[Congressional Record (Bound Edition), Volume 156 (2010), Part 4]
[House]
[Pages 5136-5149]
[From the U.S. Government Publishing Office, www.gpo.gov]




          HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 2010

  Mr. GEORGE MILLER of California. Mr. Speaker, pursuant to House 
Resolution 1225, I call up the bill (H.R. 4872) to provide for 
reconciliation pursuant to Title II of the concurrent resolution on the 
budget for fiscal year 2010 (S. Con. Res. 13), with the Senate 
amendments thereto, and ask for its immediate consideration.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore (Mr. Capuano). The Clerk will designate the 
Senate amendments.
  The text of the Senate amendments is as follows:

       Senate amendments:
       On page 118, strike lines 15 through 25 (and redesignate 
     subsequent subsections accordingly).
       On page 120, strike lines 3 through 5.


                            Motion to Concur

  Mr. GEORGE MILLER of California. Mr. Speaker, I have a motion at the 
desk.
  The SPEAKER pro tempore. The Clerk will designate the motion.
  The text of the motion is as follows:

       Motion offered by Mr. George Miller of California:
       Mr. George Miller of California moves that the House concur 
     in the Senate amendments.

  The SPEAKER pro tempore. Pursuant to House Resolution 1225, the 
motion shall be debatable for 10 minutes equally divided and controlled 
by the chair and ranking minority member of the Committee on Education 
and Labor.
  The gentleman from California (Mr. George Miller) and the gentleman 
from Minnesota (Mr. Kline) each will control 5 minutes.
  The Chair recognizes the gentleman from California.

[[Page 5137]]




                             General Leave

  Mr. GEORGE MILLER of California. Mr. Speaker, I ask unanimous consent 
that all Members may have 5 legislative days in which to revise and 
extend their remarks and insert extraneous material on H.R. 4872.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. GEORGE MILLER of California. Mr. Speaker, at this time I yield 2 
minutes to the gentleman from New Jersey (Mr. Andrews).
  Mr. ANDREWS. Mr. Speaker, I thank my chairman for yielding.
  When you take your son or daughter to the emergency room, and you're 
sitting and waiting in the emergency room, you have a lump in your 
throat, and you're hoping and praying that when the doctor comes back, 
the news will be that it's just food poisoning and not a malignancy in 
your son or daughter's stomach. For many Americans, that joyous moment 
is followed by another lump in their throat, because even though you've 
got the joyous news that your child is okay, you can't pay her bill 
because you have no health insurance. And so many of those Americans 
for so very long, since the days of Theodore Roosevelt, have looked for 
the answer. What the President signed on Tuesday and what we do tonight 
will finally give them that answer.
  We will finally say that Americans who wait on tables and pump gas 
and clean our offices at night will finally have the ability to go home 
and not only thank God for the fact that their child is better but be 
thankful for the fact that they live in this country where every 
American finally has affordable access to health insurance. That is our 
mission here tonight. Vote ``yes.''
  Mr. GEORGE MILLER of California. I reserve the balance of my time.
  Mr. KLINE of Minnesota. Mr. Speaker, at this time I yield myself 2 
minutes.
  It has been suggested that today's action will be the final word on 
the health care debate that has consumed the attention of Washington 
and America for more than a year. I would suggest instead that much 
remains to be said and seen. The ink is hardly dry on the Democrats' 
government takeover of health care, but already we are seeing its 
devastating real-life consequences.
  We discovered a loophole that leaves many young adults out of the 
reach of their parents' insurance coverage, despite the President's 
pledge that they will receive care today. We learned there is a gap in 
the law that allows insurance companies to continue denying care to 
children with preexisting conditions. Again, despite the President's 
claim to the contrary. And reports continue to document what this 
legislation has in store for workers at companies like Caterpillar, 
John Deere, Verizon, and many others. Here's what they're telling us to 
expect: $100 million or more in compliance costs this year alone for 
just one of these companies, major changes to workers' current health 
care coverage, and higher taxes, which will mean higher costs for 
consumers.
  These announcements arrived just days after the President signed his 
health care plan into law. We can only imagine what's in store for the 
American people as the weeks and months unfold and we begin to 
experience the full impact of the government control over one-sixth of 
our economy. These revelations are the obvious consequences of jamming 
a flawed bill through a flawed process. Mr. Speaker, a flawed bill 
jammed through a flawed process guarantees the health care debate will 
go on.

                              {time}  2030

  The American people have rejected a government takeover of health 
care, so let's reject this latest fix of the bill. Let's show the 
American people we will not accept even more job-killing tax hikes at a 
time when almost 15 million Americans, 15 million Americans are looking 
for work.
  Let's show the American people we will not accept even steeper cuts 
to Medicare that will leave millions of seniors less secure.
  Let's show the American people we will not exploit this economic 
crisis to launch a government takeover of student loans or take $9 
billion from students to help fund government-run health care.
  Let's show the American people we're ready to do better. Let's vote 
``no.''
  And now, Mr. Speaker, I am pleased to yield 2 minutes to the Chair of 
the Republican Conference, the gentleman from Indiana (Mr. Pence).
  Mr. PENCE. Well, here we go again. Last Sunday, defying the will of a 
majority of the American people, House Democrats rammed their health 
care bill through the Congress chock full of Big Government spending 
mandates and backroom deals. Now we're being asked to fix the bill by 
passing some sort of reconciliation measure.
  But, Mr. Speaker, the bill before us tonight doesn't fix anything. It 
doesn't fix the fact that this is a government takeover of health care 
that's going to mandate that every American buy health insurance 
whether they want it or need it or not. It doesn't fix the fact that it 
includes about $600 billion in job-killing tax increases in the worst 
economy in 30 years. It doesn't fix the fact this bill provides public 
funding for elective abortion for the first time in American history.
  Mr. Speaker, the American people know there's no fix for ObamaCare. 
We need to repeal this law and start over. If we repeal ObamaCare, we 
can start over with commonsense solutions at a lower cost and create 
jobs. If we repeal ObamaCare, we can enact medical malpractice reform, 
use the savings to cover Americans with preexisting conditions, and 
promote pro-life protections in the law. If we repeal ObamaCare, we can 
reform health care in this country without putting our Nation on a 
pathway towards socialized medicine.
  I urge my colleagues in both parties, heed the voice of the American 
people. Reject this attempt to fix a government takeover of health 
care. Work with us to repeal and start over on health care reform that 
reflects the common sense and the common values of the American people.
  Mr GEORGE MILLER of California. Mr. Speaker, I continue to reserve.
  Mr. KLINE of Minnesota. Mr. Speaker, before I yield to the 
distinguished Republican leader, can I ask the chairman of the 
committee to confirm that he is the last speaker and will be closing? 
All right.
  Then, at this time, I am very pleased to yield the remainder of our 
time to the distinguished Republican leader, the gentleman from Ohio 
(Mr. Boehner).
  Mr. BOEHNER. Mr. Speaker, the American people are asking: Where are 
the jobs? But as we see today, the issue of government-run health care 
will continue to be the focus of this body. It will remain the focus of 
this body because of the unilateral, secretive, rushed process that's 
been used to force this bill on the American people.
  Today we're passing legislation to correct major errors in the 
massive bill that was signed less than 72 hours ago. It removes some, 
just some of the special interest deals that were loaded into that bill 
as it moved through Congress.
  And to meet the majority's targets for deficit reduction, it adds 
more tax hikes on the American people and cuts more money from Medicare 
to pay for a new entitlement program. We could have given the American 
people a more commonsense bill that lowers the cost of health insurance 
in America without all of this mess.
  If you had wanted to pass reforms to ensure coverage for Americans 
with preexisting conditions and ensure that parents can keep their 
children on their health plans through age 25, you could have done so 
in a bipartisan fashion. Instead, you decided to jam through more than 
the system could handle, leaving us a sloppy mess that the majority of 
the American people believe should be repealed and replaced.
  And mark my word, we will be back to this bill over and over again in 
the next 6 months. You all know what's going to happen. We'll be back 
here to correct the mistakes that we didn't do

[[Page 5138]]

right the first time because of the rush that we were in to approve 
this massive spending bill that was hidden from the original bill.
  And I'll guarantee you, you all know we'll be back here to do a ``doc 
fix'' that will cost $250 to $300 billion. And the question is: Will we 
find the money to pay for it?
  We'll be back here to appropriate money for a new IRS group of 
individuals that we're going to need to hire to enforce this law on the 
American people.
  We'll be back to borrow money to lend to the States to pay for 
increased costs as their Medicaid rolls begin to swell.
  And then we're going to find the empty promises that were made to the 
American people, because most doctors don't take Medicaid patients. And 
so we're going to put all these new people on Medicaid, yet, how are 
they ever going to find a doctor?
  We'll be back to fix the protections for TRICARE benefits for active 
duty and retired servicemembers, veterans and their families that 
somehow got left on the cutting floor.
  And we'll be back to deal with the unintended, but certainly 
anticipated, consequences of people losing their health care because 
this bill makes it too expensive for employers to keep employees on 
their health plan.
  Several weeks ago, more than 130 economists signed a letter to 
President Obama warning that the health care bill that was being pushed 
through Congress would cost Americans jobs, and sadly, we're already 
seeing evidence that those economists were right.
  In just the last 3 days, we've seen the stories. Major employers like 
Caterpillar and John Deere talking about increases of $250 million in 
their health care costs. Medical device companies in Massachusetts 
talking about thousands of jobs being wiped out. The tourism industry 
in New Hampshire facing millions of dollars of fines because it hires 
seasonal workers.
  We're going to have to come back and fix this bill time and time 
again in the coming weeks and months to correct all the flaws and all 
of the mistakes.
  What we should be doing is working together to create a better 
environment for America's small businesses to invest, to save, and to 
rehire American workers. But, no, instead we're going to keep coming 
back here fixing the flaws in this very flawed bill.
  Mr. Speaker, when are we going to address the number one issue on the 
minds of our fellow citizens, and that is the question of where are the 
jobs? When are we going to focus on the economy and getting people back 
to work instead of all of the job-killing policies that we're seeing 
move through this Congress? When are we going to begin to listen, once 
again, to the American people who sent us here to do their work?
  Because the American people are asking the question: Where are the 
jobs?
  Mr GEORGE MILLER of California. I yield myself the balance of my 
time.
  Mr. Speaker, I rise today in support of this legislation, the last 
leg of a long journey to bring historic health insurance and student 
loan reforms to the American people.
  Two days ago President Obama made our first piece of groundbreaking 
health reforms the law of the land, a remarkable moment that will 
benefit millions of American families and small businesses. Our health 
insurance reforms and student loan reforms are truly historic.
  But the benefits for Americans start right now. And with this law, we 
make college more affordable and health care available to all 
Americans. That's what we promised we would do, and that's what we did.
  We voted to do what's right for the American people, not for the 
insurance companies. Our reforms responded directly to what we have 
been hearing from families and small businesses who are getting crushed 
by today's broken and unsustainable health insurance system.
  Our reforms respond to what we've been hearing from millions of 
students and families, working very, very hard to try and pay for 
college. And that's what we're voting on today. We're voting to make 
student loan payments more manageable for new borrowers, to strengthen 
community colleges, to invest in minority-serving institutions, to 
embolden the programs to help students succeed at gaining a college 
degree, and to reduce the deficit by $10 billion.
  We're voting to restore faith in the American Dream, to ensure 
quality affordable insurance for all Americans, and to invest in 
students and in our economy's future strength. That's what Democrats in 
Congress and President Obama are doing for the American people this 
year.
  I want to thank Speaker Pelosi, Majority Leader Hoyer, Majority Whip 
Clyburn, and our entire leadership team for their tremendous work on 
this matter.
  I want to thank Chairmen Waxman, Levin, and Slaughter; the Dean of 
the House, John Dingell; Representatives Rangel, Andrews, Pallone, and 
Stark for their outstanding contributions to this effort. And I want to 
thank my counterpart in the Senate, Senator Tom Harkin, for joining me 
on insisting on doing what's right for our families and our students.
  Tonight we have the ability to put in the hands of every American 
family health security and a more affordable opportunity to have their 
children achieve a college education. That's the road to prosperity. 
That's the road to freedom for America's families, for our students, 
for our economy, and for the future of this country.
  Join me tonight to vote ``aye'' for our families, for our small 
businesses, and for America. Vote ``aye'' tonight.
  Mr. CONAWAY. Mr. Speaker, today may well mark a great victory for 
President Obama and the Democratic Leadership of Congress. After months 
of bitterly partisan debates, massive protests, and wrenching 
arguments, it appears as though they finally have the votes to bend an 
unyielding electorate to their will and pass the most massive expansion 
of the Federal Government in two generations. Yet, a victory today 
would be a pyrrhic victory; the costs of implementing their vision for 
the future of American health care will bankrupt our treasury and rob 
us of our liberty.
  Make no mistake, the Democrat's plan pushes our Nation down a path 
from which there is no easy retreat. The changes imposed by this plan 
fundamentally renegotiate the relationship between the Federal 
Government and the citizens of our country, making Americans look first 
to Washington to secure their health care. This bill is sweeping in 
law, but revolutionary in spirit. I believe that this legislation will 
be the beginning of the end of our grand American Experiment.
  Many of my colleagues and I have discussed the staggering costs 
imposed by this legislation. In fact, it might be the single most 
expensive piece of legislation ever passed in the history of our 
country. Although supporters like to point out that the Congressional 
Budget Office scores this bill as one that reduces the deficit, more 
realistic Members will note that CB0 does not have particularly good 
marks in predicting the cost of legislation. Most recently, the CB0 was 
off by almost 10% on the final cost of the Stimulus bill, 
underestimating its final cost by some $80 billion.
  This bill, like Social Security, Medicare, and Medicaid before it, 
creates yet another massive expansion of government without a 
definitive price tag. One need not do complex arithmetic to see how 
underestimating the cost of this bill by 10% would cost us at least an 
extra $100 billion over ten years. Unfortunately, by the time we 
discover our error, it will be too late: the promises will have been 
made, the money will have been borrowed, and the checks will have been 
drawn.
  It should come as a surprise to no one that we will pay for this bill 
by borrowing. With massive deficits projected far into the future, the 
cupboard is bare. We have no money to pay for this spending. We will 
borrow it and continue to help ourselves to the fruits of our 
children's future.
  Yet, even the vast scale at which this bill borrows money and 
transfers wealth, this pales in comparison to the rate at which this 
legislation borrows our liberties and transfers authority to 
Washington. With each new board, commission, mandate, and tax, we 
surrender a small part of the authority we each hold over our own 
affairs to Washington.
  The Majority's bill will raise taxes, hand down mandates, and further 
our culture of dependency on Washington. Granting ever more authority 
to the Federal Government will continue to sever the community bonds 
that hold

[[Page 5139]]

America together. Each time we make Washington responsible for part of 
our welfare, we become just a little less concerned about the plight of 
our neighbors. Their trials and tribulations become something someone 
in the Federal Government should do something about. Unfortunately, it 
turns out that in Washington someone and something too often means no 
one and nothing.
  My constituents understand that a full accounting of the costs of 
this bill cannot be made unless we include the intangible costs. While 
many before me have recounted the massive financial charge this bill 
will toll, our freedoms and our liberty will also be diminished by this 
bill.
  The Majority's plan offers a pathologically Washington-centered 
vision of America and its passage forces us to look not first to 
ourselves, our families, and our communities for support, but rather to 
the Federal bureaucracy. This bill will force Americans to lobby the 
Federal Government on every aspect of their health care. We will lobby 
in Washington for access to medicine, procedures, and tests; our 
doctors will lobby in Washington for better payments for services 
rendered; our insurance companies will lobby in Washington for the 
right to charge higher rates; and our families will beg in Washington 
for more subsidies.
  No one on my side of the aisle disputes that individuals have a moral 
obligation to help those around who are less fortunate than they are. 
In fact in 2008, private individuals and American companies gave over 
$300 billion dollars--over 2% of GDP--to charitable causes, $21 billion 
of which went to organizations involved in health care. This personal, 
private giving is one of the hallmarks of our unique American ethos--we 
take care of our own.
  The Democrat's sweeping health care plan will destroy this core 
American value and replace it with one of subservience and deference to 
the governing elites. This bill goes well beyond simply assisting the 
poor among us. It subsidizes middle class families with billions of 
their own tax dollars. It is a vast engine of good intentions that 
transfers wealth from one pocket to the other, all while binding us 
ever tighter to a bureaucracy that will care for itself before the 
American People.
  Undoing the wrongs unleashed by this legislation will consume the 
American People and this body far into the future. This November, each 
Member of this House will appear before their constituents to be judged 
on how well they have represented their constituents over the past two 
years. Without a doubt, this health care vote will be forefront in 
their minds. Some of my Democratic colleagues have said they relish the 
idea of being judged on their support for this legislation. I suspect 
that the American people will be all too happy to oblige them.
  Mrs. CHRISTENSEN. Mr. Speaker, this is the last leg of the health 
care triathlon--three committees over here; our bill, the Senate bill 
and the White House plan; our passing ours, the Senate theirs and here 
we are for the finish.
  And for me this is a very important part.
  The Senate bill has many important provisions, some like no exclusion 
for preexisting disease for children, building our health care 
workforce and its diversity, expanding community health centers and 
community health workers, a strong CER provision, and very importantly 
the expansion of the Office of Minority Health, and the elevation of 
the Center on Minority Health and Health Disparity Research to an 
Institute at NIH.
  But it is here that Medicaid is expanded, the exchange is set up and 
the subsidies provided. It is here that we really begin to close the 
donut hole and that all of the insurance reforms are finalized.
  Very importantly for me and my constituents and all of the 
Territorial Americans, this is where our Medicaid cap is greatly and 
finally lifted, and that we are given access to the exchange.
  This is not full parity but it is a major step forward towards 
inclusion of loyal American citizens who live in the off shore areas 
that are an integral part of the United States. It will give access to 
many more of our constituents and enable us to provide prevention and 
services that we intend to use to create a healthier community and a 
better quality of life.
  Thank you again to our President, Speaker Pelosi, Leader Hoyer, Whip 
Clyburn and chairmen Rangel, Waxman and Miller, as well as my fellow 
territorial delegates who all worked so hard and together to make this 
day a reality.
  As has been said, this bill is not perfect, and this is a major step 
but just a first step in all that has to be done to create equity and 
justice in our health care system. We ask our colleagues to give the 
reconciliation bill a big yea vote, and begin a new, better day for our 
citizens and our country.
  Mr. HASTINGS of Florida. Mr. Speaker, when President Harry Truman 
first lobbied for health care reform, he could not have envisioned that 
it would take six decades for Congress to finally have the courage to 
make health care reform more than a cliche in the American lexicon.
  If this bill passes, it will mean that the 46 million Americans who 
have zero health care or who cannot afford what they do have, or who 
suffer at the mercy of chronic illnesses like diabetes, will finally be 
able to see a doctor. The over 30 percent of my constituents in South 
Florida who have no health insurance will no longer have to choose 
between buying food and purchasing their medicine.
  This historic legislation will mean improving Medicare benefits with 
lower prescription drug costs for those in the ``donut hole;'' 
providing better chronic care and free preventive care--including 
prenatal care for working mothers; making significant new investments 
in comparative effectiveness research and health information 
technology; and reducing the deficit by $138 billion over the next ten 
years.
  In the words of Dave Snow, CEO of Medco, whose subsidiary Liberty 
Medical, a health care company near my district that helps Americans 
manage their diabetes, so eloquently stated: ``Forty-six million 
Americans live every day without the security and peace-of-mind that 
come with having health insurance.'' This bill ends that now.
  Mr. Speaker, after months of discussion and indecision, the moment 
that matters is now. I applaud my colleagues who refuse to yield to the 
fear-mongering tactics that many have used to scare us out of doing the 
right thing at the right time.
  Mr. LANGEVIN. Mr. Speaker, I rise in support of the Patient 
Protection and Affordable Health Care Act (H.R. 3590), with the 
accompanying changes in the reconciliation bill. This Congress is being 
given a once-in-a-lifetime opportunity to fix a broken health care 
system that has left millions of families without the coverage and care 
they deserve.
  If we seize this opportunity tonight, we can ensure that tomorrow, a 
working mom in West Warwick will wake up knowing she can afford her 
family's health coverage; a dad in Providence will wake up knowing he 
can take his daughter to the doctor when she is sick; a small business 
owner in Westerly will wake up knowing he can finally give his 
employees the coverage he always intended; and a cancer survivor in 
Narragansett will wake up knowing she won't lose her insurance because 
of a pre-existing condition or a lifetime cap.
  Since coming to Congress in 2001, I have tirelessly advocated for 
fundamental changes to our health care system, and my constituents have 
demanded solutions. I have heard from Rhode Islanders who are 
struggling to pay their health care premiums, and from small business 
owners that can no longer afford to cover their employees. Families who 
are fortunate enough to have access to health insurance continue to 
face ever-increasing costs, while many of them are afraid they will 
lose their benefits altogether.
  Tonight, we begin to institute the changes necessary to provide 
security and stability to Rhode Islanders who have health insurance, 
guarantee coverage to the thousands who don't, and lower health care 
costs for our families, businesses and taxpayers.
  Beginning immediately in 2010, this landmark legislation will end 
abusive health insurance practices that prevent people from purchasing 
and maintaining their coverage when they are sick; it will ban yearly 
and lifetime insurance caps, so individuals with chronic, disabling 
conditions don't lose coverage and end up in bankruptcy; and it will 
require all insurers to reinvest more of our premiums back into health 
coverage through a ``medical loss ratio'' of at least 80 percent, 
ensuring that no more than 20 percent of our premiums go toward 
administrative expenses and windfall profits for insurance executives.
  After this bill is signed into law, it will strengthen coverage for 
young people by allowing them to remain on their parents' insurance 
policy until they are 26 years old. It will help our seniors by 
starting to close the Medicare prescription drug ``donut hole'' so they 
can afford their medications. It will also provide immediate tax 
credits for small businesses to make optional employee coverage more 
affordable. These are only some of the changes that will take effect 
this year to make insurance coverage more accessible and affordable for 
everyone.
  Over the longer term, this legislation will build on the strengths of 
our current employer-based system by offering tax benefits to small 
employers and encouraging businesses who offer their own coverage to 
continue doing so. Rhode Islanders who don't have coverage through 
their employer will be able to shop for their choice of a health plan 
through a new

[[Page 5140]]

``health insurance exchange,'' modeled after the tried and true Federal 
Employees Health Benefits Program, which has successfully provided 
coverage for over 9 million federal employees, retirees and their 
dependents, including members of Congress.
  Unlike the limited options that are available to most consumers 
today, the exchange will provide a more convenient, transparent and 
affordable way to choose among a variety of health plans that meets 
individual needs. People who cannot afford to purchase coverage within 
the exchange will receive financial assistance to ensure that they can 
obtain the coverage that meets their needs.
  Small business owners will reap significant benefits from this 
measure, both through immediate tax relief and the insurance exchange, 
which will allow them to band together and get the same lower rates as 
big companies. Small businesses are the back bone of the Rhode Island 
economy, and preventing triple-digit rate hikes is important to 
jumpstarting employment in our state.
  Improving access to coverage will also require investments in our 
health care workforce. Currently, our system is strained by a lack of 
nurses and primary care physicians, particularly in underserved areas. 
That is why this bill strengthens important workforce development 
initiatives like new scholarships and loan repayment programs, 
increased reimbursements and grant programs for primary care training, 
as well as immediate financial support for community health centers. 
These new programs and resources will allow us to build the network of 
nurses, doctors and other health care professionals necessary to meet 
the increased demand for services.
  Since the cost of medical malpractice is a longstanding concern for 
both doctors and patients, this bill establishes new grant programs 
designed to encourage states to implement alternatives to traditional 
medical malpractice litigation with the goal of reducing frivolous 
lawsuits while allowing legitimate cases to be heard.
  But this debate is not just about expanding coverage and reducing 
costs for families and employers; it is also about putting our country 
on a fiscally sustainable path. This bill, which is completely paid 
for, will reduce our nation's deficit by $138 billion over the next 10 
years and $1.2 trillion over the following decade--the largest deficit 
reduction in 17 years. I cannot overlook the impact that these numbers 
have on our communities, and how critical they are to moving our state 
forward.
  Finally, I have stated from the beginning that I would not support a 
bill that funds taxpayer-subsidized abortions. I have worked tirelessly 
with my friends and colleagues--both Democrat and Republican, pro-life 
and pro-choice--to reach a common ground on this issue. After much 
dialogue, counsel, reflection and prayer, I have concluded that the 
Senate language does meet the longstanding Hyde standard of prohibiting 
federal funding of abortion. This position is reaffirmed by the 
Catholic Health Association, and many of my pro-life colleagues in 
Congress who support this bill.
  Furthermore, I remain mindful that we must not lose sight of the big 
picture. Being pro-life means more than being anti-abortion. It also 
means protecting the 45,000 people who die every year because they lack 
proper health care. Nothing could be more pro-life than ensuring access 
to lifesaving and life-improving treatments for every American, not 
just those who can afford it. That is what this bill begins to 
accomplish.
  Mr. Speaker, after an injury left me paralyzed nearly thirty years 
ago, the members of my community rallied behind me and my family when 
we needed them the most. That support and encouragement changed my life 
forever. I made myself a promise that I would devote my life to public 
service so I could give back to them all that they gave to me. Tonight, 
I know that by passing this legislation, which makes health care a 
right, not a privilege, I am fulfilling that promise.
  Mr. VAN HOLLEN. Mr. Speaker, once again the House is voting on 
legislation that strengthens the new health care reform law that was 
enacted earlier this week which will bring quality, affordable, and 
accessible health care for all Americans.
  Tonight, we bring this exhaustive, year-long process to a close. The 
new health reform law will bring down health care costs for American 
families and small businesses, expand health coverage to an additional 
32 million Americans, and end the abusive practices of insurance 
companies. By the end of this year, children with pre-existing 
conditions will no longer be denied coverage, health plans will be 
prohibited from placing lifetime caps on coverage, young people will be 
able to remain on their parents' health insurance policies up to their 
26th birthday, small businesses will get tax credits so that they can 
provide affordable health coverage to their employees, and seniors will 
get help in paying for their high prescription drug costs.
  Mr. Speaker, I'm glad we finally got the job done on a very important 
issue that so many people have fighting for over so many decades.
  Mr. REYES. Mr. Speaker, today's historic passage of health care 
reform legislation marks a great victory for the El Paso community. 
This landmark legislation will significantly improve the quality of 
life for so many residents by providing access to affordable health 
care coverage to those who currently have none. It will also provide 
peace of mind to those families with insurance, who will no longer have 
to worry about the prospect of financial ruin due to a catastrophic 
illness or accident.
  Every day, thousands of families are being forced to forgo health 
insurance due to rising costs, and now more than 46 million people lack 
basic health coverage. This disturbing trend is particularly evident in 
Texas, a state with the highest percentage of children and adults 
without insurance. More than 6.1 million adults and 1.4 million 
children are without basic coverage.
  Sadly, Texas border communities fare even worse, and all of Texas' 
congressional districts along the border rank among the top 20 
districts in the nation with the highest percentage without coverage. 
In El Paso alone, 230,000--1 in 3--people are without coverage.
  Unfortunately, when it comes to meeting the health care needs of 
predominately Hispanic communities along the border, our state has 
failed. Our Governor would rather waste millions on cameras and 
helicopters than on health care for border communities that need it 
most.
  The health care reform legislation that passed today is expected to 
provide coverage to 95 percent of Americans, while lowering health care 
costs over the long term. For the first time in history, insurance 
companies will be prohibited from denying health coverage due to pre-
existing conditions, health status, and gender.
  This legislation will provide tax credits to help individuals and 
small businesses purchase private health insurance. It also sets caps 
on out-of-pocket expenses for the first time ever, so families will 
never have to experience financial ruin due to a serious illness. 
Without these reforms, health care costs will continue to consume more 
of Americans' paychecks in the years ahead. The annual average cost of 
family coverage more than doubled between 1999 and 2009, from $5,800 to 
$13,400, and is expected to double again over the next decade without 
reform. Meanwhile, insurance companies are raising out-of-pocket 
expenses for families, and covering less in health care costs.
  America now spends $2.2 trillion on health care annually, more than 
twice the amount per person than other nations, yet Americans aren't 
any healthier for it. Without action, health care costs will consume 
over 20 percent of the American economy in the next decade. This 
landmark bill will significantly reduce health care costs over the long 
term and will decrease the federal deficit by $143 billion over the 
next 10 years and an additional $1.2 trillion in deficit reduction in 
the following 10 years.
  Many Americans living in the U.S.-Mexico border region used to depend 
on Mexico to access cheaper medical care and prescription drugs. For 
decades, El Pasoans have sought cheaper health care and prescription 
drugs across the border in Ciudad Juarez, Chihuahua. A recent study 
concluded that 1 in 3 people traveled to Mexico for prescription drugs, 
and 7 percent sought health care in Juarez. But the devastating drug-
related violence that has ravaged Mexico for two years has prevented 
many families without insurance from accessing care across the border.
  While our community is spending a greater share of property taxes to 
pay for individuals without health coverage, insurance companies have 
continued to engage in practices that protect their bottom lines. For 
too long, insurers have been the gatekeepers to our health care system, 
with the power to dictate who receives health coverage and who does 
not. Americans with preexisting conditions and serious illnesses are 
too often denied coverage or are dropped from their existing insurance 
plans for developing a serious illness or reaching their cap on 
coverage, and are denied access to the medical care they need.
  When people lack access to quality affordable preventative care, they 
end up in our emergency rooms for ailments that could have been treated 
by a family doctor or seek treatment for conditions that should have 
been diagnosed earlier. When these patients fail to pay their medical 
bills from publicly-financed hospitals such as University Medical 
Center, local property taxes are used to cover these

[[Page 5141]]

expenses. Since 1998, El Paso property tax payers have spent over $400 
million to pay for treatment and services for those patients who could 
not afford to pay their medical bills.
  As Congress debated this legislation last summer, I heard from many 
El Pasoans who shared their struggles under the current broken health 
insurance system. One of the stories that had the greatest impact on me 
was that of Mr. and Mrs. Jacob Lopez. Their lives were forever changed 
when their daughter, Danika, was born with a long list of ailments and 
birth defects that required over 80 days of intensive care treatment.
  While the Lopez's had insurance through their employer, the co-pay 
for their daughter's treatment was more than the mortgage on their 
home. They exceeded their insurer's coverage limits, and were left with 
no other way to cover their daughter's medical expenses. No other 
insurance company wanted to insure the Lopez family due to Danika's 
pre-existing conditions. In desperation, the Lopez's had to quit their 
jobs to fall into poverty so their daughter could receive the treatment 
she needed under Medicaid. Last week, Mr. Lopez called my office to 
tell me that his family was forced into bankruptcy.
  As a grandfather, I would never want my grandchildren to endure the 
hardships that Danika and her family have endured. It is for children 
like Danika, and my grandchildren, Amelia, Mateo, Julian, and Orlando, 
that I am proud to vote in favor of this bill.
  Our local community leaders have expressed their support for health 
insurance reform, and both the City and the County have passed 
unanimous resolutions in support of reform. The Patient Protection and 
Affordable Care Act is endorsed by over 325 national organizations and 
associations, including the AARP, the American Medical Association, the 
American Cancer Society, the American Heart Association, the Consumers 
Union, the Catholic Health Association, the National Association of 
Public Hospitals and Health Systems, the American Nurses Association, 
and many other medical professional organizations.
  The passage of this landmark legislation by the House of 
Representatives is an historic achievement and reflects the commitment 
and determined leadership of President Obama, Speaker Pelosi, and the 
Democratic Congress to follow through on a key promise to help middle 
class families, who have endured years of rising medical costs. I 
commend my colleagues for their determination to pass this truly 
historic legislation that will lower health care costs for all 
Americans, and strengthen our country's financial future.
  Mr. SERRANO. Mr. Speaker, I want to raise an important issue that is 
affecting millions of people on the island of Puerto Rico. This issue 
deserves attention; the four million residents of the Island are U.S. 
citizens that pay Social Security and Medicare taxes.
  However, despite this fact, senior citizens living in Puerto Rico are 
not treated fairly and do not have the same benefits that a senior 
living in New York, Florida, California, or any of the other States 
enjoy. Under Medicare in Puerto Rico, senior citizens are not 
automatically enrolled in Medicare Part B. As a result, it is more 
beneficial for seniors to enroll in a Medicare Advantage plan to 
receive all of their Medicare services. Compared to the 50 States where 
the Medicare Advantage participation plan is 25 percent, in Puerto Rico 
approximately 83 percent of eligible senior citizens opt for Medicare 
Advantage.
  However, the fee-for-service, FFS, cost calculation for Puerto Rico 
is troubling. In fact, the Medicare Payment Advisory Commission, 
MedPAC, reported to Congress that the Centers for Medicare & Medicaid 
Services (CMS) ``should expeditiously use its authority to employ an 
alternative calculation method . . .''
  I couldn't agree more with that statement or the report language 
included in the House Report for H.R. 4872, the Health Care and 
Education Reconciliation Act of 2010. The language clearly stated:

       The county FFS expenditures calculated by the Secretary are 
     artificially low and unstable from year-to-year. Therefore, 
     the Committee expects that when calculating county FFS rates 
     for Puerto Rico, the Secretary will use utilization and 
     expenditure data from MA plans under current authority and 
     adjust these rates and risk scores appropriately.

  Mr. Speaker, I support the House Report language because the senior 
citizens of Puerto Rico deserve nothing less than fair and equitable 
treatment in Medicare.
  Mr. CUMMINGS. Mr. Speaker, this week, I had the honor and privilege 
of joining my Democratic colleagues at the White House, to witness 
President Barack Obama sign into law, the Patient Protection and 
Affordable Care Act (H.R. 3590)--the most significant piece of health 
care legislation since the enactment of Medicare in 1965.
  This legislation fulfills one of the most basic tenets of the 
Declaration of Independence--the provision of our natural unalienable 
rights of life, liberty and the pursuit of happiness. H.R. 3590 secures 
these rights for every American by ensuring them access to quality, 
affordable healthcare.
  While waiting for President Obama to sign the legislation, I thought 
about the thousands of families and friends who have lost loved ones 
because they lacked access to basic health care coverage.
  I also thought about the generations of activists and policy makers 
who fought to make this monumental achievement a reality.
  I have always been proud to be a Member of Congress but voting in 
favor H.R. 3590 and being present at the signing ceremony was by far my 
proudest moment.
  By signing this legislation into law, President Obama ensured that 
the United States remains a leader among industrialized nations, and 
that the American people can now take comfort in knowing that an 
illness will no longer wipeout their life savings and lead to 
bankruptcy.
  Although the idea of providing people with access to quality, 
affordable health care has been around since the early 1900s, it was 
the Democratic-led 111th Congress that made the historic statement that 
healthcare is in fact a right, not a privilege.
  We affirmed to millions of Americans that we are aware of their 
struggles and that we are willing to fight for them and do what is 
morally and fundamentally right.
  During the November 2008 election, Americans overwhelmingly voted for 
change.
  They demanded a government willing to stand up to big business, and 
that is transparent in its actions.
  But above all else, people demanded a government that is willing to 
be responsive to their needs--and we affirmed their trust in us by 
passing this legislation.
  Is the legislation perfect? No!
  I still favor a single payer system and I was a strong supporter of 
the public option.
  That being said, H.R. 3590 is 100 percent better than what was 
previously available in this nation.
  Prior to the enactment of this legislation:
  Over 47 million Americans were uninsured. In 2008, 23 million 
uninsured were employed adults and 7.3 million were children;
  Nearly 41 thousand people died each year because they lacked access 
to quality, affordable healthcare insurance; and
  Every minute, 8 people were denied coverage, charged a higher rate, 
or otherwise discriminated against because of a pre-existing condition.
  If Congress had not successfully passed this legislation:
  Employers would be unable to afford rising health care costs, and an 
additional 3.5 million people would be unemployed and without benefits 
in the next 4 years.
  Small businesses would lose $52.1 billion in profits to high health 
care costs over the next ten years; and
  By 2019, national health care expenditures would reach $4.5 
trillion--more than double 2007 spending.
  The American people have waited for over 100 years for this 
legislation and this is what they will get immediately:
  We provide tax credits to small businesses to make employee coverage 
more affordable;
  $250 will be provided to Medicare beneficiaries who hit the ``donut 
hole'' in 2010;
  Within 90 days, Americans who are uninsured because of a pre-existing 
condition will be able to obtain insurance through a temporary high-
risk pool;
  Within 6 months, insurance companies will be prohibited from denying 
coverage to children with pre-existing conditions;
  Health plans will be required to allow young people up to their 26th 
birthday to remain on their parents' insurance policy;
  Health plans will be prohibited from dropping people from coverage 
when they get sick;
  Health plans will be prohibited from placing lifetime caps on 
coverage; and
  Beginning January 2011, preventive services under Medicare will be 
free.
  To put it simply, Congress met its moral obligation in passing 
healthcare reform. With our historic vote, we told future generations 
that no American will suffer and die because of a lack of insurance.
  We told insurance companies that, while they are a valuable part of 
our nation, they will be held accountable for delivering on their 
promises.
  We told our elderly that our commitment to them remains strong, and 
that the programs they have come to trust will continue to be deserving 
of that trust.
  The reform we passed will help millions of Americans.
  In addition to providing access to health care coverage, H.R. 3590 
goes far in addressing health care disparities in our nation's minority 
communities.

[[Page 5142]]

  Specifically, it includes language that I introduced with 
Representative Jesse Jackson, Jr., (D-Ill.) H.R. 2778, the Health 
Equity and Accountability Through Research Act.
  This legislation sought to elevate the National Center on Minority 
Health and Health Disparities (NCMHD) to the level of Institute, giving 
it the authority to better address the appalling health disparities 
that are plaguing our nation's minority communities.
  NCMHD was created to promote minority health and to lead, coordinate, 
and assess the efforts of the National Institutes of Health (NIH) in 
reducing and to ultimately eliminate health disparities.
  Unfortunately, the previous structure of NCMHD created confusion 
regarding who has the responsibility for the coordinated minority 
health disparities research conducted or supported by NIH.
  Additionally, NCMHD lacked real input into and authority over all 
NIH-supported health disparities activities and funds.
  H.R. 3590 addressed these concerns by elevating the Center to the 
level of Institute, and clarifies the role of the Director as 
coordinator and manager of the NIH-wide minority health and health 
disparities portfolio.
  The bill also provides the new Institute with professional judgment 
over NIH-wide minority health and health disparities budgets as well as 
management over NIH-wide minority health and health disparities 
allocations.
  However, this is not the only improvement that minority and 
underserved communities will see.
  This comprehensive healthcare package also includes $11 billion for 
community health centers, which offer comprehensive primary care and 
mental health services to underserved populations. These health centers 
are a critical stopgap, allowing better care for chronic conditions, 
while preventing unnecessary trips to the emergency room.
  Last but certainly not least, H.R. 3590 honors the life of Deamonte 
Driver--a 12-year-old boy from Maryland whose life was cut drastically 
short three years ago when an untreated tooth infection spread to his 
brain.
  Deamonte's tragic death haunts me to this day. Eighty dollars worth 
of dental care might have saved his life, but he never got that care 
because he lacked access to a dentist.
  The health care bill that we passed will prevent others from dying in 
such a tragic fashion. Under the new law:
  Pediatric dentistry is covered as an essential health benefit;
  Funds will be provided to launch a dental campaign to new parents and 
traditionally underserved areas;
  Workforce Training Grants will be available to provide technical 
assistance to pediatric training programs in developing and 
implementing instruction regarding the oral health status, dental care 
needs, and risk-based clinical disease management of all pediatric 
populations with an emphasis on underserved children; and
  H.R. 3590 also includes a loan repayment program with preference 
given to qualified applicants who have a record of training individuals 
who are from a rural or disadvantaged background.
  However, minorities and underserved communities will not be the only 
populations that will benefit from our actions. Millions will be 
touched by healthcare reform in their daily lives in marked, measurable 
ways.
  Thirty-one million Americans will have the opportunity to protect 
themselves from the fear that a small injury could lead to bankruptcy; 
and
  147,000 families and 14,000 small businesses in my District will 
receive tax credits to help cover their employees with health 
insurance; and 56,000 young people in my District will be able to get 
insurance, at fair prices, through policies currently owned by their 
parents.
  To quote the great poet Virgil, ``The greatest wealth is health.''
  By passing and signing this legislation, Congress and President Obama 
have provided the citizens of this nation with immeasurable wealth, 
comfort and security.
  We have firmly put the power back into the hands of the people, and 
this is an experience that I will cherish long after I leave Congress.
  Mr. HASTINGS of Washington. Mr. Speaker, it's past time for this 
Congress to stop jamming through massive expansions of the federal 
government and instead support commonsense reforms that will lower 
health care costs and increase choices for all Americans.
  A bipartisan coalition in Congress and a vast majority of the 
American people today rejected the premise that government knows best 
how to run our American health care system. While it was impossible to 
stop the liberal majority from pushing through their government 
takeover of health care, House Republicans will lead the effort to 
repeal this legislation and replace it with real solutions to improve 
our health care system, without driving our nation deeper into debt.
  House Democrats today went around the regular lawmaking process and 
pushed through their government takeover of health care using a closed 
approach that blocked consideration of any Republican amendments.
  Improvements must be made to our health care system, but I reject the 
premise of this bill that government knows best how to run our health 
care.
  I am disappointed that House Democrats voted for the very backroom 
deals and political payoffs that the American people are so tired of 
and for a massive health care plan that most Americans simply don't 
want.
  This bill is about more spending, higher taxes, and more government 
control, all without lowering health care costs. This Congress is going 
in exactly the wrong direction by forcing every American to purchase 
government-approved insurance only, cutting Medicare, limiting who can 
own and operate hospitals, and eliminating health care choices.
  There is something very wrong when this Congress is passing a bill 
that arbitrarily restricts the ability of doctor-owned hospitals like 
the Wenatchee Valley Medical and its clinics to grow, rather than 
working to expand access to health care in areas like Central 
Washington.
  In the past 14 months, Democrats have given the federal government 
control of our banks, our car companies, our loans for college, and now 
our health care. I rejected those bills, and I oppose this government 
takeover of health care because I'm deeply concerned about the 
consequences that will be felt by every American.
  I am committed to doing everything possible to undo this bill and get 
to work on commonsense reforms that will actually lower health care 
costs and increase choices.
  Mr. KENNEDY. Mr. Speaker, today is a long awaited day for the 
millions of tireless champions in America who have paved the way 
towards health care reform. It is since Teddy Roosevelt in 1912, that 
the people of this country have fought to provide quality, affordable 
health care for all Americans. Today is a long awaited day for the many 
tireless champions of health care reform. My father, of course, was but 
one of them, committed to fight for those who voices would not be 
heard. Today is a long awaited day for people like Martin Luther King, 
Jr., who stood up to remind us, ``of all forms of inequality, injustice 
in health care is the most shocking and inhumane.'' But most 
importantly, today is the long awaited day for each and every American 
who will now be treated with the dignity and respect that comes with 
the equality of opportunity that affordable access to quality health 
care provides.
  It is the long awaited day for the estimated 32 million of our 
friends and neighbors who will now have access to health care because 
of this legislation. It is the long awaited day for the millions of 
Americans who have been discriminated against in the past, denied 
coverage by an insurance company because they have a pre-existing 
condition. It is the long awaited day for the millions who are dropped 
from their policy when they got sick. It is the long awaited day for 
the millions who face bankruptcy and financial turmoil even though they 
had health insurance, because they reach an annual or lifetime cap. It 
is the long awaited day for the small business owners who have been 
unable to provide their workers with health insurance or remain 
competitive, and who will now receive tax credits to help them afford 
to provide coverage for their employees.
  I am pleased that the reconciliation package resolves a number of the 
issues that are especially important to Rhode Islanders. It increases 
the affordability assurances for Rhode Island families. It delays and 
changes the so-called ``Cadillac tax'' to more appropriately target 
high-end plans and minimizes the adverse effect on middle-class 
families, older Americans, and high-risk professions. It closes the 
Medicare prescription drug ``doughnut hole'' completely. It ensures our 
primary care physicians are paid Medicaid rates that match Medicare 
rates, and our hospitals are taking less cuts for the costs they incur 
treating the uninsured. It eliminates lifetime and annual caps for all 
health care plans, including grandfathered plans. And it removes 
special deals for states when it comes to Medicaid costs, so that Rhode 
Island will be fully reimbursed for the first two years to cover the 
costs of Medicaid expansion.
  A key aspect of this legislation that is of particular importance to 
me is the extension of the mental health parity protections established 
into law last year by my legislation, the Paul Wellstone and Pete 
Domenici Mental Health Parity and Addiction Equity Act. Not only are 
these protections extended to all

[[Page 5143]]

plans in the Exchange, but mental health and substance use benefits are 
a part of the essential benefits package created by this legislation. 
For the 67 percent of adults and 80 percent of children who need mental 
health care that do not receive it, this victory cannot be understated. 
Today our Nation takes a giant leap forward towards our transition from 
a ``sick care'' system to one which is preventive, collaborative, and 
patient-centered.
  The Patient Protection and Affordable Care Act also includes a number 
of other essential components which will dramatically improve the 
quality and access to behavioral health care. This legislation includes 
workforce development provisions by providing mental health and 
behavioral health education and training grants to assist providers 
specializing in and providing services to children, adolescents, and 
adults and loan forgiveness to child mental health professionals. This 
legislation also establishes a national network of a National Center 
for Excellence in Depression, for the treatment of depression and 
bipolar disorder.
  I have been proud to serve the people of Rhode Island the last 16 
years, helping to lead the effort in the House of Representatives to 
take control of our nation's health care system away from insurance 
companies and put it back the hands of patients and their doctors. 
Though I wish my father could be here in body as well as spirit, I 
could not be more pleased that this effort, to reform our nation's 
health care system, is on the cusp of complication today, during my 
tenure here.
  I urge my colleagues to join me in providing quality, affordable 
health care to all Americans.
  Mr. CRENSHAW. Mr. Speaker, the argument has been made by my 
colleagues on the other side of the aisle that the government must take 
over our health care system to help control costs. Against the will of 
the American people and in the dark of the night later on this evening, 
the Democrat Majority is forcing a vote on a bill that will cost 
American taxpayers nearly a trillion dollars.
  The Democrat Majority plans to pay for their plan by cutting half a 
trillion dollars in Medicare and raising taxes on American families by 
over $400 billion. By taking a step back and reviewing the historical 
involvement of the government in health care, we can draw two relevant 
lessons.
  First, government involvement in health care raises the cost of 
health care. Prior to the creation of Medicare and Medicaid in 1965, 
health-care inflation ran slightly faster than overall inflation. In 
the years since, medical inflation has climbed 2.3 times faster than 
cost increases elsewhere in the economy.
  Second, more often than not, government programs exceed their 
expected cost. When initially considered, the House Ways and Means 
Committee estimated Medicaid's first year costs at approximately $238 
million. The actual cost? Over $1 billion. Today, even after you adjust 
for inflation, Medicaid costs 37 times more than it did when it was 
launched.
  What about Medicare? In 1965, Congressional budgeters said that it 
would cost $12 billion in 1990. Its actual cost that year was $90 
billion. The rate of increase in Medicare spending has outpaced overall 
inflation in nearly every year (up 9.8% in 2009), so a program that 
began at $4 billion now costs $428 billion.
  We must take to heart that Congress historically grossly 
underestimates the cost of an entitlement program. And now we are faced 
with one of the newest/biggest entitlement programs in the history of 
our great nation.
  Any Member who votes in favor of this bill, casts a vote in favor of 
increasing our national debt and inflicting higher taxes on our 
children and grandchildren. That is why I will vote against H.R. 3590 
and will do everything in my power to repeal and replace it with 
commonsense reforms that will lower health care costs, increase access, 
maintain Medicare benefits, end lawsuit abuse, and preserve the doctor/
patient relationship without raising taxes.
  Mr. CASTLE. Mr. Speaker, the debate about how to reshape health 
insurance in order to reduce skyrocketing costs, and increase access, 
has dominated the attention of Congress for the past year. While there 
are many areas of agreement, Congress and the American public remain 
divided and it is easy to see why. While I am glad the ``deem and 
pass'' procedure was abandoned, and the House of Reprsentatives allowed 
an actual vote on the bill, I feel strongly that Congressional leaders 
and the President have missed a real opportunity to take incremental, 
bipartisan steps that recognized the concerns of Americans who feel as 
though they will foot the bill for widespread reforms that they do not 
embrace.
  To expand access, H.R. 3590 will enact mandates for both individuals 
and employers, with hefty fines for non-compliance, at a time when our 
economy has already challenged cash-strapped small businesses across 
the nation. This new mandate to acquire health insurance will greatly 
expand the bankrolls of insurance companies without any new standards 
against price fixing, or steps to encourage competition across state 
lines-- both of which would create vast incentives to drive down costs. 
Such giveaways to the insurance companies only reward the rising costs 
of health care with higher taxpayer subsidies to cover them.
  Throughout the debate, I have advocated for commonsense policies that 
aim to lower costs and expand access, without compromising the quality 
of American medicine or raising taxes on the American people. I have 
urged leaders to consider legislation to drive down the costs of care 
first, in order to increase access and coverage through affordability. 
According to the Congressional Budget Office, the legislation would 
cost nearly a trillion dollars, the cost of health insurance premiums 
would actually rise, and it would be paid for through new taxes and 
fees and nearly $500 billion in reductions in spending on Medicare. 
What CBO can't accurately report, is that the bill is also littered 
with budget gimmicks to cover the actual, long-term cost of the bill.
  This bill pays for six years of coverage with 10 years of tax 
increases and back-loads the cost in the years ahead in order to 
disguise the true costs.
  The proposed cuts to Medicare are unlikely to ever occur; Congress is 
likely to override them.
  $70 billion for the new long-term care program is spent before any 
benefits are paid out.
  $53 billion is taken from the Social Security Trust Fund to offset 
new health care spending.
  Punts the fix for Medicare reimbursements to doctors, costing $371 
billion, which Congress has committed to passing.
  Uses the revenues from an expansion in federally financed student 
loans as offsets, instead of putting those savings back into education 
or for lower payments from students.
  There are many commonsense steps we could be taking, some of which 
are in this bill and have widespread support: Reforms that forbid 
insurance companies from denying coverage based on a pre-existing 
condition or disability, and ban lifetime and annual spending caps that 
put patients at risk for bankruptcy when faced with a serious illness; 
allowing unmarried children to remain on their parents' insurance 
through age 26; incentives for Americans to seek preventive care; 
helping seniors afford prescription drugs through closing the donut 
hole, and development of lifesaving drugs and therapies that protect 
patient safety and innovation; an increase in support for community 
health centers that provide routine care for thousands of patients in 
Delaware; and provisions to address physician and nursing shortages. 
These are steps we could have taken, and they should have been coupled 
with increases in competition and cost-controlling measures.
  Additional policies absent from the plan that deserve an up or down 
vote:
  Making health insurance more portable and affordable by allowing 
patients to shop for health insurance plans across state lines;
  Small business pooling and tax credits without mandates that threaten 
jobs and productivity;
  Eliminating the $60 billion in Medicare fraud each year;
  Increasing efforts to enroll the 4.3 million who already qualify into 
existing programs like Medicaid and SCHIP; and
  Limiting abusive lawsuits, which would reduce costs of care.
  While there are policies embedded in this legislation that have 
bipartisan support, they are buried under budget gimmicks that threaten 
the long-term solvency of Medicare, Medicaid and Social Security--the 
existing entitlement programs that are draining the federal budget 
based on their current obligations. Health care reform will impact the 
lives of every American, our federal budget, and 1/6 of our economy. 
Reform should hold insurance companies accountable, eliminate barriers 
to competition and quality care, promote prevention, and drive down 
health care costs. To ignore the costs and enact unrealistic and 
misleading legislation will only prolong our health care challenges for 
generations to come.
  Mr. BILBRAY. Mr. Speaker, this week, each of us cast the most 
historic vote any of us is likely to ever make. With it, revolutionary 
changes have been made to the American health care system that will 
forever alter its very nature. This vote was a long time coming and 
much needed, unfortunately, what we did pass is long on promises of 
improved care, but preciously short on reforms that the American people 
really need for better and more affordable care.

[[Page 5144]]

  It is no secret that the health care system is in need of reform. In 
2007, the latest year that figures were available, total health 
expenditures reached $2.2 trillion, which translates to $7,421 for 
every man, woman and child; millions of Americans are without health 
insurance and San Diego doctors are finding it increasingly difficult 
to care for our city's most vulnerable residents. This week's debate 
was full of passion over many issues and arguments over the proper 
answer to health reform. While we can argue over many points, there is 
one issue where there is no debate: we need health care reform.
  Studies have shown that the visit rates to emergency rooms for 
patients with no insurance are twice that of those with private 
insurance. While I support insuring all Americans can access health 
insurance and believe it must be the first priority of any health care 
reform legislation, I cannot support a bureaucratic system dictated and 
controlled by the Federal Government. Congress, just like the medical 
profession, must adhere to the Hippocratic Oath of: ``Above all, do no 
harm.''
  Throughout the past year, I have supported many bipartisan issues 
that will increase health quality and access for not just San Diegans 
but all Americans without limiting our choice of health care options--
many of which were in the legislation we passed Sunday night. We must 
first allow Americans to have the same insurance as the Congress of the 
United States. It is not fair to stand here today and pontificate on 
the benefits of health care if we do not allow hard working Americans 
to have the same health care choices we enjoy. Citizens of this great 
country must be allowed to shop wherever they want in the United States 
for health insurance, free from the barriers of state lines. If New 
Jersey offers a plan that is cheaper than California, Californians 
should have the ability to purchase that plan. We must enact strong 
medical tort reforms that can save billions of dollars--$54 billion to 
be exact according to Congress' own Congressional Budget Office, CBO. 
Finally, I support strong enforcement mechanisms to prevent illegal 
immigrants from receiving taxpayer subsidized health care.
  It is important to remember that American health care is in many ways 
the envy of the world. From our first class medical facilities to our 
world renowned life science enterprise, we are the leader in innovative 
care and solutions. These innovations are allowing Americans suffering 
from major illnesses to live longer, healthier lives. For instance, in 
a single decade, from 1993-2003 U.S. heart disease deaths dropped by 22 
percent. However, for all these benefits there is work to be done but 
not at the expense of destroying the entire health care system.
  The health care bill that was signed into law will destroy our 
already fragile economy and lead to government control of health care. 
Under this new law, there will be more than $520 billion in tax 
increases, including a $27 billion employer mandate tax and $15 billion 
individual mandate tax. With 1 in 9 San Diegans out of work, this will 
exacerbate the problem.
  There are many examples in this legislation of government control but 
one striking example is the Independent Medicare Advisory Commission. 
The creation of the so-called Independent Payment Advisory Board 
(IPAB,) which for the first time will give unelected and unaccountable 
bureaucrats the mandate to make important decisions about the future of 
the Medicare program. The cuts they propose would be in addition to the 
over half trillion dollars of Medicare and Medicaid cuts already in 
this bill.
  We all agree that Medicare reform is needed but the IPAB actually 
carves out large areas of the Medicare budget from potential savings, 
leaving draconian cuts in the reimbursement of life saving and life 
enhancing drugs as a likely outcome. As Co-Chair of the House 
Biomedical Research Caucus, I have seen the great promise that 
developments in medical technology can mean for American seniors. Just 
last summer, the existing Preventive Services Task Force changed its 
recommendations on mammograms, confusing millions of Americans in the 
process. Can you imagine if those recommendations had the force of law? 
As science progresses to further embrace the benefits of personalized 
medicine, we need to make sure that the unchecked decisions of a 
federal board in Washington do not unwittingly sabotage the doctor-
patient relationship. I am very troubled by this provision, and I want 
to work with my colleagues on both sides of the aisle to fix it or 
repeal it before it becomes effective.
  In order to pass this legislation, many back room deals were cut. 
From the ``Cornhusker Kickback'' to the ``Louisiana Purchase,'' many 
states were taken care of in order to secure support. However, 
California was once again left on the outside looking in. This bill 
does nothing to fix the Geographic Practice Cost Index (GPCI), which to 
date finds San Diego doctors being paid at a rate of rural 
practitioners; all the while they continue to practice in a high cost 
area. Additionally, this legislation does nothing to fix the 
sustainable growth rate problem that finds California doctors facing 
continuing cuts in Medicare payment rates year after year and threatens 
patient's access to care.
  I was in favor of rejecting this plan and coming back to the table 
and develop a proposal that fully addresses medical malpractice awards 
so we can save health care costs, allow United States citizens to 
purchase their health care across state lines and provide tax credits 
so hard working Americans, not Washington D.C., are in charge of their 
health care.
  A strong and accessible health care system is one of the most 
fundamental components of a strong economy. I am committed to working 
in a bipartisan manner with my colleagues to put in place real reform 
that will protect the doctor-patient relationship but will not bankrupt 
our economy in the process. American families deserve better than 
socialized health care and I plan on helping to deliver it. I will 
continue to work with my colleagues to reform a broken health care 
system in a way that is sustainable, protects the promises we have 
already made to our nation's seniors and does not infringe on our 
liberties.
  Mr. COURTNEY. Mr. Speaker, I rise today to express concerns about 
three outstanding issues in the final health care reform package: an 
excise tax on high-cost insurance plans which will be implemented in 
2018, cuts to home health care, and the formation of an Independent 
Payment Advisory Board (IPAB).
  Since introduction of the America's Affordable Health Choices Act in 
July of 2009, my colleagues in Congress and I have been working to 
craft a health insurance reform bill that creates affordable insurance 
coverage, lowers costs, and improves access to stable health care that 
is there when you need it. These efforts have been reflected in the 
Affordable Health Care for America Act, and Senate-passed Patient 
Protection and Affordable Care Act (H.R. 3590) as modified by the 
Health Care and Education Reconciliation Act (H.R. 4872).
  The final reform package reflects significant progress in terms of 
limiting the negative impact of an excise tax on high-cost plans on 
middle class Americans. The 40 percent excise tax on high-cost plans 
included in the Patient Protection and Affordable Care Act included 
cost thresholds that were inadequate to account for premium cost 
factors independent of generosity of benefits, such as age, gender, and 
region. I authored a letter, with support from 192 of my Democratic 
colleagues who opposed this proposal. The Health Care and Education 
Reconciliation Act made significant improvements to the excise tax, 
such as adopting higher thresholds for age and gender. More 
importantly, the bill delays the implementation of the tax until 2018, 
which will allow ample time to better understand its impact--especially 
in high-cost regions--and mitigate potential negative consequences.
  Another deficit mitigation component that I have concerns about in 
the reform package includes Medicare ``market basket updates'' for home 
health providers. While the Patient Protection and Affordable Care Act 
includes more modest cuts than what was included in the House-passed 
Affordable Health Care for America Act, I remain concerned about the 
aggregate size of the cuts to home health care providers. Safeguards in 
H.R. 3590 such as payment adjustment review authority by the Health and 
Human Services Secretary should be utilized if ``market basket 
updates'' prove to be unsustainable for home health care providers in 
the future. H.R. 3590 also includes provisions that guarantee Medicare 
home health benefits will not be reduced, which further reiterates the 
obligation of the Secretary to ensure fair reimbursements.
  While I supported passing H.R. 3590 as modified by H.R. 4872 to make 
significant progress in extending and strengthening current health care 
coverage, I also maintain concerns about the establishment of the IPAB. 
Over the course of the health care debate, the IPAB--along with the 
similar proposals of the Independent Medicare Advisory Council, IMAC, 
Act (H.R. 2718) and the Medicare Payment Advisory Commission, MedPAC--
have garnered attention as a mechanism to reduce aggregate health care 
costs.
  However, I believe that the solidification of IPAB would be a move in 
the wrong direction in terms of broad health care reform. Congress has 
played an integral role in shaping a Medicare system that reflects 
unique care needs of varying demographics as well as need differences 
between regions and states. Further, this system has been developed 
with

[[Page 5145]]

transparency and accountability in congressional debates. Redirecting 
control of Medicare to the Executive branch would limit the strengths 
of the current system, and would continue a disturbing trend of ceding 
Congressional authority to the Executive branch.
  That is why I cosigned letters in July and December 2009 opposing the 
establishment of a Payment Advisory Commission. While I did not support 
the inclusion of IPAB in the H.R. 3590, I am reassured that the bill 
does not empower the Board to override Medicare laws. Going forward, I 
urge that the IPAB conducts business transparently, with public input. 
I also urge that the Board reach out to all Medicare stakeholders and 
take seriously the role of the Consumer Advisory Council in the future.
  Mr. KUCINICH. Mr. Speaker, each generation has had to take up the 
question of how to provide for the health of the people of our nation. 
And each generation has grappled with difficult questions of how to 
meet the needs of our people. I believe health care is a civil right. 
Each time as a nation we have reached to expand our basic rights, we 
have witnessed a slow and painful unfolding of a democratic pageant of 
striving, of resistance, of breakthroughs, of opposition, of 
unrelenting efforts and of eventual triumph.
  I have spent my life struggling for the rights of working class 
people and for health care. I grew up understanding first hand what it 
meant for families who did not get access to needed care. I lived in 21 
different places by the time I was 17, including in a couple of cars. I 
understand the connection between poverty and poor health care, the 
deeper meaning of what Native Americans have called ``hole in the body, 
hole in the spirit.'' I struggled with Crohn's disease much of my adult 
life, to discover sixteen years ago a near-cure in alternative medicine 
and following a plant-based diet. I have learned with difficulty the 
benefits of taking charge personally of my own health care. On those 
few occasions when I have needed it, I have had access to the best 
allopathic practitioners. As a result I have received the blessings of 
vitality and high energy. Health and health care is personal for each 
one of us. As a former surgical technician I know that there are many 
people who dedicate their lives to helping others improve theirs. I 
also know their struggles with an insufficient health care system.
  There are some who believe that health care is a privilege based on 
ability to pay. This is the model President Obama is dealing with, 
attempting to open up health care to another 30 million people, within 
the context of a system run by insurance companies who make money by 
denying care. There are others who believe that health care is a basic 
right and ought to be provided through a not-for-profit plan. This is 
what I have tirelessly advocated.
  I have carried the banner of national health care in two presidential 
campaigns, in party platform meetings, and as co-author of H.R. 676, 
Medicare for All. I have worked to expand the health care debate beyond 
the current unsustainable system, to include a robust public option and 
my amendment to free the states to pursue single-payer. An early 
version of the health care bill, while badly flawed, contained these 
provisions which I believed made the bill worth supporting when it was 
considered by the Committee on Education and Labor. I voted for it. The 
provisions were taken out of the bill after it passed the Committee.
  I joined with the Congressional Progressive Caucus in saying that I 
would not support the bill unless it had a strong public option and 
unless it protected the right of people to pursue single payer at a 
state level. It did not. I kept my pledge and voted against the bill 
when it was considered by the full House of Representatives. Since 
then, I have continued to oppose it while trying to get the provisions 
back into the bill. Some have speculated that, as the final vote on 
this health care package drew closer, I might have been in a position 
of casting the deciding vote. The President's visit to my district on 
Monday underscored the urgency of this moment.
  I have taken this fight further than many in Congress cared to carry 
it because I know what my constituents experience on a daily basis. 
Come to my district in Cleveland and you will understand.
  The people of Ohio's 10th district have been hard hit by an economy 
where wealth has accelerated upwards through plant closings, massive 
unemployment, small business failings, lack of access to credit, 
foreclosures and the high cost of health care and limited access to 
care. I take my responsibilities to the people of my district 
personally. The focus of my district office is constituent service, 
which more often than not involves social work to help people survive 
economic perils. It also involves intervening with insurance companies.
  In the two weeks before the vote on the final health care package, it 
became clear that the vote would be very close. I take this vote with 
the utmost seriousness. I am quite aware of the historic fight that has 
lasted the better part of the last century to bring America in line 
with so many other modern democracies in providing single-payer health 
care. I have seen the political pressure and the financial pressure 
being asserted to prevent a real challenge to a highly profitable 
system dominated by private insurance companies.
  I know I have to make a decision, not on the bill as I would like to 
see it, but the bill as it is. My criticisms of the legislation have 
been well reported. I do not retract them. I incorporate them in this 
statement. They still stand as legitimate and cautionary. I still have 
doubts about the bill. I do not think it is a first step toward 
anything I have supported in the past. This is not the bill I wanted to 
support, even as I continue efforts until the last minute to modify the 
bill.
  However after careful discussions with President Obama, Speaker 
Pelosi, my wife Elizabeth, the frequently personal and tragic stories 
of my constituents and close friends, I have decided to cast a vote in 
favor of the legislation. If my vote is to be counted, let it now count 
for passage of the bill, hopefully in the direction of comprehensive 
health care reform. We must include coverage for those excluded from 
this bill. We must free the states. We must have control over private 
insurance companies and the cost their very existence imposes on 
American families. We must strive to provide a significant place for 
alternative and complementary medicine, religious health science 
practice, and the personal responsibility aspects of health care which 
include diet, nutrition, and exercise.
  The health care debate has been severely hampered by fear, myths, and 
by hyper-partisanship. The President clearly does not advocate 
socialism or a government takeover of health care. The fear that this 
legislation has engendered has deep roots, not in foreign ideology but 
in a lack of confidence, a timidity, mistrust and fear which post 911 
America has been unable to shake.
  This fear has so infected our politics, our economics and our 
international relations that as a nation we are losing sight of the 
expanded vision, the electrifying potential we caught a glimpse of with 
the election of Barack Obama. The transformational potential of his 
presidency, and of ourselves, can still be courageously summoned in 
ways that will reconnect America to our hopes for expanded 
opportunities for jobs, housing, education, peace, and yes, health 
care.
  I want to thank those who have supported me personally and 
politically as I have struggled with this decision. I ask for continued 
support in our ongoing efforts to bring about meaningful change. I have 
taken a detour through supporting this bill, but I know the destination 
I will continue to seek, for as long as it takes, whatever it takes, is 
an America where health care will be firmly established as a civil 
right.


                         Empowering individuals

  Smart personal choices in areas like diet, nutrition, and exercise 
are essential to a healthier world. At the same time, we must remove 
the barriers and change the incentives that discourage or prevent 
responsible behavior. The Institute of Medicine estimates that in 2004 
approximately $10 billion was spent on food advertising directed at 
children, using every method available--television, radio, the 
internet, even embedded in video games. Simply put, marketing to 
children works--companies would not make such a substantial investment 
if it were ineffective.
  Marketing directed at youth is extremely well constructed and relies 
heavily on behavioral science. The developing brain of the child can 
not discriminate fact from opinion and can not think critically; it is 
no match for a $10 billion industry that exploits this vulnerability 
using cartoons, cross branding with popular toys, giveaways, and myriad 
other methods to develop brand loyalty and shape judgment as early as 
possible. Established early, these affinities are the most enduring.
  Astonishingly, the Federal Government subsidizes this methodical 
preying on children by granting a tax write-off for expenses associated 
with it. This must stop. The government must take action to protect 
American children and ensure that they grow up in a healthy 
environment. My bill, H.R. 4310, would eliminate the tax deductibility 
of fast food and junk food advertising directed at children. H.R. 4310 
has the potential to raise billions of dollars in revenue to fund child 
nutrition and anti-obesity initiatives.
  There is precedent: approximately 50 countries, including Sweden, 
Norway, Australia, and Great Britain, have limited or prohibited food 
advertising directed at youth. Additionally, recent research has 
concluded that eliminating the tax deductibility of food advertising 
directed at youth would reduce obesity rates.

[[Page 5146]]

Long-term health care reform must address the personal responsibility, 
the corporate responsibility, and the government's fair share of the 
responsibility for improved health. I will work to ensure that is the 
case.
  Each generation has had to take up the question of how to provide for 
the health of the people of our nation. And each generation has 
grappled with difficult questions of how to meet the needs of our 
people. I believe health care is a civil right. Each time as a nation 
we have reached to expand our basic rights, we have witnessed a slow 
and painful unfolding of a democratic pageant of striving, of 
resistance, of breakthroughs, of opposition, of unrelenting efforts and 
of eventual triumph.
  I have spent my life struggling for the rights of working class 
people and for health care. I grew up understanding first hand what it 
meant for families who did not get access to needed care. I lived in 21 
different places by the time I was 17, including in a couple of cars. I 
understand the connection between poverty and poor health care, the 
deeper meaning of what Native Americans have called ``hole in the body, 
hole in the spirit.'' I struggled with Crohn's disease much of my adult 
life, to discover sixteen years ago a near-cure in alternative medicine 
and following a plant-based diet. I have learned with difficulty the 
benefits of taking charge personally of my own health care. On those 
few occasions when I have needed it, I have had access to the best 
allopathic practitioners. As a result I have received the blessings of 
vitality and high energy. Health and health care is personal for each 
one of us. As a former surgical technician I know that there are many 
people who dedicate their lives to helping others improve theirs. I 
also know their struggles with an insufficient health care system.
  There are some who believe that health care is a privilege based on 
ability to pay. This is the model President Obama is dealing with, 
attempting to open up health care to another 30 million people, within 
the context of the for-profit insurance system. There are others who 
believe that health care is a basic right and ought to be provided 
through a not-for-profit plan. This is what I have tirelessly 
advocated.
  I have carried the banner of national health care in two presidential 
campaigns, in party platform meetings, and as co-author of H.R. 676, 
Medicare for All. I have worked to expand the health care debate beyond 
the current unsustainable system, to include a robust public option and 
my amendment to free the states to pursue single-payer. An early 
version of the health care bill, while badly flawed, contained these 
provisions which I believed made the bill worth supporting when it was 
considered by the Committee on Education and Labor. I voted for it. The 
provisions were taken out of the bill after it passed the Committee.
  I joined with the Congressional Progressive Caucus in saying that I 
would not support the bill unless it had a strong public option and 
unless it protected the right of people to pursue single payer at a 
state level. It did not. I kept my pledge and voted against the bill 
when it was considered by the full House of Representatives. Since 
then, I have continued to oppose it while trying to get the provisions 
back into the bill. Some have speculated that, as the final vote on 
this health care package drew closer, I might have been in a position 
of casting the deciding vote. The President's visit to my district on 
Monday underscored the urgency of this moment.
  I have taken this fight further than many in Congress cared to carry 
it because I know what my constituents experience on a daily basis. 
Come to my district in Cleveland and you will understand.
  The people of Ohio's 10th district have been hard hit by an economy 
where wealth has accelerated upwards through plant closings, massive 
unemployment, small business failings, lack of access to credit, 
foreclosures and the high cost of health care and limited access to 
care. I take my responsibilities to the people of my district 
personally. The focus of my district office is constituent service, 
which more often then not involves social work to help people survive 
economic perils. It also involves intervening with insurance companies.
  In the two weeks before the vote on the final health care package, it 
became clear that the vote would be very close. I take this vote with 
the utmost seriousness. I am quite aware of the historic fight that has 
lasted the better part of the last century to bring America in line 
with so many other modern democracies in providing single-payer health 
care. I have seen the political pressure and the financial pressure 
being asserted to prevent a real challenge to a highly profitable 
system dominated by private insurance companies.
  I know I have to make a decision, not on the bill as I would like to 
see it, but the bill as it is. My criticisms of the legislation have 
been well reported. I do not retract them. I incorporate them int this 
statement. They still stand as legitimate and cautionary. I still have 
doubts about the bill. I do not think it is a first step toward 
anything I have supported in the past. This is not the bill I wanted to 
support, even as I continue efforts until the last minute to modify the 
bill.
  However after careful discussions with the President Obama, Speaker 
Pelosi, my wife Elizabeth, and in consideration of the frequently 
personal and tragic stories of my constituents, I have decided to cast 
a vote in favor of the legislation. If my vote is to be counted, let it 
now count for passage of the bill, hopefully in the direction of 
comprehensive health care reform. We must include coverage for those 
excluded from this bill. We must free the states. We must have control 
over private insurance companies and the cost their very existence 
imposes on American families. We must strive to provide a significant 
place for alternative and complementary medicine, religious health 
science practice, and the personal responsibility aspects of health 
care which include diet, nutrition, and exercise.
  The health care debate has been severely hampered by fear, myths, and 
by hyper-partisanship. The President clearly does not advocate 
socialism or a government takeover of health care. The fear that this 
legislation has engendered has deep roots, not in foreign ideology but 
in a lack of confidence, a timidity, mistrust and fear which post 911 
America has been unable to shake.
  This fear has so infected our politics, our economics and our 
international relations that as a nation we are losing sight of the 
expanded vision, the electrifying potential we caught a glimpse of with 
the election of Barack Obama. The transformational potential of his 
presidency, and of ourselves, can still be courageously summoned in 
ways that will reconnect America to our hopes for expanded 
opportunities for jobs, housing, education, peace, and yes, health 
care.
  I want to thank those who have supported me personally and 
politically as I have struggled with this decision. I ask for continued 
support in our ongoing efforts to bring about meaningful change. As 
this bill passes I will renew my efforts to help those state 
organizations which are aimed at stirring a single payer movement which 
eliminates the predatory role of private insurers who make money not 
providing health care. I have taken a detour through supporting this 
bill, but I know the destination I will continue to seek, for as long 
as it takes, whatever it takes, is an America where health care will be 
firmly established as a civil right.


                 moving Toward True Health Care Reform

  In pursuing meaningful change in the health care system, there can be 
no better investment than to remove federal barriers to allowing states 
to implement the only model of health care proven to cover everyone, 
lower costs and increase quality: single-payer.
  Systems that remove the insurance companies from care are well tested 
and consistently outperform systems that rely on private insurance. 
Their costs are lower, their access is universal, the coverage is 
comprehensive, and their systems are far more equitable. Such a single-
payer health care system would also provide major economic stimulus. 
Half of all bankruptcies in the U.S. are the result of the failure of 
an insurance plan to do the very thing that drives us to buy health 
insurance--protect us from catastrophic financial burdens that arise 
from health care needs. Only single-payer health care can rid us of the 
economic drag of medical bankruptcies by providing truly comprehensive 
coverage--for less money than we are currently paying.
  It is no wonder then that states are demanding single payer. Not only 
does it help people stay out of poverty, but it would provide major 
relief for states facing budget difficulties. The Lewin Group's 
financial analysis of the California single payer bill that recently 
passed the legislature twice found that ``the net cost of the program 
to state and local governments is a savings of about $900 million'' in 
2006 alone. There are also strong single payer movements in 
Pennsylvania, New York, Illinois, Colorado, and New Mexico. In fact, 
the savings to a state from a single-payer plan have been well 
documented. Fourteen states are listed below, along with their savings 
and the year of the applicable study. The worst-case scenario is Maine, 
which would break even.

       State: Annual Single-payer Savings--Year
       New Mexico (Lewin Group): $151,800,000--1994
       Delaware (Solutions for Progress): $229,000,000--1995
       Minnesota (Lewin Group): $718,000,000--1995
       Massachusetts (Lewin Group, Solutions for Progress/Boston 
     University School of Public Health): $1,800,000,000--
     $3,600,000,000--1998
       Maryland (Lewin Group): $345,000,000--2000
       Vermont (Lewin Group): $118,000,000--2001

[[Page 5147]]

       California (Lewin Group): $7,500,000,000--2002
       Maine (Mathemetica Policy): $0--2002
       Rhode Island (Solutions for Progress/Boston University 
     School of Public Health): $270,000,000--2002
       Missouri (Missouri Foundation for Health): $1,700,000,000--
     2003
       Georgia (Lewin Group): $716,000,000--2004
       California (Lewin Group): $8,000,000,000--2005
       Colorado (Lewin Group): $1,400,000,000--2007
       Kansas (Lewin Group): $869,000,000--2007

  The Employee Retirement Income Security Act (ERISA) has been used to 
thwart efforts at the state and regional level to improve health care. 
Though the law was intended to protect the integrity and quality of 
employee benefit plans including health care, ERISA has been used in 
courts to stop or make impractical health care reform efforts in 
Maryland, San Francisco, and Suffolk County, New York. It is the most 
difficult federal barrier a single-payer state will face, though there 
will be others.
  I will continue to work to help these states. We must yield to the 
wishes of those in a state who demand a health care system that is 
proven to work well. It would be entirely voluntary. If a state wants 
better health care than can be provided by the federal government, the 
federal government should not stand in their way.


                             Public Option

  A robust public option is not sufficient to control costs, cover 
everyone, and increase quality of care. However, it is a good interim 
option for those who do not want to be subject to the abuses of the 
insurance companies but are required to purchase health insurance under 
the health care bill we are passing today. The extreme inefficiency of 
the private health insurance companies and the inefficiency they cause 
throughout the health care system are well documented. Americans need 
refuge because the health insurance companies are ruthlessly efficient 
at one thing: denying care. They have to be because that is how they 
make money.
  In the short term, I will continue to fight for a strong public 
option until a single payer plan is in place.


             Integrative Medicine and Religious Health Care

  A 2008 study by the National Center for Complementary and Alternative 
Medicine at the National Institutes of Health and the National Center 
for Health Statistics revealed that 38% of American adults used some 
form of integrative medicine to meet their health care needs. However, 
access to these services is limited because of lack of insurance 
coverage of these safe, cost-effective and clinically effective medical 
approaches. Some of those modalities include chiropractic care, 
acupuncture and many others under study at the National Institutes of 
Health.
  However, some insurance companies are starting to realize that it is 
beneficial to their bottom line if they cover some integrative medicine 
approaches. More and more plans are covering chiropractic and 
acupuncture, for example. The medical literature abounds with studies 
showing that the cost-effectiveness of interventions like 
transcendental meditation for hypertension and heart disease is far 
better than that for conventional pharmaceutical interventions.
  An early version of the health care overhaul bill included my 
amendment that would guarantee that a practitioner of integrative 
medicine is one of the people that decides the minimum required benefit 
package. It also created a task force of integrative medicine 
practitioners to help inform the decision makers about what should be 
covered. Finally, it required that when a patient goes to the Exchange 
website and looks up doctors, practitioners of integrative medicine are 
easily identifiable. Though the language was removed before a vote on 
the bill was taken by the full House of Representatives, I will 
continue to work to advance integrative medicine by increasing its 
accessibility and safety.
  Under this bill, most Americans, including people who practice other 
distinctive approaches to health care, are forced to buy private health 
insurance. I recognize the difficult position for Christian Scientists 
and others similarly situated. Millions opt for spiritual care that 
coincides with their religion. But as of today, even though the care 
they prefer is covered by Medicare, Medicaid, TRICARE and some plans 
available to federal government employees, few private insurance plans 
cover it. The new healthcare legislation we are considering today does 
not prevent insurance companies from covering their care; it also does 
not create a pathway for its serious consideration by insurance 
companies. I look forward to helping to identify a way to ensure that 
spiritual and integrative care get a fair chance at coverage by 
insurance companies.
  Mrs. MALONEY. Mr. Speaker, this is a historic vote. With passage of 
health care reform, 32 million people without insurance will now be 
covered and 94 percent of Americans will now be guaranteed health care 
coverage. In New York State, close to 2.5 million people who are 
currently uninsured will have health care coverage once this bill is 
passed. The reforms we are considering today will help improve the 
lives of millions of Americans--starting immediately, and continuing 
over the course of their implementation in the next ten years.
  Starting immediately: No insurance company can deny coverage for pre-
existing conditions or gender; Young people can stay on their parents' 
coverage until age 26; If you're self-employed or a small-business 
owner you'll be able to buy health coverage on competitive exchanges; 
If you've taken early retirement over age 55 but before you're eligible 
for Medicare, you'll be able to continue your employers' coverage until 
age 65; And if you're over 65 and have Medicare's Part D drug coverage, 
the ``donut hole'' has been eliminated.
  The reconciliation bill we are voting on vastly improves the Senate 
bill's impact for states like New York who will not be penalized for 
having served New Yorkers and having an expansive Medicaid program. 
This provision will give more federal Medicaid funding support for New 
York State, which would have suffered a loss under the Senate-passed 
bill. Instead of costing millions, New York State will now save 
hundreds of millions in the first full year of implementation.
  New York's public hospital system is the leading provider of 
uncompensated care to the uninsured and underinsured. Though this bill 
lowers the ten-year reduction in Medicaid and Medicare Disproportionate 
Share Hospital (DSH) payments by $3 billion, I remain concerned these 
cuts will weaken our health care safety net in New York. After all, 
while significant coverage expansions will be achieved through health 
care reform, there will still be populations that will remain uncovered 
or underinsured, and our hospitals will continue to bear the burden and 
cost of their health care. It seems like the best approach would have 
been that DSH cuts would be made contingent upon reductions in the 
uninsured. Instead of expansion triggers in the Senate bill, the 
reconciliation bill is improved with set levels of reductions per year 
and require the Secretary of Health and Human Service to develop a 
methodology to reduce states' Medicaid DSH allotments to achieve 
mandated savings.
  More broadly, I support this bill because of the positive impact it 
will have on women's lives. As Chair of the Joint Economic Committee, I 
prepared a report that looked at the specific health care challenges 
facing women and how women would benefit from comprehensive health care 
reform. More than two million women have lost their health insurance 
since the recession began due to their own job loss or their spouse's 
job loss. 1.3 million women lost their health coverage when their 
spouse lost his job and an additional 800,000 women lost their health 
care as a result of their own job loss. More than two million women 
have faced the brutal double-whammy of a lost job and lost health care. 
While job losses during this recession were much greater for men than 
women, women have fared worse than men in recent months. And this has 
had real consequences for women's health care coverage: in the last six 
months, the number of women losing health insurance benefits due to 
their own job losses has increased by nearly 50 percent. Over one 
quarter (28%) of women ages 19-24 have no health insurance at all. Part 
of that number is likely explained by the economic challenges facing 
young women. Young women have been hit hard in the recession, facing an 
unemployment rate of 13.1 percent, significantly higher than the 
national rate of 9.7 percent, and making it less likely that they will 
have job-based coverage. Health care reform will help us to overcome 
inequities at the center of the current system--where women pay more 
than men for the same coverage, or even, where women who are not 
smokers pay more for coverage than men who are smokers. My report and 
the reality is that the health care system is serving women poorly, the 
recession has made the situation worse, and now more than ever, we need 
health care reform.
  While I am speaking of women's health care, I must mention my 
opposition to the restrictive language on abortion included in the 
Senate bill which remains in reconciliation. While not as onerous as 
the Stupak language that was part of the final House bill, this 
language will directly impact a woman's right to legal reproductive 
health services and I oppose it. But the value to women and American 
families of finally achieving health care reform is far too important 
to risk losing it.
  Mr. Speaker, a great deal of the discussion today focuses on the 
moral reasons for extending health care coverage. While I agree

[[Page 5148]]

with the moral imperative, the fiscal necessity is clear. This bill 
cuts the deficit by $143 billion in the first ten years and then cuts 
the deficit by $1.2 trillion in the second ten years. The bill is fully 
paid for and will not add a dime to the deficit. While it will cost 
$938 billion over a decade, it is critical to note that Americans spend 
nearly $2.5 trillion every single year on health care now and nearly 
two-thirds of the bill is paid for by reducing health care costs.
  We must not let this moment pass without recognizing its historic 
nature. Today, millions of Americans will win basic rights--the right 
to health care, the right to live without the fear of chronic disease, 
and the right to never having to worry about losing insurance coverage 
because of a pre-existing condition or exceeding a lifetime cap. While 
not perfect, this bill will hold insurance companies accountable; 
provide billions of dollars in tax breaks for small businesses to help 
them insure their employees; and, above all, expand access to quality, 
secure, affordable health care coverage for millions of Americans.
  I'd like to thank and commend the leadership of Speaker Pelosi, 
Majority Leader Hoyer, Chairmen Waxman, Miller and Rangel and of 
course, Chairman Emeritus Dingell who has been working on health care 
reform since he first came to Congress.
  The time is now. Our current system is broken. Costs continue to 
increase at unsustainable rates and too many families and businesses 
are feeling the debilitating burdens brought on by these expenses. Too 
many Americans have inadequate coverage or lack coverage entirely and 
are suffering or dying as a result.
  I am grateful for the opportunity to be a part of this momentous 
reform. I urge my colleagues to reach beyond the rhetoric and the 
politics. Instead, recognize that today we will make a lasting 
difference in people's lives. Today we change the health of our nation 
for ourselves, for our children, and for our grandchildren.
  Mr. Speaker, today we will cast a series of historic votes.
  The outcome of the votes will result in 32 million people without 
health insurance gaining coverage and 94 percent of Americans with 
guaranteed health care coverage.
  In New York State, close to 2.5 million people who are currently 
uninsured will have health care coverage once the day is over.
  To get to this point, the House had to first vote on the Senate 
passed health care bill and then vote on a bill that makes important 
changes that have been negotiated by the House to dramatically improve 
the Senate bill--this is called the reconciliation bill.
  Without a promise of these important fixes, like taking out several 
of these ``special deals'' I would not vote for the Senate bill. 
However, with the guarantee of these improvements, today I will cast my 
vote in favor of the Senate health care bill.
  I appreciate the opportunity to outline some of my concerns with the 
Senate passed health care reform bill.
  Most importantly, the Senate bill would have cost New York close to a 
billion of dollars in Medicaid funding. Unlike the House bill which 
saves New York billions, the Senate bill penalizes States like New York 
for its expanded coverage of its citizens under Medicaid. Under the 
Senate bill, States that have not significantly expanded their Medicaid 
programs would receive a large influx of Federal funding, but States 
like New York are penalized for doing the right thing. The House bill 
contained a more equitable solution to sharing the costs of Medicaid 
expansion under health care reform by providing increased Federal 
funding for Medicaid expansion regardless of existing State eligibility 
levels. FMAP provisions in the Senate bill would result in a 
significant loss to New York State as a significant number of uninsured 
New Yorkers who are eligible for Medicaid enroll, while the House bill 
fairly shares in the costs for currently enrolled and newly enrolled 
childless adults and parents. Fortunately, the reconciliation bill that 
we will be voting on, fixes this problem, and the distribution of 
Federal Medicaid funding is more equitable and saves money for New 
York.
  The Senate bill similarly penalized New York in terms of its 
treatment of payments to Disproportionate Share Hospitals, DSH. 
Historically, Medicaid hospital reimbursement rates, on average, have 
been lower than the cost of providing care, and DSH payments were 
instituted to cover reimbursement shortfalls and uncompensated care 
costs. The need for DSH reimbursement will remain even after health 
care reform is passed since there will millions of newly eligible 
individuals who will receive care through Medicaid.
  The Senate bill reduced Federal funding for Medicaid DSH payments by 
$19 billion and Medicare DSH payments by $24 billion over 10 years; 
reductions to DSH payments of this magnitude will jeopardize the 
stability and the services provided by our safety net system. The 
original House bill which I supported had included more reasonable 
reductions of $10 billion each from Medicaid and Medicare DSH and 
similarly, the reconciliation bill, while not as good as the original 
House bill, reduces the cuts that the Senate bill would have imposed.
  I am also opposed to the restrictive abortion language contained in 
the Senate bill. The Senate bill is significantly onerous, stigmatizing 
abortion services and creating obstacles for those consumers who would 
like to purchase this coverage and to those insurance companies would 
like to provide this coverage. Though I am strongly opposed to these 
restrictions, I am voting for the final bill because overall, reforming 
our current health care system dramatically and positively impacts 
women. As Chair of the Joint Economic Committee, I prepared a report 
that looked at the specific health care challenges facing women and how 
women would benefit from comprehensive health care reform. More than 2 
million women have lost their health insurance since the recession 
began due to their own job loss or their spouse's job loss. 1.3 million 
women lost their health coverage when their spouse lost his job and an 
additional 800,000 women lost their health care as a result of their 
own job loss. More than 2 million women have faced the brutal double-
whammy of a lost job and lost health care. While job losses during this 
recession were much greater for men than women, women have fared worse 
than men in recent months. And this has had real consequences for 
women's health care coverage: in the last 6 months, the number of women 
losing health insurance benefits due to their own job losses has 
increased by nearly 50 percent. Over one quarter, 28 percent of women 
ages 19-24 have no health insurance at all. Part of that number is 
likely explained by the economic challenges facing young women. Young 
women have been hit hard in the recession, facing an unemployment rate 
of 13.1 percent, significantly higher than the national rate of 9.7 
percent, and making it less likely that they will have job-based 
coverage. Health care reform will help us to overcome inequities at the 
center of the current system--where women pay more than men for the 
same coverage, or even, where women who are not smokers pay more for 
coverage than men who are smokers. My report and the reality is that 
the current health care system is serving women poorly, the recession 
has made the situation worse, and now more than ever, we need health 
care reform.
  I have been a strong supporter of the public option and voted for the 
House bill in large part because it contained a public option. I 
believed then and I believe now that a public insurance option will 
increase competition and reform our current system. Every day, 14,000 
Americans lose their health care coverage. A public option would have 
brought down costs and expanded access. Unfortunately, the Senate was 
unable to pass a bill with a public option, though many Senators 
supported the provision. While I am disappointed that the final bill 
that will go to the President for signature will not include it, I feel 
confident that the end product will achieve the goals of covering the 
vast majority of Americans, reduce health care costs, and reduce our 
deficit by trillions of dollars.
  Mr. Speaker, it is clear that the Senate bill had flaws and as passed 
was not as good of a bill for the State of New York as it should have 
been. If I was just casting one vote today, it would be a no vote on 
this bill. However, we are being given the opportunity to fix and 
improve the Senate bill with the upcoming reconciliation bill which is 
why I am able to vote in favor of this bill. With this vote, I am 
voting in favor of helping Americans gain affordable, quality health 
care they both need and deserve, I am voting in favor of dramatically 
reducing the Federal deficit by $143 billion in the first 10 years, and 
I am voting in favor of improving coverage by removing denials of 
coverage based on preexisting conditions or gender. I am voting in 
favor of a strong and healthy future for all Americans and for our 
great country.
  The SPEAKER pro tempore. All time for debate has expired.
  Pursuant to House Resolution 1225, the previous question is ordered.
  The question is on the motion by the gentleman from California.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. GEORGE MILLER of California. Mr. Speaker, on that I demand the 
yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, this 15-
minute vote on the motion to concur will be followed by a 5-minute vote 
on

[[Page 5149]]

the motion to suspend the rules on House Resolution 1215.
  The vote was taken by electronic device, and there were--yeas 220, 
nays 207, not voting 3, as follows:

                             [Roll No. 194]

                               YEAS--220

     Ackerman
     Andrews
     Baca
     Baird
     Baldwin
     Bean
     Becerra
     Berkley
     Berman
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Boccieri
     Boswell
     Boyd
     Brady (PA)
     Braley (IA)
     Brown, Corrine
     Butterfield
     Capps
     Capuano
     Cardoza
     Carnahan
     Carney
     Carson (IN)
     Castor (FL)
     Chu
     Clarke
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly (VA)
     Conyers
     Costa
     Costello
     Courtney
     Crowley
     Cuellar
     Cummings
     Dahlkemper
     Davis (CA)
     Davis (IL)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Dicks
     Dingell
     Doggett
     Donnelly (IN)
     Doyle
     Driehaus
     Edwards (MD)
     Ellison
     Ellsworth
     Engel
     Eshoo
     Etheridge
     Farr
     Fattah
     Filner
     Foster
     Frank (MA)
     Fudge
     Garamendi
     Giffords
     Gonzalez
     Gordon (TN)
     Grayson
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hall (NY)
     Halvorson
     Hare
     Harman
     Hastings (FL)
     Heinrich
     Higgins
     Hill
     Himes
     Hinchey
     Hinojosa
     Hirono
     Hodes
     Holt
     Honda
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson Lee (TX)
     Johnson (GA)
     Johnson, E. B.
     Kagen
     Kanjorski
     Kaptur
     Kennedy
     Kildee
     Kilpatrick (MI)
     Kilroy
     Kind
     Kirkpatrick (AZ)
     Klein (FL)
     Kosmas
     Kucinich
     Langevin
     Larsen (WA)
     Larson (CT)
     Lee (CA)
     Levin
     Lewis (GA)
     Lipinski
     Loebsack
     Lofgren, Zoe
     Lowey
     Lujan
     Lynch
     Maffei
     Maloney
     Markey (CO)
     Markey (MA)
     Matsui
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McNerney
     Meek (FL)
     Meeks (NY)
     Michaud
     Miller (NC)
     Miller, George
     Mitchell
     Mollohan
     Moore (KS)
     Moore (WI)
     Moran (VA)
     Murphy (CT)
     Murphy (NY)
     Murphy, Patrick
     Nadler (NY)
     Napolitano
     Neal (MA)
     Oberstar
     Obey
     Olver
     Ortiz
     Owens
     Pallone
     Pascrell
     Pastor (AZ)
     Payne
     Pelosi
     Perlmutter
     Perriello
     Peters
     Pingree (ME)
     Polis (CO)
     Pomeroy
     Price (NC)
     Quigley
     Rahall
     Rangel
     Reyes
     Richardson
     Rodriguez
     Rothman (NJ)
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Salazar
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schauer
     Schiff
     Schrader
     Schwartz
     Scott (GA)
     Scott (VA)
     Serrano
     Sestak
     Shea-Porter
     Sherman
     Sires
     Slaughter
     Smith (WA)
     Snyder
     Speier
     Spratt
     Stark
     Stupak
     Sutton
     Thompson (CA)
     Thompson (MS)
     Tierney
     Titus
     Tonko
     Towns
     Tsongas
     Van Hollen
     Velazquez
     Visclosky
     Walz
     Wasserman Schultz
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Welch
     Wilson (OH)
     Woolsey
     Wu
     Yarmuth

                               NAYS--207

     Aderholt
     Adler (NJ)
     Akin
     Alexander
     Altmire
     Arcuri
     Austria
     Bachmann
     Bachus
     Barrett (SC)
     Barrow
     Bartlett
     Barton (TX)
     Berry
     Biggert
     Bilbray
     Bilirakis
     Bishop (UT)
     Blackburn
     Blunt
     Boehner
     Bonner
     Bono Mack
     Boozman
     Boren
     Boucher
     Boustany
     Brady (TX)
     Bright
     Broun (GA)
     Brown (SC)
     Brown-Waite, Ginny
     Buchanan
     Burgess
     Burton (IN)
     Calvert
     Camp
     Campbell
     Cantor
     Cao
     Capito
     Carter
     Cassidy
     Castle
     Chaffetz
     Chandler
     Childers
     Coble
     Coffman (CO)
     Cole
     Conaway
     Cooper
     Crenshaw
     Culberson
     Davis (KY)
     Davis (TN)
     Dent
     Diaz-Balart, L.
     Diaz-Balart, M.
     Dreier
     Duncan
     Edwards (TX)
     Ehlers
     Emerson
     Fallin
     Flake
     Fleming
     Forbes
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Garrett (NJ)
     Gerlach
     Gingrey (GA)
     Gohmert
     Goodlatte
     Granger
     Graves
     Griffith
     Guthrie
     Hall (TX)
     Harper
     Hastings (WA)
     Heller
     Hensarling
     Herger
     Herseth Sandlin
     Hoekstra
     Holden
     Hunter
     Inglis
     Issa
     Jenkins
     Johnson (IL)
     Johnson, Sam
     Jones
     Jordan (OH)
     King (IA)
     King (NY)
     Kingston
     Kirk
     Kissell
     Kline (MN)
     Kratovil
     Lamborn
     Lance
     Latham
     LaTourette
     Latta
     Lee (NY)
     Lewis (CA)
     Linder
     LoBiondo
     Lucas
     Luetkemeyer
     Lummis
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     Marshall
     Matheson
     McCarthy (CA)
     McCaul
     McClintock
     McCotter
     McHenry
     McIntyre
     McKeon
     McMahon
     McMorris Rodgers
     Melancon
     Mica
     Miller (FL)
     Miller (MI)
     Miller, Gary
     Minnick
     Moran (KS)
     Murphy, Tim
     Myrick
     Neugebauer
     Nunes
     Nye
     Olson
     Paul
     Paulsen
     Pence
     Peterson
     Petri
     Pitts
     Platts
     Poe (TX)
     Posey
     Price (GA)
     Putnam
     Radanovich
     Rehberg
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Rooney
     Ros-Lehtinen
     Roskam
     Ross
     Royce
     Ryan (WI)
     Scalise
     Schmidt
     Schock
     Sensenbrenner
     Sessions
     Shadegg
     Shimkus
     Shuler
     Shuster
     Simpson
     Skelton
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Souder
     Space
     Stearns
     Sullivan
     Tanner
     Taylor
     Teague
     Terry
     Thompson (PA)
     Thornberry
     Tiahrt
     Tiberi
     Turner
     Upton
     Walden
     Wamp
     Westmoreland
     Whitfield
     Wilson (SC)
     Wittman
     Wolf
     Young (AK)
     Young (FL)

                             NOT VOTING--3

     Buyer
     Davis (AL)
     Reichert


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore (during the vote). There are 5 minutes 
remaining in this vote.

                              {time}  2102

  So the motion to concur was agreed to.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.

                          ____________________