[Congressional Record (Bound Edition), Volume 156 (2010), Part 2]
[House]
[Pages 1686-1693]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Virginia (Mr. Perriello) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. PERRIELLO. Thank you, Mr. Speaker, for giving us this time 
tonight to talk about the important issue of health care reform and, 
specifically, about a simple idea on which we believe folks across the 
political spectrum should be able to agree, which is that the health 
insurance companies should have to compete like every business in my 
district and like every business around the country. So we come 
together on a two-page bill--front and back, only 24-lines' long--that 
does something very simple:

[[Page 1687]]

  It removes the monopoly protections that our health insurance 
companies have enjoyed for 65 years. Enjoyed because of free market 
principles? No. Enjoyed because of the amount of money spent lobbying 
both political parties to protect that insurance monopoly.
  One thing we should be able to agree on, which costs the government 
nothing, is that health insurance companies should not be protected as 
monopolies. The Consumer Federation of America estimates that this 
could save consumers $10 billion. This is a simple American principle 
of competition, of the ending of health insurance monopolies.
  I have been joined by several of my freshman colleagues tonight, who 
have not been stuck in Washington where the logic of protecting 
monopolies may make sense. We are coming from Main Street where people 
still believe in competition and accountability and in the kind of 
principles that will ensure consumers get a better deal. When they are 
forced to compete, prices come down, and quality goes up. It is a very 
simple principle.
  My coauthor on this bill, Betsy Markey from Colorado, has been a 
great champion of good, commonsense, pragmatic solutions to our 
Nation's problems.
  With that, I recognize the gentlelady from Colorado.
  Ms. MARKEY of Colorado. Thank you very much, Tom.
  You know, for years, I operated two small businesses. One was a small 
Internet company, and the other one was a coffee shop. I remember years 
ago, before I sold one of my businesses, a national coffee chain came 
into town.

                              {time}  2250

  And we weren't given any special Federal protection. When you're 
faced with competition, you do what any small business does. You know 
what you need to do. You know how to compete and lower price or serve a 
better product. And I don't know why the insurance industry for over 60 
years has been afforded this special exemption from antitrust laws.
  There are only two industries in the United States that enjoy this 
exemption: It's the insurance industry and Major League Baseball. Okay, 
I can understand Major League Baseball. It is our national pastime. But 
why they have been able to have no competition in the industry, it also 
affords no innovation in the industry because there is no competition.
  Over the past 14 years, there have been over 400 mergers in the 
insurance industry so that now 95 percent of the insurance market is 
considered highly concentrated. There are States that have one or two 
insurance companies that are serving them.
  Again, when we had a small computer business, we had several 
employees who were across State lines, and we had the availability of 
one insurance company. The prices were expensive. It wasn't necessarily 
what my employees wanted to do, but there was no competition in the 
industry.
  This is commonsense regulation. It's, as Congressman Perriello noted, 
two pages long, easy to understand, and, again, it does what we want to 
do with health insurance reform, which is, number one, bring 
competition to lower prices and still maintain affordable health care 
in this country.
  With that, I would like to turn it over to my colleague 
Representative Tonko.
  Mr. TONKO. Thank you, Representative Markey.
  It is so important for us to underscore the value of competition that 
drives the American economy. We've seen it in so many industries and 
where competition provides choice for consumers. I think it's very 
interesting to note that over the last decade, as average households 
have stayed flatlined and as insurance premium costs have more than 
doubled, the consumers have had no choice in some situations. They have 
had to tolerate price fixing or insurance groups dividing up 
territories amongst themselves or certainly just subterfuging any of 
their competition out there.
  I think that it's time for us to make certain that there is the 
competition. Certainly by moving with this reform to McCarran-Ferguson, 
we now can hope for a better day for America's insured. It is so 
important for us to make certain that this 65-year-old prohibition is 
undone. And as Representative Perriello said, this costs government 
nothing. It is the sort of reform that I believe can drive wonderful 
benefits for the people of this country as they have looked at these 
exorbitant prices where we've seen huge increases, where there's a need 
for a stronger bed of oversight, of regulation, making certain that the 
double-digit percentage increases are not tolerated, are not just 
rubber-stamped in a way that really engages the price fixing, that 
engages the efforts out there of greed that with that monopoly power 
have enabled them to really sock it to our health care consumers. We 
need reforms. We need them now. And I think this is a wonderful effort.
  I want to applaud Representative Perriello and you, Representative 
Markey, for putting forth this initiative. I think it's going to be 
something that meets with success in this Chamber, and then we're 
hopeful that we can continue to march forward for that progress to be 
struck.
  Mr. PERRIELLO. Before I turn it over to the gentleman from 
California, I just want to say I'm new to Washington and I understand 
that it's a city where a lot of things are gray rather than black and 
white, but this is a bill that really seems to me like it's a clear 
situation of black and white. A two-page bill, 24 lines long that does 
one thing: removes the monopoly protection of the health insurance 
companies. There are no carve-outs. There are no exceptions. There are 
no loopholes. It is a clean bill.
  And it's interesting to go back as voters have rightly been 
frustrated at all of the special deals that have been cut on the other 
side of this building to understand this is not a new thing. Sixty-five 
years ago the reason we were stuck with this problem was the insurance 
lobby came in in 1945 and was able to get this carve-out of monopoly 
protections that no other industry enjoyed. And it was supposed to be a 
3-year phaseout. And what happened at the last second? A special deal 
was cut that removed that 3-year phaseout. Since then, the insurance 
industry has spent billions and billions of dollars buying their 
monopoly protection in this town of Washington. They spent $400 million 
last year while they were jacking up rates, premium rates, and out-of-
pocket expenses for consumers, for patients around this country. They 
spent $400 million lobbying to protect their monopoly protections.
  Sometimes there's a very clear choice. Do you stand with patients or 
do you stand with the profiteering of the health insurance companies? 
This is that clear choice. Do you stand for competition and 
accountability or do you stand for protecting special interest groups?
  We have a chance tomorrow, hopefully on a bipartisan basis, to come 
together and do this one thing. While we can agree or disagree on the 
overall health care approach, can't we agree that removing the monopoly 
protections that make no sense to ensure competition and accountability 
is a good thing we can all agree on, we can all read over a single cup 
of coffee, and we can all move forward with the American sense of 
competition and accountability?
  With that, I yield to a gentleman who spent much of his career 
understanding the insurance industry in his State and around the 
country. I yield to the gentleman from California (Mr. Garamendi).
  Mr. GARAMENDI. Thank you, my colleague. I look forward to your 
continued pushing of this issue.
  It was a century ago that Teddy Roosevelt established an effort, the 
progressive effort, to push back against the rapacious greed of Wall 
Street and those who were raping the American environment and began the 
progressive movement. Competition was at the heart of that effort to 
bring about justice and an opportunity for the small guy to actually 
make it.
  Right now here in Washington, those of us who care about individuals, 
who care about small business, who care

[[Page 1688]]

about the future of this economy are pushing back against those very 
same forces who over the last 65 years have been able to embed 
themselves firmly in the American system in a way that has created 
greater profits for them at the expense of people. The health insurance 
industry has clearly put profits before people, and it's time for us to 
end that.
  With this bill, we force that industry into the same competitive 
market that we want all of American industry to be in, that is, in the 
free market competitive system, and to no longer be able to monopolize 
the health insurance marketplace.
  Let me give you an example of what happens in California where 
WellPoint, Blue Cross of California, has 80 percent of the individual 
market. Last year, in 2009, they raised their rates an average of 30 
percent in that individual market. The result of that was that their 
fourth quarter profit year to year, 2008 to 2009, increased some 700-
fold from 300-plus million dollars to over $2.7 billion. How did they 
do that? They did that by controlling the marketplace, having a virtual 
monopoly on the market.
  Now, that wasn't enough for them. Because of their market control, 
they have been able to institute, although it's been delayed, a 39 
percent, up to 39 percent and a 30 percent average increase in this 
same marketplace. It is time, it's absolutely essential, that this two-
page, 24-line bill that establishes the antitrust law in this field of 
health insurance be enacted.
  Later, when we come back around with another comment, I will tell you 
how it worked in California in 1991 when we instituted proposition 103 
that eliminated the ability of the property casualty market, 
automobiles, homeowners, similar products, limited their ability to 
monopolize and to take advantage of being outside of the antitrust 
laws.
  Let me congratulate you and our colleague from Colorado for putting 
forth this bill. It is essential.
  Mr. PERRIELLO. Not to jump to the end of that story, but before we go 
on, I do believe when you instituted those reforms in your State, the 
premium rates increased at one-fifth, one-tenth of the rate of the rest 
of the country; is that correct?
  Mr. GARAMENDI. Well, what happened in proposition 103--and I was the 
newly elected Insurance Commissioner in 1991 responsible for 
implementing the law. The insurance industry had the ability to work 
together to set rates and to monopolize the market in a way that was in 
a pattern to be able to have a uniform rate system using what was 
called rating bureaus. We simply outlawed rating bureaus and forced 
each company to use its own statistical analysis to set rates. The 
result was, over a 10-year period, a $30 billion reduction in costs to 
homeowners and automobile insurance consumers in the State of 
California.

                              {time}  2300

  I will tell you this, when you force these companies to compete, when 
you eliminate their protection from the antitrust laws, you will see a 
significant rate decrease. And when you have a company such as Blue 
Cross, that dominates a segment of the market, that is what is outlawed 
under the normal antitrust laws of this Nation.
  Ms. MARKEY of Colorado. Thank you. And you're right. The rate 
increases that families are experiencing right now are absolutely 
unsustainable.
  I was home in Colorado last weekend. I spoke to one woman, she had 
gotten an increase in her premiums for next year of 35 percent.
  Another small business owner in Greeley told me he got a rate 
increase of 39 percent. How can you afford that?
  And this is at the same time we're hearing on the news that the 
insurance industry, as a whole, has realized an over 50 percent 
increase in their profit in 2009 and 2008. And yet insurance premiums 
are going through the roof.
  Now, this is not anything new. We have seen the Ford Commission, 
antitrust commission, recommend that Congress take action on 
eliminating this exemption. President Bush's Antitrust Modernization 
Commission, just a couple of years ago, recommended that Congress take 
action.
  And in 2007, Republican Senator Trent Lott and Democrat Pat Leahy got 
together and proposed legislation that was actually more sweeping than 
this that affected more parts of the insurance industry. And at that 
time, Senator Lott said, I cannot, for the life of me, understand why 
we have allowed this exemption to stay in place for so long. He 
testified in 2007 in front of the Judiciary Committee for that, with 
that statement.
  This has broad appeal with many organizations as well. The repeal of 
this exemption is supported by the American Hospital Association, the 
American Dental Association, and the National Association of Attorney 
Generals. They met 2 years ago, because right now the States are 
responsible for monitoring this, and they just don't have the resources 
to do this. Forty-seven out of 50 of our Attorney Generals around this 
country have said Congress needs to take action to repeal the antitrust 
exemption from insurance companies. The other three were not in 
attendance, but they voted no. Not a single State Attorney General 
supports having this exemption for the insurance industry. It's high 
time.
  Now, I don't like to demonize one particular industry. There's 
nothing wrong with the notion of profit in this country. We are a 
capitalist Nation. But the fact is that we also, here in Congress, need 
to be guided by the fundamental notion of fairness. And the simple fact 
is that, one, one industry in this country has had an unfair 
competitive advantage, and that needs to end.
  Mr. PERRIELLO. This is a year when there's a lot of demand for 
bipartisanship. And bipartisanship is a wonderful thing. We already 
have bipartisan support for this bill. Now, bipartisanship can't be 
defined by those who want to hold Congress hostage and prevent us from 
getting anything done. We already have the unanimous support of the 
Attorneys General in 2007 as you mentioned, not a single dissenting 
voice in saying this needed to be repealed. This is not a Federal 
takeover. The Attorney Generals both want the resources to fight this, 
and they want the expanded jurisdiction.
  We have 95 percent of our health care markets highly concentrated. 
President Bush called a bipartisan blue ribbon commission together to 
look at the issue of antitrust exemptions, and they came back and said 
there is no justification for these antitrust exemptions to exist. Any 
arguments that are being made are anachronistic, or are simply ones 
that only make sense inside the Washington Beltway.
  This is something where we need Main Street values, not Washington 
collusion, to go and challenge these monopolies and get competition 
back in the market. I yield back.
  Mr. TONKO. Representative Perriello, you know, I earlier heard 
Representative Markey speaking of the 400 mergers, and you talked about 
that resulting in 95 percent of the markets being concentrated. That 
simply states, no choice, no choice for the consumer. That means a 
runaway with costs that are going to be so inflated.
  When you look at some of the stats out there, the large five, the big 
five insurance companies, you know, we look at that profit column, at 
some $12-plus billion, a 56 percent increase from calendar year 2008 to 
2009. $12-plus billion. You know, those are benefits that could be 
shared.
  As you said, you know, we understand it's a capitalist society. There 
are efforts out there, obviously, to be productive and be profitable. 
But 12 billion, a 56 percent growth, when average household incomes are 
flatlined, is very difficult to absorb for our constituents, for 
consumers out there.
  And then to even look at the track record over the last decade from 
2000 to 2009, to know that 250 percent increase was the outcome for 
profits. The time is more than past.
  And as all these commissions had indicated, the Association of 
Attorneys General, all speaking out in defense of this. It's no wonder 
everyone is promoting this reform.
  And I, again, want to congratulate the two of you for putting this 
measure

[[Page 1689]]

out there, bringing it to the floor so that we can now make a 
statement, in a bipartisan fashion. We hope that tomorrow when this 
vote is taken there will be this effort to speak in defense of 
consumers who have taken it on the chin. These profit margins are 
cutting away at their own doability as a household. We can stretch that 
household budget by reducing those insurance premium costs, and that's 
what this effort is about: Accountability, affordability, 
accessibility, quality of care.
  This is a major cornerstone of reform that is outside that package 
that we have been trying to assemble, but this is something we can do 
immediately, and as has been stated so many times over, without any 
cost to government. So this is a win for the consuming public out 
there. And they deserve this sort of effort because they've gone far 
too long where this injustice has been allowed to occur time and time 
again because of that exemption for an industry, when all other 
industries out there are covered by the forces of the antitrust 
legislation from McCarran-Ferguson's Act of 65 years ago. So it's time 
for change. It's time for reform, and I believe this brings balance to 
the equation and is the rightful thing to do.
  Mr. PERRIELLO. As my coauthor from Colorado mentions, this isn't 
about being anti-insurance. This is being pro-competition and pro-
consumer. It is well past time to put the patient first in the health 
care system.
  We heard during the last hour some of our colleagues from the other 
side of the aisle talking about the need to protect the doctor-patient 
relationship. What decade are they living in? The doctor-patient 
relationship has been invaded for decades now. My sister who is a 
pediatrician many days spends more time on the phone with the insurance 
company than she spends with patients, insurance companies whose profit 
motive is based on denying people care, not providing people with care.
  In a good, competitive market, the insurance companies will profit 
based on providing quality insurance and coverage to patients, not by 
highly concentrated markets. This is about putting that doctor back in 
control of care, instead of that insurance company back in control of 
care, because through the free market, we can ensure that consumers are 
moving towards the insurance companies that provide that kind of 
quality care. So this is about being pro-consumer and about being pro-
patient and pro-competition. With that I yield.
  Mr. GARAMENDI. Well, there is absolutely no doubt that it's an axiom 
of American business, and the American economic system, that 
competition leads to good things, lower prices and better product. But 
in the case of health insurance, as we've seen over these last decades, 
we've seen an increasing concentration and less and less competition. 
This bill will put competition back into the health insurance sector, 
and it is desperately needed.
  Right now, in California, with Blue Cross of California, where they 
have 80 percent of the market, they don't need to compete for the 
customers. The customers are desperate to get coverage, and they've got 
to take whatever is being offered by a company that has 80 percent of 
the market. So let's get some competition back in there.
  This is also an issue that affects individuals. I know a 23-year-old 
girl who's no longer on her parents' health insurance, cannot get 
health insurance, even though she's applied to Blue Cross, because she 
had acne. And the list of preexisting conditions is three pages long. 
So if we have competition, by eliminating this antitrust exemption and 
forcing and ending the monopoly, then I think companies are going to 
have to go out and search for customers, and that would help us all.
  And let us also be very, very aware. I've spent 8 years of my life 
regulating the insurance industry, and I know this about that industry: 
It's about profit. It's not about people.
  Now, in the property casualty business, it's important to pay 
attention to people. But it's not life or death, in most cases. In the 
case of health insurance, it is about a human being's life. It's about 
the young lady that I saw at a town hall meeting this last week, a 12-
year old girl, born with a heart condition, whose father cannot leave 
the job, cannot go to a better job for fear of losing his health care, 
knowing that if he lost his health insurance, this young lady would not 
survive. She would lose her life. That's wrong, and that's got to end.
  This bill is one small piece of the larger puzzle that we're working 
on to put in place in America a health care bill where people come 
before profit. We can do that. We can do that with this bill, and it'll 
be very clear in this House tomorrow where we stand.

                              {time}  2310

  Do we stand with families who need health care? Do we stand with 
individuals? Do we stand with young Gloria and her parents and say: End 
the monopoly. Put the antitrust laws in place so that the health 
insurance industry has to compete? That's our choice. And we'll see 
tomorrow where we stand.
  Do we follow the tradition of Teddy Roosevelt, a Republican who went 
after the big corporations and said that in America, competition must 
be there, who fought back and pushed back against Wall Street? Or do we 
stand with the health insurance industry? That's our choice tomorrow, 
and it's there because two Members of this House have put forth a bill: 
my colleague from Virginia and my colleague from Colorado. I thank you 
for bringing this before us so that we can identify with the 
individuals who need health care or, on the other hand, with the 
insurance industry.
  Mr. TONKO. This dynamic of competition, as the gentleman from 
California makes mention, competition is what drives the benefit for 
the consumer. Competition is stymied by the fact in my home State of 
New York three companies, three insurers, have asked for or have sent 
dividends to corporate parents out of State that fell just shy of a 
billion dollars last year. Just three groups. Now, would they have the 
luxury to do this if they were pressured to compete, to hold on to 
their market? I don't think so.
  This year, those same three companies are looking to send $1.2 
billion outside of the State to corporate parents. This is the sort of 
action that takes hold where you're not encouraging anybody to compete 
to hold on to their market and we're exporting these billions of 
dollars. My State, I am certain, is not alone in that phenomenon, and 
it is hurting the consumers of New York State simply because there is 
this mass exodus of dividends that are being paid out to the corporate 
parent firm.
  So you look at the record in New York and what has happened over a 
10-year stretch from 1999 to 2009, and that amassed to some $5 billion 
worth. This is a pattern that is becoming more and more pronounced, 
that is again not putting pressure on the system to respond in 
competitive measure. And that dynamic being pulled out of the equation 
then causes hardship for the very people that we need to hold down 
costs for health care insurance; $1.2 billion requested this year from 
just three groups to send those dividends out of the State.
  These are reports that are disturbing, these are the forces that are 
driving this thinking to bring about the reform that is introduced in 
the Perriello-Markey legislation.
  Again, to our Representatives here who have thought in such 
progressive terms, I say ``thank you'' because this will be a major 
piece of reform that brings instant benefit, that induces competition 
into the process, and it doesn't cost government a dime.
  I am very happy that this effort is being made in this House, and I 
applaud the sponsors. I applaud all who are working to make this happen
  Mr. GARAMENDI. If I might, Mr. Tonko just reminded me of two cases. 
One, a New York case last year in which the New York Attorney General 
brought action against 11 insurance companies in your State of New York 
who had conspired not only against consumers but against doctors and 
hospitals to artificially lower their rate of reimbursement to those 
hospitals.

[[Page 1690]]

  Now, that followed on the heels of another national case in which 
insurance companies, the largest insurance companies in this Nation, 
also conspired against doctors in reducing their rates in a conspiracy. 
Those kinds of conspiracies are specifically outlawed by the antitrust 
laws of this Nation and this bill. I thank you so very much, Mr. 
Perriello and Ms. Markey, for bringing this to our attention, bringing 
this bill here, because the kind of conspiracy that we have evidence 
that exists in America today will be outlawed at the Federal level.
  These other cases were brought in State courts where there are 
antitrust laws that prohibit these kinds of conspiracies to harm the 
consumers or the providers of services.
  Ms. MARKEY of Colorado. I want to thank my colleague from California 
who has unique experience with the industry and in this field for your 
perspective on this.
  My colleague from New York has talked about competition. And it has 
been competition that has made this country great. I want to expand on 
that a little bit as well to talk about innovation. We have always been 
a country of entrepreneurs and innovators, and when you have an 
industry, an entire industry that can set prices, can collude with 
their partners, you have no innovation in the industry.
  Some of our Republican colleagues were talking just a short while 
ago, and one of them was talking about health savings accounts. I am a 
supporter of health savings accounts as well. My sister and her husband 
wanted to get a health savings account with catastrophic health care, 
but because of their age and because of where they live, they could not 
find an insurance company that would offer that type of product for 
them, which would help them to save money and to really bring 
transparency to the system to know what they were spending their health 
care dollars on; and many people want that option. They weren't able to 
get it because it was not available in their part of the country.
  Why? Because there is no need to. There is absolutely no incentive 
for our insurance industry to innovate, to change the system, to offer 
new products, to compete on prices. This is what the heart of this bill 
gets to. It gets to competition and innovation in the system, which 
again is going to lower prices and, as we have all noted, doesn't cost 
the government a dime.
  We should be able to get bipartisan support on this legislation 
tomorrow.
  Mr. PERRIELLO. The gentlelady from Colorado spoke about the issue of 
fairness as a basic principle. One of the things I hear so often back 
home is why should there be one set of rules for the people who write 
checks to politicians and another set of rules for our businesses back 
home who are working so hard just to keep people employed?
  The fact is there shouldn't be a different set of rules for the 
insurance companies just because they've been lobbying for 65 years in 
this town. Competition should apply. Monopoly protection should apply. 
People will hear this week, as this debate plays out, fancy words about 
safe harbor and this exemption and that exemption. They're sick of 
Washington providing safe harbors for those who have contributed the 
most to political parties.
  Four hundred million dollars in lobbying just last year alone. Now 
that $400 million in lobbying from the health insurance industry didn't 
come because they said, You know, those politicians are on tough times. 
They just aren't getting enough money. There's not enough money in 
Washington. We feel like we should offer them $400 million. They were 
doing it because they want to protect their monopolies.
  I just got back from a week in South Side, Virginia where we've seen 
job loss after job loss. One of the things that I heard from workers so 
often was--I was talking to a guy who just got laid off from Stanley. 
He was saying, I nearly made $40,000 back 20 years ago. Then I was down 
to $30 an hour and then down to $20 an hour. And now I just got fired 
from a job or laid off from a job for $11 an hour.
  Now, there are many things. We need to look at our trade policy. We 
need to see ``Buy America'' not to be a bad word or a bad phrase in 
this country anymore. But I also hear from workers all the time with 
this issue saying, you know, I remember when I used to go in at the end 
of the year and ask for a raise. Now I don't even ask for a raise. I 
just ask to hold on to my health care benefits. That's not because 
these business owners are bad people; they're great people. They're 
bending over backwards to try to ensure that they're able to keep their 
workers on the payroll and keep them with health care.
  The reason they haven't offered a raise to their workers in so many 
years is because that money that would have gone to a raise is going to 
the increased premiums for their health insurance just to keep people 
insured. There is a direct correlation where people aren't seeing that 
increase. Not only are they seeing their out-of-pocket health expenses 
go up, but that amount they don't see that their employer is paying has 
been going through the roof as well.

                              {time}  2320

  So we are crushing the competitiveness of American business because 
we aren't forcing the health insurance companies to compete. This is a 
basic principle that gets back to that purchasing power of working 
class and middle class Americans who are so often coming up to me and 
saying, Who is looking out for us? It seems like everything is going to 
the big guys. Who is still fighting for working class and middle class 
Americans?
  Well, here is a two-page bill, 24 lines long, that stands up for 
working class and middle class Americans by saying we are going to 
force the biggest health insurance companies in this country to compete 
for your business. And that competition is going to mean lower costs 
and higher quality. We need to put working and middle class folks ahead 
of the health insurance lobbyists and the health insurance companies.
  And with that, I yield to the gentleman from New York.
  Mr. TONKO. Thank you, Representative Perriello.
  When we start talking about this competition, we wonder about the 
benefits that are so drastically needed because we see now that some 
companies are looking at charging a 39 percent increase for the 
premium; 39 percent. That is a gross, gross, difficult outcome for 
consumers in this country.
  What is driving it? Well, yeah, there is lack of competition, but 
that lack of competition, that allows for a rather comfortable zone to 
increase CEO salaries. And when we look at the big five again, the 
largest insurers, the data shows that the CEOs were compensated up to 
$24 million in 2008. That is, I think, an outcome driven by a lack of 
competition. That pressure isn't there to respond, and so you just 
easily pass it over to the consumer. And without any sort of reform 
here, this will continue to grow.
  I know that there had been many suggesting from studies that are very 
much respected that the average family plan will be increased by about 
$1,800 per year. Today, that is an average of $13,000, I believe, for a 
family plan. Well, in a short decade, we are just going to transpose 
those numbers, so 13 grows to 31. 31,000 is a train wreck waiting to 
happen. It is unsustainable. It is the sort of outcome we get when we 
don't take the bull by the horns and say, look, there is a simple 
reform. It is straightforward. It is basic. It calls for the all-
American sense of competition, the all-American quality of competition, 
a good thing.
  If you are a strong business, you welcome competition. It is good for 
the soul. It is good for the consumer. And so let's open this process 
to competition. Let's avoid some of these hefty increases in CEO 
salaries, or profit margins that are record breaking, and all sorts of 
insensitivities, gross insensitivities to the quality of care and the 
affordability of care for individuals and families out there.
  The time has more than come. It is an important measure that we take 
before us tomorrow in this House. It will be a moment in history, I am 
convinced, so as to move forward and respond in compassionate measure, 
in

[[Page 1691]]

reasonable terms, to bring those scales of justice back into a balance 
that speaks to a favorable outcome, a progressive path that we will 
follow.
  Mr. GARAMENDI. My colleague from New York, thank you for bringing to 
our attention, did you say $24 billion for the executives of the five 
largest?
  Mr. TONKO. Million.
  Mr. GARAMENDI. Five biggest.
  Mr. TONKO. The five largest insurers being compensated $24 million.
  Mr. GARAMENDI. That ought to be enough. In fact, that ought to be 
about a hundred times too much. Competition.
  You also brought out the word ``progressive.'' It was Teddy 
Roosevelt, in the early part of the last century, that really created 
the early progressive movement and the trust busters, recognizing that 
companies like Standard Oil and others had dominated the market and 
were squeezing, driving down and harming small businesses and 
individuals, and tried to set about a better balance. And they did.
  That long tradition of standing up for families, working men and 
women, is a tradition that we now hold on the Democratic side of this 
House. It is what we are trying to do in so many different ways here 
with this bill, ending a 65-year opportunity that the health insurance 
industry has had to monopolize, to engage in conspiracies to set 
prices, and to harm the public not just in their economics and in their 
family income, but in their ability to sustain their life.
  We have a chance tomorrow to follow a long tradition of righting the 
balance, of pushing back against those forces that would dominate us 
economically, socially, and, in this case, in our very health. So 
tomorrow is a very, very important day. But it is also a day when we 
can continue the process that we have seen this last year in this 
Chamber, where the Democratic Party is pushing back against those 
forces.
  In December, we put forth a health care bill that would move us 
towards accessibility, towards accountability from the health insurance 
industry, and to affordability. We pushed back. Here is one more push 
that we are making tomorrow.
  We also pushed forward on regulating Wall Street. There are those 
over here I heard earlier this evening that said that this thing began 
in 2009. It didn't. It began because the previous administration 
refused to push back against the rapacious greed of Wall Street, and we 
wound up with the collapse of the financial industry. We need to right 
that.
  We are doing that with the bill that we put out here in December on 
regulating Wall Street, and now following up with taking money back 
from Wall Street that was put out there by the TARP and sending it to 
Main Street in our jobs bill; righting the balance in America so that 
young families, hardworking Americans have a chance, in this case, to 
get health care, to get a job in the case of Jobs for Main Street. And 
for Wall Street, the days of unbridled opportunity for greed are over. 
And it is time for them to also hew to the lines of correct American 
competition, not greed--greed has never been good--but, rather, to 
provide the financial services that this economy needs.
  We have a choice tomorrow. One more step along a policy of righting 
the ship of this Nation's economy, pushing back against the greed, 
pushing back against the rapacious attitudes that have dominated the 
American economy for the last decade.
  Ms. MARKEY of Colorado. We, as Members of Congress, we come here to 
look at all sides of an issue. That is our responsibility, to look at 
the pros and cons of legislation. Most of the issues that we deal with 
are very, very complex. Oftentimes, we are voting on a bill. We may 
like some parts of the bill, we may not like other parts of the bill, 
but you can't say, I will vote ``yea,'' but let's change this. You have 
to vote ``yes'' or ``no.''
  And I have looked--I think we all have--on all sides of this piece. 
We have talked to people in the industry. This seems pretty 
straightforward to me. The only argument that I have heard against this 
antitrust exemption is from the insurance industry themselves, who have 
said, well, the States can do it. The States have been doing it for 60 
years. That is sufficient. Let the States do it. But yet the States are 
saying we can't do this. This is unfair to put this burden on us, as 
the State attorney generals have noted. And this is a Federal issue.
  And why, why have we singled out just one industry in all of the 
United States except for Major League Baseball, which pays a luxury 
tax, some of the more successful teams, to keep some of the smaller 
teams going when they are not having a good season? I get that. I 
cannot understand why for 60 years we have singled out one industry in 
the United States for this exemption from antitrust laws. It is wrong. 
It is simple to fix, and we are going to do that tomorrow when we pass 
this legislation. This is not a Democratic bill or a Republican bill. 
This is for the American consumer.
  Mr. PERRIELLO. I think one of the reasons why Ms. Markey and I have 
enjoyed working on this bill together so much is that we both are home 
in our districts every weekend. We have done a lot of town hall 
meetings. We have done a lot of roundtables with doctors and nurses and 
patients. We both come from districts that have a lot of Republicans, 
Democrats, and a whole lot of Independents as well. And I think we 
heard a lot of things. We hear a lot of things over and over again.
  One is, What happened to common sense? Well, this bill is a simple, 
pro-competition, get rid of the monopoly protections, make them play by 
the same rules bill. It is common sense. People say, Why the 
partisanship? Why can't we get together? As you said, the attorneys 
general from all of the States, not a single dissenting vote, said they 
want this. They want this increased power to go after the monopoly. And 
they know that they need some of the resources and support to get this 
done.

                              {time}  2330

  President Bush's bipartisan commission came back and said there is no 
longer any reason why this should exist if ever such a reason existed. 
So this is a bipartisan idea. You mentioned former Senator Trent Lott 
as well. People said, what about a bill we can read and understand? Two 
pages, front and back, 24 lines, simple English. Lots of attempts to 
water this down, to add lots of legalese. No, this is a commonsense 
bill.
  People say to us, why is it that the special interests seem to win 
out over working and middle class families? Why can't we get a victory 
for working and middle class families over the special interests? Well, 
that $400 million the insurance lobby spent last year was to protect 
this monopoly, and we are saying no to that lobbying influence, we are 
saying we are going to put working and middle class people ahead.
  Finally, we have a simple choice, not one of these gray-area D.C. 
decisions. Tomorrow there will be a simple choice: Do you stand with 
patients and do you stand with competition, or do you stand with the 
profiteering and monopolies of insurance companies? It's a simple 
choice. Sometimes in this city it can get as muddled up as bad as the 
traffic, the logic and the morality, but it's a simple choice: Do you 
stand with patients, or do you want to protect the monopoly 
profiteering of the insurance companies?
  Now, not all insurance companies are bad. There are lots of great 
companies out there. If you are not engaged in monopolistic practices, 
you have nothing to worry about. But if you are sticking it to 
consumers and colluding, beware, because common sense is going to win 
out here with a simple two-page bill that is going to repeal those 
monopoly protections and put patients and consumers first.
  Mr. TONKO. I think the special interests are so glaringly obvious, my 
colleagues; the fact that they can escape these Federal investigation 
and enforcement measures, measures of antitrust laws that make them 
subject to Federal prohibitions against bid rigging or price fixing or 
dividing up market territories.
  These are tools in the tool kit that don't serve consumers well. And 
as if

[[Page 1692]]

the escaping isn't egregious enough, they can then move to prejudice 
against by not insuring because of preexisting conditions. We have 
talked about some of those more easily recognized or imagined 
conditions--heart disease, diabetes, high blood pressure, cancer--but 
it gets into the realm of the very loosely defined preexisting 
conditions--acne, domestic violence, overweight for toddlers, or what 
have you, obesity in toddlers. It is all set up in their favor. And I 
believe that there needs to be balance. And as Representative Perriello 
said, there are undeniably sound players, good, good behaviors out 
there that respond well. But for those who are taking advantage of this 
exemption that has allowed to continue for far too long, the time has 
come to put up the stop sign and say it's over, it's a new set of rules 
come your way.
  And the Attorneys General of this country obviously know something, 
they see it front and center, they see it in cases that they have to 
defend for the people in their respective States. And so they're 
advising us, in bipartisan fashion, they are advising us that a better 
day can be had, and here is the opportunity. A simple vote--hopefully a 
bipartisan vote--on a very succinct measure, one easily understood. It 
is time to end a 65-year stretch of what is I think a special response 
to an industry.
  We talk about the deep pockets, we talk about the special interests, 
we talk about the force that they have had on this process as an 
industry. Well, when I think about the recent Supreme Court decision to 
allow for open-spigot season and pour more dollars into the process to 
influence legislative outcomes, to have more pressure on the process, 
to perhaps deny progress, I get very worried about this measure hanging 
around for far too long. I think the time has more than passed to get 
this done. Let's get it done in the sort of way that acknowledges that 
we have tough work to do here. We have people hurting across this 
country, not being able to afford health care coverage, not being able 
to sustain what are these ever-spiraling increases for health care 
premiums. Let's do them the big, big benefit of changing this law and 
voting ``yes'' tomorrow in the activities that will take place in the 
House.
  Mr. GARAMENDI. Mr. Tonko, as I was listening to you, several thoughts 
came to mind. You were listing a series of activities that are clearly 
contrary to the normal competitive marketplace, price fixing and the 
like. There is also an issue in this health insurance sector called 
vertical integration, in which these large companies not only 
monopolize the market, but they have now reached into the various other 
aspects and vertically integrated, owning consulting companies, 
actuarial companies that provide them with the basic data where they 
can more easily manipulate that data, now moving into the pharmacy 
benefit programs and gaining control over the entire marketplace. That 
is one of the activities that would be able to be attacked by the 
Federal Attorney General if this law were to go into place.
  The monopolization of the market, as I described in California where 
Blue Cross has 80 percent of the individual market, leads to a terrible 
situation. And I would just like to bring us back to why we are doing 
all of this, why we are doing the health care reform that is now going 
to be taken up in the summit on Thursday of this week, why we are doing 
this particular bill. It is really about Gloria, that 12-year-old girl 
that I talked about who was born with a heart condition and also has 
diabetes. Her father is desperate to hang on to his job and the 
insurance policy that comes with it because they know--the mother, the 
father, and Gloria--know that should he lose that job, that family is 
uninsurable. And that young girl who has had to fight for every 
treatment in her 12 years to sustain her life is an opera singer, a 
Class A student, and has a future ahead of her. But if they have no 
health insurance, she is going to die because she needs constant care.
  I can talk about a carpenter who retired because he couldn't continue 
to work who I saw on his deathbed saying, I just want to live long 
enough so that my wife can turn 65 and get Medicare, because if I die 
before that, she has no insurance, and she has a preexisting condition.
  There is hurt upon this land. People are suffering for lack of a job, 
and they know that if they lose that job, they will lose their health 
care and they will lose their wealth and they may very well join the 
40,000-plus Americans that lose their lives for lack of health 
insurance.
  This side of the aisle, the Democrats, are pushing back against these 
situations. And tomorrow, one step, one more step, one more pushback 
and saying, in America, the present system is wrong, and tomorrow there 
will be an end to the ability of these insurance companies to 
monopolize the market, to engage in anticompetitive activities, price 
setting, vertical integration, and the rest.
  I want to congratulate, I want to thank Mr. Perriello and Ms. Markey 
for what you are doing tomorrow in your legislation.
  Ms. MARKEY of Colorado. And I would like to thank my colleague from 
California for sharing those personal stories of people that you know 
who are unable to switch jobs because they will not be able to get 
health insurance, people who can't afford health insurance or get 
health insurance because of a preexisting condition. We have all heard 
the stories about the auto industry--the most important part of making 
a car is the health insurance for the workers who put that vehicle 
together, that the most important line item expense for companies like 
Starbucks is not coffee, but it is health insurance. I saw that in my 
own business as well. My husband and I, every year it was double-digit 
increases. And every year we, as small business owners, had to cut back 
on how much we could afford to pay. We started out paying 80 percent of 
our employees' health insurance. We went down to 70 percent. Now it is 
60-40, because we just cannot afford to keep up. We cannot be 
competitive, particularly in a global economy where you are doing 
business overseas, your partners overseas don't have that enormous cost 
of health care that they are paying for their employees.

                              {time}  2340

  It's a real business decision to decide, Well, gee, can I afford to 
hire somebody new? Can it maybe be a contractor, and I won't be paying 
health insurance for him because I can't afford that extra, you know, 
$16,000-$17,000? So it is a difficult issue for everyone, and the 
competition is not there.
  As I mentioned, when you've got employees in one or more States, it 
is virtually impossible to find more than one company. That's all we 
could find--one company across the United States which would offer 
insurance to people in several different States. That is just wrong.
  We have all talked a little bit about the State attorneys general, 
and I want to read to you a quote from one of those attorneys general 
at their meeting when they all voted unanimously, really, for a repeal 
of this antitrust exemption. One of the assistant attorneys general 
noted:
  ``The most egregiously anticompetitive claims, such as naked 
agreements, fixing prices or reducing coverage, are virtually always 
found immune from prosecution under the law. They are always found 
immune.''
  We have a very simple choice tomorrow: Do we stand for the insurance 
industry or do we stand for the American consumer?
  It is not an issue of what is good for one industry. It is what is 
good for competition and innovation. What they have is wrong and 
unfair, and we have a chance to undo that tomorrow.
  Mr. TONKO. I know that we are coming close to the end of our hour. I 
just want to state that perhaps, if this unfairness were not being 
levied upon, thrust upon American families, maybe this moment of reform 
wouldn't be happening, but because there is that unfairness, the 
propensity to push for this reform has now reached a very solid height.
  I think that, as we go forward, as we are waxing anecdotally, what 
comes to

[[Page 1693]]

mind for me is a couple whom I know who was hit with a catastrophic 
illness--a husband and wife team. Their premiums increased by 37 
percent over the course of 2 years, and they are left now with one wage 
earner in the family. Both had been working. As the wife of this couple 
was impacted by catastrophic illness, they are now left with one wage 
earner and with a pile of debt that is $18,000 worth of uncovered 
medical expenses.
  So that's what this is about. That's what feeds the passion of this 
debate.
  I have to commend the leadership of this House. Speaker Pelosi has 
been vigilant about pushing the reforms, along with our respective 
Chairs from Education and Labor, from Ways and Means, from Energy and 
Commerce, and about really making it happen, about moving forward to 
make certain that the people's voices are heard here in this debate.
  When we talk about some of the unfairness, about some of the 
imbalance in the outcomes, what about the medical loss ratio? Fewer and 
fewer premiums collected, percentage-wise, are returned to direct care 
for consumers. It was 95 percent a decade-and-a-half ago. Today, it's 
below 80 percent. So there is a reason for a number of these issues to 
come forward. There are a number of reforms to be advanced.
  This bill, the Perriello-Markey bill, hopefully, will be approved 
tomorrow in a bipartisan vote. I am pleased to stand here in support of 
this measure. I want to thank all of my colleagues for the input that 
they are providing for this historic moment to happen.
  I thank you very much.
  Mr. PERRIELLO. We can make a difference tomorrow. We can make a 
difference in forcing competition in the health care market. We can 
also make a difference in starting to restore some of the trust in this 
body and in Washington. People across this country do not trust 
Congress, and that's for good reason. They always hear about the 
special interests coming out ahead. Here is a simple, simple thing:
  Two pages, 24 lines long, which simply say that health insurance 
companies, which are some of the biggest companies in the world, should 
have to play by the same rules.
  If the plumbers in my district got together and started to set 
prices, they'd go to jail. Why is it that the health insurance 
companies should be able to play by a different set of rules? People 
are always saying there are these commonsense reforms out there. Why 
can't we get them done?
  Well, Ms. Markey and I have come together and have taken that idea. 
It's not our idea. It came from the people in our districts, from 
conservatives and liberals alike, who agree that restoring competition 
and removing monopoly protections make sense. When we have seen 
premiums double in the last 10 years, crushing the purchasing power of 
working and middle class Americans, that's real for people. When you 
don't have to compete, the consumer loses.
  So people ask, Why can't you get these basic things done? Well, this 
is a chance not just to do something good in the health insurance 
market but to show the American people we can come together. We already 
know this is a bipartisan bill. All of the attorneys general, without a 
single dissenting vote, have said this is something we support. We want 
to be able to go after these monopolies.
  Jury after jury, juries of the American people, have found this has 
been going on only to be overturned by the judges who say, Sorry. 
Because of McCarran-Ferguson, those basic monopoly rules do not apply. 
The antitrust rules do not apply.
  This is a chance for us to do a simple two-page bill that puts 
patients ahead of the profiteering of the insurance companies. It 
doesn't say the insurance companies can't continue to make lots of 
money. They can. We're just saying you can't do it by colluding, by 
price-fixing and by doing the sorts of things that, since Teddy 
Roosevelt, we've put our foot down in this country and have said are 
anticompetitive behaviors.
  It should be a great chance for everyone in this body to show the 
people back in their districts: I'm here to represent you, not to 
represent the lobbyists who write the checks, not the $400 million that 
the insurance lobby spent last year in this city. It's a chance to say, 
I'm going to stand up for patients.
  This is not going to fix the entire health care problem, but why 
wouldn't we start with this? We know it has bipartisan support from the 
attorneys general. We know it has that bipartisan support from the 
President Bush commission that came out and said this needs to be done. 
It moves us in the right direction to put patients and doctors back in 
the driver's seat. It allows us to restore the basic sense of 
competition in this country. It says, for once, working and middle 
class families are going to come out ahead of the special interests. 
Consumers are going to come out ahead of the greed mentality that you 
talked about before.
  We can do this. The American people sent us here to do this--to 
listen and to find ideas which are not Republican or Democrat but which 
are fundamentally American ideas and to institute them. We will need to 
continue to have a debate about health care reform beyond tomorrow, but 
let's show the American people tomorrow, on the eve of this health care 
summit, that there are ideas we can come together on. We have that 
chance.
  So I come in to tomorrow with a great hope, with a great hope not 
only that we will get this bill passed but that it will restore a basic 
sense of competition and that it will put patients first. Maybe this 
could be the first step towards coming together in the health care 
debate to get things done, because people are in pain out there right 
now. We have lost millions of jobs. Yes, we took bold action a year ago 
to help stabilize the economy, but that's not enough. I'm not 
satisfied. We need economic growth.
  So I appreciate the work that Ms. Markey has put into this, that 
Chairwoman Slaughter and that Congressman DeFazio have put into this, 
and I thank the others who have fought this good progressive fight for 
so long. I look forward to seeing this through to completion tomorrow, 
and I thank you all for being part of this important, important fight.

                          ____________________