[Congressional Record (Bound Edition), Volume 156 (2010), Part 3]
[House]
[Pages 4067-4073]
[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 New York (Mr. Garamendi) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. GARAMENDI. Mr. Speaker, I request that we enter into a colloquy 
with our colleagues from the Democratic side.
  Earlier today, I had the opportunity to exit the Chamber and go out 
to the veranda overlooking the east lawn of the Capitol, and there were 
a couple thousand folks out there protesting this legislation. And in 
their chanting they were saying: Kill Obama bill. I suspect they're 
referring to the health care bill, not to the President. And I was 
thinking about what does it mean to kill the bill. What is the effect 
of killing this legislation and letting time go on with the current 
situation in the United States?
  Next to me here is what is happening in the United States today. 
Forty-five thousand Americans die each year because they are uninsured. 
They lack health insurance. Forty-five thousand. That's about twice the 
number that are found in any of the arenas today as March Madness 
continues. Forty-five thousand. But that's not the end of it.
  So we start with 45,000 Americans. What about the rest of the 
Americans? We rank 19th among the industrialized nations of the world 
in the health of our citizenry. Our children die earlier. All Americans 
die earlier than the other 18 industrialized countries. The rate of 
increase in the health care market for the individual market in 
California and in many other States was nearly a hundred percent within 
a 1-year period. Some 50 percent last year and a similar amount this 
year, an unaffordable rate increase.
  In California, the average number of claims denied by the insurance 
companies was 21 percent, and the range was from 39 to 17 percent. You 
talk about a death panel. Here's where the real death panel is. It is 
in the insurance companies themselves, denying benefits, denying 
claims, denying treatment for illnesses and for afflictions that cause 
death. This has to end. On Sunday, we will bring this kind of 
unacceptable situation to an end, because on Sunday we will pass 
affordable, available health care for America.
  I'd like now to call upon my colleague from New York (Mr. Tonko).
  Mr. TONKO. Thank you, Representative Garamendi.
  It is important, I believe, for us to recognize, as you're 
suggesting, the benefits that we're bringing because of this reform for 
Americans across this great country. Now, the chants that we heard 
today were concerned about taking away freedoms. I would suggest that 
as we look at the dynamics of this legislation, we're going to see 
great improvements--great improvements to access, to affordability, and 
to the quality of care, all of which are, indeed, important to our 
families, our individuals, and certainly to our businesses, as they 
continue to struggle with the cost of health care insurance.
  As we think of these dynamics, it's important to know--and I look at 
the benefits personalized to my congressional district in upstate New 
York, in the capital region, and amongst those benefits is an 
improvement where 1,100 to 1,200 families will be spared the pain of 
bankruptcy. When you think of the growing dynamic that health care 
costs have as they relate to bankruptcy, it's staggering. It's 
staggering. Eleven hundred to 1,200 families will be saved from the 
ravages of bankruptcy driven by medical costs, health care costs.
  I'm reminded with recent data that 62 percent of bankruptcies in this 
country are caused by exorbitant medical fees, health care that is not 
covered even though in some cases people are insured. In fact, I'm 
reminded that of that 62 percent, 78 percent had insurance when they 
were impacted by this illness, by the catastrophic situation. That 
tells us something.
  So we want to talk about freedoms. Yes, I want to provide for the 
freedom from bankruptcy, the freedom from claims being denied by 
insurance companies when you are insured. And as you indicated, 
Representative, in your home State of California, the number is 
staggering. I want to promote freedom--freedom from the greed of 
insurance executives who say the sky is the limit for compensation and 
the profit column rules the day.
  These are the freedoms that we believe are important to the American 
public: freedom from bankruptcy; freedom from denied claims; freedom 
from ever-rising costs, premiums that are escalating beyond belief; 
freedom from grief. That's what we're talking about here.
  And tomorrow will be an historic day as we look to change that 
situation and to strengthen the fabric of our American families and our 
business community as we continue with this employer-based health care 
delivery system that will allow us to go forward with a sense of 
access, affordability, and quality of care.
  Thank you for bringing us together this evening, Representative 
Garamendi.
  Mr. GARAMENDI. Mr. Tonko, thank you very much. You raised the issue 
of the insurance companies and how they act in the marketplace. I was 
insurance commissioner in California 1991 to 1995 and again 2003 to 
2007, and I can tell you horror stories about what the insurance 
companies do, and I will tell this to the insurance companies.
  When the President signs the bills tomorrow, the era of the insurance 
companies discriminating against Americans because they have a 
preexisting condition, it's over, folks. It's over. No longer will the 
insurance companies be able to say to you, No, I will not give you 
insurance because you had acne when you were a child or because you may 
have taken some asthma medicine early in your life or you have any of 
the four pages of preexisting conditions. The insurance companies will 
end their discrimination because the law will make it illegal for them 
to do so.
  And the issue of bankruptcy. The policies that will be available 
through

[[Page 4068]]

the networks will provide, by law, that there is no longer lifetime 
maximum payments so that the bankruptcies that you specifically spoke 
to will no longer be existing.

                              {time}  2030

  The maximum lifetime limitations that the insurance companies have 
used for years will be over, and shortly the annual limitations will 
also be over, and the benefit packages will be full because there will 
be national standards for benefits. The kind of cheap, useless policies 
that plague Americans when they can't afford a standard policy, they 
seek something that ultimately will not provide them with the care they 
need. So that is one of the major reforms in this. This is an insurance 
reform of extraordinary importance.
  Let me now yield to our colleague, the gentlewoman from Texas.
  Ms. JACKSON LEE of Texas. Let me thank both the distinguished 
gentleman from California for the background that he brings to the 
United States Congress as an insurance commissioner of a State and the 
distinguished gentleman from New York who made some very valid points.
  As a member of the House Judiciary Committee, in fact, we have lived 
with this for now almost 10 years. I remember trying to reform the 
bankruptcy code to protect people from things like alimony payments or 
women being denied the ability to receive alimony payments because 
credit card companies wanted to stand in front of the alimony payments 
and take first in line. So we have seen people being destroyed in a 
number of ways, and we do know that by catastrophic illnesses they are 
destroyed.
  I just want to focus on two or three points. One, the big sign, about 
45,000 Americans dying every year. I don't know why that doesn't send 
out a clarion call. We should not be so insensitive to life that 45,000 
people dying does not impact our colleagues on the other side of the 
aisle. We've been saying this over and over again, 45,000 people. That 
means somebody is dying as we speak because they did not have health 
insurance or that they were denied.
  I want to remind our colleagues of some horrible stories. I remember 
one of a young girl who had leukemia, and it was on national 
television. I think the company was CIGNA where the family actually 
went to the insurance company and begged for this young girl to be able 
to have this very special blood procedure. They were turned away, and 
they were turned away, and they were turned away until finally public 
embarrassment--the news media. And the family went again. The tragedy 
is that when the company finally approved the right of this young girl, 
11 years old, it was too late. The doctors could not perform the 
procedure. And so we have seen any number of incidences where because 
of lack of insurance, we have not been able to save a life.
  What about the recommendation of Goldman Sachs that said just a 
couple of weeks ago, If you want to make a buck, the best place to put 
your money is the Nation's health insurers, the Nation's insurers. 
You'll never have to worry about them going out of business. You will 
never have to worry about them trying to save you any dollars, and 
you'll always know and count on them raising the premiums over and over 
again. What did you say, 94 percent of the premiums are raised. A 
family of four will see their premiums go up $2,000 to $3,000 a year.
  Mr. GARAMENDI. It's interesting to observe the effect of that. This 
is Blue Cross of California. Two years ago, their profit was almost 
$300 million. The effect of those rate increases--the first rate 
increase, not the second one, but the first one which was around 50 
percent--was to increase their profits to $2.3 billion, and now they 
want to add another about 30 percent average on top of that. So what 
will their profits be after all of that? It's shameful.
  What the legislation does is to reign in the excessive increases in 
the insurance companies' premiums. It does that by requiring that a 
higher percentage of their total premiums go to medical services. Now 
if you want, go check Wall Street, go on Charles Schwab, check the Wall 
Street thing. If you want to make an investment, they will say, Invest 
in the companies whose medical loss ratio is low and trending downward. 
That simply means that they're paying less for medical care and more 
for profit. We're going to turn that on its head. We're going to force 
the insurance companies to pay for medical services and less for 
profits.
  Ms. JACKSON LEE of Texas. Let me just make one final point so I can 
close. The final point is, and what this bill will do as well, is 
provide competition. I mentioned that a good friend came on the floor 
and talked about a State where there is only one company. My State--a 
big State and is soon to gain in population through the Census, Texas--
has three. So this bill, once it passes, will open up the doors of 
choice for those who have insurance or those with employer-based 
insurance, because we're not taking away employer-based insurance. I 
think that we're moving in the right direction, and I hope that this 
story will be told tomorrow in the right way.
  Mr. GARAMENDI. And we should also remember in that competition model, 
we will be creating exchanges in which insurance companies will be 
there, they'll have to compete, and they'll compete on a standard 
policy.
  Let me now call on our colleague from Ohio (Mr. Ryan).
  Mr. RYAN of Ohio. I appreciate it, and I appreciate the gentleman 
from California and our other colleagues here.
  I have got a nephew at home who is like 3 years old I think. You know 
how these kids have different little cute things that they say. His new 
thing is that if you ask him, you know, Why are you going in this room, 
and he'll say, Well, I'm going in here because of X, Y or Z, that's 
why. So he finishes all of his sentences with ``That's why.'' You ask 
him why, he says, ``That's why.''
  So I was thinking about this debate, and people say, Well, why are 
you supporting this legislation? Well, so kids can stay on their 
parents' insurance until they're 26 years old. That's why. You know, we 
have got kids that are getting denied because they have a preexisting 
condition. The insurance company says, We won't cover you. I'm 
supporting this bill because that's going to change. The other 
provisions that you're highlighting here, tax credits for small 
businesses, up to 35 percent, and it's actually in some instances 50 
percent of a tax credit for our small businesses for people who are 
providing tax relief to small business men and women who are providing 
health insurance. That's why I'm supporting this bill. If you get sick, 
and you try to get coverage, and all of a sudden the insurance 
industry, the insurance company says, Well, we can't cover you anymore, 
that's going to be done with.
  Think about these significant investments, these significant 
protections that we are making as a country. I love the idea of all the 
tea baggers that were down here today talking about these concepts of 
liberty. I would ask them today, Tell me, what do you mean? What 
liberty are we taking from you? And let me compare it to the person in 
my district, the 1,700 families last year in my district that went 
bankrupt. Are they free? They are not free. They are trapped in an 
economic system that buries them because someone in their family got 
sick.
  My goodness gracious, what did our Founding Fathers mean when they 
gave us these ideas of life and liberty and the pursuit of happiness? 
Who can pursue happiness when they're bankrupt? Because of nothing that 
they did--it wasn't bad financing; it was bad luck. And if we don't 
start to recognize in America that some people in our country just have 
bad luck, and if the government doesn't step in and push back the 
insurance industry to say, We're going to carve out--we're going to box 
out the insurance industry so this family will have some freedom, have 
some protections, that's what this is about.
  I've got no interest in stymieing business growth. I come from 
Youngstown, Ohio, for God's sake. We've been

[[Page 4069]]

in a recession for 30 years. You think I have an interest in stymieing 
business development? I want to help it. You've tried yours. They've 
tried their side, I would say to my friends. I was here. I'm not that 
old, but I've been here 8 years now. I sat here, and I watched while 
Bush jammed through his tax policy, cut taxes for the rich. They said, 
This is going to trickle down and help the poor. It didn't help anybody 
but the rich.
  I sat here and watched while he passed a prescription drug bill, 
didn't negotiate prices, didn't do anything, didn't pay for it, 
borrowed the money, started wars, didn't have money for the wars that 
he started. I sat here and watched while the Republican rubberstamp 
Congress rubberstamped all of those policies. The economy didn't 
improve. Wages didn't go up. They had control of every single thing. 
They had a chance to implement their health care strategy. It didn't 
work because they didn't do anything. They had a chance to implement 
their energy strategy. And when gas goes to $4 a gallon again this 
summer, we're going to feel it again. This is significant stuff we're 
talking about, and Democrats are stepping up to bat for the American 
people. We are taking on the insurance industry.
  Mr. GARAMENDI. Thank you. We've discussed here the issue of 
bankruptcy, and I got a call from my daughter this afternoon. She said, 
Dad, thank God I'm a nurse and I have insurance. Matteo's arm, which 
was badly broken and required surgery, will probably be a $70,000 
event. She said, If I didn't have insurance, we would have lost our 
house. That's the situation that's faced by every family. Thankfully 
this was not the situation that my daughter and grandson faced, but it 
is faced by tens of thousands, if not hundreds of thousands of 
Americans. And it's right here. The insurance companies dominate these 
markets. Lifetime benefits. She probably has already run through her 
lifetime benefit. That child is probably going to be uninsurable 
because he has a preexisting condition, a badly broken arm. Those days 
are over.
  I would like now to yield to my colleague from California, a 
magnificent Representative with whom I have worked with for more than 
34 years. She was a California State senator and took over my position 
when I left the chairmanship at the California State Senate Health and 
Welfare Committee, Representative Watson.
  Ms. WATSON. I just want to say to my colleague and those here on the 
floor this evening, I am so proud to share the space in this Chamber 
with the likes of you. And particularly you, Congressman Garamendi. And 
he was correct in saying that, yes, when I got into the Senate, he 
relinquished his committee, and I held it for 17 years. I think he 
probably is aware of my feelings at this moment.
  I have viewed the ugliness of today, Congressman Garamendi, that is 
so reminiscent of what I went through when I was on the school board in 
the 1970s, and we had to integrate our schools. I was the only person 
there who was an African American, and I had to endure the slurs that 
were heard today. It was absolutely ugly. The use of the ``N'' word, 
spitting, the ranting, the distortions, the slurs, and the deceitful 
references to our health care reform. I felt it was despicable. I 
didn't think it could happen again here in America, but I'm reminded 
that hate continues.
  Why should there be ranting and raving when we're trying to cover the 
38 million Americans without health care insurance? And 8 million are 
in our State, California, and 6 million of them are children. I want to 
say that the legislation that we are addressing will make health care 
affordable for the middle class. I don't know how many people out there 
ranting were middle class, but this definitely will help them. It will 
provide security for our seniors and guarantee access to health 
insurance for the uninsured.
  I just want to very quickly mention what it will do for the 33rd 
Congressional District. That is my district in Los Angeles, Culver 
City, California. It will improve health insurance coverage for 304,000 
residents, it will give tax credits and other assistance to up to 
173,000 families and 15,100 small businesses to help them afford 
coverage.

                              {time}  2045

  It will improve Medicare for 75,000 beneficiaries, including closing 
that doughnut hole. It will extend coverage to 132,000 uninsured 
residents. It will guarantee that 22,200 residents with preexisting 
conditions can obtain coverage, and certainly the children, starting 
when the bills are signed into law. It will protect 1,100 families from 
bankruptcy due to unaffordable health care costs. It will allow 66,000 
young adults to obtain coverage on their parents' policies until they 
are 26 years old. Isn't that exciting. It will provide millions of 
dollars in new funding for five community health clinics in my district 
alone. And it will reduce the cost of uncompensated care for hospitals 
and other health care providers by $16 million annually.
  And I want to set the record straight: this will add and protect and 
supplement, not take anything away.
  Mr. GARAMENDI. Representative Watson, thank you so very much. I am 
appalled and personally offended and I think all owe an apology to 
those Representatives who were demeaned, who were spat upon, who were 
cursed, and who were called the ugliest of names. It is totally 
unacceptable.
  I yield to Mr. Tonko.
  Mr. TONKO. Representative Garamendi, I couldn't agree more. I think 
Representative Watson says it well. There is all the call for civil 
discussion, exchange of information to do things analytically and 
substantively when it comes to a huge industry that represents $1 of $6 
in this country, and we need to do it in a way that brings together the 
facts, not to deal with fiction. Emotion, obviously, is a part of this 
discussion. We heard it from our friend, Representative Ryan. We are 
emotionalized by this, but let's have the sort of dialogue that builds 
soundness into the reforms that we desperately need as a Nation.
  When we get back onto this message of freedom, the freedom to shop, 
many of us understand there is a capitalist model out there. People 
understand that it is good to have business be successful. And where we 
can control cost and contain cost, and allow for growth of that 
business so more jobs are part of that picture, all the better. So we 
have the opportunity with these exchanges, developed by this reform 
legislation, to allow for the freedom to shop, to find a better bargain 
for health care, and as previous speakers have said, add more people 
into the mix, more providers into the mix that want to fight for the 
right to serve you. That is a strengthener.
  And then we establish these exchanges where we require those 
exchanges to have certain rules to be met, to have regulatory aspects. 
We saw what happened when no regulation was part of the financial world 
and the banking community; it brought us to our knees in a recession. 
We need that sort of regulatory aspect, and it is part of the picture.
  The medical-loss ratio, the amount of money going back directly to 
consumers, to those insured, rather than into the profit column, will 
be a litmus test in order to offer your services in that exchange. And 
to live with the standards' minimum benefits package. These are the 
improvements that we bring.
  So again to Mr. Ryan's emotion, and I attach myself to that 
sentiment, we are promoting freedom to shop and we are promoting 
freedom from bankruptcy. These are essentials of this bill; and the 
exchanges will allow for much more competition that sharpens the pencil 
and drives the bottom line benefits for consumers. And the freedom to 
escape restriction and bias if you have acne or are overweight, or for 
women who are of child-bearing years, or those who have been violated 
through domestic violence, to use that as a standard, to deny you 
insurance coverage, that is the freedom you need, to escape those 
biases and that prejudice and that tool that allows the industry to 
grow more prosperous because it won't insure you--these are the 
freedoms we are encouraging. These were the freedoms we are 
guaranteeing.
  So I am proud to be here tonight to work with you, Representative

[[Page 4070]]

Garamendi, to make certain that we share with the American public what 
is really happening with this measure, and we are going to make history 
by approving this package.
  Mr. GARAMENDI. Representative Tonko and Representative Ryan, both of 
you have spoken to the American economy in Youngstown and the effect 
that 30 years of recession has had on that town. One of the fundamental 
problems in the American economy is the extraordinary growth in the 
health care sector.
  This little chart here really explains why many parts of the American 
economy are not competitive. This little red line here is the growth in 
the percentage of the wealth of this Nation, the GDP, that is now in 
health care. We heard earlier one-sixth. Well, it is 16, almost 17, 
percent of the total wealth of the Nation that is tied up in health 
care. We are growing faster in this sector than any other sector of the 
American economy.
  Our competitors around the world are down in the 10-11 percent range. 
President Clinton, explaining this in a speech in California that I had 
the pleasure of attending, indicated that this gap here between the 16-
17 percent of the American economy that goes into health care versus 
the 10-11 percent that our competitors are spending is like giving a 
$80 billion a year gift to our competitors around the world.
  And so when the industries in the manufacturing of America go out, 
the car industry, other heavy industries go out to compete, they are 
saddled with this extraordinary additional cost because of the growth 
in the health care sector.
  The fact is the more inflation in the health care sector, the fewer 
people are insured. This is why we are seeing small businesses shedding 
health care, and why we see the extraordinary run up of the uninsured 
as the economy goes down. It is not just losing your job; it is the 
small businesses being unable to continue to purchase health care.
  One of the most important things that is going to happen in this 
legislation for small businesses is a specific tax reduction, a credit, 
of up to 35 percent in year one and then rising to 50 percent for every 
employee that they provide health care for. So it is an enormous 
benefit and incentive to provide the insurance, to maintain the 
insurance, and that is what is going to go on in the years ahead. So 
all of the talk about this bill being bad for business, it is simply 
not true. This is what is bad for business. There is serious cost 
containment in this legislation through a variety of ways.
  I yield to Mr. Ryan.
  Mr. RYAN of Ohio. It is interesting, I was listening to my colleagues 
from New York and California, I can't get over what all of the fuss is 
about against this bill. This is something that Bob Dole and Senator 
Chafee had worked out in the eighties. This is middle-of-the road 
stuff. Many of us wanted other things in here. I am not afraid to admit 
that. There is no public option in here. This is not single-payer. This 
is right down the middle. This is bread and butter, all American, apple 
pie and Chevrolet. This is baseball.
  Look at it, tax cuts for small businesses. Many people in our 
districts make $50,000 a year. Under this proposal, a family of four 
making $50,000 a year in Niles, Ohio, will get $5,800 worth of a tax 
credit. That is a middle class tax cut. This is what is in the bill. We 
are regulating and putting in new rules for the insurance companies. We 
are not taking over, but this is pretty simple. And the gentleman from 
New York mentioned it: this is about prevention. There is no one who 
can argue with the fact, Mr. Speaker, that we have 30 million-plus 
people in the United States of America who have no preventive care at 
all, dumped into our emergency rooms, much sicker than they need to be. 
And it doesn't take a Philadelphia lawyer to figure out that that costs 
a lot of money, as opposed to giving each one of those, and they pay 
nothing, they go there and they pay nothing. They don't pay anything. 
So it is all free, shifted off to the next person who comes in with an 
insurance card.
  What we are saying is, it is cheaper for us as a country, since we 
are all already paying for them anyway through higher insurance 
premiums, it is cheaper for everybody if we give them an insurance card 
and make them pay something. No more free riders. Everyone is going to 
have to pay something, and get them to a primary care physician who 
will give them a $20 prescription drug instead of going to the 
emergency room a week or two later and costing us $10,000 or $15,000 or 
$20,000. That is what this whole thing is about.
  And when the industry is set up, as it is currently, to knock people 
off the rolls and deny coverage, especially the stories we have heard 
coming out about people with HIV and AIDS, you are not covered. That 
gets pushed off and dumped on everybody else. We are saying this is a 
pro-business bill.
  I am glad, as the one gentleman said earlier, I am glad that the tea 
baggers are in Washington, D.C. to watch this pass because this is 
going to be the most significant tax cut for middle class people in the 
history of our country, especially geared towards health care.
  When I can go home and tell my folks that a family of four making 
$50,000 a year, they are going to get a $5,800 tax credit for their 
health insurance, they probably don't know that right now, but I am 
going to spend the next 6 months making sure that every single family 
in my district knows that they are going to get that tax cut, and they 
are going to like what we have done here.
  Mr. GARAMENDI. Thank you, Mr. Ryan.
  One of the things that we have heard all day is about Medicare cuts, 
somehow the Medicare system is going to be cut. I would like to get 
into that a little bit because this bill specifically helps Medicare. 
We have talked about the doughnut hole. This is the prescription drug 
benefit which, by the way, my Republican colleagues, which I guess are 
not here at the moment, when the prescription drug benefit part D was 
put in place, the Republicans controlled this House with the President 
and they never bothered to pay, never bothered to pay for that benefit. 
And so you want to know where the deficit came from? It came from there 
and it came from the two wars that the Bush administration started and 
didn't bother to pay for either, so we ran up the deficit.
  But here is the thing for seniors, to go back on my point here, is 
that the program provides very specific benefits to seniors. It 
provides $250 this year, a $250 additional benefit for seniors to pay 
for drugs. Those that fall into the doughnut hole, that doughnut hole 
begins to close this year, and in 5 years it is totally gone.
  In addition to that, it is explicit in this legislation that the 
Medicare benefits will not be reduced.
  I yield to Mr. Tonko.
  Mr. TONKO. I think what is important to note is the nomenclature on 
this one is rather offensive. We talk about the doughnut hole as being 
Medicare part D, but who is paying that? Is Medicare paying that? No, 
our senior community. Our senior citizens are asked to contribute. It 
is not Medicare paying for that portion.
  So this one was cleverly devised. Cleverly devised. You can almost 
see the game of footsie going on because somewhere people sat down and 
thought, We can come up with this great, clever name, sounds 
attractive, sounds tempting, a doughnut hole. I can tell you many 
seniors come to me and tell me within a matter of months in any 
calendar year, I am at that threshold.
  For those who are not familiar with it, think of the simple doughnut 
with the hole in the middle. You get covered for a while, then you 
don't, and then you do. It is that threshold. Actuarial measures could 
have told them right when you have to peak there to get people into 
their own pocket paying for this device that is hurting our senior 
community.
  So when we talk again about freedom, this is freedom from the 
doughnut of the worst kind. This is freedom from digging into your 
pocket and paying for your pharmaceutical needs to stay well or to stay 
alive. So this

[[Page 4071]]

measure is great about freeing us from that doughnut hole; but this is 
not Medicare funded, this is out of the individual's pocket, and it is 
hurting our senior community. And by the year 2018, we will close that 
doughnut hole completely. It is an expensive proposition; but, again, 
as you pointed out, no one worried about paying for it when they came 
up with the plan.

                              {time}  2100

  Mr. GARAMENDI. I might add that between now and 2018, some of us are 
going to be around here, and we are going to give the Federal 
Government the power to negotiate drug prices. We are not there today. 
It is one of the things that is missing in this legislation that I wish 
was in it. But it will happen. No longer will they be free from 
competition.
  I yield to the gentlewoman from California.
  Ms. WATSON. I want to set the record straight, because there have 
been so many distortions. In church last Sunday, and I am Catholic, and 
it is Lent, and I was going down to take communion. I was four people 
before getting to the priest to get communion when someone I know 
leaned over and said, ``Don't take my Medicare away.'' The distortions 
that are out there have to be set straight.
  I really appreciate my colleagues and you, Representative Garamendi, 
for talking about closing the part D doughnut hole. I think it was 
about $2,300 that you had to expend for your own prescriptions and then 
you went into a period of time when you got no help and no discounts. 
Now that is going to be eliminated. And I just want to say for my 
friend who stopped me in church last Sunday, the legislation will allow 
6,100 Medicare beneficiaries in my district who entered the part D 
doughnut hole and are forced to pay the full cost of their 
prescriptions, that under this bill these beneficiaries will receive a 
$250 rebate in this year, 2010; 50 percent discounts on brand name 
drugs beginning in 2011; and complete closure, complete closure of the 
doughnut hole within a decade. A typical beneficiary who enters the 
doughnut hole will see savings of over $700 in 2011 and over $3,000 by 
2020. And you will be here to see that because you are from California 
too.
  Mr. GARAMENDI. Thank you, Representative Watson, for making it so 
personal to your district. The same savings are to be found in every 
one of our districts. We have different percentages of seniors in our 
districts, but the fact is that there are very, very significant 
savings in this.
  I want to take up one other issue that has been raised over and over 
again by the Republicans in the most disingenuous and I think rather 
dishonest way. And that is the reduction of some $500 billion over the 
10 years in Medicare expenses. Now, where do those reductions come 
from? They would let us believe that those savings are from the 
reduction of benefits. That is not true. There is explicit language 
here that benefits will not be reduced. I will tell you where the money 
is going to come from. It is going to come out of the pockets of the 
insurance companies that have ripped the Federal Government off to a 
fare-thee-well for the last 6 years, ever since the George W. Bush 
administration created the Medicare Advantage program, which they did, 
incidentally, in reconciliation.
  It is abominable that this government has had to pay a bonus to the 
insurance companies to provide Medicare Advantage programs when in fact 
they said they could do it cheaper than the fee-for-service Medicare 
program. Sixteen percent bonus over and above the average cost of 
Medicare for seniors is given to the insurance company for no good 
reason. Those days, that bonus, that unintended and unnecessary profit 
is going to be over.
  Secondly, there is fraud and abuse in the Medicare system not from 
the seniors who are striving to get their benefits, but rather from 
purveyors, doctors, medical device people, and out and out fraudsters. 
We are going to be hiring. Some of those people that were talked about 
earlier from the IRS and the CMS, the Medicare office, those folks are 
going to be out there chasing after criminals that are ripping the 
Medicare system off to a fare-thee-well. That is where the reductions 
are coming from, from those two places.
  I yield to the gentleman from New York.
  Mr. TONKO. Representative Garamendi, again thank you for bringing us 
together. I think in addition to that, and you are very right, to have 
oversubsidized the Medicare Advantage programs some 12 to 14 percent, 
people say where are the costs coming? Not from you, from the profit 
column. And actually, we want that to be transformed to something that 
is Medicare-related in terms of balancing the scales there and allowing 
our seniors to still have an advantage by having that program continue, 
but making certain that the oversubsidization is denied. And you are 
very right about the fraud and the abuse that may be part of that 
programming.
  But it is also important to note, I believe, that situations like 
medical home models and accountable care organizations will provide for 
the collaboratives that we need to coordinate the resources, to improve 
access, and to bring together the confluence of services in a way that 
streamlines without really hurting--actually helping the outcome for 
our seniors.
  Then of course free annual wellness visits. Making certain that those 
copayments, those deductibles are not going to saddle individuals, 
again having to be forced to dig into your own pocket. We will now have 
those free annual opportunities, screenings of essential types, the 
annual checkups. These are items that will not require--actually, 
copayments and deductibles will be denied and they will be disallowed. 
So you go forward and you encourage the preventative and wellness 
approaches to health care delivery, which is an important aspect, I 
think, to the benefits of this program.
  We have to remember that the $1.2 trillion that is saved in the 
second 10 years out and the $138 billion that is saved in the first 10 
years are just those budget-related scorings that were done by the 
Congressional Budget Office. But there are those who are suggesting 
that well beyond any kind of budget impact are the ripple effects of a 
good kind that will come simply by instituting wellness and prevention 
and access and putting clinics into the system, relieving our health 
care delivery system of uncompensated care burdens. A number of these 
things can't be scored by the Congressional Budget Office. So it goes 
well beyond the $1.34 trillion that has been projected by a very 
conservative, nonpolitical CBO group.
  So I think there is reason for great hope here. And if we could 
instill hope, if we could insert hope into the lives of people, into 
the fabric of our health care opportunities we are achieving a great 
deal. And again, because this is so critical in the lives of people and 
in the profit columns of businesses that provide jobs, this is an 
important discussion.
  Mr. GARAMENDI. I really want to home in on what you are saying, but 
let me wrap up the senior part here if I might. Let's be very, very 
clear about the Medicare program. First of all, the AARP, American 
Association of Retired Persons, say that this legislation is going to 
lower costs and improve care for seniors.
  Secondly, it is in the bill, no benefit cuts. It is in the bill. Two 
hundred fifty dollars in the pocket of seniors who have got their 
medical prescriptions in the doughnut hole to help pay for that. And 
that is this year. Not 10 years from now, this year. Medicare part D 
doughnut hole is beginning to close. It is going to take time because 
it is expensive and it does take a lot of money, but it is going to 
close by 2018. And there will be significant drug discounts for seniors 
who use generic drugs this year, saving seniors, just as you said, 
millions of dollars out of their pocket. And that is not in the CBO 
score.
  I yield to the gentleman from New York.
  Mr. TONKO. I would have to add to your list of benefits in this 
measure is the stabilization of the Medicare trust fund, providing that 
trust fund as we go forward being a stronger element

[[Page 4072]]

out there, enabling us to again provide the Medicare benefits and 
services that are required. It is an important aspect. It is important 
to 113,000 beneficiaries in my district. So we want to make certain 
it's there.
  Mr. GARAMENDI. It's not on my list. Do you want to add to my list 
another benefit?
  Mr. TONKO. I will add to your list. And I am glad, Representative, 
that you made mention that no benefit cuts are included in the language 
of the bill. So these are another bit of freedoms that we are talking 
about in this measure.
  Mr. GARAMENDI. So we add to the bill that the Medicare trust fund is 
made solvent for something either 7 to 9 years.
  Mr. TONKO. Nine years.
  Mr. GARAMENDI. Nine years. Okay. We added that one here. Medicare 
Advantage, we talked about that. The bonus to the insurance companies 
is gone. And that money is not sent off to some other program, that 
savings stays in the Medicare program. Reduce senior premiums, improve 
access, expanded benefits, extend Medicare's fiscal--I did have it 
here. I just didn't read it. Here is the Medicare fiscal health. And 
finally, the issues you were talking about, prevention, organizing the 
care so we have continuity of care.
  I yield to the gentleman from Ohio.
  Mr. RYAN of Ohio. Just listening, I want to speak directly to Members 
of the House because we've got a few minutes left tonight and some 
debate tomorrow. How does this play out over the course of the next few 
months? By listening to what you gentlemen have just got done saying 
about Medicare, the significant improvements of strengthening Medicare, 
we're going to have to run an election. And there is probably going to 
be an election on this bill. What has happened over the last few months 
is our friends on the other side have consistently tried to throw 
arguments again the wall, and they would just fall; they wouldn't stick 
because they weren't true.
  We started with death panels, and illegal immigrants, and abortion, 
and we went right down the line. None of them ended up working out. 
``It's going to bankrupt the country.'' And then we get CBO--I mean you 
just go right down the line. They said it's going to support abortion, 
and then we have 60,000 Catholic nuns, 600 Catholic hospitals, 1,400 
Catholic nursing homes, a bunch of Catholic theologians saying this is 
not a pro-abortion bill, this is a pro-life bill. Same thing with 
illegal immigrants.
  Then they say it's going to spend a ton of money, and then the 
Congressional Budget Office, a neutral third party, says it's going to 
save $1.2 trillion, reduce the deficit by $1.2 trillion in the second 
10 years, $130 billion in the first decade. That is a reduction in the 
budget deficits on the backs of what President Clinton did by reducing 
the budget deficit. So we have a history of doing that.
  So quickly, the debate in the fall about health care is going to go 
something like this. We pushed an initiative that is going to close the 
doughnut hole and give our seniors 250 bucks just this year to help 
close that doughnut hole. Our friends on the other side running against 
us will be saying we want to repeal that. We don't want that closing of 
the doughnut hole.
  We're going to be campaigning on little kids who have a sickness are 
now being denied insurance coverage because they have a preexisting 
condition, we're going to say, we stopped that from happening in the 
United States of America. Our friends on the other side are going to be 
running a campaign saying we want to repeal that.
  We're going to have in there we want to have a ban on preexisting 
conditions for all citizens across the board. Our friends on the other 
side are going to be running a campaign saying we want to repeal that. 
And on and on and on.
  People who are now getting kicked off the rolls, their insurance 
rolls, because they got sick, we're saying that could never happen 
again in the United States of America. And next fall our friends on the 
other side of the aisle are going to say, no, no, we want to repeal 
that ban. We want to continue that practice of the insurance industry 
being able to kick people off of their insurance because they got sick.
  We're going to be saying, hey, your kid that just went on the 
insurance rolls because they were 24 years old and we allowed that to 
happen because of the health care reform bill. Our friends on the other 
side are going to be saying they want to repeal that provision that 
allows young people to stay on their parents' insurance until they're 
26 years old.
  Very clear. The family in my district, your district in New York, 
your district in California, your district in California, all across 
the country, those families of four making $50,000 a year who are going 
to get a $5,800 tax cut that we put in because of this reform, our 
friends on the other side are going to say we want to run this election 
about repealing that tax cut.
  Same with the 35 percent and then up to 50 percent tax cut for small 
businesses. Our friends on the other side are going to say, we want to 
repeal that. This is a referendum on health care reform. I say I want 
to have that debate day and night for the next 6 or 7 months because 
that is a debate, Mr. Speaker, we can win and we shall win. The only 
issue now is a lot of people do not know all of these benefits that 
have been itemized here tonight. They will know in the next 6 months.
  I yield back to my friend.

                              {time}  2115

  Mr. GARAMENDI. We've got about 6 minutes left, so let's each take 
about 2 minutes.
  Mr. Tonko.
  Mr. TONKO. Thank you very much for bringing us together.
  There is so much to talk about with this bill, but you know, as what 
has been mentioned with Representative Ryan, a family living on an 
annual income of $50,000 gets the $5,800 tax credit. Well, you know, it 
doesn't end there. It goes all the way up to the threshold of $88,000 
for annual household incomes whereby families are going to receive some 
sort of benefit.
  This is an extraordinary opportunity to provide for middle-income 
America, to provide income for them so that they can promote wellness 
within their individual families. Absolutely tremendously strong idea. 
It empowers the middle class, the working families of this country.
  It empowers our small businesses. Representative Watson talked about 
the benefits in her district to small businesses. In my district, 
between 14,000 and 15,000 businesses will be given the opportunity for 
tax credits to help purchase the employer-based plans for their given 
employees. And don't they prosper from a sound and well workforce? I 
think that is important. They also will have the benefits of shopping 
within an exchange if they so choose.
  So there is all of this effort made to make certain that we advantage 
people in a way that will promote wellness, provide health care in an 
affordable and accessible fashion.
  We also do know that the benefits to our senior community, with all 
of the strengthening of Medicare without reducing those benefits, 
promoting their pharmaceutical needs being addressed fully in the near 
future so that they are not avoiding those pharmaceuticals simply 
because they cannot afford them; that is bad policy.
  So what we have here is freedom galore, freedom galore to be able to 
stay well, to stay strong, to grow and prosper, to be hopeful. This is 
a golden moment. This is a wonderful moment that we will share tomorrow 
as we come out to this floor and address this health care reform 
measure.
  And thank you Representative Garamendi for bringing us to together. 
Thank you for the opportunity.
  Mr. GARAMENDI. I appreciate your passion on this no less than Mr. 
Ryan's.
  Ms. WATSON. And very quickly I, too, want to add my thanks to my 
colleagues for providing this time.
  I want to remind our country that in this legislation, we have 
community health centers. And I remember in the beginning some people 
were very disturbed because their districts--and they feel that they 
have areas that are

[[Page 4073]]

so remote, how will this health insurance plan cover them.
  They need to know that nationwide the legislation will provide $11 
billion in new funding for these health clinics. And they'll be in 
rural areas; they will be in suburban areas. Those people who are not 
in the urban core will be provided with health care. And if the 
community health centers in the district, your district, receive the 
average level of support, these centers will receive millions of 
dollars in new assistance so that we can cover as many of the uncovered 
as possible.
  And I want to remind the viewers that if you have insurance and you 
like your insurance, you can keep your insurance. If you love your 
doctor or your health care provider, government does not come in 
between that relationship. And I want the viewing public to know that.
  And then I want to end by saying there is no deficit spending. I sat 
in my office and heard the opposition say, It's going to rob my 
children, you know, and, it's going to wreck their children, and it 
will rob them because they'll have to pay off the deficit.
  The cost of health care reform under the legislation proposed is 
fully paid for in large part by eliminating, and you mentioned it, 
waste, fraud, and abuse and excessive profits for private insurers.
  The legislation will reduce the deficit by over a hundred billion 
dollars over the next 10 years and by about $1 trillion over the second 
decade.
  So thank you, Representative Garamendi for allowing us this time to 
set the record straight.
  Onward to victory.
  Mr. GARAMENDI. Thank you very much, Representative Watson. It has 
been a joy to work with you these 35 years and work with you this 
evening.
  This is a historic moment. This is something you and I and many 
others have worked to try to provide health insurance for all 
Americans. Some 32 million Americans will receive health insurance as a 
result of this. There will be the incredible tax cuts for working men 
and women. For small businesses, they, too, will receive significant 
tax credits so that they can provide insurance for their employees. And 
there will be programs to promote wellness. There will be programs to 
create better information technology so that we don't have to waste 
money every time you present yourself with a different doctor. And you 
have the freedom to choose your own health insurance company, and your 
health insurance company no longer has their freedom to deny you 
benefits and coverage. There are serious insurance reforms in this.
  Finally, I just want to add, I have seen this sign so many times 
around the Capitol, so many times, and it says, ``We the people.'' 
Those are the first three words of the preamble of the United States 
Constitution. And it goes on to say, ``We the people of the United 
States, in order to form a more perfect union.'' That is what we're 
doing here. A more perfect union within our families so that we don't 
have to fear bankruptcy and the loss of health because we have no 
health insurance; a more perfect union in our communities so that 
everyone in our communities has health care and access to health 
insurance.
  It establishes justice.
  Thank you so very much.

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