Congressional Record, Volume 163 Issue 116 (Tuesday, July 11, 2017)

[Congressional Record Volume 163, Number 116 (Tuesday, July 11, 2017)]
[House]
[Pages H5422-H5425]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

THE TEST OF OUR PROGRESS

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 look forward to this hour, although I
will probably take something less than that.
I want to bring to the attention of the House and, more beyond that,
the citizens of the United States what is happening here with all this
talk about the repeal of the Affordable Care Act. I want to spend some
time on that issue. I want to review exactly what the Affordable Care
Act has done for Americans and what the repeal would do to Americans.
Those are really two different ways to look at this.
I want to start someplace else that has been a very special part of
my thinking about government issues, about policies of all kinds, and
it was something that Franklin Delano Roosevelt said during the height
of the Depression as the American government and Mr. Roosevelt were
talking about the various policies that were being discussed at the
time. He laid out a test to which he would apply his judgment of a
policy. It reads this way: ``The test of our progress is not whether we
add more to the abundance of those who have much; it is rather we
provide enough for those who have too little.''
I see this as a profound and extremely important criteria upon which
to judge many policies that come before us in bills, but it is also, I
think, an extremely valuable way to judge the question of the
Affordable Care Act: Has it added much to those who have little?
I will try to answer that in a few moments.
Similarly, in looking at the repeal of the Affordable Care Act, the
test of our progress is not whether we add more to the abundance of
those who have much. When we consider the repeal of the Affordable Care
Act--ObamaCare--does it add to those who have much? Does it add to
those who have little?
I will try to answer these questions in just a few moments.
So does the Affordable Care Act add much to those who have little?
The answer is: Categorically, it does. There is absolutely no doubt
that the Affordable Care Act has helped those who have little. I will
give a couple of examples. Just a couple.
One, a beauty salon operator in Sacramento, California, around the
age of 30, married, wanting to have children but not able to do so
because she had no insurance. A small-business operator, herself, maybe
one part-time employee, unable to get insurance prior to the Affordable
Care Act.
My wife visited her after the Affordable Care Act went into place,
and she was able to purchase private insurance through the subsidized
market, and she happily, excitedly told my wife: And now my husband and
I, we are going to have a baby. At last I have the insurance. And I
want you to tell your husband ``thank you.''
That thanks is not to me. It is to the men and women of the Congress
in 2010, myself included, and the Senate, and President Obama that
signed the Affordable Care Act that set up a situation in which,
through the California exchange, similar to other State exchanges, she
was able to purchase insurance. Subsidized to be sure, but nonetheless,
she was on her way to having a baby, or at least thinking about having
a baby. I will come back to her in a few moments.
A second person, small family farmer in my district unable to have
insurance throughout her entire adult life. In and out of hospitals for
everything from an accident on the farm to some more serious things.
Facing bankruptcy. The Affordable Care Act gave her the opportunity to
have insurance, to stabilize her life, her healthcare, and,
importantly, be able to avoid the financial disaster of a major medical
bill that would have clearly bankrupted her and put her out on the
street.
That is what the Affordable Care Act did to two constituents in my
district. And that story is repeated over 20 million times around this
Nation. More than 20 million Americans have been able to get health
insurance as a result of Affordable Care Act. And 6.1 million young
Americans have been able to stay on their parents' insurance policies,
not thrown off at the age of 18, but able to stay on until the age of
25. And 27 percent of Americans who have preexisting conditions--27
percent of us have some sort of preexisting condition--no longer a bar
to being able to get insurance.
I was the insurance commissioner in California for 8 years, and I saw
the forms that the insurance companies would require be filled out.
Everything in their life from the moment of their birth--in fact,
before their birth, they needed to disclose every single event. Did you
have pneumonia? Did you have an illness of this or that? All the way
down the line.
And if you answered ``yes'' to any one of those, you would probably
not be able to get insurance. And 27 percent of the American public
unable to buy insurance because of preexisting conditions, no longer
the case in America today. It is gone. That is history.
This is my experience. Thousands of times I saw this. If a person
went through that entire checklist and there was some inaccuracy in the
way they answered those questions and they went to the hospital with a
serious illness that was supposed to be covered, it was common for the
insurance companies to go back and do medical underwriting after the
event and deny the coverage. Common practice.
Something as mundane as: I did not have mumps when I was a child.
Check, check, check. Oh, you had mumps? I am sorry, we are not going to
pay for this operation.
Those days are gone. The Affordable Care Act did that.
In my own State of California, 3.7 million Californians are now
insured due to the Medicaid expansion program, which we call Medi-Cal
in California. And 1.4 million people now have insurance through the
exchange. The two examples I gave are but two of 1.4 million
Californians that have insurance. So it works. And it is not just that.
There are other things.
Seniors, the infamous doughnut hole in which, under Medicare part D,
the first couple of thousand dollars of drug expenses would be covered.
And then serious illnesses, you blow through that quickly, and then you
faced the doughnut hole, and it was out of your pocket.
So you found seniors all across this country unable to afford the
continuation of the drugs that kept them alive. It is gone--or will
soon be gone. The Affordable Care Act collapses that doughnut hole so
that in another 1\1/2\ years, 2 years from now it would be gone and the
Medicare part D would provide the drugs that are necessary to keep
seniors alive.
The repeal of the Affordable Care Act would end that and send those
seniors back where they were before, facing the ominous doughnut hole.
It goes on and on.
Medicaid expansion, 20 million Americans covered; 3.7 million in
California. The drop in insurance rates. Due to the Affordable Care
Act, the uninsured rate is now the lowest in history.
Consider this: 16 percent of Americans in 2010, before the Affordable
Care Act, did not have insurance--16 percent of the 380 million of us.

{time} 1945

Today, it is down to just about 8 percent--excuse me, that is in
2016. There has been continued improvements since then, 8 percent. That
is where those 22 million Americans are.
So we have seen this over time. As a result of the Affordable Care
Act, the

[[Page H5423]]

uninsured in America have steadily decreased as the Affordable Care Act
has taken hold.
Hospital-acquired infections significantly reduced. Under the
Affordable Care Act, unnecessary hospital readmissions due to
infections, have fallen for the first time on record, dropping 8
percent between 2010 and 2015. Why has this happened, you ask? Because
in the Affordable Care Act, there was a serious financial penalty to
hospitals when there was a readmission as a result of a hospital-
acquired infection.
Is that important? It certainly is, for those who are not readmitted
for infections.
The annual lifetime benefits, you have heard about this. You know
somebody in your family, in your community, who had a limit on their
insurance policy, $100,000 a year, or maybe a lifetime exclusion or
limit of $200,000, or $300,000, or some number. If you have a serious
illness, you blow right up through that barrier, and your coverage, it
is on your account. Hospital coverage and expenses are no longer
covered by the insurance policy.
That is gone. It is over. It doesn't exist any longer in the United
States. So the end to annual and lifetime limits is a direct result of
the Affordable Care Act.
Slower premium growth and a cap on out-of-pocket expenses. Due to the
Affordable Care Act, all health policies now have a limit on out-of-
pocket costs, which benefits all Americans.
Free preventative care. Have you talked to any seniors recently? If
you are on Medicare, you have an annual free checkup. What does that
mean? It means that your high blood pressure that you didn't know
about, your onset for diabetes and other illnesses, you find out about
it, deal with it, live longer, reduce the costs.
In part, that is the reason that we have now seen that the Medicare
viability, the financial viability of Medicare has been extended by
nearly a decade as a result of the Affordable Care Act and the kind of
policies that were built in it--for example, free preventative care.
I have already talked about young adults being able to stay, and that
is 2.3 million young adults.
Lives saved from reductions in hospital-acquired conditions. Eighty-
seven thousand Americans are alive today because of better healthcare
in the hospitals.
Public satisfaction. Eighty-two percent of the consumers in the
marketplace plans or newly insured under Medicare due to the ACA, the
Affordable Care Act, ObamaCare, have expressed satisfaction with their
coverages.
Tax credits. Seven in 10 consumers in the marketplace got coverage
through their tax credits.
I already talked about preexisting conditions.
Mental health and maternity care. Family values, well, we hear that
all the time here on the floor. Family values, this is a family value.
This is a family value, yes. And the Affordable Care Act is a family
value because maternity coverage is guaranteed. The most basic element
of family, babies are now covered.
Maternity care is now guaranteed coverage under the Affordable Care
Act. And from the moment that baby is born, through their life under
the Affordable Care Act, they have a guaranteed coverage, regardless of
any illness that they may have at birth.
I can give you story after story that I found when I was an insurance
commissioner in California. The family had coverage. The family
actually had maternity coverage. The baby is born with a serious defect
of some sort. There was no coverage for that baby because of a
preexisting condition from the very moment of birth. That is not the
case any longer in America as a result of the Affordable Care Act.
We can go on and on, and probably we ought to. We have heard a lot. I
am just going to keep this up here to remind all of us about a test of
what good public policy can and should be.
There has been a lot of talk now about the collapse of the insurance
market. We have heard the President talk about the collapse of the
insurance market. Any time he brings up the issue of the repeal of
ObamaCare, the Affordable Care Act, he always prefaces it or follows
his comments with: The insurance market is imploding. It is collapsing.
We have heard that discussion here on the floor from the leaders of
the majority party. The Affordable Care Act is collapsing. The
insurance markets are collapsing. Oh, my, my. Interesting.
Let's see, this is the 10th of July. A report was issued by The Henry
J. Kaiser Family Foundation--not a liberal organization, not a
conservative organization, but one of the best-known research
organizations on healthcare in America. The Henry J. Kaiser Family
Foundation issued a report on July 10, 2017, by Cynthia Cox and Larry
Levitt. I won't read it all to you, but I will read the discussion
point.
Early results from 2017 suggest the individual market is stabilizing
and insurers in this market are regaining profitability. Insurance
financial results show no signs of a market collapse. Hello. Anybody
listening?
Early results from 2017 suggest the individual market is stabilizing
and insurers in this market are regaining profitability. Insurer
financial results show no sign of market collapse.
First quarter premium and claims data from 2017. First quarter
premium and claims data--this is from the insurance companies--from
2017 support the notion that 2017 premium increases were necessary as a
one-time market correction to adjust for a sicker than expected risk
pool.
Although individual market enrollees appear, on average, to be sicker
than the market pre-ACA, data on hospitalization in this market
suggests that the risk pool is stable, on average, and not getting
progressively sicker, as of early 2017.

Some insurers have exited the market in recent years, but others have
successfully expanded their footprints, as would be expected in a
competitive market.
Now the caveats. While the market, on average, is stabilizing, there
remain some areas of the country that are more fragile. In addition--
and here is the important point for any policymaker in Washington,
D.C., from the President to the rest of us. In addition, policy
uncertainty has the potential to destabilize the individual market
generally.
Mixed signals from the administration and Congress as to whether
cost-sharing subsidies under the Affordable Care Act and cost-sharing
reduction payments will continue, or whether the individual mandate
will be enforced, have led some insurers to leave the market or request
larger premium increases than they would otherwise.
Few parts of the country may now be at risk of having no insurers. If
you don't mind, I would like to go back over that again. Mixed signals
from the administration--hello, President Trump and Congress. Hello, my
colleagues--who have voted to repeal the Affordable Care Act, mixed
signals from the administration and Congress as to whether cost-sharing
subsidy payments will continue, or whether the individual mandate will
be enforced, have led some insurers to leave the market or request
larger premium increases than they would otherwise.
So who is responsible for the collapse? Well, we can do some finger-
pointing, but then I would be admonishing--Mr. Speaker, I should do
some finger-pointing, but I am not going to do it right now.
I am going to go back here. ``The test of our progress is not whether
we add more to the abundance of those who have much.''
Okay. Let's look at the repeal. Let's judge the repeal based on that
criteria. Maybe you don't believe Franklin Delano Roosevelt was
correct, but maybe we ought to just see what we are talking about here.
The repeal of the Affordable Care Act, the legislation that passed
this House, the tax provisions in the Affordable Care Act, it is
somewhere north of a $700 billion to $800 billion reduction in taxes.
That is a lot of tax reduction. That was in the legislation.
I have argued repeatedly here on the floor and other places that it
is the largest single transfer of wealth from the poor and the middle
class to the super wealthy. That argument is factual because, what are
the benefits? Who wins in the repeal of the Affordable Care Act, the
poor, or the 22 million to 24 million people who will lose their
insurance as a result of the repeal of the Affordable Care Act? That
was in the House bill.

[[Page H5424]]

In the Senate bill, they are talking about similar numbers, 23
million, 24 million, 25 million people. That is a lot of Americans who
are going to lose their insurance and are going to be personally,
physically harmed as a result of the repeal.
So who benefits? The other side of this piece of legislation is one
of the largest tax reductions ever--not for the poor, small for the
middle class, but oh, my, for the wealthy, the top 1 percent of
Americans--excuse me--the top one-tenth of 1 percent of Americans would
have their taxes cut, on average, by $197,490 per year. That is the top
one-tenth of 1 percent.
How about the top 100 wealthy families in America, five of whom are
in this administration, the super wealthy, what does it mean to them?
$4 million to $6 million a year reduction, on average, in their taxes.
The test of our progress is not whether we add more to the abundance of
those who have much.
Need I stand here on the floor for hours driving home the point that
the repeal of the Affordable Care Act is more than a taking away of
healthcare benefits in which, if we were to believe the Senate and the
Senate bill were to become law, 18 million Americans next year would
lose their health insurance, and then beyond, another 5 million
Americans in the years ahead.
It is a test of our progress. It is whether we provide enough for
those who have too little. It is pretty easy, a pretty easy criteria
when applied against the repeal. Are we providing anything for them?
No, you are taking away their healthcare, their health insurance, and,
undoubtedly, their health and their lives. It doesn't meet this test at
all.
On the tax side, oh, my, the bottom 80 percent of taxpayers in this
Nation would receive the awesome, extraordinary benefit of a reduction
of $160 a year in their taxes.

{time} 2000

That is what our Republicans have offered us with the repeal of the
Affordable Care Act. Eighty percent of American taxpayers would receive
the awesome, extraordinary benefit of a $160 annual reduction in their
taxes, while the superwealthy, the top 100 families, a $4 million to $6
million annual reduction, and the top one-tenth of 1 percent of
Americans--wealthy--would receive a $197,490 reduction, on average.
Mr. Roosevelt, President Roosevelt, laid out a clear criteria.
So where are we? Where are we? We have the Henry J. Kaiser Family
Foundation report yesterday. The insurance market is not collapsing,
and where it is is the result of what this administration and Congress
are doing. They are destabilizing the market. That is what is
happening. That is why these insurers are leaving certain communities
and certain States because they simply do not know what is going to
happen.
Insurance companies have to plan now--actually, a month or two ago--
for the insurance policy that they will be selling in the fall and in
the early winter, October, November, December, for the next year, the
2018 year. And they do not know because of what this Congress is doing;
they don't know how to price, and therefore market instability is the
result.
There is more to it than that. Under the law today, the Federal
Government is supposed to be providing money for the exchanges. That
money has been withheld under this administration in numerous ways,
actively and proactively taking steps to undermine the insurance market
so, presumably, they can say: ``Oh, my, it is collapsing.''
Well, if it is, it is the President's fault, and it is the fault of
this Congress in passing such legislation.
Now, I hear a lot of talk, and it is correct, a lot of discussion
about what we can do together. Let's not fight. Let's work together.
Let's improve the Affordable Care Act. We ought to, and we can. There
are many ways it can be done.
So what can we do?
Well, we could immediately end the efforts to destabilize the market.
That would be a good start, wouldn't it? All that takes is an end to
this effort to repeal and, rather, to do what the President asked us to
do, and that is to work together as he drives forward policies that
destabilize the market as he continually talks about repeal. But he
also says, ``Let's work together.'' I agree with him. Let's work
together. I ask the President to please stop his efforts to destabilize
the market.
So what can we do?
How about if we allow the Federal Government to negotiate the price
of drugs? We can't do it now, but what if we did? Would that help
stabilize the market? It would certainly help reduce the cost. That is
not a bad idea. So idea one. Let's allow the Federal and State
governments to negotiate the price of prescription drugs and allow
individuals to buy certain medications in Canada, for example, which
they cannot, now, legally do.
We might think about expanding programs that are proven to enhance
quality and reduce costs, such as streamlining care coordination.
Coordinate the care and medical services that an individual has,
particularly for those with chronic conditions, where most of the
healthcare dollars are spent. It has been proven.
There are programs out there, pilot programs, and some are more
permanent, that allow for coordination of benefits--that is, services--
for those who have chronic illnesses. Part of that is found in the
current Affordable Care Act. It is being done. It needs to be expanded.
And we can dramatically improve the care and the health of
individuals by coordinating their care, making sure, for example, that
people with diabetes are able to get the drugs, get the treatment, work
on their healthcare, work on the food they eat, and work on exercises,
coordinate all of that. If you want to drive down the cost of
healthcare, take the six chronic illnesses and coordinate the care.
Keep people healthy. Keep them out of the hospital by being healthy. We
can do that. We do, but not everywhere.
Allow States greater flexibility in administering the Medicaid
program. Our Republican colleagues talk about this. We should do it. I
am in favor of it.
I know from my experience as insurance commissioner in California
that there are many things that can be done by the States as they deal
with the peculiar and individual circumstances of the citizens of their
State in altering the Medicaid program so that it can meet the needs of
the State. Let's do it, but not with the repeal of the Affordable Care
Act and stripping out of the program billions upon billions of dollars
so there really is no money to do anything. That is flexibility in the
Medicaid program.
We have a national health insurance exchange program. It is there,
but it has been reined in. It has not been allowed to grow as it could
by the actions of Congress. Since the Republicans took control of
Congress, they have withheld, they have reined in, the national health
insurance exchange program. This is in States that refused to establish
their own exchanges. Individuals can then go to the national exchange.
But they don't even know it is there because the advertising for the
national exchange has been eliminated. So we can do that. It is pretty
simple.
Hey, folks across America, you don't have a State exchange? You can
come to the national exchange. You haven't heard about it? I am not
surprised because there is no advertising. There is no knowledge
available to individuals. It is a pretty simple thing we can do. As
that exchange grows, we begin to spread the risk across a wider
population.
In the early version of the Affordable Care Act here in the House of
Representatives, we passed and I voted for what was known as the public
option, a national public insurance option. The Senate removed it--
mostly Republicans, but some Democrats didn't think that was a good
idea. I thought it was a good idea in 2009 when the issue came before
us because I saw an advantage in a national insurance program.

So there are five things that we can do right there, and there are
many, many more.
When the repeal of the Affordable Care Act passed through this House
on the floor, my Democratic colleagues offered 22 amendments to improve
the Affordable Care Act, to improve ObamaCare. They were all rejected.
So much for working together.
But let me make a baseline statement: Don't repeal the Affordable
Care Act; improve the Affordable Care Act. If you are determined to
repeal the Affordable Care Act, there is not much

[[Page H5425]]

we can work with. That is why I took the time to talk about the
Americans that are now covered, the seniors that now have drug
coverages, the end of discrimination based upon preexisting conditions.
That is why I talked about those things.
In a repeal--and the President called for a flat-out repeal--that is
gone. It is gone. If you want to do that, don't count on me. I won't be
there. But if you want to take the Affordable Care Act and if you want
to deal with the problems that we know are there, then let's work
together.
I just laid out five things. There are 17 more that have been
suggested by my Democratic colleagues. We can improve the well-being of
Americans. We can help those people.
As for my wife's hairdresser, I don't know if she is going to get
pregnant because she doesn't know if she is going to continue to have
coverage. For that farmer, that woman who is running her own family
farm, she doesn't know either. There are 23 million Americans who are
in that position--23, and quite possibly more--who don't know if a year
from now, 2 years from now, they will have health insurance.
So, President Roosevelt: ``The test of our progress is not whether we
add more to the abundance of those who have much; it is whether we
provide enough for those who have too little.''
I yield back the balance of my time, Mr. Speaker.

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