[Congressional Record (Bound Edition), Volume 155 (2009), Part 13]
[House]
[Pages 18350-18357]
[From the U.S. Government Publishing Office, www.gpo.gov]




              THE CONGRESSIONAL BLACK CAUCUS: HEALTH CARE

  The SPEAKER pro tempore (Mr. Perriello). Under the Speaker's 
announced policy of January 6, 2009, the gentlewoman from Ohio (Ms. 
Fudge) is recognized for 60 minutes as the designee of the majority 
leader.


                             General Leave

  Ms. FUDGE. Mr. Speaker, I ask unanimous consent that all Members be 
given 5 legislative days to revise and extend their remarks on the 
subject of my Special Order.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Ohio?
  There was no objection.
  Ms. FUDGE. The Congressional Black Caucus, the CBC, is proud to 
present this hour on health care. The CBC is chaired by the Honorable 
Barbara Lee from the Ninth Congressional District of California. I am 
Representative Marcia L. Fudge from the 11th District of Ohio, and I am 
the anchor for this hour.
  Mr. Speaker, I would now like to yield to our Chair, the Honorable 
Barbara Lee, the gentlewoman from California.
  Ms. LEE of California. Thank you very much.
  Mr. Speaker, first, let me thank my colleague, Congresswoman Marcia 
Fudge of Ohio, for leading this Special Order, not only tonight but 
each and every Monday night, to keep our caucus and the country focused 
on addressing the key issues which are looming today. She consistently 
and is constantly on the case, making sure that we speak with one voice 
on the very, very critical issues which our country and the world are 
facing.
  So thank you, Congresswoman Fudge, for your leadership.
  As Chair of the Congressional Black Caucus, I join my colleagues 
tonight in this very timely discussion of health care and of our 
efforts. Also, I want to make the case tonight for prevention as a very 
cost-effective strategy for health care reform. Prevention and, of 
course, public health should be the cornerstone of any true health care 
package. Prevention that takes place outside of the doctor's office can 
be just as important in impacting the health of Americans as health 
care on the back end when one ends up in an emergency room. Disease 
prevention is universally popular from coast to coast and across 
political spectra. Americans understand and appreciate the value of 
prevention, the value especially for reducing disease rates, for 
improving the quality of life and for lowering health care costs.
  Yes, given the rise in deficit, we all are extremely concerned about 
the

[[Page 18351]]

costs of health care, but we also must remember that an ounce of 
prevention is worth a pound of cure. For whatever reasons, those 
experts who are giving us the numbers in terms of the costs don't seem 
to, for whatever reason, want to tell us how much we will save based on 
prevention as a key element and strategy in our bill.
  In a new poll released last month by the Trust for America's Health, 
Americans actually ranked ``prevention'' as the most important health 
care reform priority. The poll also found that more than three-quarters 
of Americans believed the country should invest more in keeping people 
healthier; and by a ratio of nearly 4-1, they supported putting more 
emphasis on preventing disease rather than on treating people after 
they become sick.
  People are convinced it will save the health care system money, but 
surprisingly, the poll also found that more than 70 percent of 
Americans say investing in prevention is worth it even if it doesn't 
save money, because it will prevent disease and it will save lives. We 
also know that it will save money.
  Now, this is not about lecturing people about behavior. Instead, what 
we want to do is to remove barriers to good health that are beyond the 
control of most people. One role of government in health care is to 
provide opportunities to make it easier for people to make healthy 
choices. Americans are not as healthy as they could be or should be, 
and this is resulting in skyrocketing health care costs that threaten 
to bankrupt American businesses. Our workforce is less productive than 
it could be or it should be as it relates to competing with the rest of 
the world.
  Tens of millions of Americans suffer every day from preventable 
illnesses like diabetes, heart disease, some forms of cancer, and 
infectious diseases which rob them of health and the quality of life 
that they deserve, and it also drives up health care costs. More than 
half of Americans suffer from at least one chronic disease. Two-thirds 
of Americans are obese or are overweight, and 20 percent of Americans 
smoke. Due to the epidemic of obesity, today's children could be the 
first generation to live shorter, less healthy lives than their 
parents. This is very scary. The Nation's economic future demands that 
we find ways to reduce health care costs. Helping Americans stay 
healthier is one of the most effective ways to lower costs and to 
ensure that our workforce is strong and productive enough to compete in 
a global economy.
  According to the United States Centers for Disease Control and 
Prevention, a vast majority of chronic diseases could be prevented 
through life style and environmental changes. For too long, the health 
care system has focused on treating people after they become sick 
instead of keeping them healthy in the first place. We need to shift 
from a sick care system to a health care system. Prevention can improve 
the quality of lives of Americans, can spare millions from needless 
suffering and can eliminate billions of dollars of unnecessary health 
care costs. Research shows that strategic investments in disease 
prevention programs in communities can result in a big payoff in a 
short time, reducing health care costs, increasing the productivity of 
the Nation's workforce and helping people lead healthier lives.
  Let me just conclude by saying I have to take a moment to commend 
Congresswoman Donna Christensen and the Congressional Black Caucus' 
Health Task Force, along with the Congressional Hispanic and Asian 
Pacific American Caucuses' task forces, for their diligent and 
effective work to ensure that any health care reform bill includes a 
real public health option and provisions to address the racial and 
ethnic disparities which we face each and every day. Unfortunately, 
people of color are disproportionately seen in emergency rooms because 
they don't have health insurance and can't get preventative care.
  For example, African Americans are 3\1/2\ times more likely than 
whites to get an amputation as a result of diabetes. African American 
men with colon cancer are more than 40 percent more likely than white 
men with the same condition to receive major diagnostic and treatment 
procedures too late.
  So, Mr. Speaker, as we debate health care reform, let's look at the 
real costs and focus on the billions--and I mean billions--of dollars 
that we will save if we remember that old adage that an ounce of 
prevention is worth a pound of cure.
  Thank you, Congresswoman Fudge, for your leadership and for giving me 
a few moments to talk about this very important issue tonight.
  Ms. FUDGE. Thank you very much, Madam Chair.
  Mr. Speaker, we have the honor of being joined this evening by the 
majority whip. I would at this time yield to the gentleman from South 
Carolina (Mr. Clyburn).
  Mr. CLYBURN. I thank the gentlelady for yielding me this time.
  Mr. Speaker, I would like to say to the American people that this 
whole issue of health care reform is something that needs to be focused 
on, not as an individual condition or situation but as to what is 
happening to the American families, as to what has happened to American 
businesses and as to what is happening to the American economy.
  This is not about government-run health care. It's about removing 
insurance companies and costs from health care decisions, and it's 
about allowing you and your doctor to make those decisions. The status 
quo is not acceptable, and it is not sustainable. Here is why:
  Every day, Americans are worried not simply about getting well but 
about whether or not they can afford to get well. Millions more wonder 
if they can afford preventative care to stay well. Premiums have 
doubled over the last 9 years, rising three times faster than wages. 
The average American family already pays an extra $1,100 in premiums 
every year for a broken system that supports 46 million uninsured 
Americans. For American businesses, soaring health care costs put 
American companies at a competitive disadvantage in a global economy. 
Small businesses are forced to choose between coverage and layoffs.
  The broken health care system will cost us as much as $248 billion in 
lost productivity this year alone. We have the most expensive health 
care system in the world. We spend almost 50 percent more per person on 
health care than the next most costly nation, but we are no healthier 
for it. If we do nothing, in a decade we will be spending $1 of every 
$5 on health care. In 30 years, it will be $1 of every $3. Health care 
reform is curbing health care costs. It is the single best tool for 
deficit reduction.
  Now I want to answer a question for all of the American people: What 
is in the reform plan for the average American?
  Without reform, the health care costs for an average family of four 
is projected to rise $1,800 every year for years to come, and insurance 
companies will make more and more health care decisions. America's 
middle class deserves better.
  Now, here is what is in this reform package for you: no more co-pays 
or deductibles for preventative care; no more rate increases for 
preexisting conditions, gender or occupation; an annual cap on your 
out-of-pocket expenses; group rates of a national pool if you buy your 
own plan; guaranteed affordable oral, hearing and vision care for your 
kids.

                              {time}  2015

  With this health care, there is greater choice. Keep your doctor and 
your plan if you like them. More choice with a high-quality public 
health insurance option competing with private businesses.
  And so I want to say to the American people, this health care plan 
that we are marking up in the Energy and Commerce Committee over the 
next 2 days--and it's already been marked up in three of five 
committees in both houses of the Congress--is a plan that will say to 
the American people, You no longer have to worry about the cost 
shifting that's taking place in our current health care system; you 
will no longer have to worry about your premiums going up in order to 
cover that

[[Page 18352]]

cost shifting for those people who do not have insurance. There will be 
stability in your families, there will be decreases in your premiums, 
and there will be an expansion in the coverage for all Americans. This 
is something we cannot afford not to do.
  Ms. FUDGE. Mr. Speaker, I would now like to yield to my friend and 
colleague, the gentlewoman from Texas (Ms. Eddie Bernice Johnson).
  Ms. EDDIE BERNICE JOHNSON of Texas. Let me thank our congresswoman 
from Ohio, Congresswoman Fudge, for organizing this Special Order on 
health care.
  Over the years, the degree of accessibility and quality of health 
care in the United States has faltered. We are a Nation in crisis. Many 
Americans who are uninsured and unable to pay their hospital bills are 
deprived of the care and attention needed to ensure their well-being. 
Fundamental change is necessary to truly make progress toward a healthy 
America. We must rescue our health care from the insurance companies 
and the pharmaceutical companies.
  My experiences as a State and Federal legislator and a nurse have 
provided a unique vantage point from which to discuss this issue.
  During my 15 years as a professional nurse and that of a chief 
psychiatric nurse at the Veterans Administration Hospital in Dallas, 
Texas, I witnessed the diminishing state of our health care firsthand. 
Our system of health care is especially weak when it comes to mental 
health, for example. Individuals with mental illness do not receive 
sufficient coverage from insurers. While some are uninsured and 
unemployed, others may make too much to qualify for Medicaid. The 
limited options that our health care system offers mental health 
patients results in their inability to obtain appropriate treatment.
  Some years ago in the State of Texas, there was a lawsuit, and the 
ruling came down that said patients had a right to treatment. Many of 
the patients that were in State institutions were discharged because we 
did not have the staff to treat them. Guess what happened to them? They 
became homeless and many went to prison. They become victims of our 
flawed health care system, become unable to gain employment, and at 
times really have no other place to go but to the sidewalks and the 
streets and the doorways. People with mental illness are amongst those 
least served by local and national health care systems.
  Individuals and families across the country are being affected by the 
faults in our care system. Thousands of families are crushed by the 
growing cost of health care. Today, Americans are spending more on 
health care than housing or food, and they sometimes must choose 
between paying their health premiums or their rent or even their 
prescription medications.
  With our ailing economy, Americans should not be forced to make that 
choice, and now is the time for reform. We must not allow these 
millions of dollars that are going to lobbyists to distort this plan 
win this time. We can reform our health care system by improving and 
expanding our current systems of Medicare, Medicaid, and CHIP, making 
them available and affordable to all Americans. I don't think we ought 
to have a total Federal or a government plan, but we ought to have a 
choice because the insurance companies have no one to compete with now 
and they can charge what they want and limit what patients can get. 
They are dictating to doctors what they should order. That needs to 
end.
  We need to guarantee and provide quality and affordable health care 
to all. We need to ensure that care is patient-centered and accessible, 
setting higher benchmarks for quality and efficiency. We need to 
enforce rules that make sure our insurance companies put health care 
over profit. They've had their day.
  Americans should be able to keep the health care that they have but 
also have the option of a public plan that does not leave anyone at the 
mercy of fate in order to stay healthy and avoid bankruptcy. We can 
take the best of our current models and lessons learned and use them to 
reform our health system.
  Forty-six million uninsured Americans--including 5.7 million in 
Texas--are in great need of health care coverage. Many of our uninsured 
in Texas are working people. We need to act now to reduce health care 
costs as well as health care disparities to ensure the well-being and 
the healthiness of all Americans.
  This country we call the leading Nation and the richest country does 
less to make sure that the people here, the citizens, are healthy. We 
must change this now. We must not allow the millions of dollars going 
to lobbyists to distort this and defeat it this time.
  Thank you.
  Ms. FUDGE. Mr. Speaker, CBC members are advocates for families 
nationally, internationally, regionally, and locally. We stand firm as 
the voice of the people. We continue to work diligently to be the 
conscience of the Congress. We are dedicated to providing focused 
service to citizens that elected us to Congress. The vision of the 
founding members of the Congressional Black Caucus--to promote the 
public welfare through legislation designed to meet the needs of 
millions of neglected citizens--continues to be the goal of our 
legislative work.
  Tonight, the CBC is going to focus all of its attention on health 
care. I am proud to serve on one of the three House committees that are 
working on health care reform legislation. I serve on the Education and 
Labor Committee. The other two committees are Ways and Means and Energy 
and Commerce.
  While each member of the CBC has his or her own area of concern, I 
will focus on two categories which directly affect the most vulnerable 
citizens: the poor and those with mental illness. I will examine how 
the House's health care reform bill, H.R. 3200, the America's 
Affordable Health Choices Act of 2009, assists these two groups.
  I will begin by examining the problems people with low incomes and 
those in poverty face while attempting to access our current and 
expensive and broken health care system.
  One quote comes to mind, Mr. Speaker. This statement was made by Dr. 
Martin Luther King, Jr., more than 40 years ago. Dr. King said, Of all 
the forms of inequality, injustice in health care is the most shocking 
and inhumane. Sadly, Dr. King's statement is still relevant today.
  Statistics prove that the high cost of health insurance causes or 
deepens financial hardships. The Service Employees International Union 
reported that in 2004, half of all people filing for bankruptcy cited 
medical costs as the reason; and in 2008, half of all home foreclosures 
were due, in part, to the high cost of coverage and care.
  The numbers also prove that the high cost of health insurance causes 
people to remain or become uninsured. Due to the high cost of health 
care coverage, one in six--or 43.6 million Americans--under the age of 
65 do not have any type of health insurance. That comes from the 
Centers for Disease Control. The Children's Defense Fund reports that 9 
million children are uninsured in America.
  Statistics demonstrate that the high cost of health insurance and 
lack of access to quality health insurance disproportionately affects 
African Americans. According to a new report issued in June of 2009 by 
the U.S. Department of Health and Human Services, minority and low-
income Americans are much more likely to suffer from a chronic, 
debilitating illness than whites, and are far less likely to have the 
kind of coverage that will ensure quality care.
  For example, nearly half--or 48 percent--of black adults suffer from 
some form of chronic condition compared to 39 percent of all adults. 
Yet, one in every five black Americans lack health insurance compared 
to one in every eight whites. Considering the statistics that I 
mentioned, I'm glad to report that affordability and access to quality 
health care are two problems that are addressed by the America's 
Affordable Health Choices Act. Effective in 2013, assistance will be 
available for individuals and families that fall below the 133 percent 
to 400 percent of the Federal

[[Page 18353]]

poverty level. Financial assistance will limit individual and family 
spending on premiums from a minimum of 1.5 percent of income for those 
with the lowest income and maxing out at 11 percent of income for those 
at 400 percent of poverty or more. Also effective 2013, people with 
incomes at or below 133 percent of poverty will all be eligible for 
Medicaid.
  In addition to the financial assistance provided by our bill, while 
vitally necessary, monetary help will only address part of the problem. 
Prevention and wellness measures need to be a part of the solution as 
well. Fortunately, there are measures that are included in our 
legislation to address this gap.
  I was speaking with a constituent the other day, Mr. Floyd Perry from 
my district, who was born in 1938. He is in good health and does not 
take any medication. Mr. Perry attributes his good health to 
preventative health care, and he wanted me to share with everyone that 
preventative health care works.
  H.R. 3200 authorizes additional funding for existing community health 
centers and creates community-based programs to deliver prevention and 
wellness services and waives cost sharing, both co-insurance and 
deductibles, for preventative services--which means that you will no 
longer have to pay for cancer screenings or adult and child 
immunizations or vision screenings or hypertension treatment.
  I would like to turn my attention just for a moment to citizens with 
mental health issues.
  In my most recent town hall meetings, many constituents were 
concerned about health insurance, the affordability and the coverage. 
Some questions were fairly general, of course, and others were fairly 
specific.
  One woman in particular was concerned about mentally ill felons who 
are released from jail without access to the medications they need to 
remain mentally stable. My constituent found that ex-offenders with 
mental and emotional problems are more likely to commit crimes again 
due to the lack of treatment. Fortunately, access to mental health care 
will be improved under the current House health reform bill, but the 
distinct needs of ex-offenders are not explicitly addressed. Among 
others, my office is currently working on this issue with 
Representative Rush of Illinois.
  The following statistics will help us understand the current problems 
felons and ex-offenders with mental illnesses face.
  According to the Bureau of Justice Statistics, at mid year 2005, more 
than half of all prison and jail inmates had a mental health problem, 
including more than 700,000 inmates in State prisons, more than 78,000 
in Federal prisons, and almost 500,000 in local jails. More than two-
fifths of State prisoners--43 percent--and more than half of local jail 
inmates--54 percent--reported symptoms that met the criteria for mania. 
About 23 percent of State prisoners and 30 percent of all local jail 
inmates reported symptoms of major depression.
  We also have problems with mental health hardships with our children.
  According to the American Academy of Child and Adolescent Psychiatry, 
while almost one in five children in the United States suffers from a 
diagnosable mental disorder, only 20 to 25 percent of affected children 
receive treatments for illnesses such as attention deficit 
hyperactivity disorder, eating disorders, depression, and substance use 
disorders.

                              {time}  2030

  The Department of Health and Human Services reports that serious 
emotional disturbances affect one in every 10 young people at any given 
time, and our general population faces many more problems with mental 
illness. One in four uninsured adult Americans has a mental disorder, 
substance use disorder or both. Adults with serious mental illnesses 
die 25 years sooner than those who do not have mental illness. Almost 1 
in 4 stays in acute care hospitals involve depression, bipolar 
disorder, schizophrenia, and/or other mental health and substance abuse 
disorders.
  Treatment for mental health and substance use disorder is very 
effective. Recovery rates for mental illnesses are comparable to and 
even surpass the treatment success rates for any physical health 
conditions. For example, up to 85 percent of people with depression who 
are treated with a combination of medication and therapy experience 
substantially reduced symptoms, enhanced quality of life and increased 
productivity.
  Mr. Speaker, I see I have been joined by my colleague and friend, the 
gentlelady from Texas, Ms. Jackson-Lee.
  Ms. JACKSON-LEE of Texas. Let me thank the gentlelady from Ohio, 
first of all, for bringing this important Special Order to the floor of 
the House tonight and for her continued leadership. Allow me to thank 
Mr. Speaker for his leadership as well on these many issues because 
this is a dialogue with our colleagues on an important topic.
  And so I would like to begin by just congratulating you for focusing 
on the mental health issue, and some of our colleagues were focused on 
preventative medicine, and certainly, our majority whip indicated, in 
essence, a message to the American people of just what would be 
occurring.
  I would like to follow suit and try to walk us through the construct 
of what we're trying to do here in the United States Congress in the 
light of day, if you will. The Tri-Committee, members of those three 
committees, have marked up their bills in an open process, starting 
last week. That markup is continuing. Members will have an opportunity 
to engage in issues that they believe are extremely important.
  But while I discuss the bill, I think it is important that I point 
out that this is, in fact, the organizational chart of the Republican 
health care plan. I hope everyone can see it, and so as I discuss it we 
see that there is one option. It is the option that the President and 
the Democratic leadership and Members of Congress, which we hope will 
be bipartisan, will focus on curing the cancer, if you will, of 
uninsured people in America. When I say cancer, of course I'm speaking 
in the metaphoric manner, meaning that it is a cancerous sore to have 
people that cannot have access to health care.
  On July 25, I am going to hold a job fair because Houston has the 
highest unemployment since 1987, and many people believe Texas has been 
immune. And of course, I know that some will pick up on that and 
suggest that they told you so about the stimulus. We understand that 
the stimulus is making its way into our communities, and we know that 
jobs are being created and jobs are saved. But it's hit a point where 
various cities are being impacted at different points of time. So we'll 
have that job fair, and we expect any number of employers to come and 
we expect to have success.
  But in the interim, we realize that people are without health 
insurance. They are part of the 47 million-plus, including those who 
have never had health insurance, including those with preexisting 
diseases.
  So what is the Democrats' health insurance about? It is about closing 
the loopholes. It is about answering the call of Americans who cannot 
find pediatricians to take their children to, who have the elderly who 
need home care, who have articulated the major disparities in health 
care.
  You know, I heard my good friend from Texas rise today and talk about 
the Native Americans. I'm glad to tell him that the Tri-Caucus, Asian 
Pacific, Hispanic Caucus and African Americans, are way ahead of that 
question, and so we're focusing on the issue of disparities in health 
care.
  Just this past weekend I joined with Organizing for America to work 
with volunteers as they were calling to explain to constituents just 
what this health care package is about because we're not trying to hide 
the ball. And so it is about reducing costs, because rising health care 
costs are crushing the budgets of governments, businesses, individuals, 
and families, and they must be brought under control. That's what we 
want to do.
  It's about guaranteeing choice. Every American must have the freedom 
to choose their plan and doctor, including

[[Page 18354]]

the choice of public insurance, a vigorous and robust public option.
  Ensure affordable care for all. All Americans must have quality 
health care. And unfortunately, I'm hoping that we are watching the 
plan that our good friends have so we can realize how important it is 
to focus on what we're trying to do, and it is complex.
  What we're trying to do in this health care reform is to answer the 
call that more than 8 in 10 of those Americans surveyed say: It's 
extremely or very important that the legislation make health insurance 
more affordable. We think that's very important.
  Without reform, the cost of health care for the average family of 
four is projected to rise $1,800 every year for years to come.
  And so our draft legislation has--and I want us to have the 
comparison of what we're seeing from our friends on the other side of 
the aisle, we will have no more co-pays or deductibles for preventative 
care. Can I use a term we use in our communities? Hallelujah. Can you 
imagine? Can you imagine?
  I know that you have the Cleveland Clinic. I have come and admired 
that. It's in your district. You have done great work for the Cleveland 
Clinic. Can you imagine those scientists and doctors will have the 
ability to design a preventative medicine program? I am sure they have 
one. The Texas Medical Center will be able to design a preventative 
program.
  Dr. Lovell Jones, who heads a minority populations program at the 
M.D. Anderson, will be able to finally get his way to work on the issue 
of disparities in health care but work on prevention.
  No more rate increases for preexisting conditions, gender or 
occupation.
  An annual cap on your out-of-pocket expenses. How many of us have 
heard the stories of catastrophic bankruptcies, financial collapses, 
because families have had to deal with catastrophic illnesses?
  Group rates of a national pool if you buy your own plan and 
guaranteed affordable oral, hearing, and vision care for your kids. I 
have worked on the issues of vision care, and I know as Chair of the 
Congressional Children's Caucus children, as Chairwoman Barbara Lee 
said, are the most vulnerable.
  So we realize that we've got to do something. By a 23 point margin, 
56 to 33 percent of Americans endorse the idea of enacting major health 
care reform this year. Half call it extremely or very important, and 
the idea of not having a health plan is really nightmarish, if you 
will.
  It is a fact that 68 percent of all personal bankruptcies are the 
result of health care expenses and that 75 percent of those are filed 
by people who had health insurance. Given that, it is clear that the 
existing system of private health insurance companies is no protection 
against financial ruin.
  That's why we need a robust financial option, and I refute the 
arguments that are being made that if we have a robust public option 
that all the people in the private sector will run for this. No, they 
won't, because obviously there will be criteria. There will be 
standards which they will meet, and there will be standards which we 
meet. There may be extras that the private insurance has. We wish them 
well, and they will be judged by the market, and their particular 
members will be subscribing on the basis of their desires and their 
ability.
  But I think one thing that we need to be careful of, and we need to 
find language to ensure that--we know they're writing the bill. We 
cannot allow willy-nilly for corporations to close their doors on the 
most sick of their employees and throw them, in essence, without their 
will, without their desire, into another plan. That's what we have to 
protect against, and I believe that we'll do so.
  The public option is going to be a very good plan, but if you are any 
corporation, and you're an employee, then you should not be thrown 
unless you desire to go into the public plan. And so we will protect 
against that.
  But I think it is important to note that our plan is, again, not one 
that is throwing money out and around and flooding, if you will, the 
streets like greenbacks by throwing them out on the street. We're not 
talking about that. We are talking about being fiscally responsible.
  Let me tell you how we're doing that--and this is important because 
the argument has gotten that this is a tax bill, that this brings no 
relief to anyone, but let me tell you, we don't ultimately know how it 
will manage in the size that it is to be fully paid for. But we are 
committed to being responsible with taxpayers' dollars.
  We are going to be working on programs that will prevent waste, fraud 
and abuse. This is going to be a health care reform with integrity, and 
I ask the American people, lift up the curtain. We have the lights on 
right now. You actually see what is going on as we mark up this bill.
  But I tell you what we're going to do. We're going to strengthen 
Medicare and Medicaid program requirements for provider, suppliers and 
contractors. No more willy-nilly rates and having no knowledge of how 
much things cost. I think there's a way of doing it. There is one 
position being proposed that some of us do disagree with, but I do 
believe that we can find a way to have common ground.
  We'll require providers and suppliers to adopt compliance programs as 
a condition of participating in Medicare and Medicaid. We'll require 
Medicare and Medicaid integrity contractors that carry out audits and 
payments reviews. We're going to be looking at why are you charging 
this amount for renting something--I just saw an expose today about 
paying $1,200 to rent a wheelchair, and you can buy it for $300. Let's 
slash that out. Let's slash and burn that out. That's what we're going 
to be doing, and the American people should understand that.
  Then we're going to improve screening of providers and suppliers. 
Create a national preenrollment screening program to determine whether 
potential providers or suppliers have been excluded from other Federal 
or State programs, that have revoked licenses; allow, in any state, 
enhanced oversight periods or enrollment moratoria in program areas 
determined to pose a significant risk of fraudulent activity; and 
require that only Medicare-enrolled physicians can order durable 
medical equipment or home health services paid for by Medicare. And a 
number of other checks that we are going to have.
  This is a not a fool-around-type effort. This is going to be a 
serious effort.
  May I share with you just a few other thoughts, and I will show you 
how our plan is going to be work. I am likewise very pleased to have 
been part of the CBC health task force for a number of years, but I, 
too, want to congratulate the Congressional Black Caucus health task 
force and Donna Christensen, who I believe is right now involved in 
marking up the bill.
  We have worked for a long time as a Tri-Caucus on this issue called 
disparity, and since my colleague was speaking just a few moments ago 
about Native Americans and that public system, and you know what, I 
agree. It has not been the best. It hasn't been run by a health care 
system. It's run by the Bureau of Indian Affairs. We need to overhaul 
that as well.
  A robust public option does not entail the kinds of abuses or 
misdiagnoses that my good friend was talking about. And let me tell you 
why the Tri-Caucus of Hispanic Caucus, African American Caucus--
Congressional Black Caucus and Asian Pacific Caucus, includes Native 
Americans. And what we are going to be doing is ensuring that 
community-centric health efforts, particularly those that will expand 
access to care and improve the health and well-being of communities 
that are the hardest hit by health inequities--and that happens to be 
Native Americans among others--are integrated into health reform.
  So as we improve health reform we'll be looking to fix the broken 
native American health system. It is broken: high rates of diabetes, 
high rates of heart disease, bad nutrition in many instances, not good 
care for children. We're looking at turning Americans, all Americans, 
on this soil into healthy, healthy individuals.

[[Page 18355]]

  This is what I really like: prioritize prevention and public health 
promotion in both clinical and community settings. We couldn't have it 
any better. Recognizing that the traditional medical home has been the 
office of the family and other primary care provider, efforts must be 
undertaken to increase their numbers and the reimbursement, and they 
must be an integral part of this process.
  These words are very important. Every measure must apply equitably to 
American Indian tribes and the territories, and barriers to Federal 
health programs and the territories must be eliminated. This comes out 
of the Tri-Caucus health care reform, and we are working to make sure 
that we get those elements in our particular health care reform.
  I want to conclude by suggesting that after you see this health care 
plan, organizational chart of Republican health care plan--and we'll 
look forward to maybe something coming on this chart, but I think this 
is easy to read. This is the path to health care for all, and this has 
been done by my good friend. I am vice Chair of the Progressive Caucus.

                              {time}  2045

  We are working together. So this has been done by my good friend, 
Keith Ellison, Congressman Ellison of the Progressive Caucus. And I 
believe that this is a straightforward, neutral presentation that 
anyone of whatever viewpoint they have that wants health care reform 
can understand how this can be the path to health care for all, every 
American.
  Employer-based insurance, exactly what you have now, except costs 
less. No more discrimination for preexisting disease, and at least 85 
percent of premiums must go to patient care. Would anybody refute and 
reject that? I think not.
  Public programs--Medicare, Medicaid, CHIP--still available to 
children, seniors, and families below the poverty level. In fact, we're 
going to reinvigorate Medicare. We're going to make that vigorous and 
ensure that payments are made. Then, health insurance exchange, 
individual, small businesses, subsidized for up to 400 percent of the 
poverty level, which will include a public plan and private plan.
  The good news is that small businesses--and small businesses can be 
one person that wants to go out and follow their dream. They want to be 
inventive. They want to be creative. They want to do what they had 
desired to do maybe from a child. Now they are without health 
insurance. Their families are without health insurance. Their mother 
that they may be taking care of, their father, their elderly relative 
is without health insurance. We give them the opportunity.
  And so I want everyone to set their eyes on this as I come to a close 
about a very important point, and I hope that I can encourage you to be 
interested in this point, and that is the issue of physician-owned 
hospitals and specialty hospitals.
  I am hoping that we will have an opportunity to recognize how 
important these hospitals are in care. For example, in the State of 
Texas, let me make it clear, the economic impact of physician-owned 
hospitals, which cover eight States, concluded that Texas physician-
owned hospitals employ over 22,000 Texans, have a net economic impact 
of nearly $2.3 billion in Texas, and will pay approximately $86 million 
in taxes in 2009.
  What are they? Many people believe that they are boutique hospitals. 
No, they're not. They're hospitals in the valley, where people in the 
valley of Texas--we call that south Texas--had no hospitals. They're a 
hospital in the heart of downtown Houston in the 18th Congressional 
District where the hospital was about to close, and it serves a 
population that some are below the poverty line, some are above it, but 
it is called St. Joseph Hospital. It was the only hospital that stayed 
open during Hurricane Ike. So we want to ensure that public hospitals 
or physician-owned hospitals have their fair chance.
  Very briefly, the emergence of physician-owned special hospitals 
focusing on high-margin procedures have generated significant 
controversy; yet it is unclear whether physician-owned special 
hospitals differ significantly from nonphysician-owned specialty 
hospitals.
  The scrutiny on this lacks significant merit. Our objective is to 
support physician-owned specialty hospitals that deliver a significant 
share of their services to underserved. That could be part of the 
criteria. Currently, the House Tri-Committee bill contains provisions 
that effectively eliminate these services. We would like to see a 
revision of that.
  We have--when I say that many of us who represent these hospitals, I 
have visited them. I visited one that is in south Texas. It's state-of-
the-art. People are healthier. Emergency rooms work, and it works.
  I do want to conclude and share just a comment and yield to the 
gentlelady. I think this is my third one, but I am concluding.
  I hope the bill will include a review or that we can review this 
issue of physician-owned general acute hospitals in underserved areas. 
They should not be penalized.
  I would like to make sure that we increase health care 
professionals--I think that is already in the bill--in underserved 
communities, and especially provide grants to secondary schools.
  I came across a program in New York where a nurse by the name of 
Jose--I'll just call him Jose--is going out to high schools, taking his 
staff and doing mock operations and having them dress up in scrubs and 
getting high school and middle school students exposed to health care 
professionals. I like that idea, and I'd like to see it supported.
  Provide tax incentives for the development community health care 
centers that are environmentally safe. Introduce language providing 
employers a tax credit to develop preventative services for all 
employees, and launch a pilot program that seeks to discover proven 
alternative medicine and also to address the question of abuse of 
prescription drugs.
  Mr. Speaker and to Congresswoman Fudge, let me thank you for the 
opportunity to share these thoughts and to be here to show the 
comparison between the work that's being done by the Democratic 
leadership and our caucus and the work that is being done or 
represented to be done by the critics who are, at this point, 
criticizing the plan.
  Let's roll up our sleeves, let's work, and let's do what is right for 
America, a good health care reform package.
  I yield to the gentlelady.
  Ms. FUDGE. Thank you so much. I found very interesting the charts 
that you have there. I'm certainly hoping that people at home will see 
what we are trying to do for them. Certainly, I think it's important 
that they understand that our job is to represent them. Our job is to 
make sure that we can provide the best plan that is possible, and I 
believe that we are moving in the right direction to do that.
  I certainly do want to talk a little bit more about small businesses. 
That has been a real issue in this Congress, as to what is going to 
happen with small employers once we move to a plan such as this.
  Let me just say that I do sit on the Education and Labor Committee 
and was able to include an amendment, a very important amendment, that 
will provide small employers, those who have 100 employees or less, 
tools that can give them the resources and counseling to help them make 
better health care plan choices once this plan takes effect.
  We want to keep our small businesses very strong. We know that small 
businesses represent 99 percent of all businesses in America and employ 
more than 53 percent of our Nation's workforce, so we cannot afford to 
not help our small businesses.
  I don't know why people continue to say, Oh, we're not going to help 
small businesses. We indeed are. We all understand how important it is. 
We're going to help them when they have to make the important decisions 
about affordable health care and coverage for their employees.
  I believe that this assistance will greatly reduce the chances of a 
small business choosing a health care plan

[[Page 18356]]

that does not serve their interest or that of their employees.
  I, too, want to thank the Congressional Black Caucus for their work, 
and Dr. Donna Christensen, who has worked so tirelessly on our bill, 
which is the Health Equity and Accountability Act of 2009, which was 
under her leadership.
  But what they're talking about is making it easier for people who 
live in underserved communities to be a part of America and a part of 
what it means to be a healthy and well-rounded person in this country.
  We're going to talk about improving workforce diversity, 
strengthening and coordinating data collection, which is so very, very 
important. We're going to ensure that there is some accountability, and 
we're going to improve the evaluation and information that comes back 
to us so that we can say, Yes, we are doing well, or, No, we need to 
change, or, We can get better at this area.
  So we're going to work very, very hard to improve all health care 
services for all Americans.
  I want to just thank you for spending some time with me. I certainly 
do believe that if we put together the kind of plan that is on this 
chart, then we're going to do what the American people want us to do.
  We know that 72 percent of all Americans today want health care 
reform. I believe that if we want to do the job that people have sent 
us here to do--they have given us a direction. They have said we want 
health care reform, and I believe that it is incumbent upon us to 
provide that.
  Ms. JACKSON-LEE of Texas. Will the gentlelady yield for a moment?
  You have eloquently articulated, I think, what our marching orders 
should be. I would just like to add an addendum to the vastness of what 
we're doing.
  I want to congratulate you for that amendment. With the rising number 
of seniors who are now reaching the point where good medicine is 
keeping them where they can be with their families, this bill is going 
to be looking at home care. We appreciate the vast network of nursing 
homes, but we're finding out that that's more efficient, to be able to 
keep seniors in their home, giving them good care.
  I'm experiencing it firsthand with a senior mother who is lively at 
home and enjoys the neighbors but needs home care. And it's a very 
important aspect of our work. We're going to do that.
  I love the expression or the emphasis on prevention. Why weren't we 
doing this before? We can then have a generation who has been engaged 
in preventative medicine, making them healthier middle-aged people or 
healthier seniors.
  The other point I think is important is the returning soldiers that 
will be coming home--some on active duty. They do have a system of 
health care. It's called TRICARE. I'm very glad one of our hospitals 
has been named a TRICARE site, historically black hospital.
  But we'll have all of those individuals that will be out and about 
needing health care, whether its veterans, whether it's through the 
TRICARE system, or whether or not they will be going to a civilian 
system. That is why health care is so important.
  I yield back to the gentlelady by simply saying I'm proud to be able 
to stand by a system that responds to the needs of all Americans.
  Today, I stand with my fellow colleagues in an unprecedented era, an 
era that can bring about change that all of us can believe in. During 
the 2008 campaign, the American people cast a vote for change, and in 
an unprecedented move elected Barack Obama as the 44th President. With 
his election, the country made a bold statement. They realized the 
Nation was in peril with skyrocketing costs--that were driving many in 
the 18th Congressional District and other throughout this country into 
bankruptcy.
  Faced with these challenges, America decided to make a calculated 
risk of monumental reform. Today, as we tackle this reform of the 
Nation's health care system, we must not become idle spectators and 
allow any debate over policy divide our country and serve as an excuse 
to maintain the status quo. The fact is, those who are not eligible for 
Medicare, Medicaid, or any form of private insurance, in most cases end 
up in a dangerous position, uninsured. Today, there are over 47 million 
Americans uninsured.
  I am required to alert the citizens of America that this single issue 
affects every single American and if we do not enact the appropriate 
kind of reform, Congress will have failed by giving the American people 
less than what they deserve.
  The rising uninsured Americans and medical costs today are a direct 
link to the economic future of America. Healthcare reform is no longer 
a choice for Congress to make, it is a necessity. So I pose the 
question, what will be the reform needed to ensure a brighter future in 
our health care system? From a cost savings analysis, having a public 
option included in our reform is the least expensive option that will 
ensure quality affordable coverage for all Americans. In fact, the 
House Tri-committee bill has been confirmed to remain deficit neutral 
by the Congressional Budget Office.
  The Public Option, similar to Medicare, will provide a publicly 
driven health care system, unique to the U.S. and separate from what is 
in place in any other country. The program will ensure: (1) Early and 
periodic screening, diagnosis and treatment; (2) Case management for 
chronic diseases; (3) Dental and mental health services; and (4) and 
even language access services.
  The U.S. healthcare system is broken and if not remedied in the 
immediate future, consequences will be far greater than anything we can 
measure. That is why many of us are fighting for reform to improve the 
health in every State, city, county, and American.
  However, though a public plan will ensure so much, there are still 
some issues that need to be addressed in the Tri-Committee bill.
  (1) Ensure physician owned general-acute hospitals that provide 
services in underserved communities are protected;
  (2) support and strengthen language to increase health care 
professionals in underserved communities, especially provide grants to 
secondary schools in underserved communities;
  (3) provide tax incentives for the development of Community Health 
Care Centers that are environmentally safe;
  (4) introduce language to provide employers a tax credit to develop 
preventive services for all their employees;
  (5) launch a pilot program that seeks to discover proven alternative 
medicine; and
  (6) in the wake of ongoing abuse of prescription drugs, introduce 
language that will launch a Pilot Program to Reduce Abuses of 
Prescription Drugs.
  This legislation will not be easy, but if we want true reform we must 
guarantee no one will fall through the cracks. This means solidifying 
every hole in our current health care system. In order to ensure this, 
allowing those hospitals that serve a high indigent patient base 
maintain daily operations. The emergence of physician owned hospitals 
has generated significant controversy. Yet, it is unclear whether 
physician owned hospitals differ significantly from those not owned by 
physicians. Currently the House Tri-Committee Bill contains provisions 
that will effectively eliminate physician owned hospitals. ``The 
Economic Impact of Physician-Owned Hospitals in Eight States'' 
concluded that Texas physician-owned hospitals, which employ over 
22,000 Texans, have a net economic impact of nearly $2.3 billion on 
Texas economy and will pay approximately $86 million in taxes in 2009.
  St. Joseph Hospital is a general acute hospital, in Houston, TX, and 
the only hospital in the Houston area to remain totally operational 
throughout Hurricane Ike in September 2008. The limitations in the 
health care bill will particularly harm the hospital's ability to 
deliver much needed services to underserved communities. If a hospital 
like St. Joseph is eliminated, countless people in Houston will not 
receive adequate care. I seek to work with all my fellow colleagues, 
even those across the aisle to introduce language to exempt those 
hospitals like St. Joseph.
  Achieving diversity in our health programs must include diversity in 
our health profession. We need to enact a system that includes people 
of every race, religion and socio-economic backgrounds. By proposing 
language that awards grants to the secondary education system in 
underserved areas to encourage students to seek health professions will 
improve our health care system. Encouraging young teens and young 
adults to pursue health care careers in areas of low population are 
often times only done through scholarships and grants to relieve those 
financial barriers that keep so many young children reaching for their 
dreams.
  With the recent passage of the Clean Energy Act, a call for new 
advances in technology can be implemented in our health care system. 
Permitting incentives for the construction and renovation of community 
health centers to one of the four standards set by the

[[Page 18357]]

National Green Building Association--Bronze, Silver, Gold, and Emerald, 
will ensure that the patients will be treated in an environmentally 
safe building. Increasing funding aims to improve the air quality and 
other environmental features of buildings used for the provision of 
health care services particularly targeting underserved communities.
  While these services are great for physicians and the patients who 
see them, Americans are having a harder time preventing ever seeing a 
medical physician. Safeway has implemented a program that provides 
preventive services to their non-unionized employees. Based on the 
belief that rising health care costs are mostly driven by behavior 
(smoking, eating poorly, not checking your cholesterol, etc.), I seek 
to introduce language that will allow companies to establish a program 
that gives periodical screenings, questionnaires, prevention-related 
facilities like fitness clubs, along with advice and referrals to help 
improve behavior. Ensuring discounted premiums or refunds for those 
employees passing the screenings or showing improvement and 
establishing higher premiums for failing tests and no measurable 
improvement in behavior will hold people accountable and gives them 
incentives to live a healthy life style. This is the approach of 
Safeway, and it has kept Safeway's health care costs to $1 billion or 
so a year, mostly flat over the past five years. This achievement few 
other companies can claim.
  When it comes to healthcare, just about everyone wants alternatives, 
especially options that include alternative and complementary medicine. 
This is why introducing an amendment to provide what a large majority 
of respondents expect healthcare providers to do is so important. The 
majority of society wants more research dedicated to alternative 
medicine, and believes insurers and Federal healthcare programs should 
cover the cost of those therapies. Seventy-seven percent of the public 
favor more research. I seek to work with my fellow colleagues to 
introduce an amendment to launch a pilot program to prove alternative 
medical treatments, medicine, and services are safe. In doing so 
legislation can be enacted and will ultimately lower costs and provide 
the majority of the population requested sources.
  Though this reform seeks to improve the lives of every American 
citizen, it's important we consider every American citizen. In the 
sudden and tragic death of Michael Jackson, introducing language to 
study the abuse of prescription drugs by professional entertainers. 
Abuse of drugs often times has an impact that goes well beyond the 
individual performers, and frequently encourages impressionable young 
people to imitate this behavior. Depiction of such conduct in film and 
other video programming may also lead young people to mimic harmful 
behavior therein relating to prescription drugs. With this study, 
Congress can be guided on how best to address this dilemma and ensure 
the life of our children and celebrities alike.
  It brings great joy that the Congressional Black Caucus are at the 
forefront to lead our country in taking the initial steps to secure our 
economic future, health of our society, and the ideals of our country. 
There are those who want to destroy our initiatives, seek to divide our 
country, and maintain the status quo, and I ask my fellow colleagues in 
Congress to ensure the quality of our life will not fall to the ideals 
of those who seek this effort. It's been a long time coming, but in 
this Congress and administration, America will now see a brighter day.
  Ms. FUDGE. Let me say this as well as we talk about preventive health 
care. I do live in a community where we do have some of the best health 
care in the world. But what I also know is it costs three times as much 
to go to a hospital emergency room as it does to your doctor's office.
  What I envision with this preventative care is people who now only 
see a doctor when they are so sick that they have to go to an emergency 
room will now go to see a physician on a regular basis, that they will 
go and have annual physical exams, they will go and have their 
mammograms, they will go and have their cancer treatments.
  They will do that because it will be less expensive. They will have 
the health care to do it. We're going to make sure it is accessible 
because we're going to put money into these community clinics so that 
they can get to these clinics and go on a regular basis.
  I just believe that if we do this, we're going to see a much 
healthier and happier America. We're going to be able to take care of 
our seniors, to take care of our children. I think it's going to make a 
huge difference in where we go as a Nation.
  So I just want to be as supportive as you have been and as all of us 
are as we look at where we're going to take this country as it relates 
to health care.
  With that, Mr. Speaker, I so much thank you for the opportunity to 
address you and this body, and I yield back the balance of our time.

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