[Congressional Record Volume 164, Number 195 (Tuesday, December 11, 2018)]
[House]
[Pages H10092-H10095]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                               HEALTHCARE

  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 am grateful for the opportunity. There 
are so many things that we need to consider.
  Today, the President announced that he is going to do his best to 
shut down the Government of the United States, and he wants to call it 
the Trump shutdown.
  I wonder if he really understands what that means to Americans. The 
Department of Homeland Security--about which there is so much 
discussion as to the security of the border, the Coast Guard, all of 
the ICE agents and so forth--presumably would stand down. I guess that 
is what a shutdown means, that we would have no border security.
  So I am curious exactly what the President has in mind when he says 
it will be the Trump shutdown.
  We don't really want to do that. I have been there before in the mid-
1990s, when Speaker Gingrich decided to shut down the government. I was 
over at the Department of the Interior as the Deputy Secretary, and I 
think that the Department of National Parks and the Bureau of Land 
Management and on and on simply shut down. The National Parks shut 
down, the Washington Monument.
  So the Department of the Interior would apparently shut down--not 
apparently, would definitely shut down--under a Trump shutdown. I 
suppose the Washington Monument, the memorial to World War I, World War 
II memorials, Yosemite--that would be a problem actually. We usually go 
to Yosemite on the 18th of December. That is my anniversary.
  So, Mr. President, do you have any idea what you are going to cause 
here in America? The Department of Agriculture would shut down. Food 
safety, presumably, would shut down. It goes on and on, and all of that 
over a border wall that nobody other than the President thinks would be 
useful.
  We do need border security, no doubt about it. We just heard our 
colleague from Texas talk about this a little bit. Yes, we do need 
border security. But nobody thinks a big, massive, beautiful wall from 
here to there, from the Caribbean to the Pacific Coast, would solve the 
issue of border security.
  By the way, if you shut down the government, it is the Coast Guard 
that shuts down, and the Coast Guard has confiscated 10 times more 
drugs than the Border Patrol. So I guess we will have the President 
shut down that part of border security also.
  Nobody says a wall is the answer. They said use technology. Use 
observation devices of various kinds that sense and watch remotely, 
drones and unmanned aerial vehicles and things of that sort.
  By the way, why don't we beef up and provide the kind of security and 
the

[[Page H10093]]

kind of access that our ports of entry really need, whether those ports 
of entry are along the Mexican border or the ports?
  We really are justifiably concerned about port security. I mean ocean 
port security.
  So, come on, Mr. President. Realistically, you don't have the votes 
here in the House of Representatives for your $5 billion border wall, 
which now you would say Mexico is going to pay for.

                              {time}  1815

  Show me the money. We can negotiate this out. And Democrats--the 
leader of the House and of the minority in the Senate, Ms. Pelosi and 
Senator Schumer, went over and said: We put more than $1 billion--I 
think it was about $1.3, $1.4 billion from last year's appropriations--
and you have only spent 6 percent of that for border security. So you 
have got that billion or so available now. And now you want $5 billion. 
How do you want to spend it?
  No plans on how to spend the money. It is just fulfilling a campaign 
promise, which now, apparently, Mexico is going to pay for. We will 
see.
  I wasn't really going to talk about that. What I wanted to talk about 
is what Americans are really concerned about, which is healthcare. That 
was an issue in the campaign. I know from the Democratic Party side, we 
made healthcare a major central issue of our campaign for the people: 
affordable healthcare for the people. That is what we campaigned on. 
That is what we promised.
  On January 3, when the Democrats take control of this House of 
Representatives, we will put forth solutions to the healthcare crisis.
  The Affordable Care Act was passed in 2010, and it brought more than 
22 million Americans into the insurance market and gave them a quality 
insurance product. They had to pay for it. It wasn't all free. The 
price varied. It created exchanges, a marketplace in which individuals 
and families can go and select policies from various insurance 
companies. Unfortunately, the public option was not adopted, but 
nonetheless, there was an opportunity for 22 million Americans.
  No sooner did that bill pass than the Republicans used that 
Affordable Care Act, with what they then called ``ObamaCare,'' to beat 
up the Democrats. They did a very, very good job at it. They took 
control of the House of Representatives in the 2010 election, and in 
2011, they began a process of eviscerating the Affordable Care Act.
  More than 60 times on this floor our Republican colleagues voted to 
eviscerate, gut, kill, terminate, but never to replace, just to 
eliminate that, with 22 million Americans losing their insurance. The 
expansion of the Medicaid program across this Nation is gone, reduced, 
gutted.
  So we go into the 2018 campaign, and we said: No. No. Healthcare is a 
fundamental issue, a fundamental right. The wealthiest country in the 
world ought to be able to provide healthcare to all its citizens.
  That was our campaign. So we are going to move forward on this. One 
of the things we want to take up right away is why we want to do it.
  Those of you who follow my occasional 1-hour Special Orders here on 
the floor have seen this. This is kind of to center me, to center what 
it is we want to accomplish, why we want to do these things.
  Franklin Delano Roosevelt said it very, very well back in the late 
1930s. He said: ``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 where I am coming from, and I think that is where my 
Democratic colleagues are coming from.
  The wealthy are doing quite well. They certainly are. The tax bill 
that was passed by the Republicans without one Democratic vote last 
year in December 2017 ripped nearly $2 trillion out of the Federal 
Treasury and gave 85 percent of that $2 trillion to the wealthy 
American corporations and to the top 10 percent of the wealthy 
Americans.
  So we come back to values. We are not here to make the rich richer--
although they certainly would like that, and they certainly did get 
that in the tax bill, or scam, I think is what we would call it--but, 
rather, for people who really need help, the men and women and families 
of America who go to their kitchen table, are unable to figure out how 
they are going to get healthcare, how they are going to get a job.
  There is talk there is a tax break, but that tax break was eaten up 
by inflation for the working men and women of America.
  So let's go to the healthcare issue. One of the things we spent a lot 
of time talking about and intend to deal with is the cost of 
prescription drugs. Let's spend some time on that.
  This little chart is a comparison of prescription drugs versus 
generic drugs. Ninety percent of the prescriptions are filled with 
generic drugs and 23 percent of the prescriptions are filled with 
other, nongeneric drugs. Seventy-seven percent of the total cost of 
drugs is on the nongeneric side; and on the generic side down here, it 
is about 10 percent.
  So one solution here is to advance the availability of generic drugs. 
Clearly, a generic drug is significantly cheaper than a prescription 
drug. You may ask: Why is that?
  The pharmaceutical industry will say: The reason is, we have got to 
do all this research, and we have got to do all this marketing.
  They certainly do a lot of marketing. You turn the television on; 
they are marketing like crazy one drug or another. That is a 
prescription drug. They are not marketing the generic drugs.
  So there you have it: Generics, 90 percent of the prescriptions are 
generic, and 70 percent of the cost is on 23 percent, the prescription 
drugs.
  What has happened to the cost of prescription drugs?
  Well, if you take the average price of the specialty drugs, these are 
prescriptions, they have tripled over the last--2006 to 2015, that is 
what?--10 years. So the prescription drugs, the specialty prescription 
drugs, same drugs, over a 10-year period, the cost has tripled.
  You might ask: Well, why? Is it suddenly more expensive to make the 
same drug that you made before?
  Well, possibly. But maybe it has to do with market power. If your 
prescription drug has a patent or many, many patents, then the generic 
drug cannot be made. So you control the market for that particular 
drug. That particular drug might be rather important.
  Now, for those of you who watch television, you may actually have 
heard of a couple of these drugs. Let's just take a look here at key 
metrics for the three major brand drugs: Humira, Revlimid, and Lantus. 
I don't take them, so I really don't know how to pronounce them that 
well.

  But let's take a look here at Humira: the number of patents, 247; the 
price change since 2006, 144 percent--using patents to protect the drug 
from competition, allowing a 144 percent price increase--years blocking 
competition, 39 years before there will be any competition for the most 
expensive and most used drug, Humira.
  This one for multiple myeloma; I think that is a cancer: number of 
patent applications, 106; number of patents pending, 96; price increase 
since 2012, 79 percent price increase; years blocking competition, if 
you happen to have this particular cancer, there is one drug that seems 
to work really, really well, but it will be 40 years before there is 
competition, in other words, a generic that could be used, similarly 
with the other drug.
  So what is happening here is the pharmaceutical industry is using 
multiple patents and not a brand-new drug, but just a little minor 
tweaking of the existing drug, giving an opportunity to extend way 
beyond whatever the patent law originally intended, in some cases 30, 
40 years before a generic drug can come onto the market and replace 
what is going on.
  How can we deal with that?
  Well, let's take another example. Here is one. You have heard of 
insulin. I bet you have. Insulin prices have tripled over the last 15 
years. One of the most expensive insulin products in Medicare part D, 
only one out of the six most expensive insulin products faces 
competition. So, in the absence of competition, now the cost per year 
is $2,300.
  Another example is using patents on a drug to deal with diabetes. 
Let's take a look at this one.
  As if the patent policies and the ability of the drug companies to 
tweak

[[Page H10094]]

their product to use multiple patents over time, one after another, to 
gain market domination and to eliminate competitors for these very 
essential drugs, as if it is not bad enough now, our good President 
recently, I think about 10 days ago, sat down with the President of 
Mexico and the Prime Minister of Canada and signed a new really big, 
wonderful trade deal to somehow replace NAFTA, the North American Free 
Trade Act.
  Well, way down in the guts of that agreement was a little clause, 
subsection C, measures relating to pharmaceutical products, 
biologicals, et cetera, extended by 10 years the existing patent law 
for biologicals. This is the hot new area of pharmaceutical drugs: 
biologicals.
  So, in the patent law, as if the patent law wasn't already being 
abused sufficiently to drive up the price of medical costs in the 
United States, the President goes out with his team of negotiators and 
adds an additional 10 years to the existing patents for this particular 
type of pharmaceutical product.
  Together with the ability to tweak small, little changes in the 
processing or in the drug itself, using that to gain control of that 
particular solution to a very serious health problem that Americans 
face, the President decides to add 10 years to the foundation patent.
  So, what does it mean to Americans?
  Well, it means you are going to pay a whole, whole lot of money for 
your drug prices.
  There are solutions. I assure you that we are already, on the 
Democratic side of this coin, looking at solutions, first and foremost, 
to allow the Federal Government, which is the single biggest purchaser, 
payer for these drugs, to negotiate the price, that is, to use the 
purchasing power of government to overcome the patent lock that the 
drug companies have been able to secure using patents and other 
technologies and techniques.

                              {time}  1830

  That is the first thing, to allow the Federal Government to 
negotiate.
  So, you remember when Medicare part D was installed back in 2003? The 
pharmaceutical industry weaseled into that law--that is, the 
prescription drug benefit in Medicare--a provision that said the 
Federal Government could not negotiate for the prices of drugs. So 
taxpayers and those who have a deductible or a copay, you are being 
harmed.
  Now, generics, yes; generics are an answer. But just to complete this 
system of harming Americans by charging more than necessary for drugs 
using the patents, as we just discussed, the savior to the problem, 
which many would say is the generics, well, there is a little problem 
there too. And the problem was laid out in a recent article in The 
Washington Post.
  You have heard of antitrust laws, which basically say that 
competitors in an economic sector cannot conspire to control the price. 
Antitrust. It turns out that the generic, according to The Washington 
Post and to 47 State attorneys general around the Nation and a whole 
lot of--CVS, I believe, and a few others who buy drugs and sell them--
retailers have launched an antitrust complaint against a cabal of 
generic drug companies who are alleged to have conspired to control the 
cost of the generic drugs--that is, to maintain a higher cost--and to 
divide up the market.
  A generic drugmaker decides: I am going to make drug A, starts making 
it, controls 100 percent of the generic market for that drug. Good. 
Generic drugmaker B comes along, says: I can make that drug, and I can 
probably make it a little bit cheaper, so I am going to compete with 
company A.
  Company A said: Whoa, wait a minute. We can make this good for both 
of us. It can be a win-win. You take 25, 30 percent of the market; I'll 
take 75, 60 percent of the market; and we will both be doing very well. 
That is the allegation.
  So this is something we need to deal with also. We need to encourage 
the Department of Justice, the State departments, to use the antitrust 
laws to make sure that these kinds of conspiracies are not happening.
  Clearly, if the generic drugmakers are engaged in a conspiracy to 
control the cost or to divide up the market for their drugs, it is 
illegal. There are serious penalties associated with that.
  These cases, as reported by The Washington Post, are proceeding. 
Wonderful.
  What we need to do is to make sure that the Department of Justice, 
the Federal Department of Justice as well as the State departments of 
justice and the Commerce Department and others who are responsible for 
enforcing the antitrust laws are doing so.
  So, with regard to pharmaceuticals, with regard to drugs, I want you 
to know that the Democratic Congress is going to attack this problem, 
first by making certain that the United States Government can use its 
market power to break the monopoly that the drug companies presently 
have as a result of their ability to hold their specific drug forever, 
at least 30 to 40 years, under the patent schemes that they are now 
doing.
  There are other things that I would like to take up, and I will do so 
quickly.
  We said that we would also want to deal with the issues of 
preexisting conditions. Now, in the Affordable Care Act there was a 
requirement that insurance companies do not discriminate in the sale of 
insurance and the pricing of insurance based upon preexisting 
conditions.
  Now, what is a preexisting condition? Well, we just had one example 
up here: diabetes, childhood diabetes, type 2 diabetes, high blood 
pressure, other childhood illnesses.
  I was the insurance commissioner in California twice, in the early 
`90s, `91 to `95, and again from 2003 to 2007.
  This issue of insurance companies discriminating based upon 
preexisting conditions was rampant in California, despite our efforts 
to try to pass a law in California to prohibit the insurance companies 
from discriminating based upon preexisting conditions. We were 
unsuccessful.
  What we did find is that in the application process for insurance 
there was a form, and it listed every conceivable thing that a human 
being could be afflicted with--headaches, colds, sinus problems, sore 
throats, on and on and on--a list of maybe 20 or 30, and you had to 
check off each and every one of those.
  If you checked them off, they would go: Ah, you have got a 
preexisting condition. We will insure you, but we are going to charge 
you 10 times more than a person that didn't have that condition. And 
they would then provide the insurance.
  If you went through and you said: No, I don't have a sinus problem; 
no, I don't have a sore throat; blah, blah; and then you come down with 
a sore throat, they say: Ah, you didn't honestly fill out the form, and 
therefore we are not going to cover you for that illness.
  This was a common problem. So when the Affordable Care Act passed, in 
that law was a provision that said the insurance companies could not do 
that, they could not discriminate either in the cost of it or not 
providing insurance at all. Couldn't do it.
  However, in legislation that passed the House of Representatives, 
passed the Senate, and was signed into law--not a healthcare bill, but 
an addition to a must-pass piece of legislation--the Republicans, 
without Democratic support here, passed legislation that wiped out that 
portion of the Affordable Care Act, basically putting Americans at risk 
once again to insurance discrimination, health insurance 
discrimination.
  And suddenly America woke up and goes: Whoa, wait a minute. You mean 
to tell me that if I have diabetes I can't get insurance or I am going 
to have to pay 10, 20, 30 times more than somebody else? Even to the 
point of a woman being discriminated against because she is a woman and 
she might have a baby. Anyway, America woke up and goes: Whoa, wait. We 
don't like that.
  So, yes, we made that an issue. We made it a really big issue in the 
campaign: No discrimination based upon preexisting conditions. Can't do 
it. We are going to eliminate that problem for America.

  It wasn't too long before my Republican colleagues go: Oops, we had 
better get on board that ship.
  And I want my Republican colleagues and the President to know they 
are going to have an opportunity to be on that ship. We are going to 
put that bill

[[Page H10095]]

before the House of Representatives in the early days of the 116th 
Congress in 2019. We are going to do that.
  We will see if they are willing to stay with the promises that they 
made--most of them unsuccessful, but nonetheless the promises they 
made--to deal with the problem of insurance discrimination.
  So those are two things that are on the agenda right up front. There 
are many other things that we intend to do with healthcare because we 
believe that healthcare is a right. In the richest country in the 
world, you ought to be able to have quality healthcare available to 
you. That is our pledge. That is what we intend to do.
  A final point. A week ago I was here talking about climate change 
with my colleagues, and we were talking about the Federal Government's 
report on climate changes that are occurring. It was an eye-opener. It 
basically said we are--by ``we,'' not my generation, but the next 
generation out, 10, 20 years out--going to face a monumental problem of 
sea level rise, massive storms, massive fires, the epidemic of tropical 
diseases moving into the Northern Hemisphere in through the countries 
that have not experienced tropical illnesses.
  All of those things were in that report, and we spoke about it here. 
We called upon our government, our President, and our colleagues here--
Democrat and Republican--to aggressively attack this problem by 
reducing carbon emissions, by moving away from a carbon-based energy 
system. We can do that.
  As I said during that debate here on the floor, in 1978 I authored a 
law in California, the first in the Nation, to provide a tax credit for 
wind, solar, and conservation. And those kind of laws have been in 
place forever, and we have proved that we can do it. Over the years, 
significant efforts have succeeded in bringing on board clean green 
power.
  So, a week goes by, and in the newspapers yesterday and today are two 
articles that deserve our attention, and actually a third that just 
came up this afternoon.
  The first article was that the carbon emissions over the last year 
have grown substantially. For the United States it is around, I think, 
a 2\1/2\ percent increase in carbon emissions; and in China and India, 
the other two large emitters of carbon, significant growth.
  In other words, the world is falling backwards in addressing the 
carbon pollution that is creating climate change. Oh, my goodness, a 
wake-up call.
  We have the report that these bad things are going to happen unless 
we change the direction we are going. And then a week later we find out 
the direction we are going is not downward but, rather, upward.
  Article one: Today in the newspapers, even in the fake newspapers, is 
an article that the President's emissaries to a conference in Europe on 
climate change are advocating--advocating--for the burning of more coal 
and oil.
  This wasn't a coal conference. This was a conference on how does the 
world go to green, non-carbon energy sources. And so the United States, 
leading away from solving the problem.
  Yes, that is what our President sent those folks over to Europe to 
do, not to solve the problem but to make the problem worse. It was an 
O-M-G moment. You have got to be kidding. The least you could have done 
is keep your mouth shut. But oh, no, advocating for more coal, 
advocating for more oil, and pushing aside all of those technologies--
solar, wind, biomass, biofuel, all of those things--pushing them aside. 
No, no, no, we have got to have more coal.
  It is reprehensible and an absolute dereliction of duty and 
responsibility to this generation here and now and to future 
generations to come.

                              {time}  1845

  What would you expect from the man who wants to shut down government? 
I would expect better. We just want A Better Deal. We want A Better 
Deal for the American people.
  The rich and wealthy, they got one big beautiful deal in the tax cut. 
Working men and women and families, we have got our work cut out for 
us.
  A Better Deal for the people--that is what we want to do. Many 
different ways to do it. We are going to work at it. We ask you to work 
with us.

                          ____________________