[Congressional Record (Bound Edition), Volume 155 (2009), Part 18]
[House]
[Pages 24698-24705]
[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 gentlewoman from Maine (Ms. Pingree) is recognized 
for 60 minutes as the designee of the majority leader.
  Ms. PINGREE of Maine. Thank you very much, Madam Speaker. I am 
pleased to be here on the floor tonight with a gathering of my freshman 
colleagues. We thought we would spend our hour talking about the very 
important issue of health care.
  As everyone knows and as everyone sees in the newspapers pretty much 
every day, that is the topic on the mind of Congress and, certainly, on 
the mind of America. I know, for me, it's the issue I hear most about 
back in my district when I'm having a town hall meeting or am meeting 
with constituency groups--doctors, nurses, practitioners of any kind--
to talk about their concerns about health care. It's the number one 
thing people bring up to me.
  Certainly today, being from the State of Maine, the Finance Committee 
in the Senate--which isn't the House, but it's also going to eventually 
coordinate it with us--was voting out their bill. My colleague from 
Maine, Senator Olympia Snowe, voted in favor of the health care bill, 
making herself the first Republican to vote affirmatively on some of 
the proposals that we have before us. While she and I may differ on 
some of the policy issues, we all represent the State of Maine, and she 
spoke today about the great urgency of passing a piece of health care 
legislation. That is certainly of great concern to us, so I am glad we 
have an hour to talk a little bit about it.
  There is such a range of issues to talk about. I know I want to 
mention a little bit about some of the concerns about insurance 
companies and the importance, at least for me, of voting for a plan 
that has a very robust public option. Before I turn it over to one of 
my colleagues, I just want to tell a couple of quick stories about the 
issues that we have been facing in the State of Maine.
  Like a lot of States, we have a very small number of insurance 
companies. Many States find that 70, 80, sometimes more than 90 percent 
of their market is all taken up by one insurance company. I'm sure 
Representative Tonko from New York has some stories to talk about this 
as well and just about the issues that we have about why we need more 
competition in the market.
  Interestingly, in Maine, our Attorney General has just entered into a 
very fascinating case with Anthem Insurance Company. Anthem is one of 
the few companies that does business in the State of Maine, and they 
recently asked for a rate increase. I think they asked for 18 percent. 
The State granted them 11 percent. They turned right around and sued 
the State of Maine, and said, You know, if you're not going to give us 
what we need, we're going to have to sue you on this. I'm just looking 
here through my papers.
  I have some interesting information about just how much profit this 
particular company is making, and I will come across it in a minute 
here.
  What really struck me as profound is that many of my constituents' 
stories--as I mentioned, I run into constituents in the grocery store, 
everywhere I go, and certainly people have been contacting our office 
about the challenges of health care reform. Many of our constituents' 
stories are about the dealings that they have with their insurance 
companies. As somebody said to me recently, you know, insurance is 
great until you need it, and then 9 times out of 10, you find out that 
your company isn't there when you need it. Now I want to tell a couple 
of stories about what I've heard from my constituents.
  Representative Tonko, perhaps you'll want to weigh in on this 
conversation. Then we can go back and forth a little bit about what 
we're hearing.
  Mr. TONKO. Absolutely.
  Thank you, Representative Pingree, for leading us in this hour of 
discussion because there have been many elements of fear that have been 
introduced into the dialogue, into the discussion--into the debate, if 
you will--that have been intending to, perhaps, mislead and misinform, 
and that is not what America needs right now.
  America needs a thoughtful, very meaningful discussion on health 
care--how to provide for certainty for our business community with 
predictability in their insurance costs--because I do believe most 
employers want to cover their employees with a sound, basic health care 
plan. So we also need stability and security.
  I think I would share with you the sentiments that we need insurance 
reform to address the concerns of America--and not just for the 
uninsured and underinsured. This discussion is as much about those of 
us who have insurance in hand. The stability and the security of that 
plan is at risk, so we need to go forward so there is no discrimination 
for preexisting conditions.
  I have heard, and I am certain you have and our colleagues have heard 
in the freshman class and beyond in the greater audience of this 
Chamber. We have heard from constituents about the horror stories of 
premium increases over a short span of 2 years. I'm thinking of a story 
where there was a 37 percent increase over 2 years, which was the 
situation for a couple, a married couple, where the wife of that couple 
had been impacted by a catastrophic illness. They were left then, 
Representative Pingree, with $18,000 worth of medical bills. It is a 
growing dynamic of bankruptcy for our American families. Health care 
costs are driving families to the edge with bankruptcy.
  We are also in need of reform that will make certain that there is no 
dropping your coverage simply because you become ill. That has been a 
game that has been played on our health care consumers in this country. 
It needs to stop. Our conference, our House, wants to make certain that 
those are some of the conditions that are brought about in the 
insurance reform.
  The refusal to renew coverage if you become ill is another obstacle 
in the way of providing universal health care coverage.
  Obviously, a big dynamic is changing jobs, perhaps starting up a 
small business on one's own. Oftentimes, they are not allowed to happen 
out there simply because of the concern for the portability of 
insurance coverage. Many are

[[Page 24699]]

losing their jobs, and so 14,000 per day, if not more, are losing 
health care insurance because of the loss of a job. The list goes on 
and on. Making certain that there are no co-pays for prevention and 
wellness programs, these are concepts that are sound insurance reforms 
that can strengthen the system.
  Those who want to provide this message of doom and gloom and who want 
to use fear tactics are only taking us off track of what ought to be a 
very focused discussion on what needs to happen, because most world-
leading nations offer a tremendous health care policy, and this country 
is in need of that reform. We have been talking about it for decades. 
Now is the time for action.
  Ms. PINGREE of Maine. Will the gentleman yield?
  I just want to weigh in with a couple of thoughts about that. You're 
going through the litany of why we think it's so important to reform 
the insurance market, and so many of the things that you talk about 
are, again, the very things that I hear about from people. The issue I 
heard someone say the other day was ``job loss.'' Job lock. You know, 
people will say to me, I am ready to start my own business, but I don't 
dare leave my job because I can't go without the safety net, and I 
certainly couldn't afford to pay for these health care costs at this 
moment in time.
  I want to read you a little bit that I heard from a constituent 
recently, someone from York County, which is the southern part of my 
district, who told the story that very much echoes what you were just 
talking about.
  He was self-employed. He had a business he'd been doing for 10 years. 
His wife worked for a small nonprofit, and the nonprofit wasn't able to 
afford her health care coverage, so they did what a lot of people do, I 
find. They went to Anthem, which is the insurance company that we've 
been talking a lot about in my State, and their family of three--they 
have a 2-year-old daughter now--got an insurance policy that cost them 
$400 a month, but it also had a $15,000 deductible.
  Now, I hear about so many people who have this $15,000 in their 
deductible. It's really just kind of insurance for keeping your home. 
As you mentioned, it will keep you from going to bankruptcy court.
  So their $15,000 deductible actually amounted to a $30,000 deductible 
for their family. Basically, they just hoped that nothing would ever 
happen, because they didn't have the cash to pay the $15,000 or $30,000 
in medical bills that they'd have to pay to get up to their deductible.
  He told a story about how, when his daughter was born--their newborn 
baby--there were some complications, so they thought, well, at least 
we've got this insurance because, as we know, infant bills in the 
hospital can go very high if you have to be in the neonatal unit or 
anything else. Well, it turned out that his wife and daughter both had 
some medical issues, and they had gotten a specific rider when they'd 
gotten the health care plan, but it turned out that it only covered 
their daughter and not his wife. By the time they brought their baby 
home, they were $15,000 in the hole because of issues that had come up 
with his wife during childbirth, so they had to take money out of their 
401(k), and they had to borrow money on their credit card. They are 
just hoping that nothing else happens because they'd have to still pay 
another $15,000 in their deductible.
  Well, that's a great example of people who think they have health 
care coverage. They thought they got a special rider to make sure that 
pregnancy, childbirth--everything--was covered. It turned out it really 
wasn't there when they needed it. I don't know about you, but I hear 
about so many different people who go to look at their insurance 
policies and realize that there are all kinds of hidden issues or their 
insurance companies just say, ``Sorry. We don't cover you.'' That's 
just something we have to stop.
  Mr. TONKO. Absolutely, there is a confusion that exists out there, 
even with a lack of standardized forms, which is another tool that's 
used. So there is this confusion.
  There is this, I believe, deliberate attempt to make certain that 
there is a winner in this equation, and it certainly isn't the health 
care consumer. So many have been concerned about government standing 
between the patient and the doctor when, in fact, what we have today is 
the insurance company standing between patient and doctor, where they 
are limiting. That's why we're asking for reforms here which do not 
allow for cost caps on what insurance companies are required to cover. 
We don't want them to be stingy when it comes to providing the health 
care, especially in prevention and wellness modes, which are so very 
absolutely essential.
  There are out-of-pocket expenses. You talked, Representative Pingree, 
about the deductibles that this family in Maine had to absorb. We don't 
want that unlimited in nature. We want caps on what is required of our 
families out there--our working families across America--and we 
certainly want to make certain that the co-pays, especially in 
catastrophic situations, are capped for individuals and families. This 
is a great bit of service that we can provide.
  These whole trite sayings that we're bringing in a Halloween response 
and all of these individual statements that don't really get to the 
heart of the matter are disheartening. It's discouraging that there 
isn't that academic exchange here.
  Where is the counteroffer in this House? We have had plans out there 
for months. We've been talking about things, bringing them to hearing, 
having forums across the country. There is no alternative that's being 
offered. Maybe we heard things about status quo and leaving it as it 
is. Well, we even offer a capitalist model. We offer competition in an 
exchange that's developed in our bill to make certain that there is the 
hardiness of a robust, competitive model that is, I think, ``all 
American'' in its keeping.

                              {time}  2030

  Ms. PINGREE of Maine. Absolutely. That is why we are here tonight 
really to be able to engage in this robust public debate.
  Mr. TONKO. To dispel some of the myths and to cast aside the 
misinformation. The American public deserves better than that.
  Ms. PINGREE of Maine. Absolutely. I think first and foremost to be 
talking about the real issues.
  We are also joined tonight by another freshman colleague, 
Representative Jared Polis from Boulder, Colorado.
  Mr. POLIS. I thank my colleagues from Maine and New York. I was 
listening to your discussion, and it struck me how many of us, 
yourselves included, other Members, not only of the newly elected 
freshman class--but other Members of Congress--had town halls, listened 
to our constituents. We, in fact, heard some good ideas from folks back 
home, and I think we are working to incorporate those into the newer 
versions of the bill.
  One that a number of folks brought up in my meetings, and I know I 
wasn't alone, is why don't we encourage some interstate competition. I 
know that there are certain concerns that some of my colleagues have 
addressed about that with regards to how that might affect certain 
States, but there are ways that we can encourage, not create one level 
of Federal standards, but encourage States to enter interstate compacts 
to reduce the barriers of entry and bring down insurance costs.
  The other thing I was struck by, and this has also been alluded to, 
was the ill will on the other side. Rather than trying to get to 
``yes,'' it would seem like there are many in our country that are 
trying to stay at ``no,'' trying to stay at a ``no'' that is too 
costly, both in lives and money for our Nation to endure. There is 
plenty of room, as demonstrated, as again my colleague from Maine 
indicated, by her Senator today, in coming to the table, around common 
solutions that Republicans and Democrats can agree on. But it's 
critical that we approach this issue with the goal of getting to 
``yes.''
  Another thing, when I had people, just like other Members of Congress 
at our town hall meetings--and many of them were so vociferously 
opposed to

[[Page 24700]]

any reform, many of them were for any reform and some of them were in 
the middle. The one thing I tried to leave the people that were opposed 
to reform with was if you are going to oppose this set of health care 
reforms, fine, but please oppose it based on something that's in it 
versus something that's not in it. Because how frustrating is it to 
have to deal with mischaracterizations and, indeed, lies about the 
actual content of the bills that we are debating.
  With regard to whether, in fact, there are Federal subsidies that go 
to our undocumented population. No, there aren't. There is not even 
room for discussion there. I, personally, would like us to do more for 
our undocumented population in this bill. We are not. We are going to 
deal with that through comprehensive immigration reform, which I am a 
strong supporter of, next year.
  With regard to death panels, there are none in this bill. I have 
constituents contacting me. They have heard these things on right-wing 
Web sites. They have had people email them to them.
  I had one contact me yesterday saying the government is going to send 
people to my home to look at my kids, because they had a complete 
misreading of some part of the bill that had to do with funding for 
State pilot projects for home visitation, for people who want home 
visitation to help them with their health issues. This is information 
out there that is really not a credit to this honest public discourse 
and debate, which my colleague from New York alluded to, which is 
critical to have to come to a solution with regards to reducing costs 
and improving health care outcomes.
  I am optimistic. The signs out of the Senate today are that this is 
truly officially, not only in name, but, indeed a bipartisan effort, as 
it should be, something of this magnitude. We are taking our time, and 
we are doing it right. We are 4 or 5 months into a debate that will 
take another month or two to reach culmination. Again, there is no 
veracity in people saying this is being rushed through in any way, 
shape or form.
  I told my, again, constituents in Colorado our United States Congress 
has spent more time on health care reform than our legislature of 
Colorado meets for an entire year. They meet for about 4\1/2\ months to 
consider every single issue that the State of Colorado faces. Our 
United States Congress, and many of us who come to Congress from a wide 
variety of disciplines, have had the time to become experts in health 
care.
  That's something that we owe our constituents. I certainly know a lot 
more about health care than when I first got here. I had been expert in 
education, had run schools, been on a school board. I had started 
businesses, knew a lot about the business side. As a consumer I knew 
about health care. I had been on the board of a nonprofit relating to 
health care in Colorado.
  But to get down into the weeds and have this historic once-in-a-
generation opportunity to make a real difference in the lives of 
Americans is what public service is all about. That's why I join you in 
being excited about this tremendous opportunity that's before us at 
this point.
  Ms. PINGREE of Maine. I am pleased to see that we are joined by our 
colleague from Wisconsin, Representative and doctor, if I am correct, 
Steve Kagen.
  Mr. KAGEN. Well, it's a great honor to join you here on the floor to 
talk about health care and about making progress, making progress where 
for nearly a century, since 1910 when Teddy Roosevelt first suggested 
the idea that we should have some kind of national solution for health 
care, we are finally taking up this conversation.
  As Mr. Polis mentioned, this is the most important conversation we 
are going to have this century. So we are taking our time. We are going 
to get it right. We are going to fix what's broken; we are going to 
improve on what we already have and make sure it's at a price we can 
all afford to pay. Where I come from, having practiced medicine for 33 
years, I am always focused on the patient, much like we are all focused 
on our constituents. And you can imagine how I felt when my patients 
couldn't afford their prescription drugs.
  Now, what good is it to be a doctor if you are writing a prescription 
that the patient can't handle financially? What's wrong with a system 
where we continue to allow the Wall Street corporations that run health 
care today to discriminate against people because of the way they are 
born or because of a preexisting medical illness?
  I will submit to the jury, if you were a jury, this little piece of 
evidence: I won't mention the insurance company, blank has great news 
for people who buy their own health insurance. They have got something 
for you, all right.
  But then on the inside, I am going to read it into the Record: 
``Important information about preexisting conditions. Although we make 
every effort to extend coverage to all applicants, not everyone will 
qualify. If you have had treatment for any of the following conditions, 
you may not qualify for the coverage being offered: AIDS/HIV, alcohol 
or drug dependence, cancer, chronic obstructive pulmonary disease 
(COPD), connective tissue disorder, Crohn's disease, diabetes, 
emphysema, heart attacks or stroke, hepatitis (chronic) or liver 
disease, inpatient emotional or mental illness, organ or tissue 
transplant, ulcerative colitis.''
  It goes on to say: ``You should also be aware that we may not be able 
to provide coverage to individuals who are severely obese, severely 
underweight or who are undergoing or awaiting results of diagnostic 
tests, treatments, surgeries, biopsies or lab work. We cannot offer 
coverage to expectant parents or children less than 2 months old.''
  And here the closing sentence: ``This list is not all inclusive; 
other conditions may apply.''
  I am so proud to be working with the President who understands that 
this form of discrimination has got to come to an end. That is why in 
the House bill and every version we have seen, that is why in every 
Senate bill, there is the language that will bring an end to this form 
of discrimination.
  What we are about to do is very historic. We are going to apply our 
civil rights that we fought so hard for in the 1960s to the health care 
industry. No longer will any kind of Wall Street corporation be allowed 
to discriminate against people, not because of the color of their skin, 
but because of the chemistry of their skin. Not because of what they 
are thinking, nor on the basis of how they think, the chemistry of 
their mind.
  In my mind, bringing about no discrimination in the health insurance 
industry, in health care throughout this country will transform our 
economy, because it will begin to lower prices for everybody, making it 
possible for small business, the real economic engines of America, to 
employ people to be more profitable and to move our economy out of this 
economic ditch we find ourselves in. But there are three things that 
must be in this bill, number one is no discrimination against any 
citizen due to preexisting medical conditions. If you are a citizen, 
you have to be in the risk pool. You have to be in your neighborhood.
  Secondly, there should be complete transparency of all prices in 
health care. Openly disclose all the prices at the hospital from the 
insurance coverage, openly disclose the prices at the doctor, the 
dentist, anything that's health care related, be it a product or a 
service. Show me the price. Please openly disclose your price and then 
accept from anybody at your store as payment in full the lowest price 
you charged and accepted as payment from anybody else. The lowest price 
should become everybody's price.
  The third thing that we need--and hopefully it will be in this next 
version that we are going to see shortly we have to establish a 
standard health care plan--a standard plan such that Humana, United, 
CIGNA, Aetna, Blue Cross, WellPoint, whatever point, whatever insurance 
company are you are, when you are selling the same basic standard plan 
within a very large risk pool, you have to show me your price, and we 
will begin to have competition where insurance companies are going to 
compete to the lowest price and the highest quality.

[[Page 24701]]

  We will finally be able to compare these corporations, apples to 
apples. That's the moment I think we will really see the benefits that 
we need. Improve the quality at a lower cost. No discrimination, 
complete, complete openness in transparency and pricing and a standard 
plan.
  I think we are making progress; I don't think we are there yet. I 
think we are going to make that progress and, in my limited experience 
as a Congressman, more so as a physician, this place doesn't work well 
when it happens very fast.
  I am very pleased that we are taking our time to get it right. I look 
forward to finding Republicans, Independents, Democrats, and, yes, the 
Libertarian people that are here in this House to vote for a bill that 
moves us down the road.
  Ms. PINGREE of Maine. It's wonderful to have both your experience as 
a physician and also your experience in the House in moving forward on 
these issues. I know you have been working very hard.
  I just want to mention that we are also joined here tonight by Mary 
Jo Kilroy from Ohio, who is another new member of the House. Being from 
Ohio, I know you must have a lot of constituents who are worried about 
economic issues and jobs and making sure that they have that all-
important insurance coverage and are able to keep their jobs to have 
it.
  Ms. KILROY. I appreciate this opportunity and thank you for your 
leadership in bringing us together tonight to talk about how health 
care issues affects our districts and what we are going to do about it. 
I have heard some of my colleagues, Representative Polis, talk about 
people being concerned that we are rushing this through. I think we 
have been taking quite a bit of time, dedicating hours and hours of 
time in committee hearings, in caucus meetings, in markups, on this 
issue of health care.
  In my case, in my own district, I have been holding health care 
meetings, round tables, discussion groups, getting input from my 
constituents since February. Every time I go back to the district, 
meeting with doctors, meeting with nurses, other kinds of health care 
professionals, talking to school nurses, talking to small business and 
holding the small business round table about what they are going 
through with respect to health care, and it's very clear to me that 
this is an issue that needs attention. It's a problem, but it's also a 
problem we can solve, we can solve working together.
  I also, listening to Dr. Kagen on the issue of preexisting condition, 
couldn't agree with him more. Many of the stories that I have heard at 
those various health care meetings and round tables involve people with 
preexisting conditions, and there is this misconception that young 
people don't get sick. It's only the older people who are the ones that 
really use health care. But I discovered at several of these round 
table meetings situations where young women, in this case, had received 
diagnoses of cancer. Because they were self-employed, because they were 
between jobs, they found that they were excluded from the health care 
system.
  As a mother, I can't think of anything more terrifying than to have 
your daughter come home telling you that and knowing that they didn't 
have health care and how were you going to make sure that she got the 
care that she needs. It's a story that I hear time and time again.
  A small restaurant owner, whose wife has lupus and that the insurance 
companies have priced their small group out of his ability to pay. As a 
result he was losing one of his key employees to somebody else who 
could get health care for her.

                              {time}  2045

  Another small businessperson who had had a heart attack, this person 
is a little bit older than the young woman I talked about, but his 
small business was hurting. Because of that experience they have been 
rated so high that they are having a harder and harder time paying for 
health insurance for himself, his family and his employees. It is a 
critical issue in my community, and we can address this key issue of 
ending discrimination against people with preexisting conditions.
  It is not just these stories, these experiences that people have told 
me about. I have also heard it from our Department of Insurance 
commissioner. She tells me that in the State of Ohio, she has got a 
single-spaced list, three columns, three pages long, of various 
conditions that the insurance companies have used to deny Ohioans 
coverage based on a preexisting condition. Some of them you have heard 
from, Dr. Kagen, but some of them are also pretty absurd.
  For example, acne was on that list. And today, if you saw some of the 
news on television, you saw a baby that looks like the stereotypical 
Gerber baby, in the 90th percentile on height and weight, excluded from 
health care because the insurance company decided that this baby, this 
perfectly healthy baby, had a preexisting condition. They determined 
that that baby was, quote-unquote, obese. The absurdities that the 
health care industry has used to exclude coverage from people who use 
it, who need it, is why we have health care.
  This is a very personal issue. If I were to not work here in a 
situation where there was group coverage that I could buy and pay for 
on an exchange like we have here in Congress, whether I left this job 
voluntarily or involuntarily, I don't think I could go into the private 
market and buy an insurance policy for myself, because I have a 
preexisting condition called multiple sclerosis.
  So there are so many people and many women, men also, who are 
excluded for this problem, and now we find out it is even babies. So we 
could fix this.
  Mr. TONKO. Representative Pingree, I can't help but wonder if that 
isn't the most classic and bold example of cherry picking. When I 
listened to Representative Kagen list that number of conditions, 
preexisting conditions, it excludes a great part of the populace out 
there. The time for these games is over.
  We talk about so many of the people that might be impacted by these 
preexisting conditions, from toddlers, over to middle age, and yes, 
even to our seniors.
  When I was in the State assembly in New York State for 25 years, for 
the longest time I represented the largest per capita senior population 
of any assembly district of the 150 in New York State, so I would hear 
routinely from seniors. I hear from those same seniors now in this 
congressional district, and there is concern. There is concern about 
where their future is going with health care reform.
  Well, let me remind all of our seniors out there, this whole process 
here in the House is about providing stability to Medicare. That is an 
audience that is critically valuable to this country, people who worked 
through their lifetimes and now deserve--I think it is an American 
right--quality health care.
  When people talk about fear tactics, telling people that your 
Medicare coverage is going to be weakened, let me remind everybody that 
the cuts in Medicare were up to 21 percent for next year for our 
medical community. This bill stops that. Our bill, our final package, 
will stop that sort of cut. Those payments to physicians would have put 
the doctor-patient relationship at risk. It would have reduced 
accessibility for our Nation's seniors. We will avoid that cut. We will 
provide stability by addressing the solvency of the trust fund for 
Medicare.
  We will go forward and close that doughnut hole. No one, these 
critics about this process, about the proposals that we have put forth 
to the American public, the critics that are there now, especially in 
the political arena, where were they when we played games with the 
pharmaceutical industry and created a doughnut hole where coverage 
stopped automatically and then resumed later after we have again 
impacted financially our senior population?
  You talk to seniors, many of them naturally are in need of 
medications, of pharmaceutical requirements. Why we would exhaust them 
financially for that basic core need of health care is

[[Page 24702]]

beyond me. No one talked about that pricetag. No one talked about the 
billions of dollars we were going to cost the public and what we paid 
to the industries to do that.
  So there is a chance here to turn that around and close that doughnut 
hole. I don't know what we are going to call it. A jelly donut? We fill 
it with good, you know, so that people can then have the kind of health 
care and the pharmaceutical needs will be addressed. That is a basic 
stability enhancement that is provided with this measure.
  Avoiding the 21 percent cuts to physicians is an enhancement. Making 
certain that we provide these new models for efficiency; effective use 
of dollars; making certain that home models, medical home models, can 
be utilized, these are good concepts. And we want to go forward with 
the sounder Medicare situation, especially with the coming of the baby 
boomer generation. Everyone has talked about that. We need to make that 
part of our plan. It is part of our plan, where we provide stability 
and solvency for Medicare.
  Ms. PINGREE of Maine. I want to give a few minutes to my colleague 
from Colorado, but in making this transition I just want to say when we 
stand around and talk about the possibilities when people share their 
individual stories like Representative Kilroy has here, I get very 
excited thinking about the prospects here.
  You mentioned it earlier. Sometimes we are bombarded from the other 
side and the talk show hosts and everyone else who just try to use 
scare tactics, build up fear in our constituents and seniors and 
others. But I get excited when I think about, wow, we could really 
reform the system. We could do something around access to health care 
that people have been talking about doing for decades, and this could 
be the Congress that really starts making those steps forward.
  I think that is why we are all standing here tonight and working so 
hard on this, because we see the possibilities here of really changing 
people's lives and ending some of these ridiculous stories that we have 
been hearing.
  Mr. POLIS. To build upon what Representative Kilroy and 
Representative Kagen said with regard to the critical nature of 
preventing discrimination based on preexisting conditions and 
exclusions based on preexisting conditions, it is important for those 
watching us today to know that that is in all four bills--sorry, all 
five bills. There are five health care bills; two in the Senate, both 
of which have cleared committee, and three in the House, all of which 
have cleared committee.
  Every single bill, any of the health care reform proposals that is at 
all consistent with President Obama's principles and our principles 
here in the House as well as the other body would make that basic major 
change, that no longer would people be excluded based on preexisting 
conditions or would those conditions be excluded.
  I applaud Representative Kilroy for sharing her very powerful 
personal story. It is a personal story that is all too common. Later on 
tonight, in about an hour and a half, I will be sharing a couple-dozen 
personal stories from Colorado with members of the public with regard 
to the travails that many of my constituents have had with the health 
care system, many of which relate to discrimination based on 
preexisting conditions.
  Representative Kilroy also discussed briefly small business. One of 
the most important things that we can do to make small business 
competitive in this country is to reform health care. The brunt of our 
health care system falls on small business. Frequently for the same 
coverage, they pay more than large businesses. If they have somebody in 
a small risk pool who has a problem or has a preexisting condition, 
they might be paying three or four times as much even for their healthy 
employees because of their small risk pool.
  We are joined today in the House gallery by a small businessman from 
my congressional district. Mr. Wayland Lewis, who is with us here 
today, runs a small online publishing company. What a difference 
affordable health care would make to him and the countless small 
business people like him across the country that are the backbone of 
the American free enterprise system, for them to have access to 
exchanges, the same way we here in Congress do, the same way that big 
multinational corporations do, one large risk pool, no discrimination 
based on the preexisting conditions in a small risk pool, and also some 
tax credits, by the way, for providing health care for their employees. 
What a difference that would make and what a job-creation engine in 
this time of recession, to have that vote of confidence in our small 
businesses and allow them to do what they know is right.
  When I talk to small business people in my district that don't 
provide insurance, it is not because they don't want to. It is not 
because they don't feel they could be more competitive in attracting 
employees if they did. It is because they simply can't afford to under 
the status quo. That is one of the major tenets of this reform: Making 
America healthier, costing less, and, yes, providing the same kinds of 
advantages for small and medium-sized businesses that big multinational 
corporations have had all along, and being able to offer health care 
and security for the families that work for them.
  Ms. PINGREE of Maine. Thank you for your thoughts.
  We are lucky to be joined freshly off the podium by our colleague 
from Pennsylvania, Representative Dahlkemper, who I know has been 
working very hard on this issue in a variety of ways.
  Mrs. DAHLKEMPER. Thank you, Representative Pingree, for allowing me 
to join you and my other colleagues here tonight as a fellow freshman. 
This is certainly an historic time for us to be new Members of 
Congress, as I think we are working on probably the most important 
piece of legislation that we will probably ever take up within our time 
here in Congress, something that touches every American, something that 
touches every one of the constituents in our districts.
  I, like so many of you, spent my entire August going out and talking 
to my constituents. We, as the freshmen, were actually a pretty strong 
group that slowed down the vote on this bill. So when people say that 
we are rushing this legislation, I say, no, we actually slowed it down 
quite significantly. But I think that was great, because it gave us 
time to read the bill, really understand the bill, and, as 
Representative Polis said, learn more about health care. We all have 
learned a lot over these number of months as we have been here together 
day after day talking about health care.
  When I talk about health care reform, when I am out in my district, I 
talk about the fact that it is really a human story, and we all have 
our stories. One of the most poignant for me was a gentleman who came 
up to me, actually as I was on one of my congressional bike-and-hikes, 
because I like to really talk a lot about wellness and prevention, so I 
am trying to promote that by promoting the great resources in my 
region, bike paths and hiking areas. So we do these bike-and-hikes.
  He came up to me on his bike and said that health care was his number 
one issue. I asked him to explain to me, and he told me about the great 
health care insurance he had with his company. He worked for a very 
large corporation. But his daughter, when she was 20 and she was in 
college, she was diagnosed with acute myeloid leukemia.
  The treatment for that is very harsh. You end up being put into 
intensive care, and it really debilitates you as you go through this 
series of chemotherapy treatments. She had to drop out of college. And 
guess what happened as soon as she dropped out of college? She was 
removed from their insurance.
  So this is the kind of thing that we see over and over again. That is 
just one of many, many stories that I have heard, and I know all of you 
have heard.
  Today actually it was announced we are putting a provision in this 
health care reform where young people through 26 years, up to their 
27th birthday, will be able to stay on their parents' health care 
coverage if they don't

[[Page 24703]]

have another opportunity, if they don't work for a company that offers 
coverage. As we know, many young people in those early years, whether 
they are going to school, when they get out of school, don't get that 
first job that offers coverage, or can't find a job right now, as we 
know many of them can't, or maybe have other things that they want to 
pursue. It allows them to stay on their parents' coverage up to their 
27th birthday. I think that is a great piece.
  When I was done with the press conference about this, one of the 
cameramen who had been there told me that was the best thing he had 
heard in all the years he had been covering the news here at the 
Capitol, because he has a son who works for a very large corporation, 
19 years old, done with school, who did not have health care coverage. 
He was walking across the street and got hit by a bus, and just the 
cost that this has been to the family of this young man.
  So we are still working on this bill, and I think that is important 
for the American people to know, that we are continuing to work on this 
bill, to make it better every day so that when it comes to the House 
floor and we go to vote on this, we are going to be making such 
significant changes for this country, significant changes for these 
young people, who, as we know, 31 percent of them are uninsured, those 
in their twenties. We are going to be making significant changes for 
our seniors who are going to have their preventative services, for 
example, covered with no copay. We are going to be making significant 
changes for our small businesses, and as a small business owner, I know 
how important this reform is.
  In Pennsylvania, my State, only 51 percent of our small businesses 
cover their employees with health care coverage, and that is because 
they can't afford it. As Representative Polis said, it is not because 
they don't want to do it; it is because they can't afford the increased 
costs.
  So I want to thank you for letting me join you tonight and talk about 
this very important issue that we are continuing to debate and move 
forward really for the future of this country. I am just proud to be 
down here right now and proud to be with all of you serving and making 
this happen here.
  Ms. PINGREE of Maine. Thank you for adding your thoughts. Certainly 
those are themes that we hear about a lot. One is this important point 
that every single day in this Congress there are people working on one 
or another aspect of this bill, trying to put together all of the good 
ideas, trying to make sure that we come to some form of consensus over 
the variety of opinions.
  But your mention of the issue of young people who don't have coverage 
is a story that we all hear about often, and many of us who had our own 
children in their twenties have known that tragic moment when they turn 
23 or they end college and they are no longer covered by your plan. 
And, as you said, in today's job market, many young people don't have 
coverage or work for a company that doesn't find themselves in a 
position to cover them. So it is increasingly an important issue, and 
one I think the people are trying so hard to work on.
  Also this issue that others have already brought up tonight, I am 
also a small business owner, and the cost of coverage--I heard a 
statistic in the State of Maine that the average cost of covering your 
employees is about equal to the profit you make in your small business. 
And that is lucky for some small businesses, if they can even make as 
much profit as they are paying out every year in employee coverage.
  As you mentioned, it is important to make sure you cover your 
employees. Many companies can't afford it, and often you lose employees 
to somewhere else where they can go to get that coverage. So you might 
have a great worker, and you may lose them if you don't find a way to 
keep them covered, which is getting near to impossible with the rising 
cost of insurance, as we have talked about many times.

                              {time}  2100

  And I often think about my own State. We're 38th in per capita 
income. The economy is struggling. Our unemployment rate is right up 
there with a lot of other States in this country, and we're just hoping 
that we can start to bring it down. But the fact is, if we could pass 
universal access to health care coverage, it would be the single 
biggest change to my State's economy and I certainly think this 
country's economy.
  Mr. TONKO. Representative Pingree, I think that obviously there is a 
lot of discussion and a lot of focus on the cost. I think across the 
country, 15 years ago 61 percent of our small businesses provided 
employer-based health care. That's somewhere below 38 percent now. We 
hear the average cost of a family plan might be 12,000, 13,000, 
sometimes rising to 14,000, and people have seen record profits in the 
industry.
  We've seen and heard about the insensitivities here this evening 
anecdotally from various Members. You know, Representative Dahlkemper, 
Representative Kilroy, and yourself have all talked about these 
information tidbits that come our way. But I think what really struck 
me this weekend was the report that was released by America's health 
insurance plans, where they actually worked out a study, a report, 
commissioned a report, and they overstated the impact of the Senate 
finance bill that was voted upon today to overstate the impact on 
America's families of that plan. That's one solution that's out there. 
And I found it interesting that the firm that they hired to do the 
study actually backed away from the report because they said they 
fragmented it so. They asked them to do just tidbits, portions of that 
whole bill and then use that to calculate the impact.
  So it shows us, it tells us something that we're on to wringing the 
cost, the excess cost and the inefficiencies out of the system to the 
point where it's driving corporate greed to now respond in a way that's 
manufacturing these price tags that are, again, scare tactics to get us 
off of just and honest debate. And I think that that needs to be shared 
with the American public. The tax foundation came out with a plan, a 
review that said that our health care bill will save families, average 
working middle class families, $1,900 per year.
  Now, when they came up with this other study, when they fragmented it 
out, they didn't allow for the calculation of savings, corresponding 
savings that are part of the overall huge package of reform. And so it 
was, again, disingenuous. It was unfair to put something like that out 
there. But it does tell me, in very bold and noble terms, that there's 
fear out there that finally there may be a balancing of the scales, 
where the public will get their shot at good health care insurance 
reform and not at the expense of greed that has been allowed to run 
rampant, I think, for a long time.
  Ms. PINGREE of Maine. I just want to bring up one tidbit, and then I 
know that my colleague from Ohio has a couple of things to say. But 
when I first came to the floor tonight, I was talking a little bit 
about Anthem in our State which is actually owned by WellPoint. And I 
don't want to make any particular insurance company the villain, but 
often we're told, you know, why don't you just leave the system alone, 
yet day after day we hear about insurance companies that cancel your 
insurance and a variety of other things. And I had just been mentioning 
a case that's going on in the State of Maine.
  Maine was asked by Anthem for an 18.5 percent rate increase, and the 
State said no, something about 11 percent might be more moderate, just 
trying to hold down the cost for small business and individuals. Well, 
Anthem immediately sued the State and said they needed that full amount 
to earn a reasonable profit. Of course, WellPoint last year earned $2 
billion and paid $1 million in bonuses to many of their executives in 
our State.
  So you've got the people in our State, 38th in per capita income, 
many of whom have recently lost their jobs, saying, Wait a minute. I 
can't afford this increase, yet I can't afford to be

[[Page 24704]]

without health care coverage. And here's a company that earned $2 
billion last year telling me they can't live without making more in 
profit.
  Well, this system just doesn't seem to make any sense to me. I mean, 
it's one thing when you're talking about making Rolls-Royces or fancy 
diamond rings. Maybe you deserve to make exorbitant profits, and we 
don't need to meddle in the economic system there. But this is about 
basic health care coverage for individuals, and that's really what 
we're charged here to do--make sure that everybody, whatever their 
condition, whatever their age, has that kind of health care coverage.
  And I have to really hand it to our Attorney General, Janet Mills. 
She was on CNN the other day talking about how we're going to fight 
this. We're not going to take this, and, you know, that's not a 
position our State should have to be in. That's not a position 
individuals should have to be in, you know, just to get their basic 
health care coverage.
  Ms. KILROY. Well, Representative Pingree, I agree with you. And I 
think what you heard from Representative Tonko and what you've pointed 
to, but what Representative Tonko was talking about the public 
relations offensive that the health care insurance industry launched 
today is another example the kind of fear tactics that have been used 
all summer long regarding this health care debate. This is the latest 
example of it, that it's going to cost you more money somehow or other.
  But we can hold down health care costs with this bill, and I think 
the best way to do that is to have a robust public option to get 
competition so the Anthems or the WellPoints or the UnitedHealthcares 
or whoever have something to compete against and that we, as consumers, 
have something that we can go to instead of one of the expensive health 
care plans that use these scare tactics, that raise rates, double-digit 
inflation year after year after year, while making the kind of profits 
that you were talking about, and yet millions of people in this country 
doing without basic medical care, medical needs. We need to stand up to 
that.
  Mr. TONKO. And I think, Representative Pingree, I think when we heard 
Representative Kagen, Dr. Kagen speaking about a standard, basic 
package that would be required if you want to participate in the 
exchange, how about, you know, the medical loss ratio that has dwindled 
over 15 years from 95 percent return of all premiums collected going 
back for health care purposes to now something below 85 percent, below 
80 percent, perhaps. That is unacceptable.
  So the standards that we establish, you know, having this medical 
loss ratio defined, if you want to participate, basic core package, if 
you want to participate, hey, this is open to any and all. Government 
sets up the exchange. It stays out of that. The public option will have 
to sustain its own entity by its premiums. It will have to maintain a 
reserve. That is not what I would call unfair competition. They're all 
going to be operating under the same guidelines. And when we sharpen 
that pencil by requiring a robust public option, it drives the bottom 
line benefit for the consumer.
  We talk about small business and impacts and the future forecast and 
projections on insurance, today I think of some 430 billion that is the 
price tag paid by small business for health care provided by the 
employer. In 9 short years, absent nothing, that is supposed to go to 
$880 billion. This is a train wreck waiting to happen. And when you 
hear the options, when you hear status quo is the option that we should 
exercise, when you hear let's keep the system but provide more tax 
benefits so that employers can afford this, how much more is government 
going to write in terms of checks to keep this system going that is 
sweeping upward in a curve? We're not containing the costs at all.
  So this measure, to Representative Kilroy's comment, is an important 
way to contain costs, to Representative Dahlkemper's statement of 
wellness and prevention, by not allowing for copayments on those 
elements of the plan, that's an important bit of progress. And so I 
challenge anyone, come in here, talk facts not fiction. Come in here 
with sensitivity, not insensitivity, and let's really put this package 
together. It's a work in progress. It's been tremendous.
  I'm seeing the benefits that the freshmen class has brought to this 
discussion. I think it's uncluttered thinking. We've brought the debate 
into, I think, a really good setting so that we can move forward by 
adding our voices to this effort, and it's really a pleasure to work 
with my freshmen class.
  Ms. PINGREE of Maine. Well, thank you so much for being here. I know 
our hour is getting close to ending, and I appreciate your 
characterizing our thinking as uncluttered. I have to say sometimes at 
night, even the freshmen start to clutter up a little bit.
  But I know, Representative Dahlkemper, you've done a lot of work 
around this wellness initiative, and that's something that I hear about 
really across the board from people who think that's a great way to 
hold down costs in health care. Many of the businesses in my State that 
have adopted wellness programs have really seen cost reductions, and I 
know you can speak to this.
  Mrs. DAHLKEMPER. If the gentlelady would yield, I think that wellness 
and prevention is such a large component of this bill, and that is 
something I don't think we talk enough about. And really, as we look, 
people say to me, well, everyone can get health care in this country. 
They just go to the emergency room. Well, the emergency room is illness 
care. It's not health care. And what we're trying to do with this bill 
is actually go back to treating wellness and to treating health, not 
just treating illness, which is really what so many people in our 
country have to live with. They just wait until they're so sick they 
have to show up at the emergency room.
  And just on that point, I just wanted to make one other comment about 
a subject that I don't even hear talked about that much. But the 
largest hospital in my district told me that they had budgeted $30 
million for charity care this year. It's going to be at least 50 
million. There is no way that they can sustain this year after year 
after year. So that's just another piece to this entire issue that we 
don't talk about that often, but our providers are having trouble, 
along with our businesses and, certainly, along with individuals.
  So we do have a great wellness piece. We've been working on putting 
more wellness pieces into this bill. Again, we're continuing to work on 
this. We're looking at grants to go to communities to bring 
stakeholders together, to bring government and schools and the 
providers and businesses to work on things such as childhood obesity, 
which we know is an epidemic in this country.
  So there are still a lot of good things being worked on. This bill 
gets better and better by the day, and I believe we, again, are at a 
historic point here and we are going to be able to just provide 
stability and security to this country in terms of our health care. 
And, to me, we have to continue to sharpen our pencils, as 
Representative Tonko says, and continue to find ways to save with this 
bill and also to provide even better care for citizens of all ages.
  Ms. PINGREE of Maine. Absolutely.
  Representative Kilroy, were you hoping to squeeze in a few last 
words?
  Ms. KILROY. Well, I think this bill is an opportunity for us to make 
health care affordable for all Americans, including seniors who've been 
made to fear this bill. As Representative Tonko said earlier, helping 
them by closing the Medicare doughnut hole, helping them by eliminating 
copays for preventative services and testing and helping to make sure 
that there are lots of Medicare providers out there, because we are 
stabilizing the payment schedule for those providers.
  This bill will help us by shifting the emphasis more onto prevention 
and wellness, the way Representative Dahlkemper talked about putting 
more emphasis on primary care and doing that by shifting the way some 
of the payments are set up so that primary care doctors are paid for 
what

[[Page 24705]]

they do so well, for counseling, for listening, for taking that history 
and helping keeping us well and treating those concerns that we all 
have from time to time.
  This bill will help us contain costs, help small and large business, 
help people who are without insurance and help people with insurance. 
And as Americans, this is an American plan. It's very important. It 
will continue to give us a choice of doctors and plans. So this is a 
huge achievement if we can get this bill passed. It is a great time to 
be in Congress, be a part of this wonderful discussion and 
deliberations and, I hope, eventually final passage of a bill that will 
do so much for so many people in our country.
  Ms. PINGREE of Maine. Representative Tonko, any last words?
  Mr. TONKO. Just a quick statement. I know we're running to the end of 
our hour.
  Representative Dahlkemper talked about the concern at her local 
hospital. Across the board, hospitals are concerned, and uncompensated 
care is at somewhere between $57 and $58 billion a year. There's a 
savings immediately when we put together quality health care programs 
that are affordable, accessible, where we're providing universal health 
care. It's just a reasonable thing to do, and most importantly, it's 
the compassionate thing to do. Sometimes that gets lost in the 
discussion.
  There's this moral compass for America that we need to engage and we 
obviously are very proud to support what is the correct thing to do, 
and we have that responsibility here to enable all families in this 
country to have access and to be able to afford quality health care.
  Thank you so much for bringing us together, Representative Pingree.
  Ms. PINGREE of Maine. Well, thank you to all my colleagues for being 
here tonight. You're absolutely right. We've talked about a variety of 
issues, and I want to just end on the same note that you did. This is 
what is right about being an American and what we're all proud to be 
working on, even if it takes a few long hours and a lot of tussling 
back and forth, but we're all grateful to be here and actually to have 
this opportunity.

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