[Congressional Record (Bound Edition), Volume 155 (2009), Part 18]
[House]
[Pages 24816-24824]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Texas (Mr. Burgess) is recognized 
for 60 minutes.
  Mr. BURGESS. I thank the Speaker for the recognition.
  Mr. Speaker, I come to the House floor tonight to talk a little bit 
more about health care. It is, it seems, the number one topic of the 
day here in Washington, D.C. It's interesting because probably 50 
percent of Americans care more about what we are doing as far as job 
creation, and 14 percent are concerned about health care. You would 
think that we would adopt the Bill Clinton phrase of ``focusing like a 
laser beam'' on the economy and ``focusing like a laser beam'' on job 
creation. But health care is important, and it is appropriate that we 
spend some time discussing it because, likely as not, before the end of 
this month, certainly before the end of this year, it is possible that 
some type of bill will pass this House, although it may not be to the 
liking of a great number of Americans.
  Mr. Speaker, I know that my comments must be directed to you and not 
to others, but I would say, Mr. Speaker, that if I were able to talk to 
people about what they could do, a plan for action, I will be 
discussing that toward the end of this hour.

                              {time}  1830

  So I do encourage people to stay tuned to this debate--not 
necessarily to this discussion this hour--but stay tuned to this debate 
because it is important. It is going to affect the lives and 
livelihoods of Americans from this day forward for a long, long time. 
It is extremely appropriate that we take our time, that we get this 
right, that we do not hurry through the process, that we do not cut 
corners.
  Now, Mr. Speaker, you look at where we are 10 months into this year. 
Do we have the trust of the American people in this body? The answer to 
that question is, it doesn't seem so. What people have seen this year--
and even going back into last year in the term of the previous 
President, President Bush, they saw a couple of bailouts last year, 
they've seen more of the same this year, they've seen stimulus, they've 
seen automobile takeovers, financial sector takeovers, cap-and-trade 
that passed the floor of this House that many Americans felt was 
inadvisable in a time of economic downturn; and Washington yet still 
has the nerve to say, Trust us because we can take care of you and we 
will make your lives better. But the current polling numbers don't 
really suggest that that is something that's believed by the American 
people.
  Now true enough, the President started this year with extremely high 
approval ratings, somewhere likely in excess of 80 percent approval 
ratings at the time of the inauguration--an extremely popular 
individual--and has retained a great deal of that popularity, depending 
upon the poll that you select. Now it is down to about 50 percent, 49 
percent this morning in Rasmussen, 52 percent in the RealClearPolitics 
daily average poll. But, still, one out of every two Americans still 
has a favorable impression of the President.
  What about the United States Congress? Is it one out of two? Is it 
one out of three? It's one out of every five people holds the United 
States Congress in high regard.
  So with our current approval ratings hovering around 20 percent, why 
do we think the American people would believe that we, in fact, do know 
best and that they should trust us on an undertaking of this mammoth 
scale? And you can see how big the undertaking is.
  We heard previous speakers in the last hour talk about how difficult 
it is. We have had three health care bills that passed the various 
committees in the House last summer. You had one health care bill that 
passed the Senate Health, Education, Labor and Pensions Committee in 
June of this year; and then most recently you had the talking points 
memo that passed out of the Senate Finance Committee yesterday with a 
single Republican vote on that. I do not believe there were any 
Republican votes on any of the House products in the three committees 
that considered this bill under their various jurisdictions.
  The Congress doesn't have a lot of credibility right now on this or, 
quite frankly, many other issues. It would be a great thing, in my 
opinion, if Congress spent some time in trying to rebuild that 
credibility; but unfortunately, it's the old adage: Don't check the 
weather; we're going to fly anyway.
  And off we go with a big cap-and-trade bill in June that upset a lot 
of people; we did the three health care bills on the House side in the 
various committees in July. We ran into the town hall meetings during 
the month of August when people told us what they thought of our 
efforts, and now we're back here in the fall taking up the big bill on 
health care reform.
  As we've watched this debate, you think back to a year ago, we were 
in the middle of a presidential campaign. Both presidential candidates 
had ideas about what should happen as far as health care and the 
possibilities for health care reform. Remember now-President Obama's 
position last fall was significantly tilted towards getting coverage 
for the uninsured. It was a moral imperative. It was something that we 
had to do. Then we worked through some of the more difficult parts of 
the economic downturn, a lot of job losses were incurred during that 
time; and at the beginning of the year, many more people were concerned 
about the cost of health care and would they be able to continue to 
afford their insurance, would they be able to continue to afford health 
care. So affordability became perhaps a higher priority for Members of 
Congress who were considering these reforms during the spring.

[[Page 24817]]

  In June when the first congressional committee in the Senate, the 
Health, Education, Labor, and Pensions Committee passed their bill out 
of the Senate committee, the focus was all on cost and coverage. The 
cost numbers turned out to be significantly higher than anyone thought 
they would be; somewhere in the neighborhood of $1.5 trillion over 10 
years' time. The coverage numbers were disappointing at only a third of 
the uninsured actually being picked up. And there's no question that 
that delayed the second Senate committee, the Senate Finance Committee, 
in introducing a bill and marking up a bill which they just completed 
this week because they were trying to fine-tune those numbers.
  Now on the House side, we did, in fact, get a Congressional Budget 
Office score that came in around a trillion dollars for a 10-year bill. 
A little disingenuous because the Congressional Budget Office--in the 
hearings we had on Energy and Commerce from the Congressional Budget 
Office, the score was administered not on legislative language but on 
conversations, telephone calls, that the members of the Congressional 
Budget Office had with members of the Democratic majority who were 
writing the bill. So, yes, it was a cost number but there was some 
question as to the accuracy of that.
  And then here was a really big problem and one that really hasn't 
been addressed yet. These are enormous programs to undertake. They are 
not going to start overnight. So even if we pass a bill before the end 
of the year, it is going to be some time before these programs--whether 
it be a public option, whether it be exchanges within the States--it is 
going to be some time before the Centers for Medicare and Medicaid 
Services in the Department of Health and Human Services--which is 
likely to be charged with writing the rules and regulations under which 
these new products are formed--it's going to be some time before those 
things happen.
  The benefits are actually not scheduled to begin to kick in until the 
year 2012, 2014. It will be some time before those benefits occur. The 
taxes, of course, will begin the minute the ink is dry on the 
President's signature on the bill. So if we have a tax on high-end 
insurance plans, if we have a tax on medical devices, if we have a tax 
on any number of things, these taxes will begin to accrue January 1 of 
that year, but the benefits don't actually begin to kick in for some 
time.
  And once again, the United States Congress, when it's questioned by 
the American people, the United States Congress says, Don't worry. 
Trust us. We know best how to plan for you. We know best how to take 
care of you. We know that you don't know how to do this for yourself. 
And Congress, with its 20 percent approval rating, is just the man for 
the job to get this done for you.
  During the presidential campaign last year, President Obama promised 
to bring all parties together and not negotiate behind closed doors and 
to be broadcasting those negotiations on C-SPAN. Now we had kind of an 
unusual situation occur in May and June of this year when stakeholders 
in the health care community met at the White House and offered up 
things that they could do, things that they could do to hold down the 
cost of health care--you had to wonder where were these individuals for 
the 15 years before--but you had groups. The American Medical 
Association, of which I am a member, was in those meetings; the 
American Hospital Association was in those meetings and offered up a 
number of things that they could do for substantial cost savings.
  A little bit of controversy then last week as the Senate was working 
through its product, will those things that the American Hospital 
Association offered, are those going to be taxed or not? And there was 
some back-and-forth with the Congressional Budget Office as to what 
those numbers actually meant.
  Medical devices. Again, similar situation. PhRMA came to the table 
with--I forget the number now, but it seems like it was about $80 
billion in cuts that they were going to be offering.
  Well, none of these things that were agreed to behind closed doors 
last May, none of these deals are available to us as Members of 
Congress so that we can know what did America's health insurance plan 
group, when they came to the table and said, We can save you billions 
of dollars, Mr. President, and he said, What took you so long? But as 
members of the committee that were charged with working through this 
bill last July, why did we not have that information available to us? 
Why was it a surprise at the Senate Finance Committee when, hey, we 
thought these breaks we were giving the hospitals were going to still 
be subject to a corporate income tax, not an off-tax item? Why was 
there even that discrepancy or that discussion? Why not share with us 
those deals that were struck down at the White House?
  And indeed, last month I sent a letter to the White House and asked 
for the release of those discussions, the transcripts of those 
discussions, the minutes or notes of those discussions, pertinent e-
mails that may have occurred during those discussions.
  Just quoting from my letter to the White House: It has been now over 
4 months since the White House announced numerous deals with major 
stakeholders in the health care debate to save upwards of $2 trillion 
in the health care system. Little to no details regarding the 
negotiations have been released. And recent actions and press reports 
have reminded me of the importance of openness and transparency 
throughout the legislative process--the very openness and transparency 
that we were promised by this President during the campaign.
  So the letter has gone to the White House. I eagerly await a response 
to that. I am in fact somewhat surprised, my committee, the Committee 
on Energy and Commerce that has a fairly robust oversight and 
investigation subcommittee, I am somewhat surprised that they have not 
been curious about the deals that were made down at the White House 
early in the spring; why they have not been curious about some of the 
e-mails that may have occurred during the back-and-forth working 
through these negotiations. Again, the letter went to the White House 
on September 30, and I await a reply.
  I will ask later to include this letter as part of the Congressional 
Record this evening so that people will have the opportunity to read 
through that letter themselves.
  But again, the American people just simply do not trust the American 
Congress, the United States Congress, to make these kinds of decisions 
for them.
  When you look at some recent polling data when the question was asked 
if Congress works through this process and comes up with a major health 
care reform piece of legislation, is health care going to get better or 
is it going to get worse? Well, a quarter of folks think it's going to 
get better. About 26 percent say, Yeah, we think Congress will make the 
kinds of improvements that are necessary and health care will, in fact, 
improve. Fifty percent say it will get worse. Not great numbers with 
which we're working.
  You know, it was startling for many of us, the interest that was out 
there over the summer during the August recess on the health care bill, 
on cap-and-trade. Town hall activity was widely reported in news media 
outlets across this country. My district back in Texas was no 
exception. Town halls where I might typically have 30, 40, 50 people 
show up on a Saturday morning, 1 or 2,000 people would show up. In 
fact, one venue we had to change from inside to outside and just held 
the bulk of the meeting out in the parking lot because of the number of 
people that showed up.
  I have to tell you, Mr. Speaker, August in Texas in the parking lot 
is--you're asking a lot of people to stay with you through an hour or 
so discussion of a health care bill. But they did, and they asked 
questions, and they were respectful.
  I don't think that this August was an anomaly. I don't think that the 
American people had some sort of fugue state during August where they 
reacted to the health care legislation and the cap-and-trade 
legislation and reacted in no uncertain terms as to how

[[Page 24818]]

angry, how anxious they were about these bills that we were passing.
  But when we get back to Congress in September, it's like August never 
happened. It was unimportant. ``Don't pay any attention to those people 
back home because we're Congress. Trust us. We know best. We know best 
how to take care of you. We know best how to give you what we think you 
need.''
  We got back in September and I think I thought after seeing the 
August town halls, I thought this Congress would hit the pause button, 
hit the reset button, hopefully the rewind button on this health care 
legislation, but no such luck.
  We went at it full force. We, in fact, even had a little bit of an 
extended markup in the Energy and Commerce Committee where it was 
suggested to the chairman of my committee, you know, that August was a 
rough month for a lot of people, a lot of people on both sides of the 
dais--Republicans and Democrats both, even Republicans who voted 
against the bill--people were angry that the bill was even being 
considered and would likely pass.

                              {time}  1845

  On the Democratic side, there were a number of town halls that were 
quite contentious. We thought, I thought Members would welcome the 
opportunity to, well, let's sit down and revisit this. Let's 
reorganize. Maybe there were some good ideas on the other side of the 
dais. Maybe Republican members should have been brought into this 
process and take some ownership of this bill, if nothing else. Don't 
leave us being the only ones out there to defend it; but, no, that 
wasn't the case.
  The chairman of the committee said August, in so many words, August 
didn't matter. The people that spoke up were few and far between, and 
these large crowds that showed up at the town halls were somehow 
manufactured and didn't count. Not only did they not count, we were not 
reconsidering any part of the bill. We had some additional amendments 
that Members on the Democratic side wanted to offer. I offered a couple 
on our side as did other Members on the Republican side. But for the 
most part those amendments were struck down on a party-line vote.
  Both sides of the aisle genuinely see a problem and genuinely want to 
work toward improvement of the process. You have heard me say it 
before. You have heard other Members of Congress say it before. Some 
people dispute it as a fact, but I will say it: America has the best 
health care system in the world. There are distributional problems, and 
there are inequities in the insurance system that need to be fixed, and 
they are within our purview. They are within our capability of fixing, 
but we do not need to turn the entire system on its head to effect 
those ends.
  How could we best go about improving what we call health care in 
America? Well, we can ensure that patients continue to have, continue 
to get, care, have access to care, and continue to get the best care. 
That would be a good thing for us to work on together.
  Instead of being an obstacle, instead of threatening cuts every time 
you turn around, we could help doctors, nurses and hospitals continue 
to provide that excellent care. We, as Members of Congress, and 
sometimes it's do as I say, not as I do, but perhaps we could set a 
better example about living healthy lifestyles, staying within our--
staying within our ideal weight. Maybe that's something we should look 
at.
  Again, an amendment to that effect was turned back in my committee on 
Energy and Commerce. You know, really, one of the keys is going to be, 
if we are going to hold down medical costs, we really do have to 
involve the patient in the process. We have to have patient involvement 
in the doctor's office. We have to have patient involvement in making 
those healthy lifestyle choices. If we do not have the patient 
involvement and increase the patient knowledge base, the health 
literacy, if you will, about things like preventive care, about things 
like the importance of eating right and staying fit and the importance 
of regular health checkups and medical screenings, if we don't do that, 
the cost for health care is going to continue to increase and increase 
at a rate at which it's go going to be very, very difficult, regardless 
of the number of new taxes, regardless of the cuts to doctors and 
hospitals and nurses. Regardless of all of those things it's going to 
be very, very difficult for Congress to keep up.
  We do put the system at risk when we do that. There could be a day 
when the generation or two coming behind us will say we can no longer 
afford the type of tax rate that you have left for us. We will have to 
do something drastically different, and we don't want to do that. We 
don't need to do that.
  Now, you have heard a lot of discussion about how Republicans have 
been obstructing the process. Let me clarify that just for a moment. 
There are 177 or 178 Republicans in this body, 256 Democrats in this 
body. It takes 218 votes to pass a bill, to send it on to the Senate. 
The Democrats in this body could pass whatever bill they wanted. They 
do not need Republican support. They have, in fact, told us that on 
more than one occasion. The famous phrase that came out in January or 
February, well, after all, we won. There hasn't been a lot of reaching 
across the aisle, because it was just simply not necessary.
  Now, you think back to February. Again, the President had an approval 
rating of, I don't know, 70, 75, 80 percent. The President could have 
passed whatever health care bill he wanted in February of this year. 
There would have been nothing anyone could have done to stop it. In 
fact, there likely would have been very few people with the courage to 
try to stop it because the President was seen as so popular and so 
powerful, evidenced by the fact that the President did get a $787 
billion stimulus bill passed through this House, a bill that many 
thought was ill advised, a bill that many thought was duplicative, 
unnecessary and wasteful.
  But they got it passed, no Republican input into that bill as it was 
being written and no Republican support on the floor; but they didn't 
need it. It passed overwhelmingly with only Democratic votes, went down 
to the Senate for a similar fate, went down to the White House and was 
promptly signed into law by the President.
  It was followed a week later by an omnibus bill that spent a lot of 
the same dollars on the same things. Again, not much in the way of 
Republican support was solicited or required for that. It passed 
because, after all, 218 votes are all that are required to pass a bill 
on the floor of this House. The Democrats with their 256 majority have 
more than enough votes to pass almost anything they want.
  Now, the Republicans even tried--and I don't know the answer to that 
for everyone, but I will tell you that I did. I met with the transition 
team in November of last year.
  I met with the chairman of my committee in January of this year and 
said, look, I didn't give up a 25-year medical career to come here to 
sit on the sidelines. I want to be involved in this debate. I may not 
be able to be with you on some issues. There are some things that I 
think are just the wrong approach to reforming health care, but let's 
sit down and have the discussion and see what can be worked out.
  I was thanked for my interest and never received a call back. Oh, I 
did get called down to the White House in March for a photo op, but 
that was about it. There wasn't much more to it than that.
  Then as the bill was being written behind closed doors for the 
various committees where we worked on the bill on the House side, 
certainly at no point was I ever offered any input.
  Now, I did, as did many members in my committee, offer a number of 
amendments, and we did amend the bill in committee. It would be 
interesting to see now whether or not those amendments stay in the 
bill.
  But I don't think anyone is fooling themselves. There was not--there 
was no way to amend that bill, H.R. 3200. There was literally no 
amendment you could offer except striking the language in the bill and 
offering the new bill. There really was not. It was not salvageable, in 
my opinion.
  Now it's interesting because all three committees have passed the 
bill. They

[[Page 24819]]

all amended it and some of those amendments will be completely--the 
incentives will be aligned. Some of them actually will be at a 90-
degree intersection.
  Someone is going to have to redo that bill. That is happening now, 
and you can expect that there is probably a heavy hand from the White 
House in aligning all three of those House bills into one product. We 
will likely get to see it a few hours before we vote on it. It may come 
as early as the end of this month, and we are promised that it will, in 
any case, be something that we see before Thanksgiving. I expect that 
that is true.
  I don't know whether any Members on my side will vote for it. There 
don't seem to be a large number of Republicans who are supporting H.R. 
3200. I don't know if any Democrats will vote against it. We certainly 
saw that in all three committees that there were some Democrats who 
simply could not support the things in the bill and did vote against 
it.
  The public option continues to be a political football kicked from 
one side of the rotunda to the other. The House wants a robust public 
option, the Senate not so much. How will it pass on the Senate side if 
they have a public option, or will a public option be ignored by the 
Senate but added back in the middle of the night when the two bills 
come together in the House Senate conference before we vote on the 
final product?
  It's anybody's guess and, Mr. Speaker, again, you know, just speaking 
to you, I would say if I were able to speak to the American people, I 
would say stay tuned to this because it is going to be a very important 
process. You will have a House unified bill coming up the next couple 
of weeks. How long we have to evaluate that before we vote, I think, is 
going to be very telling. If it's a very short period of time, there is 
probably some bad stuff in the bill that they don't want you to know 
about before we actually vote.
  Now, we are arguing for 72 hours. I will just tell you, for what's 
likely to be at least a 1,000-page bill, more likely a 1,500-page bill, 
72 hours is a very short interval of time to work on a bill of that 
magnitude. Bill language is inherently very difficult to read. There is 
a lot of referral back to the Social Security Act. There is a lot of 
referral back to the Medicare or the Medicaid provisions in the United 
States Code.
  It takes some doing to get through that bill language and really 
understand what the implications of what you are reading. But it 
doesn't mean we shouldn't do it. It just means that we need have the 
time to do it. I certainly encourage the Democratic leadership to give 
us the time necessary and make the facilities available to us so that 
we can have the opportunity to read through that bill and read through 
it with experts and come to understand what's being contained within 
the bill.
  You know, the President has said repeatedly that if you have good 
ideas, I will listen. In fact, here in the House, in the joint session 
that was held on September 9, the President said, right from the podium 
behind me, and I am quoting now, ``I will continue to seek common 
ground in the weeks ahead. If you come to me with a serious set of 
proposals, I'll be there to listen to you.''
  Well, that's kind of interesting, too. During the campaign, the 
President said that he would sit down with people who might be regarded 
as folks that don't like us very much, folks like Ahmadinejad and Hugo 
Chavez. The President said, I will sit down with leaders of other 
countries and meet with them without preconditions.
  Well, when it comes to congressional Republicans, he does set some 
preconditions. We have to come with a serious set of proposals. We 
can't just show up with ideas. I prepared a serious set of proposals 
and sent it to the White House on September 16 of this year, about a 
week after we had the joint session of Congress. I prepared a number of 
things within the letter.
  Attached to it were a number of bills that I had introduced that I 
thought should be parts of whatever type of health care reform is 
passed. I am still waiting for a response to that. Things like 
addressing the problems of the physician workforce, things like 
addressing the liability, the problems that doctors face with the 
liability insurance, fixing the sustainable growth rate formula, some 
price transparency, a lot of good ideas contained within here.
  Again, I will, at the end of this, I will submit this for the Record. 
But, again, no response from the White House.
  The list talked in some detail about those things that the 
Republicans agree should be a part of the meaningful reform. You know, 
we hear it said all the time that there is agreement on, like, 80 
percent of the things contained within health care reform. I think that 
number is a little bit high. But, nevertheless, we hear it said all the 
time.
  But what is the primary thing? What is the number one thing I heard 
about over and over and over again in the town halls in August?
  The thing that is really grating on the American people is those 
individuals who want insurance but can't get it. They can't get it 
because they have had a tough medical diagnosis. They have a 
preexisting condition. They had insurance on their job and they lost 
their job and they couldn't keep up with the COBRA payments, so they 
lost their insurance. Now they are stuck without insurance, but have a 
preexisting condition. It wasn't that they wanted to drop their 
insurance; but the conditions were such, the rules were set, that they 
didn't have any choice but to let that insurance coverage go, even 
though they knew it might be difficult to get back into a state of 
coverage in the future.
  Another thing that just really bothers people is the fact that 
Americans can do the right thing and have health insurance and pay that 
premium religiously, get a tough medical diagnosis, and the insurance 
company looks back and says, you know what, we really never meant to 
offer that policy to you in the first place, or we think there was 
something you obscured in your history. Now, by a process of what are 
called ``insurance company rescissions,'' they are going to take that 
insurance policy away.
  The President even referenced that in his speech on September 29, and 
that's wrong. People acknowledged that it's wrong, both sides of the 
aisle.
  Now, in cases of fraud, correct. The insurance company has to have a 
right of action. They have to have a way to protect other people that 
have insurance. You don't want people coming and buying insurance under 
fraudulent terms.
  But for people who have an omission from a medical history that makes 
no difference as to their subsequent care and diagnosis, these are 
things that are generally recognized by the American people as being 
egregious overstepping by the insurance companies, and that needs to be 
fixed. Here is the sad part, Mr. Speaker, that could have been fixed. 
That could have been fixed before we went home for the August recess. 
We just simply chose not to do it.
  So, if we provide a way for someone who has a preexisting condition, 
perhaps through a reinsurance, perhaps through high-risk pools, perhaps 
through high-risk pools with additional State and Federal subsidies, 
there can be ways to bring individuals who have a preexisting condition 
into a state of coverage.

                              {time}  1900

  It's a shame. It's a shame we never had a hearing on that in our 
health subcommittee. We had hearings on almost every other issue under 
the sun, but we never had a hearing on, is there a way, short of an 
unconstitutional individual mandate, is there a way to get people 
insurance coverage who have had a bad medical diagnosis and lost their 
insurance? We never had a hearing on that. We could. I think we should. 
I think bright minds on both sides of the aisle could get together and 
work out ways that this problem could be solved.
  Rescissions. Again, with a history that's now newly disclosed, has 
nothing to do with the medical diagnosis, and it was in no way 
fraudulently withheld from the insurer, rescissions need

[[Page 24820]]

to stop. States that have high-risk pools, there are 34 of them. States 
that have the opportunity for reinsurance. These are States that are 
working, trying to offer their citizens a method of dealing with this 
problem. We could encourage more States to pick up high-risk pools. 
We've got some States where they're working well, some States where 
they're working less well. I always felt that in my home State of 
Texas, it wasn't working so well. It turns out it's really not a bad 
program, it's just not funded to the level that it need be.
  Well, if we could encourage a contribution from the Federal 
Government, the State government and perhaps even the private sector, 
the insurance companies themselves, perhaps we could get that figure 
down to a point where people can actually utilize the program. Because 
people that then are subsequently covered by those high-risk pools in 
Texas love the program. I had someone come up to me after a town hall 
in the district in August that said, Please, whatever you do, don't do 
anything that's going to mess up my high-risk pool because that's the 
best insurance I've ever had. The problem is it's limited to the number 
of people who can access that.
  We have people losing their jobs. It's an unfortunate, disastrous 
occurrence that happens in a recession. Some people are laid off. And 
if you have employer-sponsored insurance, there's trouble brewing. Yes, 
because of rules and laws that Congress passed many, many years ago, 
COBRA coverage that is extended for 18 months is available to an 
individual who loses his job, but that insurance has to be the same 
insurance that that person had while they were employed.
  So the individual can pick up the premium for that employer-sponsored 
insurance, but most of the time the employer is not continuing to pay 
their part so the individual has to pay the entire freight; in fact, 
it's actually 102 percent because there's an administrative cost tacked 
onto that. Well, that is an expensive issue for someone who's just lost 
their job.
  Could we offer people another choice? If someone loses their job, 
they've got good employer-sponsored health insurance, they are 
protected. As long as they keep their insurance, they're protected 
against falling into that preexisting condition trap. But right now 
it's either pay that large premium--and again you just lost your job so 
it may be hard to do that--or become uninsured.
  We offer people two choices right now. What if we made something else 
available to people? What if we allowed people to transition into the 
individual market and not have to go through the COBRA system to do 
that, but still protect their ability to have the coverage for a 
preexisting condition should one have developed or develop during the 
time that that individual is transitioning to insurance on the 
individual market. Why does it always have to trigger the COBRA 
insurance? Why is there not an intermediary step that is less 
expensive, but still provides the protection?
  Other things we could do. What if someone has COBRA, has that 
coverage, but they move to another State and they may not be allowed to 
take that coverage with them? Why not allow that transition from State 
to State without rerating that individual, without causing that 
individual to be rerated by a new insurance company where now their 
preexisting condition that they've acquired along the way prevents them 
from getting or obtaining that insurance in the individual market in a 
new State?
  I liken that to the National Football League, and you have a player 
in the National Football League who gets traded from one city to 
another, their insurance goes with them. No problem. If they had a knee 
injury in one city, it's going to be taken care of in the new city. But 
if their fan who wants to follow their favorite football player moves 
from city A to city B, they've got to start all over again, if they're 
in the individual market, and during the time that they do that, they 
may find that they are rerated by their insurance company, 
reunderwritten by their insurance company, and if they had even a 
modest diagnosis like high blood pressure, depression or adult onset 
diabetes, it can be a very expensive adventure for them buying 
insurance in that new State.
  So why don't we allow that type of transition so that someone doesn't 
have to be rerated? We talk a lot about being able to buy insurance 
across State lines. I think that's important, too. That's a little bit 
heavier lift. It's a little bit more difficult for Congress to come to 
that understanding, but this ability to allow someone to buy in the 
individual market without being rerated when they change States, that's 
easy and we should be able to do that. Again, I frankly don't 
understand why we don't take that up.
  Again, remember if we pass this big, comprehensive, robust public 
option health care bill, when do you get the benefit? Four years. We're 
going to have people losing jobs next year. We're going to have people 
losing jobs the year after that. What are we going to do for those 
individuals in the short term?
  And, again, I'll reference back to the President's own speech that he 
gave here on September 9. When he was at the podium giving the speech, 
John McCain was in the audience. He acknowledged that John McCain had a 
good idea for covering people with high-risk pools and that perhaps 
that would be a way to provide some immediate relief for people who 
couldn't wait for the 4 years before the Federal Government starts this 
new robust public option plan.
  You hear me talk about medical liability. Medical liability is a big 
deal. The fact that it's been left out of the House and Senate bills, I 
think, is a big deal. Look, we're asking our doctors to be our 
partners. Whatever the brave new world of health care reform looks 
like, whatever we go to, we're going to ask our doctors to be there and 
be at our sides and help us, or be the ones to take care of the 
patients and answer those emergency calls in the wee hours of the 
morning.
  We're asking our doctors to stand with us on this. And yet we won't 
do the one thing that would simplify the lives of doctors across the 
country, keep doctors from dropping out of the practice of medicine, 
and, that is, bring some sense, some stability, to the medical justice 
system that we have in this country.
  Now, Texas has done what I consider to be a very good thing, with 
putting caps on noneconomic damages. They did that in 2003. They had to 
do it with a constitutional amendment so that it would become 
immediately effective and didn't have to go through all sorts of court 
challenges; and, boy, it was like turning a switch and things have 
improved in Texas since that bill was passed. But you will also hear 
people say, Oh, medical liability, it doesn't save that much money. You 
can do whatever you want, but it's like a 1 percent savings.
  But that's based on a very old study that really only looked at the 
cost of the premiums themselves, from back in the early 1990s, the 
American Medical Association, a very famous study called the Tonn 
study, frequently still quoted here 15, 20 years later. The Tonn study 
did say that you weren't going to save much money with medical 
liability. But, of course, the Tonn study discounted what would happen 
as far as the practice of defensive medicine.
  Let me ask you this: medical liability premiums have gone up year 
over year over year. Medical liability has continued to be a problem 
year over year over year these last 20 years. Do you think the practice 
of defensive medicine is more widespread now than it was 20 years ago? 
Well, you bet it is. You bet it is. Twenty years ago we didn't have PET 
scans. We barely had MRIs. The more new things, new technology that 
becomes available, doctors are continually trying to see what is the 
maximum I can do so that I won't look bad if things go wrong and I'm 
called into court and have to defend my medical judgments. So it's no 
small wonder that the cost of defensive medicine has gone up and up and 
up.
  Now the Congressional Budget Office has put out a new report. In a 
letter to Senator Hatch, they talk about their

[[Page 24821]]

new estimate for what medical liability reform would save the Federal 
Government. This is just in the Medicare and Medicaid system, and it's 
estimated to be $54 billion over 10 years. That's getting to be a 
significant amount of money.
  But wait a minute. Remember that the Federal Government is now 
responsible for about 50 cents out of every health care dollar that's 
spent in this country. Fifty cents out of every health care dollar 
that's spent in this country actually originates right here on the 
floor of this House. So that $54 billion over 10 years only represents 
about half of the medical expenditures in this country. It doesn't 
count those that are paid for by private insurance, those that are paid 
for out of just individuals paying their bills or that is gifted to 
people through charity.
  So double that number. It's over $100 billion over the 10-year life 
of the health care bill that is a potential savings with modest medical 
liability reform. Again, that's not going to pay for the whole health 
care bill, but it would pay for 10 percent of it. Don't you think if we 
could pay for 10 percent of what's being proposed that we ought to at 
least consider it in our committees, that we should at least consider 
it in the legislative language that's being proposed?
  I will just tell you what's happened in Texas since 2003 when we did 
pass a cap on noneconomic damages. Since 2003, Texas has licensed 
15,000 new physicians. Over a similar time span preceding that, that 
number was about a third. We've gained 192 new obstetricians; 26 rural 
counties have added an obstetrician, including 10 where previously 
there was no OB doctor.
  Texas is a big State. We've got 242 counties, so there's a lot of 
counties in Texas. But, still, 10 counties without an obstetrician 
before that now have one. That's prenatal care that's available to 
patients that wasn't available before unless you drove multiple miles 
to a medical center. That's doctors who are there when patients need 
them, frequently when time is of the essence, in the process of having 
a baby. So that is a good thing.
  Thirty-three rural counties have gained ER doctors, including 26 
counties that previously did not have an emergency room doctor now have 
one since the passage of commonsense medical liability reform in 2003. 
Doctors have contributed $594 million in charity care since the bill 
was passed.
  I introduced similar language at the Federal level, H.R. 1468 for 
those keeping score at home; and I had offered that as an amendment to 
our committee bill last July. I was at first struck down on a 
technicality. Then I was struck down on a party-line vote. It doesn't 
seem that the Democratic majority has really had any interest in trying 
to reform the medical justice system in this country.
  Yet now the Congressional Budget Office in a letter to Senator Hatch, 
where he requested a new analysis of the cost of defensive medicine, 
has said that it would be a savings of $54 billion over 10 years, and 
they do cite several studies in there where they've gained that 
information.
  Again, at the end of this hour I will ask to make the Congressional 
Budget Office report, the letter to Senator Hatch, a part of the 
Record.
  Portability, being able to take your insurance with you. There was a 
time when I was a youngster when you went to high school, perhaps went 
to college, but whether you graduated from college or just started 
after high school, you took a job and you probably continued that job 
until you got your gold watch in retirement.
  It doesn't work that way anymore. I don't know exactly what the 
figure is, but the estimate from the Census Bureau is that people will 
have perhaps 10 or 11 jobs during the course of their productive years. 
So it only makes sense that if we continue, and we likely will 
continue, to have employer-sponsored health insurance, that we allow 
more portability than is within the system now. Some people have talked 
about things like defined contributions from employers, rather than 
just the employer providing the insurance, providing a designated sum 
of money for the purchase of that insurance.
  There is a lot of discrepancy for what insurance costs. In the State 
of New Jersey, the average health insurance premium for a family of 
four recently quoted at $10,000. You go across the State line to 
Pennsylvania and it drops $4,000, to $6,000. Well, there's not a lot of 
difference right there on the State line between one segment of the 
population and those that are north of the line in New Jersey. Why not? 
Why not allow people to perhaps look into the purchase of insurance in 
other markets that may fit their needs and may be more affordable?
  And then, of course, again we get into the issue of someone who moves 
across the State line, why not allow that portability? Just in the 
interest of completeness, the State of Texas, a family of four, the 
average insurance premium is $5,000 a year. The State lines concept is 
one, and we heard the President talk about it in his speech of 
September 9. He talked about a part of rural Alabama where if someone 
was going to the individual market, they only had one insurance company 
from which to choose.

                              {time}  1915

  And that's not terribly surprising. Insurance companies tend to be 
natural monopolies. They tend to want to form monopolies and capture 
market share. But the President's quite correct; you don't get much 
competition if you've only got one insurance company. So the 
President's solution to this problem is, well, let's create a public 
option and we'll have two insurance companies for that family in 
Alabama to choose from. But there's over 1,300 insurance companies in 
the United States of America. Why not open the market up so that more 
of those 1,300 insurance companies that already exist in the country--
we don't have to create a new one, we don't have to pay all that start-
up capital for creating a new program--why not just allow them to 
compete across state lines?
  And you know, interestingly enough, Democrats that reflexively 
opposed this idea year in and year out now seem to be warming to the 
concept. At the very least, if you have a public option that is 
available in Alabama, it's going to be the same public option that's 
available in Tennessee, and the same public option that's available in 
Texas. Guess what? That public option is going to be sold across state 
lines because it is a Federal program. So why don't we, before we go to 
all the trouble and expense and anxiety of creating an entirely new 
Federal entitlement and type of insurance, why not just simply allow 
some open competition across state lines?
  Now, cooperatives are something that we hear, that word gets a lot of 
traction, co-ops. You know a purchasing co-op that could go across 
state lines, I could be okay with that. A co-op that was just a 
dressed-up public option, I'm not so much in favor of that. But 
certainly, allowing people to band together, people that may belong to 
the same alumni association, the same church, you name whatever 
association, realtors, dentists, physicians offices, that want to get 
the purchasing power of a much larger group in that individual market, 
we should allow them the freedom, the freedom to be able to make those 
associations and to purchase.
  You know, tax credits--and I will admit there are people on my side 
that get nervous when you talk about tax credits. But tax credits to 
help with the purchase of insurance I think is certainly something that 
was talked about during the last presidential campaign. I think it is a 
way to provide immediate help, not help 4 years from now, but immediate 
help to people who don't have employer-sponsored insurance, where 
otherwise the cost of insurance is an obstruction to them getting that 
coverage. Maybe if we take away some of the issues with preexisting 
condition rescissions, we take away some of the issues with 
portability, still it may be an affordability issue, and if we could 
help that with the tax credit or even a pre-fundable tax credit, I 
think that is something that is, it's at least worth having the 
discussion.
  And again, through all the hearings that we've had on this, we never 
once

[[Page 24822]]

visited that issue. We never once invited the Congressional Budget 
Office in to kind of give us some views and estimates on what this 
might cost or what this might look like. Instead, we just simply said, 
we're Congress, we know best, we're going to build an entirely new 
insurance company that's administered by the Federal Government and 
that will be your competition. Take it and like it because we, after 
all, know best.
  Again, the ability for people to associate, whether it be a church 
group, an alumni association, maybe it's time that we gave people the 
option of not having insurance that's tied to a single employer, 
because, again, many people will change jobs over time. Allow the 
cross-state purchasing.
  We've talked about things like association health plans. Various 
bills have been introduced that would deal with this. H.R. 3218 
introduced by Representative Shadegg from Arizona is one such plan. And 
certainly, that is one that should be included in any compendium of 
plans that are offered as conservative or Republican alternatives to 
what is being proposed in health care.
  Medicare payment reform. We're going to pay for half of this 
trillion-dollar bill with cuts in Medicare. Well, I've got to tell you, 
I get more letters, more mail from individuals who are doctors who are 
concerned about what we, what Congress is doing to them in physician 
reimbursement. It's easy to say, oh, man, doctors they make so much 
money, so you cut them a little bit--who cares? December 31st of this 
year, under the current formula, sustainable growth rate formula, 
physicians will undergo a 20 percent reduction in reimbursement.
  Now, true enough, Senator Baucus' bill does delay that by 1 year. 
That's our typical response. We'll do something to kick the can down 
the road. If we do that, then next year they face a 25 percent 
reduction in reimbursement. In some specialties, cardiologists, in 
particular, where there's been some re-basing of what are called 
relative value units for the work that they do, are facing cuts in 
excess of 30 percent at the end of the year. Well, I'm here to tell you 
that you don't have that much excess capacity in the average doctor's 
office where you can squeeze 30 cents out of every dollar in savings 
and expect those offices to stay open.
  Well, wait a minute. We've got an unemployment rate that's 
approaching 10 percent. Cardiology offices are small business across 
the country, and they are facing a 30 percent reduction in Medicare 
reimbursement, when oftentimes Medicare is 50, 60 or 70 percent of the 
business that they do. How do we expect them to keep their doors open 
after January 1st? How do we expect them to make employment decisions 
for their employees in their offices over these next couple of months 
while they're living with this kind of limbo?
  I mean, they're sitting here watching Congress and wondering if we're 
just going to run out the clock on December 31st. When these huge cuts 
go into effect, what are they going to tell their employees? If they 
wanted to hire someone new earlier this year they're certainly not 
thinking about doing that now. And we've got a 9.6 percent unemployment 
rate.
  Cardiology offices are small businesses. Echo techs, phlebotomists 
that draw blood in the lab, people that put the patient back in the 
room. All of these jobs are now at risk because of what Congress is 
doing, or not doing, with fixing the sustainable growth rate formula 
and the cuts in Medicare. If we pass a bill like the Baucus bill, the 
cuts only become deeper and more Draconian. Again, you don't save $500 
billion out of the Medicare program over 10 years by not making some 
pretty harsh decisions.
  And you know, if you think it's bad now with the sustainable growth 
rate formula, what's it going to look like if we enact some of these 
things that have been discussed over on the Senate side and indeed on 
the House side? What if we create this body that's going to come to us 
every year and say, in order for the books to balance, Mr. or Mrs. 
Congressman, we are going to have to cut fees that are paid to 
hospitals, doctors, nurses, nursing homes by whatever percentage amount 
they say.
  Congress, if we pass this law, simply votes that up or down. They 
don't take any responsibility for it. There's no accountability. We 
just simply pass those cuts on. That's a terrible way to do business. 
Wouldn't it be better if we found a way to deliver care more 
economically so we didn't have to come to our provider community, to 
our doctors, to our hospitals, to our nurses and nursing homes, and 
say, We're going to have to keep a little bit more of your money this 
year in order to make our books balance?
  Now, ensuring the future physician work force, I think, is extremely 
important. H.R. 914, the Physician Workforce Investment Act that I 
introduced last Congress and this Congress as well, I've provided that 
to the White House. You know, here's the deal. We can sit here and talk 
all night long about health insurance, and that may be an important 
discussion to have, but I've got to tell you, if you don't have any 
doctors there at the end of the day, all the insurance in the world 
isn't going to do you a bit of good. In fact, I'd far rather have a 
doctor and no insurance than I would have insurance and no doctor, 
because if I'm in trouble, if I'm needing someone to take care of me, 
the insurance company typically hasn't been all that great at that 
endeavor. But physicians always respond.
  Preventive care and wellness programs. Clearly, these are going to be 
necessary in the world going forward. The model that was brought to us 
by Safeway Stores, the model that we were not allowed to consider in 
our markup in committee, but realistically, we have to do that. H.R. 
3148, which is the Burgess-Christian CBO scoring bill, would allow for 
the Congressional Budget Office to score those savings that could be 
achieved with healthy lifestyles.
  Price transparency. We did include some language in the bill that was 
passed. H.R. 2249 was the Health Care Transparency bill that I 
introduced two Congresses ago and have continued to introduce every 
Congress. A lot of that language was inserted into H.R. 3200, for which 
I was grateful. But at the same time, transparency has got to be there. 
So if we're going to ask people to make more and more decisions for 
themselves, we have to give them the information with which to do that. 
Mandates have no place in a free society.
  And when I hear the Senate talk, and I hear the House talk about 
we're going to have an individual mandate and an employer mandate, wait 
a minute. I'm not even sure that's constitutional. Mandates just create 
laziness, create laziness on the part of the insurers, create laziness 
on the part of the insured, and certainly create laziness on the part 
of your Congressman. Wouldn't it be better if we required people to 
actually build programs that people wanted, rather than just force 
people to take what we think they ought to want? Mandates are an 
anathema to free society.
  And there are ways to do this. Prescription-drug benefit in part D, 
for all its faults, Dr. McClellan, when he was constructing that 
program, had six protected classes of drugs and said there had to be at 
least two drugs offered within those six protected classes, and people 
flocked to those programs. It has been a success in the number of 
seniors that now have credible drug coverage and seniors that are 
satisfied or very satisfied with the drug coverage that they have.
  Normally, if you have a mandate you're going to get about 85 or 95 
percent compliance. We've got about 85 percent compliance with the 
voluntary system right now. You're not going to get that much more with 
the mandate. Even without mandates in the prescription-drug benefit, by 
creating programs that brought value to people's lives, 93 percent 
uptake on a credible drug program.
  So, you know, I've got to tell you. I will never sit down here and 
advocate for private insurers. But I will tell you that most Americans 
do have coverage under a private insurance, and they like it. They 
don't want to lose it. That has been one of the big obstacles to

[[Page 24823]]

getting sweeping health care reform. The President always says if you 
like what you have you can keep it. I think that's right. Sixty percent 
of the American people like what they have, and they don't want it to 
change, so that makes it difficult to do reform that is on this scale 
and this sweeping.
  I'll tell you another little secret. The Federal Government, the 
public option that we already have, doesn't pay its full share of the 
freight of the cost of delivering the care. It's subsidized by the 
private sector. If you shrink the private sector and grow the public 
sector, how are you going to make that up? Where's that money actually 
going to come from? And that's something that I never hear discussed.
  Yeah, insurance companies do bad things. And we'll hear stories, 
we're going to hear stories in my committee tomorrow about how bad 
insurance companies are. But if we didn't have that cross-subsidization 
of the private sector, we could not afford the public sector. Now, 
people will tell you that it's the cost of the uninsured that we're 
leaning on the private sector to provide for us. No, that's a small 
amount. That cross-subsidization that's coming to the public sector is 
the lion's share of that. That 9 percent figure, about 2 percent is 
people who have no insurance; 7 percent goes to paying the freight that 
Medicare and Medicaid are not carrying themselves.
  We have a good system. Let's build on what we have. Let's not tear it 
down and then create something out of whole cloth to go in its place. 
You know, the government can referee some of these things, but the 
government doesn't need to be the man in charge of all of these things. 
Again, remember, the United States Congress, we've got about a 20 
percent approval rating. I think reforms can and should go forward. I 
think there are good ideas on both sides of the aisle here. I'll take 
the President at his word. I'm anxiously awaiting their response to my 
letters.
  I look forward to this debate we're going to have over the next 
several weeks, and I would encourage people that, every morning when 
they get up, remember, you've got one Member of Congress and two 
Senators. They need to hear from you on this issue. Whether you agree 
with me or not, I promise you they need to hear from you on this issue 
before we have this vote.
  For more information on H.R. 914, the Physician Workforce Enhancement 
Act of 2009; H.R. 1468, the Medical Justice Act of 2009; and H.R. 2249, 
the Health Care Price Transparency Promotion Act of 2009, log on to 
http://thomas.loc.gov.

                                     House of Representatives,

                               Washington, DC, September 16, 2009.
     President Barack Obama,
     The White House,
     Washington, DC.
       Dear Mr. President, I am once again compelled to write to 
     you to accept your offer to meet with you at the White House 
     to discuss the health care reform proposals currently before 
     us.
       I listened intently as you addressed the Joint Session of 
     Congress on September 9, 2009, and you once again extended an 
     olive branch to members of the minority. I want to reiterate 
     that I am completely committed to working in a bipartisan 
     fashion to deliver reforms that all Americans can be 
     comfortable with, increase access to care, lower health care 
     costs for America's families and businesses, and deliver 
     changes to the health system that improve quality.
       I thank you for your public commitment to accept innovative 
     ideas from Republicans and hope that you will follow through 
     with your public pledge by reviewing this letter thoroughly. 
     As you stated last week: ``I will continue to seek common 
     ground in the weeks ahead. If you come to me with a serious 
     set of proposals, I will be there to listen. My door is 
     always open.''
       I accept your gracious offer and want you to know that it 
     is not my intention to ``kill'' health reform. In fact, I 
     stand proudly by my bipartisan work in the U.S. House of 
     Representatives on health care issues. Several of my 
     amendments in the Energy & Commerce Committee were accepted 
     unanimously while others are currently under negotiation with 
     Chairman Waxman for inclusion in a final House product.
       That said, I have read the America's Affordable Health 
     Choices Act (H.R. 3200) and I do concede I have many concerns 
     with the approach the bill takes. Many of the items you 
     outlined in your speech do have wide bipartisan support. 
     While we may have disagreements on the policy approaches to 
     address those problems we will never know if we can find 
     common ground if we do not try.
       To assist you in identifying measures that could gain wide 
     bipartisan support I am enclosing four pieces of legislation 
     that will make incremental but important reforms to our 
     health system. I believe that, with your leadership, these 
     measures could be passed and signed into law before 
     Thanksgiving. These efforts would show that we can work 
     together to make important reforms that improve access to 
     care and protect the doctor/patient relationship.
       Physician Workforce: H.R. 914, the Physician Workforce 
     Enhancement Act, would establish an interest-free loan 
     program for eligible hospitals to establish residency 
     training programs in certain high-need specialties. Under the 
     program, eligible hospitals could receive up to $1,000,000 
     that must be repaid within 3 and a half years. H.R. 914 will 
     provide needed resources to smaller and emerging communities 
     so they can attract and retain the medical professionals 
     their communities will rely on in the future. If we do 
     nothing to assist the training of physicians, waiting lines 
     will grow longer, lapses in treatment will occur, and many of 
     our small and rural communities will be at risk of not having 
     physicians to meet their growing needs.
       Medical Liability Reform: As you alluded to in your speech, 
     too many doctors are forced to practice defensive medicine 
     and face the constant threat of lawsuits and unsustainable 
     medical liability insurance rates. This results in millions 
     of dollars in unnecessary tests and procedures. Seasoned 
     medical professionals are retiring early because staying in 
     practice is no longer financially feasible, further 
     contributing to our nation's doctor shortage. This is a 
     growing crisis that is pushing affordable health care beyond 
     the grasp of millions of Americans. H.R. 1468, the Medical 
     Justice Act, is based on medical liability reform implemented 
     in Texas. The reforms have created a magnet for doctors and 
     provided the funding mechanism to improve access to care and 
     enhance patient safety. To prove the success of Texas' 
     reforms, I'd like to share a few of the statistics, from the 
     Texas Medical Association:
       Since the 2003 reforms, Texas has licensed 14,496 new 
     physicians. This is a 36 percent increase from pre-reform.
       Thirty-three rural counties have seen a net gain in ER 
     doctors, including 26 counties that previously had none.
       After years of decline, the ranks of medical specialists 
     are growing in Texas. In my field of obstetrics, Texas saw a 
     net loss of 14 obstetricians in the two years preceding 
     reform. Since then the state has experienced a net gain of 
     192 obstetricians, and 26 rural counties have added an 
     obstetrician, including ten counties that previously had 
     none.
       Charity care rendered by Texas hospitals has increased by 
     24 percent, resulting in $594 million in free care to Texas' 
     patients.
       Texas physicians have saved $574 million in liability 
     insurance premiums, a significant savings that has allowed 
     more doctors to stay in their practice.
       Medicare Reform: Many new Medicare beneficiaries find it 
     difficult to locate a doctor who will accept Medicare. This 
     is because physicians around the country realize that 
     Medicare is an unstable payer, subject to the whims of 
     political will and influence, and are doing what they must to 
     protect their small businesses. Physicians are scheduled to 
     receive a significant reduction in Medicare payments on 
     January 1, 2010. The Ensuring the Future Physician Workforce 
     Act, a bill I plan on introducing shortly, will give doctors 
     what they really need a stable and reasonable predictor of an 
     inflationary reimbursement under Medicare. This will allow 
     seniors to maintain access to their doctor. The legislation 
     also rewards quality reporting of data, further incentivizes 
     the adoption of Health Information Technology, and brings 
     increased transparency on utilization, billing, and funding 
     to the Medicare program.
       Health Care Price Transparency: A patient should be able to 
     know what they are paying for and how much they will pay out-
     of-pocket. H.R. 2249, the Health Care Price Transparency 
     Promotion Act, directs states to establish and maintain laws 
     requiring disclosure of information on hospital charges. The 
     legislation requires hospitals and health plans to make this 
     information available to the public, and to provide 
     individuals with information about estimated out-of-pocket 
     costs for health care services. H.R. 2249 aims to make health 
     care more affordable by promoting greater transparency about 
     the cost of health care services for patients seeking care. 
     The legislation sets a national floor for transparency. As 
     someone who has committed his Administration to transparency, 
     this is an important step in helping make health care, and 
     specifically health care costs, more transparent, which 
     empowers the consumer.
       As a practicing physician for over 25 years, I believe I 
     bring a unique perspective to the current health care reform 
     debate. I am committed to finding areas of collaboration 
     between the political parties that can deliver meaningful 
     system reforms that will benefit all Americans. I would 
     greatly appreciate the opportunity to review both the efforts 
     outlined above and also my areas of concern with H.R. 3200 so 
     that we may mutually

[[Page 24824]]

     work to bring quality, affordable health care to all 
     Americans.
       I look forward to the opportunity to meet with you at your 
     earliest convenience. Should your staff have any questions 
     about any of the attached proposals or would like to arrange 
     a meeting, please contact me or my Legislative Director J.P. 
     Paluskiewicz at my Washington, D.C. office.
           Sincerely,
                                         Michael C. Burgess, M.D.,
     Member of Congress.
                                  ____



                                     House of Representatives,

                                Washington, DC September 30, 2009.
     President Barack Obama,
     The White House,
     Washington, DC.
       Dear Mr. President, I write you once again on the topic of 
     health care reform. As you know, Democrat leaders in the 
     House of Representatives are currently working to merge the 
     three committee bills. Meanwhile, the two Senate products are 
     waiting to be merged pending completion of the Senate Finance 
     Committee's mark-up.
       I have closely followed the health care debate for months, 
     making note of actions by all parties involved, including the 
     House, Senate, White House, advocate groups, and the health 
     care industry. These reforms have wide-reaching implications, 
     and you have stressed the importance of conducting business 
     in public so that the American people are aware and involved 
     in the process.
       In fact, during a Democratic Presidential primary debate on 
     January 31, 2008, you said: ``That's what I will do in 
     bringing all parties together, not negotiating behind closed 
     doors, but bringing all parties together, and broadcasting 
     those negotiations on C-SPAN so that the American people can 
     see what the choices are, because part of what we have to do 
     is enlist the American people in this process.''
       It has now been over four months since the White House 
     announced numerous deals with major stakeholders in the 
     health care debate to save upwards of $2 trillion in the 
     health care system. Little to no details regarding the 
     negotiations have been released, and recent actions and press 
     reports have reminded me of the importance of openness and 
     transparency throughout the legislative process.
       Roll Call reports today that negotiators working in the 
     House to merge the three committee bills plan to trim the 
     cost of the legislation by roughly $200 billion. I wonder 
     what programs or services are being cut, who will be 
     affected, and how these cuts are being decided.
       In the Senate Finance Committee's mark-up, Senator Bill 
     Nelson (D-Fl) introduced an amendment regarding drug prices 
     in Medicare and Medicaid. During the debate on the amendment, 
     Senator Torn Carper (D-Del), while arguing against the 
     amendment, said ``Whether you like PhRMA or not, we have a 
     deal,'' referring to the deal PhRMA cut with the White House 
     earlier this year.
       In addition, within the Senate Finance Committee plan is a 
     commission to slow the growth of Medicare spending, most 
     likely through changes to reimbursement policy. However, 
     hospitals would be exempt from this commission because, 
     according to CongressDaily, ``they already negotiated a cost 
     cutting agreement'' with the White House.
       Despite your promise to make all health care reform 
     negotiations in public, we still have very few details on 
     what exactly was agreed to during these highly publicized 
     negotiations. In fact, even the stakeholders involved have, 
     at times, seemed at odds with what was actually agreed to. 
     But the one thing we all know is that, through press 
     statements, many deals were made. Unfortunately, even where 
     brief descriptions of policy goals are available, details on 
     achieving these goals are absent, a point made by the 
     Congressional Budget Office (CBO).
       I am compelled to ask--how could Congress have done its' 
     due diligence in creating the policy before us without 
     crucial details surrounding these deals? Were the votes we 
     have seen in the Senate Finance Committee as of late a direct 
     result of these backroom negotiations? Will CBO be able to 
     actually score any of these deals to apply those cost savings 
     to legislation? Were these negotiations in the best interests 
     of patients?
       Having little to no information, I cannot judge. However, 
     this begs even more questions. Is Congress enacting the best 
     policy reforms for Americans, or are certain changes being 
     made or not made because of the negotiations orchestrated by 
     the White House? Will smaller stakeholders suffer more from 
     our policy choices because of what larger groups may have 
     negotiated behind closed doors?
       Mr. President, I do not write this letter to chide you for 
     engaging in what I consider the most pressing debate before 
     Congress. I applaud you for your leadership in compelling 
     Congress to act. In order to fully understand the policy 
     choices before us, though, we need to know what took place 
     earlier this year during these meetings at the White House. 
     You have made it very clear that you value transparency and 
     have sought to make your Administration stand out in this 
     regard. As a member of the House Energy and Commerce 
     Committee's subcommittee on Oversight and Investigations, so 
     do I. The last thing I would want to see is a formal 
     investigation of these meetings.
       Thus, I formally request full disclosure by the White House 
     in the following areas regarding all meetings with health 
     care stakeholders occurring earlier this year on the topic of 
     securing an agreement on health reform legislation, efforts 
     to pay for any such legislation, and undertakings to bend the 
     out year cost curve:
       1. A list of all agreements entered into, in writing or in 
     principle, between any and all individuals associated with 
     the White House and any and all individuals, groups, 
     associations, companies or entities who are stakeholders in 
     health care reform, as well as the nature, sum and substance 
     of the agreements; and,
       2. The name of any and all individuals associated with the 
     White House who participated in the decision-making process 
     during these negotiations, and the names, dates and titles of 
     meetings they participated in regarding negotiations with the 
     aforementioned entities in question one; and,
       3. The names of any and all individuals, groups, 
     associations, companies or entities who requested a meeting 
     with the White House regarding health care reform who were 
     denied a meeting.
       In our efforts to improve access to health care services, 
     the American people expect us to act in their best interests, 
     rather than protecting business interests of those who are 
     interested in currying favor in Washington, DC. If these 
     health related stakeholders have made concessions to 
     Washington politicians without asking anything in exchange 
     for the patients they serve, Congress and, more importantly, 
     the American public deserve to know. Conversely, if they 
     sought out protections for industry-specific policies, we 
     need to know that as well.
       We must learn what these negotiations mean for the millions 
     of concerned Americans. How they will be better served, 
     including having affordable health coverage and access to the 
     providers they need? These negotiations may have produced 
     consensus on policy changes that are proper and needed, but 
     Congress will never know for sure that we are acting in our 
     constituents' best interests until all the facts are known.
       I look forward to the opportunity to speak with you at your 
     earliest convenience on this matter. Should your staff have 
     any questions about this request please contact me or my 
     Legislative Director J.P. Paluskiewicz at my Washington, D.C. 
     office at 202-225-7772.
           Sincerely,
                                         Michael C. Burgess, M.D.,
     Member of Congress.

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