and the period is part of the quote. It should have gone on, 
as Dr. Roe suggested, until they can't.
  This promise has surely been broken. Millions of citizens have 
received cancelation notices from their insurers. They are now left 
with uncertainty over whether this new coverage will also be 
affordable.
  Speaking of affordability, Mr. Speaker, let me share with you a few 
other stories from constituents, and then I will yield back to the 
gentleman from Tennessee because I know there are other Members on the 
floor that also want to speak on this issue.
  Mike told me that ObamaCare ``has been a financial disaster'' for his 
family. It used to cost him just under $300 a month to cover his wife 
and daughter on his insurance, but, under ObamaCare, even that bronze 
plan--you know, there are four options, and bronze is supposedly the 
least expensive--will cost him $700 a month.
  And get this, Mr. Speaker: a $5,000 deductible. He was formerly 
paying $300 a month. If you like your insurance, you can keep it.
  As Dr. Roe said, Mr. Speaker, everybody's premiums are going to be 
going down on an average of $2,500 per year. Not so. Not so.
  Teresa from Cartersville, also in my 11th Congressional District of 
Georgia, she and her husband told me that their premium is increasing 
from $550 to more than $900 a month. That is almost, Mr. Speaker, a 40 
percent increase.
  Robert, from metropolitan Atlanta, again, a little part of my 
district, told me that even though they were underwritten in June, his 
wife's policy had increased from $387 to $557 a month. That is a 30 
percent increase.
  Finally, before I yield back to the gentleman from Tennessee, Robyn 
from Atlanta received notice that her family's premiums will increase 
by 15 percent without any additional benefits.
  I yield back to Dr. Roe, and I look forward to continuing this 
discussion with my colleagues as we go through the evening.
  Mr. ROE of Tennessee. I thank the gentleman for yielding.
  Let me back up a little bit so that this is a little bit more 
understandable for people. Typically, in this country--and we had 
problems. There is no question we needed health care reform. I think 
everybody in this Chamber--
  It is one of the reasons that the doctors that you see here tonight 
ran for Congress, because we wanted to be part of the health care 
reform debated here. Unfortunately, we were not.
  There were nine of us in our Physicians Caucus on the Republican side 
during the health care debate. Not one of us, not one, was included in 
the debate on health care. Not any amendment. We offered 80 amendments, 
to my recollection, to this health care bill, and not one was allowed 
to be heard on the House floor and voted on.
  This would be a better bill if the other side of the aisle had simply 
slowed down, taken a breath, and let us help amend this bill.
  People say now, well, Phil, can't you just tweak it a little bit and 
help?
  No, you cannot. It is so complicated and so expensive, it is very 
difficult to do.
  Now, this bill does do some things I like. I do like the under 26-
year-old being able to stay on their parents' plan. The private market 
would have offered that.
  You also had a problem with preexisting conditions. I want to spend 
just a minute with that because it is not totally understood, or not 
understood well by the public.
  We worry about us getting a preexisting condition, losing our 
insurance and not being able to get coverage. In America, about 160 
million of us get our insurance through our employer, through ERISA-
based plans. Preexisting conditions do not affect those plans. You 
cannot be denied coverage. My practice had an ERISA-approved plan. You 
had to take everybody in the plan.
  Number two, if you get Medicaid, you cannot be denied coverage, and 
Number three, if you have Medicare. So it really left the small group 
market and the individual market and the uninsured.
  Now, people are wondering, why did I lose my insurance coverage?
  In other words, I had a policy I liked.
  I want to tell you today, Mr. Speaker, one of the most arrogant 
things I think I have ever heard in my life I heard on TV this last 
week by several pundits, and those comments are this: that your 
insurance is no good. I heard the President say that.
  Well, look, not everybody can eat at Ruth's Chris. Some people have 
to eat at McDonald's or have to eat at Shoney's. They can't all eat at 
the most expensive one, but they buy what they can afford and what 
meets their needs.
  The reason that the costs are going up so much are the following: in 
this bill, there is something called essential health benefits. You 
don't get to decide what you buy for your family. The government 
decides what you buy for your family.

                              {time}  2015

  And let me read this to you, because I want you to hear this very 
closely to see if you need all of these services. One is ambulatory 
patient services; that sounds pretty good. Emergency services. Sure, 
you want a plan that covers you when you go to the emergency room. 
Hospitalization, absolutely. I think you will see most plans do that.
  Maternity and newborn care. Well, I don't know about that. What does 
a single 30-year-old male need maternity care for? What do I need 
maternity care for at my age? I certainly have cold sweats thinking 
about that right now.
  Mental health and substance abuse disorder services, including 
behavioral health treatment; prescription drugs; rehabilitative and 
habilitative services and devices; laboratory services; preventive and 
wellness services; chronic disease management; pediatric services, 
including oral and vision care. Well, if you are a family at an age 
where you don't need all of those things, probably your plan doesn't 
hit some of those. If you miss any of them, your plan is not an 
approved plan.
  The second thing that made you lose your plan was--and this is where 
I challenge the President here tonight--one of two things occurred. I 
read the plan and I understood by reading that plan that if you changed 
anything in the bill, if you changed the prescription drugs, if you 
changed your copay, if you changed anything significantly in that plan, 
you lost your grandfathered status, or if you didn't meet the essential 
health benefits. No one said that.
  So if the President had read his own bill, he would have known that 
and would not have come out and said, If you like your plan, you can 
keep your plan, because that clearly isn't true. Or number two, as 
Congressman Kurt Schrader said today, that we were misled. I think that 
is the term he used. So either of those two things occurred. If the 
President said, You can keep your plan, or he just did it for political 
purposes, which I hope he didn't do because a lot of people are hurt.
  Mr. Speaker, 16,000 low-income small business people in my State had 
a plan called Cover Tennessee. It wasn't the greatest plan in the 
world. It covered, I think, 12 doctor visits a year, all preventive 
services, an operation. It covered up to about $25,000. It didn't have 
lifetime limits. And 16,000 people had that. They could afford that. 
And many of them bought a catastrophic policy so that if they had 
something that cost more than $25,000, it would be covered.

[[Page H6986]]

So it was basic health insurance coverage. It did for them and their 
families what they needed. It gave them some certainty and peace of 
mind. That is all gone. They have lost that.
  As Dr. Gingrey was pointing out just a moment ago, he was mentioning 
some people in Georgia--and you can find this story from the Atlantic 
to the Pacific Ocean. One story I heard this weekend, an employer of 
mine who is a building contractor, he has looked at his business. He 
has 110 employees. He said, Phil, I think I am just going to have to 
pay the $200,000 fine. I can't afford what they are going to force me 
to buy. I can't do it and stay in business.
  I have an employee that I know personally because she works in my 
office whose insurance is going to go from $400 a month for her family 
of three with the ObamaCare plan--``if you like your plan, you can keep 
it''--to $800 a month. This is an employee who makes in the mid-$50,000 
range. This is not somebody who is rich who can afford this. That is a 
car payment or a college education payment or whatever she wants to 
spend her money on. You can hear this story over and over again.
  There are 66,000 Tennesseans who got a letter from Blue Cross 
explaining that their plans didn't meet the essential benefits package 
in the individual market. That is one insurance company, and this is 
going on all over.
  So this business about the costs going down--I think we will be on 
the Key Bridge jumping in the Potomac River when we finally get the 
bill for this. That is how expensive it is going to be.
  And, by the way, most people don't understand this. A lot of our 
Governors have read the fine print; and Governor Bill Haslam of 
Tennessee, a good friend of mine, wanted to expand coverage. He wants 
to expand coverage. But he wants it done through market-oriented 
principles. And one of the things that we have had in Tennessee with 
our health care coverage expansion is that we went through health care 
reform 20 years ago.
  In 1993-94, we began a program called TennCare. In the TennCare plan, 
we had a problem with access and not enough people had coverage in our 
State. So we did this. And within 10 short years, our spending had 
tripled. And almost half the people--47 percent, I think--of the people 
who got insurance on TennCare dropped their private health insurance 
and got it through the TennCare program. What our Democratic Governor 
Phil Bredesen did in the mid-2000s was--because we have a balanced 
budget amendment in our State, with the approval of the legislature--he 
had to cut 200,000 people from the rolls.
  And people say to me, Dr. Roe, don't you think this bill will just 
fall under its own weight? And I say, No, I don't. And the reason is 
because the Federal Government can deficit-spend. We can print money. 
If we had to have a balanced budget in this body right here that we are 
standing in, I can assure you, we would be having a different 
discussion about this bill.
  One other thing I want to read about the Governors that have signed 
up for this great deal with Medicaid, which is a program for our low-
income people--
  And by the way, I want to publicly state that the group I am in and 
the group I was with from the time Medicaid became available until I 
left practice, we took those Medicaid patients; and for many of them, 
we didn't get paid a lot of money. But that is what physicians do, we 
care for people who are uninsured and people who have policies like 
Medicaid.
  But this new policy, the insurance policies must cover these benefits 
in order to be certified and offered in the health insurance 
marketplace. States expanding their Medicaid programs must provide 
these benefits, these essential health benefits to people who are newly 
eligible for Medicaid. So that means at the end of the 3 short years, 
the percent that the State has, which is no guarantee, is going to be a 
large sum of money and much larger than I had thought of after I 
started seeing these premium increases.

  The other thing that has been said out there--and I have heard it for 
the last 4 years--is that Republicans have no ideas about health care 
reform. Well, there is a plethora of our ideas from this side of the 
aisle for health care reform. And one that I happen to have right here 
in my pocket is a Republican Study Committee called the American Health 
Care Reform Act, and I chaired the Health Subcommittee which wrote this 
bill. Dr. Tom Price, Dr. Broun of Georgia have a bill. Louie Gohmert, 
others. There are many of them. The Republican substitute bill of 4 
years ago is an excellent health care bill that is market-centered. And 
it does something that I think is essential for the American health 
care system to survive as we know it, and that is, to maintain the 
physician-patient relationship.
  This will tear that down because what does it do? So many people are 
going to lose access to their doctor. And as there are fewer and fewer 
doctors out there to see you, the waits are going to get longer and 
longer and longer. I think that is the very fabric that has made us the 
system that we are and the envy of the world, where people come from 
all over the world. And I think that can cease. And when you see great 
universities, like Vanderbilt University, cutting down on the number of 
doctors they are educating because of these cost constraints and 
cutting down on the number of young doctors that are going into the 
M.D.-Ph.D. programs that go into medical research and into faculties in 
medical school, boy, 10, 15, 20 years ago, we are going to suffer a 
great price for the mistake we have made right now.
  I would like to take now the opportunity to introduce one of my 
colleagues from Georgia, a family practice physician, Dr. Paul Broun.
  Mr. BROUN of Georgia. Thank you, Dr. Roe.
  The Federal Government is out of control. It has become too big. It 
is spending too much. It is taxing too much. It is regulating too much. 
It is borrowing too much. And it is sticking its ugly nose into our 
business too much. It has to stop, and ObamaCare does every one of 
those things.
  As a medical doctor, I understand firsthand the disastrous effects of 
ObamaCare and have been fighting from the very beginning to stop this 
terrible law.
  Every day, I hear from my constituents in the 10th District of 
Georgia on how this law is hurting them. Premiums are increasing. 
Cancelation letters are flying all across the State of Georgia. 
Business owners are being forced to lay off employees, and patients are 
finding that they no longer can afford their health insurance 
altogether.
  I will share with you a few examples. One Georgia businessman, who is 
the owner of several fast food restaurants, currently employs over 200 
full-time workers. He recently told me that he is seriously considering 
letting them all go and hiring only part-time employees; this due to 
the burden of ObamaCare.
  A resident of Henry County wrote to me that as an uninsured woman 
with preexisting conditions, she was looking forward to enrolling in 
ObamaCare. Then when she went to sign up, she found that a quarter of 
her income would have to be paid in premiums alone. Due to the high 
cost, she had no other choice but to remain uninsured.
  One man from Monroe, Georgia, contacted me just last week to inform 
me that his insurance costs have increased by 800 percent, 800 percent 
due to ObamaCare.
  A woman from Barrow County told me that her husband's insurance that 
he bought through AARP has already been canceled, and to get another 
policy with the same coverage would cost him $150 more a month than 
what he is paying now. This couple currently pays more in health 
insurance than what they pay for their mortgage. Increasing their 
payments by an extra $150 a month would be a tremendous, tremendous 
financial burden on them.
  Sadly, this is just the beginning. It is expected that more than 
400,000 Georgians will lose their current health insurance due to 
ObamaCare. Until we are able to stop this disastrous law, we will 
continue to hear more and more of these stories.
  As a medical doctor, I know what is best for my patients. That is why 
I have introduced legislation, H.R. 2900, the Patient OPTION act. It 
would repeal ObamaCare in full and put patients in charge of their 
health care decisions, where they can buy health insurance at a cheaper 
price than what they are currently paying. My Patient OPTION Act was 
endorsed by FreedomWorks in the last Congress.

[[Page H6987]]

  My bill will make health insurance cheaper for everyone--literally 
cheaper for everyone. Not like the President promised us. But he lied. 
It will provide access to good quality health care for all Americans, 
and it will save Medicare from going broke.
  If Americans want full control of their coverage, health insurance at 
a lower cost, and the freedom to make their own decisions in health 
care, then the Patient OPTION Act is the only true solution.
  It is clear that Georgians and Americans are hurting under ObamaCare. 
That is why I will not stop fighting to rip ObamaCare out by the roots 
and to replace it with reform that will actually lower costs, deliver 
care, and focus on the true needs of all American families.
  Through the voice of ``we the people'' demanding the repeal of 
ObamaCare, we can work to repeal ObamaCare and replace it with 
legislation that serves the best interest of patients, not government. 
That solution is my Patient OPTION Act, H.R. 2900.
  Mr. ROE of Tennessee. I thank the gentleman.
  I would like to spend a few minutes now beginning to talk a little 
bit about the effects on businesses and how this will affect 
individuals.
  I serve as the chairman of the Health, Employment, Labor, and 
Pensions Subcommittee on the Committee on Education and the Workforce; 
and we have held several hearings around the country over the last 2, 3 
years outside of Washington, D.C. We have held them in Concord, North 
Carolina; Evansville, Indiana; Butler, Pennsylvania; Lexington, 
Kentucky; and others. And we have actually asked small businesses to 
come in and testify on how this plan will affect their business.

  Let me give you just a couple of examples. We were looking at a small 
textile owner in North Carolina, and I won't mention his name tonight. 
But, anyway, it is part of the public record. He has a business where 
he had supplied--his business, he was self-insured as many small 
municipalities, large municipalities are. Many businesses are self-
insured. And it didn't look like their plans were going to be affected 
too much by the Affordable Care Act, the ObamaCare bill. However, they 
have to pay a $63 fee per person insured. Most people don't know this 
because it doesn't personally affect them. It just affects the business 
owner. Or in the case of my hometown of Johnson City, Tennessee, that 
little bill is going to come to $177,000 next year. One major 
corporation, which will remain unnamed, came to my office and shared 
with me that their bill for that this year would be $25 million.
  Let me explain to you about this small businessman in North Carolina. 
He provided 80 percent of the health insurance. The employee paid 20. 
He paid all preventive services. If you needed a colonoscopy, if your 
wife needed a mammogram, he paid 100 percent. He had a nurse onsite and 
a wellness program that he paid for. It is the Cadillac of all 
Cadillacs.
  So what does he get for that? He gets a $63 fee for every single 
person he has insured this year. The following year, it decreases a 
little bit and the following year. Guess what that money is used for. 
That money is used to indemnify insurance companies so that they will 
provide insurance on these exchanges, and it will limit as a stop-loss 
for them. That is how complicated this bill is.
  Now, I have had numerous businesses that are in the 50 range that I 
have talked to. And where we are, small business is the kingpin. The 
majority of our people are employed by small business. What incentive 
is there for a business to go above 50 when this arbitrary number was 
picked? And I have no idea to this day why 50 was picked.
  So what is magical about 50? Well, if you go above 50 employees, as 
my practice is, and you decide not to provide health insurance, and you 
are now, that costs you $2,000 per employee as a fine, tax, penalty, 
whatever Judge Roberts wants to call it.

                              {time}  2030

  But that is what this is--a tax, I assume, a penalty or a fee on 
those. Many people are willing to pay that. Businesses are. Or, if they 
are at 47 or 48, guess what they are doing? They are not going to 50. 
Or, if they need more employees, what are they doing? They are hiring 
part-time people.
  I can assure you that I have heard this over and over and over again 
about how businesses are cutting back their employees' hours to under 
30 hours a week, because now we define full-time employment as 30 hours 
per week. I assume the only place 30 hours a week is full-time 
employment must be France, because there isn't any place I know of on 
the planet that 30 hours a week is full-time employment. Certainly, in 
Tennessee, it is not.
  I would now yield to Dr. Gingrey, again, my friend from Georgia, if 
he would like to have a few words to say.
  Mr. GINGREY of Georgia. Mr. Speaker, I thank the gentleman. I know 
there is another member of the House GOP Doctors Caucus that has just 
joined us, so I will just take a moment and then yield back to Dr. Roe 
so he can yield to Dr. Harris.
  I wanted to take just a moment to emphasize what Dr. Roe was talking 
about, Mr. Speaker, in regard to these mandates.
  Mr. Speaker, the Affordable Care Act, which we found out now is the 
``Unaffordable Care Act,'' all of these mandates that are larded up 
into this essential coverage that the Federal Government is requiring 
is, indeed, the reason that the cost is going up. You can't include all 
those things that Dr. Roe was talking about without somebody paying for 
it.
  We talk about other options and what we on the Republican side, 
particularly the physicians, have offered in regard to alternatives. 
Many States have a lot of mandates in the health insurance program, 
and, under current law, you can't buy health insurance in another 
State. And so we have been pushing for years--the 11 years that I have 
been here--to pass what is called an association health plan, where a 
group or even an individual can go on the Internet--and probably not 
have the trouble they are having with healthcare.gov--and find out that 
in Tennessee, maybe, there is a policy that fits them to perfection. If 
they are a 55-year-old single man who doesn't need infertility 
coverage--and maybe their State requires it--doesn't want to have to 
pay for that, so he can get a more cost-effective policy that fits his 
needs to perfection.
  But by buying that health insurance across State lines, that is 
something that the other side of the aisle has completely rejected. And 
yet they have the mendacity, the audacity to say that we have no ideas, 
we have no plans, we have no alternatives. Indeed, we do.
  Mr. ROE of Tennessee. I thank the gentleman.
  I will introduce our next speaker tonight, my colleague from 
Maryland's First District, Dr. Andy Harris, who is on the faculty of 
Johns Hopkins University and is an anesthesiologist and has been a 
great member of the Doctors Caucus. I hope that Dr. Harris will address 
some of my concerns in his remarks about educating future young 
physicians. That is a great part of my life. Certainly, I want to see 
that continue.
  I think one of the things that also struck me was how it affects our 
colleges. We didn't think it would affect universities much, but in our 
community colleges. I have talked to a lot of them. One of them was 
over in North Carolina. Many of them now are limiting their adjunct 
faculties. And what an adjunct faculty member is is someone who is not 
there full time, but they may need a specialty let's say in accounting 
or physics or math or whatever it may be, and then they teach several 
classes. They now have limited those hours, those classes, to simply 
three per semester. The reason is because they will have to provide all 
these benefits if they go above that. Because our good friend, the IRS, 
has determined for every hour you spend in class, there are 2 or 3 
hours that is counted for preparation for that class. That is counted 
as work. So now community colleges are cutting back the number of hours 
students can be taught by this particular faculty member. The reason 
that is important is because a student may need a certain subject that 
is out there that this faculty member teaches and can't get it, and it 
delays their graduation.
  I have had community college presidents tell me this can be the case 
in their community. The State of Virginia has cut back to many part-
time

[[Page H6988]]

workers. I think Secretary Sebelius was in front of our committee and 
stated that this is just basically people just talking about it, a 
supposition. And I said that is not true because people are making 
those decisions in lieu of what is going to happen. That is what 
businesses do.
  I now, Mr. Speaker, would yield to my good friend, Dr. Andy Harris 
from Maryland.
  Mr. HARRIS. I want to thank the gentleman from Tennessee for 
yielding.
  The gentleman from Tennessee is absolutely right. In fact, in 
Maryland, in a front-page article 2 weeks ago, in our leading newspaper 
on the front page above the fold, there was a story about how 
Maryland's community colleges are cutting back their adjunct faculty to 
make sure none of them teach more than 30 hours a week. And it is just 
like the doctor from Tennessee says--some of these faculty are 
important. You have got to have them to fill in niches in your 
curriculum, and now they are constrained by a 30-hour-a-week definition 
of full-time work.
  Mr. Speaker, the fact is that, remember, it is not just that when you 
hit 30 hours you have to offer insurance. You have to offer the 
insurance the government says you have to offer.
  As I am going to mention, from literally dozens of communications I 
get now on a weekly basis from people in my district, the insurance 
under the Affordable Care Act is anything but affordable.
  William in Cecil County writes to me--and I am going to read these 
verbatim:

       My wife and me are currently insured with the Maryland 
     Health Insurance Plan.

  Mr. Speaker, the Maryland Health Insurance Plan was our version of 
covering everyone with a preexisting condition in Maryland. So, Mr. 
Speaker, in Maryland, every citizen had coverage, whether they had a 
preexisting condition or not, because they could get it through the 
Maryland Health Insurance Plan. And, in fact, William writes that he 
and his wife were currently insured with the Maryland Health Insurance 
Plan.

       We just received a letter stating we can keep our 
     insurance; however, when I questioned them for how long, they 
     said, Until the end of your current policy. So June 30, 2014, 
     we'll be sent to ObamaCare. My wife has multiple serious 
     health issues that our current insurance has kept her alive 
     and able to function pretty normally.

  Now, Mr. Speaker, William is worried, and he is justifiably worried 
because every day we pick up the newspaper and we read about another 
State where you can't get to your doctor. Your doctor is not going to 
be on that insurance plan because the only way they can make those 
premiums less expensive than they already are is to limit who you can 
go and see when you are sick. Yes, Mr. Speaker, the government telling 
you who you can go and see when you are sick. And that is what William 
and his wife were worried about in Cecil County.
  But Carl in Queen Anne's County writes to me:

       I have to put in my two cents. When ObamaCare first started 
     a couple of years back, my health care started to go up. When 
     we called Blue Cross, they told us, You can thank Mr. Obama. 
     It went up to $1,600 per month. Now my wife does have stage 
     IV cancer. I am a truck driver. I have to pay for our health 
     care. So much for the care cost dropping.

  Mr. Speaker, I don't know if you remember, but our President said 19 
times that the price of a policy for a family was going to go down 
$2,500 a year. Mr. Speaker, Carl is going to pay $1,600 a month now. It 
didn't go down $2,500. It went up thousands of dollars a year.
  Tim from Queen Anne's, I guess, writing in tongue-in-cheek:

       Thanking you for the new health cares rules that have 
     resulted in our family losing coverage from Giant Food. I'm a 
     general contractor. After 22 years of coverage with my wife, 
     and now faced with a $1,000 a month bill to cover my family.

  That is $1,000 a month. Not $2,500 less, like was promised us 19 
times, period.
  He goes on to say:

       I bet you still have your insurance.

  Well, Tim, we not only have our insurance, but the President gave 
Congress, actually, a special deal that you don't get; because you see, 
Tim, if you got the same deal, your employer could be able to subsidize 
you on an exchange. That is the deal the President gave Members of 
Congress and their staff. Sorry, Tim, you didn't get that.
  Fran from Worcester County writes:

       My CareFirst BlueCross policy has been canceled. I chose my 
     policy. My policy was great. President Obama promised more 
     than two dozen times that, If you like your health care plan, 
     you can keep your health care plan.

  Now this is Fran's opinion and not necessarily mine.

       I believe that he knowingly lied. What are you going to do 
     about this?

  Fran, I have got to tell you, I think it might be too late to do 
anything about it. This horse has left the barn. Millions of Americans 
have gotten their cancelation notices. Millions of more Americans have 
gone on the exchanges to find out that their plan is not going down 
$2,500 a year. It is going up an average of, Mr. Speaker, $5,000 a year 
for the average family--a 41 percent increase on an average premium 
this year of $12,000.
  Andrea from Harford County writes:

       I just thought you might like to add my family to the 
     statistics of the government's intervention in my perfectly 
     fine 20-year-old CareFirst BlueCross BlueShield insurance 
     plan. I'm self-insured and, hence, the first to be----

  Mr. Speaker, I am not going to say the word here because of decorum 
on the House floor.

       When I am forced to accept the new, not-as-good, higher 
     deductible, limited doctor choices, I will be paying an 
     increase of 197.5 percent.

  This is what Andrea writes me.
  Mr. Speaker, Andrea is not getting a $2,500 a year cut in her family 
insurance plan. She is getting a 197.5 percent increase.
  Mr. ROE of Tennessee. Will the gentleman yield?
  Mr. HARRIS. Yes, I will.
  Mr. ROE of Tennessee. Then how do you answer to her that the pundits 
that we heard all last week and some of our colleagues here on the 
House floor, including the President, who said these were substandard 
plans that these individuals' plans were? And I have just heard you 
say, Dr. Harris, three or four times that people were perfectly 
satisfied; they met their needs.
  Mr. HARRIS. Thank you very much. Reclaiming the time, I will tell you 
about more.
  I am more than happy to share these with the President. If he wants 
to call up Andrea and explain how a 197.5 percent increase fulfills his 
promise, more than happy to have him do it.
  Andrea goes on to say:

       I'm not feeling the love. I believe the Congress and the 
     President should have to live under the same laws, rules, and 
     regulations that they insist I do.

  Andrea, I couldn't agree more. I don't know why the President carved 
out a special exception for Members of Congress and their staff that 
they actually can get their employer to subsidize their plan on the 
exchange when no other employer in the United States that employs 
15,000 people--because, Mr. Speaker, that is what the Congress 
employs--get that kind of deal.
  Andrea, you are absolutely right. I think they should live under the 
same rules.
  That is why, Mr. Speaker, on September 29 we sent a bill over to the 
Senate that said no special deals for Congress. The Senate rejected it. 
The President said he would veto the bill. He wants to keep that 
special deal--not for Andrea, but for Members of Congress and their 
staff. He wants to keep that special deal.
  Matthew in Queen Anne's County, tongue-in-cheek, writes:

       I would appreciate if you could pass on my appreciation to 
     the President for the ObamaCare legislation. Thanks to the 
     new law, my employee-sponsored health plan has increased my 
     premiums by 100 percent for my family plan. So much for 
     looking out for the middle class.

  Mr. Speaker, Matthew hit the nail on the head. The President promised 
if you like your plan, you can keep it, period. You can keep your 
doctor if you like him, and your family's plan is going to be $2,500 a 
year less.

                              {time}  2045

  Mr. Speaker, Matthew's plan is going up 100 percent. How in the world 
can someone in the middle class afford that? How in the world can we 
ask our hardworking middle class men and women, with families, to pay 
100 percent more for their health care? We can't. We shouldn't.
  It gets worse.

[[Page H6989]]

  Linda from Cecil County writes:

       I have a genetic disorder called Lynch syndrome that 
     predisposes me to a number of cancers.

  Yes, Linda was born with a syndrome so that she is actually 
susceptible to getting cancers:

       I have had cancer twice in the past 7 years, and was 
     fortunate enough to be covered by MHIF.

  Remember, Mr. Speaker, that that is the plan we already had in 
Maryland, like over 30 other States, which covered their people who had 
preexisting conditions. She was fortunate enough to have been covered 
since she was first diagnosed:

       This program was truly a godsend, and I can tell you how 
     grateful I was for it as I did not then, nor do I now, have 
     employer coverage. I was not eligible for Medicaid at the 
     time because my unemployment benefits disqualified me.

  She received the cancelation of her policy effective December 31, and 
was advised that she should purchase insurance through the new 
exchange, but, Mr. Speaker, she says:

       I began trying to obtain insurance as soon as the exchange 
     opened. Although I was able to establish an account and an 
     application, I was informed that I am not eligible for a tax 
     subsidy because I am eligible for Medicaid. While many people 
     might be happy to receive free Medicaid, it creates a 
     nightmare for me.

  That is what Linda in Cecil County writes. The President's Affordable 
Care Act is creating a nightmare for her.
  She goes on to say:

       There are very few specialists in Cecil County--by the way, 
     that is a rural county in Maryland--so nearly all of my 
     doctors are in Delaware. Since they don't take Maryland 
     Medicaid, I can no longer receive treatment from them.

  That is a real benefit that Linda got:

       I will have to travel twice the distance to obtain all new 
     doctors if I am forced on to Medicaid.

  Mr. Speaker, that is what the Affordable Care Act is doing to Linda. 
Thank God that there, but for the grace of God, go I that I don't have 
Lynch syndrome. She does. She worries every day about going to a doctor 
and being told she has cancer. What the President's Affordable Care Act 
told her is: You can't go to the doctors you are used to going to who 
have guided you through those cancers and who have saved your life. We 
are going to throw you into a whole new plan--Medicaid--and, oh, by the 
way, you can't go see your doctors anymore.
  Mr. Speaker, that is heartless. That is just heartless.
  She goes on to say:

       MHIF saved my life, and I have had excellent coverage and 
     care for 7 years.

  Mr. Speaker, Linda liked her plan, and she doesn't get to keep it. 
She doesn't get to keep her doctors. She gets to wake up every morning 
now, worrying about her cancer and whether she is going to find a 
doctor who can take care of her. She had those doctors. She doesn't 
have them now. She had doctors close by. Yes, she had to cross State 
lines, but her health insurance covered it. Her new health insurance 
doesn't cover it.
  That is what this plan is doing. This plan affects each and every 
American in ways we are only beginning to understand.
  As was famously said, you have got to pass this bill before you know 
what is in it. Mr. Speaker, we are finding out what is in it. America 
is finding out what is in it. Five million people found out this month 
what was in it. It is a cancelation notice for the plans they liked. 
These people had plans they liked. They weren't throw-away plans. They 
saved Linda from cancer twice. Every single American is going to be 
affected by this in ways we are just discovering, and America doesn't 
like it.
  Mr. Speaker, very simply, America deserves better.
  The SPEAKER pro tempore. Members are reminded to direct their remarks 
to the Chair and not to a perceived viewing audience.
  Members are reminded not to engage in personalities towards the 
President.
  Mr. ROE of Tennessee. Mr. Speaker, I would like now to mention a 
couple of things and to talk about this a little bit. We don't have a 
lot of time left, but it is extremely important. I know that both of my 
colleagues on the House floor tonight have taught in medical schools 
and that we have a huge problem in this country with graduating enough 
doctors and educating them. Let me give you an example.
  When you graduate from medical school, you are not then prepared to 
go out and practice. You need to go and either do your specialty 
training or surgery--or whatever it may be--or a family practice 
residency or a primary care residency. In my small town of Johnson 
City, Tennessee, we have lost about 50 primary care residency slots. 
Those are 50 primary care doctors per year who are going to have to 
look elsewhere for residencies. Last year, for the first time in my 
lifetime, we had over 1,000 young students graduate from medical 
school--with huge debt--who could not find residency programs. Those 
are 1,000 students who are doing something this year before they can 
get into the residencies they need in order to be able to train to take 
care of us as patients.
  The American Medical Association and others have said, in the next 10 
years, we will have 90,000 too few doctors to see us. We all know what 
that means. That means that we wait longer and longer to see the 
doctor. I think it is a tragedy that is out there that we have young 
doctors--and I can't imagine graduating from medical school when I did, 
Mr. Speaker, and not being able to find a slot.
  The reason that has happened is that Medicare pays a certain amount--
a cap that they put on--for residencies to train young doctors. Then 
hospitals and universities, through their endowments and other income, 
put more money in to help train these doctors. What has happened is, 
because of the Affordable Care Act, the hospitals are getting less 
money, and they are having to look to cut. That is why they are cutting 
their staffs, and that is why they are cutting residency programs and 
are delaying training.

  Folks, let me tell you that, downstream, Mr. Speaker, this is a very, 
very bad thing for us and for the health care of this Nation.
  I now would like to yield to Dr. Gingrey from Georgia.
  Mr. GINGREY of Georgia. I thank the gentleman for yielding.
  I did want to speak about the young people, and I am talking about 
those who have had their 27th birthdays. They are aged 27, so they are 
not eligible any longer to be on their parents' health insurance plans. 
I have concerns over the effects of this law on these young people.
  I have warned for some time, and I have even introduced legislation 
to insulate the young from rate hikes, which are the direct result of 
these age-band provisions in the Affordable Care Act. Health insurance 
companies know, and their actuarians know, as they are educated, as 
they have studied, as they have gone to college and have gotten 
master's--advanced degrees--in figuring out what the premiums need to 
be at different age bands. The Federal Government has come along in 
this law and has said, well, it doesn't matter; that you can't charge 
any more than three times the premium for, let's say, a 62-year-old 
versus a 28-year-old.
  What that is doing, of course, is making the insurance companies just 
simply raise the premiums for everybody so they can possibly make a 
profit.
  I just want to conclude with one thing, Mr. Speaker, and then I will 
yield back to Dr. Roe for some closing comments.
  When this bill was marked up in 2009 in my committee--the Energy and 
Commerce Committee--as it was in Dr. Roe's as well, I submitted an 
amendment that said very simply: if you--the Democratic majority party 
and President Obama--are going to cram this down the throats of the 
American people, who don't want it and who have said they don't want 
it--60 percent of them said they don't want it--and if you are going to 
make them accept this, then, Mr. President, you, the First Lady, your 
two beautiful daughters, all of your Cabinet members, and all Members 
of Congress should also have to abide by what we, the people, have to 
abide by.
  That amendment--my amendment--was rejected strictly, 
straightforwardly by a party-line vote. All of the Republicans on the 
committee voted for it as a fairness issue, and all of the Democrats 
voted against it.
  So what happens?
  A Republican Senator put it in its version, which gets in the bill, 
but

[[Page H6990]]

there is, all of a sudden, no subsidy. So, therefore, the President, by 
executive order, is saying that, oh, okay, these Members are now in 
ObamaCare, but because of their income, they are not eligible for any 
subsidy, so we are going to let them keep what the Office of Personnel 
Management gives them--our tax dollars--and 70 percent to 75 percent of 
the premium is paid by we, the people, to Members of Congress.
  That is grossly unfair. I just want to make sure that all of my 
colleagues, Mr. Speaker, understand that, and I think they do.
  Mr. ROE of Tennessee. I thank the gentleman.
  In conclusion, let's go back and look at why we needed health care 
reform in this country. We needed it because costs were rising and 
because we had a problem with access for many of our people. That 
clearly was true. There was no question about it. There were also 
problems with preexisting conditions. We know that.
  The Republican Study Committee has a plan out there called the 
American Health Care Reform Act. It addresses all of these issues. It 
truly does lower costs, and it does one important thing that I 
mentioned earlier in my remarks. I think the patient-doctor 
relationship--medical decisions--should be made between a patient, a 
doctor and the family. That is who should be making them, not the 
insurance company and not the Federal Government. You should be 
deciding what you purchase.
  We have talked about a lot of complicated issues here tonight because 
this is a very complicated bill, but it is important for everyone to 
understand it as best one can because it affects every American 
citizen. That is why we in the Doctors Caucus on the Republican side of 
the aisle read that bill and tried to understand it, because it was 
going to affect every citizen in a very personal way.
  We want to continue this discussion on the House floor, and I have 
certainly enjoyed this 1 hour with you this evening.
  Mr. Speaker, I yield back the balance of my time.

                          ____________________