[Congressional Record Volume 163, Number 121 (Tuesday, July 18, 2017)]
[House]
[Pages H5969-H5971]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                             FAMILY VALUES

  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, it has been a most interesting day here 
in Washington, D.C., this last week in which we have seen the battle 
royal over the repeal of the Affordable Care Act. I want to really 
speak about the Affordable Care Act, what it has managed to do for 
Americans.
  Much of the conversation over these last several days has been on the 
other side of it: how it could be repealed and how, somehow, that would 
be good for Americans.
  But the Congressional Budget Office has made it clear that the bill 
that passed the House of Representatives some time ago, about a month 
and a half ago, was bad news for Americans. Some 18 million people 
would lose their health insurance in very short order within a year or 
so, and some 24 million would lose their health insurance over the next 
5 to 7 years. That is a terrible situation.
  When you take a look at what has happened in the recent period since 
2014 when the Affordable Care Act was actually in full force, we have 
found many millions of Americans with insurance.
  In my own State of California, we now have over 5 million 
Californians with insurance that they previously did not have. About 
1.5 million of those Californians are in the exchange--the California 
exchange, which we call Covered California--and another 3.5 million are 
covered in the expanded Medicaid program. That is good news.
  It is also good news that people who previously were unable to take 
care of their medical issues found coverage.
  I remember a woman, actually, my wife's beautician, who came to her 
as the Affordable Care Act was implemented in California and told her: 
At last I can get insurance. My husband and I are going to have a 
baby--or we want to have a baby. We couldn't afford it before. But now 
I have insurance. I am on the exchange. I have the subsidy, and I can 
afford it--family values.
  In the last 6 months, as the new administration has taken hold and as 
the repeal of the Affordable Care Act has become the talk of the 
Nation, in a more recent visit, she said: We have delayed getting 
pregnant because we are not sure if I can have insurance. If they 
repeal, if they kill ObamaCare, I won't have insurance, and we won't 
have a baby.

                              {time}  1800

  Family values. I want to talk about values: family values and others.
  I used this last week, and I am going to use it over and over again, 
because this is a statement of values. This is from Franklin Delano 
Roosevelt in the midst of the Great Depression.
  President Roosevelt said this: ``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.''
  That is a statement of values. That is a statement of purpose. That 
is the reason why he and the Democrats, during the Great Depression, 
took the actions like, for example, Social Security. For those who have 
little, Social Security.
  Then, again, in the sixties, for those who have little, this same 
statement of value came into place. During Lyndon Johnson's Presidency, 
the Democrats created Medicare for seniors--men and women over 65. All 
you needed to do to get health insurance was to live until you were 65 
years of age. They also added Medicaid for the poor--principally, 
children and mothers.
  It is a statement of values. It is a statement of purpose. It is a 
statement of where their heart lies and what they thought was 
important.
  Today, we are working on the Affordable Care Act, sometimes, often 
derisively, called ObamaCare. But many of us proudly call it ObamaCare, 
where 5 million Californians have health insurance. Across this Nation, 
there are 20 million in all States, although some States chose not to 
extend the method of buying insurance on the exchanges. And so the 
Federal exchange exists.
  This House went the opposite direction. So what did it mean? The 
uninsured rate in America declined down to the lowest number ever in 
our history, as men, women, and families were able to get health 
insurance.
  I think of a farmer, a single woman in my district, who never had 
insurance, never could get health insurance, couldn't afford it until 
the Affordable Care Act, ObamaCare, came along. She was able to get 
insurance. She was able to get cancer treatment. If she didn't have 
insurance, she surely would have died. We have countless examples.
  When I was the insurance commissioner in California, we would always 
fight the insurance companies over their denial of insurance. They used 
to call it preexisting conditions. Since the Affordable Care Act went 
into place in 2011 and 2012, preexisting conditions were no longer 
legal as a mechanism for denying insurance in the United States of 
America. Insurance companies could not rate people on preexisting 
conditions.
  I remember those lists. It was two pages. As insurance commissioner, 
people would come to me and say: Why do

[[Page H5970]]

I have to fill out this form of everything I have ever done in my life? 
A broken leg playing football in high school had to be listed--asthma, 
coughs, contagious diseases. Even mundane things like: Are you a pilot; 
are you into dirt bikes and dirt bike racing?
  These were all reasons why insurance would be denied. But with the 
Affordable Care Act, no more. That history was gone.
  So, today, the President of the United States, perhaps proudly, stood 
before the American people and said: I will let it die. I will let it 
die. I will let the Affordable Care Act fail.
  What is the message to the American public? What is the message that 
the President of the United States, Mr. Speaker, has said to the 
American public?
  Mr. Speaker, he has said: I will work to deny the American people 
health insurance.
  Mr. Speaker, the President of the United States has, in so many 
words, said that he will take action to deny the American people health 
insurance--not all of them, just 20 million. You proactively take 
specific actions.
  And what are those actions? To tell the IRS to not enforce the 
mandate so that people will be able to go without insurance until they 
have an accident or sickness and wind up in the emergency room so that 
everybody else can pay for their care.
  He will not allow the payment of the cross-subsidies for those 
insurance companies that have enrolled an excessive amount of very sick 
people and other insurance companies that have enrolled a healthy 
population. That cross-subsidy is critical.
  He will create more uncertainty so that the insurance companies do 
not know how to price their insurance. He has already removed the 
ability for the Federal and State exchanges to advertise. There is no 
insurance company, I can tell you from my own experience, that can 
survive without advertising. They have got to talk about what it is 
they are offering. They have to sign up people, and they have to have a 
cross subsidization of healthy, sick, and not so sick people in their 
pool of risk. But he set up a system so that those exchanges that are 
in existence in the States and the Federal exchanges will not have the 
money to advertise.
  California is a big State. We can get along without President Trump. 
So we have set up our own mechanism of providing money for advertising 
Covered California. A couple of other States have been able to do the 
same, but not every State.
  There has been discussion that the market is collapsing. I want to 
read to you an analysis done by the Kaiser Family Foundation that just 
came out a week ago that would counter the arguments that this is a 
collapsing market. I am going to read this. It is a little long, but I 
think it is worth understanding.
  ``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 a market collapse.''
  Perhaps I should read that again and perhaps the President might also 
want to read, although I understand he doesn't. Perhaps if he did, he 
would read the Kaiser Family Foundation report coming out July 2017.
  ``Insurer financial results show no sign of a market collapse. First 
quarter premium and claims data 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.''

  I am going to come back to that after finishing reading this.
  ``Although individual market enrollees appear on average to be sicker 
than the market pre-ACA, data on hospitalizations in this market 
suggest 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 been successful and expanded 
their footprints, as would be expected in a competitive marketplace.
  ``While the market on average is stabilizing, there remain some areas 
of the country that are more fragile. 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 
subsidy payments will continue or whether the individual mandate will 
be enforced have led to some insurers to leave the market or request 
larger premium increases than they would otherwise. A few parts of the 
country may now be at risk of having no insurer on exchange, though new 
entrants or expanding insurers have moved in to cover most areas 
previously thought to be at risk of being bare.''
  Not my words, but rather the words of the Kaiser Family Foundation.
  So, Mr. Speaker, the President apparently intends to destroy the 
Affordable Care Act by saying that it doesn't work. In fact, his 
actions may make it a situation in which it would not work.
  I suppose if he has his way, we are going to see, in 2018, the number 
of uninsured rise back to where it was before the Affordable Care Act. 
That is about 22 million Americans without insurance.
  Well done, Mr. President. Well done. If that is what you want, I want 
to know what your values are. What are your values?
  Mr. Speaker, I would ask the President: What are your values, Mr. 
President? You have been supporting the Republican legislation to 
repeal and replace. It happens to do much for those who have much.
  The largest single tax break for the wealthy ever in this Nation's 
history was in the legislation that passed the House of Representatives 
with the repeal and replace legislation, so much so that Mr. Trump's 
Cabinet, made up of the wealthiest Cabinet perhaps ever in America's 
history, would receive huge tax breaks of well over $4 million a year, 
and quite possibly a much higher number.
  Those are not the values of the Democratic Party, those are not the 
values of Franklin Delano Roosevelt, and those are clearly not the 
values of Americans who care about each other, who are concerned about 
those who have little.
  Ask the American public if they want to do away with Social Security. 
Ask the American public if they want to do away with Medicaid. Do away 
with Medicaid? Yes, 60 percent of the Medicaid money supports seniors 
in nursing homes. You want to do away with that? I don't think so. But 
that is what it would do.
  The Affordable Care Act does need to be improved, and the Democrats 
have been trying to do that for some time. How can we do it? Many ideas 
have been proposed.
  When the legislation was heard in committees here, the Democrats 
proposed several amendments to improve the Affordable Care Act. The 
first amendment was to do away with the repeal, but, of course, that 
didn't pass in committee and certainly wasn't on the floor.

                              {time}  1815

  So how do you deal with improving the Affordable Care Act?
  Let's start with drugs. We know that for the Medicare system, that 
the Federal Government cannot negotiate the price of drugs. And for the 
exchanges--the Federal exchanges, we cannot negotiate the price of 
drugs. It was a law that was written with Medicare part D back in 2002 
and 2003.
  So why can't we negotiate the price of drugs?
  We ought to be able to do that. You want to reduce one of the cost 
factors, let's negotiate the price of drugs.
  How about another one? How about consumer services? Increasing the 
risk pool, increasing the number of men and women that are in the pool 
by advertising?
  I talked earlier about the President removing the money for 
advertising on the Federal exchanges and State exchanges.
  You want to improve it, improve the risk pool. A broad risk pool is a 
fundamental fact of any insurance program that is successful. But to 
take overt action, to diminish the risk pool, and to put into the risk 
pool less healthy people, and to keep people who are healthy out of the 
risk pool--please keep in mind that any of us at any particular day may 
find ourselves in need of very serious medical attention, perhaps a car 
accident, perhaps a contagious disease, Zika, who knows what it might 
be, or a pregnancy. So expand the risk pool by advertising, by 
enforcing the mandate, which is the third element that could be done.

[[Page H5971]]

  The President has already taken action to tell the IRS not to enforce 
the mandate. So the young healthy invincibles shirk the law knowing 
that they don't ever have to pay a penalty because the IRS is not 
looking.
  Okay, if that is what you want to do. However, if you want to improve 
the healthcare of America, if you want to hold premiums stable and 
perhaps even declining, expand that risk pool.
  How about a few other things?
  When the Affordable Care Act passed the House of Representatives in 
2009, there was a public option in it. Unfortunately, the Senate 
wouldn't stand for a public option. But bring the public option back so 
that there would be a national public option insurance company 
available to everybody. Bring that back. That is another idea that 
ought to be the improvement of it.
  Another thing: States can and have successfully modified the Medicaid 
programs in their State. Expand the ability of States to experiment 
with different ways of providing services under the Medicaid program. 
Not by eliminating it, as the Republicans would do--that is, 
eliminating the expansion, as the Republicans would do in their repeal 
and in TrumpCare--but, rather, allow the States to experiment with 
different ways of providing the medical services in the Medicaid 
program. And there are some great ideas out there.
  We know that many of the people in Medicaid have long illnesses, high 
blood pressure; perhaps they have other illnesses that require constant 
care. We know that there are examples of programs that provide ongoing 
services so that these illnesses are constantly being able to be 
monitored and dealt with.
  You want to deal with blood pressure, take a couple of cheap pills 
and you keep the blood pressure down and you avoid stroke and diabetes 
and the like. Those programs should be existing in most States, in most 
Medicaid programs. So we ought to provide the opportunity for the 
States to experiment with different ways of keeping down the cost of 
medical services.
  There are many other things that we can do with regard to the 
delivery systems. California has been a leader in creating various 
delivery systems that do keep down the cost of care--comprehensive 
delivery system, preexisting conditions being taken care of. So we can 
do this with a variety of ways.
  All of these should be on the floor of the House of Representatives 
and the Senate and presented to the President as we have the Affordable 
Care Act in place and we have ideas on how it can be improved.
  Programs such as mandatory care, all of those can be taken into 
consideration. But, no, we are not going to do that. We are just going 
to let the Affordable Care Act die, so says our President.
  It is unbelievable that you sign on, presumably to provide more 
opportunity for Americans, to provide better medical care for 
Americans. But, no, that is not what is going to happen here. The 
President of the United States said he is going to let it die, let it 
collapse. How cruel, how harsh, and how unlike previous Presidents. I 
pray future Presidents who say: My job as President of the United 
States is to carry out, yeah, the preamble to the Constitution, to form 
a better union.
  But apparently that is not the case with this President.
  So the Affordable Care Act is the law of the land, and it is the 
responsibility of the President to carry out the laws of the land, and 
that includes things that he thinks may be discretionary, such as the 
IRS mandate, such as the advertising, the cross-subsidization for those 
insurance companies that have higher risk pools than other insurance 
companies.
  We live in a very important moment where at risk are 22, 23, 24 
million American lives. Thankfully, four senators stood strong and 
courageous and said, no, they were not going to support the repeal of 
the Affordable Care Act.
  It is not over. This fight is going to go on for some time, and as it 
goes on, I would hope the American people understand what is at risk. 
It is the well-being of their neighbors, it is the health of their 
communities, and, indeed, in some cases, it may be their own life. We 
will see.
  But today, a good thing happened--actually it was yesterday a good 
thing happened. The Senate was unable to pass a repeal of the 
Affordable Care Act and a replacement that was in every way a terrible 
blow to Americans. So we are thankful, and we look to the future and we 
look to the fight ahead.
  I can tell you this: My colleagues on the Democratic side are 
absolutely determined that the Affordable Care Act be improved and that 
it continue to be the law of the land. And the millions upon millions 
of Americans that have had the opportunity to purchase health 
insurance, to be covered in health exchanges, to be covered under the 
expansion of the Medicaid program, we are there for them and we are 
going to fight this. And we will succeed because Americans know what is 
at risk in the legislation that passed the House of Representatives 
with the repeal of the Affordable Care Act and the legislation that 
almost passed the Senate. This isn't over. Our determination to stay 
the line remains.

  Mr. Speaker, I yield back the balance of my time.

                          ____________________