[Congressional Record (Bound Edition), Volume 155 (2009), Part 19]
[House]
[Pages 26586-26593]
[From the U.S. Government Publishing Office, www.gpo.gov]




                    REPUBLICAN HEALTH CARE SOLUTIONS

  The SPEAKER pro tempore (Mr. Polis). Under the Speaker's announced 
policy of January 6, 2009, the gentlewoman from Wyoming (Mrs. Lummis) 
is recognized for 60 minutes as the designee of the minority leader.
  Mrs. LUMMIS. Thank you, Mr. Speaker.
  I am going to be joined this evening by Republican freshman 
colleagues of mine, and this session will be cochaired by my fellow 
freshman from the great State of Minnesota, Erik Paulsen.
  Erik, thank you for joining me this evening, and our other freshman 
colleagues will be joining us shortly.
  We're going to be talking about health care from the perspective of 
freshmen. We're going to be talking about some Republican alternatives 
to the large bill that the Speaker introduced last week and unveiled 
and that we're discussing this week. We'll be doing some comparisons 
between bills that Republicans have to provide better solutions, to 
take incremental approaches, to address the most important concerns 
that the American people have about their health care system first, and 
about the need to take a very deliberate, careful approach to changing 
an American health care system that needs tweaking rather than throwing 
out and replacing.
  I yield to my colleague from Minnesota, Mr. Paulsen.
  Mr. PAULSEN. Well, thank you. I thank the gentlelady for yielding and 
for organizing this little discussion tonight, and I know we're going 
to have some of our freshman colleagues joining us.
  I think, first and foremost, it's important for me to outline--and I 
think you share this view. You know, no one is denying that our health 
care system is in need of reform. Certainly, as a freshman Member, I 
know that the Members of our class, actually both Republican and 
Democrat, know that there need to be changes in the status quo. I know 
the Republicans, in particular in the freshman class, have been very 
frustrated that the media may not center or focus on some of the 
proposals that we actually have offered because, as you indicated, 
there are some very incremental approaches and piecemeal approaches 
which actually could be done and could be done bipartisanly to show 
success and progress in helping lower premiums for families, for 
individuals, and for small businesses.
  As most of the public is well aware now, I think, just as early as 
last week, we had dropped on our desks a 1,990-page bill, which is a 
huge, mammoth bill, and we can bring that up a little later for a prop. 
It is a big piece of legislation, and I know we're going to be voting 
on that later this week.
  I think I've come to realize in my first few months in office, as 
probably you have, that Washington is a place where actions are often 
taken without properly weighing the consequences and the impact of 
those actions. I think the bill that has been laid before us is very 
misguided in that it's going to have a heavy tax load put on the small 
business community. It's going to tax medical device companies in 
particular and medical device products, which impacts my district very 
greatly and the jobs there. We'll talk a little bit more about that in 
a little bit.
  Our goal also is to make sure we are providing adequate coverage and 
are lowering the costs of health care premiums for all Americans--for 
individuals, families, and small businesses--because it is a pocketbook 
issue; but I think the approach that the majority is taking is a very 
misguided approach, and we're going to have some discussion about that 
tonight and about some of our alternatives, which, I think, make 
absolute common sense.
  I would like to yield back.
  Mrs. LUMMIS. I look forward to having our colleagues join us so we 
can discuss some of those.
  We have been maligned as a party for not having a health care 
solution to counter the Pelosi approach and the Obama approach to 
health care; but in fact, we have over 53 bills that you can read 
online which will address health care reform. We offer and challenge 
the Democrat leadership, who controls this Congress, to pick and choose 
from among the better ideas that Republicans have and to bring some of 
those

[[Page 26587]]

bills through committees and to the floor so we can debate them openly 
in a transparent manner.
  They were not crafted behind closed doors as was the Democratic bill. 
They were crafted in the traditional manner with the help of 
legislative draftsmen and -women to address specific components of our 
health care system in a way that they can be aggregated into a larger 
reform package or addressed individually if we prefer. So we can have a 
healthy debate on a variety of subjects.
  Even the Chicago Tribune noted recently that Republicans have a 
number of great ideas. Here is an excerpt from a recent editorial in 
the Chicago Tribune:
  GOP proposals contain smart ideas to increase choice and competition 
in the health insurance market. These excellent ideas could expand 
coverage for the uninsured without cratering the Federal budget or 
curbing the competition and innovation that drive the U.S. health care 
system.
  My colleague Mr. Paulsen is on the Financial Services Committee, and 
I am on the Budget Committee. Among the things that he and I have seen 
in our committee work in the last 10 months is that we are aggregating 
more debt than George Washington through George W. Bush combined and 
that, while our colleagues on the Democratic side of the aisle 
criticize Republicans for spending too much and criticize their 
inheriting a deficit, in fact, since we arrived in Washington--we 
freshmen along with the Pelosi Congress--they have increased the 
deficit, doubling it in 5 years and tripling it in 10. So it is not an 
excuse that they inherited a deficit.
  Indeed, they did, and indeed, Republicans predating Mr. Paulsen and I 
did overspend, but you don't solve an overspending problem by making it 
two times worse in 5 years and three times worse in 10 years. Our 
approaches to the health care bill are to advance solutions that will 
not add a dime to the deficit.
  How many people believe that the $1 trillion-plus Democratic health 
care bill is not going to add a dime to the deficit? In fact, a poll 
recently showed that more people believe we'll discover life on other 
planets than the Democrats' health care bill will not add to the 
deficit.
  The Republican bills, however, do not add a dime to the deficit. Here 
are three of them that I'd like to highlight this evening. As I said, 
there are 53 on a Web site that I'll provide to you later in this 
discussion.
  One of them is H.R. 3400, Empowering Patients First Act. The prime 
sponsor is Representative Tom Price, a physician from Georgia. It is 
the product of the Republican Study Committee.
  The bill uses a mix of new tax credits and deductions to make the 
purchase of health care feasible for all Americans. The bill expands 
the individual health insurance market, using association health plans 
and interstate health insurance shopping to give people more choices. 
The bill encourages the creation of State-based portals so people can 
compare plan prices and benefits. For those with preexisting 
conditions, the bill redirects unspent stimulus funds towards State-
based high-risk pools. Importantly, this bill is fully offset through 
redirecting stimulus funds, stepping up efforts to root out waste, 
fraud and abuse in our entitlement programs, reducing defensive 
medicine through medical liability reform, and capping discretionary 
spending.

                              {time}  1930

  This bill scores in the favorable column.
  Another bill, sponsored by Representative John Shadegg of Arizona, 
entitled Improving Health Care for All Americans Act, has many of the 
taxation provisions incorporated into it that were eventually added 
into H.R. 3400. Then the Patients' Choice Act, which is a fun one to 
highlight, because it takes a little bit different tack, is sponsored 
by Representative Paul Ryan. The bill provisions include some reforms 
that are badly needed to Medicare and Medicaid without decreasing 
benefits.
  I yield to the gentleman from Minnesota.
  Mr. PAULSEN. Thank you for yielding.
  Well, I think, as you just mentioned, there is no doubt that there 
have been other Republican plans that have been offered. There are a 
variety of bills, 50-some bills that have been out there. In fact, all 
of these, nearly all of these pieces of legislation have actually been 
introduced prior to this mammoth nearly 2,000-page bill that has been 
dropped on our desk just last week.
  I want to go back to some of the comments you made earlier about the 
deficit, because as someone who came to Washington fully acknowledging 
and recognizing that Republicans were part of the problem on deficit 
spending many years ago, that is no reason to continue to do the same.
  Seeing ourselves now face our very first trillion-dollar budget 
deficit is of great concern to me. I know it is of great concern to my 
constituents, for their children and their grandchildren, thinking the 
share of the national debt for each person now has gone up to about 
$38,000. Compared to when I was born, it was about $1,500 per person.
  At some point we are going to have to pay back that debt, and that's 
a heavy burden that's going to fall, unfortunately, on our children and 
our grandchildren. The bill that is being proposed by the Speaker does 
not address health care costs.
  You mentioned earlier there is not a good track record of government 
introducing legislation and having it be cost-effective or innovative. 
The reality is, if you look back at 1965, congressional forecasters 
predicted at that time that Medicare would cost about $12 billion in 
1990.
  Do you know what its actual cost came in at? The actual cost came in 
at $90 billion. Today, just like Social Security, it is now on a path 
to insolvency due to runaway costs. We have massive problems with 
existing entitlement programs. It doesn't seem to me to make a lot of 
sense to have a new entitlement program that the government doesn't 
have a good track record on.
  Mrs. LUMMIS. The gentleman from Minnesota has four really cute little 
girls, and I carried one of their Scooby-Doo backpacks through the 
Minnesota airport while we were transferring planes trying to get back 
to Washington for votes. A lot of us have kids or grandchildren that 
will be affected by this legislation because they will be paying for it 
for years to come.
  One of the things we all learned from our parents in this baby boom 
generation is the importance of handing a better America to your 
children, and that is something that I don't want to be responsible for 
being the first generation to renege on. That's why I am so much more 
supportive of these Republican bills than of the Speaker's bill.
  Among the things that are in the Republican bills that are so 
important are meaningful tort reform. I say this with a caveat; I am 
one of those Republicans who would rather see tort reform done at the 
State level. I think we see more innovation and creativity. We see some 
States that want to have caps on noneconomic damages. We see some 
States that want health care panels, States that want to make sure that 
expert witnesses, within the certain specialty that is charged with 
malpractice, are the ones that are designated as witnesses. There are a 
whole variety of ways to address tort reform.
  I prefer that it be handled at the State level, but I have signed on 
to several of these bills that have State tort reform provisions even 
at this Federal level because I think they take a much better approach 
to the overall subject of health care reform. In other words, the 
Republican plan has meaningful tort reform. Oddly, the Speaker's bill 
contains a provision that says they will give out grants for 
innovations in tort reform but not to States that have placed a cap on 
noneconomic damages.
  If you talk to some of the former legislators, now Members of 
Congress, who are from States that enacted caps on noneconomic damages 
and medical malpractice cases, you will learn that their medical 
malpractice premiums for their physicians dropped, thereby

[[Page 26588]]

allowing their physicians to either charge their patients less or stay 
in practice in small communities where they don't have as many patients 
to spread out the costs of that extremely expensive malpractice 
insurance premium.
  Then we have interstate health insurance shopping. This is really 
what I think is going to be one of the most exciting keys to reducing 
the costs of health insurance, because it's going to create more 
competition. Coming from the smallest population State in the Nation, 
Wyoming, and not being able to buy insurance across State lines for 
health care the way I can for automobile insurance, I don't have the 
options, because of our little small pool of citizens, to spread the 
costs.
  It's going to be very important that we have the ability to shop for 
health insurance across State lines and that we do it in a transparent 
way. I see these ads on TV for car insurance. Well, there is a little 
sign that you look at that compares one company's premium to another, 
to another. You can go online and shop and compare and put in the kinds 
of factors that you want in your automobile insurance.
  We should be able to do that for health insurance. We should be able 
to buy our health insurance premiums that way, and the Republicans' 
bills will allow that to happen.
  Then, further, association health plans, the Republican plans have 
it; the Democrat plan does not have it. Association health plans, once 
again, would allow groups with some common interest to pool, to create 
a larger pool, whether it's your church denomination, your Rotary Club, 
your alumni association or any other group that wanted to form an 
insurance pool for purposes of providing health insurance to their 
member participants.
  This I call kind of an equivalent to what's available in the banking 
community. You have commercial Main Street banks, and then you have 
some credit unions. I kind of associated this kind of association 
health care plan with the notion of a credit union.
  These are things that we have that would increase and stimulate 
competition in the private sector, and these are in the Republican 
plans. They are not in our colleagues', who are members of the 
Democratic Party, plans.
  Now I would like to call on one of our colleagues who is from the 
State of Colorado. Mike Coffman is here this evening from my 
neighboring State of Colorado.
  I yield to you and thank you for attending this evening's discussion.
  Mr. COFFMAN of Colorado. Thank you, Representative Lummis.
  What I think is of concern to those of us from Colorado, and I think 
many people across the country, is what is the impact upon jobs and 
employers. There is a concern about small business in particular.
  There is a provision in the Pelosi bill, the Pelosi health care 
reform bill, that has a surcharge on small businesses and employers. 
Now, granted, it has moved up to where it was in the first version, 
H.R. 3200, where it was if somebody had the average annual payroll 
between $250,000, and then it started as a surcharge at 2 percent up to 
$400,000 on an average annual payroll, with an 8 percent surcharge, 
that number has been moved up a little bit; but I think it's still 
going to be devastating to the economy. With $750,000 and above it's an 
8 percent surcharge, and then it's graduated a little bit down below 
that.
  To put a surcharge on employers, a payroll tax, if you will, on 
employers that are just trying to keep their doors open, to keep 
making, to be able to make the payroll that they have, I think, is 
going to be a devastating job killer to this economy. I think we ought 
to focus on job creation and not job killers.
  Mrs. LUMMIS. The gentleman is correct. In fact, we have found that 
studies determined that 5.5 million more jobs will be lost as a result 
of the taxes placed on small businesses under the Democrat version of 
the bill. Furthermore, there is a double whammy for small business. For 
businesses under 500,000 in payroll, there is not a big hit. But, of 
course, a lot of businesses in my State of Wyoming, there are 1,400 in 
my State of Wyoming that will be hit because they pay these taxes at 
the individual tax return, but they are small businesses that pay 
payrolls of more than $500,000. That means 1,400 businesses in Wyoming 
are going to be slapped with that tax.
  I yield to the gentleman from Minnesota.
  Mr. PAULSEN. Thank you. Maybe I will ask the gentleman from Colorado 
a question, because he makes a really good point about this bill, that 
the proposed 1,990-page bill by the Speaker is bad for small business. 
Why would the Congress in a tough economy want to further penalize 
small businesses when they are struggling to get by and a third of all 
small businesses are going to be impacted by this surtax that you had 
mentioned?
  We want to help small businesses grow, knowing that they are the 
engine of economic growth for this country, and we are making it 
tougher and tougher on them. Why would Congress even consider that?
  Mr. COFFMAN of Colorado. The majority of small businesses, they are 
the job creators. They are the engine for job creation in this country, 
these really small businesses. Whether we like it or not, the reality 
is that oftentimes start-ups don't have the cash flow to support health 
insurance. I started a small business in Colorado and for the first 7 
years was not in a position to offer health insurance. When I could, it 
was at a 50/50 split with the employee.
  What this legislation says is that's not even good enough, that you 
have to be able to pay 72.5 percent of a federally approved plan 
through the insurance exchange or, for a full-time employee, 65 percent 
of the family. Anything less than that, you are going to be hit by a 
surcharge.
  You know, the reality is that oftentimes small businesses just--I 
mean, if you are struggling just to keep your doors open, and you get 
hit with a payroll tax, it's not like an income tax, that if you make a 
profit, you pay the tax.
  This is, you are going to pay this whether you are losing money or 
not. This is whether or not you are going to have to lay off employees 
or not. It's a very bad direction to go, and it's certainly not in the 
Republican version. It's, unfortunately, in the Democrat version that 
we will be voting on later this week.
  Mr. PAULSEN. Just to mention, I mean, it sounds like it just defies 
common sense. With unemployment at near 10 percent--I know there are 
going to be some new job figures that will be released in the very near 
future--but it defies common sense of why we would really hit the small 
business community even harder and make it tougher for them to raise 
jobs.
  As the gentlewoman mentioned earlier, the Republicans have a proposal 
to allow small business to pool together through these associated 
health care plans to actually help small businesses provide health 
insurance for their employees.
  Mrs. LUMMIS. That will do wonders in my State of Wyoming where a lot 
of people are small business people, in fact, mom and pop sole 
proprietors, ranchers, that are just the mom and the dad in the family, 
and they have individual insurance policies that they purchased as an 
individual because they are it, they are the business. Under the 
Democrats' bill, those are the very people who are going to be 
completely foreclosed from being able to purchase individual health 
insurance plans after 2013.
  We have been joined by our colleague from the State of Pennsylvania. 
Glenn Thompson has with him a very large stack of paper. Representative 
Thompson, what is that?
  Mr. THOMPSON of Pennsylvania. This is a health risk, a serious health 
risk, for those of us who are carrying it around and, frankly, for the 
country. This is the Nancy Pelosi health care bill, 1,990 pages, and 
that's just part one.
  Part two, I am sure we will see within the next 24 to 48 hours; that 
will be the manager's amendment. That will be all the buyouts, the 
bribes, the deals that are being made right now by the Speaker and my 
Democratic colleagues to buy their votes to support this.
  I don't know what to expect. I don't know if my colleagues have a 
guess. We

[[Page 26589]]

do a guess here in terms of the number of pages, this manager's 
amendment, which, frankly, will be all of the deals that are made. How 
many pages do you think the manager's amendment might be when we see 
this in the next 24, 48 hours?
  Mr. COFFMAN of Colorado. I think it's about a couple of inches thick, 
would be my guess. The manager's amendment to the cap-and-trade, I 
think, was several hundred pages. I am speculating, but this is double 
the size of cap-and-trade. So let's go for 600 pages.
  Mr. THOMPSON of Pennsylvania. Six hundred. Do I have another bid?

                              {time}  1945

  Mrs. LUMMIS. The rumor I heard was 800.
  Mr. THOMPSON of Pennsylvania. The gentlewoman from Wyoming says 800 
pages. How about my good friend from Minnesota?
  Mr. PAULSEN. Well, I am going to just gander a guess. It is going to 
be several inches thick, which is too thick for us to read in a short 
period of time, unfortunately, and probably for the public to have that 
right to know.
  Mr. THOMPSON of Pennsylvania. Now, that was a rather safe guess; a 
rather safe guess.
  Yes, that manager's amendment is coming. And there are lots of just 
flawed approaches to health care here. Speaking as someone who worked 
in that field for almost 30 years as a manager in rural hospitals and a 
skilled nursing facility and many different settings, I want to talk 
just briefly about some of those, because it has to do with one of the 
charts you had up there about the promise to not add a dime to the 
debt, not a dime to the deficit.
  This bill was based on the premise of Medicare growth being held at 4 
percent. Now, why is that important? Well, Medicare is a significant 
amount of money, so 4 percent of Medicare is a lot of money. But let's 
talk about reality here, and that is what this bill lacks is a good 
dose of reality.
  Medicare growth rates have been steady at 7 to 8 percent a year. That 
is just the reality of it. If you think about it, those in the baby 
boomer generation who are now retiring, becoming qualified 
beneficiaries under Medicare, that is a significant number of people 
adding to the Medicare rolls from this point forward. So, 7 to 8 
percent.
  If we just look back a year to 2008, the Medicare growth last 
calendar year alone was 9 percent, 9 percent, and yet this bill was 
based on holding Medicare at 4 percent. I think that is pretty flawed 
math. That is not even fuzzy math. That is just wrong.
  We know that this is built on half a trillion dollars in new taxes, 
and you talked about some of those. Small businesses. Taxes on 
individuals who choose not to buy in, to buy insurance, are penalized. 
Medical devices will be taxed as an excise tax.
  The other part of the funding mechanism is a half a trillion dollars 
in Medicare cuts. We have talked about that during other forums here, 
when already Medicare systematically has been underfunded from almost 
the day it was created. Medicare only pays today about 80 to 90 cents 
on every dollar of health care costs that a hospital or doctor has. And 
to do another half a trillion dollars in Medicare cuts, that is just 
wrong. The people that are going to suffer from that are the providers 
and older adults. This will bankrupt hospitals.
  Mrs. LUMMIS. Reclaiming my time, I would echo some of your concerns 
in saying that in rural areas Medicare is not reimbursed at the same 
rates as it is in urban areas. So hospitals and physicians in rural 
areas receive less compensation for Medicare patients than they do in 
urban areas; so much less that in Casper, Wyoming, a town in central 
Wyoming, only about one-third of their actual out-of-pocket expenses 
are reimbursed from the Federal Government when they treat a Medicare 
patient.
  Well, the hospital, because it is a quasi-public hospital, is going 
to keep taking those patients. But private physicians don't have to 
keep taking those patients, and when they are undercompensated, some of 
them choose to no longer take Medicare patients. And in a State that 
has a dearth of physicians anyway because we have such a small pool of 
patients, we are losing more and more access to doctors, even today.
  My concern under the Democrats' bill is that we will be worse off as 
a State in terms of the number of physicians who will take Medicare 
patients and the hospitals that will take Medicare patients because of 
the poor reimbursement levels and decisions that are being made by the 
majority party in Congress to make further cuts in Medicare.
  I yield to the gentleman from Colorado.
  Mr. COFFMAN of Colorado. Thank you, Congresswoman Lummis.
  One of the things that concerns me is how seniors are treated in this 
bill, and I think you certainly mentioned some of the things. But half 
of the bill is paid for by cuts to Medicare, roughly half, and that is 
stripping hundreds of billions of dollars out of the Medicare system. 
So a couple of things concern me.
  There are going to be cuts certainly to Medicare Advantage. Many of 
the 10 million seniors that we know that are on the Medicare Advantage 
program will lose their coverage.
  But what concerns me is the solvency of the system. If in fact there 
are savings in the Medicare system through looking at waste, fraud and 
abuse, as the proponents mention, that money really needs to stay in 
the Medicare system for seniors, because the actuaries or the trustees 
of the Medicare system are projecting that Medicare will run out of 
funding in 2013. So what we ought to be concentrating on, and there 
seems to be no discussion, is what is going to happen to the seniors in 
Medicare. Will they simply move into the public option? And then the 
public option, we defer to bureaucrats in the bill to define what are 
essentially the procedures, the treatments that are authorized.
  So they are going to be making that decision, and on what basis are 
they going to be making that decision? Is it going to be on the 
quality-of-life issues in terms of maybe end-of-life care isn't 
important? We don't know these things. But I think the seniors ought to 
be real concerned about what is going to happen to their Medicare 
system, their Medicare plans under this particular proposal.
  Mrs. LUMMIS. Before I yield to the gentleman from Minnesota, I wanted 
to remark on something I learned today. The Republicans had a little 
reading room where we could go and read the bill and share ideas, and 
especially learn from ranking members of the various committees who 
have been studying these concepts at least, even though they haven't 
seen it in bill form, for not only months, but years.
  One of the things that I learned today in that session is that the 
enforcer in the Democratic bill is actually the IRS. One would think 
that with 111 new government agencies that the enforcement mechanism 
for providing health care, what is supposed to be a very positive 
notion, would not be the IRS.
  What thinks the gentleman from Minnesota?
  Mr. PAULSEN. Well, I thank you for yielding. I just want to go 
reference back to the comment that the gentleman, my good friend from 
Pennsylvania, had made on the tax on medical devices.
  I have the privilege of being the co-Chair of the House Medical 
Technology Caucus. So just about 2\1/2\ to 3 weeks ago I conducted a 
field hearing in Minnesota in my district and we heard directly from 
those that would be impacted by this very onerous tax, because the 
Senate originally proposed a $40 billion tax on medical devices, and 
now the House, Speaker Pelosi's bill, the 1,990-page version has a $20 
billion tax.
  I want to tell you what we heard directly from people. One, we heard 
directly from small companies. I have a medical alley in my district 
that employs about 20,000 people in this sector, this economy, and 
these are folks that are producing these new lifesaving technologies 
that really give families and individuals the peace of mind that they 
are going to be taken care of in

[[Page 26590]]

their elder years, or for their children, for instance.
  Some of these companies, one in particular that just turned 
profitable, was very direct in saying, You know what? If we get hit 
with this tax, unfortunately, we are going to have to take that 
reduction in payroll. That is where the tax is going to hit us is in 
payroll and in layoffs and out of research and development.
  So we are actually stifling innovation. It is an innovation tax.
  Then we heard from a venture capitalist who is involved in new 
startups to try and get these little companies going again, some that 
have five employees, some that have nine. They are hoping to come up 
with the ``next best thing.''
  We are putting another nail in the coffin for them, as it was 
explained. We are making it that much tougher, because it is kind of a 
lottery right now. It is so difficult for a company like this to get 
the venture capital and then bring a product to market.
  Finally, we heard from patients. We heard from patients that would be 
directly impacted. In particular, there was one individual that has an 
artificial limb, a prosthetic, that now as a patient we are making 
health care more expensive for him by having a tax on his products. And 
the tax that we have now as part of the Pelosi bill is going to put a 
tax on wheelchairs, on hearing aids, on the bandages that hospitals 
purchase. So it is absolutely a move in the wrong direction. It is 
going to make health care more expensive.
  Mrs. LUMMIS. And, in fact, we also learned today that the bill runs 
counter to the President's promise that this was not going to tax 
people who make less than $250,000 a year. Because of the taxes that 
the gentleman from Minnesota just described, 90 cents out of every 
dollar that applies in this bill in additional costs will fall on 
people that fall in exactly that category, the $250,000 and less income 
earners.
  I yield to the gentleman from Pennsylvania.
  Mr. THOMPSON of Pennsylvania. Well, I thank the gentlelady from 
Wyoming.
  I think innovation is one of the things that our health care system 
fosters in this country. When you look at the advancements that we have 
had, whether it be in medical devices or lifesaving technology, 
diagnostic, invasive, noninvasive, lifesaving interventions, that comes 
out of the type of health care system that we have today. It is the way 
it has been designed and the way it works. It provides those 
encouragements.
  I have a number of similar small businesses that started very small, 
I don't know if they started in somebody's garage, but started as small 
operations, and they developed tremendous innovations, innovations in 
terms of prostheses for individuals who have lost limbs.
  Actually, one of them is an incredible small company developing a 
limb that is not just a powered limb, which is the cutting edge for a 
prosthesis, an artificial leg, but this one actually self-charges. In 
the use of it, that friction builds up the power.
  The application of it is just tremendous, starting with our wounded 
warriors who rehabilitate and return to the field. This is an 
artificial limb and you don't have to plug it in at the end of the day. 
It recharges while you use it. We wouldn't get that innovation.
  Any time we tax something, we repress it. We hold it back. We destroy 
it. This tax on medical devices is just, well, I agree, it would be a 
nail in the coffin of innovation for health care in this country.
  Mr. PAULSEN. If the gentleman would yield, he raises a good point, 
because having visited Pennsylvania and knowing there are some 
technology sectors right in your district in particular, and there are 
many States, and maybe that is because some States don't have these 
medical device technologies growing, they are not being incubated. It 
is Massachusetts, it is California, it is Tennessee and Minnesota, 
which surprises me, because the Speaker being from California is 
proposing this tax. It is actually going to hurt many of these devices.
  Again, we talked about the nature of the economy, almost 10 percent 
unemployment. We are going to be making it tougher to have very well, 
high-paying jobs, tougher for those companies to keep those jobs. It 
just doesn't make any sense to me.
  Mrs. LUMMIS. One of the math items in this bill that just doesn't add 
up is the fact that they are going to be paying for 6 years of benefits 
under this bill with 10 years of revenue collections. And yet when we 
get, then, to that magical 11th year where we need to be able to pay 
for it as we go, obviously we won't be able to just stop providing 
benefits and have the taxes run for 4 years where we don't tap into 
them before we involve ourselves in the benefit component of the 
program again.
  So that is a one-time in the first 10 years type of financial 
balancing act or financial gimmick that is being used in this bill to 
make it sound like it is in some way financially balanced. It is not, 
and it will suck more out of this economy in the second and ensuing 10 
years and in decades when once again our children are going to be 
paying for it.
  So, this bill really does defer to our children and grandchildren 
huge financial obligations that the people in this room feel is not 
only unnecessary, but highly inappropriate.
  Mr. THOMPSON of Pennsylvania. If the gentlelady will yield, you are 
going down a tremendously important road here in terms of what this 
legacy of costs that we are passing along to our children and our 
grandchildren and great-grandchildren at this point is, on top of all 
the other deficits that have been accumulated by this Democrat-led 
Congress since January.
  I had the opportunity to spend some time this morning with a former 
Congressional Budget Office director. And going back to the point of 
the flawed math here, of saying that growth in Medicare will be held at 
4 percent, when we know that it is an average of 7 to 8, 9 percent last 
year, his estimates are this cost will actually be at somewhere around 
$1.8 trillion in terms of math.
  To give us some idea, I just want to point to a project that actually 
is literally under our noses. It was a project that did not occur on 
our watch. This was years past, and it is a beautiful place to visit 
and we take our constituents there, the Capitol Visitor Center.

                              {time}  2000

  I certainly encourage people to come to Washington to visit that, but 
there is a prime example of estimates that were made, and in the end it 
was 300 percent more expensive than what the original cost estimates 
were. So even if we're at a trillion or $1.2 trillion or $1.8 trillion, 
and we know that we cannot afford that, where could these costs go once 
this legislation passes? Just based on the example of a project that we 
should have pretty good oversight on because it was being constructed 
right under our noses.
  Mrs. LUMMIS. I yield to the gentleman from Minnesota to introduce our 
colleague from Tennessee.
  Mr. PAULSEN. I will yield to the gentleman, but in particular, my 
colleague from Tennessee, whom I have learned a great deal from, one of 
the things that I appreciate about you is you're a former mayor and you 
know how to get things done, and certainly I think Members of Congress 
could take some lessons from you. Coming from this great State of 
Tennessee, you've got some of those medical technology companies in 
your great State. And we should hear from you as a physician as well. 
You've got a very unique perspective, and you can offer a lot to this 
Congress.
  I yield to the gentleman.
  Mr. ROE of Tennessee. I appreciate the gentleman yielding.
  I would like to start out by saying that I don't think there's a 
conflict at all either from the Republican side or the Democrat side 
that we have a need to reform health care in this country, because 
costs are not sustainable on the current path. I don't think anyone 
disagrees with that. And, secondly, it's a noble goal and an attainable 
goal, I believe, to cover our citizens with health care. I believe we 
can do that in

[[Page 26591]]

this country. I don't think this bill is the one that does it, and I go 
back to an experience that I've had in Tennessee.
  The gentleman from Pennsylvania was talking about the cost of the 
Visitors Center. Let's go over the costs of health care in this country 
and estimates by government people, by the CBO and others. Let's go 
back to 1965, and I do believe that this is the single biggest debate 
on a social issue since the civil rights movement in the 1960s and 
Medicare in 1965. In 1965 the estimate was Medicare would cost $3 
billion to $4 billion a year, and that's what it cost. The estimate in 
1990, 20 years later, it was going to be a $15 billion program. What 
was the actual cost? Over $90 billion. And today our Medicare program 
is over $400 billion.
  Let's also dial back to Medicaid. The Medicaid program, the 
government insurance for low-income people and infants and children, 
has gone up 37 times since its inception.
  In TennCare we had the argument that I hear and, again, I dealt with 
it as a physician and also as a mayor. In the early 1990s we had a lot 
of people in Tennessee who were uncovered. So we wanted to cover as 
many of our people as we could. So we got a waiver from Washington to 
experiment with a managed care plan called TennCare. And HHS, the 
Health and Human Services here in Washington, exempted us from the 
current Medicaid plan.
  When we started this plan, we started with eight different companies 
that would go after your business on a competitive basis, and this was 
going to hold costs down. We would compete among these plans.
  So what actually happened in Tennessee was this: in 1993 the State 
spent $2.6 billion on our TennCare program. Between there and 2004, 10, 
11 budget years later, that had risen to almost $8.5 billion. It had 
over-tripled in price, where we thought the costs would be less than 
that. We thought it would hold costs down.
  What actually happened with the public option? Well, what happened 
with the public option was this: 45 percent of the people who got on 
TennCare had private health insurance, and they made a perfectly 
logical decision. It was cheaper, it had first-dollar coverage, it was 
a very generous plan. So they dropped their own private health 
insurance coverage and got on TennCare.
  Now, I just got the numbers this afternoon, and they are what I 
thought they were. In our State our TennCare plan pays about 58 percent 
of the cost of actually providing the care. Medicare pays 91 percent in 
Tennessee of the cost of providing the care, and the uninsured pay 
somewhere in between. And what happened in our State was those costs 
got shifted to private insurers.
  Well, the State was then left with--almost every new budget dollar 
that came to the State of Tennessee was used for health care, not for 
K-12, not for roads, not for other things, colleges and so forth. So 
what did the Governor, who is a Democrat, and the legislature, which is 
now Republican, what did they do? Well, they rationed care. And how did 
they ration care? They cut the rolls. And every year that we had a 
raise, it was almost double digit. The year that broke the bank was a 
19 percent increase in costs in 1 year.
  So we have seen the public option. We have seen the competition. And 
the problem with any public plan is it doesn't pay the cost of the 
care. And when you do that, three things happen for somebody: one is 
you decrease access because you don't have someone who will take those 
patients on that don't pay the cost of the care. Number two, when you 
decrease access, you decrease quality of care because the patients 
can't get to a physician other than through an emergency room. And, 
three, somebody else, that's the private insurers in our State, pay 
more money. So we had decreased access, decreased quality, and 
increased costs. So that's what I'm fearful of here that will happen 
with this.
  There is a better way. I mean, I can sit down with the expertise in 
this room right now and we can write a plan with our Democratic 
colleagues in 30 minutes. A quick example of that is the current Baucus 
plan calls for increasing access to 91 percent of our population. Now 
85 percent of our population is covered. You can do two things that 
will get you to 91 percent on one page, and that is, number one, allow 
young people, like I've had children in my own home that have had to do 
this, that don't have health insurance when they graduate from high 
school or college, to stay on their parents' plan until they're 26 
years old. This current bill, the Democrats have had that in there, and 
I agree with that 100 percent. And, number two, simply sign up the 
people who already qualify for Medicaid or SCHIP, and you will get to 
91 percent. So it's a fairly simple thing to do without a lot of 
government bureaucracy, new plans, czars, commissioners, and so on 
that's so complicated right now. I'm sure some of you have tried to 
wade through this bill, and some of it's almost incomprehensible.
  I thank you for yielding.
  Mrs. LUMMIS. We are all freshmen who have been talking here. Many of 
us served in some capacity either in our State legislature, in your 
case as a mayor, a couple of State treasurers; so we know how State 
government works. And what we see, as States could not print money, we 
had to live within our means. So when the Federal Government places an 
unfunded mandate, meaning they require States to provide a service and 
then don't provide the money for the State to provide the service, the 
State has to come up with the bucks. And this has been called the 
``mother of all unfunded mandates'' by the Democrat Governor of your 
home State of Tennessee.
  And those of us who are here--I know that you were leader in your 
Minnesota legislature--tried to find good legislation that was sitting 
around and had been introduced by Members of either party. And in 
honesty, in my legislature, if a Democrat had a great idea, and we were 
Republican legislators, we'd go steal their ideas and put Republican 
names on it and sponsor it. It was the best form of flattery. The ideas 
were coming up.
  And you know who did that maybe better than anybody I have ever seen 
on a national scale was Bill Clinton. He took what was cultivated in 
the States and nurtured in the States a plan to reform welfare, and he 
slapped his name on it and he made it his. And he worked with 
Republican Members of this Congress to reform welfare.
  We could do that today. We have 53 bills out there that our 
Democratic colleagues could say, hey, this is a good idea or I like the 
idea of letting young people stay on their parents' insurance until 
they're 26 years old. That helps them out, especially in these tough 
economic times when it's hard to find a job. There are ideas out there 
that would solve these problems.
  Yet we are faced with a bill that is almost 2,000 pages long that 
we're expecting a big additional amendment to, that was drafted behind 
closed doors, that has some nonsensical language in it that people 
can't understand that we only get 72 hours to read. It all seems like a 
bad dream. But it's the American Congress. And there are so many better 
options out there. I just am so frustrated with the majority party that 
they won't look through our 53 bills that they could read online and 
say that's a good idea, let's put a Democrat's name on it and make it 
our idea. We'd be delighted.
  I yield to the gentleman from Tennessee.
  Mr. ROE of Tennessee. I thank the gentlewoman from Wyoming for 
yielding.
  Just to make your point, something that I promised I would do when I 
came here as a local mayor, I had dealt with unfunded mandates until I 
had had them up to here on the local level. The State has to deal with 
these. And I made a decision I'm not going to vote for an unfunded 
mandate that the Federal Government puts on local government or State 
government.
  And our Governor right here that you mentioned, Governor Bredesen, 
who is a Democrat, by the way, and is very knowledgeable in health 
care, I have great respect for him and the knowledge that he has. He's 
had to make

[[Page 26592]]

some tough decisions. He has looked at this current plan and evaluated 
it from the viewpoint of the State of Tennessee. I think it's September 
of next year, 2010, the money that the States get from stimulus is 
gone. It's over with. So he's looking at this unfunded mandate to us.
  And let me just tell you how critical it is in our State right now 
because of jobs. We are losing jobs in the State. The unemployment rate 
is above 10 percent, and we're a sales tax-based State. We don't have a 
State income tax. And he has estimated that this particular plan, H.R. 
3200, now 3962, that's out there will conservatively cost our State 
$735 million in the first 5 years. And if it has the same benefit 
package, which remember the commissioner will decide what an adequate 
benefit package is, it will cost the State as much as $3 billion to $4 
billion.
  Let me tell you the dire straits we're in. The SCHIP program right 
now, the State Children's Health Insurance Plan, known in Tennessee as 
CoverKids, we can't enroll any other kids in there because we can't 
afford the current plan. So if we come down with another unfunded 
mandate, we don't know what we're going to do in the State.
  Mrs. LUMMIS. We are now down to the speed round, which means we have 
2 minutes left for each Member of this discussion to summarize.
  And I would like to start with the gentleman from Pennsylvania.
  Mr. THOMPSON of Pennsylvania. I thank the gentlewoman for yielding.
  I just want to build quickly on affordability. And our Democratic 
colleagues have recognized this with this bill, and I just call 
attention to page 25, section 101, which is the national high-risk 
pool. These are the folks we should be doing something for. They're 
high risk, preexisting conditions. They have a difficult time accessing 
health insurance. And the language that's built into this, our 
Democratic colleagues recognize this isn't going to be sustainable. 
We're not going to be able to fund this. Within the legislative 
language it says, given once the money is spent and goes beyond the 
premiums checked, it allows the Secretary of Health and Human Services, 
if all are exhausted, to do three things: cut benefits, increase 
premiums, and create waiting lists. Page 25, section 101.
  I think that's a general acknowledgment early in this bill. And if we 
can do that type of rationing for folks who are most at risk, who we 
should be doing health insurance reform for, what does it mean for the 
rest of us?
  I thank the gentlewoman for coordinating tonight.
  Mrs. LUMMIS. You are well under your time. Thank you for 
participating.
  I yield to the gentleman from Colorado.
  Mr. COFFMAN of Colorado. I thank the gentlewoman from Wyoming for 
yielding.
  One concern certainly that I have is that we are, I think, not 
focused on all that we have in terms of a safety net. For instance, in 
my home State of Colorado, there is a high-risk insurance pool called 
Cover Colorado. We have a premium tax on all insurance products, 
whether it's health care or it's property and casualty, some of which 
goes into the general fund, some of which goes into a subsidized health 
insurance plan for people with preexisting conditions that can't 
otherwise reasonably get insurance but don't qualify for a public plan 
because of their income or their assets. So they are covered under this 
program where they are charged a flat 140 percent of what the average 
premium cost is in Colorado.

                              {time}  2015

  We have 183 community health clinics in Colorado. If you look at the 
community health provider network Web site for Colorado, they saw over 
400,000 patients--not patient visits but patients in the State of 
Colorado--where they got preventive care, primary care, dental services 
and mental health services, mostly at taxpayers' expense, all for the 
uninsured and underinsured. We have Medicaid for the poor and disabled. 
We have Medicare for the elderly. So there is a tremendous safety net 
right now. To include emergency room care for those that don't have any 
form of insurance or are not on a plan and walk in, they're required by 
law to receive all appropriate screening and subsequent treatment. So I 
think we need to be aware of what the safety net is right now.
  Mrs. LUMMIS. I thank the gentleman from Colorado for participating 
this evening, and I yield now to the gentleman from Tennessee.
  Mr. ROE of Tennessee. I thank the gentlelady from Wyoming. Just a 
couple of brief things that we hadn't touched on maybe as much. 
Certainly I am one of the few people in this Congress who have had to 
go down to the emergency room at 3 or 4 o'clock in the morning and see 
someone who doesn't have health insurance coverage or has a malignancy 
that needs care. I have seen it and have dealt with it. Certainly what 
we would like to do is make sure that we can find a way to help those 
folks that don't have coverage right now. We have got 85 percent of the 
people in this Nation who have coverage, and what are they worried 
about? The cost. I will tell you now that we will never get the costs 
under control in this country without liability reform. Unless you have 
medical malpractice reform in some reasonable way--and one of the 
problems that we have in malpractice reform is that we don't have a way 
to adequately compensate someone who's been injured.
  Right now in this system, in Tennessee, the system that we had 
doesn't do that. Since the inception of our malpractice company, owned 
by the physicians in Tennessee, since 1975, over half the dollars that 
have been paid out have been paid to attorneys and not to the injured 
party. Less than 40 cents of every dollar that we pay has been paid to 
someone who's been injured. There is something wrong with that. So we 
have to look into this as a Nation and decide how we're going to 
proceed. Certainly people are injured and do need compensation for 
their injuries. But the system we have now is broken. It needs to be 
fixed. This particular bill does nothing for that.
  I will yield back the remainder of my time so that others can speak. 
I appreciate you having me on with you tonight.
  Mrs. LUMMIS. We are blessed to have three physicians in our 
Republican freshman caucus who have been gracious in educating us about 
the medical practice in their parts of the country. It's a great 
privilege to serve with them in Congress and also the gentleman from 
Pennsylvania who spoke earlier, who has managed health care in his 
State. We are deeply grateful for his participation.
  I thank the gentlemen from the Republican freshmen for participating 
in this evening's effort. I can tell you that the women in the 
Republican Conference have been discussing health care as it relates to 
women this week, and we'll be doing so again tomorrow. I will look 
forward to pursuing that discussion again tomorrow. But to wrap things 
up this evening for the remainder of our time, I would like to turn it 
over to my colleague and cohost for this evening's Special Order by the 
Republican freshmen, the gentleman from Minnesota (Mr. Paulsen).
  Mr. PAULSEN. I thank the gentlelady for helping coordinate the 
opportunity for all of us tonight as freshmen to express some of our 
concerns and certainly opposition and reservations to the bill that has 
been put now before us that we will likely be voting on later this 
week. We talked about why this bill is bad for the American public. I 
just want to recap. Number one, we talked about why this bill is bad 
for small business. It raises their taxes. It's going to cost jobs. 
We've talked about why this bill is bad for individuals. It mandates 
that they will have to buy coverage or else they're going to have to 
pay a penalty. We've talked about--not at great length but why the bill 
is, indeed, bad for seniors. That is no doubt. I talk to a lot of 
seniors in my district that are under Medicare Advantage right now, and 
they are very concerned about having to give up the health care plan 
that they're under right now. These Medicare Advantage plans, they 
offer a lot of what the President himself in this very Chamber

[[Page 26593]]

talked about, good services that benefit a lot of these seniors, going 
for regular checkups without having to pay an additional copay, having 
vision care, having dental care. That is what Medicare Advantage plans 
offer. And to cut Medicare by $500 billion, to me, makes absolutely no 
sense.
  If you really think about it--and my good friend from Tennessee, the 
doctor, mentioned earlier--some of the good provisions we should be 
supporting, like allowing young adults to be put on their parents' 
policies--I mean, that's common sense, and we support that initiative. 
We just wish that we could hit the reset button and not have a 1,990-
page bill where we would have just a provision where we could do that, 
as well as allowing the small businesses to pool together. We can 
absolutely cover preexisting conditions. That is something we 
absolutely should do and we support doing. So there are some good 
things that we should focus on. Unfortunately, those aren't the 
priorities of this bill, unfortunately. And ultimately, the American 
want people want to have the peace of mind that they can get the 
coverage that they need when they need it, and they want to ensure that 
they--not the government, not special interests, not Members of 
Congress--are not going to stand between a patient and their doctor.
  In short, I think we all agree that the bill before us is the wrong 
approach. It's a very dismissive wave of the hand by Congress to those 
who have raised the voice on this most personal issue in their lives. 
There's no other issue that affects families more personally than 
health care, whether it is taking care of your children, thinking about 
how you're going to care for your parents or grandparents down the 
road. There is a better way, as you mentioned. There is a better way, 
and the gentlelady from Wyoming had gone through a great detail of 
other proposals that are out there that, quite honestly, there's 
bipartisan support for. The truth is, with the right reforms, we can 
absolutely control health care costs and lower premiums. This bill does 
not lower health care premiums. It will be a massive intrusion from the 
Federal Government on our individual and personal economic freedoms, 
though.
  I yield back for our closing.
  Mrs. LUMMIS. I thank the gentlemen from Minnesota, from Tennessee, 
from Pennsylvania and from Colorado for joining me this evening. People 
from all over the United States will be paying a house call on Speaker 
Pelosi on Thursday at noon this week on the Capitol steps. We will be 
there to greet them and hopefully discuss with them our concerns about 
the Democratic approach and to offer better solutions.
  I thank the Speaker this evening for his kind attention and tolerance 
of his fellow freshmen Republicans' efforts this evening.

                          ____________________