[Congressional Record (Bound Edition), Volume 155 (2009), Part 17]
[House]
[Pages 22467-22475]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Missouri (Mr. Akin) is recognized 
for 60 minutes as the designee of the minority leader.
  Mr. AKIN. I thank the Speaker and my colleagues for this opportunity 
to once again take a look at the area of health care, something that 
has been capturing the attention of Americans and legislators for lo 
these many weeks, and to take a look at some of the controversy that's 
developed between one statement and then a different statement and the 
two don't seem to agree. So what is the real story? And we're going to 
take a look at a number of those areas today. Various statements that 
have been made on health care, what the record seems to support, what 
Congressional Research has to say, people who are reasonably scholarly, 
take a look at the facts and say, well, what really is going on.
  I think the first thing, and I think this is something that has 
caught the attention of Americans, is a concern over the cost of health 
care. If you bear with me just a minute, I'm going to try to get some 
charts up here to help illustrate it.
  Through experience, just history and common sense tells us when the 
government is trying to do something, there are some side effects. 
Sometimes it's excessively expensive. Sometimes there is bureaucracy 
and rationing, inefficient allocation of resources, and degraded 
quality.
  If you take a look at various government Departments, you think of 
things like the Post Office Department, something that's not noted for 
its efficiency, or the IRS, not noted for its compassion particularly, 
and the excessive expenses that seem to come up.
  We established a Department called the Department of Energy. It was 
originally established to try to make sure that we were not dependent 
on foreign energy and foreign oil. That Department has grown 
tremendously, and we have become increasingly dependent on foreign oil.
  So when we talk about the government, particularly the government 
injecting itself into a lot of areas, one of the concerns becomes 
particularly the cost.
  Now, we were reassured on this point by President Obama when he spoke 
here in this Chamber not so many weeks ago, and this is part of his 
speech:
  ``Most of this plan can be paid for by finding savings within the 
existing health care system, a system that is currently full of waste 
and abuse.''
  Of course, what he's talking about, one of the major places where 
he's going to get money is from Medicare, which is kind of an 
interesting thing because in the past it was Republicans who were 
accused of raiding Medicare. Here President Obama is saying that this 
can be paid for by finding savings within the existing health care 
system and part of the piece of that is going after Medicare.
  So the question is, Is this something that's going to cost us a lot 
of money and what is the record of this administration and the 
government in general in terms of spending?
  Here we have, from the beginning of this year, the spending pattern 
of the President and the Democrat leadership. And he complained at the 
beginning of his speech on health care that he had inherited a trillion 
dollar deficit, and, in fact, it was $240 billion. And yet here he has 
in a matter of 6 months or so burned up $3.6 trillion. So this 
statement that most of this plan can be paid for by finding savings 
within the existing system that's currently full of waste, and then he 
goes on to say ``Here's what you need to know: First, I will not sign a 
plan that adds one dime to our deficits.'' He's not going to add one 
dime to our deficits either now or in the future, period. Well, $3.6 
trillion in debt is a lot of dimes. I don't know how many dimes. They'd 
probably stack up from here to the Moon for all I know.
  I'm joined today by some distinguished colleagues and particularly a 
doctor and a gentleman who has had experience in medicine for a good 
number of years and somebody who has studied up on this entire system.
  Congressman Fleming, if you would join us, if you would like to make 
a comment.
  I would like you to, first of all, take a look at this question. Is 
this proposal of the President something that really is not a big deal 
financially, or is this something that could become extremely expensive 
to the Federal deficit?
  Mr. FLEMING. Well, I thank the gentleman, Mr. Akin, for the question.
  Of course, I, among all of our Republican colleagues and our Democrat 
colleagues, was here to hear the President make these statements, and 
it's very interesting when he said not one dime would be spent, and yet 
I don't know of anyone in America who agrees with that. Even the CBO, 
who is led by someone who was actually appointed by him, says that even 
with all of the razzle dazzle and the sleight of hand and pulling 
rabbits out of the hat, still there's $256 billion that's not covered, 
and that's after the $500 billion that's being gutted from Medicare, as 
you adroitly pointed out.

                              {time}  1945

  Mr. AKIN. Say that again. How much was gutted from Medicare?

[[Page 22468]]


  Mr. FLEMING. Well, it is a two-step situation. About $350 billion.
  Mr. AKIN. That is more than the deficit he inherited from the Bush 
administration. He is going to take that much out of Medicare?
  Mr. FLEMING. That is the first step. The second step is nearly 
another $200 billion that comes out of Medicare Advantage. So the total 
comes to something well over $500 billion, half a trillion dollars.
  Mr. AKIN. $500 billion taken out of Medicare. That is a pretty gutsy 
move, it seems like to me, to be taking $500 billion out of Medicare. 
And he is calling that, what his statement was: Most of the plan would 
be paid for by finding savings within the existing health care system, 
a system that is currently full of waste and abuse.
  I guess he is looking at the waste and abuse would be $500 billion 
out of Medicare; is that correct?
  Mr. FLEMING. Well, $350 billion would be from the so-called fraud, 
waste and abuse. The other $150 or so billion, almost $200 billion, 
would be to directly tear down, dismantle, if you will Medicare 
Advantage.
  Mr. AKIN. I have heard politicians going along on this line, and it 
sounds like to me that there is a line item, or there are three line 
items, waste, fraud and abuse, and you can just cut the numbers out of 
those lines. Is that how it works?
  Mr. FLEMING. It seems to me that it is easy to do on paper, but this 
program is over 40 years old. And every politician that has come along 
has promised to do away with fraud, waste and abuse. Not one has been 
able to do it, and our President nor our colleagues on the other side 
of the aisle have even hinted how that would be accomplished.
  Mr. AKIN. That is interesting; $500 billion out of Medicare alone. 
That is a significant number.
  We are joined by Congresswoman Foxx who has dazzled us down here in 
the last few years. I think of her as the grandmother of the 
legislators. It is a delight to have you here.
  Ms. FOXX. Thank you very much, Congressman Akin, for leading this 
hour tonight and for all of the leadership that you have given, 
particularly this session, on bringing to the attention of the American 
public some of the things that need to be brought to their attention.
  I think you are certainly on the right track in talking about the 
fact that it is impossible to do what the President and Speaker Pelosi 
have been saying about expanding health care coverage, government-run 
health care coverage, to other people without it costing another dime.
  It reminds me of Congressman Miller saying last week, on another 
issue that I think you want to talk about in a little bit, on the 
government taking over the student loan program.
  Mr. AKIN. I appreciate your bringing that up, but I would like to get 
there in just a minute.
  Ms. FOXX. He said on the floor that we would go from the government 
having 22 percent of student loans, only 22 percent, to having all of 
them, and it wouldn't cost the government a dime. My point is these 
people keep promising programs and expanding programs and nothing is 
going to cost anything.
  Mr. AKIN. Reclaiming my time, I would like to ask my friends here, 
and here is the specific statement made by the President. And I think 
it is helpful, you take the specific statements and you take a look at 
them and say: Does it make sense or does it not? Here is the statement, 
and what is a rational analysis of this?
  ``Here is what you need to know. First, I will not sign a plan that 
adds one dime to our deficits, either now or in the future.''
  We have heard that we are not going to add a dime to the deficits, 
and in just 6 months we have scored $3.6 trillion from all of these 
different programs. You have the Wall Street bailout and the economic 
stimulus, the SCHIP, the appropriations bill, and this cap-and-tax, 
which is the biggest tax increase in the history of our country, and 
for him to say it is not going to add a dime to our deficit.
  He also promised during the campaign that nobody making less than 
$250,000 would pay any taxes, and yet this cap-and-tax that we did 
means that as soon as you flip a light switch, you are starting to pay 
taxes. Now tell me, do people who flip light switches, do they all make 
over $250,000? There is a question of credibility when you hear a 
statement as broad and as general as that.
  Here is another one: ``Most of this plan can be paid for by finding 
savings within the existing health care system, a system which is full 
of waste and abuse.''
  Every year we are putting a patch on Medicare because the doctors are 
getting paid so little that they are getting to the point that when 
somebody walks into their office and says, I'm on Medicare, they say, 
Sorry, I can't afford to take any more Medicare.
  So as a doctor, if you keep getting paid less and less for Medicare 
people, there is going to come a point where the people who have 
Medicare, they have government insurance, but they don't have 
government health care because a doctor won't accept the wage.
  So I guess when we hear this, I don't know if this passes the sniff 
test.
  Ms. FOXX. If the gentleman would yield, I think another point that 
needs to be made is that the President has said on many occasions that 
when he took office he inherited a $1 trillion deficit.
  Mr. AKIN. That isn't true, is it?
  Ms. FOXX. I wanted to see if you would help me with my memory on 
that. My memory is that when President Bush left office and President 
Obama came in, that the deficit was $259 billion, too big a deficit, 
but only $259 billion, compared to the $1 trillion which occurred 
almost immediately because of the stimulus package. The stimulus 
package created the $1 trillion deficit; is that your memory?
  Mr. AKIN. It isn't just my memory. There is an expression that 
everybody is entitled to their opinion, but there is only one set of 
facts. And the facts are that it was in the range of $250 billion or 
so, and many of us who are conservatives would say that was too much. 
But still, it is not in the range of a trillion, or $3.6 trillion, 
which we are burning with all of these programs.
  Here is another chart that I think people are vaguely aware of. 
President Bush, before, went where you are not supposed to go 
politically and said to the American public, Medicare and Social 
Security are broken. And maybe people beat him up for that, but in 
general Americans realize Social Security and Medicare, these programs 
are broken, partly because they weren't designed right to begin with 
and partly because of the demographic shift and all of those of us who 
are baby boomers and all of that. But here is a chart on the expansion 
of Medicare and Social Security.
  My question is, if we can't manage Medicare and Social Security, and 
those costs are going up to this point where you have this dotted line. 
You have Medicare, Medicaid, and Social Security added together absorb 
the entire budget. There is no money for the arts, no money for public 
radio, and no money for defense or anything else, just those three 
programs. It totally gobbles up about the maximum you can get, because 
if you raise taxes more, you get less in because you kill the economy. 
So is it reasonable when you have the experience of Medicare and 
Medicaid expanding the way they are, the solution to this is obviously 
the government being more involved? Somehow, that doesn't pass the 
sniff test.
  I yield to Dr. Fleming.
  Mr. FLEMING. A point you raised, Mr. Akin, is a very important one 
that is often left out of the debate, and that is that Medicare and 
Medicaid are paying such low rates, far below cost in many cases, that 
it is only the private insurance market that is making up the 
difference, that keeps doctors solvent and keeps their offices open. If 
you look at the increase in private insurance premiums and the fact, 
and the President points this out frequently, the rate of increases is 
higher than inflation, well, what is causing that is the government-run 
health care that we already have which is being subsidized by the 
private market.

[[Page 22469]]


  Mr. AKIN. Reclaiming my time, therefore, following your line of 
reasoning, if you keep taxing the privates more and more, they are 
going to get smaller. And when that gets smaller, your base of 
collecting those tax revenues gets smaller, and you have more and more 
people who are subsidized who are absorbing the resource, and pretty 
soon you are in a death spiral. Is that your point?
  Mr. FLEMING. Exactly. People say how will this ever lead--what you 
really have is a competing public plan against private plans, and how 
will this lead to rationing and long lines? The bottom line is, when 
you artificially suppress the income to the providers, doctors and 
hospitals and DME companies and so forth, what you end up with is 
really an artificial market which then is being collapsed in the 
private sector into a public sector market, and there is no way that is 
going to control costs, short of long lines.
  Mr. AKIN. Speaking directly on that point, and I appreciate your 
going there because that is something that I thought was very 
interesting. In the context of our health care debate, something that 
happened here last week on the floor, and people should be paying big 
attention to this, and it seems like it is an unrelated subject but it 
is not at all, and that is the student loan situation. We are fortunate 
to have Congresswoman Foxx who was literally involved in the middle of 
that situation.
  I would like to explain the history of the student loan program and 
how that connects to this concept, because one of the huge debates 
here, aside from the cost of the thing, is the question of whether 
there should be a government insurance plan included. The Democrats are 
about 50/50 divided on that point. The Republicans are not at all 
divided. We think no, absolutely not. It is a deal breaker. We do not 
want the government getting into the insurance business.
  So why would we be concerned? Well, because where that is going to 
lead. Let's go over and take a look at what happens in student loans 
and how that then relates to health care.
  I yield to the gentlewoman from North Carolina.
  Ms. FOXX. I will give you a very brief synopsis of it. I handled the 
rule on the floor last week, so I was familiar with the bill. The 
Democrats have been trying to do this for a long time.
  We have had in the Federal Government two ways for students to be 
able to borrow money to go to college. One was called the Direct Loan 
Program. They would go directly to the Department of Education and 
borrow money, pay it back over a period of time.
  The second was something called the FFEL, and I can't remember 
exactly what those letters stand for, but students could borrow money 
from banks but the Federal Government would guarantee those loans. Back 
in the sixties when the Direct Loan Program was begun, right after it 
started, actually, it ran out of money and ran into all kinds of 
problems. Congress had to bail it out. That was long before my time, 
but it has constantly had problems.
  Mr. AKIN. Reclaiming my time, was that the government Direct Loan 
Program always had problems?
  Ms. FOXX. Yes.
  Mr. AKIN. The deal is the government makes a loan to some student, 
you're going to go to college. The kid goes to college, doesn't repay 
the loan, and the government and the taxpayer has to then pick up the 
tab?
  Ms. FOXX. That's right, put more money into it. So what happened was 
only about 22 percent of the people getting loans were getting them 
from the Direct Loan Program. Actually, that is a higher percentage 
than it had been over the years. The other 78 percent were getting 
their money from banks, and then the money was guaranteed by the 
Federal Government. What Chairman Miller's bill did was say we are 
eliminating the private sector.
  Mr. AKIN. Here is the interesting thing, though. If you went for a 
direct loan from the Federal Government, you got a lower interest rate 
on your loan, so you would think, shoot, everybody is going to go for 
that kind of loan, and, in fact 20 percent did, and the other 70-some 
did not. They paid more money in interest. Why? Because the loan was 
administered through the private sector. And the private sector was so 
much easier to deal with, they were willing to pay more in interest 
just not to have to deal with the Federal Government on it.
  So what we did last week, then, was to basically eliminate, and there 
were some people that weren't federally insured at all and they were 
just totally private. So 20 percent of the market was just private. You 
had not quite 20 percent that was just straight Federal Government, and 
then you had in between the sector of private money with a guarantee 
from the Federal Government. So we have taken that huge sector in the 
middle and gotten rid of that so now the government runs 80 percent or 
so of the student loans; is that right?
  Ms. FOXX. It will work that way if the Senate passes that bill, 
despite the fact that we kept saying over and over and over again, 
Department of Education has no business becoming a bank, and that's 
basically what they are doing.
  Mr. AKIN. So the first thing we are seeing is once more the Federal 
Government is getting their fingers into everything, and in this case, 
they are basically taking over student loans. But they started with the 
idea that we are just going to help the students get a lower interest 
rate. That was the toe in the door, the nose of the camel under the 
tent, to the point where now 60, 70, if this bill were to pass the 
Senate, where you have the government now in the student loan business.
  Now, let's fast forward. How does that parallel our concern on health 
care? Well, our concern is you put a public option in and the 
government starts with that. It seems like just a little thing.

                              {time}  2000

  Then pretty soon you say, well, every insurance policy in the country 
has to be the same as the government's, which is what the legislation 
says. And pretty soon, guess what? You have one provider, the Federal 
Government, and the government has now taken over all of the health 
care.
  I yield to my good friend, the Congressman from Georgia, who has a 
distinguished record here in the House but also is a medical doctor, 
which we don't hold against him. I would just be delighted to recognize 
my good friend, Dr. Gingrey.
  Mr. GINGREY of Georgia. I thank the gentleman for yielding, Mr. 
Speaker. I hope my patients don't hold it against me as well.
  But actually I just wanted for you to yield me time so I could ask 
our good friend from North Carolina, Ms. Foxx, a question in regard to 
this. You are right, she is a Member of our side of the aisle on the 
Rules Committee, does a great job of handling rules for us, and 
apparently does all of the education bills that come on the Floor.
  There was some discussion, Representative Foxx, about how many jobs, 
in this time of losing jobs--they keep saying 14,000 people a day lose 
their health insurance; we know why, because they are losing their 
jobs--but in this particular instance, as far as that private sector, 
can you give us a number on that?
  Ms. FOXX. We have an estimate that between 30,000 and 40,000 jobs in 
the private sector will be lost as a result of that education bill, and 
that, again, makes the statement that Mr. Miller from California made 
so astounding, because it is like the statement that President Obama 
has made about the health care bill. Mr. Miller said this will not cost 
the citizens of this country one single dime.
  Mr. AKIN. Wait a minute. Reclaiming my time, you are starting to blow 
my circuits. You are saying that a Congressman on this floor, the head 
of the Education Committee now, says that this government loan program 
is not going to cost us a dime?
  Ms. FOXX. The complete takeover is not going to cost a dime.
  Mr. AKIN. In other words, the Federal Government is going to go in 
and take over all of these student loans, and it is not going to cost a 
dime. You

[[Page 22470]]

know what you would have to prove to prove that true? You would have to 
say that every single loan is going to be made good. That is what you 
would have to say almost to make that happen. I mean, that is beyond 
credible.
  Ms. FOXX. It also is beyond credible when we know that there are 
30,000 to 40,000 people in the private sector servicing the existing 
loans. It is incomprehensible to me.
  Mr. AKIN. 30,000 or 40,000--that is jobs lost?
  Ms. FOXX. Jobs lost, and that they believe that people in the 
Department of Education are going to absorb the program into the 
Department without adding any personnel. Now, that is beyond belief for 
anybody in this country I believe, to think that you add 
responsibilities to people who work in the Federal Government and they 
are not going to ask for additional personnel.
  Mr. AKIN. You know, there is kind of an overused phrase around here, 
``people of faith.'' I mean, I think we are talking of people of faith 
that could make statements like that with a straight face almost.
  I would like to just shift a little bit to my good friend from 
Georgia, and he in a way to me is a hero because he has done something 
which I think is a tremendous educational tool for the people of the 
United States.
  On this House floor we are denied many, many times any kind of 
amendment that we can offer because it might be embarrassing to have to 
vote on something. But in committee, we still have the freedom to be 
able to offer amendments. And a third point of some considerable 
contention on health care is the question of rationing.
  Is it going to end up that the government is going to, instead of an 
insurance agent getting between you and your doctor, which we don't 
like, even worse a bureaucrat telling the doctor and the patient, 
Sorry, you can't go there. Give him some aspirin and send him home. 
That is something that has been a concern.
  So my good friend the doctor from Georgia offered an amendment in 
committee on this very point, and I don't think this has received 
nearly enough attention, Dr. Gingrey. But I want to review the simple 
sentence that you put in, because I think this really busts wide open 
this entire question about whether we are going to have rationing of 
health care.
  ``Nothing in this section shall be construed to allow any Federal 
employee or political appointee,'' that is, a bureaucrat, ``to dictate 
how a medical provider practices medicine.''
  My understanding of what you are saying, doctor, is that that doctor-
patient relationship, which we all consider to be the backbone of good 
medical care, is sacrosanct, and we are not going to put bureaucrats in 
charge of doctor-patient and medical decisionmaking.
  Was that your point? And tell me about your amendment.
  Mr. GINGREY of Georgia. Well, Mr. Speaker, I thank the gentleman from 
Missouri for yielding, and that essentially is the amendment that we 
proposed. There were a number of others. But on that particular one, 
early on, back on July 30 I believe is when we were marking up into the 
wee hours of the night, and the big concern was with when you look at 
the chart, this massive bureaucracy that was created between the 
patient here and the provider, there were all these government 
bureaucrats who had the authority under this bill, H.R. 3200.
  Mr. AKIN. Was that that fantastic colored flowchart that we saw that 
had all the boxes and arrows all over?
  Mr. GINGREY of Georgia. Mr. Speaker, the gentleman is right. I was 
able to hold that up when we were marking up the bill in Energy and 
Commerce, and, of course, C-SPAN cameras were there and showed the 
morass of bureaucrats on this in a chart depiction. But I think people 
got it, Mr. Speaker. They could see.
  Mr. AKIN. So isn't that your point? You don't want bureaucrats 
getting in the way of medical decisions. Is that what you are trying to 
get at here?
  Mr. GINGREY of Georgia. Absolutely.
  Mr. AKIN. And how did it go? Tell me about the votes. Your amendment 
passed without any question, right? Everybody agrees to that doctor-
patient relationship, right? There wasn't anybody that voted against 
your amendment?
  Mr. GINGREY of Georgia. Well, what I am going to say, Mr. Speaker, 
the gentleman asked that question. I have answered that. If you asked 
every doctor and if you asked every patient, the answer would be, We 
don't want some government bureaucrat coming in this exam room telling 
either one of us what to do. This is a sacred relationship, really.
  Mr. AKIN. I agree. It is a sacred relationship. How did the committee 
vote?
  Mr. GINGREY of Georgia. They voted it down, Mr. Speaker. The 
gentleman asked a specific question. They voted a lot of great 
amendments down.
  Mr. AKIN. What I have got here in my notes, it says the Democrats, 32 
voted against it, one voted for it. Republicans, 23 voted for it, none 
of them voted against it. So it is a straight party-line vote, with the 
exception of one?
  Mr. GINGREY of Georgia. Mr. Speaker, there was maybe one or two 
exceptions in the vote. They have 36 members on the Energy and Commerce 
Committee. I say ``they,'' Mr. Speaker. The majority party. They were 
assigned to that committee by the Speaker of the House, Ms. Pelosi. And 
we have 23 Republicans. So it is 36-23.
  Mr. AKIN. So your amendment failed then?
  Mr. GINGREY of Georgia. Absolutely it did, as did all the other 
amendments. You might say, Mr. Speaker, that the deck is pretty well 
stacked against us.
  Mr. AKIN. Okay. But when it failed, what does that say to us if you 
are worried about bureaucrats making health care decisions? Does that 
give you any sense of comfort?
  Mr. GINGREY of Georgia. Mr. Speaker, the question, does that give you 
any sense of comfort that bureaucrats won't come between the doctor and 
his or her patient, it gives you total discomfort, is the answer to 
that question. Otherwise, we would have had almost a preponderance of 
members, both Republicans and Democrats, voting in favor of that 
amendment. Surely some, more than one or two, felt that way, but they 
didn't vote that way.
  Mr. AKIN. I really appreciate, doctor, your offering this amendment, 
because I think this, if there is ever any indication of where this 
health care is going and why the American public is concerned about it, 
this would be one of those things. Because we are talking about 
promises on the one hand that you can keep what you have and your 
doctor-patient relationship is good and don't worry about that; 100 
million people in America have their own insurance and their own 
doctors and providers and they feel like they are getting pretty good 
health care. And yet here, this amendment says that.
  We are joined by a fantastic Congresswoman, Congresswoman Lummis. I 
would be happy if you want to jump in here.
  Mrs. LUMMIS. I do, and I thank the gentleman from Missouri for 
allowing me to. I was sitting in my office in the Longworth Building 
listening to this discussion, and my fellow freshman colleague, the 
physician from Louisiana, was talking earlier about Medicare and the 
effects of $350 billion of waste, fraud and abuse coming out of 
Medicare to magically fund a big portion of the proposed health care 
bill that Ms. Pelosi and her colleagues have prepared for us.
  Mr. AKIN. Let's talk a little bit. What part of Medicare did that 
come out of? Did you happen to notice that? I mean, is there any line 
item that says waste, fraud and abuse in Medicare that you can just 
take money out of? How do we do that?
  Mrs. LUMMIS. You know, there certainly isn't. And the most amazing 
thing to me about listening to that discussion is, when I was home for 
the August work period, I met with the physicians and administrators at 
Wyoming Medical Center in Casper, Wyoming. They told me that they are 
currently reimbursed at 37 cents on the dollar for their actual out-of-
pocket costs of treating a Medicare patient.
  Mr. AKIN. Let me stop. That is an incredible number. In other words, 
we

[[Page 22471]]

have a doctor like Dr. Gingrey, Dr. Fleming, and they accept a patient 
on Medicare. It costs them $1 to provide some type of medical care. 
They are getting reimbursed how much? $1.50?
  Mrs. LUMMIS. No.
  Mr. AKIN. $1?
  Mrs. LUMMIS. No.
  Mr. AKIN. How much?
  Mrs. LUMMIS. Thirty-seven cents.
  Mr. AKIN. Thirty-seven cents out of a dollar. So they are losing 
money on a Medicare patient.
  Mrs. LUMMIS. They are losing roughly two-thirds of every dollar that 
they spend.
  Mr. AKIN. So we are going to cut $500 billion out of Medicare and 
expect doctors to continue to do that? I don't understand how that is 
supposed to work.
  Mrs. LUMMIS. It is a stunning departure from rational thinking.
  Mr. AKIN. I think that is a great phrase, ``a stunning departure from 
rational thinking.'' You know, I think we are seeing a little more of 
that than we need down here. You are such a nice person. That is a nice 
way to say being stupid, isn't it? In Missouri, we are not very good at 
explaining things. I wish I was as politically correct as you are.
  I see my good friend, Congressman King from Iowa, over here, and he 
is having way too much fun. I think we have to let Steve have a chance 
at chatting with us for a minute.
  Congressman King, somebody who is known for calling things plain and 
straight talk, I appreciate your midwestern perspective. Please join 
us.
  Mr. KING of Iowa. All those compliments some might argue are a 
stunning departure from rational thinking, Mr. Akin, and I am glad I 
came over here just to hear that exchange between you and Cynthia 
Lummis tonight.
  I am sitting here thinking this: That there is a great, huge 
philosophical divide going on in this Congress, and the people on the 
left side of the philosophical spectrum and the left side of the aisle 
seem to believe somehow they can generate all of this government, all 
of this government oversight, and take on a huge operation of the job 
that is being done now, a lot by the private sector, punish the health 
insurance companies, replace them with a Federal health insurance 
company, and somehow the incentive that is there today that has allowed 
some profit for doctors to get back their huge investment in their 
education and their training and their internships and nursing and all 
of the expenses it takes to have a front-loaded education, somehow 
there is going to be an incentive there to have more doctors and more 
nurses, when we know it is going to be less.
  They cut the funding to Medicare by half a trillion dollars and argue 
that it is waste, fraud and abuse, and somehow the President makes the 
argument that, let's see, he can find this savings that is there 
because of waste, fraud and abuse, but the quid pro quo is we don't get 
to save the wasted money unless we take on the socialized medicine part 
of his package.
  Mr. AKIN. Isn't that amazing? We have two medical doctors here, Dr. 
Fleming and Dr. Gingrey, and we have been really leaning on our medical 
doctors. I guess the question I have is, I have been here 9 years, and 
over this period we passed some bill, I don't know how many years ago, 
that says we are going to keep ratcheting down how much money we are 
spending on Medicare, and it obviously isn't working, if you take a 
look Medicare growth and costs. And every year we do the Medicare patch 
so the doctors aren't going to go bankrupt all the time, or at least so 
they will keep taking Medicare patients.
  So it seems to me when we do the patch, we are putting more money 
into Medicare, and now we are talking about taking $500 billion out of 
it. This thing somehow, Dr. Gingrey, do you want to address that for a 
minute, or Congresswoman Foxx?

                              {time}  2015

  Mr. GINGREY of Georgia. Mr. Speaker, I will be glad to take some time 
from the gentleman from Missouri, and then I will be glad to yield back 
to him so he can let our family practitioner, the gentleman from 
Louisiana, Dr. Fleming, also speak on this issue.
  But yes, this sustainable growth rate formula--and it's very 
complicated. I've had six courses of calculus at Georgia Tech, and I 
still can't quite figure out how they come up with these numbers--is 
flawed, and everybody knows it's flawed and needs to be done away with. 
You can't fix something so badly flawed. For the last, I would say, 5, 
6 years when they calculated that formula, the doctors end up taking a 
cut in something that already is underpaying them. It doesn't cover 
their basic expenses. It's calculated far differently from the way 
hospitals are reimbursed.
  Mr. AKIN. Every year we're patching that, though, aren't we?
  Mr. GINGREY of Georgia. Mr. Speaker, the gentleman is right in his 
comment, that every year we're patching it. And that's no way to run a 
bank. That's no way to do business. You patch it, and yet then the next 
year you take the cut for that year plus the patch that you removed. So 
you essentially have 5 percent for the patch and 5 percent for the 
current year. In fact, on January 1, 2010, the doctors, if we don't do 
something about it, will take a 20 percent cut.
  Mr. AKIN. How many years can you practice medicine--let's say our 
salaries were cut 20 percent every year. How long would we be doing 
what we're doing? I mean, that's a tough deal. So we're cutting this. 
We keep adding money to it to prevent that cut from taking place, and 
now we're going to take $500 billion out of Medicare and everything is 
going to work fine?
  Dr. Fleming, what do you think about that?
  Mr. FLEMING. Well, I will just briefly comment, because I know we 
have got other speakers here who are anxious to get on the record 
tonight.
  The whole concept behind SGR, sustained growth rate, is that the 
government in its infinite wisdom said, Well, out in the future 
someplace, we're going to spend no more than this many dollars, and the 
doctors are going to have to get together amongst themselves--the 
hundreds of thousands of them--and decide how they're going to do that. 
Of course the obvious thing occurred. How in the world are doctors and 
hospitals going to be able to do that? Anybody under part B.
  Mr. AKIN. Is this a conference call? You're going to have a 
conference call?
  Mr. FLEMING. As far as I know, I was never invited to a conference 
call. I have never received an e-mail about it. I just went along, 
practicing everyday, like my colleagues do. All of a sudden we are 
told, we're spending above the SGR rate. It goes back to exactly what 
our debate is today. We can pick and choose a number out there in the 
future that's going to be a goal, and we are going to practice and 
spend less than that amount. But that does not affect the day-to-day 
behavior inside the exam room, which is, again, why our bill H.R. 3400 
is so important because it gets to the behavior and the decision-making 
between the doctor and the patient. That is where the money is saved. 
Not in some conceptual decision made out in the future that we're going 
to spend only this many billions of dollars next year or the coming 
years.
  And that's why the SGR is an abysmal failure. Of course we all know 
that it's really a joke. We do a patch every year, but it never would 
work, and it never will work.
  Mr. AKIN. I appreciate your response as a medical professional on 
that, and the fact that it's going to be awfully hard if year after 
year we're putting more money into Medicare to try and prop it up. As 
Dr. Gingrey has said, that's no way to run a ship. And that's true. But 
we're constantly putting more money in it, and all of a sudden we're 
being told by the President that he is going to take $500 billion out 
of it because it's waste, fraud and abuse; he is going to put it into 
this program, and there is not going to be a nickel of deficit involved 
in that.
  Another claim that the President made--and I have been sticking a 
little bit on the theme of, there's a lot of debate over what's true. 
This guy says this, somebody else says that, and America is arguing 
about this stuff.

[[Page 22472]]

What our objective is is to try to add some kernel of truth to one of 
these things.
  Here's another statement. First, if you're among the hundreds of 
millions of Americans who already have health insurance through your 
job, Medicare, Medicaid or the VA, nothing in this plan will require 
you or your employer to change the coverage of the doctor you have. Now 
we've heard this over and over from the President. We've heard it from 
different Democrat Congressmen claiming this, and yet this isn't really 
true, from what we're seeing, as we take a good, closer look at it.
  The first thing that strikes me is, if you are among the hundreds of 
millions of Americans who already have health insurance--in other 
words, you have 100 million Americans who already have health 
insurance, and you like it, you like your doctor-patient relationship, 
and you are saying, Hey, just leave me alone, what's the objective? 
Well, the objective is to find some other number of people who don't 
have health insurance. So how many is that? We have an expert on that 
here in Congressman King. But let's just be very liberal. Let's say the 
President, who said originally it was 46 million, now he is going to 
take it down to 30 and probably if you looked at it closer, it's less 
than that. But let's say even if there were 30 that didn't have health 
insurance, and you have hundreds that have, why are you going to scrap 
the hundreds right off the bat in order to deal with the 30?
  Mr. KING of Iowa. If the gentleman will yield, and I thank the 
gentleman from Missouri.
  There have been two flawed premises that have been under the 
foundation of this health care debate from the beginning. One is that 
we spend too much money on health care. That has not been adjusted for 
a number of reasons. The other is we have too many that are uninsured. 
The number that's the most consistent is 47 million uninsured. But when 
you break the number down, you start subtracting from that 47 million, 
those that are here illegally--which the President has decided now, 
he's changed his mind and now he doesn't want to fund those--those that 
are here legally are under the 5-year bar; those that make over $75,000 
a year and presumably could pay their own premiums; those that qualify 
for an employer plan; and those that qualify for a government plan, 
like Medicaid, but don't bother to sign up. Once you take 47 million 
and you subtract from that universe, that list that I have given, you 
end up with 12.1 million who are Americans without affordable options.
  Mr. AKIN. Reclaiming my time, my first point, when you read this, if 
you have hundreds of millions who already have health insurance, you're 
going to tamper with all of this to deal with 12 million?
  Mr. KING of Iowa. To deal with less than 4 percent, which is 12.1 
million.
  Mr. AKIN. So less than 4 percent. We're going to redo the whole 
system to deal with 4 percent. Even on the surface, it doesn't seem 
intuitively obvious to the casual observer that that's the way that you 
might deal with this thing.
  Congresswoman Foxx.
  Ms. FOXX. I thank the gentleman for yielding.
  I wanted to speak to what you started out talking about tonight, 
along with this comment. What are we to believe on all of these issues? 
There are lots of numbers being thrown around, lots of comments being 
made. First of all, let me give a statistic that I know of. Eighty-nine 
percent of those people that you talk about are happy with their health 
insurance.
  Mr. AKIN. So you are saying of Americans in general, 89 percent are 
saying, We're pretty comfortable with what we've got.
  Ms. FOXX. Right. The ones who have health care coverage.
  But the point I wanted to make tonight is something that has just 
been coming out in the last day or two about what's happening in terms 
of informing the American public about what----
  Mr. AKIN. This is the area that's kind of sacred to Americans, the 
idea of free speech, that you can have your opinion, you can disagree 
with a family member or a neighbor. But we can have this debate and 
this discussion, and we're not going to hide information.
  Is that what you are getting at?
  Ms. FOXX. That's right.
  There is an organization called Humana which provides health 
insurance, primarily the Medicare Advantage Program, to seniors all 
over this country.
  Mr. AKIN. So we've got Humana. It's a health insurance company 
provider, and it's particularly working with Medicare money and 
packaging that money into more of like a private medical plan type 
thing?
  Ms. FOXX. Correct. The Medicare Advantage Program.
  The Humana organization sent a letter out to the people who 
participate in that program, saying, We want you to be aware of what's 
happening in this health care debate. We'd like you to send back a card 
so we can send you information about what's happening. We do want you 
to know that the current bill under consideration--they don't name H.R. 
3200, but we assume that is the bill they were talking about--will be 
cutting funding for this program. Well, that is absolutely true. Anyone 
who reads that bill will see that it's true.
  Mr. AKIN. So specifically, the bill that's being proposed by Nancy 
Pelosi--and indirectly by the President--is going to cut Medicare. 
Specifically in Medicare, it's going to cut Medicare Advantage, and 
Humana works with that. I just want to make sure we get this down.
  Ms. FOXX. Sure.
  And this is a program that seniors like very much. Well, where the 
rub comes in is suddenly the organization, the Centers for Medicare & 
Medicaid Services, doesn't like the fact that Humana is exercising its 
free speech options and educating the people that are being covered by 
its program and writes to them and says, You cannot do this anymore. 
You can't write letters to the people participating in your program. It 
says, ``We are instructing you to immediately discontinue all such 
mailings to beneficiaries and to remove any related materials directed 
to Medicare enrollees from your Web sites.''
  Mr. AKIN. Wait, wait, wait. Stop again. I feel like I have just 
blasted off and gone to some other country or some other planet.
  Ms. FOXX. You're living in 1984.
  Mr. AKIN. You are saying that we have a private company who is 
insuring people. They write a letter to the people that are buying 
their product and say to them, essentially, you're being targeted by 
Nancy Pelosi's health care bill. So they are a constituency, they are a 
group of Americans who have a right to have an opinion. Obviously 
they're somewhat predisposed to like it because they wouldn't be in the 
program if they didn't like it, and they're being told, Your program is 
going to be cancelled. The program you like in Medicare is going to be 
canceled. So they're warning their people that are buying their 
product, Look out. You're about to lose something. If you like it, 
you're going to have to say something about it.
  And now the government is threatening Humana for communicating?
  Ms. FOXX. That is absolutely true.
  Mr. AKIN. I don't know if we have even got a First Amendment anymore.
  Ms. FOXX. Mr. Speaker, I would like to enter into the record of this 
discussion tonight the letter from Humana to its enrollees, the letter 
from CMS, and the CMS press release that was sent out related to that.
  Mr. AKIN. I appreciate your sharing that. I guess I appreciate it. I 
think it's a little bit chilling. I mean, the President said something 
about calling us out. That sounds like something my principal did to me 
all the time when I was, you know, talking or chewing gum or something.
  Going to Dr. Gingrey, have you heard about this situation? This is 
kind of a little spooky--that you can't send people a letter in 
America?
  Mr. GINGREY of Georgia. Mr. Speaker, the gentleman asked me the 
question if I had heard about that. And absolutely I have heard about 
it. It's amazing, isn't it, that what we hear from the leadership in 
the majority

[[Page 22473]]

party and from 1600 Pennsylvania Avenue is that everybody that is 
questioning H.R. 3200, or the bill that came out of the Health 
Committee in the Senate and has great concerns about whether illegal 
immigrants are going to be covered, whether the general taxpayer, 
whether they are pro-life or pro-choice, is going to have to pay for 
subsidies that low-income people get through the exchange if they 
choose a plan, either a government plan or a private plan, that offers 
abortion services. It's in the bill. I mean, it's clear language. And 
yet we're just getting all wee-wee'd up, according to certain sources, 
because we don't understand. It's like the only people that are telling 
the truth are the White House and the Democratic majority party. 
Everybody else is lying. It's absolutely insulting.
  Mr. Speaker, that's why the people in the town hall meetings were so 
wee-wee'd up. They're tired of being insulted by these people that have 
all the power, all the power in the White House and both Chambers of 
Congress.
  Mr. AKIN. Wait a minute. I am still coming back to this deal where 
you are a business and you are writing a letter to the people that 
you're providing a product to, and the government tells you you can't 
send a letter to them and you have to take it off your Web site? Is 
this 1984? I mean, what is this, George Orwell or something? I find the 
whole pattern here to be upsetting. I really do.
  My friend from Iowa, are you running away on us here? I was just 
about to recognize you, gentleman. Did you want to jump in on this?
  Mr. KING of Iowa. I appreciate the gentleman yielding. A number of 
things jump out in my mind, and that is, yes, this subject matter gets 
me all animated. I don't know quite how to pick that up with Midwestern 
vernacular. I wanted to point out the President's vernacular. We have 
to be very careful and listen very closely to this President because he 
is a master of casting ambiguities that couch things in terms where he 
is not confined by the definition of the language.
  For example, right there, ``Nothing in this plan will require you or 
your employer to change the coverage of the doctor you have.'' Remember 
for months he said, ``If you like your plan, you get to keep it.'' And 
John Shadegg said, ``If you like your plan, get ready to lose it. 
That's the reality of it.''
  Now the President, in his address before Congress--which I will point 
out was I believe September 9, 2009--the President changed the language 
to read what's down there, ``Nothing in this plan will require you or 
your employer to change the coverage or the doctor you have,'' except 
you may not be able to access coverage or the doctor you had because 
the plan might bring about a change in premiums, it might disqualify 
the policies, it might disqualify the very health insurance company. 
And so nothing in the plan might require you to change, but you may not 
have the option to keep the one you have because they have eliminated 
the existing policies.

                              {time}  2030

  Mr. AKIN. Yes, Gentlemen, this was the President's claim.
  So we hear this one claim on one side. Now, what is the balancing 
counterclaim? Well, here is one. This is a poor guy from MIT who wishes 
he hadn't said it because he was attacked for making this statement:
  With or without reform, that won't be true. This is about this 
statement. He says, That won't be true. His point is that the 
government is not going to force you to give up what you have, but 
that's not to say other circumstances will not make that happen.
  So, in other words, he can say you can keep what you've got; but in 
fact what happens is, just like in the funding for higher education, 
the government comes in and changes everything, and you don't have 
access to it anymore.
  Please, the gentleman from Iowa.
  Mr. KING of Iowa. Again, listen carefully to the words the President 
says. Here is a little bit of a different subject.
  After the blowup on that night of September 8, which was the joint 
session of Congress, regarding the issue about funding illegals through 
this, the President then came back, and he said, ``I want to be clear: 
If someone is here illegally, they won't be covered under this plan.''
  In other words, he is going to oppose any language that's ambiguous 
that might allow for illegals to be covered under H.R. 3200 or under 
another health care plan.
  However, just a few days later, the President went before an open 
borders organization, which I recall to be La Raza, and he said, Well, 
we need to move forward on legalizing the people who are here 
illegally.
  So we have this language that says, if someone is here illegally, he 
won't be covered under this plan; but if you legalize everybody who is 
here, this language here becomes moot. So listen carefully to the 
ambiguities that the President threads into his language, and you might 
find out well after the fact that it's a little late to raise the 
issue.
  Mr. GINGREY of Georgia. If the gentleman would yield for just a 
second on that point.
  Mr. AKIN. I yield.
  Mr. GINGREY of Georgia. The gentleman from Missouri, thank you.
  Mr. Speaker, I want to respond to my good friend from Iowa because 
he's absolutely right. The President did make the comment of, hey, you 
know, this problem will go away. All we have to do is grant amnesty to 
12 million illegals, and then we won't have this problem, and they'll 
all be eligible for government subsidies under the government plan or 
under the exchange or whatever.
  He did say, Mr. Speaker, emphatically that there should be a 
provision in H.R. 3200--if that happened to be the bill, and I hope it 
won't be. He said that he agreed that there ought to be an absolute 
provision that specifically states that before people are eligible for 
any of these government subsidies they have to have proof of their 
legality, not citizenship, but proof that they're in this country 
legally. That proof, he said, speaks for itself. I'm paraphrasing what 
the President said, but he was pretty emphatic.
  I yield.
  Mr. AKIN. I would just like to jump to the record here. This is the 
August 8 speech:
  There are those who claim that our reform effort will insure illegal 
immigrants. This, too, is false.
  He is saying people are saying things that are false. That's pretty 
close to calling them something else. They're saying things that are 
false.
  The reforms I am proposing would not apply to those who are here 
illegally.
  This is a statement that he made. Is it true or is it not? Well, one 
of the ways that you can check it out is to take a look at the bill. 
Another way that you can do it is to hire a group of legal scholars who 
works for Congress, called the Congressional Research Service. They're 
not Republicans. They're not Democrats. They looked into this 
statement. What did they find in this?
  Under 3200--this is Pelosi's health care bill--the health insurance 
exchange would begin operation in 2013, and it would offer private 
plans alongside a public option. Then he goes on: 3200 does not contain 
any restrictions on noncitizens, whether legally or illegally present 
or in the United States temporarily or permanently, participating in 
the exchange.
  In other words, in spite of the fact that the bill says this 
shouldn't apply--and there is actually language that says it shouldn't 
apply to illegals--in practice, when you turn the bill on, there's no 
screening mechanism.
  Mr. GINGREY of Georgia. If the gentleman would yield, don't take that 
poster down just yet.
  If you'll notice, Mr. Speaker, on that poster, it is dated August 25, 
2009. In the Energy and Commerce Committee, H.R. 3200 passed committee 
on July 30, 2009. So this is an opinion rendered by CRS almost a month 
after that bill passed committee.
  Mr. FLEMING. If the gentleman would yield.

[[Page 22474]]


  Mr. AKIN. I yield to Dr. Fleming.
  Mr. FLEMING. There were also attempts by my friends, Dr. Gingrey and 
others, to actually say, well, okay, if this is fuzzy language and if 
we're going to debate this and say it's ambiguous and if some say it 
does cover illegals and some say it doesn't, let's just settle it by 
putting an amendment into the bill that will settle that for good.
  Mr. AKIN. Reclaiming my time, if the objective is that we're not 
going to cover illegals, if that's the objective, you are saying let's 
make it clear to everybody. We'll put a simple sentence or couple of 
sentences in the bill, and we'll make it clear that we're not going to 
cover illegals, and that's offered as an amendment.
  Mr. FLEMING. Yes.
  Mr. AKIN. How did that go as an amendment? Did it pass? I assume it 
passed.
  Mr. FLEMING. My understanding is the amendment failed according to 
party line.
  Mr. AKIN. A party-line vote again?
  Mr. FLEMING. Yes.
  Mr. AKIN. So we have the President saying we're not going to be 
covering illegal immigrants. In fact, the bill from a completely 
unbiased source says there is nothing in it to protect against that, 
and the amendment to specifically prohibit it was defeated on a party-
line vote. So that's why there's some tension on this subject, isn't 
there?
  Mr. FLEMING. Yes.
  Mr. AKIN. One person is saying something, and it isn't all 
necessarily so.
  Mr. GINGREY of Georgia. If the gentleman would yield for a 
clarification.
  Mr. AKIN. I yield.
  Mr. GINGREY of Georgia. On that very point that Dr. Fleming made, Mr. 
Speaker, in regard to the amendment:
  Back in July, during that 2 or 3 days of markup, that amendment was 
offered by my colleague from Georgia, the ranking member with 17 years' 
experience on the Health Subcommittee of Energy and Commerce. He 
offered that very same amendment, and it was rejected on party line.
  Mr. AKIN. Reclaiming my time, I appreciate, Doctors, your help. We 
have just a couple of minutes before I have to close, and I would like 
to correct one other thing. It's an assumption that has been kind of 
hidden in this debate over the months, which is that American health 
care is really cruddy and terrible and that it has to be totally torn 
down and rebuilt.
  Now, this summer, while we were debating this, my dear father, who is 
88 years old, went to a heart doctor. His original heart doctor had 
been diagnosed with cancer, and he retired. He goes to a new heart 
doctor.
  The heart doctor says, What has the doctor done for your heart?
  Dad says, Well, I'm getting these medicines.
  He said, But what did you do? Well, come in, he says, for a stress 
test.
  He went in for the stress test. Within a couple of days, he had 
scheduled an angioplasty. My father was put under anesthetic. They went 
in and looked around with their little camera. He came back out. They 
hadn't done anything. They called us in the office. I was with my dad 
on Monday. He's 88 years old.
  The doctor says, You need open heart surgery.
  He says, What are the numbers?
  The numbers are these, he said. There's a 10 percent chance for a 
major complication in open heart surgery. If you don't get it, there's 
a 50 percent chance you're going to have a major heart attack.
  So I'm sitting there with my dad and my mom in the office. The doctor 
says, When can we schedule surgery?
  He said, Tuesday or Thursday.
  That is tomorrow or two days. So we scheduled surgery. My dad had a 
seven-way heart bypass. He was home from the hospital on Saturday. The 
whole process took about 2 weeks, 2\1/2\ weeks, and he's doing fine. 
That's the miracle of American medicine.
  Let me explain one thing, which is, if you're some sheikh in Bahrain 
with unlimited money, where do you want to go to get your health care? 
To the good, old USA.
  I say to you doctors, Hats off for the great health care that you 
provide. Yes, there are some things that we can do to improve it, but 
it doesn't mean we have to burn the entire barn down.
  Mr. FLEMING. Will the gentleman yield?
  Mr. AKIN. I yield my last minute or so.
  Mr. FLEMING. Some might say that that's anecdotal, but let me point 
this out: for all cancers, 66.3 percent of American men and 63.9 
percent of American women survive. In Europe, it's 47.3 and 55.8. So 
we're not talking about just a single story like you gave, which, I 
think, is representative. What we're talking about across the board are 
statistically significant differences in cancer survival rates in the 
U.S. versus Canada versus Europe.
  Mr. AKIN. Let's do that statistic one more time, and we'll probably 
have to close up with that.
  In the U.S., your survival rate is 60-something percent overall.
  Mr. FLEMING. For all cancers it's 66.3 for men and 63.9 for women.
  Mr. AKIN. Okay. This is over 5 years?
  Mr. FLEMING. Yes, versus Europe, which is 47.3 percent.
  Mr. AKIN. So, if you've got cancer, you'll want to be in the good, 
old USA then.
  Mr. FLEMING. Absolutely.
  Mr. AKIN. Yes.
  I very much appreciate your all joining us tonight. I thank my 
colleagues and the American public for continuing this discussion on 
health care.
  God bless you all. Thank you.

       Dear __: With the media reporting daily on Congress' and 
     President Obama's efforts to enact meaningful health reforms 
     this year, many Humana Medicare Advantage (MA) members are 
     contacting us with questions. Members just like you want to 
     know what these reforms might mean for their Medicare health 
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     Advantage.
       We are working diligently to ensure that our nation's 
     leaders understand how proposed reforms might affect you. At 
     the same time, we have created the Partner program to keep 
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     officials. There are two things you can do now to help show 
     Congress the importance of Medicare Advantage:
       Opt into the Partner program. Becoming a Partner is easy. 
     Just complete the accompanying, postage-paid form and follow 
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     Advantage members who are receiving information about this 
     issue and learning how to get involved to protect your 
     Medicare health plan coverage.
       Let your Members of Congress know why Medicare Advantage is 
     important to you. Congress is considering significant cuts to 
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       On behalf of Humana's 28,000 employees, I would like to 
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           Regards,

                                         Philip Painter, M.D.,

                                            Chief Medical Officer,
                                                  Humana Medicare.

[[Page 22475]]

     
                                  ____
         Department of Health & Human Services, Centers for 
           Medicare & Medicaid Services, Center for Drug and 
           Health Plan Choice, Baltimore, MD.

                               Memorandum

     Date: September 21, 2009.
     To: All Medicare Advantage Organizations, Medicare Advantage-
         Prescription Drug Organizations, Cost Based Organizations 
         and Demonstration Plans.
     From: Teresa DeCaro, RN, M.S./s/, Acting Director, Medicare 
         Drug and Health Plan Contract Administration Group.
     Subject: Misleading and Confusing Plan Communications to 
         Enrollees.

       CMS has recently learned that some Medicare Advantage (MA) 
     organizations have contacted enrollees alleging that current 
     health care reform legislation affecting Medicare could hurt 
     seniors and disabled individuals who could lose important 
     benefits and services as a result of the legislation. The 
     communications make several other claims about the 
     legislation and how it will be detrimental to enrollees, 
     ultimately urging enrollees to contact their congressional 
     representatives to protest the proposals referenced in the 
     letter.
       Our priority is ensuring that accurate and clear 
     information about the MA program is available to our 
     beneficiaries. Thus, we are concerned about the recent 
     mailings as they claim to convey legitimate Medicare program 
     information about an individual's specific benefits or other 
     plan information but instead offer misleading and/or 
     confusing opinion and conjecture by the plan about the effect 
     of health care reform legislation on the MA program and other 
     information unrelated to a beneficiary's specific benefits. 
     Further, we believe that such communications are potentially 
     contrary to federal regulations and guidance for the MA and 
     Part D programs and other federal law, including HIPAA. As we 
     continue our research into this issue, we are instructing you 
     to immediately discontinue all such mailings to beneficiaries 
     and to remove any related materials directed to Medicare 
     enrollees from your websites. If you have any questions about 
     whether plan communications comply with the MA program 
     requirements and guidance and federal law, we urge you to 
     contact your Regional Office account manager.
       Please be advised that we take this matter very seriously 
     and, based upon the findings of our investigation, will 
     pursue compliance and enforcement actions.
                                  ____

         Department of Health & Human Services, Centers for 
           Medicare & Medicaid Services, Office of Media Affairs, 
           Washington, DC.

    Medicare Issues New Guidance to Insurance Companies on Medicare 
                                Mailings

       Medicare today called on Medicare-contracted health 
     insurance and prescription drug plans to suspend potentially 
     misleading mailings to beneficiaries about health care and 
     insurance reform. The Centers for Medicare & Medicaid 
     Services (CMS) recently asked Humana, Inc. to end similar 
     mailings. Humana has agreed to do so.
       ``We are concerned that the materials Humana sent to our 
     beneficiaries may violate Medicare rules by appearing to 
     contain Medicare Advantage and prescription drug benefit 
     information, which must be submitted to CMS for review'' said 
     Jonathan Blum, acting director of CMS' Center for Drug and 
     Health Plan Choices. ``We also are asking that no other plan 
     sponsors are mailing similar materials while we investigate 
     whether a potential violation has occurred.''
       Humana is one of a number of private health plans that 
     contracts with CMS to offer health care services and drug 
     coverage to Medicare beneficiaries as part of the Medicare 
     Advantage and Part D programs. CMS learned that Humana had 
     been contacting enrollees in one or more of its plans and, in 
     mailings that CMS obtained, made claims that current health 
     care reform legislation affecting Medicare could hurt 
     Medicare beneficiaries. The message from Humana urges 
     enrollees to contact their congressional representatives to 
     protest the actions referenced in the letter.
       ``We are concerned that, among other things, the 
     information in the letter is misleading and confusing to 
     beneficiaries, who may believe that it represents official 
     communication about the Medicare Advantage program,'' said 
     Blum.
       Specifically, CMS is investigating whether Humana 
     inappropriately used the lists of Medicare enrollees for 
     unauthorized purposes.
       Based on the findings of the investigation, CMS will pursue 
     appropriate compliance and enforcement actions.

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