[Congressional Record Volume 160, Number 53 (Wednesday, April 2, 2014)]
[House]
[Pages H2833-H2839]
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 Texas (Mr. Castro) is recognized 
for 60 minutes as the designee of the minority leader.


                             General Leave

  Mr. CASTRO of Texas. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days to revise and extend their remarks 
and include extraneous material on the subject of my Special Order.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. CASTRO of Texas. Today, we are here to talk about the Affordable 
Care Act, and especially the big week that we have had in this country 
in making sure that millions of Americans will now enjoy access to 
quality, affordable health care.
  Last week, we had a chance to talk about this and had other Members 
from all over the country who represent wonderful districts come 
forward and talk about how the Affordable Care Act has been very 
beneficial to their constituents. Part of the discussion last week and 
in the previous months, really since October, has been about whether 
Americans would accept the Affordable Care Act and how many people 
would enroll and how many States would expand Medicaid.
  The numbers are very clear that, despite all of the advertisements 
and the millions of dollars that has been spent on television promoting 
misinformation about the Affordable Care Act, demonizing this as 
socialism and other bad things, that despite all of that, the American 
people have clearly rejected that narrative, that they believe the 
Affordable Care Act and what it is doing for this country are good 
things and that in the wealthiest nation on Earth, as we are, that 
people should be able to afford health care, that they should not be 
denied because of preexisting conditions, that students should be able 
to stay on their parents' plans after college, and that Medicaid for 
low-income Americans should be made more readily available.
  Let's look at some of those numbers. We know, for example, that 7.1 
million people ended up signing up for the Affordable Care Act in the 
exchanges. Now, that is on top of the 3 million students who can now 
stay on their parents' plans because of this act. That is on top of all 
of the States that expanded Medicaid to make sure that folks who don't 
make a lot of money, the vast majority of these people working hard day 
in and day out, that they are going to be covered, too.
  There are still about 19 States, including my home State of Texas, 
that have chosen not to expand Medicaid. That has been such an 
incredible blow to the people of my State. For example, we have the 
highest percentage of people in the Nation that have no health care 
coverage.
  On Monday, I was back home in San Antonio and there was a large 
enrollment fair, as there was in many cities throughout the country on 
Monday. It was probably about 6, 7, and this fair was going to close at 
8. So I went over to see how it was going and to say hello to folks. 
There was a long line of people waiting. Families were there, two and 
three and four and five family members. People brought their young kids 
to enroll them in insurance.

[[Page H2834]]

  One of the narratives during this debate has been this idea that has 
been pushed that this is just benefiting people who may be lazy or not 
working. One of the things that struck me when I was making my way 
through that line was that there were so many people there that had the 
insignia of the company that they work for or their uniform on. They 
told me that they had just come straight from work and how grateful 
they were that this was going to go on until 8 so that they had time to 
come after work.
  It was really a stark reminder that--despite all of the stories or 
this idea of the makers and the takers in this country, or 47 percent 
of people versus 53 percent--the vast majority of people who are 
benefiting from this law, benefiting from things like Medicaid, are, in 
fact, not just takers, but are hardworking Americans who are powering 
our economy. All they want is a fair chance at the American Dream.
  We talk a lot about freedoms in this body. The United States Congress 
is, of course, one of the main bodies in government that is entrusted 
with protecting American freedoms. So we talk about our First Amendment 
rights, whether it is freedom of expression, freedom of speech, freedom 
of religion, or Second Amendment rights, other amendments, the right 
against self-incrimination, all of these things, all of the Bill of 
Rights enshrined in the Constitution. But I pose the question to those 
who continue to want to repeal the Affordable Care Act: What good are 
any of those rights that we are entitled to as Americans, that previous 
generations of Americans and this generation of Americans have fought 
so hard to preserve, what good is freedom of expression, freedom of 
religion, freedom of speech if you are stuck in a hospital bed sick, 
broke because you can't pay your hospital bills, worried about your 
family and your future?
  Remember, that is not an uncommon situation for Americans over the 
years.

                              {time}  1545

  The biggest reason for personal bankruptcies before the Affordable 
Care Act was the fact that people were racking up these huge health 
care bills that they couldn't pay, and this happened for a few reasons. 
Sometimes people just couldn't afford the insurance for their primary 
care physicians--the doctors they would go see--or emergency room 
doctors, not doctors in some clinic or private practice. Sometimes, 
even if they could afford insurance, they were hitting lifetime caps--
somebody with cancer, somebody with MS--somebody like my grandmother 
and my mother with diabetes, who suffer from complications. My 
grandmother, before she passed away from congenital heart failure 
because of diabetes, had her leg amputated.
  There are so many people who can't enjoy the freedoms that we are 
supposed to be able to enjoy because they can't afford health care 
coverage, so they have ended up not going to the doctor for many years. 
They have put off going to the doctor for a long time because, if they 
went without insurance to the doctor, then they wouldn't be able to 
make their mortgage payments or to pay their rent or pay their car 
bills, cars that they need in order to get to work. These are the 
common experiences of millions of Americans, not just of low-income 
Americans--certainly, low-income Americans--but also of Americans in 
the middle class, who power our Nation and power our economy.
  I want us to consider the success of the Affordable Care Act. Of 
course, there was the Web site that had a tough rollout, and a lot of 
people doubted whether the program would be successful. This has shown 
also that the Affordable Care Act is about more than just a Web site 
that had a glitch. Again, the fundamental reason that this law has 
passed is that America is the wealthiest nation on Earth, and for 
generations, other countries with a lot less money have been able to 
provide and make available health care to their citizens a lot better 
than the United States of America has.
  Consider this: with the Affordable Care Act, up to 129 million 
Americans who have preexisting health conditions, including up to 17 
million children, no longer have to worry about being denied coverage 
or being charged higher premiums due to their health statuses. Again, 
you might have a woman who is 55 years old or 60 years old. She loses 
her job that gave her insurance, so now she tries to find another job, 
and tries to buy insurance, and she is rejected. She tries to go on to 
the individual market, and finds that she can't afford the prices on 
the individual market.
  What is that person to do? A lot of them are suffering from chronic 
diseases.
  In south Texas, for example, we have an incredibly high rate of 
diabetes. In other parts of the country, in other communities, it is 
other diseases, but whatever it is, these ailments are common, and they 
are forcing people oftentimes into bankruptcy, into not being able to 
pay their bills or in not being able to get health care coverage. So 
lifting the lifetime caps has made a mountain of difference for people. 
It has helped ease their minds, and it has also made things more fair.
  Yesterday, the President was pretty very forceful in his comments. I 
think they did the press conference in the Rose Garden, but I was on an 
airplane, so I couldn't watch the press conference, but I got to see 
some of the clips. He made a comment that really struck me, which is 
that the Affordable Care Act is here to stay. This law is not going 
anywhere despite all of the opponents and despite the millions of 
dollars that have been spent on television for misinformation and 
demonizing this law.
  The reason it is not going anywhere is not just because of the 
political reality. I mean, the politics, really, are tough on both 
sides. The country had been evenly divided for a long time. The reason 
that it is not going anywhere is because of the human reality, because 
we want fewer people going bankrupt because they are hitting lifetime 
caps and their insurance companies won't pay for their bills anymore. 
It is because you want more people who are not using the emergency 
rooms as their only way to get medical care and putting off ailments 
and diseases because, if they go to the doctor, they know that a month 
later or 3 weeks later they are going to run up these huge bills, and 
they know they can't pay them.
  By the way, many folks have pointed this out, but certainly, when we 
had a dialogue last week, I pointed out again that there is a measure 
here also of personal responsibility, of people getting insurance in 
the same way that many States require you to get auto insurance. Why do 
States require you to get auto insurance? It is because, if you rear-
end somebody, somebody has got to fix his car. In many public hospitals 
throughout the Nation, certainly in Texas--in San Antonio, for 
example--what happens routinely, oftentimes not from San Antonio but 
from surrounding counties, is that these folks come in, and you can't 
deny anybody emergency room coverage. You have to treat them. Then you 
send them a bill, and they can't pay the bill. They don't have 
insurance, and they can't pay the bill. Guess who pays the bill? That 
bill has to be paid somehow. The taxpayers end up paying that bill. 
Somebody has to eat that cost, and it is not the hospital. They pay a 
fraction of it, but those costs are spread, and all Americans have to 
pay them State by State, county by county. So this is a way that people 
can not only benefit from the Act but can also take a measure of 
personal responsibility for their own health care coverage.
  That is why in the 1980s and in the 1990s, which was before this 
issue became so political and before President Obama was inaugurated in 
2009, that originally the kind of legislation that we now know as 
ObamaCare, or the Affordable Care Act, was actually legislation that 
was promoted by the very conservative Heritage Foundation. It was 
considered to be a conservative idea in the same way that somebody 
getting car insurance--taking personal responsibility in case you hit 
somebody on the road--is thought to be a conservative idea. You are 
going to own up to your responsibilities. It has been very interesting 
over the last 4 years and even over the last few months to see the 
evolution of the arguments about health care coverage and about the 
Affordable Care Act and about how politics sometimes and often has 
trumped public policy.
  In a minute, I would like to yield to my good friend from California, 
Mark Takano, but before I do that, I want to share with you just a few 
stories of

[[Page H2835]]

people from my area, from Texas, who said that I could share their 
stories with them and how grateful they are that they are now able to 
afford health care.
  The first one is a woman named Magdalena. She is a substitute teacher 
and had a hard time transitioning to San Antonio since moving from Del 
Rio. Del Rio is a city right along the Texas-Mexico border. It is about 
2\1/2\ hours from San Antonio. She has dedicated herself to taking care 
of her family, and she often puts her family in front of herself. Like 
many mothers, she was worried about her health as she moved into her 
senior years. She was skeptical about trying to fill out an 
application, but she eventually came to an Enroll SA event. Many cities 
had Enroll SA or Enroll Austin or Enroll Dallas. After sitting down 
with a counselor, she was able to get a plan for 5 cents a month. This 
is a woman who had previously been unable to get health care coverage. 
She returned to the registration table and wept tears of joy, with her 
eyes filled with hope, and the volunteers wept along with her. Her face 
just lit up because now her life was truly changing.

  Like many others, Magdalena is a hardworking American, somebody who 
has taken care of her family, who is going to work day in and day out, 
who is not asking for very much--just a chance to enjoy the freedoms 
that we talk about here in Congress a lot.
  With that, I would like to yield to my colleague from California, 
Congresswoman Loretta Sanchez.
  Ms. LORETTA SANCHEZ of California. Thank you so much to the gentleman 
from Texas, San Antonio, and New Braunfels.
  Mr. Speaker, today, we are talking about the Affordable Care Act. 
This is so, so important as we have seen this week 7 million-plus 
American enrollees, and I know there are still some who tried to get in 
at the very end and are in the pipeline. I am hoping we push even 
closer to 8 million new enrollees into the Affordable Care Act.
  It is interesting because we over here on the Democratic side have 
really been working to enroll people--we have been working to talk to 
people about how important it is to have a health care plan--while at 
the same time we have seen from the other side 50-plus votes to try to 
undercut, to undermine, to eliminate the ACA, but here we are. They 
were repealing. We were enrolling.
  California's enrollment numbers surpassed 1.2 million people this 
past Monday, which is more than double of any other State. On top of 
that, the expansion of Medi-Cal, which is our Medicaid piece of this, 
has covered another 1.5 million low-income families, so we are pretty 
excited. California looked at this and said, this Medi-Cal plan--this 
plan of having a health care plan for lower income families, for the 
members in these lower income families--is so important. For the first 
3 years, it is paid 100 percent from the Federal Government.
  So, if you are sitting in a State like California and if you have 1.5 
million new families who didn't have health care before that was paid 
for, they were putting up with being sick, doing what we call in 
Spanish ``aguantamos.'' If you got sick, you wouldn't go to the doctor. 
You wouldn't go and you wouldn't go, and you would work through. You 
would go to work, and you would be sick. You wouldn't go until, 
finally, you couldn't take it anymore. You were really, really sick. 
Then where would you go? You would go to the emergency room, which is 
the highest cost place in the entire health care system. Instead of 
putting up with not having health care--instead of aguantamos--we now 
have 1.5 million families who are in Medi-Cal and, again, as of Monday, 
1.2 million people who are in what we call our exchange, Covered 
California.
  This is very, very important, but there is also another piece of this 
that is incredibly important, which is that now we have to work with 
people. Now that we have enrolled them for the year, we need to work 
with people who have never before had a health care plan. They don't 
know what a primary doctor is. They don't even know what a specialist 
is. They don't know what the process is to go. They don't know about 
getting a baseline. Go and get an annual physical for free under these 
plans. This is for free. We have to teach them.
  So you go in. You get a relationship with a doctor. You get a 
physical. You get a baseline. You get your blood drawn. For someone 
like me, that is incredibly important because, for example, diabetes 
runs in my family. My granddad died of it, my grandma, my aunt, her 
five kids. It is 3\1/2\ times more likely to be in Latinos than in the 
average Anglo in America. It is being able to go and get blood work 
done so that can you see where you are, whether you have the propensity 
to get diabetes, for example, because diabetes in over 50 percent of 
the cases can be stopped; it can be turned back. It is about having 
some nutritional understanding, being able to eat the right way, 
sequencing your food, exercising after you eat--just a 15-minute walk. 
There were just two studies that were released this past May that said, 
if you have a propensity for diabetes but if you walk 15 minutes after 
you eat, you can cut that propensity by almost 50 percent.
  This is information that our communities do not have. Low-income, 
immigrant communities in particular are less likely to have this kind 
of information. Now, if they have health care plans and if we teach 
them how to go and get that baseline--get their annual physicals, get 
their pap smears, get their mammograms--and if there is something 
wrong, let's work on fixing it, and it takes personal responsibility to 
do that.

                              {time}  1600

  I have to get up early in the morning and go and run. I have to go to 
the gym to ensure that, since the propensity is high for me, I don't 
get that because it takes some personal responsibility--personal 
responsibility not to eat pizza all the time, and things of that sort, 
yes, personal responsibility.
  It takes a health care plan, it takes knowledge, it takes access. 
These places have to be close by. We have to have clinics and doctors 
signed up into these plans so we can go to them. It takes cultural 
knowledge, as you know, being from San Antonio. Some of it is a 
language barrier. Some of it is just understanding how our community 
works and how we spread it by word of mouth, rather than go to 
computers to find our information.
  Knowing all of this will help us ensure that, now that people are 
enrolled, they begin to use the plans effectively, and when they use 
them effectively, we drive down that cost curve that was happening. In 
California, on average, it was a 17 percent increase in medical health 
care costs on an annual basis. That was not sustainable.
  The only people who could have liked the old system were the wealthy 
or the healthy. If you got sick, you had the money, or you never got 
sick; but today, we can fix these things.
  Today, we can fix these things by moving forward with these health 
care plans and with teaching people how to use them efficiently and 
effectively, so that all of society becomes stronger and healthier, and 
that is why we voted to put this in. That is why we have worked so 
hard.
  I am so thrilled that the gentleman from Texas wanted to discuss this 
issue today.
  Mr. CASTRO of Texas. Thank you, Congresswoman. Thank you for your 
passion over the many years on health care and many other issues, and 
you raised several wonderful points, but there are a few in particular 
that I wanted to mention.
  We debate our national debt and deficit here a lot. Since the 
Affordable Care Act was passed, as we know, health care has been the 
biggest driver of our debt. The Affordable Care Act has actually slowed 
the cost of health care, the slowest growth that we have seen in 
decades.
  So this is something that has actually been good and will be good for 
our fiscal health in this country. Thank you for alluding to that.
  Also, you mentioned that in many of the communities we represent--not 
only in California or in Texas, but many places--ailments like diabetes 
are things that affect so many people in our neighborhoods and our 
cities, but it is not just diabetes.
  In other places, it could be cancer or sickle cell anemia or multiple 
sclerosis. All of those patients will now find a lot more relief 
because the United States Congress passed this bill.

[[Page H2836]]

  Ms. LORETTA SANCHEZ of California. I couldn't agree with you more. 
There are pockets of this.
  I just want to leave with one story. A few years ago, we had this one 
company who was a lensmaker kind of company. It was somebody who had 
retail stores, and you would go in and get your eyes checked. They 
would grind lenses and get glasses for you. Usually, they could do it 
in one stop, in 2 or 3 hours, et cetera.
  They said: Let's do this in your area, Loretta; let's hold a health 
care fair.
  We had a lot of different types of people offering services, and they 
said: For the first 400 people who show up, we will have 
ophthalmologists there--medical eye doctors--and we will take a look 
and see what is going on with people. If we need to grind lenses, we'll 
grind lenses for them and give them free glasses.
  Because even if you had a health care plan, most people didn't have 
vision or dental, so people were not buying glasses. They couldn't 
afford it.
  I got there at 7:30 in the morning to this health care fair. It 
started at 8. There were 600 people in line already, so we gave coupons 
for these people to be able to walk into one of those retail stores and 
get the service for free. We kept the first 400.
  One of the young ladies that worked with me stayed all day with one 
of the doctors, making sure the patients were coming in and out, giving 
him the things he needed, et cetera. At the end of the day, the doctor 
turned to her and said: Do you know that 80 percent of the people that 
we saw today had diabetes or were about to get diabetes?
  They didn't even know it because one of the first symptoms for 
diabetes is blurry vision, so these people were thinking they are 
getting old and their vision is kind of going, but the reality was they 
were sick.
  They didn't know it because they did not have health coverage, and, 
like I said, that is a disease that you can really get rid of or 
eliminate in your life if you work at it.
  These people need that knowledge. These people need that ability to 
walk into the doctor and to get their blood tested and to see what is 
going on, so that we can tell them: if you don't change what is going 
on in your life, you are going to be diabetic.
  By the way, the plans before, if you had diabetes and you had to have 
your leg chopped off, for example, we would pay for that. You see what 
I am saying?
  We wouldn't be paying to let them know you may be getting diabetes or 
you have diabetes; we would pay after the fact to chop off their legs. 
Or, if they went blind, we would have them at home because, now, they 
couldn't work.
  So it is going to make Americans healthier. When Americans are 
healthier, they will be more productive. They will have less sick days. 
It will be good for industry.
  So I am really thrilled to have voted for the ACA. I am really 
thrilled, 4 years-plus now, and that we are seeing it now, at the 
ground level, with people signed up for plans; and now, we have just 
got to make sure they go and use these, so that we can get them 
healthy.
  Mr. CASTRO of Texas. Thank you, Congresswoman Sanchez.
  Now, I would like to yield to my friend from Houston, Texas, 
Congresswoman Sheila Jackson Lee.
  Ms. JACKSON LEE. Let me thank the convener of this Special Order and 
the colleagues I have heard since I have come to the floor, like 
Congresswoman Sanchez.
  Congressman Castro, thank you very much. Coming from similar 
territory--the State of Texas--I just hope that you will allow me, just 
for a moment, to juxtapose the present pending bill on the floor.
  I heard you speak of the bill, H.R. 2575, as well, and with all due 
respect to the proponent of the bill, it is confusing. It is confusing 
in the backdrop of the number that you have standing alongside of you, 
7 million Americans and growing.
  Because there were many Americans who were in the queue--in the line, 
when March 31 came, and because of President Obama, they will now have 
extended the opportunity to finish the work, and I was with a lot of 
navigators and people enrolling over the weekend. They were excited 
about being able to finish the task.
  In Texas alone, that was the epicenter of unemployed. I keep saying, 
``unemployed.'' Certainly, it has unemployed persons as well. There are 
164,000 without unemployment insurance, which really is what baffles me 
about this effort at repeal and this effort of determining that, with 
30 hours of hard work, you can't get health insurance.

  In the State of Texas, 5.198 million individuals on private insurance 
have gained coverage for at least one preventative health care service, 
such as mammograms, birth control, and immunizations. That is for 
people with private insurance.
  Also, 10.695 million individuals with preexisting conditions like 
asthma, cancer, or diabetes, including 1.6 children, will no longer 
have to be worried about being denied coverage in our own State alone.
  As well, 5.189 million Texans have gained expanded mental health and 
substance abuse or use disorder benefits, and 4 million-plus uninsured 
Texans will have new health insurance options through the idea of going 
into the marketplace.
  Also, 233,000 seniors and people with disabilities have saved $866 in 
prescription medications, and 357,000 young adults have gained health 
insurance, and 7 million Texans will no longer have to worry about 
annual limits. That is, of course, those who are uninsured and who can 
access the new Affordable Care Act insurance.
  The other point is that, over these last 2 days, we have seen the 
reality of Americans clamoring for health insurance, with 4 million 
people accessing the healthcare.gov Web site.
  And let me make this as breaking news--because this is what we were 
hearing from those opposing it--80 to 85 percent of those who have 
enrolled have paid their first premium. This is not a story of I have 
enrolled and you never hear from me again; this is a story of serious 
decisions being made by serious persons.
  Let me offer, as well, some of the tragedies over the years--and I am 
very pleased to have cast that vote for the Affordable Care Act. I have 
been to any number of townhall meetings to share it with my 
constituents, some of whom who did not understand or agree.
  In the course of the hearings, I have heard of so many stories that 
we don't repeat anymore, like the little girl that had leukemia. Her 
parents took her over and over again to the insurance company to get 
the opportunity for her to be covered. She had a preexisting disease. 
She had no coverage. She ultimately lost her life.
  I believe--I don't want to call up facts that are not accurate--they 
even took her to the insurance company's office to plead for her to be 
covered. It was at that point near the end of her life, which she 
shortly thereafter lost.
  We have the mother who came to us and said yes, her son had a 
difficult history. He was a trained lawyer. He was doing pro bono work. 
He was in Atlanta, Georgia. Frankly, he had gotten hepatitis. Because 
he had no health care, the only coverage he could get was from going 
into an emergency room. He had waited too long.
  He was going into the emergency room, being the only source of health 
care. If he had had the ability to go to a doctor, in spite of his 
history of drug abuse at that time--a trained lawyer--he would have 
been able to maintain his life.
  My last one is the issue of a young resident who took a summer 
position in Atlanta, Georgia, but his health care was in a 25-mile 
perimeter around Washington, D.C.
  He fell ill with kidney disease during that summer. His father was a 
doctor. He was a student. He didn't have the ability to stay on his 
parents' insurance. His insurance was a school-based insurance that 
said it could only be around the school.
  Congressman, his father had to drive hours to pick him up and put him 
in his car and pray for his survival and get him back into the 
perimeter of his health insurance.
  This is what we lived with before the Affordable Care Act in 2010 and 
before the President ultimately signed it, and so I am baffled as to 
why, for the 52nd time, there is an attempt to repeal the Affordable 
Care Act with H.R. 2575.
  Let me just say that the importance of this Special Order is to 
emphasize whose side Members are on. I am on

[[Page H2837]]

the side of those who are clamoring for good health care and who have 
children who need good health care. I am on the side of those who need 
the expanded Medicaid and ask the State of Texas to do it.
  As I close, just on this bill, H.R. 2575, I am still trying to 
understand what it means to tell someone who works full time, 30 hours 
a week, in a company that has 50 employees, that you cannot get health 
care.
  So to the employers out there, frankly, I believe that some people 
are speaking for you that may not be really speaking for you. Because 
when you pay your employees and they get health care, they have more 
cash to buy your goods.
  More people have income to come back to the grocery store, come back 
to the restaurant, come to the small clothing store, or to buy flowers.
  Why would you deny employees health care so that they can get sick, 
go to the emergency room, and have days off? It doesn't make sense.
  I think this bill is way before its time. There is no evidence that 
we need to reduce the hours of working Americans. There is evidence 
that we should pass unemployment insurance for those who are 
chronically unemployed. We need to do that.
  There is evidence to raise the minimum wage, but there is no evidence 
that this is a problem of catastrophic moment that we are debating it 
for 4 hours on the floor.
  So I want to congratulate the gentleman for his leadership on this 
question.

                              {time}  1615

  Mr. CASTRO of Texas. Thank you, Congresswoman Jackson Lee. Thank you 
for all of your work on this and many other issues. You are one of the 
most tireless folks, Republican or Democrat, who is involved in all the 
floor debates and amendments and proposing legislation. So thank you.
  Just a few things that you mentioned. You were talking about the bill 
that we just discussed, and it was essentially saying that for sizeable 
businesses, not small businesses, because the small businesses are 
exempted from the requirements of the Affordable Care Act. That is 
worth repeating again. Small businesses are exempted from the 
requirements of the Affordable Care Act, so this was about larger 
businesses.
  Instead of requiring that they offer health care coverage to their 
employees at 30 hours, the Republicans wanted to move it up to 40. One 
of the myths has been that all of these employers are reducing hours 
and cutting employees hours and this is hurting the workers. Well, the 
Congressional Budget Office, which both sides use as a neutral resource 
to figure out what's what, said that there is no evidence of that. 
There is no trend that says that part-time work versus full-time work 
is increasing because of the Affordable Care Act.
  I also pointed out earlier in the discussion that part of the 
challenge in this economy is that American business has bounced back, 
but ordinary Americans still have not fully bounced back.
  So, when we see that the stock market every other week, if not every 
other day, is hitting alltime highs and at the same time there are 
millions of Americans still struggling to find work, I think it is fair 
to ask why an employer shouldn't offer health care coverage to somebody 
that is working 32 or 35 hours a week.
  Under the Republican plan, somebody that was working 39 hours a week, 
as Steny Hoyer mentioned earlier, you wouldn't be offered health care 
coverage necessarily. And we believe that that is wrong. We believe 
that the freedoms that we would otherwise enjoy as Americans, those 
freedoms are harder to enjoy if you are sick and unhealthy and broke 
because of medical bills.
  So the Affordable Care Act is not perfect and, quite frankly, nothing 
this Congress does, from health care to education to any other issue, 
is ever going to be perfect. If anybody is expecting perfection from 
this place, they are always going to be disappointed. But this is a 
bill that is absolutely a step in the right direction and one that we 
are going to continue to improve with the help of the American people, 
with the voices of the American people.
  But I will tell you what. As I mentioned earlier, this law is not 
going to be repealed. We are not going to go backward. We are not going 
to go to the way things were because the way they were was not good, 
and this is much better.
  Thank you, Congresswoman.
  Ms. JACKSON LEE. Thank you.
  If I could just make one final point. First of all, I am excited 
about the embracing by new Members like yourself who came out of State 
legislatures and knew how difficult it was to provide health insurance 
for our fellow Texans. But the embrace that you are now offering is one 
that gives us confidence that it will not be repealed, even though this 
is the 52nd time that it has been offered to repeal.
  I just want to leave these facts for you as you continue your debate. 
This is a values question. This is a fairness question.
  As you stand on the floor right now, the Budget Committee is meeting, 
with a budget as its underpinning, the underlying bill, that will give 
millionaires a $200,000 tax cut, and yet we have a bill here on the 
floor that wants to take the living substance from under the feet of 
workers working 30 hours a week, that gives them the stability and the 
confidence that they have health insurance for companies that are 50 
and above, 50 persons and above. That is not a small company. I can 
tell you, I would ask that employer: Are you going to get rid of Mrs. 
Smith, who has given you 10 years of hard work, and put her at 29 hours 
because you don't want to give Mrs. Smith health insurance?
  I think we are on the right side of the issue on this. The Affordable 
Care Act has helped seniors, it has helped single parents, it has 
helped individuals with preexisting disease, and it has helped young 
people who have surged into buying it. We should continue to embrace it 
and recognize that it has a value and it is going to turn lives.
  My message to our Governor, if I can end on this note: Governor 
Perry, it is time to opt into the expanded Medicaid, which is part of 
the Affordable Care Act, which will give millions of others in the 
State of Texas their opportunity to benefit from good health care--
being healthy and being able to work.
  That is our challenge, and I look forward to working with you on 
these issues.
  Mr. CASTRO of Texas. Thank you.
  I yield now to a wonderful legislator from California (Mr. Takano).
  Mr. TAKANO. I thank the gentleman from Texas for yielding time.
  I rise today to stage an intervention, an intervention for Speaker 
Boehner and the House Republicans. Now, this intervention is not 
because they are wearing goofy hats or are spray tanning too much. This 
intervention is over their obsession with repealing or delaying the 
Affordable Care Act, also known as ObamaCare.
  Now, just this week, the open enrollment period ended, and it is 
estimated that more than 7 million Americans signed up for private 
health coverage through healthcare.gov or their State exchanges. That 
number does not include the millions of young adults who are staying on 
their parents' plans or those getting coverage through Medicaid for the 
first time. The open enrollment period was one of the final pieces of 
ObamaCare.
  Now, millions of Americans finally have access to affordable coverage 
that can't be taken away just because they get sick. Despite that, 
Speaker Boehner and the House Republicans are committed to fighting a 
battle that they have lost and have scheduled the 52nd vote to repeal 
or delay ObamaCare.
  The Affordable Care Act passed the House. It passed the Senate and 
was signed by the President and has been upheld by the Supreme Court. 
Despite millions of dollars being funneled into misleading ads that 
discouraged people from getting covered, this is a law that millions of 
Americans have embraced and have benefited from. We saw an incredible 
surge in the final days of open enrollment, with consumers reportedly 
lining up around the block at some sign-up centers.
  But if you talk to Republicans, it is clear they are still in the 
first stage of denial, denial of the facts, denial of the benefits, 
denial that our health care system is finally doing what it is supposed 
to do for the first time in a long time. My Republican colleagues must

[[Page H2838]]

stop making excuses and blaming others. They have put themselves in 
this position.
  Even in the first few days of the rollout, when the system was 
admittedly struggling, Republicans were predicting ObamaCare's complete 
and total failure. John Boehner called the initial numbers ``a symbol 
of the failure of the President's health care law.'' My colleague from 
California, Congressman Darrell Issa, said, ``It is time for the 
President to finally acknowledge ObamaCare isn't working and to delay 
the law.''

  Funny how they believed the numbers then, because they seemingly have 
doubts about what is being reported now. According to Senator John 
Barrasso, the administration was ``cooking the books.''
  To my Republican friends, I want to say: this is a safe place. We are 
here to help. Your addiction to repealing ObamaCare and peddling 
conspiracy theories about the law are not doing any good for yourselves 
or for the American people.
  Stop standing on the wrong side of history. Let's move on. Let's 
accept that ObamaCare is the law of the land. Let's get back to being 
productive as a legislative body.
  Mr. CASTRO of Texas. Thank you, Congressman. Thank you for your 
comments, and also thank you for all of you in California who have been 
one of the States that has shown the Nation what is possible in helping 
to offer insurance to the hardworking men and women of your State.
  We, as Americans, we appreciate that.
  Mr. TAKANO. Well, it is a point of pride that even in my area of 
California, the Inland Empire, my county has met, has exceeded its 
enrollment goals under Covered California, and just a few days ago we 
had reached a million in California alone. It is because we have a 
State legislature and a Governor who cooperated from the beginning. I 
don't understand any Governor or any State legislature that would 
intentionally try to keep low-income people from getting coverage.
  Mr. CASTRO of Texas. You make a wonderful point. California and 
several other States have had the benefit of a State legislature and a 
Governor who have been helpful in making sure that the Affordable Care 
Act, health care coverage, is available to their residents.
  In places like the State where I live, in Texas, you have a Governor, 
State legislators, both Senators who are actively working and 
campaigning against the Affordable Care Act. So, many of us, not just 
elected officials but others who are trying to make sure that people 
have health care coverage, have faced a very strong headwind when 
trying to get the word out about the Affordable Care Act.
  I told a story earlier about a woman who showed up at an enrollment 
fair in San Antonio and she ended up being able to provide insurance 
for herself and her family, but she went there and she was skeptical at 
first. Well, part of the reason she was skeptical is because there has 
been so much misinformation about this law and so much demonization 
about the law that I am not surprised that a lot of Americans would 
say, hey, you know, that thing doesn't sound like a good thing. It 
sounds like a bad thing.
  Mr. TAKANO. There has been so much distortion. And to my way of 
thinking, it is diabolical to spend money on distorting ads to confuse 
people intentionally, to get young people to not sign up for the law, 
to undermine the law in that way
  Mr. CASTRO of Texas. That is right. You bring up a good point.
  There was a group that was specifically set up to go on to college 
campuses, funneled millions of dollars to go on to college campuses to 
convince college students not to enroll in the Affordable Care Act. 
That is just amazing to me.
  Mr. TAKANO. Fortunately, I can tell you stories of someone who is 
under 30, one of those young invincibles, but who was wise enough to 
know that it made sense for a young person to sign up because it was so 
very affordable, and he convinced his employer that she needed to take 
a look at what the exchange had to offer.
  As it turned out, he discovered he had a very serious condition, and 
he was one of those young people who discovered that they did need 
health insurance and that he was facing far larger bills than if he 
didn't have any coverage at all.
  Mr. CASTRO of Texas. California also, I believe, expanded Medicaid, 
and that is something that Texas didn't do. In fact, I remember several 
months back, when the State legislative session in Texas was still 
going on, and usually it goes to about the end of May or early June. We 
went down there and we were doing a press conference, and at the same 
time, the Governor and the Senators, Lieutenant Governor, all 
Republicans were doing their press conference.
  Our junior Senator, Senator Cruz, compared folks who need Medicaid 
and accept Medicaid to drug addicts, compared them to drug addicts. And 
the State's leadership implied that--not implied, said--allowing 
Medicaid to low-income Texans was like getting people hooked on sugar 
or drugs.
  Mr. TAKANO. Forgive me. I may be speaking--I don't think what I am 
saying is an exaggeration, but I see that the denial of the expansion 
of Medicaid by some of these States is nothing less than a war on the 
poor. I don't know how else to say it.
  Twenty-four percent of my congressional district were uninsured 
before the ACA. I have seen charts and maps of congressional districts 
color-coded, and I have seen many of those districts in Texas that are 
at the same level of uninsured as my congressional district.
  In my congressional district, we benefit greatly from the expansion 
of our version of Medicaid, which is Medi-Cal. And the beauty is that 
the expiration is not to end it as of the 31st of March. People who 
qualify for Medi-Cal can continue to sign up for it year-round.
  But to think that in Texas that it is not available to people who are 
low-income, to me, is unconscionable.
  Mr. CASTRO of Texas. I appreciate those words. Unfortunately, in 
Texas there are a lot of people suffering needlessly, hardworking 
people. These are not lazy people. These are people that are going to 
work day in and day out, but they are suffering because their State 
leadership--even though Texas was going to get up to $90 billion for 
Medicaid expansion. The Federal Government was providing the funds 
through 2017 and then providing 90 percent of the funds after that. 
Despite the fact that it made economic sense, still, the State's 
leadership refused to do it.

                              {time}  1630

  I think it is worth mentioning a few other things. A lot of us, we 
saw there were long lines on Monday, March 31 of people waiting to 
enroll in the Affordable Care Act. It is worth noting that anybody that 
started that process on March 31 but was not able to complete it has 
until April 15 to actually finish it off. So the 7.1 million number of 
the number of folks that have enrolled will very likely, I would think, 
go up by at least a few hundred thousand people.
  Mr. TAKANO. At least the folks in Texas, who can sign up with the 
Federal exchange, can get insurance if they are online, but it is 
unfortunate that those low-income Texans have no place to go.
  I will just say to the folks in California, those low-income people 
who can still qualify for Medi-Cal, that you can still sign up. There 
is not a deadline for you. You are presumed qualified if you meet a 
certain income test. So the effects of the Affordable Care Act are 
still going to continue in my State for those who need health care the 
most and those who have heretofore not had access to medical care.
  It has been a pleasure sharing this time with you on the floor, 
Representative Castro.
  Mr. CASTRO of Texas. Thank you very much, Congressman.
  There is another benefit of the Affordable Care Act that I haven't 
talked about yet that is also very important to know. We know that 7.1 
million people have signed up. Three million or more college students 
or young adults are able to stay on their parents' plans because of the 
Affordable Care Act. Millions more have benefited from Medicaid 
expansion. Millions of Americans also benefit because there is no 
longer lifetime caps. You know, you are not going to have somebody who 
is suffering from cancer in a hospital bed have a doctor or an 
administrative billing person from the hospital come talk

[[Page H2839]]

to you about the fact that you are about to hit your lifetime cap. So 
now, not only are you lying there sick in the hospital bed, but you are 
also thinking about how you are going to pay your mortgage and keep 
your kids in college. That is not going to happen anymore.
  So when you hear people talk about repeal--and first of all, repeal 
with no plan to replace it. I mean, the only thing coming from the 
other side is, just get rid of this whole thing. There is no plan to 
replace it.
  So I think what we owe the American people is, when we talk about 
repealing a law, especially something as important and big as this, I 
think it is a very fair and necessary question to ask: What are you 
going to replace it with? Are we going to go back to the old system, 
where that cancer patient lying in a hospital bed now is going to hit a 
lifetime cap with the insurance company so they are going to be told 
that they either have to leave the hospital or they are going to get 
stuck with $250,000 of bills, and they have to sell their house because 
they can't afford it anymore? When you hear the word ``repeal,'' you 
should understand that that is what is at stake, that is what we would 
go back to, the old system.
  Until folks come up with an alternative--and in 4 years, there has 
been no alternative, and really, there is no reason to think that over 
the next 4 years there is going to be one. Unless you can come up with 
an alternative, then we are talking about going back to that time.
  But the thing that I wanted to mention and something that is often 
overlooked here is that part of the Affordable Care Act, another 
benefit of it is that mental health care coverage is vastly expanded 
because of the Affordable Care Act. That is extremely important. 
Millions of families in this country, individuals and families, have 
either suffered themselves or have family members who suffer from 
serious depression, anxiety, bipolar disorder, other mental health 
afflictions that--quite frankly, in America and many other countries of 
the world, for the longest time, we never took mental health issues as 
seriously as we have taken physical health issues.
  So for a long time, people would tell you, oh, you are depressed. 
Well, you just need to snap out of it. Or they treated things like 
bipolar disorder very lightly. They thought somebody just had a bad 
attitude.
  In Texas, in 2011, I and others worked on getting young people with 
serious emotional disturbances covered by insurance companies in Texas. 
And, you know, the Democrats are in a deep minority in Texas. The whole 
time I was there, for five terms, we were in a deep minority. So you 
would have a Republican-controlled legislature. And my bill went 
nowhere. It didn't go anywhere. It died. So serious emotional 
disturbances weren't covered. But under the Affordable Care Act, things 
like that will be.
  The reason that was important was because families were coming to 
me--in my district office, there is one family in particular that came 
to me and said, We are scared of our son. Our son is a teenager, and he 
has gotten violent before. So we call the cops. The cops take him to 
the hospital. There is nowhere to keep him for any kind of long-term 
treatment because, by the way, the State provides inadequate resources 
for mental health care coverage. They can't really put him in jail 
unless he has really assaulted somebody. So there is just this cycle, 
where we are having this issue with our son, and we are scared to be in 
the same house with him. But we can't really do anything. And the law 
offers us no relief.
  Well, one of the benefits of the Affordable Care Act is that serious 
emotional disturbances and many other mental health issues will now be 
taken more seriously, and they will be more covered by health care 
companies than they have ever been in the history of the United States. 
And that hasn't been a big focus because a lot of this has been about 
politics. And a lot of the milestones and, quite frankly, the 
celebrations about the more than 7 million people signing up, that has 
been the big focus of this whole thing. But we shouldn't overlook some 
of the things that haven't gotten as much attention.
  For me, as somebody that worked on mental health legislation in 
Texas, and I know many other people, Republicans and Democrats, have 
worked on things like that--to the families who are dealing with 
situations like that, that is a big deal. That means a lot to them. And 
that is helping them out.
  So, as Americans, when you hear folks talk about repealing this law, 
I hope that we all fully understand exactly what we would be going back 
to. And those legislators who propose repealing it are irresponsible if 
they don't provide to the American people a full alternative and an 
explanation for what that alternative would do for them and what it 
would cost for the country. You know what the Affordable Care Act is 
about. We have seen no plan on the other side.
  So as I close, I would like to say ``thank you'' to all the Members 
of Congress from different places in the Nation who joined me today in 
talking about this milestone for the Affordable Care Act. I am very 
personally glad that over 7 million people have now signed up and are 
benefiting. And millions more are benefiting through Medicaid 
expansion, college students, and all of these people who won't be 
kicked off of insurance because they have hit lifetime caps. Or, you 
know, somebody that tries to get insurance, and the insurance company 
sends them a letter back saying, we can't insure you because you have a 
preexisting condition, or your doctor submits a bill to the insurance 
company, as it used to be, and the insurance company writes back 
saying, Well, you know what, we are not going to cover that $3,000 bill 
because you had a preexisting condition. That is what repeal would be 
about, going backward.
  So with that, Mr. Speaker, I yield back the balance of my time.

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