[Congressional Record Volume 163, Number 13 (Tuesday, January 24, 2017)]
[House]
[Pages H675-H677]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  1845
                      FIXING OUR HEALTHCARE SYSTEM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2017, the Chair recognizes the gentleman from Texas (Mr. 
Sessions) for 30 minutes.
  Mr. SESSIONS. Mr. Speaker, tonight I rise in support of describing to 
each of my colleagues some important attributes of a big issue that we 
are all working on, and that is about health care. I rise today to talk 
about not just the current state of health care, but also a direction 
about where this body has an opportunity and a chance to go to make 
America's healthcare system even better so that it is the greatest 
healthcare system in the world.
  President Obama signed what is known as ObamaCare, the Affordable 
Care Act, into law on March 23, 2010. This was an attempt then by the 
President and his party, receiving no votes from the Republicans in the 
House or the Senate, to offer a brand-new vision to the American people 
of their idea of health care.
  It took several years for the American people really to comprehend 
and understand this undertaking, but we are now in the sixth year of 
ObamaCare, and it has turned out that it not only is not sustainable, 
but it has provided millions of people who have lost coverage, higher 
premiums. It is not uncommon to see where some healthcare providers are 
raising their rates by 60 percent, and in 2013 alone, 4.7 million 
Americans had their preferred healthcare system canceled.
  So the plan began with the high accolades of President Obama and 
Democrats, only to see, in its sixth year, it has become a concrete 
life preserver to many who are not only on the plan, but those who 
would wish to have their own healthcare coverage and cannot because of 
this law.
  Tonight what I would like to describe to my colleagues is a chance 
for them to begin understanding that the American people have elected 
Donald J. Trump, Republicans, back into the majority, and Republicans 
back again into the majority in the United States Senate. This was done 
because there were a number of ideas that were made well aware to the 
voting public that Republicans would have an answer not only to repeal, 
but to replace the Affordable Care Act.
  Republicans, in fact, now that we are in our second or third week of 
being in the majority, with President Trump taking office last Friday, 
Republicans have begun working not only with themselves, but with this 
administration on ideas that will make the replacement of ObamaCare 
even better for each and every person in this country.
  The ability to make this transition, I believe, will require a 
deliberate and disciplined approach by Members of Congress and the 
American people for us to listen to each other, for, you see, 
Republicans do have better ideas to fix health care for all Americans. 
The basis of the understanding about where Republicans will come from, 
I believe, is embodied in the law as it exists today.
  In 1943, employer-sponsored insurance exemption was given. It was 
during World War II. It was at a time when there were wages that were 
frozen but opportunities for benefits to be given to employees that 
would not be taxed. And so back in 1942, this benefits system arose. 
Sure, it became an opportunity as a result of being employed. It became 
an employer benefit. And that is what has taken place today with about 
150 million Americans who receive the benefits of pretax contributions 
not only by their employer, but also by the employee to their 
healthcare system.
  Well, just last December, under the 21st Century Cures Act, Congress 
made a new change, updating, allowing more

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people in the system, this time small business, allowing small business 
the opportunity to deduct up to $4,500 per employee, a chance for them 
to receive their health care on a pretax basis.
  What this has established now is a different, unfair system that Mr. 
Trump was speaking about when he was on the campaign trail. He referred 
to it as a rigged system. Now, he was not just speaking about the 
healthcare system. He actually was speaking about much of the way 
America operates, systems that are not fair for the average American 
not only to have a shot at making their life better, but in this case, 
a healthcare system where about 150 million Americans get their health 
care on a pretax basis and others do not. This is the basis of where I 
believe Republicans have an opportunity to help make the tax advantage 
for all Americans available.
  So the question is: Who is insured and who is uninsured? Well, we can 
go to the chart that we see here. About 49 percent of all the people in 
this country who are insured, health care would be provided by an 
employer, meaning that an employer most likely is able to offer, as a 
benefit, a healthcare package on a pretax basis, and the employee is 
able to receive that, allowing them to make their own contributions on 
a pretax basis.
  As an example, as a Member of Congress, I have this opportunity. My 
employer, being in the House of Representatives, provides about 70 
percent, which is standard for the operations of almost any business in 
this country, 70 percent, and the employee would provide 30 percent. In 
this case, I provide the premiums of about $13,000 for my health care.
  Then I have a $3,600 deduction under my ObamaCare health insurance 
that I receive. I am required by law, as a result of being a Member of 
Congress, to receive, to buy into health care that would be ObamaCare, 
and then I have a $3,600 deductible that is a pretax contribution. So I 
make about a $17,000 contribution to my health care every year. Not 
unusual for employer-provided contributions on a pretax basis.
  Medicaid is about 20 percent of all the people who are insured, and 
then, as you see here, Medicare is about 14 percent.
  As you look at Medicaid, Medicaid is what is commonly known as 
insurance for those people who are at or below the poverty level to 
gain coverage. But it comes with strict requirements. Many of those 
requirements work against the opportunity to go and get a job for fear 
that they will lose their contribution that comes from the government 
because they might not have an opportunity to receive other help.

  Then, as you see, we have got exchanges, and those that just buy 
their own insurance. And then about 9 percent, or about 30 million 
Americans, are uninsured.
  This is the current status of where we are in America today.
  When I say these things to people back in Dallas, Texas, I receive a 
lot of feedback, and one of them that I have selected comes from a man 
who is self-employed. He falls under the what might be off exchange, 
meaning he pays for his own health care without it being on a pretax 
basis. He said: I am being penalized for being an entrepreneur--
penalized.
  This is true of the 20 percent who are on Medicaid. They are in a 
system that essentially keeps them there and keeps them from going to 
gain the opportunity to receive full-time employment because it might 
not be an employment that provides health care.
  So Republicans have a daunting challenge. We have a challenge to 
understand that there are about 12 to 20 million people who presently 
are on ObamaCare, including Members of Congress, and it is a very 
expensive--not only to the country, but also to individuals--insurance 
plan.
  The biggest problem with ObamaCare is not its expense. The problem is 
that people are not on the system, as we were told would happen. We 
were told there would be upwards of 40 million people, providing an 
opportunity for more people to pay into the system, to sustain the 
system, and for it to be, what I would say, structured in such a way to 
where it had young people, middle-aged people, and perhaps older people 
up to Medicare age who would be paying in or be a part of a system--and 
it didn't work that way.
  Younger people are not in ObamaCare because it is tremendously 
expensive, and they have found that to meet their deductible, it takes 
thousands and thousands of dollars. It does not meet their needs. It 
does not meet my needs with my family. It would not be a preferred 
healthcare choice that I or my family would make.
  So we now have a choice, a chance as a result of the American people 
saying: Okay, Republicans, let's see what you can do. Bring us your 
ideas to make health care better.
  Here is one of the facts that we know. We know that of the family 
working status of uninsured, 74 percent of people who are uninsured go 
to work. Now, this is a staggering fact because we were told by 
President Obama and Democrats that they were going to make sure that 
people got health care, the working poor, as we were told, people who 
needed coverage. But, in fact, 74 percent of 30 million people get up 
and go to work.
  What we find is that they have lost, many times, their full-time 
status because of ObamaCare rules and regulations, mandates on 
employers to where employers cut their full-time status to part-time 
workers. Because we have so many part-time workers, they cannot afford 
to get the payments that are necessary, even though they were above the 
Medicaid line.
  So Republicans now have a choice to be able to say, if we are going 
to outthink ObamaCare, if we are going to make sure that we believe--as 
President Trump has said just in the last few weeks and on the trail as 
he was running, he believes we should have a system that is not rigged. 
We should have a system that helps cover every single American and 
creates an opportunity that is sustainable and does not mean that we 
have 60 percent or even double-digit increases every year in health 
care because of the inequities that exist in the system.

                              {time}  1900

  This is the system that exists today.
  So what might be one of those options or alternatives?
  One of those options or alternatives might be a bill that I have 
worked on for 2 years, with over 500 physicians from across this 
country, known as the National Physicians' Council for Healthcare 
Policy. The National Physicians' Council for Healthcare Policy has 
formally met with hundreds of doctors nine times. They are co-chaired 
by Dr. Marcy S. Zwelling from Los Angeles, California, and Dr. John T. 
Gill from Dallas, Texas.
  We have worked diligently with economists also to put together a plan 
that matches what President Trump is speaking about, but probably has 
not had time to fill in all of the rest of the activities.
  This is what I would like to tell you. We believe that we should 
first allow every single American to be a part of a pre-tax credit, an 
advanceable credit that can be given to every single American to allow 
them to buy into a nongovernment healthcare system. That means, yes, 
people who are on Medicaid today can receive their health care and go 
out and get a job without fear of losing their healthcare coverage. It 
means that you no longer would have to go to the Federal Government and 
the IRS and to tell them how much work or how much money you think you 
will do this next year, and if you guess wrong, to pay differently. It 
creates a well-understood system, and can be done for the same amount 
of money that is presently in the system today.
  It means that a person, a family, would be able to, effective this 
next November, go online and go to a database and fill it in. I am from 
Dallas, Texas. I would put my name in, I would put my wife's name, our 
social security numbers, and our children, and it would allow this pre-
tax credit that is advanceable, assignable, and refundable, not coming 
to me, but going to a healthcare plan that I could then purchase. I 
could co-purchase, I could put my own money in on a pre-tax basis.
  But what it would mean to me, Pete Sessions, is that I would be out 
of ObamaCare. I would choose to be in what is called a health savings 
account, an HSA. A health savings account requires that you have a 
major medical component with any coverage that you get.
  What is major medical?
  Major medical is hospitalization, the chance, the risk that you would 
have of

[[Page H677]]

needing hospitalization. It could be a car wreck, it could be cancer, 
it could be something really unexpected. But I would then purchase this 
major medical policy that is well known in the marketplace today, and 
then have a choice of deciding the type of coverage where I would pay 
the first $5,000 that is required. And then after that, based upon the 
risk that I would choose.
  If I were younger, I would choose probably a plan that would be 90/
10. That means that I would pay 10 percent beyond what happened after I 
paid my $5,000. Perhaps I couldn't afford that and would want to move 
to a 70/30 where I accept more of the risk.
  The other component that I would then choose is a health savings 
account. That is I would take the $17,000 that I contribute to my 
health care every year, cash, and I would take that to a pre-tax cash 
account that would be available for me to go to the doctor. Instead of 
showing up with a card, I would shop the doctor that I choose, only 
buying the things that I and my family needed, choosing my doctor, and 
asking my doctor and the marketplace what services would be available 
for a cash price.
  Generally speaking, cash prices are about 18 percent less. Because a 
doctor would receive that money directly in, rather than having to file 
a claim, or wait time to get back their money. It would allow my family 
a chance to receive virtually an 18 percent opportunity upfront 
savings. It would allow me to manage the things which I needed to and 
not worry about paying for the things I didn't use. It would save my 
local doctor, who would then look at me as a preferred customer as 
opposed to me shopping around, perhaps with others in the marketplace, 
based upon a model of ObamaCare, which today you can't always count on 
who your doctor would be. A far better idea. Every single American that 
would qualify would receive this opportunity, but not required.
  Now, how do we make it better, because there is more?
  We would, under every single one of these circumstances, take away 
the mandate on an individual and the mandate on the business. We would 
do away with the Cadillac tax, because I don't think health care should 
be taxed. I think everybody should have an opportunity, and the world's 
greatest healthcare plan would allow that. Every single person would 
have a chance to have their health care provided, just as I have mine, 
too.
  So what I want to say to the Members today is Republicans are going 
to be sharing ideas. We are going to be presenting our ideas at the 
Energy and Commerce Committee, at the Ways and Means Committee, and we 
believe we have an opportunity under three scenarios to make sure that 
health care is available and ready for every single American.
  First, we need to establish a Republican alternative that can be 
implemented this year. Not waiting. Our better idea is ready in a bill 
ready to go.
  Would we do hearings? Yes.
  Would we want to scrub that and maybe add some things? Yes.
  We should be ready to do it and make the transition this year. We 
should use reconciliation to repeal the most onerous parts of mandates. 
Yes, we should. And I believe we are doing that.
  Should we make sure that we replace before we repeal? Absolutely.
  And we should allow HHS, under what is today becoming Dr. Tom Price, 
a proud Member of this body, a chairman of the Budget Committee, who is 
in hearings over in the Senate to be the secretary of Health and Human 
Services, he should use everything that is available in law today to 
manage a system and to make it better. But my bet is that he will count 
on real people, not government, to make these decisions. And in doing 
so, he will empower a better opportunity.

  So what Republicans want to do is to establish a tax benefit system 
while allowing a continuation of an employer-sponsored system. Those 
people that are on a system today that is provided by your employer, 
that would continue. But we would do away with the mandates on the 
individual and the business and the Cadillac tax. And we would 
encourage each of these companies to continue that system and work with 
their employees on a benefit system to make it better.
  We would make HSAs available to every single person, not just Members 
of Congress, to where they would have an opportunity to have a system 
that would help their health care and their families and not be use it 
or lose it. It would make no sense that I would have to spend $43,000 a 
year simply to start over next year when I could actually benefit from 
saving and being efficient with my money. Maybe I am 30 years old and 
want to save for the future. Maybe I am 50 and cannot save, but I would 
roll over the system and make it work for me.
  It will allow private physicians to endure. And what this does is 
empowers the private physician.
  But there is more. And that is we will also keep--I believe we 
should, and the world's greatest healthcare system would, keep what are 
known as consumer protections that today exist in law: dependent 
coverage through age 26, no lifetime or annual limits, modified 
guaranteed availability and renewability, prohibition on preexisting 
condition exclusions, prohibition on discrimination based on your 
health status, and nondiscrimination in healthcare coverage.
  I would like to tell the Members that back in Dallas, Texas, I am 
proud to also represent the disability community. I believe I can look 
at every single person back in Dallas, Texas, in the 32nd Congressional 
District of Texas, and say this: If you like your health care, you can 
keep it. If you like your own doctor, you can keep your own doctor.
  But, more importantly, I believe that we will give equal to or better 
than opportunities for every single American. We will end the 
discriminatory services that ObamaCare is today. Because virtually 
every single doctor and virtually every single hospital will begin 
taking coverage, where today only about 24 percent of doctors take 
ObamaCare because it does not reimburse properly. And hospitals all 
over Dallas that do not take ObamaCare, leading edge hospitals in 
Dallas, Texas, and across this country, will begin taking this new 
health care because it reimburses based upon actual cost and 
marketplace availability.
  So to my colleagues who want to go back home and talk to their 
constituents about Republican ideas, I don't know which one we will end 
up with. What I do know is that Senator Bill Cassidy and I have worked 
with hundreds of physicians for 2 years, and we have a bill, the 
world's greatest healthcare plan. The world's greatest healthcare plan 
is a bill that you can understand that is guaranteed to provide people 
a better opportunity without guessing about their healthcare coverage, 
and it is not use it or lose it.
  So it is my hope that my colleagues that saw this this evening and 
took part in this will understand that there is an opportunity to go 
back home and sell the world's greatest healthcare plan for their 
people back home, too.
  I thank my colleagues for being here tonight.
  I yield back the balance of my time.

                          ____________________