[Congressional Record (Bound Edition), Volume 156 (2010), Part 4]
[House]
[Pages 4531-4537]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              {time}  2000
                           HEALTH CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentlewoman from the Virgin Islands (Mrs. 
Christensen) is recognized for 60 minutes as the designee of the 
majority leader.
  Mrs. CHRISTENSEN. Mr. Speaker, it is my honor this evening to anchor 
an hour for the Congressional Black Caucus on health care reform. I 
have several of my colleagues here to join me. Interestingly enough, 
three are from three of the relevant committees that put the bill 
together in the House.
  When I left my private practice of 21 years, I promised my patients 
that I would continue to do everything I could to ensure that they got 
the health care they needed, even though I was leaving the practice. 
Too many were uninsured. Too many had several chronic diseases. Too 
many could not afford even 1 month's supply of medicine. And our low-
capped Medicaid funding was of very little help.
  Last night our Democratic leadership and my Democratic colleagues 
helped me make good on that promise. Because of the landmark 
legislation that we passed last night, the most momentous piece of 
legislation since Social Security, Medicare and the civil rights bills, 
not only my constituents but all Americans will have access to 
affordable, quality, and comprehensive health care. And African 
Americans and other minorities will benefit because of the provisions 
that are included to reduce the disparities that Surgeon General 
Heckler called an affront to American ideals and to the genius of 
American medicine.
  So tonight some of my colleagues will help to explain the many 
benefits of the bill we passed last evening and the way that our 
communities will be able to be helped by the legislation.
  I would like to first call on the gentleman from North Carolina (Mr. 
Butterfield) a member of the Energy and Commerce Committee and the 
Health Subcommittee who played a very important role in developing the 
bill as it went through Energy and Commerce.
  Mr. BUTTERFIELD. Let me thank the gentlewoman for yielding me this 
time, and thank her for all of her good work on the legislation. For 
the past 12 to 14 months, I have watched you as you have worked 
tirelessly to get a finished product that we can all be proud of. And 
so I want to thank you on behalf of the 600,000 people that I represent 
in the First Congressional District of North Carolina.
  Mr. Speaker, every President in this country for the past 50 years or 
more has tried to reform health care. Unfortunately, all of them have 
failed, both Democrat and Republican. We have a health care system in 
this country that is in serious need of reforming. And President Barack 
Obama, during the Presidential campaign of 2008, campaigned on the 
platform that if elected, he would bring health care reform to the 
American people and for the American people. It was a hotly contested 
campaign, as we can all remember, but he was victorious because the 
American people had confidence that President Obama had the ability and 
the vision to bring people together to enact this worthwhile 
legislation and to do other great things for our country.
  Well, we started the 111th Congress, and President Obama told us from 
day one that he was ready to deliver on the promise that he made to the 
American people. And so we in the Energy and Commerce Committee and 
Congresswoman Christensen and many of us worked very hard to put 
together a good, strong piece of legislation. But I can tell you that 
we would not have enacted this bill last night without the courageous, 
visionary leadership of President Barack Obama.
  In the Energy and Commerce Committee, we worked very hard to craft 
legislation that we were very proud of. At the same time as we were 
doing our work, the United States Senate was also crafting a piece of 
legislation and they completed their work on Christmas Eve, as we all 
remember. Well, what the American people may not fully understand is 
that in this body, before we can have a piece of legislation delivered 
to the President's desk, both the House and the Senate must agree. And 
so during the Christmas holidays, the Democratic leadership from both 
Chambers worked very hard to try to reconcile the differences between 
these two bills.
  The unfortunate thing, Mr. Speaker, and Mrs. Christensen, is we had 
no participation, no help whatsoever from our Republican friends on the 
other side of the aisle. When I say we had no help at all, we actually 
had none. The fact of the matter is that out of the 178 Republicans who 
serve in the House of Representatives, not a single one worked with us 
on this legislation. We tried unsuccessfully on many occasions to try 
to include Republicans in our deliberations, but there was apparently a 
strategic decision, a political decision on their part to not 
participate.
  Over on the other side of the Capitol, the same thing happened in the 
United States Senate. Out of the 40 Republicans who serve in the 
Senate, not a single one worked with us. And so it was Democrats who 
had to try to get this legislation shaped and to get it ready for 
passage. And so during the Christmas holidays, the Democratic 
leadership worked very hard. They worked through Christmas Eve and New 
Year's Eve and all through the holidays to try to reconcile their 
differences. And finally toward the end of the holiday season, there 
was a compromise between the Chambers and we reached a decision on this 
legislation.
  The problem was that we lost a seat in the United States Senate. Due 
to the unfortunate passing of our hero, Senator Edward Kennedy from the 
Commonwealth of Massachusetts, we lost a Democratic seat in the United 
States Senate. Senator Kennedy's replacement was not from the 
Democratic Party. We found ourselves with less than the supermajority 
that is required in the United States Senate.
  So President Obama called the leadership together many times, and we 
decided that we would go forward, notwithstanding the fact that we had 
a setback, that we would go forward and that this House of 
Representatives would take up and pass the Senate-passed bill, and that 
is important. That is a point that I want to make tonight. The bill 
that we passed last night was

[[Page 4532]]

parliamentarily correct. It conformed with all of the rules of the 
House and the Senate. The bill that we passed last night was the 
identical bill that the United States Senate passed on Christmas Eve 
with 60 votes. We passed that bill last night in the House with 219 
votes in favor of passage. We only needed 216 votes to get it done. 
Today the bill is on the President's desk, and we will go down to the 
White House tomorrow morning for the signing of the Senate bill that 
was passed by the House of Representatives.
  Now here is the problem that we have. The Senate bill that we passed 
has some shortcomings. It has some areas that need improving, and so 
the President has worked with the leadership here in the Congress and 
we have come up with some fixes, if you will, with some amendments, 
with some changes to the Senate bill that will make it better. We all 
know about the provision in the Senate bill that was put in by a single 
Senator, that is going to be removed, and there are going to be other 
provisions of the Senate bill that will be removed.
  Last night, not only did we pass the Senate bill but we also passed 
the fixes that the President asked us to pass, and those fixes are now 
pending in the Senate for consideration this week.
  Senator Reid, the majority leader in the United States Senate, has 
told us that the Senate will begin working on the fixes tomorrow after 
the President signs the bill. But, Mrs. Christensen and Mr. Speaker, we 
have made monumental progress. No President has ever been able to do 
this, but because of the vision and the masterful leadership of the 
President and the Speaker of this House and the majority leader and the 
majority whip all working together, we have been able to finally pass 
this legislation.
  This legislation does not go into effect immediately. There will be a 
phase-in. As you can imagine, we cannot reform the health care system 
in America and the health insurance system in America overnight. It is 
going to take time. But I can tell you, and I can tell the American 
people, that by the year 2019, 95 percent of the American people will 
have health insurance and access to quality health care. That is what 
we promised the American people. That is what we are going to deliver. 
There will be a phase-in starting within the first 6 months of this 
year.
  We are going to help our seniors with their prescription drugs. Those 
who fall into the doughnut hole, they will be given a stipend to help 
them purchase. We will allow families to maintain their children on 
their insurance policy up to age 26. So there will be a gradual phase-
in.
  Finally, let me conclude by saying that I represent a low-income 
district. The First Congressional District of North Carolina that I 
represent is the fourth-poorest district in the United States of 
America. We have a lot of low-income people, and I am happy to report 
to my constituents and to people all across America that for the first 
time in our history, individuals will be able to qualify for Medicaid. 
Low-income individuals will be able to get Medicaid. Right now families 
can qualify for Medicaid, but not individuals. An individual who makes 
less than $14,400 a year will get Medicaid. A family of four that makes 
less than $29,000 a year will be able to qualify for Medicaid, which is 
free. For an individual who is between the incomes of $14,400 a year 
and $43,000 a year, you will be able to get assistance. You will be 
able to get a subsidy in purchasing insurance. If you are at the low 
end of $14,400 a year, you will pay $36 a month in order to get a 
quality insurance policy. If you are at the high end of $43,000 a year, 
you will pay $342 in order to get a high quality insurance policy.
  Now for a family of four, it is a little bit more but it is very 
affordable. For a family of four that makes $29,300 a year, your 
premiums will be $73 to insure four people in your family. At the high 
end, if you make $55,000 a year, you will pay $369 a month. We have 
made tremendous progress with the passage of this bill. We are very 
proud of the progress that we have made, and I just want to publicly 
thank the Speaker of the House of Representatives, Nancy Pelosi, the 
majority leader, Steny Hoyer, and the majority whip, Mr. Clyburn. I 
want to thank all of the leadership and the chairmen of each one of the 
relevant committees who participated in this bill: the Energy and 
Commerce Committee under the leadership of Henry Waxman and formerly 
John Dingell; the Ways and Means Committee under the leadership of Mr. 
Levin from Michigan, formerly under the leadership of Mr. Rangel; and 
the Education and Labor Committee under the leadership of George Miller 
from California. All of these committees, working together with the 
Budget Committee led by John Spratt of South Carolina and Louise 
Slaughter from New York leading the Rules Committee, all of these 
individuals working together to get us to the point where we were last 
night.
  The passage of this bill is monumental. It is historic. Yesterday was 
not an ordinary day in the House of Representatives. I thank my 
colleagues who voted for this legislation. I look forward to the 
results that it will yield.
  Mrs. CHRISTENSEN. I thank Congressman Butterfield, and thank you for 
going through the process that we have gone through over the past year 
because it has been a little difficult, I think, for the American 
people to understand, and I think you helped to clarify how we got to 
where we were last night, and also you were able to clarify what some 
of those exchange subsidies and Medicaid would mean to the average 
family.
  I just wanted to say before I recognize Congressman Scott, when you 
look at the uninsured that are going to be helped in this country--10.8 
percent of non-Hispanic whites are uninsured. The uninsured rate for 
African Americans is 19.1 percent; for Asian Americans, 17.6 percent; 
and for Hispanics, the Latino Americans, the uninsured rate is 30.7 
percent. So just providing coverage for the 32 million Americans that 
will be covered for the first time by this legislation will make a big 
difference in the lives of people of color and their families. But 
insurance is not enough, and there are other provisions that we will 
talk about a little later.

                              {time}  2015

  But at this time, I'd like to yield such time as he might consume to 
the gentleman from Virginia, Congressman Bobby Scott, who not only is 
on the Education and Labor Committee, which played a major role in 
crafting the original House bill, but also on the Budget Committee, a 
senior member of the Budget Committee, which had a major role in 
preparing and reporting out the reconciliation bill that we voted on 
last night.
  Mr. SCOTT of Virginia. Thank you very much. And I want to thank you, 
Dr. Christensen, for your hard work and dedication. The Congressional 
Black Caucus is fortunate to have a leader in health care who is a 
physician and knows health care and, particularly, a physician with an 
expertise in public health. So we're very fortunate, and I want to 
thank you for bringing us together. You've worked long and hard on 
health issues, and particularly those issues in which there are health 
disparities, where African Americans suffer disproportionately in some 
diseases and knowing what we can do about it.
  Mr. Speaker, America has been debating health care for 100 years, and 
we've come to some agreements. We know, for example, and I think 
there's general agreement within this House, that the status quo is 
unsustainable; 14,000 Americans losing their health insurance every 
day. The costs are going up. Twenty years ago, the average American 
family spent about 7 percent of the family income on health care and 
now it's 17 percent, and it's going and continuing in that direction.
  Millions have no insurance at all, particularly those with 
preexisting conditions who are unable to get any insurance. So we know 
that one thing that, if we're going to deal with the problem, one thing 
that we have recognized is that any solution that's going to be 
meaningful has to be comprehensive. You cannot solve the problem of 
preexisting conditions, those with preexisting conditions not getting 
insurance unless everybody has insurance.

[[Page 4533]]

  If people can wait until they get sick before they buy insurance, 
many people will wait until they get sick before they buy insurance. 
And those in the insurance pool, on average, will be sicker and sicker; 
the cost, average costs will be higher; more people, healthy people 
will drop out; and the costs will spiral out of control. We know that. 
So we know if we're going to deal with preexisting conditions, it has 
to be in the context of a system where virtually everyone is buying 
insurance.
  We know that we have to make some comprehensive changes. We know we 
need to debate the issues. But, unfortunately, during the recent 
debate, we've heard complaints. We've heard some blames. We've heard a 
lot of misrepresentation. We've heard some slogans and even name 
calling. And yesterday, we finally took a huge step in guaranteeing 
quality and affordable health care for all Americans, and we have a 
bill that we can discuss. You can talk about what might be in the bill, 
what isn't. We have a bill. And let's talk about what's in the 
legislation.
  First, the bill will provide affordable health care insurance for 
over 30 million Americans who are uninsured today, including those with 
preexisting conditions. The gentleman from North Carolina has outlined 
how affordable it is. Those at the very low end of the spectrum will 
pay very little. Those much higher up in the spectrum will pay more, 
but it's still easily affordable, particularly when you compare it to 
what people are having to pay today.
  These bills will provide security for those who have insurance 
because 14,000 Americans will no longer lose their insurance every day. 
And those who have insurance will not have to watch the cost of their 
insurance skyrocket every year.
  And insurance companies would be no longer able to cancel policies 
right when you get sick by looking back and finding a little comma out 
of place or something so they can cancel your policies when you most 
need them.
  They also can't stop making payments in the middle of your illness, 
because we remove lifetime caps on benefits. Just because you have a 
very expensive and chronic disease, with the insurance that we're 
providing, you will get the medical care that you need.
  No longer will those with health insurance have to pay copays for 
preventive services. And those with insurance won't have to go 
bankrupt, because the bills provide affordable limits on copays and 
deductibles.
  Most of the people in bankruptcy court are there because of health 
expenses. And most of those there because of health expenses have 
insurance, but their copays and deductibles are such that they still 
have to lose everything in bankruptcy court.
  And because the legislation will provide affordable health insurance 
to virtually all Americans, families with insurance will no longer have 
to pay an extra $1,000 a year to offset the health care costs for those 
that show up in the hospitals without any insurance.
  Seniors will no longer have to fall into the doughnut hole where 
they're paying premiums and getting no benefits.
  Our youth will be able to stay on family policies until they're 26 
years old.
  Small businesses will see significant savings in health insurance 
because they can purchase insurance with the same price advantages as 
big businesses do now with the large cost advantages of volume. And 
many small businesses will also receive tax credits, temporary tax 
credits to help them provide insurance for their employees.
  This plan is more than paid for. CBO projects significant savings 
during the first 10 years and huge savings in the next 10 years. The 
major funding for it is treatment of unearned income for those making 
more than $250,000, just like earned income.
  Whatever your earned income, you pay a Medicare tax on that income, 
if it's earned income. If it's unearned income, stocks and bonds and 
trading and dividends and interest, you don't pay a Medicare tax on 
that.
  The major funding in this provides that whatever your income, you 
will be paying a Medicare tax. So those making more than $250,000 will 
pay on their unearned income just like everybody else is paying on 
their earned income.
  The gentleman from North Carolina has indicated some of the 
provisions that go in fairly soon. Most won't go into effect until 2014 
because it takes time to put all of the provisions together and get 
them active, but there are a lot of things that go into effect right 
away.
  Small business tax credits, for those small businesses to make 
employee coverage more affordable, tax credits up to 35 percent of the 
premiums will go into effect immediately.
  We will also begin to close the doughnut hole. For those seniors in 
the doughnut hole, we'll provide a $250 rebate to help them, and 
gradually we will eliminate the doughnut hole.
  Pre-preventive care under Medicare. Right after the bill becomes 
effective, we'll eliminate copayments for preventive services and 
exempt preventive services from deductibles under the Medicare program. 
So those who are getting preventive services won't have to pay copays 
and deductibles.
  There's help for early retirees. We'll create a system to help offset 
the costs for those businesses that are providing health care for early 
retirees, those 55 to 64. Before they get on Medicare, there will be a 
program to help those. Those are very expensive to cover, and many 
companies want to cover them but can't afford it. We will provide an 
affordable way for them to cover them.
  We will end rescissions. There will be a ban against insurance 
companies from dropping people when they get sick.
  There will be no discrimination against children with preexisting 
conditions. We will prohibit health insurance from denying coverage to 
children with preexisting conditions.
  There will be a ban on lifetime limits and coverage. We will prohibit 
health insurance companies from placing lifetime caps on coverage. So 
if your chronic illness is very expensive, they can't cut you off right 
in the middle of treatment. There will be a ban on annual limits on 
coverage. And there won't be a complete ban early on, but we will 
tightly restrict any new plan's use of annual limits to ensure that you 
can get all of the health coverage that you need. Eventually, there 
will be a total ban on lifetime benefits.
  Free preventive care under all new private plans. We will require all 
new private plans to cover preventive services with no copays and with 
preventive services being exempt from deductibles.
  We will provide a new independent appeals process to ensure that 
consumers in new plans have access to an effective internal and 
external appeals process so that, if you're not treated properly by 
your insurance company, you have an effective means to appeal.
  There'll be immediate help for those with preexisting conditions. 
Eventually, those with preexisting conditions will get insurance just 
like everybody else, won't be able to discriminate against those with 
preexisting conditions. But until the plan is fully implemented, those 
with preexisting conditions will be able to buy from a high-risk pool 
that will be subsidized because, obviously, the cost of that insurance 
will not be, should not be affordable, but we'll make it affordable 
with subsidies. So those with preexisting conditions can get relief 
right away.
  It extends coverage for young people up to their 26th birthday on the 
family policy. If young children aren't getting health insurance on 
their job or while they're in school, they can stay on their parents' 
policy up until their 26th birthday.
  We significantly increase funding for community health centers, and 
that starts right away. So within the next 5 years, we will absolutely 
double the number of patients being seen at community health centers. 
And we'll start making investments in training programs to increase the 
number of primary care physicians, nurses, and other public health 
professionals. All of that goes into effect right away.
  Now, some are criticizing the plan, and it's interesting to listen 
carefully to the criticism. With all of what this

[[Page 4534]]

bill does, one of the criticism is, Well, the bill has too many pages. 
Another is, We don't like the order in which we're casting the votes. 
Look at all of this comprehensive health care, and all they can talk 
about is the order we're voting in and the number of pages.
  Now, some believe that the program is unconstitutional, and, when 
pressed, they'll also say that, Well, Medicare is unconstitutional, 
too, and they want to repeal Medicare. And when we talk about repealing 
Medicare, I'd like to refer everyone to the budget introduced by the 
lead Republican on the Budget Committee. The long-term budget on that 
committee offered by the Republican side does not include a Medicare 
program. It includes a little voucher program where the cost increases 
will not keep up with medical inflation, so gradually, year by year, 
the value of that voucher erodes to the point where, 50 years from now, 
it'll be worth about 25 percent of the costs of medical care for senior 
citizens. They will allow it to wither on the vine. So when you talk 
about Medicare being unconstitutional, be careful, because they 
actually want to repeal Medicare as we know it.
  Others complain that it takes away their freedom to be uninsured. I 
was first elected to the Virginia House of Delegates in 1977. This is 
the first year I've heard anyone talk about their urgency of the need 
to enjoy the freedom to be uninsured.
  Now, I'd like to--they say, well, they're going to debate it during 
the campaign for reelection, and I can't wait, because what will the 
campaign be?
  Seniors, get back in that doughnut hole where you belong. We're going 
to repeal the law.
  Young adults, get off that family policy and get out there on your 
own.
  Small businesses, give those tax cuts back and start buying insurance 
at the retail rate rather than the wholesale rate. Pay 18 percent more 
like you're doing today.
  Those with preexisting conditions, give me that policy back. You 
weren't supposed to get the policy. That was in the legislation that we 
want to repeal.
  I can't wait for that debate because, as I said last night before we 
took that important vote, I said that future generations will look back 
at the votes we cast last night just as today we look back at the votes 
on Social Security and Medicare. And when they passed Social Security 
and Medicare, the votes were not unanimous. There were those that voted 
``no.'' But future generations will look back and see that many of us 
proudly voted in favor of health care for all. And I hope they look 
back with the same pride on those votes we cast last night as we do to 
the votes cast in favor of Social Security and Medicare.
  Mrs. CHRISTENSEN. Thank you, Congressman Scott. And thank you for 
going over the provisions and those that come into play this year, when 
the President signs the bill, when the reconciliation bill is signed, 
and which provisions start perhaps in a year or so, because it's very 
important to understand that as this bill is passed, within 6 months, 
many of the provisions that provide, that stop the exclusion for 
children with preexisting disease, for example, is already in place, 
that the doughnut hole will start to be closed, that we'll start to 
build our primary care workforce to meet the needs of the 32 million 
newly insured, and that the small business tax credits will begin, all 
within 2010.

                              {time}  2030

  I would like to now yield such time as he might consume to my co-
chair of the Congressional Black Caucus Health Task Force and also a 
valued member of the Ways and Means Committee--again, one of the 
committees that had a major responsibility for crafting the bill and 
the pay-fors in the bill that we passed in the House and the bills that 
we worked on and passed last night.
  Thank you, Danny, for joining us.
  Mr. DAVIS of Illinois. Thank you very much, Donna, and I want to 
thank you for the tremendous leadership that you have shown the whole 
time that we have been together in Congress. As a matter of fact, we 
came in at the same time, and you've been engaged in health activity 
before getting here and you have been a leader ever since.
  As I listened to Representative Butterfield, I was reminded of the 
fact that the Bible says that where there is no vision, the people 
perish. And I think we have been very fortunate to have a bold, 
courageous, and visionary President as the leader of this country. As a 
matter of fact, he was bold enough, brave enough, and visionary enough 
to say that we are going to reform health care delivery. And many 
people thought that that was a far stretch, that it was a far reach 
because people had been trying to do it, had been talking about it, but 
had not been able to accomplish it. And I guess as the boys on the 
street would say, And then along came Barack. Along came President 
Obama.
  I know that there are thousands and thousands of people who have been 
engaged in the struggle to push health care forward. And, Donna, I can 
imagine that you have been in thousands of hours of discussions over 
the years with the National Medical Association, with the American 
Public Health Association, with the Black Nurses Association, with the 
National Dental Association, with the National Association of Social 
Workers, all of these groups.
  I was thinking of my own experiences in terms of having worked in 
health care prior to running for public office having sat on the boards 
of hospitals, having worked in neighborhood clinics, having been 
president, as a matter of fact, of the National Association of 
Community Health Centers; and so that goes back at least 30 years. 
Individuals have been opened.
  And although the 1-hour that we're doing tonight was taken out under 
the auspices of the Congressional Black Caucus and your leadership, the 
last person who called my office just before I came over was not black. 
It was not an African American. As a matter of fact, he was a non-
African American gentleman who called the office, and I happened to 
answer the phone. And he says, Is this the office of Congressman Danny 
Davis? And I said, Well, yes, it is. He says, Well, I just want to 
leave a message for the Congressman. And I want you to tell him that I 
actually cried when this bill was passed, when that vote was taken. And 
I just want him to know that people in my community and my family and 
my neighborhood have been waiting for this day. And I said, Well, I 
want to thank you for calling. He said are you the Congressman. I said, 
Well, yes, I am.
  And I represent a district--I call it the most interesting piece of 
geography in North America. There is nothing quite like it. It includes 
the Gold Coast in Chicago, all of downtown Chicago, the Magnificent 
Mile, downtown Chinatown, Greektown, Old Town, New Town, Brushfield. 
But it also includes pockets of poverty. It includes suburban 
districts. It has 21 hospitals in it, four medical schools, 92 
community health center sites, of course, research institutes. So you 
can imagine what a bill like this means to the people of my district.
  For example, it will improve coverage for 334,000 of my residents. 
Not 3,000. Not 4,000. But 334,000. It will provide tax credits for up 
to 158,000 families, 14,000 small businesses.
  The doughnut hole, it will remove the doughnut hole ultimately for 
76,000 beneficiaries who right now have those experiences. It's going 
to extend coverage to 52,500 uninsured individuals who currently go to 
the county hospital when they have to get the health care who 
experience episodic care and living in a county where the taxpayers are 
always crying, of course, about the heavy burden of having to pay for 
health care for these individuals. And so the coverage is so impactful.
  My congressional district also trains an awful lot of medical 
personnel. As a matter of fact, at the University of Illinois of 
Chicago, we train more African American physicians than anybody else in 
the country other than Meharry and Howard. We train nurses, we train 
inhalation therapists, we train medical personnel that go all over the 
world because we have the largest medical center district in the 
country.
  And so health care is a big piece, a big part not only of the service 
but a big part of the economy. And people

[[Page 4535]]

who have never, ever before in their lifetimes had any health insurance 
at all now can feel safe, comfortable, and secure in having the 
coverage that they need.
  This legislation, in my mind, is the most impactful health 
legislation that we have seen since Medicare and Medicaid. And someone 
was asking me the other day, they said, Well, you know, the Medicare, 
the money that we spend--I said, Well, you know, there is no point in 
talking to me about Medicare. I am confident that both my mother and my 
father would have died sooner had there not been Medicare. As a matter 
of fact, my mother went 150 miles sometimes to get to the hospital so 
that she could receive dialysis for an ailment that she had.
  There are people that live all over rural America who've had no 
access to health care at all. There are people in inner-city America 
who live close to the medical center district where we have all of 
these resources; we have resources but they have no money. Therefore, 
they cannot access the resources, and they have to pass by all of these 
hospitals. They have to pass by all of these resources and know that 
they cannot access them.
  I agree with my colleagues who have suggested that that has been a 
magical piece of work. African Americans often wonder where are people 
placed. Well, it just happens that there were African Americans on all 
of the committees of Judicial--all of the committees. Three members of 
Energy and Commerce--of course you, Donna, Representative Butterfield, 
Congressman Bobby Rush, all on Emergency and Commerce; five members of 
the Congressional Black Caucus on Ways and Means. Much of the time that 
we were discussing and debating this bill, Charles Rangel was in fact 
the chairman and had a great deal to do.
  I will just mention that in addition to the health components of this 
legislation are the tremendous increases in education for minority-
serving institutions like Historically Black Colleges and Universities, 
Hispanic serving institutions, Native American institutions, 
institutions for Pacific Islanders. So comprehensively it does 
education, it does health, and it is just great. And I'm so delighted.
  Mrs. CHRISTENSEN. I am pleased to yield to Mr. Butterfield.
  Mr. BUTTERFIELD. Mr. Davis, I want to thank you so much for the 
presentation you've made. And I just really enjoy the stories that you 
tell and the way you represent the people of your congressional 
district.
  You know, all of us have unique congressional districts. We say that 
all of the time. No two Members of this House are identical. You have 
your district and I have my district, and each one is unique.
  As I travel throughout my district in North Carolina, many people 
tell me that they have health insurance but it's not worth the paper 
that it's written on. They are counted as insured; but in reality, they 
are uninsured.
  For example, a gentleman in my district told me that he has had 
insurance for more than 10 years on the job and he pays $200 a month 
out of his paycheck, but he's never used it. And when I asked him why 
he hadn't used it, he said because the deductible is $5,000 per year 
and as far as he was concerned, he is uninsured.
  I went into another part of my district and went to a dialysis 
center, and a young man there told me that he had been insured by a 
very reputable insurance company and that he needed a kidney transplant 
and his sister donated a kidney to him. And it was a successful 
transplant and it worked very well. But after 2 years, his insurance 
company stopped paying for the anti-rejection medication that he needs 
for his kidney. And he lost the kidney, and now he is back on dialysis 
and the government is paying hundreds of thousands of dollars a year to 
sustain him.
  Those are the types of stories that I hear in my district, and they 
are so sad.
  There's a minister in my district who was--he is a married man, and 
he and his wife had a family policy and they were paying $400 a month 
for insurance. And the minister was diagnosed with prostate cancer, and 
his wife was diagnosed with a neurological condition; and because of 
those two conditions, the insurance company raised the premiums for 
$400 a month to $3,500 a month, which was more than his income. Those 
are the types of stories that I am hearing in my district.
  And I want to find out if the same thing exists in urban America. I'm 
in rural America. Do you hear those types of stories in urban Chicago?
  Mrs. CHRISTENSEN. I yield to Mr. Davis.
  Mr. DAVIS of Illinois. You know, you wouldn't think it but, yes, as a 
matter of fact. Gee, I would hate to be in a situation especially at my 
age and not have health insurance and preexisting conditions be a 
factor in whether or not I could get a policy. I mean, it would 
probably be sky high, off the roof. You could never get it.
  And this is just such a great development. It's enough for us to be 
talking about for the next 5 years again.
  I want to just thank you, Donna. I really do. Because much of what we 
do is process. I mean, consent is certainly a part, but it takes hours 
and hours. It takes negotiations, interaction. You've been there all 
the way. You've been our leader on health care, and it's such a 
pleasure to serve with you and know of your tremendous dedication to 
this cause.

                              {time}  2045

  Mrs. CHRISTENSEN. I thank you for those kind words, but I can say 
without any hesitation that each one of us here this evening, in our 
own capacities, and in the committees that we serve, and in the 
subcommittees that we serve, have really put in a lot of hours and have 
really helped to shape the final product that we are so proud of having 
voted on last night. And the Congressional Black Caucus played a major 
role in shaping that.
  Congressman Butterfield mentioned Medicaid and the expansion of 
Medicaid, and we talk a lot about food desserts, but in many of the 
poor communities around this country we have provider desserts. The low 
reimbursement rates that have traditionally been paid and for Medicaid 
providers has caused hospitals and many health care providers not to be 
able to sustain practices or keep their doors open in poor communities.
  This bill will change that. We will be increasing the reimbursement 
to Medicaid providers at the same level as Medicare and hopefully that 
that will encourage more physicians and providers to come into the poor 
neighborhoods where many of the patients are Medicaid beneficiaries and 
provide the care that they need.
  You know, the turn of the 19th century one of our great 
intellectuals, W.E.B. Du Bois, spoke about the peculiar indifference to 
the poor health of African Americans in this country. And I am so 
grateful to be a part of a group of 42 individuals in the Congressional 
Black Caucus who have worked over the years, over the 40 years of our 
existence, but particularly in this last year as we have shaped this 
bill, to begin to end that peculiar indifference to the state of our 
health.
  Some of the other areas besides the Medicaid expansion and the 
improved reimbursement to providers to encourage them to come back into 
poor communities is the expansion of the workforce. We know that as the 
32 million people begin to come into the health care system that we are 
going to need so many more providers. But we are also an increasingly 
diverse society here in the United States, and so there is great 
emphasis on diversifying that workforce. I am talking here about some 
of the disparity provisions, the provisions in the health care reform 
bill that are targeted at reducing those health disparities that 
African Americans and other people of color have suffered from for so 
long. And part of reducing those disparities is making sure that we 
have a diverse workforce to work within those communities.
  So in addition to encouraging, through programs like the health care 
opportunities program and increasing funding for that, increasing 
funding for the National Health Service Corps program, which pays 
individuals 4 years of their medical tuition, in addition to increasing 
loan repayments, especially for individuals who practice in poor

[[Page 4536]]

and rural areas, we also have included provisions that provide 
additional support to institutions, minority-serving institutions, as 
Congressman Davis spoke of, the HBCUs, the Hispanic-serving 
institutions and the tribal colleges, but also any institution that has 
a history of training underrepresented minorities.
  Those professions would be for physicians, for nurses, for nurse 
educators, and there is a specific section that deals with increasing 
the public health workforce, a very important part of the workforce 
when we talk about the emphasis that we are now going to be putting on 
prevention. In addition to that, there are mental health workers for 
our communities.
  We also have grants to community-based organizations to train 
community health workers who, I think, will be the backbone of the new 
health infrastructure, especially in communities that are poor, that 
have not had good health over the years, where people from within those 
same communities will be trained to be able to do outreach and support 
to people in their communities.
  There is a provision that expands and strengthens the Office of 
Minority Health in the Department of Health and Human Services and adds 
two new offices, one in the Food and Drug Administration and the other 
one in the Substance Abuse and Mental Health Services Administration, 
two important agencies that do not have a specific office focus on 
minority health.
  And at the National Institutes of Health, where we have had a Center 
For Minority Health and Disparity Research, we now will elevate that, 
with the signing of the Senate bill tomorrow, to an institute where 
that institute will have more, more funding, to begin with, but also 
more influence over the research that's done at NIH in every area to 
ensure that the concerns and the interest and the impact on minority 
populations or any population that is experiencing health disparities 
will be considered.
  Data collection is another area that we have been able to insert 
provisions on, and not only to collect data on disease but to also talk 
about and collect data on racial ethnic minorities, gender, and to 
follow the disparities in Medicare and Medicaid, to monitor those 
disparities and to report on those disparities so that they can be 
corrected.
  I want to speak lastly about the issue of the territories. This was 
something that, of course, the delegates from all over the offshore 
areas of the United States worked very hard on, and we were very lucky, 
blessed, to have the full support of the Congressional Black Caucus, 
Hispanic Caucus and Asian Caucus, and of our leadership. We would not 
have had the inclusion in this monumental landmark legislation were it 
not for the support of our colleagues in those caucuses and the support 
of our leadership.
  So I want to especially thank our Speaker again, she has been thanked 
many times here this evening, but for her strong support and for her 
strong leadership; our Majority Leader, Steny Hoyer; our Majority Whip; 
the chairs of the committees, the relevant committees here in the 
House, Chairman Rangel and also Chairman Levin, Chairman Waxman, 
Chairman Emeritus Dingell, Chairman Miller, and all of the entire 
leadership team for giving us the support, and really the entire 
Democratic Caucus, for encouraging us and supporting us and ensuring 
that, no, we don't have full State-like treatment, as the 50 States, 
but we do have a significant increase in Medicaid and the ability to be 
included into the exchange, and I want to thank our leadership for 
that.
  We are coming close to the end of our time, and if there is no other 
issue that my colleagues want to raise, I want to thank them for 
joining me here this evening and helping to explain to the American 
people what is actually in the bill, clearing up some of the 
misconceptions and some of the misunderstandings that are out in the 
public.
  Again, we are very proud to have been a part of this process and to 
have passed the bill that we did last evening, and we look forward to 
the President signing it tomorrow.


                             General Leave

  Mrs. CHRISTENSEN. Mr. Speaker, I would like to ask unanimous consent 
that all Members may have 5 legislative days in which to revise and 
extend their remarks and include extraneous material under the 
Congressional Black Caucus Special Order on health care reform this 
evening.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from the Virgin Islands?
  There was no objection.
  Mrs. CHRISTENSEN. Mr. Speaker, I yield back the balance of my time.
  Ms. LEE of California. Mr. Speaker, I first would like to thank my 
dear friend and colleague, Doctor Donna Christensen of the Virgin 
Islands for anchoring this special order hour. I cannot think of a more 
fitting person to lead us in a discussion of health care tonight than 
Dr. Christensen, who is not only a medical doctor, but also the co-
chair of the CBC's Health and Wellness Taskforce along with Congressman 
Danny Davis of Illinois.
  Dr. Christensen has been at the forefront of our fight to ensure that 
health care reform makes significant strides toward eliminating racial 
and ethnic disparities, and achieving disparities for residents of the 
U.S. territories. Thank you, Dr. Christensen for your leadership and 
your hard work.
  I'm Congresswoman Barbara Lee of the Ninth Congressional District of 
California and chairwoman of the 42 member strong Congressional Black 
Caucus. I stand here brimming with pride and joy because of what we did 
here last night after such a long journey that began many decades ago.
  Yesterday morning members of the Congressional Black Caucus attended 
church services together, where we were reminded of the moral 
imperative to reform health care.
  Strengthened by the power of prayer we forged ahead with clarity of 
purpose, courage and determination, undeterred by the losing hateful 
rhetoric and threatening tactics of anti-health care protesters.
  Last night, my colleagues and I cast a historic and monumental vote 
to improve the health and wellness of millions of Americans who suffer 
because they are uninsured and under-insured and because of massive 
gaps in our nation's health care system.
  I spend a lot of time in emergency rooms with my 85 year old mother 
and my sister who has Multiple Sclerosis. I see these people--the 
uninsured. They are desperate. Many are hard working people who may 
have lost their jobs, or simply fallen on hard times, or have never 
even had the opportunity to make their way in society. Some of them 
can't hold a job because they are chronically ill. This is simply 
unacceptable.
  So, the members of the Congressional Black Caucus cast our votes for 
all those people who deserve health care but simply can't afford it. We 
cast our votes for our senior citizens who will see their prescription 
drug costs go down. We cast our votes for our children and 
grandchildren, so that they can live longer, fuller and healthier 
lives. We cast our votes in the memory of those people who didn't have 
preventive care and died prematurely.
  Throughout the long and arduous process culminating in the historic 
vote last night, many members of the CBC worked tirelessly to make sure 
that this bill holds insurance companies accountable and included a 
number of cost-saving provisions. We were vocal advocates for 
provisions in the bill to combat health disparities, illnesses and 
diseases that disproportionately affect our community.
  The statistics are startling, but they are clear:
  Nearly one in five African Americans (19%) is without health care 
insurance.
  African Americans in general spend a higher percentage of their 
income on health care costs compared to their white counterparts (16.5% 
vs. 12.2%). However despite spending a larger share of their income on 
medical care, African Americans face continuing health care 
disparities.
  African Americans also tend to reside in areas without hospitals or 
hospitals that have limited resources and may affect the quality care 
they offer. This is particularly a problem for hospitals in 
predominately African American communities where Medicaid 
reimbursements are low, charity cares is higher, and there is a 
shortage of health care providers who find it more difficult to 
maintain a practice.
  African Americans suffer from higher percentages of chronic diseases 
such as heart disease, kidney disease and diabetes which are 
perpetuated by a lack of access to quality care. Currently, 48% of 
African American adults suffer from a chronic disease compared to 39% 
of the general population.
  To those who suffer from those health disparities, our vote last 
night carried significance

[[Page 4537]]

similar to the passage of the Civil Rights Act in that it fulfills a 
dream that has been elusive for far too long and for far too many 
Americans.
  Among the key provisions in the legislation that CBC members fought 
to have included are:
  Expanded support for community health centers, which play a vital 
role in expanding access to preventive and other care in our nation's 
most vulnerable communities.
  Key health equity provisions: greater support for programs that will 
increase the racial and ethnic diversity in the nation's health 
workforce, as well as improved data collection so that we can better 
measure health inequities and develop solutions to end all health 
disparities.
  Strengthening the existing Office of Minority Health at HHS, creating 
new Offices of Minority. Health across HHS agencies, and establishing 
the National Center on Minority Health and Health Disparities at NIH as 
an Institute.
  Inclusion of coverage for residents of the U.S. territories, 
including a significant infusion of new Medicaid dollars, as well as 
access to the Exchange so that Americans in the territories will have 
access to affordable, high-quality health insurance plans.
  The bill guarantees transparency on rates and enables state insurance 
commissioners to recommend to the National Insurance Commissioner 
whether a particular insurer should participate in the Health Insurance 
Exchange, taking into account excessive or unjustified premium 
increases in making that determination. This will hold private insurers 
accountable, ensure affordability and help provide quality coverage for 
American families:
  Expansion of community health centers.
  This bill makes several immediate reforms that will directly improve 
the health and wellness of millions of Americans. Some of those 
provisions are:
  Offers tax credits to small businesses to purchase coverage;
  Provides relief for seniors who reach the Medicare prescription drug 
donut hole;
  Provides immediate access to insurance for Americans who are 
uninsured because of a pre-existing condition through a temporary high-
risk pool;
  Requires new plans to cover preventive services and immunizations 
without cost-sharing;
  Requires new plans to cover an enrollee's dependent children until 
age 26;
  Prohibits pre-existing condition exclusions for children in all new 
plans;
  Prohibits individual plans from dropping people from coverage when 
they get sick.
  I could go on because the list of all the good things in this bill 
are many.
  So to put it simply, this bill is a victory not only for our 
constituents, but for all Americans because it will make us a stronger 
and healthier nation.

                          ____________________