Congressional Record, Volume 163 Issue 39 (Tuesday, March 7, 2017)

[Congressional Record Volume 163, Number 39 (Tuesday, March 7, 2017)]
[House]
[Pages H1577-H1581]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

REPEAL OF THE AFFORDABLE CARE ACT

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, I rise this evening to cover several
very, very important points.
Tomorrow is International Women's Day, and I was going to talk about
the role of women in our society, talk about my five daughters and what
they have been doing in their life of service, and my wife, but events
intervened. And yesterday, our good friends on the Republican side
introduced a piece of legislation that will dramatically affect women,
young and old; children. They introduced a repeal of the Affordable
Care Act.
We are still trying to figure out all of the details involved in it.
It is going to be a little hard, since it was changed late in the
night. But there are some things we do know. I would like to start off
with what we do know about the Affordable Care Act so that when we come
to debate on the floor in the days ahead the Republican repeal and
replacement of the existing Affordable Care Act, we have a foundation.
If you will indulge me, I will try to lay out some facts, not
alternative facts, but facts. For example, 20 million Americans have
gained coverage as a result of the Affordable Care Act. The percentage
of uninsured in America is the lowest it has ever been. Mr. Speaker,
6.1 million young adults between the age of 19 and 25 have gained
insurance coverage by being able to stay on their parents' insurance
program--6.1 million. Of the Americans who have preexisting conditions,
and that is 27 percent of us who have some sort of preexisting
condition--heart issues, diabetes, broken legs, bad backs, whatever--27
percent of those Americans are guaranteed coverage even though they
have a preexisting condition.
I was insurance commissioner in California for 8 years, and I must
tell you the battles--well, it would take several days to talk about
the battles that I had with the insurance companies who were denying
coverage because of preexisting conditions. No longer the case in
America. The Affordable Care Act said no. And by the way, the lifetime
limits, they are gone, also.
California, which I have had the pleasure of being a citizen of, 3.7
million Californians are now insured under the Medi-Cal program, and
1.4 million have gained coverage through the exchange, called Covered
California. About 1.2 million of those have received subsidies,
averaging over $300 a month. Over 5 million Californians will be
directly affected by a direct repeal.
And in the expansion of Medicaid, or Medi-Cal as we call it in
California, if that is eliminated, that is a $16 billion hit to the
State of California, and, obviously, an enormous hit to those 3.7
million Californians who have been covered under the Medi-Cal
expansion.
Secondary impacts: employment. Maybe 200,000 jobs would be lost in
California.
Individual stories: boy, they abound. Just this evening, I got a call
from my wife, and she said: You really ought to talk about that young
family in Woodland, California, whose 2-year-old son was diagnosed with
some sort of a medical illness. They were able to get coverage before
that under the covered California program. They went back a year later,
and the kid had a brain tumor.
Fortunately, it was resolved because they had insurance. They were
able to get the early diagnosis. And under the current law, the
Affordable Care Act, they will be able to keep their coverage, even
though previous to the Affordable Care Act, this young child and,
quite probably, the family would be uninsurable.

It is working. The Affordable Care Act is working. Are there ways to
improve it? Undoubtably, there are, and we could sit down and talk
about ways to improve it.
But yesterday, our Republican colleagues introduced legislation that
is going to have a profound negative impact on men and women all across
this Nation. We will spend time in the days ahead to talk about the
details, but we do know that, in general terms, there will be less
coverage at a higher cost for literally everybody, except for a few
special folks. And I would like to just put up a chart about that.
Let's start with this one.
You see, in the repeal bill that was introduced, there are very
serious tax cuts. We are talking about hundreds of billions of dollars
of tax cuts over the next 2 years. Well, we all want a tax cut. But
under the repeal, there are some very special people who are going to
get a really big tax cut. Take a look at this.
The top 20 percent of taxpayers will receive 74.2 percent of the
multihundred-billion-dollar tax cut, which is estimated to be somewhere
in the range of $700 billion to maybe as much as $1 trillion, depending
upon the final calculations.
By the way, the Congressional Budget Office has not had time to
score, that is to tell us what the cost, what the benefits are, of the
Republican proposal. But we do know from earlier studies of this, 75
percent of the multihundred-billion-dollar tax cuts go to the wealthy.
Wow. And where does the money come from? It comes from the poor, it
comes from the working families, the men and women who are struggling
here in America. Maybe they are making a good living--$50,000 to
$60,000 a year. They are going to see their benefit package reduced.
One more way to look at this is the famous pie chart. So who gets the
tax breaks? Not the top 20 percent. Let's just focus more clearly here
on the top one-tenth of 1 percent. What do they get? They are not a
percentage. This is not the top 1 percent. This is the top one-tenth of
a percent. What do they get? Well, they get nearly $200,000 a year in
tax reductions. That is not bad. So the top 1 percent gets 57 percent
of that 6-, 7-, $800-billion tax cut, and everyone else will get 43
percent.
So what we have here is a massive shift of wealth from the working
men and women of America, from American families, to the very top--you
know, the 1 percenters. That is who is getting the benefit in this
massive tax cut that has been proposed. I don't know if that is good
policy. It is not in my district. I don't think it is good policy for
America.
We spent a lot of this last year in the Presidential campaign talking
about the shift of wealth to the superwealthy and away from the great
majority of Americans. But, here we go. In the very first big
legislation of this year, we see the Republicans in a massive effort to
increase the wealth of the superwealthy at the expense of the rest of
Americans.

[[Page H1578]]

There are many, many more things to talk about here. But I want to
just take a deep breath, which I need, because I guess I am getting
rather excited about what is happening--or maybe angry is a better
word--and turn to my colleague from the great State of Virginia to
carry on while I take a deep breath and cool off a bit.
Mr. Speaker, I yield to the gentleman from Virginia (Mr. Scott).
Mr. SCOTT of Virginia. Mr. Speaker, I don't blame the gentleman. I
appreciate the opportunity to discuss the Affordable Care Act. As we
discuss this, as he has indicated, it helps a little bit to talk about
what the situation was before the Affordable Care Act passed.
We knew that costs were going through the roof. We knew that those
with preexisting conditions, if they could get insurance, would have to
pay a lot more for that insurance. We knew that women were paying more
for insurance than men. We knew that millions of people every year were
losing insurance. That is what was going on before.
People talk about small businesses. Well, small businesses had
trouble getting insurance because if they had a person with a chronic
illness, it would be unlikely that they could afford small-business
insurance. But now, the costs have continued to go up, but they have
gone up at half the rate they were going up before.
Those with preexisting conditions can now get insurance at the
average rate. Women are no longer paying more than men. And 20 million
more people have insurance, not millions of people losing insurance
every year, 20 million more people have insurance.
Now, the full name of the Affordable Care Act is the Patient
Protection and Affordable Care Act. There are certain protections, like
insurance companies can't cut you off after they have paid a certain
amount. There are no more caps. They can't rescind your policy. After
you get sick, they can't just decide not to renew your policy. There is
no copay or deductible for prevention and cancer screening. We are
closing the doughnut hole. The average senior has saved already about
$1,000 because of the Affordable Care Act support for closing the
doughnut hole. Those under age 26 can stay on their parents' policies.
Those are some of the benefits of the Affordable Care Act.
Now, we didn't solve all of the problems. There are still problems.
But if we are going to change the Affordable Care Act, we ought to
improve the Affordable Care Act. Unfortunately, the bill that was
introduced in the middle of the night fails on a number of areas.
Now, we would know precisely how bad a bill it is if they would wait
a couple of days for the CBO to score the bill. It would point out all
of the flaws. But there are just a couple.
One is just a fundamental principle that it purports to cover
preexisting conditions without a mandate for coverage. We know that if
you allow people to wait until they get sick before they buy insurance,
people will wait until they get sick before they buy insurance. The
average insurance pool is sicker, more expensive. Healthy people drop
out, and the thing spirals out of control. We don't have to speculate
how this works because we know.
New York State tried it, and the cost went up so much that when the
Affordable Care Act came in with a mandate, the cost for individual
insurance dropped more than 50 percent. Washington State tried it. It
got so bad that by the time it got going a couple of years, nobody
could buy insurance. Nobody could buy insurance in the individual
market. So we know what happens when you try to cover people with
preexisting conditions without a mandate.

{time} 2000

So this plan, when it starts off with that policy, we know it is
bound to fail.
We also noticed another flaw: that it saves money by allowing people
to purchase insurance that doesn't cover everything. We have people
buying insurance now that have to buy the basic essential benefits
package. When you can start picking and choosing, you might save a
little money, but things like maternity care, if that becomes an
optional coverage, then anybody that wants that will not be able to
afford it.
It will cost whatever it costs to have a baby. They just have to pay
the bill. They might as well not have insurance. So that is because, if
anybody purchases maternity insurance, it is because they expect to
have a baby in the coming year, and it becomes unaffordable. If
everybody pays the average, everybody pays everything, then everybody
can afford the maternity coverage.
So allowing people to pick and choose what they want, that might help
a few, but those that need that coverage won't be able to afford it.
A final flaw, as the gentleman pointed out, is massive tax cuts.
Well, when you reduce the revenue available, two things happen: there
is less support for Medicaid, and there is less support for people in
paying their premiums. So in the fullness of time, fewer people will be
insured; and so you have a plan with fewer people insured, watered-down
benefits, and a plan that is ultimately going to fail.
That is not an improvement. If we are going to deal with the
Affordable Care Act, we ought to have an improvement; and until we have
an actual improvement, we ought to leave the Affordable Care Act alone.
I am delighted to be here discussing the Affordable Care Act with the
gentleman, warning people that, if they go forward without a
Congressional Budget Office evaluation so they know what is going on,
we may have a plan that is a lot worse than even before the Affordable
Care Act.
Mr. GARAMENDI. Mr. Scott, thank you so very much. You bring to this
discussion a very important perspective as the ranking member of the
Education and the Workforce Committee. You have that perspective of
understanding the effect of this legislation on the working men and
women and families of the United States.
I was just looking at some of the early comments that have come out
about the bill, which is less than--well, it is almost 24 hours old
now. Families USA said: ``The GOP healthcare proposal would be
laughable if its consequences weren't so devastating. This bill will
strip coverage for millions of people and drive up consumer costs.''
The Catholic Health Association of the United States said: ``This
proposal would also take many backward steps in the continual effort to
improve our healthcare system. . . .''
It goes on and on, and as more and more people come to understand the
issues that the gentleman was discussing, I think they are going to
find that, no, we will take the Affordable Care Act as it presently
exists, and we will make some modifications to it to improve it.
The gentleman raised a very interesting point. It reminds me of
another conversation I had earlier this week with my wife. She had gone
to her hairstylist, who is about 29 years old, has run her own business
for the last 7, 8 years, and she told me wife: It can't be true. They
can't do it, can they? They can't kill the Affordable Care Act, the
ObamaCare?
She said: For the first time in my life, I was able to get insurance;
and now that I have insurance, there is this maternity benefit that is
in my package, and now my husband and I, we can afford to have a child.
It was directly to the point the gentleman was making. If there is an
option here on maternity coverage or any coverage for women's health,
then we are going to find a situation where people will pick and
choose; they will wait to get their insurance, and then the insurance
pool is left with very expensive cases and the cost is not spread out.
The gentleman may have some other examples that may have come along
or some other comments that he would like to make. I would be delighted
to have the gentleman share those on the floor, and I will yield to the
gentleman.
Mr. SCOTT of Virginia. Shortly after the Affordable Care Act passed
and went into effect, a young lady approached me in a store--she was a
clerk in a store--and said: Bobby, don't let them repeal ObamaCare
because my son is alive today because of ObamaCare.
I said: Well, what do you mean?
She said: Late last year, he was diagnosed with a fatal disease for
which there is a cure, but we couldn't afford the cure. Thankfully, he
lived to January 1, when ObamaCare kicked in, and we can afford the
cure. My son is alive today because of the Affordable Care Act.
If it is repealed, what happens in that case? What happens in all of
the other

[[Page H1579]]

cases when people don't have insurance? We have heard it represented
that, well, anybody can get health care. All they have got to do is
show up at the emergency room.
Well, yeah, that is fine. You can show up at the emergency room with
a stroke, but you can't get blood pressure pills that could have
avoided the stroke to begin with. They can stabilize you and send you
home, but in terms of a cure or a surgery that may cure the problem,
you don't get that. You just get stabilized in the emergency room, and
that is not health care. We need people with insurance so they can
obtain the preventive care and the corrective care that will get them
off on the right track.
The gentleman talked about stripping coverage. When you take that
kind of money out of the system, less support for Medicaid, fewer
people getting Medicaid, less support for premium support so that
people can actually afford it--if you look at the proposal, a lot of
people can't use the tax cut because it is insufficient to pay the
premium and they don't have the rest of the money.
So we need to make sure that CBO scores this. They will highlight all
of these problems. They will show that many fewer people will be
insured and that it is not an improvement. We shouldn't do anything
unless we are actually improving the Affordable Care Act.

Mr. GARAMENDI. The gentleman is correct on that. I was just looking
at some statistics here a moment ago about the shifting of cost.
Under the Affordable Care Act, there are many, many benefits for
Medicare. Leaving aside the Medicaid population for a moment, the
Medicare population, available to every individual 65 and older, there
have been significant improvements.
You mentioned the doughnut hole earlier, the drug benefit. If you run
up heavy expenditures on your drugs, you would come to a point where
you had to pay 100 percent. Medicare didn't cover it. Well, that
doughnut hole is collapsing, and in another 2 years, the Medicare
program will cover all of the drug costs without limitation.
Also, there is the free annual checkup that is available to everybody
that is on Medicare. The result of these kinds of things, where drugs
are available, blood pressure drugs, diabetes and the like, has led
to--together with the additional taxes that the superwealthy are
paying--has increased the solvency of Medicare by 11 years.
Now, the fiddling that is going on with the proposal that our
Republicans have put through, it is not clear exactly what the result
would be; but we do know that one of the major tax cuts is the
elimination of this Medicare tax that the superwealthy have been
paying, and that is over--together with one other tax is almost $340
billion. So the support for Medicare and the solvency of Medicare
becomes a question mark as a result of the proposals.
We don't have all of the answers to this, but we do know that a 60-
year-old presently getting an insurance policy from the Affordable Care
Act, from ObamaCare, and making somewhere around $40,000 a year--
perhaps working at Walmart--they are going to see a 57 percent
reduction in the tax credit that is currently available versus what the
Republican bill has.
So a 60-year-old making $40,000 a year under the ACA, ObamaCare, will
receive somewhere around a $9,000 tax credit to support the purchase of
insurance. Under the Republican bill, they are looking at $4,000--not
$9,000, but $4,000--so 57 percent reduction in the support that they
receive, probably leading to them not being able to afford insurance
and winding up in your emergency room example.
Mr. SCOTT of Virginia. To add insult to injury, part of the scheme is
to allow insurance companies to charge senior citizens even more. Right
now they are limited to three times what they charge everybody else.
Their bill allows up to five times. That is a two-thirds increase in
the cost. So if the tax credit wasn't enough to begin with, it is going
to get worse.
Mr. GARAMENDI. Well, let me make sure I understand. I was 60 a while
ago, but let's say I am 60 and I am getting a health insurance policy
under ObamaCare, the Affordable Care Act. I may have to pay three times
what a 25-year-old pays, but under the proposal that has been brought
to us by the Republicans, I would pay five times?
Mr. SCOTT of Virginia. That is right.
When everybody pays an average, if you allow some people to pay more,
some people are going to pay less, but it is a zero-sum game. Every
time they show somebody can pay less, then know that somebody will pay
more. They have a scheme, for example--they call it association plans--
where you get a group of healthy people, they come from out of the
insurance pool and get a better rate because the insurance company will
look at the association and say: Those are the young, healthy people, I
can give them a better rate. They can save money.
What happens to everybody else? They have to pay more.
Last time they came up with this idea, the research showed that 80
percent of the people will pay higher premiums if you allowed people to
withdraw from the pool, a healthy group. Now, actually, it will always
work, because the group you pull out, if the bids come in higher than
average, nobody is going to buy the insurance. They are going to go
right back into the regular pool. So any time you have one of these
things, it will only work if you are pulling out young, healthy people,
and that leaves behind, for everybody else, higher rates.
Mr. GARAMENDI. The fundamental nature of insurance is you gather a
large population of healthy, not-so-healthy, and perhaps some very sick
people into a large population, and the cost is spread across the
entire population.
What we may be ceding here in this particular proposal is the
unravelling of that fundamental insurance concept with young people,
healthy, not bothering to buy insurance, staying out of the market; and
then, eventually, when they become ill, they will get back into the
market, leaving everybody else to pay for it.
There is another piece of this shifting of cost that did occur prior
to the Affordable Care Act--significantly reduced, as a result of it--
and that is the uninsured still get sick.
The gentleman mentioned the emergency room a while ago, and for the
most part, in America, a person can get to an emergency room with or
without insurance; but if they don't have insurance, there is still a
cost associated with the visit to the emergency room and any other
thing they may need. They may need to have their leg repaired, a broken
leg, or maybe they need an appendectomy or whatever. That is still a
cost. The question is: Who picks up that cost? That is called
uncompensated care, and it was a huge problem prior to the Affordable
Care Act.
I had hospitals throughout my district and throughout California
coming to me and saying: We can't afford this because we are not able
to cover that uncompensated care for people that didn't have insurance
that showed up at the emergency room.
Now, we know that from the early analysis done of the proposed
legislation by our Republican friends that the number of uninsured is
likely to increase, perhaps as much as 11 million people--maybe more,
maybe somewhat less. Those people will still get sick. They may have
money of their own to cover their costs, but the chances are they
don't. That uncompensated cost will then be borne by the people who do
buy insurance. It is a cost shift to those who have insurance.

Mr. SCOTT of Virginia. In fact, when we passed the Affordable Care
Act, the estimated cost on a family policy was about $1,000 a year on
the family policy for uncompensated costs shifted on to the insured
public. In fact, in Virginia, it is estimated that approximately $15 a
month is paid on everybody with insurance, $15 a month to go to the
400,000 people that would have had insurance if we had expanded
Medicaid.
So if you have 100 employees, you can just figure you are paying
about $1,500 a month extra because we did not expand Medicaid. 400,000
people will go to the hospital, won't pay, and when people with
insurance go, they just have to pay a little extra, about $15 a month
per person in the Commonwealth of Virginia because of that.
Mr. GARAMENDI. There are so many pieces to this healthcare system.
One thing that I want to put on the table here from my experience as
insurance commissioner in California is that there are two fundamental
parts

[[Page H1580]]

to the healthcare system in the United States, and really around the
world. One of those two parts is how we collect the money and then pay
for the services. We call that insurance. It is also Medicare,
Medicaid, veterans' programs, and the like. These are the way in which
we collect money and pay for the services.

{time} 2015

The other part of the healthcare system is the delivery of services;
these are the doctors, the clinics, the hospitals, and other providers,
mental health providers, and the like. We often get confused by putting
these two things together.
There has been a lot of talk about what we are doing with the
Affordable Care Act. It is essentially a mechanism to pay for services.
It is an insurance mechanism. Using the private insurance system, these
various exchanges are set up to pool the population of people who do
not have insurance from their employer, the individual people,
individual coverage. It pools them so that you have that large
population so that the cost is spread out across that large pool and
the insurance becomes affordable. That is an insurance mechanism. That
is a pooling. It has nothing to do directly with the provision of
medical services.
The medical services are then provided out of that pooling
arrangement by the individual doctors, maybe clinics, maybe hospitals,
maybe group practices. Some of that will be capitated pay, and others
will be a fee-for-service.
We haven't changed directly the way in which services are provided,
that is, the delivery of services. And this is found in hospitals. In
the Affordable Care Act, there was a penalty for hospitals that had
readmissions for infections. What we have seen, as a result of that
provision dealing directly with the way in which services are delivered
in hospitals, is a dramatic decline in readmissions for hospital-
acquired infections. What that means is some 60,000 people are still
alive today because they didn't get a hospital-acquired infection.
Mr. Speaker, I yield to the gentleman from Virginia (Mr. Scott).
Mr. SCOTT of Virginia. Mr. Speaker, well, that part of the Affordable
Care Act has actually improved the quality of service.
There are other things in the Affordable Care Act, such as funding
for education of more providers, more doctors and nurses, and other
providers because we have a lack of professionals. One area, for
example, is psychiatry. If the Veterans Administration hired all the
psychiatrists they need, there wouldn't be any for anybody else. We are
so far behind. And the Affordable Care Act provides for that service.
As you pointed out, there is a difference between the ability to pay
for the services and the services that are there. People frequently
compare the single-payer plan in Canada, which in many areas is a rural
area. So you don't have the critical mass of population to support a
high-tech medical system. So if you are going to have a baby, it is
probably going to be delivered by a family doctor, not an obstetrician.
In some areas, you have to go 200 miles to find a neurosurgeon. That
doesn't have anything to do with the fact that they can pay for the
services. It is just that the services aren't there.
So when people talk about the health delivery system, as you pointed
out, that is different. The fact that you can actually pay for services
doesn't diminish the opportunity to have those services there; it
actually increases the possibility that those services will be there.
Mr. GARAMENDI. Mr. Speaker, that is exactly right, and I see that in
my district. I have a large rural district in California. And, even
today, there are areas where it is difficult to find a physician to get
medical services.
This is one of the things, as you so correctly pointed out, the
Affordable Care Act had a part of that. One of the titles dealt with
the education of medical personnel. And so what we have seen, at least
in California--and I suspect across America--with the Affordable Care
Act in place, we are seeing that one of the fastest growing areas for
new jobs is the healthcare sector because we are adding a lot of
people--we need more--and then the educational programs that you talked
about, which comes under the jurisdiction, I believe, of your
committee. That is an important part.
One of the things that I hope the American public comes to understand
is this is not just a sound bite that was used in a political campaign.
We are going to repeal the ObamaCare and we are going to replace it is
a nice sound bite. But we are talking about the lives of Americans, we
are talking about their health, their ability to stay healthy, their
ability to get medical services.
When you start tinkering with something that is so personal--that is
what people say in my district: This is about my ability to stay
healthy, my ability to get medical care. That is what I hear.
They are saying they are frightened. They are concerned that the
legislation and all of the discussion in the political campaigns has
been so heated that they are afraid they are going to lose what they
presently have.
A quick look at what has been presented to Congress just in the last
24 hours indicates that a couple of facts are clear. First of all,
there is an enormous tax break for the very, very wealthy, probably to
the tune of 3- to $400 billion over 10 years. That is an incredible tax
break for the superwealthy and for the health insurance industry. That,
we are pretty sure, is in this legislation. We don't know the exact
numbers; but we do know that early indications are that there is a
shift, tax breaks for the wealthy, and cost increases for everybody
else. That we know.
We also know that there are certain elements of support for
individuals that will be removed. As we go about debating this and
understanding the full import and get the Congressional Budget Office
information, I think we are going to find that Americans are going to
say: Well, wait. Wait, wait, wait. You are doing what to me? What are
you doing to me? You are taking away my health insurance?
I suspect that will lead to a rebellion of some sort. Certainly it
has agitated a lot of people in my communities about the justifiable
fear of what may be coming to Americans.
Mr. Speaker, I yield to the gentleman from Virginia (Mr. Scott).
Mr. SCOTT of Virginia. Mr. Speaker, the gentleman indicated, in rural
areas, one of the things that we have done is funded community health
centers, which provides, where there are no professionals, a community
health center where you can actually go to get comprehensive primary
health care and then referred to a specialist somewhere if that is
needed. That funding would be obviously in jeopardy.
As you pointed out, when you have tax cuts in terms of resources,
that will translate into fewer people actually insured. They will have
watered down benefits. And because there is no mandate to ensure that
everybody is in the pool and they are trying to cover preexisting
conditions, you have a prescription for disaster. That is not an
improvement of the Affordable Care Act.
We need to insist that CBO score the legislation before we start
taking votes so that people know exactly what they are getting into.
Mr. GARAMENDI. Mr. Speaker, the gentleman from Virginia is absolutely
correct about that. Unfortunately, my understanding is that as early as
tomorrow--that would be Wednesday--that the committees intend to mark
up the legislation. Normally, that means the version of the legislation
that will pass out of committee is completed. And, I suspect, usually
it is associated with a vote that takes place in committee. We don't
know for sure if it is tomorrow or the next day, but we do know that if
it is this week, we will not have the Congressional Budget Office
information.
The gentleman mentioned something that I probably should have jumped
on immediately because of my rural district, and those are the clinics.
As a result of the Affordable Care Act, there are now seven significant
clinic organizations that provide services to about 23 specific sites
around my district. They are providing, really for the first time in
many of the communities that I represent, immediately available
healthcare services to a variety of people, some of whom have had an
employer-sponsored health plan and others of whom are on Medi-Cal in
California.

[[Page H1581]]

The apparent reduction in the Medicaid, Medi-Cal for California,
support from the Federal Government that will occur over the next 2\1/
2\ to 3 years will eliminate one of the principal ways in which those
clinics have been able to continue to operate and, that is, the
expansion of the Medicaid population in California.
It appears that the legislation that is proposed will shrink the
Medicaid program across the Nation and severely curtail in California
the support available for people who are currently on Medi-Cal. That
will be devastating to these clinics in these rural areas.
We have had discussions about this. They say: Watch carefully. If
this is what happens, we are going to be out of business. We are going
to shut down our doors.
Mr. Speaker, I yield to the gentleman from Virginia.
Mr. SCOTT of Virginia. Mr. Speaker, the clinics will shut down.
Insurance companies will stop writing insurance if people can wait
until they get sick before they buy insurance. The insurance companies
reacted to that system in Washington State by selling nobody any
insurance. So we know what is going to happen.
The CBO, when they score this, will point that out, and we will know
exactly what the problems are.
Mr. GARAMENDI. Mr. Speaker, I thank the gentleman from Virginia (Mr.
Scott) for joining us this evening. This is a fundamental part of
American life, that is, our health care. It is about 18 percent of the
total GDP, gross domestic product. It is extremely important in terms
of the total well-being of our society and our economy.
Changes to the Affordable Care Act that are being proposed will have
a dramatic effect. And what we do know about it is that there will be a
massive shift of wealth from working men, women, and families to the
superwealthy. We know that from the tax proposals that have been made
in the analysis of the tax.
We also know that there is a very, very high probability that perhaps
11 million people will lose their insurance coverage, either in the
private insurance market through the exchanges or through the Medicaid
programs across the Nation. And the effect on the providers, the
hospitals, the clinics will be profound.
So when we have something as important as this, it is just wrong. It
is wrong for the majority in this House to put this legislation before
the committees without a full hearing on what the effect will be. But
it appears that tomorrow, Wednesday, we will have the first markup in
this process.
What I want--and I think the gentleman from Virginia (Mr. Scott)
does, too--is for the American public to hear the debate, to understand
the implications where we are today with the Affordable Care Act and
what it has brought to us in terms of quality and accessibility to
health care and what it would mean with the proposed changes.
Mr. Speaker, I yield to the gentleman from Virginia (Mr. Scott).
Mr. SCOTT of Virginia. Mr. Speaker, I thank the gentleman from
California for organizing the Special Order so that we could actually
discuss some of the problems with going forward without a CBO score,
without knowing what we are doing. Certainly, it is not an improvement
in the Affordable Care Act.
Mr. GARAMENDI. Mr. Speaker, I thank the gentleman from Virginia (Mr.
Scott) for expressing Virginia's view. From California, it is, whoa,
wait a minute, let's be careful.
Mr. Speaker, I yield back the balance of my time.

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