[Congressional Record (Bound Edition), Volume 155 (2009), Part 20]
[House]
[Pages 27136-27143]
[From the U.S. Government Publishing Office, www.gpo.gov]




   PROVIDING MEANINGFUL, STABLE AND SECURE HEALTH INSURANCE FOR ALL 
                               AMERICANS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentlewoman from Florida (Ms. Castor) is 
recognized for 60 minutes as the designee of the majority leader.
  Ms. CASTOR of Florida. Mr. Speaker, the House of Representatives is 
poised for a very historic milestone this evening. We are on the cusp 
of beginning debate on the Affordable Healthcare for America Act, and 
Democrats are going to deliver what American families and businesses 
have been asking for when it comes to their

[[Page 27137]]

health: one, meaningful, stable, and secure health insurance; two, 
improved Medicare for our seniors; and, three, vital consumer 
protections.
  For families with health insurance, health reform will provide 
coverage you can count on. All Americans will have affordable options, 
even if they change their jobs or if their employer does not offer 
health insurance. We are going to get into a few of the important 
consumer protections tonight with a few of my colleagues.
  Under this revised bill, families will not have to worry about 
insurance companies canceling their coverage because someone in the 
family gets sick or is diagnosed with cancer or another illness. Health 
insurance companies will no longer be able to bar you from health 
insurance just because you have cancer that is in remission or you have 
had a heart ailment. We are going to ensure that our neighbors are not 
forced to go bankrupt when a serious illness strikes.
  What is insurance for, after all? It must be meaningful for American 
families. You have to admit, American families have been doing 
everything right. They have been paying their copayments, they have 
been paying their premiums, even as the cost has risen astronomically. 
What our health reform bill says is, in return, these American families 
must have coverage that is meaningful, stable, and secure.
  Now, we reached this historic milestone reflecting back upon other 
important milestones in American history. It was January, 1935, when 
President Roosevelt sent his economic security bill to Capitol Hill. At 
that time, the Congress took that economic security bill and renamed it 
the Social Security Act; and, after many months of heated debate, in 
April of 1935 the Congress adopted the Social Security Act. President 
Roosevelt signed that bill into law at a ceremony in the White House 
Cabinet Room.
  After President Roosevelt, it was President Truman who sought to 
build upon Social Security and provide that important stability and 
security to American families by launching the health care initiative. 
Unfortunately, it stalled under President Truman; and we have been in 
that stalling pattern for decades after, with the exception of 1965, 
with the adoption of Medicare.
  In 1965, the House took up consideration of the Medicare bill; and 
President Johnson signed that bill into law at a special ceremony in 
Independence, Missouri, in 1965. President Johnson at that time, over 
the objections of some aides, insisted that the ceremony happen in 
Independence, Missouri, and that President Truman, who launched the 
national health care debate, be in attendance.
  At that signing, President Johnson said, ``No longer will older 
Americans be denied the healing miracle of modern medicine. No longer 
will illness crush and destroy savings that they have so carefully put 
away over a lifetime so that they may enjoy dignity in their later 
years.''
  Mr. Speaker, with our corresponding health reform act that follows 
upon Social Security and Medicare, no longer will illness crush and 
destroy American families. They are entitled to dignity as well.
  Now, during those debates, Mr. Speaker, there was a lot of 
opposition, great opposition from the Republican Party. The 
Republicans' record on Social Security and Medicare in America is not 
outstanding. They opposed Medicare from the beginning.
  In 1965, the GOP said that Medicare was ``brazen socialism,'' and 
they have kept up that mantra year after year. They have tried to 
undermine Medicare. The Republicans have voted against protecting and 
strengthening Medicare since it was adopted. They have sought to 
privatize Social Security and Medicare. They have consistently wanted 
to move seniors into private markets. And, just this spring, House 
Republicans offered a budget that would eventually lead to the end of 
Medicare programs as they are presently known. If we had listened to 
Republicans, American seniors during the economic downturn would have 
seen their lifetime savings nearly disappear.
  So here we stand again on the cusp of an historic milestone, to 
follow upon the legacy of Social Security and Medicare, the 
foundational values of the Democratic Party, popular initiatives that 
provide great security and stability to all American families; and we 
are going to deliver again for America's families.
  We have some outstanding Americans here in the Chamber tonight. I 
would like to yield time to my good friend from Ohio, Mr. Ryan.
  Mr. RYAN of Ohio. I thank the gentlelady, and I think that is a 
perfect articulation of what has happened and why that tomorrow and 
this weekend has become such a monumental day.
  I know our friends on the other side have been trying their best to 
try to undermine and scare. I just was hanging in my office just 
answering the phone with people calling in with complete misinformation 
about what this bill is going to do.
  This is very, very simple. When you look at what happened with 
Medicare, there was a gap in the capitalistic system. Insurance 
companies couldn't make money off of insuring our grandparents and 
older parents because there was no money to be made there. So the 
government had to come in and establish the Medicare program, which I 
am sure our friends on the other side of the aisle would not want to 
get rid of right now, and now they are actually sticking up for all the 
slowing of the growth and all the changes we are making.
  But the bottom line is this: We have two issues here. We have an 
economic issue where health care will bankrupt our country if we do not 
start reining in the spending. In the next 10 years, one of every five 
dollars in our economy will be spent on health care. In 30 years, one 
of every three dollars will be spent.
  If we do absolutely nothing, which up until two days ago our 
Republican friends wanted us to do, but now they know something is 
going to pass so they have to hurry up and hustle and get some plan 
together, but if we do absolutely nothing, the average family in our 
country will pay $1,800 more a year next year in their health care 
costs. That is if we do nothing. And keep projecting that out, $1,800 
the following year, $1,800 the following year. Compounding is a very 
powerful thing. So we must for economic reasons get our health care 
house in order, and this bill does it. It reins in the spending for 
Medicare and makes it stronger and more efficient by closing the 
doughnut hole.
  In addition to that, we have human rights issues that we are dealing 
with in this country. American people who are sick, who go to the 
insurance company and get denied coverage, as we heard the other day at 
our press conference, because of infertility. You get denied coverage. 
Then the kicker was that spousal infertility was a reason to deny 
coverage and diabetes and cancer and all of these issues that insurance 
companies use to deny coverage.

                              {time}  2045

  To me, that's a human rights issue; and we cannot, as a country, look 
ourselves in the mirror anymore as of tomorrow, hopefully, and at the 
end of this year and not say, Health care is a right in the United 
States of America. If we all collectively, through investments in NIH 
and private investments and premiums and money, have come up with ways 
to make someone healthy, but we, as a society, say, You know what, 
sorry, you can't afford this one, and just those of us in the club are 
going to be able to afford it, you can't.
  So, you know, you're going to have to get sicker faster, and you are 
going to have to die earlier than everyone else because you can't 
afford it. That is unacceptable. I yield to my friend who has been such 
an instrumental part--I just watched you in the Rules Committee--and 
continue to defend what we're trying to do here. To explain to the 
American people how important this is, I yield to my friend from New 
Jersey.
  Mr. PALLONE. I want to thank my colleague from Ohio who is here 
almost every night, it seems, talking about how important this health 
reform legislation is and explaining it very well, I must say, in 
commonsense terms. Your comments made me think about,

[[Page 27138]]

actually, one of our Republican colleagues in the Rules Committee much 
earlier today--I was there for 6 hours--who basically talked about this 
bill in ideological terms and referred to it as socialism or a 
government takeover of health care. I explained in the Rules Committee, 
and I would like to explain now, how untrue that really is.
  Basically, we're just building on the basic system and using a lot of 
the framework, if you will, that exists now in both the private and the 
public sectors. What I point out is that for people who get their 
health insurance through their employer, private health insurance, they 
keep it, and the majority of Americans will continue to get their 
health insurance through their employer. Nobody's changing anything in 
terms of the process for that. A lot of other Americans, if they're 
seniors or disabled, get their insurance through Medicare, which is a 
government program, and then those who are below a certain income get 
their health insurance through Medicaid, which is another government 
program.
  And I could mention other government health programs. The Indian 
Health Service, the Veterans program, whatever. What's new here, 
really, is that for those Americans who have no health insurance 
because they can't access it, it's not affordable or they have all 
these discriminatory practices based on their preexisting health 
conditions or their gender or whatever, now we are establishing a 
health exchange. It is just basically an opportunity for to you go to 
your computer or to some office where the government will entertain, if 
you will, private health insurance companies to come in and say, Look, 
if you offer a certain benefit package that includes what we think 
should be included and you're willing to offer it through this 
exchange, you can.
  The government will make this exchange available, and people can buy 
health insurance through the exchange. They would have a basic benefit 
package where they can pay for other things that are not in the 
package, you know, dental care or whatever.
  But the advantage is now that this acts as a very large group plan. 
The reason that employers, you know, oftentimes are able to offer 
insurance is because they buy it through a large group plan that brings 
costs down, but for individuals or small businesses that try to buy 
health insurance privately right now, it's hard because if you buy it 
individually or you have a very small group of employees, it becomes 
much more expensive because insurance becomes cheaper the larger the 
pool is.
  So if the government is now offering this exchange where all these 
private insurers come in and offer insurance, it's essentially like a 
group plan, and the cost comes down considerably because it acts that 
way.
  Now within this health exchange, we're also going to offer a public 
option, which you can compare to Medicare or Medicaid if you'd like, 
and that's going to compete with these private insurance companies. So 
in addition to costs coming down in this exchange because it's like a 
group plan, costs also come down because there is now not competition 
between a public option, like Medicare, and all these private insurance 
companies. But, again, there is no ideology here that the public option 
is like Medicare and Medicaid. The private insurers are the same 
private insurers that offer insurance now but, because it's a large 
group plan, the costs come down. So there is no radical change here in 
the way we're doing business.
  We're not taking over health insurance. We're offering a public and 
private option. Now the third way that the costs come down is if you're 
below a certain income and you buy your insurance in this exchange, we 
offer you a major subsidy, and that can be 80 percent of the cost of 
your premiums if you're maybe making about $25,000 or $30,000 a year or 
maybe only 10 percent if you are making, say, $80,000 a year. So we're 
bringing costs down using innovative methods but methods that don't 
really take away from the private sector.
  And for anybody to say this is a government takeover, this is 
socialism, this is radical--you know, I don't know what you want to 
call it, it's just not true. This is just a different way of doing 
things that I believe works and that I think collectively will cover 
everyone and make it affordable so that you don't have to worry that if 
you lose your insurance, you don't have a place to go.
  Within this context, we're eliminating all the discriminatory 
practices so that insurance companies can't charge more because of a 
preexisting health condition or because you are a woman versus a man. 
They can't say that in the course of a year they'll only pay out a 
certain amount of money or in the course of your lifetime they'll only 
pay a certain amount of money. They can't drop you because you get 
sick. All of these discriminatory practices are very difficult and make 
it difficult for a lot of my constituents, I know, to find insurance. 
Those practices will all go away.
  I yield back to the gentlewoman from Florida.
  Ms. CASTOR of Florida. I would like to yield to the gentlewoman from 
California (Ms. Watson). She has been here for a while and has been 
listening closely to this debate.
  Ms. WATSON. Mr. Speaker, I have been here for about an hour and a 
half. I have heard the Affordable Health Care for America Act 
denigrated, demonized. I heard the most disrespectful description of 
our Speaker, of our President, and I have heard them call this 
socialistic. But what I never heard from all of those who are opposed, 
including the medical doctors, was a sense and a feeling for protecting 
the health of Americans. All I heard was them describing the number of 
pages. They even gave us the number of times that ``shall'' was used. 
They talked about this heavy load that they would throw out and 
abandon. But I never heard them throw in ``for the American people.''
  There was something very insensitive about what they were saying. I 
never felt the depth of concern about protecting Americans' health. I 
heard misstatements. I even heard lies. And let me explain to you where 
I was able to pick up on the misconceptions. They talked about taxing, 
increasing taxes. They talked about small businesses going out of 
business. They talked about the debt on their children, their 
grandchildren and those yet unborn. Let me try to clear up some of the 
mythical misstatements that were used while I sit here in the last hour 
and a half.
  Will the bill raise taxes? Get this: for the average individual, the 
bill would not--would not--raise taxes. If you are an individual who 
makes more than $500,000, that's a half a million dollars, or a couple 
who makes more than $1 million, you would be taxed 2.5 percent. That's 
not the average family's income. The average family does not make 
$500,000 or $1 million. It will be taxed, yes, 2.5 percent. If you make 
more than $250,000 and you do not purchase insurance, then you would 
have to pay a tax of 2.5 percent.
  The Medicare part D prescription drug doughnut hole, this hole is 
created when a patient's prescription drug costs exceed a yearly limit. 
This includes those whose prescription drugs costs more than the 
initial benefit of $2,700. Catastrophic coverage begins after the 
beneficiary has paid $4,350 for medications. Over time, the bill 
creates a 50 percent discount for prescription drugs bought in the 
doughnut hole.
  Will this bill increase health care costs? No. This bill is designed 
to reduce health care costs. The House bill is designed with a public 
option. Now what does the word ``option'' mean? It means, you have a 
choice. Option means your choice, your decision. So the House bill is 
designed with the public option which will compete with private 
insurers in the exchange and reduce health insurance premiums. Though 
the program is government run, it will be self-sufficient and not 
require tax dollars at the initial startup.
  I have heard over and over again that the government will get between 
you and your provider. That is so untrue. People talk about government. 
These

[[Page 27139]]

are the people who work for government and who are paid by government. 
And how do they get their pay? Because some taxpayer paid their taxes, 
and that's how we all get paid. If you're so against government, why 
did you run to be part of it? Because every minute you're here, you're 
using taxpayers' money. That's your salary. So if you don't believe in 
government, you ought not to be part of it. It was so irrational. I was 
steamed while I was listening, but I held my cool. Private insurers are 
unhappy with the public option and are, therefore, attempting to 
disqualify its advantages.
  Now, you cannot tell me that the 10,000 people who were out there 
yesterday demonstrating just woke up and said, We need to go to 
Washington, DC, and demonstrate. It was an organized effort, my 
friends. Some people were paid. There were buses that were paid for to 
bring people in town. And what I said before, I will say again. Why is 
there so much anger and hostility over providing health insurance for 
all Americans? What does that anger portray? Why are people so 
irrational? Why aren't they more reasonable about what government is 
trying to do?
  This started out covering those who were uncovered, about 38 million, 
and it's grown into, as our opposition says, a socialistic program to 
cover ineligible people, to cover those most feared people that are 
here illegally. I never heard compassion for Americans. So there was an 
organization that put that group together to come and shout and show 
their anger. I'm saying, Well, what is it that they're so angry about? 
They have been told that benefits will be taken away from seniors. 
Nothing can be further from the truth. Will the House bill negatively 
affect small business? No. The House bill exempts most small businesses 
from the employee mandate. Small businesses with a payroll less than 
$500,000 are exempt. Small employers with pay rolls between $500,000 
and $750,000 will have contribution phases from zero percent to 8 
percent required contribution. Businesses with payrolls above $750,000 
will be required to contribute the full 8 percent of average salary for 
their employer.

                              {time}  2100

  What is the public option? Now, remember ``option'' means choice. 
``Option'' means decision. It's a government-run health insurance 
option. It's like going into a market and having all these plans laid 
out and you make the choice. If you like your insurance, you keep your 
insurance. If you don't like your insurance or you want to buy 
insurance, you come to the marketplace. Taxpayers will not have to pay 
for the public option. It is a mechanism with which the government can 
encourage healthy competition in the health insurance market. Also an 
option that will be accepting of high-risk individuals. Now let me tell 
you what the immediate reforms will include:
  There will be a ban on lifetime limits. There will be immediate 
sunshine or light against insurance price gouging. It will be 
transparent. We're creating a review-and-disclosure process for rate 
increases.
  It will prohibit health insurance companies from rescinding existing 
health insurance policies when a person gets sick.
  There will be limits on preexisting conditions. Insurance companies 
can only look back 30 days rather than the current 6 months.
  Complete ban, existing conditions exclusive occurs in the exchange 
will begin in 2013.
  It will prohibit domestic violence from being included as a 
preexisting condition.
  It will immediately ensure the medical loss ratio of 85 percent of 
premium health care dollars.
  Dependents can remain on their parents' insurance until the end of 
their 26th year.
  It will extend COBRA coverage until the exchange is up and running.
  Grants to States for immediate health reform initiatives will start 
immediately. And I want to say that again because I've heard people say 
that States will lose and be burdened. Grants to States for immediate 
health reform initiatives.
  It improves benefits, reinsurance for early retirees.
  It creates an immediate fund that will finance a temporary program 
for those who are uninsurable.
  It creates a voluntary long-term care insurance program.
  It increases funding for Community Health Centers.
  It expands primary care, nursing, and public health workforce by 
increasing the size of the National Health Service Corps.
  It increases Medicaid reimbursements to 100 percent Federal funding. 
And in 2013 the exchange will be up and running. Individual and 
employee mandates take effect.
  Preexisting conditions cannot be used to refuse a health insurance 
policy.
  It expands Medicaid to 150 percent of poverty.
  It will be open to small employers with 25 or fewer employees.
  Affordable credits issued to those below 400 percent of the Federal 
poverty level.
  The public option then is operational, and the exchange expands to 
everyone over the next 5 years until 2018, when all employers will have 
to meet the essential benefits package.
  So, Mr. Speaker, I conclude by saying this will be an historical 
movement for Americans. We are looking forward to a tremendous change 
in where we place our emphasis. We plan to build a stronger, healthier 
America, and I would hope that all Members of this House will recognize 
that we are bringing a health care benefit to our Nation so it will 
stay the greatest Nation on Earth.
  Ms. CASTOR of Florida. I thank my good friend from California.
  I can't blame you, after listening to some of the debate, for having 
some consternation because here we are, we are poised to take this 
historic step on behalf of the American people that really is akin to 
what this great body has done in 1935 for Social Security, again in 
1965 for Medicare. The vast majority of Americans would never think of 
turning back the clock to a time before we had those very important 
securities, that stability for American families. But that doesn't mean 
that they came easy. They didn't. And a lot of the arguments that were 
used then against Social Security and against Medicare have been used 
over the past year.
  But you just have to stand up. You have to stand up and speak out for 
the families, the seniors, the older Americans that you represent and 
understand what this reform will mean to those families, finally giving 
them health insurance that is meaningful.
  One of my very good friends that has been so involved in this debate 
for many years, I've had the privilege of serving with him on the 
Energy and Commerce Committee and the Health Subcommittee, and he's 
simply an outstanding voice on behalf of the families in Connecticut. 
So I feel very privileged tonight, as we're poised to take this 
historic next step, to yield to my good friend, Mr. Murphy from 
Connecticut.
  Mr. MURPHY of Connecticut. I'm glad to be here and I thank my friend 
from Florida for yielding.
  This is an historic moment. It doesn't come around very often when 
you have the opportunity to make good on a promise that seemingly every 
President has tried to make good on, frankly, with a couple of 
Republicans thrown into the mix over the years, to bring health care 
out to the millions of people that don't have it. And as my friend Mr. 
Ryan said, we don't have a choice any longer. If we allow the status 
quo to continue, we're not just going to bankrupt every family and 
business out there, we're going to bankrupt our government.
  The sad thing is that at this critical juncture in the history of 
American government, the history of the American health care system, 
you would like to think that the arguments that were happening on the 
floor of the House or in the Rules Committee where Mr. Pallone was all 
day or on the airwaves is a debate about what's best for this country. 
Instead, it seems that some of the debate is about what's

[[Page 27140]]

best for one political party. This idea of the bill that we're debating 
being socialized medicine is laughable. It's laughable, but we have to 
talk about why we are hearing that phrase come up over and over again.
  You have to go back to the spring of this year when the Republican 
Party's favorite pollster, Frank Luntz, came out with a memo, before 
the Democrats had even put their bill on the table, before there was a 
bill to critique, and the memo essentially said here's how you kill 
health care reform: You call it ``socialized medicine.'' You call it 
``government-run health care.'' Before anybody had even looked to see 
what the bill was, the decision was made that for political purposes, a 
bunch of people are going to get behind killing this thing and they're 
going to call it these names no matter actually what's in the text.
  Now, as it turns out, the bill that's presented before the House for 
a vote this weekend or early next week is so far from socialized 
medicine, from government-run medicine, to make that claim is 
absolutely outrageous. But if you make it over and over again and you 
get a few allies on talk radio and the cable news entertainment shows, 
the same people will start to internalize it.
  The fact is that the Congressional Budget Office says pretty plainly 
that over the 10-year window of this bill's rollout, there will be more 
people, millions of more people, on private health care than there are 
today. Why? Because we fix the existing private health care market. We 
think that the salvation of our system can be the private market but 
not under the rules we're playing by today. Under those rules, the 
price of health care over the last 10 years has shot up by 120 percent 
for small businesses in my district. This year, our major insurer in 
Connecticut announced they were going to be raising rates by 30 percent 
in one single year for small businesses. The rules of this game have 
meant that millions of Americans are kicked off their health care just 
because they get sick and millions more can't get on health care 
because they were sick to begin with. The rules of this market don't 
work.
  So all we say is let's set up some fair rules that aggregate the 
purchasing power of individuals, that don't deny health care to people 
that need it. Let's just fix the market. That's what this bill does. It 
fixes the market.
  We are at the very last minute, Mr. Ryan, presented with an 
alternative bill from our friends. Now, you and I have been on this 
floor for a long time. We come down here and we talk about the 
differences between the Democrats' approach to health care and the 
Republicans' nonapproach to health care, but then over the last year we 
have talked about the places we agree on. And one of the places that we 
all thought we agreed on was that if you have a preexisting condition, 
you shouldn't be denied health care. I mean, I heard Republicans come 
down here night after night and say we should absolutely do that, and I 
listened to them on the talk shows and they said Democrats and 
Republicans should come together. We came down here on the floor and we 
wanted to lock arms and say you know what, let's do it. Let's stop sick 
people from being denied health care.
  Then we see their proposal that they're apparently going to offer on 
the House floor as a substitute to the Democratic plan, and it does 
nothing for people that are sick and need health care. It doesn't even 
come close to banning the practice of insurance companies to deny 
coverage based on preexisting conditions.
  So even the things that we thought we had agreement on we don't any 
longer, because when it comes down to it, the Republicans are more 
interested in preserving the profits of their friends in the health 
insurance industry, more concerned with stopping President Obama's 
quest to bring health care to Americans at a lower cost because it 
scores political points, Mr. Ryan.
  Ms. CASTOR of Florida. I thank my good friend from Connecticut. What 
a great summary.
  And I know my good friend from Ohio, just what you were saying when 
you kicked it off, we simply cannot stand still. We cannot wait a 
decade more to stand up for American families and provide them with 
some meaningful and stable insurance that they're paying. I mean, they 
have been doing everything right; isn't that right? Paying those 
copays, paying those premiums month after month after month, and then 
someone in their family gets sick. And the health insurance company 
oftentimes will say or find a way to say, We're sorry, your policy does 
not provide what you thought it provided.
  I yield to the gentleman.
  Mr. RYAN of Ohio. There are a lot of issues here.
  Earlier in the evening, I was watching someone, one of our friends on 
the other side, in the Rules Committee explain the Republican plan. And 
one of the questions from one of the committee members was, Does your 
plan cover everybody? And after dodging that question for quite some 
time, the answer is no. And then he went on to say that, Well, our plan 
is incremental.
  And that's the slow walk that our friends on the other side want to 
do here. They want to kill this and go back to the original political 
memo that was given: How do we kill health care reform? How do we not 
give Barack Obama a victory on health care? And that's all this is is 
playing the politics of it and to say, Well, our plan doesn't cover 
everybody. Our plan doesn't bring down costs. Our plan is not going to 
reduce costs for small business by allowing them to go in and do all 
this negotiation.
  I mean, think about what our friends on the other side of the aisle 
are going to vote against when we take this vote in the next couple of 
days. They're going to vote against everyone in America being protected 
from being denied insurance because of a preexisting condition. They're 
going to vote against that. They're going to vote against our saying 
that no one in America will ever go bankrupt again because of a health 
catastrophe in their family. Our friends are going to vote against 
that. Subsidies to help middle class families afford health care, 
they're going to vote against that. Extending COBRA until the exchange 
gets set up, they're going to vote against that. Increasing the age to 
27 years old so that people can stay on their parents' insurance, 
they're going to vote against that. And giving small business people an 
opportunity, instead of swimming with the sharks in the current 
insurance market, to go in and negotiate with hundreds of thousands, if 
not millions, of other people to drive costs down, they're going to 
vote against it.

                              {time}  2115

  So we are sitting here telling you, Mr. Murphy, here is what we are 
for: the exchange, competition, choice, the public option, eliminate 
preexisting conditions, no more bankruptcies, stay on your parents' 
insurance until you are 27, here are some subsidies, close the doughnut 
hole on Medicare part D so our seniors can have consistent prescription 
drug coverage. They are going to vote against it.
  We are here saying, this is what we are for, this is what is going to 
pass, and this is what is going to help the American people. You can 
call it whatever you want. Our friends like the socialized 
transportation system we have here when they fly into Reagan Airport 
and back to their own airports. They like socialized Medicare for their 
parents. They like socialized public schools. They like socialized 
roads, socialized ports, and socialized defense. They like all that. 
But the one thing that is not socialized, they try to label it as being 
socialized. It doesn't make any sense.
  Ms. CASTOR of Florida. I think you have summed it up well, Mr. Ryan. 
We are simply going to stand up for American families against the 
powerful interests that oftentimes and unfortunately the way health 
care has developed in America, it is take the money from well people. 
And the profits of these health insurance companies has been 
astronomical.
  Why is it so difficult when somebody needs to call upon that policy, 
they have been diagnosed with cancer, they

[[Page 27141]]

high blood pressure, and it is a fight. It is not a fight when you have 
to send the premium or the co-payment in, but it is a fight when you 
need to call upon what you have been paying for month after month.
  So our reform is going to give the consumer, these families that we 
have the privilege to represent, greater bargaining power when it comes 
to their health.
  You have to hand it to President Obama. He has reached out. He 
reached out early on in a bipartisan way. I know each of us here on the 
floor tonight have done the same. Early on, I called a bipartisan 
meeting of the Members from the State of Florida to say, What are our 
Florida priorities? We came up with a number. We have a terrible doctor 
shortage. We want to improve Medicare. And I am glad some of those 
ideas are incorporated in our legislation.
  We have been having bipartisan meetings. We have had committee 
meetings, hundreds of committee meetings over the past couple of years, 
and hundreds of amendments incorporated. Our families back home, this 
isn't something where we are only listening to one side of the aisle. I 
know all of us have been taking the ideas, no matter what your 
political persuasion, because this is a critical American issue and it 
demands a unique, American solution.
  As we begin the debate, I know there will be a lot of partisan 
rhetoric, but I want folks at home to know that we are going to stand 
up for you and fight for your family to ensure that if you have a 
diagnosis in your family of a serious illness, we are not going to let 
that insurance company cancel you. And if you have to change your job 
and your cancer is in remission, our reform will ensure that you will 
have affordable options. These are our fundamental values.
  I yield to Mr. Pallone.
  Mr. PALLONE. I want to thank all of you for what you have been 
contributing to this debate.
  I was on C-SPAN this morning where they ask you questions. These are 
questions that I get from some of my constituents who initially at 
least were opposed to the bill. One question is from people who say, 
Well, why should I help contribute through subsidies, for example, to 
help pay for health insurance for people who don't have insurance? And 
another, I am young. I am healthy. This guy got on and said, Why should 
I have to have insurance at all if I don't want it?
  The bottom line is, right now, a significant portion of your premium, 
whether you get it through your employer or you get it by buying it on 
the individual market, as well as a significant portion of Medicare and 
Medicaid, is paying for people that have no insurance. So when that 
person who has no insurance goes to the emergency room and they rack up 
a bill of $10,000 or $20,000, you end up paying for it if you have 
insurance. It could be 2 or $3,000 a year of your premium is actually 
paying for that uncompensated care.
  The bottom line is, if everyone has insurance, even if you are 
subsidizing it in some way through your tax dollars, that brings your 
cost down because now that person, instead of going to the emergency 
room, they go to a doctor on a regular basis. They don't get sick and 
run up the costs of having to be hospitalized or put into a nursing 
home, and so the system saves money and you save money.
  The next thing, what about the guy who was on C-SPAN this morning: I 
am 25 years old. I don't want to buy health insurance. Why should I buy 
it? I don't need it. I can probably stay around for another 10 years 
until I have any serious problem.
  Again, it is the same thing that I mentioned before. The only way 
that insurance becomes cheaper is if more and more people are included 
in the insurance pool. So if you have this health exchange and you want 
to make insurance under this health exchange affordable, you have to 
have all of the people in it. Then you have the healthy and the young 
people, the older and the sick people, and you have a larger pool that 
essentially brings costs down because everyone is in it.
  I think it is important to dispel some of these arguments about why 
should I help the other guy or why should I have to have insurance. The 
only way this works to bring costs down is if everyone is covered and 
everyone has access to a doctor on a regular basis and everyone pays 
into the system. Either their employer pays or they buy it through the 
health exchange. That is the beauty part of this. Everyone gets covered 
and everyone contributes and the cost goes down and we emphasize 
prevention, not having people get sick and not having to go to the 
hospital because they don't have enough preventive care.
  We could go on and talk about the idea of prevention and wellness, 
which is an important part of this system, but I yield back.
  Ms. CASTOR of Florida. Chairman Pallone, you have hit upon another 
important underpinning of this bill, and that is personal 
responsibility. We are, through many initiatives in this bill, calling 
upon the American people to take personal responsibility for their 
health.
  You are right. It is very expensive, very expensive, and American 
families know it. They know that one of the reasons that the costs have 
risen astronomically, and they are in the open enrollment period now, 
and families I hear from, they can't believe the rate of increase. But 
they understand, especially in a State like Florida where we have the 
second highest percentage of uninsured out of the 50 States, that we 
are paying, the folks with insurance are paying for the uninsured that 
show up in our emergency rooms, the most expensive place to receive 
care, and those costs have to be paid for somehow. Most often, it will 
make its way onto the copayments, premiums, and policies of American 
families that have taken personal responsibility, and that is just not 
fair. We can do better, and through our Affordable Health Care for 
America Act, we try to shift this very expensive way we deliver health 
care and make a historic investment in wellness and prevention.
  Communities all across the country are going to have new incentives 
to build their communities in a sustainable way. Our hospitals are 
going to partner with universities and communities and nonprofits all 
across the country to focus on the most effective way to reduce 
childhood obesity and encourage folks to refrain from smoking, the way 
we can really control costs over the long term.
  I appreciate the leadership of Chairman Waxman and you, Chairman 
Pallone. You encouraged me to offer an amendment in the Energy and 
Commerce Committee to encourage small businesses to do more in wellness 
initiatives. Big companies encourage employees to exercise and eat 
right and quit smoking. But, oftentimes, it is the small businesses 
that are left in the lurch. Certainly in this economy, they do not have 
the wherewithal to initiate those types of wellness programs. But in 
our health reform bill, we provide grants to those small businesses 
that are willing to cut their health care costs through new wellness 
initiatives. I know that it will pay great dividends for families and 
those businesses.
  Mr. PALLONE. If I can talk about small businesses, a lot of people 
don't understand that the way that this bill is set up in the bill that 
we are going to vote on in the next few days, small businesses, when 
they try to buy health insurance, like individuals, because the 
individual is only buying for himself or the members of his immediate 
family, the cost is high because he is not part of a large insurance 
pool.
  The same is true for small business. In other words, if you have only 
five or ten employees and you try to buy a health insurance policy on 
the open market, you have the same problem. You are only insuring two, 
three, four, five, maybe up to ten people, and you are not part of a 
large insurance pool and so your costs are very prohibitive.
  What we do in this bill is say that not only can an individual go to 
this health exchange and be part of this large insurance pool, but also 
a small business can do it. If a small business can't afford a small 
group policy or has one but it is increasing, the costs of the premiums 
are going up, they can go

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into the exchange. They don't have to have all of their individual 
employees and their family go into the exchange policy. They can go 
into the exchange and buy a small group policy, and it will probably be 
a better benefit package than they have now. So they are essentially 
buying a small group policy that is part of a larger pool that brings 
the cost down.
  That hasn't really been brought up very much. What you mostly hear 
is, is my employer going to continue with his insurance or is he going 
to send me into this health exchange? The reality is that the business 
can buy a group policy for a lot less and with better benefits in the 
health exchange. I think you are going to find a lot of small 
businesses do that because they are going to get additional tax credits 
for it and it is just a better package.
  So many people today complain not only about the cost of health 
insurance, but when they actually buy it, it doesn't cover anything, or 
it covers very few things and there are a lot of out-of-pocket 
expenses. So we are also trying to eliminate those problems, that you 
can buy a basic benefit package that has good coverage and that doesn't 
have a lot of deductibles and co-pays as well. That is an important 
part of the reform as well.
  Ms. CASTOR of Florida. I thank you for that. Small businesses clearly 
are going to be big winners under this initiative.
  Just a couple of months ago, I had a roundtable of small businesses 
from the Tampa Bay area, and there is one great business that has a lot 
of those retail shops in the airports. They do very well. She told me 
the story about trying to negotiate with health insurance companies. 
The problem, unfortunately, has grown over time where there is not much 
choice. There are so few options. As these small businesses attempt to 
go out and compete with their small numbers of employees, it is 
practically like sending a person out alone. It is just astronomical. I 
don't understand it because the profits of these health insurance 
companies are so high, but they don't offer affordable options to small 
businesses.
  She told me this terrible story where, because they have a largely 
female and young workforce, it was very important to them that they 
have maternity care covered. And so they negotiated and had an agent, 
and maternity care was covered. The only problem was the health 
insurance company refused to pay for the baby's delivery of one of her 
employees.

                              {time}  2130

  These kinds of tricks have got to end. It's time that we stand up for 
families across America, make insurance meaningful, provide some 
stability, some security, just like Social Security did in 1935 and 
Medicare in 1965. These are the types of commitments we are trying to 
make with the American people.
  We have great support as we launch the debate. I mean, let's go over 
a few of these great endorsements from just this week. Coming from the 
State of Florida, the AARP endorsement will ring out loud and clear 
because the AARP advocates for older Americans and our seniors. And the 
American Medical Association, also, doctors across America believe in 
our health reform initiative.
  Mr. PALLONE. If I could ask the gentlewoman to yield on that.
  Ms. CASTOR of Florida. I will yield to my friend.
  Mr. PALLONE. The major reason why the AMA, which is the major doctors 
association of this country, I believe supports the bill is two 
reasons: first of all, right now under Medicare the reimbursement rate 
for physicians as well as hospitals is rather low; it doesn't pay for 
the actual cost of their delivery services under Medicare. So we have a 
major increase in here for provider payments, in other words, both 
hospitals and physicians.
  Part of the problem under Medicare is, I know in New Jersey it's not 
hard yet, but it's starting to get more difficult to find a doctor who 
will actually take Medicare. If you're on Medicaid, it's almost 
impossible because the reimbursement rate under Medicaid is about 30 
percent of actual cost in New Jersey, and we increase that rate as 
well.
  With regard to hospitals, by eliminating the uncompensated care, 
because now everybody is covered, they are getting more money for 
Medicare, more for Medicaid, and we have eliminated the people that 
don't have any insurance, which basically, you know, they have to sort 
of eat that, it goes into their balance sheet. So we're going to make 
it a lot easier for hospitals to stay open. I've had two close in my 
district in the last 10 years because they were too dependent on 
Medicare and Medicaid, and they had too many people who didn't have 
health insurance.
  I yield back.
  Ms. CASTOR of Florida. And that's highly important because our 
hospitals oftentimes are taking care of folks who do not have health 
insurance. So there is a great amount of uncompensated care, and it 
feeds that vicious cycle in America where someone has to pay that cost. 
And it is put on to the backs of families with insurance oftentimes 
having to pick up the tab for some people who have not taken personal 
responsibility for their health.
  As we launch into the debate, it is very heartening that we have 
groups like the American Medical Association and AARP on our side, 
along with the American Cancer Society, the American Academy of 
Pediatrics, the American Academy of Ophthalmology, the Campaign for 
Tobacco-Free Kids. I mean, these lists go on and on. These are 
Americans and interest groups from all across the country that have 
been involved for years in trying to get to this point to provide 
meaningful health care to American families, to ensure that that 
insurance, when you pay those premiums and copays, is really something 
you can count on. It's coverage that you can count on.
  And then correspondingly, as we've gotten smarter and realize we need 
to do more in prevention and wellness, we're going to invest in a great 
new health care workforce. It means a lot to my home district in Tampa 
because we have a large research university, the University of South 
Florida, with a College of Medicine, College of Nursing, College of 
Public Health, Physical Therapy directly across the street from the 
busiest VA hospital in the country.
  The new loan repayment scholarships that will be provided to young 
people, or anyone that wants to find a job in the health care 
workforce, this is a landmark investment in that new workforce. When 
you look at the unemployment numbers across America right now, the one 
sector where jobs are being created and there are opportunities is in 
health care. It might be in IT, in the electronic medical records, but 
we are going to need a modern health care workforce. Fortunately, 
that's what our initiative provides.
  I yield to my friend.
  Mr. PALLONE. Well, I will just say, I don't want to call it a jobs 
bill because that's not the major focus of it, but it essentially is.
  This is an economic issue. We are creating jobs, and we are certainly 
making it a lot easier for businesses to function because they don't 
have all these additional costs that are associated with more expensive 
health insurance.
  So this bill actually addresses a lot of economic problems in a 
significant way. I would characterize it as a jobs bill, and in some 
ways as an economic recovery package as well. And, again, I yield back. 
Thank you.
  Ms. CASTOR of Florida. Well, I think as we begin to close our hour 
out, we are eagerly looking ahead to the debate. We've had many, many 
months--many years waiting for real health reform for American families 
and older Americans, and we are very close. I would really like to 
thank my colleague, Chairman Pallone, for his years of service on 
behalf of New Jersey families and Americans when it comes to health 
care.
  The Democratic bill that will soon be on the floor will finally 
deliver for American families, building upon those fundamental values 
and early initiatives that came under Social Security in 1935 and 
Medicare in 1965. It has taken us awhile to get to this point, but I 
think we will get home.

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