[Congressional Record (Bound Edition), Volume 156 (2010), Part 3]
[House]
[Pages 3570-3577]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Texas (Mr. Burgess) is recognized 
for 60 minutes as the designee of the minority leader.
  Mr. BURGESS. I thank the Speaker for the recognition. Well, here we 
are, Tuesday night, Washington, D.C., 20 minutes until eight o'clock in 
the evening. What a day we have had here in the Capitol. Mr. Speaker, 
many of your constituents and my constituents probably tried to call 
our offices today to register how they felt about this health care 
bill. I know I have been encouraging people, whether they agree with me 
or not, whether they think I'm spot on or all wet, I have been 
encouraging people to call and let Congress know what you think about 
this massive government takeover of one-seventh of our Nation's 
economy. And people have responded. They have been calling.
  But today they were met with either busy signals or interminable 
rings, because apparently the House switchboard was overwhelmed with 
the calls that were coming in. I will tell you I was concerned because 
I called my number for my office and got a busy signal, and yet walking 
around in the office, certainly not all of the phones were in use. So 
apparently this problem that Americans have encountered all afternoon 
has been one that has at its root and its cause in the antiquated House 
switchboard. I do hope the Speaker, I hope the Architect of the 
Capitol, and the Capitol business manager, will take that into account, 
because clearly, clearly we need to be able to hear from our 
constituents when we have such important legislation coming up to the 
floor.
  So where are we as we work through this? Are we in the last throes? 
Are we still in for a long, hard slog? We have heard terms like the 
final push, the final stretch, the 5-yard line. President Obama, 
Speaker Pelosi, and Majority Leader Reid have ignored calls by 
certainly every Republican, by many Democrats, many independent 
Americans, and just the American people in general, to really put the 
breaks on this current bill and to look at some of those things that 
people really want to see done, and do those.
  We don't have a lot of credibility right now in the United States 
Congress. Recent polls I think today put it around 17 percent. No one 
trusts us with a 1,000-page bill that we passed out of committee last 
July 31. They darn sure didn't trust us with a 2,000-page bill that the 
Speaker's office came up with in October and that we passed in this 
House in early November. They darn sure didn't trust the 2,700-page 
bill that passed in the Senate on Christmas Eve. And they sure don't 
trust what they see as a very difficult, tortured process that is now

[[Page 3571]]

working its way through the House. And the reason they're having to 
resort to such legislative hijinks is because fundamentally this is a 
flawed bill. This is a bad bill. And it didn't have to be this way.
  Look, most of us went home during August. We did our summer town 
halls, as we always do. We were all, I think, somewhat astonished at 
the outpouring of the American people just showing up on a hot Saturday 
morning in Texas to stand in a parking lot and listen to their 
Representative and question their Representative about what they saw 
happening up on Capitol Hill. To be sure, cap-and-trade was in the news 
those days; to be sure, the stimulus bill was in the news those days. 
But they were most concerned about this massive takeover of health 
care. Most of the questions dealt with that. And it wasn't like they 
didn't want to see anything done. But they didn't trust us to overhaul 
the entire system with one massive bill.

                              {time}  1945

  Sure, they want some help with preexisting conditions. Yeah, they'd 
like to see people be able to buy across State lines and bring some 
cost down. Maybe some liability reform would be nice. Boy, wouldn't it 
be great if COBRA was a little more flexible. These were the things we 
heard. When we came back in September, I thought, okay, rewind, pause, 
slow this thing down, and let's look at it. Maybe let's work together. 
Maybe Republicans and Democrats can kind of come to some common ground 
because every Democrat was hearing the same stuff I was hearing. And I 
know that because I saw it on the evening news. I saw the YouTube 
clips. Their town halls in Florida, their town halls in Arkansas, their 
town halls in Michigan were exactly the same as the town halls that 
were going on in north Texas. There was no difference.
  But instead in September, we come to a joint session of the House and 
the Senate. The President came and addressed us, and it was nothing of 
the sort that we're going to rework this process. We weren't going to 
check the weather. We're going to fly anyway, full speed ahead. Let's 
get this thing done. I think I heard it said again tonight in the 
discussion that just preceded us, A crisis is a terrible thing to 
waste; so let's take this economic crisis that we're in and force this 
health care bill on the American people. They don't know what's good 
for them, but we do; and this is what they're going to get.
  It is a terrible bill. It's a flawed bill. It's a very tortured 
process. I'm going to do everything in my power to stop it, but it may 
become law. And if it does, we need to know what's in it, and we need 
to know then what our next steps are to deal with those bad provisions 
that are contained within the bill.
  I've been joined tonight on the floor by a gentleman that I've come 
to admire during my time in Congress. He has been a leader on this 
issue and on the committee in which we jointly serve, Energy and 
Commerce, and here on the House floor. John, did you have some thoughts 
you wanted to share with us tonight?
  Mr. SHADEGG. I do. I want to thank the gentleman for conducting this 
special hour, and I want to talk about a number of issues that you have 
already referenced. Number one, health care reform: I certainly think 
we need health care reform. I know you do. I know that we believe that 
while the current system provides very high-quality health care, it 
often denies people access. But I want to talk a little bit about 
what's in the bill as well. The gentleman talked about this massive 
takeover.
  One of the things that stuns me more than anything else--and I know 
that you find this confusing--is that the proponents of this bill say 
that Republicans are defending the health insurance companies in 
America. Really? Really? This bill says that we're going to enact a 
mandate, an individual mandate compelling every American to buy health 
insurance from the health insurance companies that are selling them 
health insurance now. Huh? I'm sorry, I find that a little confusing.
  There is an individual mandate that says if this bill passes and 
becomes law, as the Speaker would like to do this week, you--every 
single American, every American listening tonight--must go out and buy 
health insurance from the very health insurance companies that are 
ripping us off right now. Why? Why in God's name would we want to force 
Americans to buy health insurance from the same health insurance 
companies that are ripping us off right now?
  This is a massive subsidy to those health insurance companies. It's a 
law. It will be the law of the land that says, you must, whether you 
want to or not, buy a government-approved health insurance plan from 
one of the companies selling health insurance right now. If they were 
doing a great job of selling health insurance right now, wouldn't the 
cost be affordable? Wouldn't they be holding down cost? Wouldn't they 
be giving us good service? Wouldn't they not be cheating us? I've got 
to tell you, I don't know any Republican who thinks that it's a great 
idea to compel people to buy health insurance from the same insurance 
companies that are selling us health insurance now. And yet that's what 
the individual mandate in this bill does.
  I guess they like it because it has been applied in Massachusetts. In 
Massachusetts they passed a mandate like this. They said that every 
single person in Massachusetts, by gosh, we're going to force you to 
buy a health insurance plan from some health insurance plan offered 
from a health insurance company in Massachusetts, and that will fix the 
problem. Did it fix the problem, Doc?
  Mr. BURGESS. Not entirely. And what they found was, since you have to 
buy the insurance, the cost may have gone up a little bit.
  Mr. SHADEGG. Oh, the cost went up. Wait, the cost went up? They have 
forced everybody in Massachusetts, like this bill would do, to buy a 
health insurance plan on the premise that the cost would go down. But 
in Massachusetts where they did it, the cost went up.
  Mr. BURGESS. Up. Because you've got to buy it, or you get a fine.
  Mr. SHADEGG. Ah, so it's Republicans who oppose this bill that are 
the pals of the health insurance industry? I don't think so. And you're 
telling me that in the one State where we've already tried this, a 
mandate that you must buy health insurance, costs did not go down, but 
costs went up. The cost of health insurance for the people in 
Massachusetts from before they enacted the mandate to after they 
enacted the mandate went up?
  Mr. BURGESS. That's my understanding from the reports that have been 
done by Heritage and other groups. But interestingly, if Massachusetts 
wants to enact a mandate, they are a State. And if their residents say, 
Okay, we are happy with you, Governor. We are happy with you, State 
legislator or State senator, for enacting this mandate and they reelect 
them to office, that's all well and good. But here we're talking about 
the 50 States and various territories, a mandate applied across the 
board. This has never been done in this country before because there's 
a document called the Constitution that says we shouldn't be doing 
this.
  Mr. SHADEGG. Wait, the gentleman's telling me that never before in 
Federal law have we ordered people to buy a particular product, that we 
don't do that in Federal law as a routine matter?
  Mr. BURGESS. Just as a coincident fact for being born and living in 
the United States, no.
  Mr. SHADEGG. No, we don't force people to do that. I guess we do say 
that if you want to drive in some places, you have to buy auto 
insurance to insure against damage to somebody else. Right?
  Mr. BURGESS. Correct. And still, that is a State mandate.
  Mr. SHADEGG. That's not a Federal mandate?
  Mr. BURGESS. Correct. And there are some States who don't have the 
mandate.
  Mr. SHADEGG. So this would be the first Federal mandate saying you 
must

[[Page 3572]]

buy a product because the Federal Government tells you you must buy a 
product?
  Mr. BURGESS. That's my understanding. It is such a good idea, as you 
correctly pointed out in your very graphic demonstration. The strong 
arm of enforcement here is the already existing Federal agency that 
collects our income taxes every year.
  Mr. SHADEGG. You are referring to the sign I have next to me.
  Mr. BURGESS. Yes.
  Mr. SHADEGG. That's the IRS. The IRS is going to force you and me to 
buy health insurance from an approved health insurance company, 
federally approved health insurance. Maybe you can answer the question 
that is posited on this graphic: Why does the Democrats' bill subsidize 
health insurance companies? I don't quite get that. Why is it that 
Democrats are so adamant that we subsidize America's health insurance 
companies, those companies that are already ripping us off, 
overcharging us, undercompensating, don't pay our claims when we submit 
them, make the doctors turn in 46 copies of every form, then kick it 
back, then kick it back again? Can you tell me why the Democrats want 
to subsidize America's health insurance plans by ordering every 
American to buy one of those plans? Because I don't get it.
  Mr. BURGESS. If the gentleman will recall in May and June of this 
year, six groups met down at the White House. It was a great photo-op. 
My AMA was there. The Hospital Association was there; PhRMA showed up; 
AdvaMed, the people who make medical devices; AHIP, America's Health 
Insurance Plans; and the Service Employees International Union all 
gathered at the White House. The President came out after this meeting 
and said that these groups have offered up $2 trillion in savings to 
the American people in order to get this health care bill done. So I 
don't know. I wasn't there. I can't get information on these meetings.
  Mr. SHADEGG. Wait, wait, wait. Are you telling me this is a deal? 
You're telling me these health insurance companies went into the White 
House and struck a deal, and the deal says, If you'll pass a bill 
forcing everyone in America to buy our product, we, the health 
insurance industry, will support your bill. That's a pretty good deal. 
Can I take, like, maybe some other company, a lumber company or an auto 
company, into the White House and say, Hey, if you'll strike a deal, 
we'll support some bill you want. You just have to force every American 
to buy our product. Right? Because, what the heck, let's strike a deal.
  It seems to me the health insurance companies must have very good 
lobbyists closed tight, very closely to the Democrat Party. Because if 
I remember correctly, the health insurance industry wanted two things. 
They wanted a mandate. They wanted you and me to be forced to buy 
government-approved health insurance from these health insurance 
companies and to have the IRS enforce it. They wanted it. They got it. 
They did not want a so-called public plan to compete with those health 
insurance companies. The health plans said, No, no, no. Competition, 
no, no, no. We health insurance plans don't want to have to compete. So 
we don't want to compete with a public plan. We don't want to have to 
compete across State lines. We don't want to have to compete for the 
business of individuals. We don't like that thing about competition.
  As I understand it, those health insurance plans get out of this bill 
a mandate that you and I have to buy their plan, and there is no public 
plan to compete with them. That's good lobbying, I guess. If the 
Democrats will carry your water and say, We're going to enact a law 
that says that every American must buy health insurance from these 
health insurance plans and, oh, by the way, those health insurance 
plans don't have to face any competition.
  They don't have to compete with a public plan. They don't have to 
compete across State lines. They don't have to even compete for your 
business and my business because right now, the Tax Code says that if 
we get it from our employer, it's tax free; but if you and I want to go 
out and buy it alone, if we made poor United or poor Aetna have to 
compete with each other for Dr. Burgess' business or for John Shadegg's 
business, oh, they wouldn't like that. That might drive down costs. 
That might drive their profits down. That might drive down profits or 
the salary of their executives.
  Well, they didn't want that. And in the Democrats' bill, you know 
what, they don't have to. There's no competition across State lines. 
There's no competition under the Tax Code letting you and I buy health 
insurance on the same tax-free basis that our bosses can buy at the 
companies. Boy, I'll tell you, those health insurance plans got good 
lobbyists in the White House. And that was a meeting, that was a deal 
that was struck down at the White House?
  Mr. BURGESS. Well, we don't know because the White House refuses to 
provide us with any information, even though they've been asked nicely. 
They were asked more forcefully with the resolution of inquiry in our 
committee. Chairman Waxman and Ranking Member Barton did send a 
correspondence down to the White House asking for that information to 
be supplied to our committee. To date, what we've gotten back is a 
series of press releases and reprints of pages off of Web sites, but no 
real information.
  It would be fascinating to know if it's part of that $2 trillion 
deal: okay, you're going to get a mandate. Maybe we'll leave out the 
public option. But, oh, by the way, we're going to trash you every day 
during this process, so get ready for the next year and a half. We will 
vilify your industry six ways to Sunday because they certainly have 
done a good job of doing that.
  The gentleman points out an excellent point: if an individual is able 
to buy a policy with the same breaks that a company gets, and that 
individual is able to keep that insurance over time, a longitudinal 
relationship with a health insurance company, what a novel concept. 
I've had the same car insurance since I was 18 years old. I can't tell 
you how many different health plans I've had because when I was in 
business for myself, I was always trying to find a better deal because 
that was one of the number one line-item expenses on my budget every 
year, providing insurance for my employees. So you were always looking 
to see if there wasn't a better deal somewhere.
  And as a consequence, I frequently changed health insurances until I 
discovered what was then the medical savings account and now is the 
health savings account.
  So kind of through the back door, I have now developed a longitudinal 
relationship with an insurance company. They send me emails, and they 
ask me to do certain things to keep myself healthy, and it works well 
between us. Why we didn't embrace that sort of model going into this, I 
just, frankly, don't understand.
  Mr. SHADEGG. The gentleman raises one of the things that makes me so 
upset in this debate. And quite frankly, as you've pointed out, I've 
worked on health care reform since 1995. It seems to me morally 
indefensible, morally indefensible to say to the American people, If 
you work for a big, big, big employer--like you and I do, the Federal 
Government--or like we'll say, General Motors or Intel or Motorola or 
AT&T or any of those big employers, you work for a big employer, you're 
a lucky guy or a lucky gal because your health insurance is tax free. 
Your employer buys the health insurance and writes off the cost of 
buying that health insurance. Your employer then gives that health 
insurance coverage to you, and it's not income to you. So the tax on--
we'll say a $5,000 insurance policy--zero, zip, zero, nothing because 
you were lucky enough to go to work for a big employer.

                              {time}  2000

  But the law in America--and I think this is what is morally 
indefensible. And the law in America, even after this bill passes, says 
to the little guy, to the least among us, to those who are just barely 
getting by, to that person who works for, we'll say, a small garage or 
maybe, in my State of Arizona, a small lawn service company----

[[Page 3573]]


  Mr. BURGESS. Or a doctor's office.
  Mr. SHADEGG. Or maybe even a small doctor's office. If their employer 
doesn't give them employer-paid health care coverage, here's what we do 
the little guy. Here's what we do to the least among us. We say, Oh, 
you really ought to be insured, but we're going to smack you down. 
We're going to make you pay income tax first before you buy that health 
insurance; that is to say, we're going to punish you if you decide to 
spend your money on health insurance.
  So the $5,000 health insurance policy that this guy over here got 
from his employer that cost him zero in taxes, maybe it cost him or his 
employer $5,000, that plan for the little guy who doesn't work from an 
employer that provides health care coverage, that plan costs $5,000, 
we'll say, plus another third, or another, close to a third, we'll say 
another 15 or $1,800. That plan costs the little guy $6,800, because he 
has to go out and earn the $5,000, then he has to go out and earn 
$1,800 in income taxes on top of that and spend the total $6,800--
$5,000 on insurance, $1,800 on income tax--to get the same policy that 
the guy that worked for the big employer got for free.
  How can we morally justify that in this Nation? How can we say that 
it is right to treat those people lucky enough to work for the Federal 
Government or a big employer, Intel, Motorola, you name it, UPS, you 
get essentially free health care paid for by your employer and not 
taxed to your employer or you, but this little guy who works, or woman 
who works for a small day care company or who works for a small sewing 
shop, she gets no health care for free, and she has to pay income tax 
on her income before she even gets to go buy a health insurance policy? 
How can that be justified, and why isn't that fixed in this bill?
  Mr. BURGESS. Great point. And another point that is so often missed 
in this discussion, let's take the example of the National Football 
League. You've got the Arizona Cardinals; I've got the Dallas Cowboys. 
A player who is lucky enough to be traded from Arizona to Dallas--I'm 
thinking it's an upgrade--their health insurance goes with them. If 
they had a knee injury in Arizona, they're covered for that knee injury 
day one in Dallas on the new team.
  But if the fan who wants to follow their favorite player moves from 
Arizona to Dallas, they cannot take that insurance policy with them, 
necessarily, across State lines. And, oh, by the way, that new policy 
you're buying in Texas, that knee injury may be excluded because, after 
all, it was a preexisting condition. We will not apply the same degree 
of portability for the little guy that we do for the person who's 
covered under the large multi-State plans, the ERISA plans that the 
multi-State corporations can provide for their employees.
  Make no mistake. I think that is wonderful that the large employers 
do that, and I don't think there is anyone among us who would want to 
see that system changed. But you are correct. We should provide the 
same breaks across the board.
  Mr. SHADEGG. Going back to my board here, why don't Democrats want to 
force United to have to compete with Aetna for the business of that 
little guy so that he or she can buy health insurance, tax-free, like 
Intel can or Motorola can or the Federal Government can?
  Why is it that America's politicians, about to pass this bill perhaps 
as early as this weekend, don't want to force those health insurance 
companies to compete? What's wrong with competition?
  You mentioned auto insurance. I turn on the TV at night and I see TV 
commercials for every single auto insurance company I can imagine. I 
see one for GEICO. They've got their little gecko. I see Progressive. I 
see Allstate. I see State Farm. I see Farmers. I see all these 
insurance companies. They're all pounding me with their ads, and every 
ad says, Come buy your auto insurance from our company, and we will 
charge you less and give you better service.
  And yet, there's not a single ad like that I've ever seen on TV where 
Aetna or United or any of those health insurance companies who, by the 
way, don't want competition from a public plan but do want an 
individual mandate compelling us to buy their product, I never see them 
advertise to me and say, Hey, John, come buy our health insurance 
policy, and we'll charge you less and give you better service. Could 
that be because they don't have to compete for our business? Because 
under the Tax Code that we're not fixing in this bill, you and I can't 
afford to buy health insurance directly from them, so they don't have 
to compete. They're protected from competition. They just want an 
individual mandate. Since they don't have to compete with each other, 
they complain that not enough people buy their policies. I think it's 
because their policies are too expensive. Since they don't have to 
compete, now they need a mandate to force us to buy their policies.
  Why don't they have to compete like the auto insurance companies do?
  Mr. BURGESS. Well, of course, the life insurance business, the 
premiums for life insurance plummeted with the introduction of the 
Internet with these companies that would advertise and then sell their 
policies on the Internet.
  Mr. SHADEGG. So competition brought down the cost of that kind of 
insurance.
  Mr. BURGESS. Yes. And the power of the Internet could apply to health 
insurance as well. But, as you know, there is some difficulty selling 
in the individual market across State lines, and therein is where the 
regulatory part of what we--the regulatory environment that we set here 
in Congress that we're not fixing in this bill, as you point out.
  Mr. SHADEGG. Not fixing in this bill?
  Mr. BURGESS. Not, not fixing in this bill, that that will continue to 
exist.
  There are sites you can go to. You can go to Google and type in 
``health savings account'' and get a variety of plans that will come 
up. And I encourage people who are looking for individual insurance, 
that is a reasonable thing to do. Yes, you have to pay with after-tax 
dollars. Some of those policies can be quite affordable if you're 
willing to accept the fact that it will be a high deductible type of 
policy.
  But, realistically, when you look at health care expenses--and I'm a 
physician. I've watched people spend their money in health care for 
years. Some expenses are so small that they're actually financed out of 
cash flow: aspirin and Band-Aids. Some expenses are predictable but 
larger: braces, having a baby, maybe arthroscopy on that knee injury. 
Those could be saved for or borrowed for if we allowed the correct 
flexibility within the health savings account, for example. And then 
there are the ``Boy, I hope that never happens to me'' events: the 
leukemia, the heart attack. Those are the ones where this catastrophic 
insurance really is a godsend when people have that.
  But, again, we did nothing. We had--we both sit in the committee that 
deals with this. Did we have a hearing on how to provide more 
flexibility, more competition with the insurance market? No. It was, if 
you want everyone covered, it is an individual mandate. That really was 
the only offering. We never had a hearing to ask the question: Is there 
a way to cover people with preexisting conditions without an individual 
mandate? We never asked that question, so it's not surprising that we 
don't know the answer to that.
  Mr. SHADEGG. You know, it stuns me that you just said that, under 
current law in America, if you work for an employer who gives you 
health care through your employment, it's tax free. There's no income 
tax paid on it by your employer, no tax paid on it by you when you 
receive it. But you can go on the Internet and you can buy health 
insurance on your own, but you've got to buy it with after-tax dollars, 
making it a third more expensive. Isn't it shocking?
  Then, or more accurately, not to be cynical about it, isn't it pretty 
logical then that the health insurance companies don't compete? They 
don't care about our individual business because they know you and I 
can't afford to buy with after-tax dollars what we can get from our 
employer for free.

[[Page 3574]]

  Tell me, I guess I just do not understand why we wouldn't want to fix 
the Tax Code so that every single American could buy their health 
insurance tax-free just like their employer, so they could hire it and 
fire it and hold it accountable.
  The gentleman mentioned preexisting conditions and the Commerce 
Committee. I think the gentleman knows full well that, in 2006, we 
passed legislation through that Commerce Committee which dealt with the 
problem of preexisting conditions. We, as Republicans, in 2006, said, 
You know what? No one in America should go uninsured or go without care 
because they don't--because they have a preexisting condition. So we 
passed legislation encouraging all 50 States to create a State high-
risk pool. Under a State high-risk pool, the State would be required to 
accept and insure anyone that had a preexisting condition.
  I happen to have an older sister who is a breast cancer survivor. 
She's now lived 20 years beyond her breast cancer. She has a 
preexisting condition. If Arizona had taken advantage of that 
legislation, the State would have created a high-risk pool and she 
could have, if she was denied coverage, or if she was told her premium 
would cost too much, she could have applied to the State high-risk 
pool. She would have been entitled to be admitted to the State high-
risk pool. She could not have been charged more than 110 percent or 120 
percent of the cost of health insurance for a healthy person. But all 
of her care would have been paid for, and the extra cost of her care, 
as a member of that State high-risk pool, would have been shared; that 
is, would have been spread, the extra cost would have been spread 
amongst every single person in the State of Arizona who purchased 
health insurance, or would have been spread over the State tax base and 
subsidized by State revenues.
  That legislation passed the Commerce Committee, passed the floor of 
this House by voice vote, passed the United States Senate by unanimous 
consent, and was signed into law, and is the law today. It didn't force 
the States to create high-risk pools, but 33 States have.
  Now, we can improve upon that. I'd like to make them mandatory. But 
we've already dealt, or we can deal with preexisting conditions without 
a mandate, an individual mandate compelling people to buy health 
insurance from the same health insurance companies that are already 
doing a lousy job of offering us health insurance. And yet, when the 
President of the United States--this is very important. When the 
President of the United States held his health care summit--and I note 
you didn't get to go and I didn't get to go. But at the health care 
summit, the President misdescribed, and so did Secretary Sebelius, a 
high-risk pool. Both of them said, if you put all the sick people in 
and give them no help, of course their premiums are going to go up. But 
no State high-risk pool in America puts the sick people in and says to 
them, Now pay your own premiums.
  What high-risk pools do is they put in the sick people; they 
guarantee them coverage; they cover their preexisting conditions, and 
then they spread the extra cost amongst all the taxpayers or all the 
people who buy health insurance in that State. And the reason people 
are willing to do that is because, but for the grace of God, you and I 
don't know that tomorrow we won't need to be in that high-risk pool. 
And I know you've dealt with high-risk pools.
  Mr. BURGESS. That's correct. Thirty-four States do have the high-risk 
pools. Nathan Deal, the ranking member on our Health Subcommittee, and 
I tried to put some further refinements out there this year during the 
health care debate.
  I don't like mandates. I know we had that discussion in committee 
today. I don't like mandates. So what if we allowed States either a 
high-risk pool or an option for reinsurance, provided some Federal 
subsidy to the State. They don't have to take it, but if they do take 
it, then whatever they decide they want to do, they need to then set up 
that high-risk pool or that reinsurance for that set of business that 
is otherwise likely to go without insurance coverage. Because we all 
know, folks our age, employer-sponsored insurance, we're in a 
recession. You lose your job, you have the heart attack, you didn't 
keep up with the COBRA payments, boom, you're in that category and now 
there's nothing you can do to extract yourself.
  And the only option we were given was an individual mandate, or let 
the government take everything under their control.
  Mr. SHADEGG. Federal legislation already passed in 2006 offered all 
50 States some Federal money to help set up the State high-risk pool to 
care for those people with preexisting conditions and offered Federal 
money to subsidize or to underwrite the cost of those high-risk pools.
  The reality is, every Republican plan, every Democrat plan deals with 
preexisting conditions because it's something that we, as a society, 
have already decided that we should do. Every single one of us knows 
that any moment we could be struck with a heart condition or diabetes 
or, like my oldest sister, breast cancer. We might be in the position 
and we oppose the, even, concept of someone being denied care because 
of a preexisting condition.
  But I don't think the answer is a mandate. You said you don't like 
mandates. Okay. Some people may like mandates. I guess the issue is do 
they work. And of course the answer is, in Massachusetts, they worked 
to provide coverage, but the cost of care goes up.
  Mr. BURGESS. Well, they may not be constitutional at our level. And 
the other thing to remember about a mandate, for a mandate to work, you 
have to know that it's in existence, and you have to know what the 
penalty is, and the penalty has to be pretty stiff.
  You alluded to the IRS already. The IRS has a mandate on every one of 
us that we'll pay Federal income taxes. Every single one of us knows, 
we may not know exactly what bad thing happens, but we know it's bad, 
and most of us know we don't want it to happen to us.
  So what is the compliance rate with the IRS in filing tax returns? 
Well, it's about 85 percent. What do we have as uninsured in this 
country right now? About 15 percent. How much more are we going to get 
coverage if we give up that much freedom by allowing us, us, Congress, 
to set a mandate as a condition for living in the United States of 
America? How much more coverage are we going to get?
  I mean, the point is arguable, but just at first glance, it might not 
be that much.

                              {time}  2015

  Now, on the issue of the preexisting conditions bill, I know when 
Nathan Deal and I looked into this and the Congressional Budget Office 
scored and said what would it require in the additional Federal subsidy 
to make these things really work for people, the Congressional Budget 
Office came back with a score of $20 billion over 10 years. Real money 
to be sure, but at the same time it is nowhere near the $1 or $2 
trillion that is on the table today if the House takes up and passes 
this Senate bill that they passed on Christmas Eve.
  I do have to make one point about the public option. The Senate bill 
does not have a public option per se, but there is language in the 
Senate bill that allows the Office of Personnel Management to oversee 
the exchanges and guarantee that there is one for-profit and one not-
for-profit insurance company available in every exchange. If an 
exchange does not have an insurance product available, OPM will set up 
either a for-profit or a not-for-profit in that exchange.
  Well, suddenly you are going down the road of a public option because 
what is the Office of Personnel Management? Well, it is a Federal 
agency. It is not used to doing that much work, because they oversee 
what goes on in the Federal Employee Health Benefit Plan, but now they 
are going to be tasked with this vast new set of powers, and it's 
anyone's guess how that will actually work out.
  Mr. SHADEGG. The gentleman started by commenting about the shutting 
down of the switchboards and whether

[[Page 3575]]

or not individual citizens could get through to their Member of 
Congress today and express their feelings, and I would suggest right 
now maybe their intensely felt feelings in opposition to or in support 
of this bill. It seems to me that the American people, who are 
frustrated by that process, maybe ought to think about what 
organizations or groups they are a member of that might be able to get 
through.
  I am a little concerned that individual Members of this body maybe 
aren't taking phone calls right now, maybe aren't reading the faxes or 
the emails they are getting right now. But everybody who sits on this 
floor listens to the big organizations in their district. They listen 
to the Chamber of Commerce in their district. They listen to the farm 
bureau in their district. They listen to the cattle growers in their 
district. They might listen to the homebuilders, who by the way under 
the Senate bill are singled out for particularly mean or unfair 
treatment, high taxes, in this bill. They might listen to the 
contractors association.
  It seems to me that anybody who wants to make their voice heard and 
is a member of any kind of a professional association or a political 
association that has contact with Members of Congress, if you can't get 
through to your Member of Congress, maybe you ought to call the local 
Chamber of Commerce and say, hey, I read where Congressman Smith or 
Congresswoman Jones is going to vote ``yes'' or ``no''. That is not 
what I want. You supported that, Congressman. Why don't you call him or 
call her and say, hey, I want a ``yes'' vote or I want a ``no'' vote. 
Because I will bet those Members of Congress will take calls from, for 
example, the local Chamber of Commerce or the local farm bureau or the 
local cattle growers association or some other organization in their 
congressional district that has spoken to them in the past, maybe 
supported them in the past. It seems to me that now is the time that 
you can use those organizations to reach out and talk about some of the 
issues in this bill.
  You and I haven't talked so far tonight about some of the procedures. 
We haven't talked about the Slaughter solution, under which it appears 
the majority is going to push this bill through and try to say that 
they are really not voting for the Senate bill, or, for that matter, 
some of the special deals in the Senate bill. I find it interesting, 
yesterday apparently Speaker Pelosi said, quote, ``Nobody wants to vote 
for the Senate bill.'' She actually held a meeting with the press and 
said, quote, ``Nobody wants to vote for the Senate bill.'' I guess that 
is why they have come up with the Slaughter solution.
  Let me ask you this question. Doesn't the Constitution say that for 
the Senate bill to pass the House, Members of the House have to 
actually vote for it or vote on it? Don't they have to pass that bill?
  Mr. BURGESS. Certainly that is my understanding. And we both have to 
pass the same bill.
  Mr. SHADEGG. The exact same bill.
  Mr. BURGESS. The exact same bill. We learned that in December of 
2005. The Deficit Reduction Act had one word different between the 
House and Senate bills, and the whole thing was held up.
  Mr. SHADEGG. Because of one word difference? One word difference. The 
Senate has already passed the Senate bill, the House has to pass that 
exact bill word for word. It can't have one word missing?
  Mr. BURGESS. Actually, that is a House bill that the Senate passed. 
So we would simply have to concur with the Senate amendment, and that 
would be the identical bill. But in this case the Slaughter rule would 
say we don't even have to bring that bill to the floor, we just deem 
it--Deem me up, Scotty--we just deem it as passed and then go on to the 
reconciliation process to try to fix some of the problems with the 
bill. No guarantee that they will be fixed.
  Mr. SHADEGG. I kind of think the American people are fairly bright. I 
think they see through this. If you are deeming a bill passed in a 
rule, aren't you actually passing that bill and aren't you voting for 
that bill? And isn't this just a trick or a scheme to get around the 
requirement that Members actually vote for the Senate bill? I guess Ms. 
Pelosi says, this is a quote, it is right here, ``Nobody wants to vote 
for the Senate bill.'' But when they vote for a rule that says it's 
deemed passed, aren't they voting for the Senate bill?
  Mr. BURGESS. There is no question that they are. You are right, the 
American people can see through that. It's an elaborate charade. It 
will provide no protection.
  Mr. SHADEGG. An elaborate charade. Trickery. If the American people 
think we are engaged in trickery, why not engage in trickery.
  Mr. BURGESS. But, and I am sure the gentleman feels the same way, I 
would not want to stand in front of the 2,000 people on a hot August 
morning in a town hall in Denton, Texas, and say, you know what, I 
never voted for that bill. I voted for the rule that deemed the bill.
  Mr. SHADEGG. There we go. So the reason you wouldn't want to stand on 
the floor and vote for that Senate bill is not just because of the 
policy in it, it is because that bill will contain the Cornhusker 
Kickback, right?
  Mr. BURGESS. Correct.
  Mr. SHADEGG. It will contain the Louisiana Purchase.
  Mr. BURGESS. And Gator Aid.
  Mr. SHADEGG. Right. It will contain Gator Aid. It apparently contains 
$100 million for a local hospital in Connecticut that Chris Dodd got 
in. It contains $1.1 billion for Medicaid in Vermont and Massachusetts. 
I guess not Arizona or Texas. Our States didn't get that deal, right? 
No, just those States got the deals because Dodd or Sanders and Kerry 
got them in, right? It contains, I like this one, $1 billion that 
Senator Bob Menendez got in for New Jersey drug companies. Pretty good 
deal. I am not sure I would want to vote for that. My constituents 
might say, well, Congressman, why didn't you get a billion dollars for 
some companies in Arizona?
  It contains $1 billion for Menendez. We are talking serious money 
when you go to John Kerry and Debbie Stabenow. They got in $5 billion 
for union health care plans in Massachusetts and Michigan. You already 
talked about the provision, the Florida Gator Aid, I guess, Medicare 
Advantage. I will tell you this is one that my constituents find 
offensive. Arizona has lots of people on Medicare Advantage. Apparently 
Senator Bill Nelson of Florida got in a provision saying Medicare 
Advantage won't be cut in Florida. I don't know how I go home and 
explain to my Arizona colleagues that it will be cut in Arizona. But I 
really don't know, since I am going to vote against this bill, how my 
Arizona colleagues go home--by the way, the press reported that the 
President wanted some of these special deals taken out. But AP reported 
over the weekend that these Senators don't want those special deals 
taken out.
  I think I agree with Nancy Pelosi. She said nobody wants to vote for 
the Senate bill because of all this junk, all of these secret special 
deals. So somehow they are going to not vote for it but they are still 
going to pass it? How do you do that under the Constitution? Maybe our 
colleague from Texas can tell us how you can pass something without 
voting on it.
  I guess Newt said it today, there was a point in time when Members of 
Congress didn't read the bills that they passed. Now they are not going 
to vote on the bills that they pass. So what do we need to be here for?
  Mr. BURGESS. I would just go back, too, to that instance with the 
Deficit Reduction Act, where a small difference in the House- and 
Senate-passed bills led to a court challenge, and we came back in 
January. We left on December 21st or whatever day it was when we passed 
that bill out of the House, it went over to the Senate, there was a 
problem, they couldn't fix it under unanimous consent because of an 
objection, and we had to repass the bill in January.
  The reason I know this is because there was one of those doc fixes in 
that bill. And the doc fix did not go into effect December 31 and every 
doctor who

[[Page 3576]]

saw Medicare patients across the country took a 6 percent ding in their 
Medicare reimbursement rates because we had not passed the bill by 
January 1.
  Now, Dr. McClellan, Mark McClellan, to his credit, who at the time 
was Director of the Center for Medicare and Medicaid Services, came 
back and said, you don't have to refile those claims, we will take care 
of them if Congress passes the bill within a month or two of coming 
back, which we did. So they went back and reimbursed. But a terribly, 
terribly complicated process. All of it was brought up because one or 
two words different in the bills, because the Constitution says we 
shall pass the same bill and then it goes down to the President for 
signature.
  Mr. SHADEGG. I am trying to understand this. So if the Medicare 
Advantage participants in Arizona who are having their Medicare 
Advantage cut, and the Medicare Advantage participants in Florida who 
are not, under the Gator Aid that Senator Bill Nelson cut, that special 
deal, having their Medicare Advantage cut, if the House only deems the 
bill passed, can they sue and can they win? Or will the courts say, 
well, no, no, no, your Congressman may have said he didn't vote for the 
bill, he just deemed it passed, but trust me, we, the courts say he did 
vote for the bill. And so Arizona taxpayers on Medicare Advantage lose 
out, Florida taxpayers because of Bill Nelson and the special deal he 
cut currently in the Senate bill, which you say can't have a word 
changed when it comes here, they win out. Pretty good deal.
  By the way, I look at some of these other deals, there is special 
funding for coal miners in Montana. There is just provision after 
provision. In North Dakota there are special provisions providing 
higher Medicare payments there. There are special provisions for Hawaii 
that apparently the two Hawaii Senators got in. There are special 
provisions for longshoremen in Oregon. You know, this thing looks to me 
like it is chockablock full of special deals for special Members, 
special Senators who say, well, you know, I want a special deal or I 
won't vote for it. No wonder Ms. Pelosi says, and I quote, ``Nobody 
wants to vote for the Senate bill.'' But doesn't the Constitution say 
they either got to vote for it or it don't pass?
  Mr. BURGESS. So we have two problems. The Constitution says we have 
to vote on the bill. We say the mandates may be extraconstitutional in 
their scope. And then the whole question of equal protection under the 
law. We have a constitutional scholar with us, so we turn to the 
gentleman from Texas, the judge from east Texas, for perhaps his 
rendition of this complicated process that faces us.
  Mr. GOHMERT. Well, clearly the majority leadership thinks that the 
American people are so stupid that if you have a rule that says, you 
know what, if you vote for the rule, then the bill automatically is 
deemed passed. I just don't know anybody in the American public that 
can't figure out when you voted for the rule, I don't care what you 
say, you voted to pass the bill.
  As far as it passing constitutional muster, who knows anymore with 
this Court. But I do know, as the gentlemen, both of you have been 
talking about the deals and Medicare Advantage, and I have got the 
Senate bill here, this lovely thing, and the truth is the only people 
that ought to pass this bill are people that eat it. A little digestive 
humor there. If you eat it, then yes, you should pass it. But otherwise 
this bill should not be passed.
  But if you look at page 904 of part one of two parts of the Senate 
health care bill, and you wonder, gee, I wonder why AARP came out a 
couple weeks ago and said, oh, yes, we like the proposal, we are all on 
board. Well, you look at the Senate bill, it says that nothing in this 
section shall be construed as requiring the Secretary to accept every 
bid submitted by a Medicare Advantage organization. And so also the 
Secretary may deny a bid submitted by a Medicare Advantage organization 
for a Medicare Advantage plan if it proposes significant increases. But 
the bottom line here is the Secretary doesn't have to accept a bid.
  And what is the consequence of saying we are not going to allow any 
more Medicare Advantage bids, we are just going to cut that out? Do you 
know what retirement organization is in the business of selling a kind 
of supplemental insurance?
  Mr. SHADEGG. Wait. Wait. Let me guess. Could it be AARP?
  Mr. GOHMERT. Well, it seems like maybe they do sell some supplemental 
medical insurance. So by golly----
  Mr. SHADEGG. Maybe they got a better deal out of this.
  Mr. GOHMERT. Maybe 904 is one of several reasons AARP said, you know 
what, this could be all right. We could get millions and millions of 
dollars in new insurance sales.

                              {time}  2030

  But did you see that the pharmaceutical industry says they like this 
bill, they are okay? And I read a headline today that the 
pharmaceutical industry was going to spend millions trying to get 
people to vote for it.
  Mr. SHADEGG. So AARP likes it and PhRMA, which are big drug 
companies, like it. All of the big insurance companies like it because 
you're mandated to buy their product. And there is no public option 
competing with them, and they don't have to compete across State lines. 
Looks to me like all of the big guys really like this bill. They like 
the fact that they are getting lots out of it. What does Joe Six-Pack 
get?
  Let me make a point. I put up a quote here from Speaker Pelosi. She 
said it on March 9. ``But we have to pass the bill so that you can find 
out what is in it, away from the fog of the controversy.'' Wow. Pretty 
stunning quote. Maybe those are things she doesn't want you to find out 
until after we pass it.
  I know the gentleman has a point to make. I just want to point out. 
Talking about deals in the bill and special deals for health insurance 
companies. According to The Boston Globe of December 22, 2009, the 
Senate bill waives from any annual fee on health insurance companies 
certain additional fees, and this provision exempts two insurance 
companies, Blue Shield-Blue Cross of Nebraska and Blue Cross-Blue 
Shield of Michigan. That might be one more of those special deals put 
in there by a couple of powerful Senators, Ben Nelson of Nebraska and 
Debbie Stabenow of Michigan, cut a little deal for a couple of Blue 
Cross-Blue Shield Nebraska and Michigan companies--maybe that is what 
Mrs. Pelosi meant when she said, But we have to pass the bill so that 
you can find out what is in it.
  Mr. GOHMERT. I appreciate the gentleman yielding.
  If you look at page 1,957, along the same lines of what kind of deals 
that are in this bill, this has to do with health savings accounts. We 
know that there are millions and millions of dollars in health savings 
accounts that only can be used for health care. Well, I know I have an 
HSA, and if I can get an over-the-counter drug, a generic drug, that is 
what I buy.
  Well, good deal for the pharmaceutical industry here beginning at 
page 1,957, because it says that such terms shall include an amount 
paid for medicine or drug only if such medicine or drug is a prescribed 
drug.
  So you may want--like in my case, I have hay fever. I've had since it 
since I was a little kid. I go and get a generic for like $2.50. And 
now if I want to spend my HSA on it, I can't go spend $2.50. I've got 
to go pay megabucks to the pharmaceutical companies in order to get a 
prescription drug.
  Wow, maybe that is part of the deal that made them think, You know 
what? You know Joe Six-Pack, as my friend from Arizona says, may not 
get anything out of it, but by golly, we're going to make a lot of 
money on this bill. Let's throw our support behind it, and the 
President will love us for it, too.
  Mr. BURGESS. One interesting point. You have these groups that went 
down to the White House in May and June--and I'm not going to criticize 
them for going down and advocating on behalf of their industries, on 
behalf of their groups. But what is so onerous about this is the 
President has proclaimed this Sunshine Week. Transparency is going to 
be the watchword

[[Page 3577]]

of his administration. Remember? We heard it over and over again. 
Everything will be up on C-SPAN, everybody will be able to see it--
except for these deals that were struck down in the White House in May 
and June. And now they come back and say, Well, there really wasn't 
anything written down. Two trillion dollars in savings and you didn't 
write a word of it down?
  Now, in Texas, as the gentleman knows, we trust each other. A 
handshake is as good as a signature a lot of times. But when it's $2 
trillion, you're probably going to need a little more than a handshake 
even in Texas, because are people going to perform as they said they 
were going to perform?
  When Senator McCain wanted to push an amendment that dealt with 
reimportation in the markup of the Senate bill, in the debate of the 
Senate bill at Christmastime--I don't agree with reimportation. I think 
it's unsafe. I think it's unwise. But Senator McCain was prevented from 
offering that amendment because, to quote somebody at the time, That 
wasn't part of the deal that we had.
  Well, wait a minute. If there is a deal that someone knows about, is 
it written down somewhere? Could we please see what else is in that 
deal? We're the legislative body. If there are deals struck at the 
White House--and it is Sunshine Week--if there are deals struck at the 
White House, let us see what those deals are.
  I'm not criticizing the groups that went down there and advocated on 
behalf of those groups. That is fine. They should have done that. But 
we, as the legislative body, should have been privy to any of that 
information as we tried to craft the legislation that would have to 
either enact or confirm or deal with those deals.
  Mr. SHADEGG. Well, it seems to me that while we do not know what the 
quid pro quo was for any given deal, we know a couple of things: We 
know the insurance companies went in first and foremost and said, We 
want an individual mandate. We want the government to compel every 
American to buy federally approved, Federal Government approved health 
insurance, and we want the IRS to enforce that mandate. You must buy 
Federal Government approved health insurance. That is what the 
insurance companies wanted going into the deal. Funny, that is what 
they got. They got an agreement that there would be an individual 
mandate.
  So if this becomes law, every single American will be required to buy 
a government-approved health insurance plan. And if they don't, the IRS 
will tax them. Huh.
  We also know, although the gentleman points out, there is no 
individual mandate in the Senate bill--there are some things that are 
pretty close to it--the insurance companies didn't want competition. 
They certainly didn't want across-the-State-line competition, they 
didn't want the State tax code to say you and I could buy it tax-free 
so they would have to compete with each other like the auto insurance 
companies. It sounds to me like we can kind of decipher some of the 
outlines of the deal that occurred.
  Mr. BURGESS. And I can be as critical of the insurance companies as 
anyone else, but they take the path of least resistance. Their capital 
is not necessarily any more courageous than anyone else's. The easiest 
way to get to what they want is an individual mandate.
  But I suspect if we set up pretaxed expenses, buying across State 
lines, if we develop that market for them, I'll bet they'd find a way 
to compete, I'd bet they'd find a way to work in that market and win in 
that market.
  Mr. SHADEGG. I think the gentleman makes an excellent point.
  The truth is America's health insurance companies are playing under 
the rules we set, and the rules we set say they really don't have to 
compete for my individual business, for John Shadegg as an individual 
customer, or yours, or our colleague from Texas because the Tax Code 
says we cannot buy health insurance like our employers can. We can't 
buy it tax-free, but our employers can.
  I think the gentleman is absolutely correct. I think the reason that 
the auto insurance industry competes every day, day-in and day-out, 
pounding us on TV saying, you buy our plan from GEICO or Progressive or 
Allstate or Farmers, we will give you better service for a lower cost; 
and the health insurance companies don't compete day-in and day-out 
saying, you buy our health insurance plan from United or from Aetna or 
from Blue Cross-Blue Shield, and we will give you a better price at a 
lower cost.
  The reason they don't compete like that is because the government 
sets the rules. And the rules say that they sell pretty much 
exclusively to big companies, and we say to the poor working stiff who 
can't get employer-based health care, too bad, pal. You kind of don't 
count in the system. The insurance companies don't really want their 
business, they don't market to you, and if you buy their product, you 
have to buy it with after-tax dollars. Tragically not fixed in this 
bill.
  Mr. BURGESS. Let me point out just one thing.
  We hear over and over again Republicans have no solutions for health 
care. HealthCaucus.org is a Web site that deals only with health care 
policy. On that Web site, Dr. Burgess's prescription for health care 
reform, the seven or nine things that I heard consistently in my town 
halls this summer are up there. People can download that and look at 
that themselves.
  Suffice it to say that we really have been frozen out of this process 
from the beginning. They were not interested in our input last year 
because they had a supermajority in the House of Representatives. You 
can't pass a bill with 40 extra votes? What's the matter with you?
  Well, now, the entire argument, the entire argument is within the 
Democratic Caucus. They don't have the votes on their side because it 
is a badly flawed product and a badly flawed process that they are 
trying to push through on the American people.
  People do need to understand this bill has nothing to do with health 
care any longer. This bill has, as has been pointed out tonight, if we 
wanted to fix these things, we would have fixed them. This bill is 
about higher political power for the party in charge, and they want to 
obligate the American citizenry to re-up their contract every 2 years 
in order to not lose the benefits that they are ostensibly going to get 
with the bill.
  The bill is a bad deal, Mr. Speaker. I would submit that the American 
people need to continue to weigh in on this. All is not lost. Time is 
not up. There is time to make a difference.
  I'll yield to the gentleman for a final thought.
  Mr. GOHMERT. I just appreciate all the work you've done. There are 
several bills that have been proposed by Republicans.
  Mr. BURGESS. I thank the gentlemen for their time this evening.

                          ____________________