[Congressional Record (Bound Edition), Volume 155 (2009), Part 14]
[House]
[Pages 19440-19447]
[From the U.S. Government Publishing Office, www.gpo.gov]




                CONGRESSIONAL BLACK CAUCUS: HEALTH CARE

  The SPEAKER pro tempore. 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.

[[Page 19441]]




                             General Leave

  Ms. FUDGE. Mr. Speaker, I ask unanimous consent that all Members be 
given 5 days to revise and extend their remarks on the subject of this 
Special Order.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Ohio?
  There was no objection.
  Ms. FUDGE. Mr. Speaker, I would like to just set the record straight. 
I've listened to my colleagues from across the aisle, and I do want to 
make clear to the American people that, if you have health insurance 
now and you want to keep it, you can. You don't need to change.
  I also want to say to the American people that this plan is, one, 
about choice. It's not about government-run anything. It's about 
choice. It's about making sure that we spend more time worrying about 
the people than we do about the insurance companies. So I just want to 
make sure that people understand.
  I'm very curious to understand and to know what my colleague meant 
when he kept saying ``they,'' ``they,'' ``they.'' I don't know if he 
was talking about retirees or about the working poor or if he was 
talking about minorities or if he was talking about people who have 
been laid off or about people who have lost their jobs because their 
companies have closed. I don't know who ``they'' is, but certainly, at 
some point, I'd like to know who that is.
  Now to my remarks, Mr. Speaker.
  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 Congressional District of 
Ohio. I am the anchor of this CBC hour.
  The vision of the Founding Fathers 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 a focal point 
for the legislative work and for the political activities of the 
Congressional Black Caucus today.

                              {time}  2100

  Tonight, the CBC will focus its attention on health care reform. I am 
proud to serve on one of the three House committees that authored H.R. 
3200, the America's Affordable Health Choices Act of 2009.
  The public health insurance option--also known as the Public Plan--is 
an essential part of H.R. 3200. The Public Plan is an innovative tool 
that will move America's health insurance system beyond the status quo 
and into a system that provides choices and forces private insurance 
companies to compete. Competition guarantees that all Americans will be 
able to access quality coverage while preserving what works in today's 
system and expanding choices and containing costs.
  Some argue there is no need for a public plan, as did our colleagues 
on the other side of the aisle. Others say that a public plan will put 
private insurance companies out of business. I say this: Today's health 
insurance companies are operating in a manner that is making health 
coverage increasingly out of reach for the average American. Premiums 
are soaring higher and higher, and health insurance choices are 
becoming fewer and fewer.
  For example, in my home State of Ohio, since 2000, the average family 
premiums have increased by 92 percent, that's 9-2, 92 percent. When 
faced with such an increase, you would think that Ohioans would have a 
number of choices and could decide to move to another insurer that 
offers a more competitive premium.
  Well, it's not that easy, Mr. Speaker, because the choice of 
insurance companies is severely limited in the State of Ohio and across 
America.
  In Ohio, the top two insurance providers controlled 61 percent of the 
health care market in 2008. In fact, 94 percent of the metropolitan 
areas in the United States are highly concentrated, meaning that one 
insurance company or a small group of insurance companies dominate the 
majority of the market.
  And the problem is even worse for small businesses. In Ohio, the top 
5 insurers control 85 percent of the market that provides health 
insurance to small businesses. This is what we call a consolidated 
health insurance market. There is no real competition. So the companies 
that are monopolizing the market are setting the prices and the 
standards that have led to more than 1 million uninsured Ohioans and 46 
million uninsured Americans.
  A public plan will be one of several options within H.R. 3200, the 
new health exchange that it will provide that is needed to reform our 
health insurance market.
  As I mentioned earlier, H.R. 3200's public plan offers competition. 
Currently, our health insurance system is inefficient and expensive. 
Without competition, private insurers have no incentive to improve. By 
forcing market reforms in the area of administrative costs and through 
better delivery of services, the public plan will serve as a real 
competition and set the standard by which other insurers are measured.
  The public plan will operate as a guaranteed backup that will ensure 
everyone that everyone has access to affordable health care no matter 
what happens. A public plan will give millions of hardworking families 
peace of mind. Both the public plan and competing private plans will 
offer a standard benefit package that covers essential health services 
such as inpatient and outpatient hospital care and maternity and mental 
health services. The package will also offer preventative services like 
Well Baby and Well Child Care and screenings for diseases like diabetes 
and hypertension.
  Preventative care is a benefit that is important to cutting the cost 
of health care. Providing preventative care will allow us finally to 
spend less by keeping healthy people healthy, instead of waiting until 
someone is very ill and then providing more costly treatment.
  Under the standard benefit package, patients will no longer pay for 
preventative services, and the annual dollar amount spent on health 
care by consumers will be limited to $5,000 for an individual and to 
$10,000 for a family. Therefore, no one should ever again face 
bankruptcy from health care costs.
  The private insurance market must be reformed. We cannot afford to do 
nothing. $100 billion of America's $2.5 trillion in health care 
spending goes to the cost of administering private insurance. 
Projections have shown that it is possible to save more than $3 billion 
in 2009 alone and $40 billion over 10 years simply by reducing 
administrative spending in health care.
  The status quo is unacceptable, Mr. Speaker. Things will only get 
worse if we continue to let private insurance companies set the 
standards. Every American risks losing their health insurance and/or 
seeing their costs skyrocket without action. Families will continue to 
spend a disproportionately large amount of money on health care 
expenses.
  The cost of an employer-sponsored family health insurance plan will 
reach $24,000 in the year 2016, an increase of 84 percent if we do 
nothing to fix our broken system. American businesses will continue to 
fall behind. Employers' spending on health care premiums will more than 
double to $885 billion in the year 2019. And one in five employers will 
stop offering health benefits altogether because of rising costs in the 
next 3 to 5 years.
  Further, our government will not be able to keep up with the rising 
cost of health insurance. As Americans lose their private insurance, 
many will be added to the already strained government programs. 
Combined with the rising cost of care, spending on Medicare and 
Medicaid will double from $720 billion in 2009 to $1.4 trillion in 
2019.
  It is time to level the playing field with the public plan.
  The public plan will be required to meet the same benefit 
requirements and comply with the same insurance reforms as private 
plans. Individuals and families will qualify for financial assistance 
in purchasing health insurance and will have the option to choose among 
the private carriers and the public plan.

[[Page 19442]]

  Today's health insurance companies can either be more efficient and 
provide the coverage that Americans need or make way for the insurers 
that will agree to be responsive to the financial and health care needs 
of millions of Americans.
  In closing, I would like to highlight two important pieces of health 
reform legislation. The first, to address the needs of the poor and 
those with low incomes, I recently introduced the Health Information 
Technology Public Utility Act of 2009 to facilitate nationwide adoption 
of electronic health records, particularly among America's free 
clinics. Although health care IT funding was included in the American 
Recovery and Reinvestment Act of 2009, America's free clinics are not 
eligible for funding under the Act. This piece of legislation has also 
been introduced in the Senate by Senator John Rockefeller, a Democrat 
from West Virginia.
  Lastly, recognizing the health care needs of our Nation's underserved 
populations, the CBC introduced the Health Equity and Accountability 
Act of 2009 under the leadership of delegate Donna Christensen. Along 
with other CBC Members, I urge our colleagues to include this 
legislation in the America's Affordable Health Choices Act of 2009.
  With that, Mr. Speaker, I would now like to yield to the 
distinguished Member from the Virgin Islands, my friend and colleague 
and an expert in health care reform, Representative Christensen.
  Mrs. CHRISTENSEN. Thank you, Congresswoman Fudge. Thank you for 
yielding. Thank you for being so steadfast in anchoring this special 
order every Monday night. I know many times I have wanted to join you 
and have not been able to be here and to support you in it, but you 
have managed to keep it going and to provide good information on many, 
many topics to the people who are listening across America.
  I also want to thank you for your very clear explanation of what the 
public plan really is. We've heard a lot of misinformation about that 
public plan, as Congresswoman Fudge says, one of many plans that will 
be in the exchange that will offer choice. And it is not a single-
payer, it's nothing like the Canadian plan--not to disparage the 
Canadian plan; I think they have a good system--but ours will not be 
that. It will be an exchange where you, the American public, will have 
choices and can choose a public plan or a private plan. So thank you 
for making that clear.
  And as we meet, Mr. Speaker, the Democratic Caucus is probably 
finishing up downstairs discussing the health care reform, America's 
Affordable Health Choices Act, going through it section by section; and 
there is nothing about abortion in it. There have been many complaints 
about the bill, and some of them are rather weak and just plain wrong. 
Some people complain that they don't know what's in the 1,000-page 
bill. Well, the basic outline of that bill has been available for 
almost 4 weeks now, and the bill itself for over a week. I think that 
has given enough time for everyone and their staff to have the 
opportunity to read the bill if they wanted to. And as important as 
that bill is, I hope everyone has taken the time to read it.
  Other complaints are of regional disparities in Medicare and Medicaid 
reimbursement. They've been a big issue for us. It's one that may now 
be solved satisfactorily--at least on the regional level--and poor and 
minority communities, which have also had historically disparate and 
low reimbursement rates, will also see that fixed in H.R. 3200.
  But no one has more of a disparity than the people that I represent 
and those in the other territories who are not getting equal treatment 
in Medicare or Medicaid and who, as of now, are not even in the 
insurance exchange. And yet, despite all of that, because of the 
overall good this bill will do for us in the territories and our fellow 
Americans, I fully support this bill.
  I want to also address some of the myths that are out there. No bill 
is perfect. Especially not one that has to do as much as this will have 
to do to fix the longstanding systemic malfunctioning of our health 
care system.
  But what we have produced after many meetings, many preliminary 
hearings, followed up by a week of daylong hearings where over 50 
people and organizations testified, it's a good bill. And we can get it 
out of the Energy and Commerce Committee this week. If we can do that, 
we're not going to bring it to the floor and keep everyone in here, but 
we would like to get it through this week so that when we go home, 
we'll have time to read the final product, discuss it with our 
constituents at home, and come back prepared to pass it when we return 
in September.
  But I firmly believe that we have to keep moving forward. If we 
don't, it won't be a President Obama loss or Speaker Pelosi loss or 
even a Democratic Party or Caucus loss. It will be a serious loss of 
the American people, especially to the more than 46 million who are 
uninsured and the millions more who are underinsured or intermittently 
insured. As well, it will be a loss to the poor, rural, and minority 
communities in our country.
  Too many of the under- and uninsured are people of color, so this is 
an important issue for the Congressional Black Caucus. That's why we've 
devoted four or more of our special order times here on the floor of 
the House to this issue and to urging support and passage of the health 
care reform bill in the House. It's why we met with Speaker Pelosi last 
week, why we're going to sit down with the President, and why we've 
written or discussed our concerns with chairmen and ranking members of 
the relevant committees in the House and the Senate. In many of our 
efforts, we are joined with the Congressional Hispanic Caucus and the 
Congressional Asian and Pacific Islander Caucus as a Tri-caucus in 
support of this bill.
  To go back to some of the gross misrepresentations and to explain the 
real provisions of the bill, let me say that one erroneous criticism 
that's often heard is that this bill will put Washington bureaucrats in 
between the patient and the doctor or other health care provider. 
Nowhere is there anything in this bill that would do that.

                              {time}  2115

  Yes, your Members of Congress, the Democratic Members of Congress, 
want to include a public plan. Yes, we want to ensure that every 
insurance provides a comprehensive, basic package of services, that 
they must accept you for coverage, that they do not exclude you if you 
have a preexisting disease, that they cannot drop you if you get sick, 
and cannot put a limit on how much they will pay over a year or over 
your lifetime.
  What we in Washington want to do in this bill, and will do when we 
pass it, is to make sure that there is no obstacle between you and your 
doctor. And yes, we want everyone to be able to get the important 
preventive care without having to pay for it. We want you to be the 
healthiest you can be. And again, we are taking down important barriers 
that stand in the way of your getting the health care you need.
  Preventive care, such as mammography, colonoscopy, immunizations, and 
others, will cost you nothing. And we insist that if you have insurance 
or a provider you like, as Congresswoman Fudge said, you can stay with 
those, you can keep that provider and that insurance carrier. We do not 
put government between you and your doctor.
  Many of you either have or work for a small business. You are the 
target of much of the fear-mongering that is out there. Rather than 
raise taxes on small businesses, as the opponents of your getting your 
health care would have you believe, this bill makes it easier for small 
businesses to provide or continue to provide insurance because of the 
exchange, because of the public plan and the tax credit that they will 
get if they provide insurance for their workers. And smaller businesses 
which aren't able to pay high salaries or have less employees will be 
exempted from having to provide that insurance, but their employees 
will have access to the exchange and be able to have their insurance 
premiums subsidized so that it

[[Page 19443]]

won't take a big chunk out of your already stretched salary.
  Some of you, like many in my district who are Medicare or Medicaid 
beneficiaries, have difficulty finding a doctor or provider who will 
give you the services that you need. Some of you live in communities 
which don't have a hospital and have to travel many miles to one 
because the one that was there was not able to keep its doors open 
because of low reimbursement rates in your community. The House health 
care reform bill, H.R. 3200, will increase reimbursements. Many of our 
congressional districts lose over $100 million every year in 
uncompensated care, and that compromises the ability to get the quality 
of care you need and deserve.
  First of all, with this bill, your local hospital will be able to 
survive, maybe even return, because when it is passed, they will be 
paid for every patient that they take care of.
  Secondly, Medicare will pay more, especially to primary care 
providers and those providers who come together to make sure that your 
care is better managed and more complete in groups called 
accountability care organizations or medical homes. And if the 
community you live in can demonstrate that they not only provide good 
care but improve your health, the reimbursement will also be increased.
  So this legislation that we want to see passed will not only increase 
payment to help make sure the providers you need are there in your 
communities, but those providers will be supported and encouraged to 
take the time needed to listen to you and to coordinate your care to 
ensure that you will be healthier. This is a real win-win.
  Those of us who become health care providers choose this life of 
service to help individuals and communities have a better quality of 
life and help individuals live long enough and well enough to see and 
enjoy their grandchildren. The new payment structure and the eliminated 
copayments for preventive care will help us to do what we went into our 
professions to do in the first place.
  And then, as we have always said, for those who have not had the 
ability to be fully a part or fully utilize the health care system for 
many reasons, just providing insurance, as important as that is, is not 
enough. And for African Americans and other people of color who are the 
most disenfranchised in the current system of health care delivery, the 
additional services and support are critical if we are ever to close 
the health gaps that cause us to die prematurely from preventable 
causes, that causes our life expectancy to be 7 to 8 years shorter than 
other Americans, and that causes over 86,000 excess deaths that should 
never have happened every year in this rich country.
  And so the bill includes a major expansion of community health 
centers, more National Health Service Corps scholarships to help more 
of our young people enter the health profession, more loan forgiveness, 
especially for those who are going to be a primary care provider, the 
main doctor or nurse practitioner you see to get and manage your health 
care.
  There will be funding to help more students better prepare for 
medicine, for nursing, for pharmacy, allied health and other health 
professions, and support for institutions that train underrepresented 
minorities. This is important because, although there is a need for 
many more primary care providers, it is just as critical that they come 
from all communities, including communities of color, which make up 
more than 30 percent of our population.
  The Congressional Black Caucus has always taken the position also 
that communities know best what they need, and the way to ensure that 
when health information and care is provided, it is done in a way that 
will be understood, accepted, and effective. We have, therefore, been 
able to have community-based and -driven programs included in the bill.
  These provisions are patterned after our health empowerment zones, 
which provide the technical assistance and funding to enable 
communities to not only meet their specific health care needs with 
respect to specific diseases, but to also be able to address the social 
and economic determinants of our health: housing, economic 
opportunities, safety, the environment, nutrition, and others.
  Also included are provisions to ensure that data is collected which 
includes race, ethnicity language, and other socioeconomic factors, and 
also provisions that provide that language differences would not be a 
barrier to getting health care.
  This bill, H.R. 3200, America's Affordable Health Choices Act, must 
pass and must not be allowed to be derailed by any group or industry 
that does not have our best interests at heart. The basis of the 
opposition has nothing to do with better health for all of us who live 
in this country. We recognize, as the gentleman said, this effort is 
about change, and change is what the people in this country voted for. 
It is about major change, which is always difficult. But this is change 
that must happen, and it must happen now.
  Sure, there will be losses to some in the interest of providing more 
to everyone to ensure that the benefits of this country will be more 
fairly shared; that is a basic tenet on which this country was founded, 
and in no place is this more important than in our health.
  This country has the best and most advanced health care services, 
expertise, and technology, but because so many are not able to access 
it, we lag behind the rest of the industrialized world in life 
expectancy, maternal and infant mortality, and health in general. 
Closing the insurance gap, as well as the racial and ethnic minority 
gaps, will make this country the true leader in health that we ought to 
be.
  So my plea to those who are listening outside of the beltway is do 
not let the misinformation and the self-serving propaganda steer you 
wrong and away from supporting this important legislation that many of 
the best minds in this country have guided to ensure that your right to 
health care will be protected and delivered.
  This bill is important to the African American community. It is 
important to the Native American community and all communities of 
color. It is important to rural areas, And it is important to every 
American. With your help and support, it can also provide more equity 
to your fellow Americans in the U.S. territories.
  Passing H.R. 3200 is important to all of us, our families, and our 
communities. We cannot lose this great opportunity that President 
Barack Obama has worked so hard to bring this far. As he has said to 
us, it is not if we can afford this bill or if we can afford health 
care reform, the real issue is we cannot afford not to do it.
  Covering everyone, providing increased access to preventive care and 
disease management, will surely reduce health care spending because 
prevention saves. But most importantly, it will improve and save lives. 
So I join my Congressional Black Caucus colleagues in saying, let's 
pass this bill. Let's get it out of the Energy and Commerce Committee. 
Let's give the American public a bill before we leave for our recess, 
and then let's come back in September and pass it and provide quality 
health care to every American.
  I yield back the balance of my time.
  Ms. FUDGE. Thank you very much. Let me just, again, thank my 
colleague, Dr. Christensen.
  I just have to say that there are so many of us in this House who 
look to you not just because you are a physician, but certainly because 
you have studied health care for many, many years and have advocated 
for reform. And we thank you for your work and certainly want to 
support your efforts in making sure that this gets done the way that it 
should.
  We have now been joined by our colleague and friend from the great 
State of Texas. I would now like to, Mr. Speaker, yield to the 
Honorable Sheila Jackson-Lee, the gentlelady from Texas.
  Ms. JACKSON-LEE of Texas. Let me thank the gentlelady from Ohio. And 
I appreciate her anchoring this Special Order in order to pursue a very 
important discussion on the leadership of the Congressional Black 
Caucus and the

[[Page 19444]]

Health Task Force, along with the work of so many of our Members who 
are on the jurisdictional committees, and also, as I indicated earlier, 
the importance of the CBC Health Task Force, of which I have served on 
for a number of years.
  I, too, want to add my appreciation to that task force, to the 
chairwoman of the Congressional Black Caucus, Congresswoman Barbara 
Lee, and as well the chairperson of the Health Care Task Force and 
Health Reform Task Force, Dr. Donna Christensen, who was just on the 
floor, thanking her for leading us through the years. I have worked 
with her through the years as we were able to get the CHIPs program and 
a number of other steps toward complete health care reform, and I am 
glad to have been able to do so.
  I have an idea, and we have entered into some discussions, to add to 
the TriCaucus, which includes the Hispanic Caucus and the Asian Pacific 
Caucus, the Progressive Caucus, for which I serve as the vice Chair. I 
am also part of the Progressive Caucus negotiating team on health care 
reform, and we have done that. We have found that we have had now maybe 
a quadruple caucus that has overlapping issues equaling more than 100-
plus Members, maybe upwards of 200 Members who have a common goal 
dealing with health disparities as well as dealing with the question of 
public option.
  So I would like to, just for a moment, Congresswoman Fudge, go 
through some of the important issues.
  I think we should reestablish the fact that there are 47 million 
uninsured Americans. Many people want to break that down. There are 
people who don't want insurance. There are others who have other 
problems. Why don't we just say that we have 47 million uninsured who 
have not been given any other option, so they are uninsured? And who 
knows, if they were presented a plan that addressed their needs within 
a reasonable cost, small businesses included, which of course hire or 
are, in fact, the employers, small businesses, of upwards of 50 
million-plus individuals--I think the number is larger than that. If we 
gave small businesses, if we gave the uninsured--because many of the 
people are working, they are in small businesses, they are uninsured; 
not because they don't want that opportunity, but because they have 
invested every single cent that they have in that small business, and 
many of the small businesses are sole proprietors.
  I believe the work that the Congressional Black Caucus and this 
quadruple caucus conglomeration, along with our caucus, really is 
emphasizing how we expand these various aspects of ensuring that 
Americans get insurance.
  Now, you could point to the fact that maybe one poll would not be 
accurate, maybe two polls, but we have four polls here that say that 
people want a public health insurance option. And the interesting thing 
is, as this is a very strong element of the Congressional Black Caucus, 
is that the public option has three elements to it: It has the basic 
plan, the premium plan, and the premium plus. It means that this is not 
a second-class plan. And I think most Americans realize--the highest 
number is the NBC WSI poll, 76 percent; CBS poll, 72 percent. The EBRI 
poll, which speaks about the public option having 83 percent of the 
support of the American people because they know that we are not 
constructing a second-class plan. We are constructing a plan that will 
give the option for so many different people to be engaged.
  In addition, one of the emphases that we have had is this question of 
reducing health disparities. This is enormously important. And included 
in that, we have the Secretary of HHS is required to conduct a study 
that examines the extent to which Medicare providers utilize or make 
available information on various aspects of disparities, which I think 
is very important.
  This legislation also provides for promoting primary care, mental 
health services, and coordinated care, key elements. We all know that 
we passed the mental health disparities bill. This keeps that in place, 
but it also has provisions to promote and support the increased primary 
care physicians, which means that we are trying to get people to the 
doctor before they are, in essence, ready to be admitted to a hospital. 
This is a very important aspect of preventative care. You come for a 
checkup, not come to be admitted to the hospital. And this is an 
element of that.
  And one of the disappointments I had is that the Congressional Budget 
Office, which is only language that people inside the beltway 
understand, called the CBO--in headlines across America you hear the 
term ``CBO''--has not given us a real figure for how much money we will 
save by upping the amount of preventative care. And I think that is key 
and something that the members of the TriCaucus, and now with the 
addition of the Progressive Caucus, have in fact supported emphasizing.

                              {time}  2130

  I want to go to the question of this economy. We inherited this 
economy, and I think it's important to own up to the facts. Some people 
may argue that this administration has been overly busy, has done a 
mountain of legislative initiatives. What more are they going to do?
  Well, the facts are that our economy was crumbling when this 
President took office. The bailout structure was already in place. The 
TARP moneys were already in place. The automobile industry was already 
collapsing. And we simply had to come in as the Red Cross, as the Boy 
Scouts and the Girl Scouts and try to make our camp better than we 
found it. That's what we are doing here today.
  And part of the work that is being done by this number of caucuses, 
including the Congressional Black Caucus, with the emphasis on 
preventative care and the public option will do this: the program will 
ensure early and periodic screening, diagnosis, and treatment; case 
management for chronic diseases; dental and mental health services; and 
even language access services. So we are getting ahead of the problem. 
We are diagnosing what the problem is. These percentages show that the 
American people understand where we are trying to go.
  And I just want to add this, as I talk about the President and his 
whole concern on this question of the economy, to make mention of the 
fact that the economy generates unemployment. In my district I hosted 
this past Saturday a Federal job fair because I believe that since we 
know that there are about 600,000 Federal jobs, we need to break 
outside the beltway and get out in America and tell Americans what 
options there are for public service first and, two, to work for the 
United States Government.
  We had an organized effort, a very open facility that had free 
parking. But we were expecting about a thousand to come. Over 3,000 
Houstonians came in the heat of the day to be able to access U.S. 
Federal jobs. I would guesstimate that the large percentage of those 
who came do not have health care. And that's why we are here on the 
floor today. Unemployment equals not having health care for yourself or 
for your family. Many of those were long-term workers, some of those 
were recent graduates, and some of those were people who had been 
chronically unemployed for a period of time through no fault of their 
own.
  But they came because they want to work, but they have no health 
insurance. What we are doing now is on the basis of responding to that 
need.
  And let me tell you a component of this health reform that I believe 
we need to work a little harder on, and that is to recognize the value 
of what we call physician-owned hospitals. In a recent meeting, a 
Member got up and explained in the far reaches of New England how 
physician-owned hospitals are crucial in instances where there are no 
hospitals for miles and miles around and particularly where there is no 
other competition.
  As we stand today, physician-owned hospitals under the current health 
reform bill, 104 physician-owned hospitals underdeveloped, 42 of which 
are scheduled to come online by the 2010, would have to be shut down. 
We have a simple fix. It's to change the date which these hospitals 
will be grandfathered in to the date of enactment of this bill.

[[Page 19445]]

  And what that would mean is that you would keep 104 hospitals which 
are at risk right now, 20,000 new jobs would be lost in 21 States and 
over 40 hospitals in my own home State as well. At least $5 billion in 
current investments will be lost. It will also affect hospitals that 
were built to serve working men and women with little or no insurance. 
This is not a partisan issue. This is about providing more care through 
the physician-owned hospitals. And as well, it would highlight the work 
that physicians do to maintain health care, because if they are 
invested, they are obviously concerned about their work product.
  As an example, I just want to cite St. Joseph Medical Center. In 
August 2006, over 80 medical staff members out of 500 elected to 
purchase a stake in the hospital to keep it from closing. Because of 
this partnership, St. Joseph Medical Center remains today as a viable 
institution caring for hundreds of thousands of patients each year 
through the various services of this general acute care inner-city 
hospital with an emergency room, the only downtown hospital with 4 
million workers in that surrounding area. Nearly 5,000 new Houstonians 
are born annually at this hospital, the first maternity hospital in 
Houston.
  So as we look to ensure that we have value in our health care reform, 
I believe that we are going in the right direction. I believe we should 
do this now. But as we do so, let us not leave out institutions that 
have been very helpful in the past and let us look to our physicians 
who have both the management aspect of a hospital and really the caring 
part of it, the nurturing, the medical aspect of it, what a wonderful 
partnership, and not close those hospitals in 21 States because we have 
an arbitrary date of January 1, 2009.
  It is, of course, something I think can be resolved just as I believe 
that we can resolve the issue dealing with home health care. More and 
more of us of all economic levels are finding it more fiscally 
responsible to have our care at home. Whether you are ethnic, African 
Americans, Hispanics, or Asian, or whether you are in the majority, 
these are resources that can provide the kind of comfort of care at 
home. Let us not undermine the home health care. Let us make it more 
fiscally responsible. Let us make it more efficient. But let us not 
undermine it.
  Let me conclude my remarks by making sure we emphasize, as I move 
this chart, that people want a public health insurance option. Don't 
let any media or any advertising that is bias that is going to tell you 
that this is going to take away your own private health insurance, that 
it is going to be second class or third class. The American people know 
what they want. They understand that the public option will have to be 
competitive.
  Be reminded in 1965, prior to that we did not have Medicare, and we 
saw the mortality rates, the passing away of Americans at a younger age 
over and over again. If you take the statistics of what age you passed 
before 1965 because of poor medical care, you see the distinctive 
difference in today where we have centenarians, those who are living 
past 100 years, those who are in their 80s, and might I say they are 
living well because they have Medicare. The American people understand 
that.
  But as I close, I think it is important to note that when we look to 
our friends who are on the other side of the aisle or trying to oppose 
working together in a collaborative way, it says the organizational 
chart of the House Republican health plan, and it's very colorful, but 
it is full of questions because we don't know what the plan is.
  We do have to make sacrifices. We have to make sacrifices to work 
together on preserving physician-owned hospitals. It's not just St. 
Joseph Charity Hospital in Houston, Texas, in the inner-city with 1,800 
full-time jobs that adds to the economy, paying millions of dollars in 
taxes, providing $40 million of uncompensated care each year. It says 
Sisters of Charity, $40 million in uncompensated care. That means 
that's what they give to the indigent. This is a chart that says 
nothing will happen.
  I believe it is important for the efforts to be made in collaboration 
with the Congressional Black Caucus, which really was out front on this 
question of inequities in health care, the disparities in health care. 
We have a decade-long history on working on disparities in health care, 
and it is economic disparities as well. It means people who have less 
means are not getting access to good, quality health care.
  I don't know what the answer is with this plan. It's all questions. I 
don't know what the answer is to preexisting disease. I don't know what 
the answer is to home health care. I don't know what the answer is to 
providing a huge segment of preventative care or producing more primary 
care doctors or nurse practitioners. I don't know what the answer is 
here.
  But we in the Congressional Black Caucus want to make sure that we 
move this legislation forward, that we have an opportunity to make 
people whole, and that we look on the fact that any State that is 
looked upon such as Texas as not being vulnerable to unemployment, that 
we are supposed to be the shining example of not having problems, then 
you can imagine what is happening across America. People are 
unemployed. We know that we are going down in the economy before we go 
up. The stimulus is going to work, but we must have a public option 
plan that America wants, and we must have it now.
  I want to thank the gentlewoman from Ohio for allowing me to 
participate and to be able to emphasize the importance of moving 
forward on this health care reform with viable changes that will make 
it better for all Americans and particularly to thank the Congressional 
Black Caucus for starting out 10 years ago on this question of 
disparities, this question of access to health care, and this question 
of recognizing the need for 47 million uninsured Americans to cease and 
desist.
  And might I say the American people are wise because they know if we 
do not do it today, it will be 47 million, 57 million, 67 million, 
maybe upwards of 100 million who will not be insured and not have the 
ability to take advantage of good health. That is what this Special 
Order is about.
  I thank the gentlewoman for yielding.
  Ms. FUDGE. Mr. Speaker, I just want to again thank Representative 
Jackson-Lee. She is always well prepared. She understands the issues, 
and she talks very clearly to the American people.
  So I thank you again for participating.
  I now yield to our colleague, the gentlewoman from California, who 
this, I think, may be her first time joining us in the last couple of 
months, Representative Diane Watson; and we are looking forward to her 
remarks.
  Ms. WATSON. I thank the gentlewoman for yielding.
  Mr. Speaker, I am so pleased to be here to join my colleagues with 
the Black Caucus. We spent a day in a seminar so that we would 
understand every single provision in the bill that will be in front of 
us at the end of the week. It is so important that we come together 
because we have a golden opportunity to plant the sapling of health 
care reform. And I want to remind all my colleagues that America's 
Affordable Health Choices Act is just the beginning of a better 
national health care structure. Together we can work to make it grow. 
We must plant this sapling now before it is killed by the wayside as it 
has so many times been done before.
  Our efforts to tackle health care began under the leadership of 
President Harry S Truman, who attempted to include universal health 
insurance under the Fair Deal reforms. Hillary Clinton in 1993 
spearheaded this effort. Now, thankfully, President Barack Obama has 
made it one of his top priorities.
  We have known our options for years. Just because our Republican 
colleagues began to listen only recently does not mean that we have not 
carefully considered what is at stake. We are not rushing through 
deciding the fate of millions of Americans. Rather, we have taken too 
long to deliver what is necessary.
  The naysayers have rallied around the cost of this health care 
reform. Please recall that we have spent tens of

[[Page 19446]]

billions of dollars in Iraq, $15 billion a month factually. And if we 
would take that money, we could have the most thorough and the most 
beneficial health care system in the world.
  My city, the City of Los Angeles, alone has spent $9 billion and the 
Nation has spent $890 billion since the start of this unauthorized war. 
I agree that the $1 trillion price tag of health care is hefty, but it 
is a better use of our taxpayers' money than a war in Iraq. I would 
rather reform the system now and reduce the costs that my constituents 
must bear directly.
  Employer-sponsored health insurance premiums have more than doubled 
in the last decade. This is four times faster than the average wage 
increase. Middle class Americans have seen the average annual family 
contribution for employer-sponsored coverage rise to $3,354 in 2008 
from $1,619 in the year 2000. For a family earning $50,000, health 
premium costs now consume 7 percent of their pretax income. Incomes are 
not rising to keep up with these costs especially in an economy where 
so many people are losing their jobs.

                              {time}  2145

  If this reform fails, we will have little hope of reining in the 
skyrocketing costs of health care for the middle class. To reduce the 
cost of health care for the average middle class working family, we 
have to reform the system and introduce a public option.
  Mr. Speaker, the public option is a necessary and pivotal part of 
health care reform. With it in place, Congress introduces competition 
into the health care system. With fair price competition, we introduce 
efficiency and quality, not bureaucracy. Your government is not going 
to stand in between you and your doctor. Your government is providing 
an opportunity for you to choose your insurance.
  I want to make this crystal clear: We have close to 390 million 
people in the United States. We are focusing now on the 48 million 
without health insurance. The rest of Americans who have their 
insurance and like it are not affected. They can keep whatever they 
have. We are focusing on those who don't have it, so that we will see 
to the health care of all Americans.
  With the basic benefits guaranteed in the exchange, I hope that 
insurance companies and the government will be left outside of the 
examining room. It is a fallacy to believe that we are going to get in 
between a doctor and a patient.
  With the public plan, we offer Americans personal patient choice. Let 
me repeat that: We offer personal patient choice, and the freedom to 
stay healthy. I want to say that once more. This reform is about the 
freedom of choice. Our plan offers Americans the choice to keep their 
health insurance, if they choose to keep it.
  In the public plan, we are only offering the public in the exchange 
the option to choose the plan that is created by the government--
created by the government. The public plan may not be perfect, but it 
establishes a strong framework that we can build upon.
  Bringing health care to the floor means that Congress is ready to 
ensure that Americans have health insurance. We are making small 
businesses more attractive by providing them with a means with which to 
offer their employees health insurance. We are reducing the crushing 
cost on our large employers, and we are providing the people with more 
choices.
  I truly hope that with the understanding of what is being presented 
and with the multitude of hours put in by many committees, many Members 
and staff, this will be the historic first step on the road to making 
health care for all Americans possible.
  Mr. Speaker, I look forward to voting with my colleagues on this 
issue, and I would like to see it done at the end of the week so there 
is not a meltdown and the naysayers take the day. So let's do the right 
thing for the American people, and let's ensure that this country 
remains a strong, healthy country in perpetuity.
  Ms. FUDGE. Mr. Speaker, I do indeed want to thank my colleague and 
friend Representative Watson from California. Certainly she presented 
to us information that I think is important to the American people, 
well thought out and well said. I thank you so much for being a part of 
this hour.
  Mr. Speaker, I yield to Representative Jackson-Lee from Texas.
  Ms. JACKSON-LEE of Texas. I enjoyed having the opportunity to be here 
with Congresswoman Watson from California. I know that she has been 
steady on these issues, and I think it is extremely important that we 
do work together.
  One of the points I think we will have an opportunity to engage in 
discussions on as we continue to make our way through the putting 
together of this bill is to ensure that we each have an opportunity to 
reflect on some of the concerns that can help make the bill better. 
Here are some of the issues that I think will help make the bill 
better.
  I am interested in grants to high schools and middle schools that 
would increase health care professionals, particularly those in 
underserved communities. I mentioned a week or so ago that I was 
visiting in New York and met a nurse who started the program through 
his hospital where he would go to middle schools and high schools and 
allow the children to dress up in scrubs and participate in mock 
operating sessions or operating rooms. What a difference it makes. It 
is almost like our children would dress up as firefighters or police 
officers. That would incentivize the children to think of the medical 
profession as something they are interested in. I am looking at 
hopefully submitting a proposal for that.
  Next, an amendment that will address the question of providing 
incentives for the development of community health care centers that 
are housed in healthy green buildings, because we will be seeing a 
large amount of money going out to increase the number of community 
health centers, qualified Federal community health centers. I think 
they are excellent sources of health care. Why not incentivize them to 
make sure they are put in green buildings that are free of various 
toxins that would probably undermine the good health that people are 
coming there for.
  Tax credits for employers who not only provide good health care 
benefits, but encourage their employees to utilize these benefits. So 
education, outreach, making sure that employees have information about 
accessing their health care.
  A pilot program to study and demonstrate the benefits of proven 
alternative medical techniques and medicines. These are simply to look 
at holistic ways of being healthy as well as making sure people have 
access to the information.
  A program to study this ongoing problem of people who seek to 
overutilize prescription drugs. That is, to work with doctors, nurses, 
clinics, hospitals and other health professionals to educate us about 
the issue of using prescription drugs.
  So I am hoping as we make our way through and as we continue to work 
with the Congressional Black Caucus on these very important issues of a 
public option, of ending health disparities, of ensuring that we have 
universal health care, as Americans seemingly have come together to 
rally around, I believe we will have a better product by listening to 
the Members who have some constructive thoughts and proposals that 
don't undermine the basic structure of the bill; not undermining the 
public health option. Not taking away large sums of resources so that 
we cannot in the right way give quality plans, but various small 
proposals that would enhance the bill is the way I think we should go, 
and keep the basic structure of what we are all committed to, the 
public option and complete health care reform that will help the 
American people.
  Ms. FUDGE. I thank the gentlewoman.
  Mr. Speaker, in closing, I would like to say just two things.
  One, of course, is we all know health care needs to be reformed. We 
all know that the time is now to do it. We know that the cost to not do 
it is going to be significantly higher the longer we wait.
  I just want to say that, people who think that those who are 
uninsured

[[Page 19447]]

shouldn't be given an opportunity--nine million of the uninsured today 
are children. We need to do something about that. Many uninsured are 
seniors, and we need to certainly do something about that.
  So I would hope that all Members of this House would look at the 
needs of the people we represent and move to do the right thing.

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