[Congressional Record Volume 163, Number 6 (Tuesday, January 10, 2017)]
[House]
[Pages H290-H296]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    WHO GETS THE BREAKS FROM REPEALING THE AFFORDABLE CARE ACT? THE 
                              SUPERWEALTHY

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2017, the gentleman from California (Mr. Garamendi) is 
recognized for 60 minutes as the designee of the minority leader.
  Mr. GARAMENDI. Mr. Speaker, indeed, we do have an extraordinary 
country. Down through the last 230 years, this Congress has met, has 
discussed, decided, voted upon, and set in place policies that advanced 
our country. And we are so very fortunate, all of us Americans, to be 
living here with all the promise that this incredible history has given 
us.
  But at this period of time, we also have some profound questions 
about where this country is going. We wake up and we say: What is 
happening here? What is happening in the international scene? What is 
all this about Russia hacking? What is all this about trying to 
influence the American election? Did they really, and did it really 
happen, and was it effective?
  Well, we know it really happened. The American public is scratching 
their head and they are saying: What is it?
  And then all this talk about change, all this talk about we are going 
to change things; we are going to repeal ObamaCare, and we are going to 
replace it with something great. Hmmm. I wonder what that might be. And 
I suspect all across this Nation there are men, women, families that 
are also wondering: What do they mean it will be great? What is it that 
is great?

  Well, if you were to go around the Capitol, if you were to talk to 
Members in the House of Representatives or over in the Senate and say: 
So it is gonna be great; what is it?
  Well, we will tell you tomorrow or we will tell you later, but it 
will be great.
  Maybe, maybe not.
  Right now, the Senate is working on a piece of legislation that will 
set the stage for the repeal of the Affordable Care Act--and some would 
derisively call it ObamaCare. Repeal it.
  Oh, yeah, get rid of that thing. But not to where it is going to be 
great as soon as it is gone.
  Really? I don't think so.
  I know that in my part of California, a lot of people--in fact, more 
than 20,000--don't think it is great at all. They are going to lose 
their health care. And there are a whole lot of seniors in my community 
that are going: Wow, it is going to be great.
  Really?
  But I will lose my annual check-up. And that awesome drug doughnut 
hole that was so frightening just years ago is going to come back? That 
is not so great.
  I drove into town or into the Capitol today. I don't live so far 
away, but it is 20 degrees, and I decided I would rather drive than 
freeze. So I drove in and an advertisement came on the radio, and it 
said: You are going to get a trillion-dollar tax cut. Wonderful. The 
middle class will have a trillion-dollar tax cut. I said: Well, that is 
not what I saw last night when I read the statistics about the great 
repeal of the Affordable Care Act. In fact, I read something quite 
different from the tax committees, from Americans, various people.
  Let me put something up here. Here it is. Who gets that trillion-
dollar tax cut? Who is it? Is it the middle class? Well, I don't think 
so, because when you look at the numbers, it goes to the very wealthy. 
They are the ones who are going to get the tax cut with the repeal of 
ObamaCare.
  When the Affordable Care Act is repealed the way it is presently 
going, the bill that is over in the Senate will require that the taxes 
that were put in place to support the Affordable Care Act and to 
provide insurance for 20 million people--that is both the government 
insurance, the Medicaid, Medi-

[[Page H291]]

Cal in California, and the subsidized insurance from the various 
programs that exist State by State--that money was raised from the 
wealthy.
  When the tax cuts come into place, here is the real story. The top 1 
percent--do you remember the 1 percenters? Do you remember all that 
discussion about the 1 percenters and the 99? The 1 percenters get 57 
percent of that trillion dollars, and everyone else gets to split the 
remaining 43 percent. The top one-tenth of the taxpayers in 
California--we are talking about the superwealthy. We are talking about 
the folks that are actually going to be in the President-elect's 
Cabinet, you know, the billionaires that he is going to put in the 
Cabinet. We are talking about those guys--oh, roughly a $200,000-a-year 
tax break. But after all, they are hurting. They need a few more 
hundred thousand dollars along the way.
  So the trillion-dollar tax break that is the foundation of the 
repeal, if you eliminate the money, the program is not working. There 
will not be annual visits for seniors so that they can stay healthy, so 
that they can control their blood pressure, diabetes, mammograms, and 
all the rest that go with it. There won't be money for the 3.7 million 
Californians that presently are able to get coverage under the Medi-Cal 
program. There won't be money for the almost 2 million Californians 
that are in the subsidized pool called Covered California. That money 
won't be there. Those folks are going to be out.
  And by the way, the repeal will remove the insurance for 30 million 
Americans all across the country. But who gets the real benefit here? 
The superwealthy, the top 1 percent will get 57 percent of that 
trillion-dollar tax break, and the rest of us will share in the 43 
percent remaining.
  Another way to look at it, folks. It will be great, but for whom? 
Well, if you break the American public into the five sectors, the first 
20 percent, next 20, next 20, next 20, and then the top 20--so these 
are the real poor down here in the lower 20 percent, and these are the 
superwealthy in the top 20 percent.
  So what happens? When you repeal the Affordable Care Act, as is now 
happening in the Senate--and it will be over here either this week or 
early next week; and then this House will take it up and it, too, will 
vote on that very same budget bill that will create a trillion-dollar 
tax cut over the next decade--who will get the money? There you go. The 
top 20 percent will wind up with a full 74 percent of that.

                              {time}  1930

  Despite that little advertisement that I heard on the radio, which 
said, ``Oh, the poor and the middle class are going to get it,'' 
really?
  Let's see. Of the bottom 20 percent--6.7--oh, and the next will get 
5.9 percent of it--do you have any idea what they are going to lose?
  They are going to lose the subsidies on their insurance programs. 
They won't be able to afford it. They will lose their insurance. For 
some of them, they are on the Medicaid or the Medi-Cal program in 
California, and they will be out of luck unless, of course, the State 
of California can find $16.8 billion to replace the money that just 
disappeared with the repeal of the Affordable Care Act, and that money 
is then transferred to the top 20 percent.
  These folks down here, the bottom 20 percent--actually, the bottom 60 
percent of the American public are the losers.
  Who are the winners?
  The ones who are already able to buy insurance. I love this trick. I 
was the Insurance Commissioner in California. I loved this little 
trick: ``Not to worry. We are going to give an opportunity for people 
to buy their own insurance and give them a tax break.''
  Do you mean these people down here have enough money jingling around 
in their pockets that they are going to be able to go out and buy the 
insurance and get the tax break?
  Uh-uh. It is the folks up here on top who will, once again, benefit.
  This really is a massive shift of $1 trillion from those people who 
are now insured, for those people who are now able to get care in the 
clinics that have been established across America--in outlying areas 
and in rural areas in my district. It is a massive shift from the 
ability of those people to get health care, for those people who are on 
the exchanges and are able to get subsidized insurance so that they can 
afford it, for those people who are seniors and are able to get their 
free annual checkups and have their drug costs reduced as the doughnut 
hole shrinks. It is a massive shift of money being taken directly out 
of their benefits and their pockets and going to the wealthy of 
America. That is what is happening. That is what this repeal of the 
Affordable Care Act is.
  Then you look at the implications of that. What about the hospitals 
that have been able to ramp up their services? What about the reforms 
that were in the Affordable Care Act--the insurance reforms--that said 
to the insurance companies: ``Oh, no, no, no, you can no longer 
discriminate because that person happens to be a woman or has a 
preexisting condition''?
  This is important, Mr. Speaker. If you are scratching your head and 
wondering what is going on here, listen carefully because this super 
rapid train is about to come into the House of Representatives and 
sweep through here, wiping out the healthcare benefits of 30 million 
Americans. For those who are not directly affected, they, too, are 
going to wind up in a very precarious situation because the reforms 
will also be repealed.
  Joining me tonight to discuss this and Social Security--oh, by the 
way, Social Security is also on the chopping block--are two of my 
colleagues: Marcy Kaptur from Ohio, who has been an extraordinary 
leader on the issues of manufacturing, of making it in America, of 
looking out for seniors, and for people who are in need of help and 
support.
  Congresswoman Kaptur, would you care to join us and share with us 
your thoughts on what is happening in Washington?
  Ms. KAPTUR. Thank you, Congressman Garamendi. You are such a rare and 
talented Member. I thank the people of California for sending you here. 
You serve them every day of the week, 7 days a week--24/7. It is a 
privilege to appear with you tonight and also with Congressman Paul 
Tonko, one of our most talented Members from upstate New York--a region 
like my own that has just been battered by the global economy and the 
outsourcing of jobs. We all are just honored to serve in this Congress, 
and we respect it and its history and its potential.
  Mr. Speaker, as I travel my own district and State, I am finding I 
have to reassure people. Anytime there is a change, I guess, in public 
life, people need to be bolstered that everything is going to be okay. 
We are here to be that squad and to say to the American people that 
they have power, too, and that it isn't just the super rich of this 
country or the billionaire class.
  We can label them ``wealth power.'' And that has power; yes, it does. 
Sometimes extraordinary power. But there is also ``people power.'' I 
consider myself having been lifted here by people power over many 
years, and I appreciate the people of my region for allowing me to 
serve our country and to learn every day, to learn from them, to learn 
how to make the instruments of the Nation work better for them.
  There is also ``spiritual power.'' I am amazed at how people's 
spiritual groundings help them through difficult situations and 
transitions.
  Then there is ``intellectual power.'' We hope to use some of that 
here once in a while. That is a power in and of itself. We think about 
the power of liberty of a free people to improve their Nation, to heal 
their Nation, to expand opportunity in their Nation.
  We are aided and abetted by a very curious media--sometimes more 
ridiculous than it needs to be--but also of people digging, trying to 
find that elusive truth that should lead us all forward. So we find 
ourselves helping to heal our Nation by being Members here, and we all 
hope for the best for our people and for our country. I think the 
Members here are very well motivated.
  I rise to defend, really, and to support two foundational programs of 
our society: Social Security and Medicare. I will try to be brief so 
others can comment.
  I am very proud to say that our family is one of those families who 
would have been completely destroyed had it not been for Social 
Security and Medicare. Those didn't exist when my parents were born and 
grandparents were

[[Page H292]]

living in our country. But in 1935, after our country crashed 
economically and there were major bank failures and the stock market 
crashed and wiped out the savings of millions of Americans, the Nation 
turned to the Federal Government, to the President, to guarantee for a 
large segment of our society--senior citizens--decent incomes.

  The Social Security Insurance Act was enacted at the urging of 
Democratic President Franklin Delano Roosevelt. He was regarded as a 
saint in our household because what happened around our country was 
that seniors before that time--many of them--were living in what we 
called poorhouses. They were dying in terrible circumstances, and there 
was no security as a person aged.
  Can you imagine how revolutionary it was at that time to create a 
social insurance program--probably the largest insurance program 
America has ever had--to ensure that as people aged or if workers 
became disabled in the workplace or if they died that their children 
would have sources of income?
  The program did all of that. In thinking back, gosh, over 70 years, 
how transformational was that?
  As for our grandpa, who died in a county hospital in Ohio before the 
enactment of Medicare, I know the conditions that he died under. And I 
know that, when our mother died, it was a different situation. She had 
Social Security and Medicare, and we were able to take care of her. The 
same was true with our father.
  Intergenerationally, I see our country getting better. I am proud of 
that. I am also proud to be a Democrat and a member of a party that has 
created Social Security, which has become an indispensable part of our 
way of life. As I have said to seniors and to workers, it is an earned 
benefit. People pay for it every time their paychecks are nicked, and 
their employers match it.
  Obviously, to survivors--and, obviously, I have neighbors who have 
lost spouses, whose children then benefit from the survivor benefit--
what an incredible gift this idea is to the American people. There are 
35 million people today in our country who depend on Social Security--
one out of every six Americans. Every day, Social Security lifts 20 
million people out of poverty--people who used to live in poverty.
  Can you imagine what that was like?
  We don't ever, ever want to go back to that world.
  In 2014, the latest data show us that more than 6 million children 
under the age of 18 live in families who receive income from Social 
Security, lifting more than a million children out of poverty. Social 
Security has never been a welfare program. It is an earned benefit, and 
all Americans who contribute to it during their working lifetimes 
receive benefits. Social Security is a compact of trust between 
generations. It is the ever-present sentry at the economic security 
gate for retirees, for those hurt on the job, or for their survivors, 
and it is America's greatest insurance program ever.
  I happened to be living when Lyndon Johnson helped to create the 
Medicare program, which provides health insurance coverage now to over 
55 million people in our country--essential health security for 
seniors. Today, only 2 percent of the elderly in our country lack 
health insurance compared to 48 percent--half the people of this 
country--in 1962, after World War II, before Medicare even existed. 
That seems sort of modern times, the 1960s; yet it really was not. I 
would say that that is a ``wow'' by any measure.
  Yes, people are living longer. Thank God the program is working. 
People are getting free preventative healthcare screenings and are 
lowering the long-term costs of care because of early diagnosis. 
Seniors don't have to pay for mammograms or diabetes or cancer 
screenings, thanks to the Affordable Care Act; so we keep trying to 
make the system better.
  Since House Republicans won the majority in 2011, every House 
Republican budget has tried to end the Medicare guarantee and turn 
Medicare into a privatized voucher program.
  Do you know what that is going to do?
  It is going to shut out millions of Americans who are elderly--or who 
are about to be elderly--from insurance. The reason we have Medicare is 
that insurers weren't insuring seniors--that is the reason it exists in 
the first place--or they will make the price so high that people won't 
be able to pay for it; or they will cherry-pick only the healthy 
people. Then those who have diabetes, those who have had prior cancers, 
those who have multiple sclerosis, those who have Parkinson's will be 
cast aside.
  What kind of a country would this be, for heaven's sake?
  The American Association of Retired Persons and the National 
Committee to Preserve Social Security and Medicare completely opposed 
the Republicans' plan to voucherize and let every senior go out there 
in the market and try to find a plan of his own, because they know what 
that means. These two programs are the most pro-life programs this 
Nation has ever created. We should be so proud of what we have been 
able to do as a country over the last century.
  The Republican attacks on Social Security and Medicare need to stop. 
They are America's bulwark for millions and millions of people, and 
they have proven themselves to be America's most important, lifetime 
security programs.
  I thank Congressman Garamendi and Congressman Tonko for being down 
here tonight. I know how passionately you care about the people of our 
country way beyond just your districts and why we are here. We are here 
to stand with them.
  Mr. GARAMENDI. Thank you very much, Ms. Kaptur.
  I loved your talk of the history and how it came to pass that we have 
Social Security and Medicare and what happened when we did not. It was 
really profound. It reminded me of my own history.
  I remember, as a young kid, that my father took me to the county 
hospital where the neighboring rancher was--we were out on a ranch in 
California--and it was horrible. That is where he was sent to die 
because there was no Medicare.

  Ms. KAPTUR. If the gentleman would yield, I can remember the stench.
  Mr. GARAMENDI. Oh, the stench was unbelievable.
  Ms. KAPTUR. I can remember that.
  Mr. GARAMENDI. I am sorry your father endured that.
  Ms. KAPTUR. My grandpa.
  Mr. GARAMENDI. Your grandfather.
  Ms. KAPTUR. Our father had to fight to get him in there because there 
wasn't enough space for people who were ill and dying. That was before 
hospice and that was before Medicare. I remember, as a young girl, that 
that was a hard thing to experience, but our mother and father never 
protected us from the inevitable.
  Mr. GARAMENDI. I was just thinking that I have got more stories to 
tell, but I really want to turn to our colleague from New York. Mr. 
Tonko and I are often on the floor--with you also--to discuss jobs in 
America, how to enhance our American economy with research, economic 
development of all kinds, transportation infrastructure, Make It In 
America.
  Mr. Tonko, tonight we are on a somewhat different subject, but I know 
it is one that you are very familiar with, one that you have spent your 
entire career addressing in trying to help seniors and others who have 
been on the short end of the stick. Thank you so much for joining us, 
Mr. Tonko.

                              {time}  1945

  Mr. TONKO. Mr. Speaker, I thank Representative Garamendi for bringing 
us together in this Special Order format to talk about some key 
critical components that address American families significantly. 
Representative Garamendi and Representative Marcy Kaptur, who both do 
their homework, are a great addition to the House because they 
challenge us with facts, not fiction. They care deeply and passionately 
about improving and enhancing the quality of life. So to stand with 
both on this issue is a good feeling for me.
  Just a couple of observations: I think it is okay for government to 
have a heart. We speak to the heart and soul of working families across 
this country by understanding that health care is not a privilege; it 
is a right.
  So let's begin with that fundamental basic observation, a right. What 
we have seen with this right is that over 30 million Americans have 
been added to the rolls of the insured over the course of the 
Affordable Care Act.
  Now, Representative Kaptur did a great job of speaking to history of

[[Page H293]]

Medicare, of Social Security, and of the Affordable Care Act, as did 
Representative Garamendi. I remember being at the 75th anniversary 
celebration of Social Security, and people were talking about the 
discrediting going on before Social Security was enacted into law. 
There were those who demonized it before it became law. There were 
those who have fought it ever since. They don't want that right for 
working families.
  I would suggest that Social Security, Medicare, and the Affordable 
Care Act are rock solid elements of a foundation upon which to grow 
quality of life and longevity. It is a basic fundamental additive that, 
when brought to our working families across this country, we are 
providing a service and we are addressing them with dignity. That is 
what this is about.
  The demonization of the Affordable Care Act is interesting. Because 
if you look at polling, you will find that people say that ObamaCare is 
destroying the Nation. Well, what about the Affordable Care Act? That 
is working. My friends, it is the same issue, it is the same concept, 
and it is the same program.
  So what we have tried to do is discredit a program that took on a 
major challenge, took on major industries, and needed to provide a 
balance and an actuarial outcome that is providing a go-forward and 
accomplish what you have enacted as a mission. The actuarial science 
has got to be precise.
  So for those who want to repeal, they are talking about, in cases, 
pulling a brick out of the foundation and having it get wobbly, and it 
is going to crash the marketplace. We are going to have all of these 
people who have been enrolled or have been forever enrolled in health 
care impacted by rising costs and disruptive outcomes that will put 
them at risk.
  So like the Social Security Program before the ACA, like Medicare 
before the ACA, as you floated these boats, as you went forward with 
time, you learned where you needed to tweak, and you adjusted, by 
amendment format, to make the program stronger. That is what we have 
been asking for in a partnership here in the House and with the Senate. 
Let's work on those areas that may need improvement, but do not repeal 
because repeal without replacement is a disaster. It is a disaster 
waiting to happen.
  We have provided hope for working families across this country. We 
have had the testimony presented to us, anecdotal evidence, that this 
is working, that for the first time families have enjoyed a connection 
to a system, a standardized approach. What was the program?
  People say: Well, I don't want to pay for someone else's health care. 
You have been paying for it before the ACA. It was called the emergency 
room. It wasn't standardized because whoever you got at that emergency 
room in whatever location, as you traveled looking for assistance, 
didn't provide a steady flow. It was a wasteful outcome for taxpayers 
and an insufficient outcome, a cruel outcome for those consumers who 
were impacted by being underinsured or uninsured.
  So let's set the record straight. We have had a program up and 
running for 8 years now. The Republicans have chastised this program 
saying it needs to be repealed. We have taken over 65 votes, or 65 
votes, I believe, to repeal, but there has never been a replacement 
plan. So what kind of gimmick is this to pull away a program that is 
working for tens of millions of families added to the rolls but not 
replace? That is disaster waiting to happen.
  So we challenge our colleagues here in the House and in the Senate 
down the hall to be academic about this, to be compassionate about it, 
to be passionate in our resolve, and to make a difference by putting 
together the improvements that we require and not repealing.
  Now, we look at the Affordable Care Act and what it means to our 
health care. But if you repeal, you will wreak damage on the budget. 
You will destroy our economy. You will have a huge workforce 
displacement, and you will slash care for America's working families. 
Is this the outcome that we want?
  Remember, we were the last industrialized nation to come to the table 
and provide guaranteed health care for our families. That is not 
something of which we are proud. That was destructive. That was 
insensitive. It was not effective. It was a waste of tax dollars the 
way we did it.
  So now we go forward with a program that allows us to now take a look 
at the history, albeit brief, on the Affordable Care Act, but 
understanding where we need to fine tune. We do that, and the challenge 
is there for all of us: take the cost out of the system for a stronger 
future and provide at least the same level of quality, if not enhanced 
quality, as we go forward. That should unite us in a common cause, 
cutting the cost of the program and enhancing the quality of services 
provided. What a great mission for all of us to embark upon.
  So let's not play politics with the health care for tens of millions 
of people who are new to the system and for all of us who have been 
covered routinely by the system. We can do better than that.

  Let the lessons of Social Security and Medicare, which, as my 
colleagues indicated earlier, address the American public with dignity, 
improvement, enhancement, and hope, the best commodity we can deliver 
as a government to her people.
  So I thank Representative Garamendi for the opportunity for us to 
speak to these issues. Frankness is required right now. The lack of 
theater would be an improvement. No theater on this. Let's settle for 
facts, not fiction, and working together to bring about what is a sound 
resolve that allows us to provide stability and success for the 
American public. That, I don't think, is too much to ask.
  So I thank the gentleman from California (Mr. Garamendi) for bringing 
us together.
  Mr. GARAMENDI. Mr. Speaker, it is always a pleasure for me to be on 
the floor with Representative Tonko because of his passion, his 
knowledge, his ability to articulate with clarity, in this case, the 
importance of the Social Security program, Medicare, as well as the 
Affordable Care Act. The gentleman makes a compelling argument.
  I want the public of America to really grasp the importance of what 
is happening here in Washington. Yes, we are going to have a new 
President, and there will be an inaugural and all of the celebration 
that goes with that.
  Let me put it this way: When that is done, there is a majority of the 
Congress and the Senate, together with the President, that fully intend 
to embark on unraveling the very critical safety net for more than 30 
million Americans. And for everyone else who has insurance at every 
age--Medicare all the way down who has insurance--they will also see a 
dislocation and an unraveling of their insurance benefits because this 
market could seriously unravel. So as the gentleman said so clearly, be 
academic, study the facts, and study the pros and the cons of the 
various alternatives that are out there.
  I know, as an insurance commissioner and having been dealing in the 
issues of health care for many years now, that there are improvements 
needed in the Affordable Care Act. There is no doubt. We have been 
saying that since shortly after it became law. And even when it became 
law, I said this should be done this way or that way a little 
differently. We are 8 years into this and, as you say, millions, tens 
of millions actually--around 30 million directly--are involved and 
benefiting from the program, either through Medicaid, through the 
exchanges, or through the various benefits that are out there. So it is 
really, really important.
  I want to also pick up on something that Representative Kaptur 
brought to our attention. I am going to put one more chart up here. I 
was surprised and a little bit appalled, just before we broke for 
Christmas, that the new chairman of the subcommittee of the Ways and 
Means Committee who deals with Social Security introduced a piece of 
legislation. We looked at it.
  It was just before the Christmas holidays, so I picked it up and 
started looking at it. I go: whoa, wait, wait, wait. This is a major 
step to unravel the Social Security system. Remember, back in the 
George W. Bush administration, in the first 3 years of his 
administration, he tried to privatize Social Security. He failed 
miserably at that. Thankfully, he failed. Congress wouldn't stand for 
it. At least, the Democrats in Congress wouldn't stand for it.

[[Page H294]]

  I see this piece of legislation introduced in the last session, in 
the last days, and I am going: Whoa, what does this mean? This man 
becomes the chairman of the subcommittee that deals with Social 
Security, and I am going: oh, no, they wouldn't; they wouldn't go after 
Social Security again. But the bill does. It does it in a way that, 
once again, gives enormous benefits to the wealthy and not so much for 
the others.
  This is a little chart about what happens if that piece of 
legislation by Mr. Johnson actually becomes law. These are the benefits 
that would be received today. In 10 years, these would be the benefits. 
This is the top 20 percent rather, and right here is the middle. That 
is about a $3,000 a year reduction.
  Keep in mind that, I think, well over 50 percent of the seniors in 
the United States depend upon Social Security as their principal source 
and, in many cases, their only source of income.
  So you get a decline. What do they want to do? They want to increase 
the age to 69 before you could apply for full Social Security. They 
want to radically change the cost-of-living index. I know what I heard 
from my constituents when there was no cost of living over the previous 
2 years--and a very small one this last year--the cost of care for 
seniors continues to rise because they are on the expensive side of 
things. There are some other provisions in it. So this is a wake-up 
call. This is a wake-up call.
  Clearly, the majority party here in the House and in the Senate have 
promised to repeal the Affordable Care Act, which we have talked about. 
They have also made it clear that in the past--and we believe in the 
months ahead--they will attempt to privatize a large portion of the 
Medicare program. So Medicaid will be largely gutted, and the increases 
that we have seen through the Medicaid program will be wiped out.
  The Medicare program will have significant benefit reductions, and, 
if they intend to voucherize it, which they have talked about, then as 
Representative Kaptur said, they will throw the seniors to the mercy of 
the insurance companies.
  My basic point tonight was to raise the alarm and to begin to discuss 
here amongst our colleagues the reality of what is being planned for 
America. Don't look at this as a partisan issue, Republican or 
Democrat. Look at this as a personal issue.
  Look at this as an issue that was given to me by a woman who is a 
farmer in the community I represent north of Sacramento who never had 
insurance. She was an entrepreneur, a self-employed farmer. She never 
had insurance. If she needed care, she would go to the emergency room. 
That worked when she was young, but then she became a little older, and 
then cancer.

                              {time}  2000

  The treatments for her cancers were unaffordable. She would go 
bankrupt. The Affordable Care Act came along with guaranteed coverage 
and an insurance policy through the exchange in California that she 
could afford that would provide her with unlimited medical services for 
the rest of her life. No cap, no annual cap, no lifetime cap. She got 
her cancer treatments, and she has moved along. She said: I still need 
care. And if they repeal the Affordable Care Act, I won't get it and I 
will die.
  That story is repeated across America. It is repeated in my district. 
I can give many more examples. So this really is, in her case and in 
many others, a life-or-death situation. So, yes, we will be academic as 
Mr. Tonko has said. We should be. We should understand the implications 
of one policy versus another. We should understand when you start with 
repealing a trillion dollars of taxes, that will have a profound impact 
on health care in America. And the benefits will go to the wealthy. 
That is academic.
  But it is also this woman, a small farmer who developed cancer. She 
had no hope. The Affordable Care Act comes along, and she is able to 
get insurance and she is able to get the chemotherapy necessary to save 
her life. She is back on the farm.
  Repeal the Affordable Care Act and this woman, along with millions of 
Americans, are in serious jeopardy. So be aware. Social Security on the 
chopping block; Medicare on the chopping block; the Affordable Care Act 
is on the chopping block. Tax reductions for whom? Yes, mom and pop 
would get $130 a year from the tax cuts. The billionaires in the Trump 
administration would get $200,000 a year in tax cuts. Mom and pop are 
likely to lose their insurance.
  I now yield to the gentleman from New York (Mr. Tonko).
  Mr. TONKO. Thank you, Representative Garamendi.
  As you talk about public sentiment about Social Security, the 
Affordable Care Act, and hearing the evidence you have provided from 
your constituent within your district, it becomes very apparent where 
the American public is.
  When polled recently, only 20 percent of the American public is in 
support of efforts to repeal without replacement--20 percent. So the 
great, great majority understands what is going on here.
  We have also seen during the recent campaign season, which probably 
went a year and a half to 2 years long, a lot of talk about repealing 
the Affordable Care Act, undoing the act. That happened in the same 
timeframe as 11.5 million people were added to the rolls for 2017. So 
there is an appeal here that is drawing the American public toward the 
coverage provided by ACA. So the sentiment here is to get things done 
and provide, again, the stability.
  I am also a cosponsor of legislation entitled Strengthening Social 
Security Act that would improve how we calculate the benefits for 
Social Security. We are not advancing reducing those benefits or 
raising the retirement age to 69 or whatever level; we are talking 
about enhancing benefits. When you talk to seniors, they will say we 
either have got nothing or we got just a bit of an increase that was 
taken away with the other hand for some other purpose.
  So, yes, we need to revisit just how we give that green light to a 
COLA adjustment, and we need to calculate that approval with items that 
are truly essential for the senior citizens, not big screen televisions 
or certain items that are adding to a luxurious note, but one that 
speaks to their basic core needs to live day to day. So the 
Strengthening Social Security Act does just that. It takes into account 
all of the essentials in that calculus that will determine whether or 
not a COLA adjustment is given that given year. So that is important.
  I also believe it is time for us to look at that cap that we have 
created, that we have placed on contributions to Social Security. You 
know, some people by February 12 or 14, whatever date it is, are done 
paying. They are done contributing by that point in the year. Well, the 
standards of $118,000, or $127,000 coming this year, are just capturing 
most of those revenues. The hardship is placed on the working, middle-
income community, those looking to ascend the middle class. There could 
be a far greater contribution from other income strata that we ought to 
look at to provide stability.
  A point needs to be made that Medicare, Medicaid, and the Affordable 
Care Act are all intertwined. There were strengtheners that were 
provided for these programs. There was a partnership of revenue stream 
that was calculated and assumed that again provides for the quality of 
response to the consuming public, and especially those in senior years.
  I have a large percentage of senior citizens in the makeup of my 
constituency. It is important to recognize that many who are on 
Medicare end up getting Medicaid assistance because of situations that 
are called upon where they are perhaps placed in nursing homes, adult 
homes, or the like. So we have to be cognizant here of the public 
sentiment, where is their thinking, and we know exactly what they want. 
They want stability for these programs. They want strengthening of the 
programs. They want to make certain that all of these efforts that have 
lasted for decades, or were introduced as late as 2010, will continue 
so they have a future that is that more secure, that more certain.
  So tonight we talk and implore our colleagues to please help improve 
the Affordable Care Act. Let's not repeal, and certainly do not repeal 
without a replacement plan. That is a disaster that will really cause 
havoc in the marketplace. It is one that doesn't prove to be 
actuarially sound. Also, let's make certain that we don't have these 
efforts again to voucherize Medicare, to privatize Social Security. 
These are programs that have provided stability.

[[Page H295]]

  When I came into the House in 2009, it was at the lowest point of the 
recession which President Obama was handed upon his entering into the 
Presidency. There were 700,000, 800,000, 900,000 jobs lost a month in 
the deepest, darkest moment of the recession. What did we see? We saw 
individuals who took their lifetime's worth of savings and entrusted 
them to a marketplace, and they lost everything for which they had ever 
worked, and others realized they didn't lose a single cent of Social 
Security. Therein lies a tremendous bit of testimony as to the 
meritorious achievements of a Social Security system, one that provided 
that safety net for all families, one that made certain there was some 
sort of continuous flow, a backup, a reinforcement, as you went into 
retirement years.

  We are reminded of Medicare and what the results were for retirees, 
how long they were expected to live and what their quality of life was 
like. It was tremendously, favorably turned around with the benefits of 
Medicare.
  So with an impassioned plea, I encourage this House, the Senate, to 
do the right thing: stand for the American public and allow them to be 
addressed with dignity with these programs that have proven themselves. 
And where there is a need to further assist, as there has been time and 
time and time again with Social Security, as there has been time and 
time again with Medicare, let's provide that same approach to the 
Affordable Care Act.
  I thank the gentleman from California for bringing us together and 
being able to share our thoughts and advocacy to do the right thing.
  Mr. GARAMENDI. Mr. Speaker, I thank Mr. Tonko very much. It is always 
a pleasure and learning experience to be on the floor with Mr. Tonko.
  I now yield to the gentlewoman from Ohio (Ms. Kaptur). We are about 
to wrap it up as we are nearly out of time.
  Ms. KAPTUR. Mr. Speaker, I am honored to join Mr. Garamendi and Mr. 
Tonko, and I want to place in the Record, since both of you have talked 
so eloquently about the Affordable Care Act, you know how you will be 
walking through your district, maybe at a parade or some public event, 
and someone will break from the crowd and run toward you. I am thinking 
about one particular woman who came up to me in one of my smaller 
communities. She was in tears. This was during the summertime. She has 
cerebral palsy, and she never was able to get care. I don't know why 
she didn't qualify for insurance, I don't know all of that, but she 
hugged me and thanked me.
  And then around the corner from where we live, there is a little 
produce market that I go into all the time. I am friends with one of 
the women who works there. This little business couldn't afford 
insurance, so their employees, when the Affordable Care Act passed, 
went to the private marketplace to get a plan. This particular woman 
who works long hours and lost her husband to cancer told me: Marcy, why 
are people complaining about the Affordable Care Act? Guess what, now I 
have cancer.
  She said: I was able to go and get all of the tests, and now they 
have me on chemotherapy.
  So, with cancer, this woman is working. She was only able to get 
insurance through the Affordable Care Act. Multiply that times 10,000, 
20,000, 1 million, 20 million, whatever the number is. Think about the 
number of people in our country who were without insurance. Sometimes I 
am speechless when I meet these citizens because I think: Where were 
you hiding before? Where were you?
  Another place I was, a woman was mixing up. She said: Well, I have 
health insurance, right? I pay car insurance.
  I said: No. Car insurance doesn't cover health insurance.
  People sometimes don't act in their own self-interest. She didn't 
even know that because she had auto insurance, that didn't cover health 
insurance. Can you believe that? So she was in a job where, with the 
Affordable Care Act, she could go out to the exchange and buy a plan.
  It is amazing to me some of the things that have happened and how I 
see the Affordable Care Act off to a very good start.
  As Mr. Tonko said, don't just repeal it until you have something to 
replace it with. You cannot pull the rug out from under these people's 
lives. It would be unconscionable to do that.
  We have several Christians, several other denominations in this 
House. It would be very unChristian to do that, for those who are 
Christian. And for those of other denominations--pick your 
denomination--I just think it would be very cruel.
  I thank the gentleman for allowing us to speak out this evening on 
behalf of citizens who can't speak for themselves and to try to help 
perfect what we as a Republic can do for our citizenry.

                              {time}  2015

  Mr. TONKO. Representative Garamendi, if I just might, I am listening 
to Representative Kaptur talk of the interaction she had with her 
constituents, and I would just add my similar experience.
  Some of the most cherished efforts of the Affordable Care Act are 
about preexisting conditions. Being a woman, being a pregnant woman, or 
being a woman or a man fighting cancer made it very difficult for 
people to get that insurance, and lifetime caps. You know, people being 
rolled into surgery, wheeled into surgery, and being told that they 
were discontinuing their plan.
  So these are elements of the Affordable Care Act that could be at 
risk if we start playing around with the actuarial balance that has 
been achieved. And preexisting conditions, they rang right up there as 
one of the biggest concerns people have about repeal.
  Ms. KAPTUR. On that point, another woman came up to me, I was over at 
the medical hospital with my brother, and she has epilepsy, and she has 
another condition. She told me, she said: You know, Marcy, I have to 
cut my pills in half. Can you help me try to find pills so that I can 
afford to pay for all the medicines that I need to take care of myself?
  Rather than repealing, can't we find a majority of Republicans to 
help us, to help our citizens be able to get medicine at prices they 
can afford?
  Why can't we have competitive bidding for pharmaceuticals? Why can't 
we have that? We have it for the VA. We have it for the Department of 
Defense. Why can't we have it for the rest of our citizenry so that we 
can get the best price?
  But I thought: Cutting your pills in half? And so what happens to her 
is, if she doesn't take enough of the medicine, then she has a seizure. 
But she has got other things wrong with her, so she is trying to cut 
this pill and cut that pill. And I thought, this is crazy. This is 
crazy.
  Can't we do better as a country than this for our people?
  I have never understood why the price of pharmaceuticals has shot up 
so much. I can't tell you how many cases we get in our office where we 
have to call these companies and beg, you know, do you have some 
foundation where we can get a few more pills from Lilly or a few more 
pills from this company or that company in order to help people in our 
district.
  It shouldn't be our job to turn into a medical dispensary because the 
system isn't working. There ought to be a way to take care of this.
  Mr. GARAMENDI. As we look at this issue, this conversation puts 
before us and the American people really two paths to travel. The 
President-elect recently said: We're going to repeal ObamaCare, and 
it'll be great. And our Republican colleagues have bought into that and 
are now processing legislation to do that.
  The discussion today from my two colleagues here indicates another 
path, and that is, make it better. Make the Affordable Care Act better. 
The drug issue, there is no reason in the world that the pharmaceutical 
companies should be prevented from price competition. They are. It is 
the law of the land that prevents the government and other purchasers--
the government from negotiating prices. That is a law that can be 
changed.
  There are many things that we could do to improve the health care of 
America. But two paths: one, working together to improve the Affordable 
Care Act and Medicare and Medicaid, and the Veterans Administration, 
the programs that provide the health care and the insurance for 
Americans; or another one, a path that is going to be extraordinarily 
destructive.

[[Page H296]]

  The repeal of the Affordable Care Act, which is already underway in 
the Senate and will soon be over here in the House, promises Americans 
not just the 30 million that have insurance but all Americans with a 
very serious health problem in the future.
  Final comments, and then we will be out of time.
  Mr. TONKO. Just a quick comment. We have talked about much here this 
evening. I joined you a bit after you started. I don't know if you 
mentioned the hospital situation.
  Mr. GARAMENDI. Very briefly.
  Mr. TONKO. But representing a number of hospitals, from stand-alone 
clinics to some very specific specialty type of health centers, they 
are all concerned about the impact of repeal. And certainly, being a 
major employer, if not the major employer in some of my counties, as 
you reduce that care, you are reducing the workforce. So now we are 
creating another impact, and it is why the ripple effect of repeal is 
so strong and devastating, and will raise our deficit.
  Mr. GARAMENDI. I thank the gentlewoman from Ohio (Ms. Kaptur) and the 
gentleman from New York (Mr. Tonko) for joining us. I can assure you, 
we will be back.
  Mr. Speaker, I yield back the balance of my time.

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