[Congressional Record (Bound Edition), Volume 155 (2009), Part 21]
[Extensions of Remarks]
[Pages 28962-28963]
[From the U.S. Government Publishing Office, www.gpo.gov]




          STATEMENT ON: AFFORDABLE HEALTH CARE FOR AMERICA ACT

                                 ______
                                 

                            HON. JAY INSLEE

                             of washington

                    in the house of representatives

                       Tuesday, December 01, 2009

  Mr. INSLEE. Madam Speaker, I rise today to express my support for the 
Affordable Health Care for America Act. Today marks an historic day for 
the health of all Americans. Today, this Congress joins with the 
American people to say that health care is not only a policy issue, but 
an issue of morality; and no longer will the conscience of this country 
allow Americans to go without access to affordable, comprehensive 
health care coverage. I want to thank Speaker Pelosi and the House 
leadership for their steadfast determination; and Chairmen Rangel, 
Miller, and particularly Chairman Waxman of the Energy and Commerce 
committee on which I am proud to sit, for their thoughtful leadership 
on this issue.
  Access to affordable health care has the power to break the shackles 
imposed on Americans today who are fearful of leaving their job, 
starting a new business, or going to the doctor due to their lack of 
coverage. In my district alone, this bill has the power to provide 
coverage for 30,000 uninsured residents; improve employer-coverage for 
524,000 residents; provide credits to help pay for coverage for up to 
120,000 households; improve Medicare for 84,000 beneficiaries, 
including closing the prescription drug donut hole for 7,400 seniors; 
allow 20,000 small businesses to obtain affordable health care coverage 
and provide tax credits to help reduce health insurance costs for up to 
18,600 small businesses. Additionally, this legislation will protect up 
to 1,100 families from bankruptcy due to unaffordable health care 
costs; and reduce the cost of uncompensated care for hospitals and 
health care providers by $28 million.
  As a member of the Energy and Commerce committee I was able to fight 
to include several provisions that will improve access to affordable 
health care in Washington state, the most important of which is 
President Obama's public health insurance option. Like our President, I 
believe that it is important to protect the interest of the consumer by 
providing choices so that people may decide which health insurance 
solution works best for them and their family. That is one reason I am 
a strong advocate of a public health insurance option. The President's 
public health insurance option will be offered in a health insurance 
exchange, created in this bill, alongside coverage sold by private 
insurers; thereby using natural market competition to control the 
rising cost of health coverage while protecting consumer choice. The 
implementation of this exchange will make insurance affordable for an 
additional 36 million Americans, raising the share of legal, nonelderly 
residents with health insurance coverage from 83 percent to 96 percent. 
The public insurance option will bring competition to the marketplace 
and consumer interests will be protected by addressing affordability 
and access issues that plague our current system.
  Washington state is a leader in high-quality, efficient health care. 
Our doctors and hospitals produce some of the country's best health 
care outcomes. We have a culture of medicine that places emphasis on 
patient safety, outcomes, and care. And yet for decades we have been 
penalized for our efficiency by receiving lower reimbursement rates per 
service under the Medicare fee-for-service reimbursement model. On 
average our providers are reimbursed fifteen to fifty percent less per 
service than their counterparts in other parts of the country. The 
reason for this discrepancy is that our statewide efficiency gives the 
appearance that it merely costs less to deliver care in the state 
because our overall patient costs are lower.
  Opponents have argued that practice expenses vary by geography. But, 
on November 5, 2009, the American Medical Association (AMA) released 
the results of its 2007-2008 study that included physician practice 
expense information from over seventy medical specialty societies and 
the Centers for Medicare and Medicaid Services Physician Practice 
Information (PPI) survey. The results of the study showed that expenses 
did not differ significantly by either metro location or census region 
and reconfirmed what providers in

[[Page 28963]]

Washington state have known for decades--that the Medicare physician 
payment formula is flawed.
  To this end, I was honored to be one of eight Members chosen by 
Speaker Pelosi to negotiate a resolution to this geographic disparity 
issue that has plagued our country for decades. The result, after four 
months of negotiations, is an agreement that will move the nation to a 
system that rewards high quality, cost-effective care; reimbursing for 
the value rather than the volume of services. It will fix existing 
Medicare geographic payment inequities and will cover both physician 
and hospital payments. This will provide an historic transformation of 
the Medicare payment system to ensure better care for patients and 
reduce health care costs over the long term.
  The first part of the agreement addresses the geographic variation in 
the rates doctors are paid per service. The bill instructs the 
Institute of Medicine (IOM) to conduct a study to evaluate and make 
recommendations to improve the geographic adjustment factors in the 
Medicare reimbursement formulas which will be completed one year after 
enactment. The Secretary of HHS will then implement a new Medicare 
payment rate that takes into account the IOM recommendations. An 
initial investment of $4 billion per year in 2012 and 2013 is allocated 
to make payment rate adjustments. After 2013 reimbursement adjustments 
will become budget neutral.
  Geographic variation in the utilization of services is addressed in 
the second IOM study on high value care. The IOM will make 
recommendations on how to transform the Medicare payment system to 
reward value and quality of care. Value is defined as the efficient 
delivery of high quality, evidence-based, patient-centered care. The 
study will be completed by April 15, 2011. No later than ninety days 
after the report is completed, the Secretary of HHS will submit to 
Congress a preliminary implementation plan based on the IOM study, 
which MedPac and GAO will evaluate within forty-five days. The IOM's 
quality and value-based payment recommendations will automatically go 
into effect unless the House and Senate pass joint resolutions of 
disapproval by May 31, 2012. The goal was to finish all studies and 
changes before the public option goes into effect in 2013 so the 
recommendations would be incorporated.
  This deal is a real victory for Washington state. Correcting the 
fundamental inequalities in Medicare reimbursement rates that underpay 
Washington state physicians will ensure access to Medicare physicians 
for Washington state seniors and Medicare beneficiaries. Additionally, 
this provision sets in motion a fundamental shift in the way we will 
reimburse for medical care going forward; moving away from a fee-for-
service model and towards an outcome-based model. This shift will 
provide real cost containment by incentivizing and reimbursing for the 
quality, not the quantity, of medical care across the United States; 
saving the country billions of dollars.
  A compounded issue resulting from Medicare reimbursement disparity is 
the reliance on Medicare Advantage plans by Medicare beneficiaries in 
low cost areas. Medicare Advantage plans in Washington state have 
played a critical role in providing seniors with access to care because 
they have been able to reimburse providers at a higher rate than 
traditional Medicare, thereby attracting providers into the network who 
would otherwise be unable to treat Medicare beneficiaries due to cost. 
It is for this reason that I fought tirelessly to ensure a quality 
bonus for high-quality, efficient Medicare Advantage plans. Under the 
language I negotiated in the House bill, four-star rated plans and 
above, in the bottom thirty percent of costs to the system, would be 
eligible for a 1.5 percent bonus in 2011; a 3.0 percent bonus in 2012; 
and a 5.0 percent bonus for each subsequent year. These bonus payments 
will ensure the continuation of high quality health care for Medicare 
Advantage recipients in Washington state.
  Washington state is not only a leader in patient care, but also in 
medical innovation. The biotech industry is an important health care 
partner in Washington state. Across the state roughly 1,060 biotech 
companies employ 23,047 Washingtonians. The state ranks eighth in 
National Institute of Health grants and in the past two years academic 
bioscience research expenditures totaled $685 million. The innovation 
occurring in the state has lead to some of the leading biologic 
therapies for life-threatening illnesses such as cancer, multiple 
sclerosis, diabetes, HIV/AIDS and many serious rare diseases.
  Biologics are living organisms, different and more complex than small 
molecule drugs. Biotech medicines can be determined to be the ``same'' 
as the original drug, but science is not yet at a point where they can 
be determined to be ``identical.'' And even small differences between a 
copy and an original biologic can cause differences in effectiveness, 
and, in some cases, serious side effects. Therefore it is necessary 
that policy reflect the uniqueness of these therapies, and ensure drug 
efficacy and patient safety. I believe a pathway for the approval of 
biosimilar biologics is the critical next step to providing patients 
with increased access to lifesaving therapies. I also believe that we 
can create a pathway that provides patients with lower-cost medicine 
without sacrificing safety or eliminating incentives to create 
breakthrough medicines.
  This is why I, joined by my fellow committee members Anna Eshoo and 
Joe Barton, introduced H.R. 1548, the Pathway for Biosimilars Act. The 
legislation protects patients by ensuring patient safety, recognizing 
the scientific differences between small-molecule drugs and biologics, 
maintaining the physician-patient relationship, and preserving 
incentives for innovation. I was proud to co-sponsor an amendment in 
the Energy and Commerce Committee markup of H.R. 3200 that incorporated 
key pieces of our legislation. The amendment includes twelve years of 
data exclusivity for innovator biologics, ensuring not only that these 
life-changing and life-saving biologic treatments are more accessible 
and affordable, but that we also foster continued research and 
development investment needed to search for new cures and treatments. 
The strong bipartisan votes in both the House and Senate on this issue 
demonstrate that Congress is committed to a fair and safe pathway for 
biosimilars. I commend the House for adopting my legislation as part of 
HR 3962, and it is my sincere hope that it will be included in the 
final conference agreement.
  A few other provisions that I want to highlight are great examples of 
how Washington state's health care leadership has helped shape federal 
health care legislation. Earlier this year the state passed a common 
sense law that will save billions of dollars in administrative health 
care costs by standardizing insurance claims and forms processes, and I 
was proud to fight for the inclusion of similar language in the 
Affordable Health Care for America Act. Washington state has also been 
innovative in health care plan structures allowing for the emergence of 
direct primary care medical home plans that provide low cost coverage 
of primary care services. This model has granted access to care for a 
population that has been shut out from traditional health care coverage 
due to high costs. I was grateful to see the inclusion of this coverage 
model in the health care reform legislation. I am proud to represent a 
district and state that is leading the way on health care policy.
  Once again I would like thank Speaker Pelosi and the House leadership 
for their continued determination that brought all facets of the 
Democratic Caucus to the table and ensured that each member had a voice 
in the debate. As a result the House of Representatives has produced a 
health care reform bill that will provide access to affordable health 
care and bend the cost curve; and I am once again proud to offer my 
support.