[Congressional Record (Bound Edition), Volume 156 (2010), Part 4]
[House]
[Pages 4606-4611]
[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 California (Mr. Garamendi) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. GARAMENDI. Madam Speaker, if I might spend a few minutes talking 
about an extraordinary and historic day today, the day in which America 
finally, after more than a century, has managed to achieve a program 
that will in the years ahead create universal access to health care. A 
country that has universal insurance coverage is not so far away.
  A few days ago, one of my colleagues used this quote by Martin Luther 
King to point out why this is such a historic and important day. Martin 
Luther King said, ``Of all forms of inequality, injustice in health 
care is the most shocking and the most inhumane.'' Those days are over. 
Unfortunately, Martin Luther King is not here today to see this 
historic passage.
  Earlier, 6 hours ago, President Obama signed the health care 
legislation, and in the week or days ahead the Senate will follow up 
with corrections to that legislation, and we will be on our road to 
universal health coverage in America.
  Along that road in the days ahead some very important things are 
going to happen. I received a phone call earlier today, and on radio 
yesterday was asked by a business person in the San Francisco Bay Area: 
How does this affect me? My wife and I have a small business. How does 
this affect me? And I answered this way: Are you purchasing health 
insurance now? And he said: Yes, and we can no longer afford it. We are 
going to have to drop it. We are one of those people that have been 
faced with the 40 percent increase from Blue Cross of California.
  I said, well, two things: In the years ahead, companies such as Blue 
Cross of California will have their rates reviewed as to the 
appropriateness of the increase. But that is not today. But beginning 
today, actually January 1, 2010, 35 percent of what you spend on health 
insurance will become a tax credit and subtracted directly from your 
tax obligations.
  I also received a call in the last couple of days from a rancher in 
my district. He asked: How does this affect me? I have three employees, 
part-time, but I try to buy health insurance for them. I asked him: Do 
you have health insurance for yourself and your wife? He said: Yes, 
also on the ranch policy.
  I said: It will help the same way. You will receive immediately, and 
every small business in America, 100 people or less, 100 employees or 
less will receive that tax credit of 35 percent. And in the year ahead, 
in 2011, that will increase to 50 percent.
  So the burden of purchasing insurance for small businesses, which, 
after all, are the entrepreneurial part of our economy, where most jobs 
are actually created and where most health insurance policies have been 
lost, they will receive a significant reduction in the cost of their 
insurance immediately and more in the days ahead.
  I was also asked about seniors. But before I go to that, let me just 
pick up this issue of why this is such an important day for America.
  In America of yesterday, 45,000 Americans died every year prematurely 
because they did not have health care. Our health care statistics rank 
us 19th among the industrialized nations of the world and even behind 
the nation of Colombia. This is the number of our children that die 
prematurely early in their life. Our general health, we do not live as 
long as other nations, our people die earlier, our children die more 
often.
  We have also seen an extraordinary rate increase for those of us in 
California that obtain our insurance from Blue Cross, 94 percent over 
what amounts to just a little more than a 1-year period of time.
  There was talk last summer about the death panel. Well, the death 
panel actually occurs from the insurance companies. In California, the 
average number of claims that were rejected, denied--and these are 
efforts that doctors have made to provide insurance--21 percent, one-
fifth of all claims, all requests for services were denied by the 
health insurance companies. One company actually denied 39 percent of 
them. The number of Californians without insurance is about 24 percent.
  Now let's go to the issue of seniors and think back on those words of 
Martin Luther King. The Medicare program in America was made stronger 
as a result of the legislation that was signed today. The Medicare 
program in America, its financial solvency has been extended somewhere 
between 7 years and 9 years out ahead. So all of this talk about the 
Medicare program becoming insolvent simply isn't the case any longer as 
a result of today's action by President Barack Obama--I should use my 
left hand--when he signed that legislation.
  It's an incredibly important day.
  I am also delighted to notice that I have now been joined by my 
colleague from the great State of Illinois, Jan Schakowsky, who is here 
to join me in this. And with the permission of the Chair, I would like 
to engage in a dialogue with her.
  Welcome. I know that you represent a very special part of this 
Nation. We are talking about seniors here and about the effects of this 
legislation on seniors. A couple of days ago you spoke to this issue.
  How does it affect Illinois?
  Ms. SCHAKOWSKY. Well, one of the things that I think is really 
refreshing about what is going on today, and ever since the legislation 
was finally passed, is that there is real focus on how this bill is 
going to help real people. No more the myths of if we do this, this is 
going to happen, all these mythical things I heard you talking about, 
the death panels, et cetera. But now we are having a real conversation. 
And Americans, including our seniors, are looking at, what does this 
bill really mean to me?
  Let me give you an example of the Ninth Congressional District in 
Illinois. We know that 101,000 beneficiaries of Medicare are going to 
be helped by this; that Medicare will be made stronger, including 
beginning the closing of the doughnut hole. That gap in coverage that 
can be $36,000 out of pocket, that is going to go away in this bill 
over time, and it is going to start right away.
  So what we are going to find out now, and I actually saw a poll today 
that the majority of Americans now--it's changing really quickly--say 
that they are either enthusiastic or pleased that this legislation 
passed, beating out those who say that they didn't want it or that they 
are afraid of it. And so I am so glad that we are now at this phase of 
the discussion.
  This day is really one I have dreamed about my whole adult life and 
what I have been working for for a while as executive director of the 
Illinois State Council of Senior Citizens for 5 year. So we have been 
talking about this for a long time.
  Mr. GARAMENDI. It's a happy day for America. It is a really happy day 
for America. We are on our way to solving one of this Nation's great 
problems.
  Earlier today I was in the East Room of the White House with both of 
you. Sitting next to me is an extraordinary Representative from really 
an important part of this Nation, a part of the Nation that has been 
really harmed by the economy. And we were talking about the way in 
which this legislation

[[Page 4607]]

as the President was signing it would affect her district. So let me 
call upon the gentlewoman from western Pennsylvania, Kathleen 
Dahlkemper.
  Mrs. DAHLKEMPER. Thank you so much for yielding to me.
  Pennsylvania has the second largest population of seniors in the 
country, and this legislation will go a long way to securing our 
seniors' future in terms of the benefits that they get from Medicare.
  I am so proud to be here tonight talking about this, proud to be one 
of those who voted ``yes'' and helped to make this historic legislation 
move forward. It was certainly a great day on Sunday, and it was even a 
greater day today when the President signed it into law.
  I think about the fact that as I campaigned just 1\1/2\ years ago, so 
many seniors told me about the financial problems they were having with 
this doughnut hole issue, and they would cut their pill in half or they 
would only take it every other day.
  I was with my father-in-law one day driving somewhere and I asked him 
how his diabetes was. He has got adult onset diabetes. He said, Well, 
you know I got into that doughnut hole. So one of those pills, I am 
only taking it every other day. And he was basically self-medicating. 
He was determining what he could afford, not what the doctor ordered. 
And I know that this is a problem for so many seniors.
  So we are going to close that doughnut hole, which I think is one of 
the great benefits, and we are also going to allow our seniors to get 
more preventative care without the copays, and going and getting taken 
care of themselves so they can get a better quality of life and enjoy 
those years that we hope to enjoy in our lives.
  Mr. GARAMENDI. Actually, in 2011, just 10 months from now, the 
Medicare program will provide wellness and preventative care, and it 
will not cost the seniors anything. It will be part of the program, 100 
percent paid for by the Medicare program.

                              {time}  1900

  Your father-in-law, is it, that was cutting his diabetic medicine in 
half so that he could make it through?
  Mrs. DAHLKEMPER. He was doing that. He was trying to spread it out so 
he could extend his prescription, his filled prescription longer, and 
reduce the out-of-pocket cost that he was experiencing.
  Mr. GARAMENDI. One thing that would clearly help him, beginning 
January 1, we backdate this to January 1, 2010, there will be a $250 
rebate, a check written to him. If he shows he spent $250 on that 
medication, he'll get a check from the Federal Government to reimburse 
him for that $250 that he spent once he got to the doughnut hole. 
That's an immediate benefit.
  You've got to be sure to give him a phone call as soon as you leave.
  Mrs. DAHLKEMPER. I will. He's just coming back from a trip, something 
all seniors should be able to do, go enjoy themselves and not have to 
spend everything that they have on making sure that they have their 
prescriptions.
  I want to thank the gentleman for hosting tonight. I'm just pleased 
to be here and pleased to see this legislation come forward.
  Mr. GARAMENDI. I know that you have another responsibility that you 
will soon take, and that is to preside over the House. Thank you so 
very much for joining us for these few minutes before you take the 
chair and make sure that we keep our time.
  Mrs. DAHLKEMPER. I thank the gentleman.
  Mr. GARAMENDI. Thank you.
  I notice that a woman that I have had the pleasure of working with 
now for--well, neither of us will say the total number of years, but 
she became the chair of the Senate Health and Welfare Committee in 
California when I moved out of that job to become majority leader in 
the California senate.
  I would like to now introduce and yield to Congresswoman Diane 
Watson, and then if the gentlewoman from Illinois could follow.
  Ms. WATSON. Thank you so much, Congressman John Garamendi, one of our 
newer Members; however, old in leadership, ability, ability to 
conceptualize and he saw a spot for himself in this debate.
  And I want to say, we are glowing in the aura of being in the White 
House and seeing the President, Barack Obama, sign with 19 different 
pens what is going to change the quality of health care through 
insurance for this whole country, for Americans.
  You're only as strong as your weakest link. I told them earlier today 
that the people at home who have doubts about what we did and what 
we're doing and don't really understand; the opposition always showed 
all of these hundreds and thousands of pages and people became confused 
and they really were misled. But think of somebody on a high wire and 
he's got a pole in his hands, or she has a pole in her hands, and she 
slips, or he slips, and underneath there is a safety net. If that 
safety net has a hole in it, what's going to happen? People are going 
to fall through and the end will be there. We in government are the 
safety net. We have to look larger. They say all politics is local, but 
we have to look at what we had signed into law by the President, what 
it will really do.
  And I just want to say, that mother who has a son 9 years old and has 
chronic asthma and had no way of getting him covered can now see that 
he is covered and get the kind of care that he needs.
  This is a true story. It happened in Sacramento. There was a young 
mother, a beautician. She worked, paid her rent in her little booth 
where she did hair. She had to quit and go on welfare so her son could 
be covered because he was in the hospital at least three times a week.
  Mr. GARAMENDI. He had a preexisting condition.
  Ms. WATSON. He had a preexisting condition and she could not get 
insurance coverage. That will be taken care of.
  Mr. GARAMENDI. I yield to the gentlelady from Illinois.
  Ms. SCHAKOWSKY. Unfortunately, Representative Garamendi, I am going 
to have to leave, too. But before I did, I wanted to focus on what 
happens this year for people. The physical rollout of the bill takes a 
number of years to happen. But if people are wondering what's going to 
happen this year, I wanted to just give some examples.
  Starting as soon as the bill is passed, tax credits to small 
businesses to make employee coverage more affordable. Those tax cuts of 
up to 35 percent of premiums will be immediately available to 
companies, to small businesses that choose to offer coverage to their 
employees. Of course, in 2014 the tax credits will cover 50 percent of 
the premiums. Right away. We talked about the $250 rebate to Medicare 
recipients. And also there's going to be a 50 percent discount on brand 
name drugs for people who are in that doughnut hole, in that gap in 
coverage; and the doughnut hole being closed completely by 2020.
  Ninety days later, immediate access to insurance for Americans who 
are uninsured because of a preexisting condition through a temporary 
high-risk pool. We put billions of dollars into a high-risk pool for 
people. Six months after enactment, that's when health plans are 
prohibited from denying coverage to children with preexisting 
conditions.
  Mr. GARAMENDI. That's what Congresswoman Watson was talking about, 
that young child, the mother. That child has immediate access--6 months 
from now. Let's count it up. That would be September. She would be able 
to get health care coverage for her child.
  Ms. SCHAKOWSKY. Also in 6 months, and this is going to affect 52,000 
young adults in my district alone, to require health plans to allow 
young people up to their 26th birthday to remain on their parents' 
insurance policies. At their parents' choice, of course. So that's 
pretty good for our young people.
  Mr. GARAMENDI. That's downright exciting.
  Now I've got a 24-year-old daughter. About 11 months ago, she went 
off our policy. She couldn't get insurance, even though she had been 
with the same insurance company for 23 years, and suddenly she was 
uninsurable because she was a woman in a childbearing age. Those days 
are over. She

[[Page 4608]]

can come back on my policy. We've got 52,000 people in my district, the 
same young population, that will be able to stay with their parents. 
Please continue.
  Ms. SCHAKOWSKY. That's a story in itself, why your daughter after 
having been insured with the same company for 23 years, and now 
couldn't pay for her own insurance and they would raise her rates.
  Mr. GARAMENDI. It wasn't a matter of paying. She couldn't get 
insurance.
  Ms. SCHAKOWSKY. Oh, they excluded her. Unbelievable.
  Mr. GARAMENDI. Because she had that preexisting condition called 
``female.''
  Ms. SCHAKOWSKY. Now in 6 months from the enactment of this bill, from 
today, health plans won't be able to drop people when they get sick. 
And Illinois happens to be number one in what is called rescission, and 
that's just canceling people because they go back digging through their 
records and say, uh-uh, we're going to drop your policy.
  Six months from today, health plans will not be able to have lifetime 
caps on coverage. And people who have chronic illness, they can reach 
those caps in a very few months if they get sick. And in 6 months 
tightly restrict new plans' use of annual limits to ensure access to 
needed care. These tight restrictions will be defined by Health and 
Human Services. So that's a good thing. We're going to begin to 
regulate what they do.
  And finally, beginning in January of next year, that's when the 
seniors don't have to pay any copayments for preventive services; 
exempts preventive services from any deductibles under Medicare. What a 
great thing that is to keep older adults healthy in this country.
  And also in January, what we call a medical loss ratio, that's kind 
of a fancy term for saying that insurance plans will have to spend 80 
percent of premium dollars on medical services for a small group 
market, or individual market, and 85 percent in a large group market. 
Eighty-five cents on every dollar is going to have to go to health 
care, not to bonuses or stock options for executives, but for health 
care. This is a great bill.
  Mr. GARAMENDI. What year does that kick in?
  Ms. SCHAKOWSKY. January 1, 2011.
  Mr. GARAMENDI. So it's not going to be about profit? It's going to be 
about actually providing benefits to people?
  Ms. SCHAKOWSKY. Exactly. They're going to have to pay, for individual 
market, 80 cents on the dollar has to go to health care for a small 
group, and then 85 percent for large groups.
  Mr. GARAMENDI. So those companies in Illinois and California that are 
denying claims to fatten their bottom line are going to have to 
actually provide medical services and pay for it. Oh, my goodness. What 
a shock.
  Ms. SCHAKOWSKY. That's right. But they'll be prohibited 6 months from 
now from dropping people off their policies. Those days are over.
  In some ways, we're saying to the American people now who have been 
staying up at night like those parents worrying about their children, 
Sleep well. We're actually going to solve those problems and lift this 
tremendous weight off the shoulders of Americans.
  Thank you so much for doing this. Thank you, Congresswoman Watson. I 
appreciate it.
  Mr. GARAMENDI. Thank you so very much for joining us and sharing that 
specific information.
  As you were talking about the rescission issue, 4 years ago as 
Insurance Commissioner in California, we came upon several insurance 
companies that were just doing this really to fatten their bottom line. 
It happened to be the biggest company in California, Anthem Blue Cross. 
There were some complaints brought to us, brought to others, and we 
began to investigate them when we found that there was a pattern of 
practice within that company, that when an expensive claim, when one of 
their customers became sick with something that was expensive, perhaps 
diabetes or acute heart or cancer, they would go back and comb through 
the application looking for an error that may have been made.
  For example, and this was one that was a very real example, as a 
young child, one of the people that had had their policy canceled had 
an asthma attack as a young child, probably 3 or 4 years of age, had an 
asthma attack. That was sufficient in the minds of Blue Cross Anthem to 
rescind the policy and to not pay for the very expensive care that the 
mother had incurred. Those kind of days are over. The message to the 
insurance industry is, You can no longer harm your customers. You're 
going to have to abide by your contract. You're going to have to 
provide coverage. And no longer are you going to be able to 
discriminate based upon a preexisting condition, upon sex; females, for 
example. You can no longer do those kinds of practices. Immediately, 
this year, those insurance reforms go into place and that will help 
every American that has a private insurance policy, whether you're in a 
group or you're in an individual policy, an extraordinarily important 
reform. I would have loved to have had a law like that in California 
during my days as Insurance Commissioner. We had to use other ways, 
contractual ways. We didn't have the law, we didn't have the power that 
is now given to the American people to force the insurance companies to 
behave.
  Ms. WATSON. What we failed to do, Congressman, was emphasize, this 
really is a health insurance reform.
  Mr. GARAMENDI. Yes.
  Ms. WATSON. Too many people think that we're going to change the way 
health is delivered. And I say to people when I have town halls, How 
many of you have insurance? And the hands go up. How many of you like 
your insurance? And hands come down. I say, Well, keep your hand up if 
you like your insurance. If you like it, keep it.

                              {time}  1915

  Mr. GARAMENDI. Exactly.
  Ms. WATSON. If you don't like it, and it's not meeting the needs of 
yourself and your loved ones, then you can go and shop around and find 
an insurance that is affordable. But you know what makes me just 
delighted tonight? That is that we have prevention written into this 
law. Wouldn't it be wonderful if you could go and check to be sure that 
you don't have breast cancer? That's one of the penalties, I guess, for 
being a woman. But you know, men can get breast cancer. You were in the 
legislature in California when we discovered in 1980 that breast cancer 
research was done on men. And a group of us women got together and 
said, We're not going to vote for the budget unless you have $28 
million in there to do research on breast cancer.
  Mr. GARAMENDI. I remember those days too. And I also remember what 
you were talking about a moment ago, and that is the way in which the 
insurance industry has in the past really harmed us. It's as though we 
were thrown to the sharks. We had no option. We will have a better 
option in the purchase of insurance in the days ahead. In fact, for 
those people in the 50 to 65 age group who have preexisting conditions, 
there is an insurance exchange that is immediately available to them. 
They will be part of a group, a high-risk group. They will be able to 
get insurance immediately. I think it's within 90 days they'll be able 
to apply for that insurance. Right now there's no way they can get 
coverage. They're not old enough for Medicare. They're probably 
virtually unemployable because they have a preexisting condition, and 
employers don't want to hire them because they know the insurance 
companies are going to raise the rates on everybody if they would be 
hired. So they are really in a dark hole. But this legislation provides 
a mechanism for those people in that category to get insurance in a 
high-risk pool that is actually paid for by the Federal Government. And 
that will be available this year right away.
  Ms. WATSON. If I can just describe some of the other preventive 
services that will help to keep people's stress levels down. Because 
they feel that if they have a condition, but they don't

[[Page 4609]]

have insurance, that when they go to get help, they're going to say, 
What's your insurance? I don't have one. Well, you know, I don't know 
if we can help you here. Go to the county hospital. And what people 
have to understand, when you have an organized society, everyone has to 
pay. We are only as strong, as I said, as our weakest link, and if we 
have communities where everyone is ill in that community, can we be a 
strong Nation?
  We're going around the globe. We're fighting three wars at the 
current time--or two and a half--and we're saying, Do it our way. Well, 
I tell you, Congressman Garamendi, I have actually felt shame in the 
last 3 or 4 days. The people that were out on the streets taunting, 
showing hatred, calling people despicable terms right here on the 
floor, when another Member destroyed our decorum by saying ``baby 
killer,'' and then somebody's apologizing for him.
  We're trying to show that we're this strong Nation globally, and we 
have values, and we care about people. But yeah, we spit on them. We 
call them names. We make fun of them in some way or the other. And 
sometimes it's a mental condition that has not been treated.
  Mr. GARAMENDI. Well, mental health and addiction health is included 
in the coverage in the years ahead. No longer will there be this 
division between physical health and mental health. Mental health will 
be treated the same as what is the classic physical health insurance. 
An incredibly important part of this legislation requires that mental 
health be included in the insurance program. And what family in America 
hasn't been affected with either an addiction issue in their family or 
with a mental health issue in the family? It is common to all of us. So 
the coverage will be there. We're not making any aspersions to anybody 
in our company in this building or out on the street.
  Ms. WATSON. No, no.
  Mr. GARAMENDI. But the facts are the facts that mental health is 
desperately needed, and it will be treated the same as what we call the 
physical or the normal health programs of the past. And that was 
brought to us by Patrick Kennedy, who fought vigorously over this last 
year making sure that that issue, addiction and mental health, are 
included. And if that is, go to any police station around the Nation. 
Follow the policemen in their work during the day or the night. Many of 
the calls--and I know from my own experience in California from ride-
alongs as the Lieutenant Governor, as the insurance commissioner, ride-
alongs with the police. Many of the calls--I don't know, maybe 50 
percent or more. On the day I was there, it was every call, and that 
was about five--was a mental health issue. Oh, it's Gladys. She's off 
her meds, and she causing trouble again. Or the addiction issues which 
are common. We know the prisons are filled with addicts. We need to get 
at that.
  There's also in this legislation--and you've talked about prevention. 
Some of this happens immediately, but it will take time. The research, 
the mind research--what is addiction? How do we treat it? Is there a 
way that we can treat addiction? And the mental health issues are so 
much a part of our lives. So there is an enormous amount of money that 
will go into research of all kinds that will benefit us in the years 
ahead, also including medical information technology.
  We know that mistakes in hospitals and in the doctor's office are 
often a result of scribbles on a pad of paper, trying to be interpreted 
by the nurse or the doctor who follows up in the next shift. But 
medical information technology that is readily available, where your 
information can be on a flash drive. You and I are from California. We 
get hit walking across the street here. We could have a flash drive in 
our wallets. They can plug it in at the emergency room, and they know 
everything there is to know about us without having to start at the 
beginning.
  Ms. WATSON. I'm glad you mentioned California and walking across the 
street. You must have automobile insurance if you have a license and 
you drive a car in California. Because I don't care how good a driver 
you are, there will be a time when you're going to need insurance. So 
we mandate it. Are you aware that it has been said since the bill has 
been signed that 12 States are going to come together to sue us because 
we're mandating that you have to have health insurance? Well, I can 
tell you this: if we don't require it, then you're going to pay one way 
or the other. Because you see, when that person gets hit, and they 
don't have any insurance, and they're laying out in the street, the 
ambulance is going to come. Because we are a humane society, we're 
going to pick them up, and we're going to take them to the county 
hospital or the DSH hospital because we're not going to let anyone in 
this country lie on the ground because they don't have insurance and 
die because they can't get health care. That's not the kind of people 
we are.
  But I tell you, listening to these ranters rather than reasoners, you 
know, I'm thinking, what are we turning into as a Nation? Why are 
people ranting about providing health insurance? And I want to tag 
insurance on because that's what this bill is all about.
  Mr. GARAMENDI. It certainly is. And for that unfortunate person that 
was out on the street, got hit by a car, was off to the hospital, the 
emergency room, there's a cost there. If that person doesn't have 
insurance, who's going to pay? Well, I'll tell you who's going to pay. 
It's going to be the taxpayers who pick it up, either the local county, 
or city, or the State, and the Nation will pick up that cost, or it 
will be passed on to the insurance policies and the premiums that 
everybody else pays. So those people who are not insured are getting a 
free ride, and the rest of the people that are insured and the 
taxpayers get to pick it up.
  So those days where we spread the risk--and this is insurance. I know 
insurance. I was the insurance commissioner. You spread the risk 
throughout the entire society, and the entire society shares in the 
cost of the system. That's the only fair way to do it. If you wait 
until you don't have insurance, you wait until there's an accident, you 
may go bankrupt. But the chances are that you don't have enough money 
to pay for it, and the cost is going to be shifted. So this is a 
fairness thing also.
  You spoke earlier about the attorneys general who want to seek 
Federal court repeal of this legislation. There's also Members of 
Congress who have already introduced legislation to repeal it. I'm 
going, Well, that will be interesting. What are they going to tell the 
52,000 young men and women in my district?
  Ms. WATSON. In their own districts.
  Mr. GARAMENDI. They're going to be able to stay on their parents' 
insurance for another 3 years. What are you going to do? They're going 
to get thrown off. You're going to repeal it so they get thrown off? 
And what about those seniors who are going to get $250 and a closing of 
the prescription drug doughnut hole? You're going to tell those seniors 
that, Oh, sorry. We've decided to repeal that, and you're going to have 
to continue to pay for that out of your pocket. And by the way, the 
discount on the generic drugs, that's gone away. After all, the drug 
companies don't have enough profit yet so they deserve to have more 
profit. Is that what you want? I don't think so. I don't think the 
public wants that. And I don't think that that rancher who contacted me 
about providing insurance for himself, his wife, and for his three 
part-time people is going to be happy to learn that the 35 percent 
credit on the money he spends for insurance, and in a couple of years, 
the 50 percent reduction in the cost of health insurance for him, I 
don't think he's going to be too happy. Or those 50- to 65-year-old 
people who are sick with a preexisting condition who are uninsurable 
and under this legislation will be able to enter a pool to get 
insurance, a high-risk pool that will pay for their insurance, they're 
not going to be happy.
  So for those who want to repeal this, let's keep in mind what this 
legislation actually does. This law provides access to insurance, high-
quality insurance for men, and women, and children. But

[[Page 4610]]

I forgot to talk about all those children who have preexisting 
conditions that will in 60 days be able to get insurance. This program 
is a fundamental change and takes America to a new higher plateau of 
justice.
  Talk about repeal. When the American public comes to understand what 
is in this--with all of the fearmongering aside, with all of the 
rhetoric about ``kill the bill'' aside--when they come to understand 
what's in this bill, it will not be repealed.
  Ms. WATSON. Why would we in this House allow the repeal of something 
that we did with so much pride?
  Mr. GARAMENDI. Well, we won't.
  Ms. WATSON. And if it got out of this House and got to the other 
House, why would they--when they had people sign on to a letter that 
they would pass it--and what would influence the President of the 
United States to sign that bill? So I think what's happening is that 
it's just an opportunity for opposition to be heard again and continue 
with the devastating misstatements that they're giving to people. You 
know, it really troubles me that people--well, I guess it's the mob 
mentality--can buy that. And that's why it's so important that we do 
what we're doing tonight to try to set some reality.
  We talked about mental health. Do you remember, we were walking into 
the Rayburn Building early this morning after we came back, and there 
was a gentleman there with fatigues on, and he got up and saluted? And 
I said, That's an intelligent man. But like in California and under the 
Reagan administration, they closed many of the DD centers, mental 
health hospitals, and there were some who wanted to sell off that 
property with the promise of sending the mentally ill out to be treated 
in their own communities and that the money would follow. Well, the 
money never followed. In my city on any given night, there are 80,000 
to 90,000 homeless people. And if you were to go through on the 
streets, if you were to go through that group, you will find that out 
of 10, 6 of them are in need of mental health treatment.
  Well, we did something a few months ago; we increased the budget for 
veterans and their mental health--thank goodness. Now this will follow. 
And that gentleman that saluted us as we went in, he can get the kind 
of help he needs and get off the streets. It's obvious that there's a 
great deal of intelligence there. He just got a bad deal.
  Mr. GARAMENDI. If I might, your discussion reminded me of the 
community clinics in your district of Los Angeles, in my own district, 
and throughout the State of California and other States that provide 
the safety net service for those people that are homeless, those people 
that are in need, those people that are low income or unemployed. In 
this legislation, there is an extremely important increase in the 
safety net services in three different ways.

                              {time}  1930

  First of all for the community clinics spread throughout the Nation, 
there is $11 billion over the next 3 years that will go to those 
community clinics so they can expand the services for those people that 
are low income, unable to have insurance right now; but in 3 more 
years, they will have that insurance. It will bring up the community 
clinics so they can meet the needs that exist today. That money will 
begin to flow out to the community clinics, and in my district, in 
Contra Costa County, Alameda, Solano and Sacramento counties, it will 
result in enough money to build 10 new clinics in areas that are 
desperate for medical services.
  Ms. WATSON. You know that, in California, 85 percent of our land is 
agricultural, and sometimes people are great distances away from the 
delivery of quality health care. Now we are going to have a whole 
system of clinics where they can go. I am just so thrilled because we 
emphasize prevention. We are even going to increase Pell Grants so 
students can get larger amounts of money to stay in school and become a 
general practitioner to take care of these people and see them on a 
regular basis to keep them from going into the hospital.
  You know, one of the areas that we really haven't dealt with is long-
term care. We haven't solved that problem yet, but we hope we can keep 
people healthy and keep them from having the need to have long-term 
care. We want to keep our seniors--and in California we receive a lot 
of them because they are bypassing the overindustrialized States, even 
Florida and Texas, and they are coming to us. Many years ago we 
increased the benefits under Medi-Cal. We have our own system, and 
while I was there, it was many years ago, we increased the benefits up 
to maybe 32 to 34 that were not required in law. Now we are saying 
let's emphasize the front end and keep people out of acute care 
facilities by keeping them healthy.
  Mr. GARAMENDI. There are specific provisions in the legislation that 
expand the programs for long-term care. We have gone on for some time 
now, and I would like to do two more things, if you will join me. I 
would like to review what we have done. But before we get to that, I 
will review what is in the legislation. But before we get to that, 
somebody is going to ask, How are we going to pay for it?
  Well, this piece of legislation is fully paid for. It is paid for in 
a variety of ways. Part of that pay-for comes from a significant 
reduction in the unnecessary bonus that the insurance companies get for 
providing Medicare Advantage programs. This has been the great scare 
tactic, that Medicare benefits would somehow be cut. Absolutely not. 
There is a specific line in the bill that says Medicare benefits will 
not be cut. What is cut is the unnecessary bonus that the previous 
administration gave to the insurance companies to do what they should 
have done without having that bonus. It is a 16 percent additional 
bonus over and above the cost. We get that money back. We plow that 
money back into Medicare, and we will be certain that the Medicare 
programs will not see a reduction in benefits. That's one way.
  Also in this program, for those people that for years and years have 
been able to get a free ride, there are tax increases in the outyears 
for income earned on those people who have $200,000 or more of income, 
and have income from stocks, bonds, dividends, and capital gains. They 
have been getting a free ride since Medicare came in some 43 years ago, 
so that will be the other way. And then there are savings in the 
legislation. The bottom line is that the program is totally paid for.
  And let's talk about the deficit.
  Ms. WATSON. It reduces the deficit. I wanted to say that. This will 
be the largest deficit reduction measure in 17 years and will cut the 
deficit, get this, by $148 billion; $148 billion over the first 10 
years and $1.2 trillion over the next 10 years.
  And small businesses--and that is what killed the Clinton proposal, 
universal health care. They said it would kill small business. This is 
what we do: Small businesses will receive $40 billion in tax credits to 
make it easier for them to provide coverage for their workers.
  Mr. GARAMENDI. That is the 35 percent credit that we talked about. In 
my district, I have 14,500 small businesses that will qualify for that 
if they are purchasing health insurance for their employees. It is an 
encouragement to purchase health insurance by reducing the cost by a 
third, and in 3 years out, it will be a 50 percent reduction in the 
cost of insurance for those small businesses.
  Ms. WATSON. Now that the bill is signed into law, we probably should 
have town hall meetings like this so people will actually know. You 
have these very fine charts, and I am going to let you take the rest of 
the time to let folks know what we did when that bill was signed.
  Mr. GARAMENDI. Let's run through it very, very quickly.
  Small businesses' tax credits, we talked about that; 35 percent right 
now beginning January 1, carrying on, and eventually in 2014, going to 
50 percent.
  Ms. WATSON. Do you think you might be able to hire some people to 
work? It is jobs, jobs, jobs.
  Mr. GARAMENDI. Exactly, and small businesses are where the job 
creation is.

[[Page 4611]]

  We talked a lot about the Medicare program, the doughnut hole on part 
D, $250 for those senior citizens that are currently in the doughnut 
hole with their drugs. They are going to get a $250 rebate, a check 
from the government to help them, and we begin to shrink the doughnut 
hole, and in the years ahead, it will disappear.
  Ninety days from now, this would be in June, there is an immediate 
help for the uninsured in the exchange. This is what we were talking 
about. These are those who have a preexisting condition, those 50 to 
60, 65 years old, they will be able to enter into a temporary, high-
risk pool, and eventually, in 2014, they will be able to purchase 
insurance through the purchasing exchanges.
  Six months, September 2010, no discrimination against children with 
preexisting conditions. Think of that child. You talked about that 
child, the mother who had a child with diabetes, uninsurable. At birth 
with a birth defect, cannot get insurance, but in 6 months, in 
September 2010, those children will have access to insurance. The 
insurance companies cannot deny coverage.
  This is the one--I only wish this was a year ago, but maybe my 
daughter can get back on--52,000 young adults in my district will be 
able to stay on their parents' insurance policies beginning September 
2010. This is good news for a whole lot of kids throughout America.
  We talked about rescission. We talked about the way in which the 
insurance companies go back when there is an expensive case and find 
some excuse to dump the individual from the insurance policy and then 
the individual is left with the cost. Those days will be over in 
September 2010.
  Lifetime limits. September 2010, lifetime limits, no longer will an 
individual blow through the lifetime limit on an insurance company and 
be left totally to themselves. This is the reason we have bankruptcies; 
65 percent of bankruptcies are a direct result of medical issues, and 
those people have insurance.
  Ms. WATSON. Let me just interject this here at this point. The public 
needs to know that if you are insured under this program and you are 
sick and you can't work, your insurance will cover you. Too many 
people, as you've said, have gone bankrupt because they had to borrow 
on their homes and they couldn't repay what they borrowed and they are 
sick and can't work.
  Mr. GARAMENDI. Well, those days are going to be over. September 2010, 
the lifetime limit on health insurance, over. And restrictions are 
placed on a descending amount of the annual limits and those eventually 
phase out in 2014. So annual limits are gone in 2014, and they begin to 
phase out beginning September 2010.
  Effective January 1, 2011, 9 months from now, free preventive care 
under Medicare. You have talked about prevention. January 1, senior 
citizens, free prevention care. How important that is, keeping them 
healthy. And also the issue of what are the insurance companies doing 
with the premiums we pay. Beginning January 2011, 80 percent of those 
premiums are guaranteed to go for medical services, not for profit, not 
for bonuses to the high and the mighty of the insurance companies, but 
rather, and this is the individual market, but rather for medical 
services, and in large group markets, employers, 85 percent. So for 
those big shots in the insurance industry that have been receiving 2, 
3, 4, and even greater, million-dollar bonuses, I'm sorry, only after 
you pay for the services that your customers have contracted with you 
to provide. The days of rescission are over.
  It was a glorious day today as we sat there in the East Room of the 
White House, after all of the work that has been done for more than a 
century by Presidents from Theodore Roosevelt, Democrat and Republican 
Presidents, by men and women in previous Congresses, by you and the 
others who were here in the early days of this year, finally, a 
fundamental change for the better for America's health, for the men and 
women and children in this Nation. It is a good day, and what a 
privilege for all of us to be part of that this day.
  Ms. WATSON. You know what? These people who got elected and feared 
that an ``aye'' vote on this would really harm them, they don't belong 
here, because if you can't make a vote for the greater good of society 
and go back to your district and explain it to your constituents, you 
don't belong here. What I have been saying, what we did in the last 48 
hours was for the greater good of America and not just a select few.
  So, Congressman, I want to thank you for the opportunity to again 
have this period with you, and I am going to strongly suggest when we 
are in our caucus that we go back now and hold those town halls and lay 
it out like you have done this evening, and I want to thank you for 
that.
  Mr. GARAMENDI. Thank you for joining us, and I thank my other 
colleagues for joining us.

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