[Congressional Record Volume 160, Number 149 (Tuesday, December 9, 2014)]
[House]
[Pages H8925-H8927]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          HONORING CONGRESSMAN JOHN DINGELL ON HIS RETIREMENT

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2013, the Chair recognizes the gentlewoman from California 
(Ms. Speier) for 30 minutes.
  Ms. SPEIER. Mr. Speaker, one of the great privileges of serving in 
this body is that occasionally we walk among giants. Most of us 435 
Members are ordinary, but among us are a few extraordinary citizens who 
become Members of Congress and serve this great country.
  We are saying good-bye this week to one of those giants. John 
Dingell, after serving some 59 years in this Chamber, is leaving us, 
and leaving us with a legacy of legislation that is truly astonishing: 
the Endangered Species Act, the 1990 Clean Air Act amendments, the Safe 
Drinking Water Act, legislation to create the first international 
wildlife refuge in North America, not to mention the Civil Rights Act 
or the Affordable Care Act or any number of other giant pieces of 
legislation.
  He has often said when asked about the jurisdiction that he was in 
charge of as chair of the Energy and Commerce Committee that he would 
point to a map of the Earth when asked about his jurisdiction and would 
say,

[[Page H8926]]

``If it moves, it is energy, and if it doesn't, it is commerce.'' That 
is the way he would define the jurisdiction under his leadership.
  We are thrilled that his wife now continues that extraordinary legacy 
by joining us as a Member of the next Congress, and I look forward to 
working with her on so many very important issues.
  So to John Dingell I say, I walked among many here in this Chamber, 
none as giant as you, and forevermore I will remember your great 
leadership to this body and to this country.


           Medicaid Primary Care Pay Bump and Women's Health

  Ms. SPEIER. Mr. Speaker, I now would like to shift gears, Mr. 
Speaker, and speak about an issue that, frankly, John Dingell would be 
very concerned about as well, and that has to do with Medicaid primary 
care pay bump.
  At the end of this year there will be up to 7 million more women who 
are eligible for Medicaid through the Medicaid expansion program who 
will not be able to get health care because they can't find a doctor.

                              {time}  1815

  Medicaid pays less than Medicare and private insurance for primary 
care. That is not surprising. In 2012, the average Medicaid rates were 
only 59 percent of Medicare rates for primary care services.
  Now, you may be scratching your head and saying: Well, why would we 
somehow cheat the poor out of health care? That is precisely what we 
are doing. By reducing the amount of money available to physicians who 
provide care to the poor in this country, we are basically saying: 
``Find it if you can.''
  In my home State of California, the Medi-Cal reimbursement rates are 
on average only 43 percent of Medicare rates for primary care services. 
This map shows what the situation is. The very light color are those 
States which were at 33 to 57 percent, the medium blue is at 59 to 82, 
and the dark blue is at 85 to 98 percent of Medicare rates. As you see, 
most States are in that 59 to 82 percent range, but many large States, 
like California and Florida, are between 33 and 57 percent.
  The Affordable Care Act addressed this issue by creating a 2-year 
Medicaid pay bump for certain primary care services for millions of 
low-income individuals newly eligible for Medicaid-covered care. 
Without congressional action by the end of this year, that pay bump 
expires and, with it, health care for millions of Americans.
  I come to the floor today to demand that we extend the Medicaid pay 
bump past 2014 and protect health care for our low-income constituents.
  Additionally, the way the current pay bump is structured 
disadvantages women, many of whom prefer to see their trusted OB/GYNs 
to access primary and preventive care services. As we know, primary 
care and preventive care are crucial to the general health of our 
citizens, as well as to the reduction of health care costs, but the pay 
bump doesn't cover these crucial primary care providers.
  When I was in the State legislature in California, I, like many of us 
here, tended to find legislation that related to something that I knew. 
I realized that I never went to the doctor. The only time I went to the 
doctor was to visit my OB/GYN once a year.
  When primary care providers were being identified, I thought: Why 
shouldn't OB/GYNs be allowed to be primary care providers as well? So I 
introduced legislation in California which became law that specified 
that indeed OB/GYNs could be primary care providers.
  What we do know is almost 6 in 10 women report seeing their OB/GYN on 
a regular basis. It is the one thing that women do at least once a 
year. One-third of women view their OB/GYN providers as their main 
source of care, so Federal recognition of the primary care role that 
OB/GYNs play for women in the ACA's Medicaid pay bump lags behind this 
general recognition in many other sectors of our health care 
infrastructure.
  Thirty-five States and the District of Columbia classify OB/GYNs as 
primary care providers for their Medicaid programs. In TRICARE, the 
Federal health care program for our military servicemembers, OB/GYNs 
are recognized as primary care case managers.
  OB/GYNs are included under the primary care provider definition in 
community health teams, a grant program that supports primary care 
practices and patient-centered medical homes. In the primary care 
residency program called the Teaching Health Center Graduate Medical 
Education program, which aims to increase the number of primary care 
residents and dentists trained in geographically isolated, 
economically, or medically vulnerable communities, OB/GYNs are included 
as one of the primary care disciplines.
  Let's be clear. Lack of recognition of OB/GYNs as primary care 
providers under the ACA pay bump puts women who receive their health 
care from Medicaid at a disadvantage. Twenty-three percent of women 
Medicaid beneficiaries report a problem finding a new doctor who will 
accept their insurance, compared to 7 percent of Medicare beneficiaries 
and 13 percent of women with private insurance, due very simply to the 
very low payment plans and rates that exist for Medicaid.
  I urge my colleagues to extend the Medicaid pay bump past 2014 and 
expand it to include a protection for women's health by officially 
including OB/GYNs as primary care providers.
  With that, Mr. Speaker, I yield to the gentleman from Minnesota, 
Congressman Rick Nolan, my very good friend and someone who I admire 
greatly as well.
  (Mr. NOLAN asked and was given permission to revise and extend his 
remarks.)
  Mr. NOLAN. Mr. Speaker and Members of the House, I want to join my 
colleagues in paying tribute to a great Member of Congress serving with 
us today but who is planning to retire, the Honorable John Dingell. I 
would like to do so by telling a little story.
  Some 40 years ago, I was elected to the Congress of the United States 
for the first time. Before I had even been sworn in, I faced my first 
big challenge. The Congressman that I preceded had passed some 
legislation called the Big Stone Wildlife Management Area. The editor 
of our biggest newspaper had applauded him for that. I supported it in 
my campaign. I said: ``I'll do everything I can do see that it's fully 
implemented and fully funded.''
  Well, I had just been elected, and the President of the United States 
announced that the project was not going to go forward, it was not 
going to be implemented, and it was not going to be funded. Here I am, 
I have just been elected, at least it appears as though I am already 
doing harm and damage to the district, and I haven't even been sworn in 
yet.
  We came out here for a little orientation session, and I decided I 
would check with the chairman of the Interior Subcommittee that is 
responsible for this kind of legislation, to see if he had any advice 
for me on how I could effectively deal with this.
  He said: ``Come see me tomorrow.'' So I went to see him the next day 
and he said: ``Put out a press release. The project is going to be 
fully staffed, it's going to be fully funded, it's going to be fully 
implemented.''
  I said to him, questioningly: ``Gee, Mr. Chairman, the President of 
the United States of America says it's not going to be fully funded, 
it's not going to be fully implemented.''
  He put his arm around me and he said: ``Son, let me tell you 
something. Presidents come and go around this town with quite 
regularity. Old dogs like me have been here forever, and I'm going to 
be here forever. The bureaucracy will listen to an old dog like me 
before they'll listen to some darn fool President of the United 
States.''
  Well, needless to say, apprehensively, I put out the press release 
saying the project was going to be fully funded, fully implemented, and 
indeed, it was. In the process, I learned an incredibly valuable lesson 
from Mr. Dingell, and that is there are many ways to effect public 
policy beyond the legislative actions--which of course are perhaps most 
important--that we make here in this Chamber.
  By getting a hold of these bureaucracies and talking to them and 
telling them what you would like to see happen and, when appropriate, 
being supportive of their mission and their goals, they are inclined to 
be supportive of you as well.
  That little story happened 40 years ago. Well, then I went on a 32-
year hiatus. I spent the next 32 years of my life in the private 
sector, in business, community service, and raising my family.

[[Page H8927]]

I came back here 40 years later and who is still here proving his point 
but John Dingell.

  As I said, 11 Presidents have come and gone, but he is still here. I 
believe he has served longer than any other Member of the Congress in 
the history of the country; perhaps, most importantly, he is maybe the 
greatest Member to ever serve in the Congress.
  There are so many good things that have happened in this country over 
the better part of a half a century that we can attribute to the good 
work of the honorable Representative, the great Representative John 
Dingell.
  John, we are all so grateful for your incredible service. I am 
thrilled and honored to be able to be here to join my many other 
colleagues in saluting you for your great service to the people that 
you have represented so ably from your own district, but your larger 
vision as well of what has been so important for the progress of the 
people here in America.
  Thank you for your wisdom. Thank you for sharing that with so many of 
us who benefited from having sought your wisdom. Thank you for your 
effectiveness and all the great things you have done for this country. 
We salute you, Mr. Dingell.
  We love you, and we will miss you, but we will be forever grateful. 
This country will always be a better place for you having served in 
this Chamber.
  Ms. SPEIER. Mr. Speaker, I yield back the balance of my time.

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