[Congressional Record (Bound Edition), Volume 157 (2011), Part 1]
[House]
[Pages 170-177]
[From the U.S. Government Publishing Office, www.gpo.gov]




                REPEAL OF THE AFFORDABLE HEALTH CARE ACT

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 5, 2011, the gentleman from California (Mr. Garamendi) is 
recognized for 60 minutes as the designee of the minority leader.
  Mr. GARAMENDI. Madam Speaker, it's a great privilege to be here on 
the floor with you. Congratulations to you and the other new Members of 
the Republican Party.
  We have some extraordinarily important tasks ahead of us. This 
afternoon, I'm going to be joined by some of my colleagues. We've just 
heard a very useful discussion on the role of the Constitution and how 
it plays into it. And indeed, today we did spend about 3 hours reading 
through the Constitution, and I think it was to all of our benefit. We 
started off with the new Speaker actually reading the preamble. I think 
that's a good place for us to start, because we're going to discuss 
health care today and we're going to discuss an effort by the majority 
party, the Republicans, to repeal the Affordable Health Care Act that 
was passed last session. And this issue has become a constitutional 
issue, so reading the preamble to the Constitution and Article I, 
section 8 is useful.
  ``We the people of the United States, in order to form a more perfect 
Union, establish justice, insure domestic tranquility, provide for the 
common defense, promote the general welfare''--promote the general 
welfare--``and secure the blessings of liberty to ourselves and our 
posterity, do ordain and establish this Constitution for the United 
States.'' And then later, in article I, section 8, ``Congress shall 
have power to lay and collect taxes, duties, imposts and excises, to 
pay the debts and provide for the common defense and general welfare of 
the United States.''
  It's about the general welfare of the United States that we'll be 
discussing in this next hour, and that's the welfare of the people of 
the United States. It speaks to us, the citizens--all of us--whether we 
are a newborn baby or a senior in the last of life--how do we provide 
for that general welfare?
  Last year, in a major step forward, the first time in more than 
nearly four decades, this Congress, together with the Senate and the 
President, passed the Affordable Health Care Act, a very, very 
important and extremely useful step in providing for the welfare--that 
is, the general welfare--of the American population. It's a law that 
makes life better from birth to retirement. Part of this law, a very, 
very important part of it, deals with what we call the Patient's Bill 
of Rights--the Patient's Bill of Rights, vis-a-vis, the insurance 
industry.
  I think all of us can go back to our districts, to our homes, and 
even to our own lives and find numerous episodes where the insurance 
industry has said, No, you cannot have this procedure; or, No, you 
cannot have coverage because you have a preexisting condition.

                              {time}  1540

  Today, we are going to talk about the Patients' Bill of Rights and 
the Republican effort that is now underway in the Rules Committee in 
this building, as we speak, to write a rule that they will bring to the 
floor next week, without one hearing, to completely wipe out this 
extraordinarily important effort to provide for the general welfare of 
the American people. We are going to discuss that in great detail.
  Now, for me, this is a very important part of my life. I spent 8 
years of my life as the insurance commissioner in California, taking on 
the insurance companies, trying to force them to honor their 
commitments, to force the insurance companies to pay the claim of a 
patient who had undergone chemotherapy, to provide insurance that was 
contracted for and not to rescind that health care policy. I cannot 
even begin to count the number of cases that came before me as 
insurance commissioner

[[Page 171]]

where the insurance companies would rescind a policy because the person 
suddenly became ill and had a very expensive episode.
  The Patients' Bill of Rights prohibits that. We are going to talk 
about that. I want to start here, and then I'm going to turn this over 
to my colleagues.
  I am going to give an example of a very dear friend who lived here in 
Washington. He was a Peace Corps volunteer, married. He was working 
here in Washington, DC, as the director of the National Peace Corps 
Association, the returned volunteers. He had a child. That child had a 
severe disability--kidneys didn't work. He was insured. His wife was 
insured. The pregnancy was insured. The delivery was insured. But that 
child, on the day the child was born with that preexisting condition of 
kidney failure, was uninsurable under the parents' policy.
  That kind of action is prohibited by the Patients' Bill of Rights. No 
more would that happen to men and women, families, pregnant women 
across this country who deliver babies that have some problem. Those 
babies will be insured whatever the condition might be.
  Our colleagues on the Republican side will bring to this floor next 
Wednesday, without one hearing in any relevant policy committee, a 
repeal of the Patients' Bill of Rights. What of the babies that are 
born in the future that have some issue? How will they be provided for?
  The rest of the story is this family has spent 20 years now 
struggling to provide the health care services that their child needed. 
They have been close to bankruptcy many, many times. They have 
struggled through it. The child is no longer a child--a young adult--
and under the law today, he has health insurance.
  Is that what the American public wants from the Republican Party--the 
repeal of that Bill of Rights that guarantees coverage for that young 
man? I think not.
  Let me now turn to our colleague from the great State of Virginia.
  Bobby Scott, would you please share with us your own views and how 
this is going to affect the general welfare of the American people.
  Mr. SCOTT of Virginia. Thank you, and I appreciate your hard work. 
Thank you for organizing this Special Order so we can discuss the 
problems with repealing health care.
  You have gone all through the need for health care during your life 
and how the bill provides assistance for those with preexisting 
conditions. It limits insurance company abuses, like what's called a 
``recision,'' when you have paid your premiums all these years and then 
finally get sick, and they want to cancel your policy right when you 
need it. There are lifetime and annual limits on benefits where they 
pay a certain amount, and once they get to that, you can be in the 
middle of a treatment, and they're not going to pay another dime for 
the rest of your life or at least for the rest of that year. There are 
many people with chronic diseases who hit up upon these limits very 
frequently.
  You have talked about young people on their parents' policies, who 
are working, who finally get jobs. They don't cover benefits. Up to 26 
years old, they can stay on their parents' policies.
  We have talked about prevention, the importance of prevention. A lot 
of people, because of copayments and deductibles, can't afford their 
annual checkups. This bill provides for annual checkups without 
copayments and deductibles.
  For those senior citizens in the doughnut hole, where they get no 
benefits, adding insult to injury, they have to continue paying their 
premiums, and get no benefit. We have assistance for them.
  It is outrageous that they would elect to try to repeal this. No 
hearings. No nothing. Just put a label on it and call it ``ObamaCare'' 
and then expect people to go along with the repeal. You just can't 
label things and expect people, by virtue of the label, to take action. 
They call it ``government-run health care.'' No. Government-run health 
care was the single-payer plan. That was defeated.
  The option of a public option would have been nice. People talk about 
choice. Well, in the plan that's on the books today, they have the 
choice of all the plans of anybody who wants to sell insurance in their 
States. They have a choice of all of them. It would be nice to have an 
additional choice--a choice of a public option where you have the 
choice of a policy that is not run by a for-profit corporation with a 
financial interest in denying you coverage or canceling your policy. It 
would be nice to have that option. You don't have to pick it, but it's 
just nice to have that option.
  One of the things that we want to make sure is that we have as many 
options as possible, including a public option if we can ever get 
there; but when we talk about repeal and replace, there is no replace 
tomorrow in the rule that they are suggesting. They just want it 
repealed. We want to know what they're going to replace it with and 
what they're going to leave out.
  Are they going to leave out the part where people with preexisting 
conditions can get covered? Are they going to say, ``No, you can't get 
covered''? Does the insurance company get to decide who has the 
privilege? Are health insurance companies going to tell young people 
under 26 to get off their parents' policies? Are they going to tell 
those in the doughnut hole to get back in the doughnut hole where they 
belong? Are they going to talk about those who can't afford prevention 
to get prevention? Are they going to tell those who are going to run 
out of coverage because of the limits, ``No, that's enough. You've had 
enough, and you can't get any more coverage''?
  What are they going to tell all of these people?
  We need to make sure that we keep this policy, all of these 
provisions, intact. I have no idea what they want to replace it with, 
but I think, if they went step by step and if the people looked at the 
provisions of the bill, they would elect to keep everything that's in 
the bill today.
  Now, there are some things that people don't like. When you have a 
good plan, you have to pay for it. Unfortunately, they're not paying 
for it. We were fiscally responsible. When we passed it, we were under 
PAYGO. They've repealed a lot of that so that they can go trillions of 
dollars in the ditch without paying for it. We paid for it. In fact, 
the CBO originally said that the first 10 years of the program would 
reduce the deficit by $140 billion. Now the estimate is $200-some 
billion in the next 10 years. So it is fiscally responsible.
  There are things we can do better together than everybody out for 
their own. We need to oppose the repeal of this health care to make 
sure that people have the protections and the Patients' Bill of Rights 
that they have under this legislation.
  Mr. GARAMENDI. Thank you very much.
  You've raised about seven of the major issues that are involved in 
this repeal that the Republicans will bring to this floor next 
Wednesday without one hearing in any relevant policy committee, a 
repeal that will affect every single American--that will affect their 
well-being, their health, their ability to get health insurance, and 
their ability to stay healthy.

                              {time}  1550

  So we have an enormous issue before us and we want the American 
public to be aware of what's going on here. It is the repeal of the 
Patient's Bill of Rights.
  Let me move on to one of our other colleagues from Tennessee. Mr. 
Steven Cohen, if you will join us, please.
  Mr. COHEN. Thank you. I appreciate the opportunity to share with you, 
and I want to first start because this day has been a day that started 
with the reading of the Constitution which is a document that we all 
revere. I have a little pocket copy of it right here, and we revere it. 
We pledge when we take our oath of office to protect and defend and 
support the Constitution, but we all know that it's interpreted by our 
Supreme Court, and it's Supreme Court history would have been better 
today for people to understand.

[[Page 172]]

  And you mention that the foundation of the particular health care 
bill is in the preamble: We, the people of the United States, to form a 
more perfect union, establish justice, et cetera, promote the general 
welfare.
  Also, in article I, which is the legislative article, section 8, it 
says that the Congress shall have the power to regulate commerce among 
the several States; and further, it says in article I that the Congress 
shall have the authority to make all laws which shall be necessary and 
proper for carrying into execution the foregoing powers and all other 
powers vested by this Constitution of the Government of the United 
States, in either Department or office thereof. So, in my opinion--I'm 
a lawyer, but there's lawyers on both sides--there's plenty of 
justification for this health care bill.
  Do you know next week when the Republicans will try to repeal this 
opportunity for Americans to get health care and wipe out these pre-
existing conditions clauses, et cetera, will they be coming under the 
idea that health care is not part of the general welfare? Will they be 
coming basically on a constitutional argument that they may make that 
this wasn't allowed to require a person to buy insurance even though we 
can, of course, require a person to sign up for the draft and lose 
their liberty for a while and serve in the Army--and we can do that, we 
can conscript soldiers, but we can't make them buy insurance. Is that 
what they're going to say, or are they going to come and talk about 
these things that Mr. Scott talked about and say that we don't think 
it's good policy for parents to have their children on their insurance 
until they're 26 or it's not good policy for women with breast cancer 
to get treatment at a certain amount? What are their tactics?
  Mr. GARAMENDI. Well, I would assume that they will try to go into 
their interpretation of the Constitution and avoid the very difficult 
argument of forcing or eliminating the Patient's Bill of Rights and 
allowing the insurance companies to engage in gross discrimination 
based upon sex. Clearly, women are discriminated against by the health 
insurance companies unless the Patient's Bill of Rights is there to 
protect them. Similarly, the two examples that you gave, pre-existing 
conditions, I cannot imagine that they would even attempt to 
successfully or even would be unsuccessful to argue that somehow these 
protections for the individual are not worth having.
  I think they will go into some obscure interpretation of the 
Constitution. We'll see. There's going to be a debate on the floor. 
Unfortunately, there will be no hearings to precede that, and there 
will not be a discussion of the details.
  Mr. COHEN. And they will control the amendments that will be 
permitted to be discussed on this floor. I know Speaker Boehner said we 
were going to be able to have amendments and be able to have good 
discourse.
  Mr. GARAMENDI. As you know--I saw you in Rules Committee earlier 
today--it is my impression that the Rules Committee is going to 
prohibit any amendments on the floor. We'll see. I mean, that has yet 
to be decided by the Rules Committee. We don't know, but surely the one 
amendment I would propose is: don't do it, maintain the Patient's Bill 
of Rights, maintain these protections that we all need.
  There's not a person in this Nation that is not subject to the 
possibility of an incident that would become a reason for rescission. 
That's my experience. Eight years hammering the insurance industry, you 
have got to honor your contract. Yet because of the laws, they were 
able to wiggle out of an expensive incident.
  Mr. COHEN. When I was a child, I had polio when I was 5 years old in 
1954. I was fortunate. My father was a doctor, and so sometimes 
professional courtesy, but I'm sure he had insurance that covered my 
hospitalization. But there were years later, I think it was 11 years 
later I had a tendon-lengthening operation that was immediately related 
to my polio and necessary on my Achilles tendon. That wouldn't have 
been permitted necessarily if they could use the pre-existing condition 
such as polio to have denied coverage; and whether or not how my father 
dealt with the expense and whether it's because he was a physician, I 
don't know; but I'd hate to see children in the same situation and 
parents in the same situation not be permitted to get that type of 
coverage later on.
  Mr. GARAMENDI. I don't know if you were a Member of Congress at the 
time, but we all under this law would have the same policy that every 
American would have. We wouldn't have any different policy than the 
American public would have, and the question about rescission, and 
you're a prime candidate should you lose office, which you shouldn't, 
to be uninsurable if the Patient's Bill of Rights were repealed.
  Under the Patient's Bill of Rights, if you were to leave Congress, 
you could get an insurance policy because the pre-existing condition 
that you have, polio, and an operation resulting from the polio would 
go into play as a pre-existing condition, and you would not be able to 
get an insurance policy.
  Mr. COHEN. Let me, if I can, read something that I've had prepared 
for today that came from a constituent's story, John Hopkins; and I 
know John Hopkins. He's a very important and active member in my 
community and contemporary. He sent me an email, and Mr. Hopkins 
requests I share this story with the House as we consider repeal of the 
Affordable Care Act. I want to share it with everybody here on C-SPAN.
  John was diagnosed with two unrelated cancers during his life. If you 
know anything about cancer, getting it twice for unrelated reasons is 
almost unheard of, but it happened to John Hopkins. Midway through his 
first bout with cancer, he was, of course, dropped from his health 
insurance plan. He was left with a medical bill that wiped out his and 
his wife's entire retirement savings, as well as the value of their 
house. They were never able to repay the debt in their lifetime. When 
he was diagnosed with a second bout of cancer 2 years later, he had no 
health insurance because there was no insurer anywhere in the market 
who would offer him a policy because of the pre-existing condition.
  He got some coverage in Tennessee because of a plan called Access 
Tennessee for uninsurables, but it was limited to $250,000 a year. As 
we all know, annual limits are set to be phased out by 2014 because of 
this law, and lifetime limits are already a thing of the past. A 
quarter of a million dollars may seem like a lot of coverage; but when 
somebody needs something like a bone marrow transplant to cure their 
leukemia, that single treatment would exceed the annual cap.
  My Republican colleagues have decided their first priority as the new 
majority will be repealing the Affordable Care Act; and when they vote 
to do this, they will be voting for the following: denying Mr. Hopkins 
the ability to enroll in a health insurance plan that doesn't 
discriminate against him for daring to be diagnosed with cancer again. 
They will deny John Hopkins the ability to enroll in a health plan that 
will actually continue to cover his treatment after he exhausts the 
current annual cap of $250,000, an amount that many cancer patients 
meet in a matter of weeks upon diagnosis, let alone those who are 
fighting two cancers over a number of years.
  And it will send a message to John Hopkins and every other single 
American who has ever been diagnosed or will ever be diagnosed with a 
disease like cancer that they're on their own when it comes to 
coverage, that sure they're free to get treatments and meet with their 
doctors, undergo laborious and life-saving surgeries year after year, 
just so long as they can foot the bill or try to keep it under the 
annual cap, because when it comes to cancer, budgeting your treatment 
should surely take precedence over anything else. Right?
  Mr. Garamendi, I am ashamed that we are considering repeal of this 
affordable health care bill; and when I see these numbers about 
$250,000 and I think of the fact that the Republicans were against any 
caps on taxes, they realize $250,000 annual income in many places is a 
middle-income salary, but for limitations on health care, they think 
the insurance company should

[[Page 173]]

determine that and that's enough; and if you have got cancer, it's not 
enough.
  Another friend of mine Facebooked me, Jimmy Barrasso. Jimmy worked 
for a long time for a company in Memphis. He's always been successful. 
He lost his job with that corporation. Because he had high cholesterol, 
he had difficulties getting insurance, and it took him a long time to 
find private insurance because of that pre-existing condition. He just 
sent me this on Facebook. He was friending me and he mentioned it, and 
I wanted to relate it.
  There are so many people in this country who are getting benefits and 
will get benefits and many of the benefits don't go into effect until 
2014, and the idea that this Congress, the 112th, as its first act 
would do such harm to the general welfare of the American public is 
hard to fathom.

                              {time}  1600

  Mr. GARAMENDI. Mr. Cohen, thank you so very much. Your closing 
sentence needs to be repeated. That the very first piece of legislation 
taken up by the new Republican majority in the 112th Congress is to 
repeal the Patients Bill of Rights. It's unfathomable.
  Let me now call on Frank Pallone, our colleague from the great State 
of--yes, it is--New Jersey.
  Mr. PALLONE. Well, first of all, let me thank you, my colleague from 
California, and each of the other speakers here for the contribution 
they have made tonight, and particularly when I listened to my 
colleague from Tennessee talk about those particular cases of 
individuals that were impacted, because that's really what this is all 
about.
  Again, it is amazing to me that the first act of this new Republican 
majority is to try to repeal a bill, health care reform, that really is 
making a difference for people on a personal level, particularly with 
the patient protections.
  You know, I thought to myself when I was coming down here: Who 
benefits from repeal? Who could possibly benefit from repeal? Because, 
as many of you talked about, all the people who are going to be harmed 
by it, who would benefit from it? And the only group I could think of 
that would benefit from the repeal are the big insurance companies 
because, if you think about it, what do they want to do? They want to 
keep increasing premiums. I read that in your State--I don't know, you 
may have already mentioned it--Blue Cross/Blue Shield, whatever, is 
talking about a 50-something percent increase. I cannot fathom these 
double-digit increases.
  And, of course, as this health care reform kicks in, it's going to be 
more and more difficult for the types of increases that we've seen in 
premiums that these big health insurance companies have put forward. 
And the reason the insurance companies want to get rid of the Patients' 
Bill of Rights and reinstitute all of these discriminatory practices, 
whether it be denying care because of preexisting conditions or 
reinstituting lifetime caps or, you know, the different protections 
that we've seen kick in, the reason they want to do that is also money-
oriented. In other words, they have to pay out money. You talked about 
the cancer person.
  I was up at the Rules Committee earlier, and Ms. Slaughter was 
talking about someone who had cancer and was treated and ran into the 
lifetime cap, and then the cancer reoccurred and she didn't have any 
more coverage because she had hit the lifetime cap. And that's a 
perfect example. They want to have lifetime caps. They want to have 
annual caps. They don't want preexisting conditions. They don't want 
your kids on your policy because it saves them money. The way that they 
make profits and pay dividends to their shareholders is by raising 
premiums and having discriminatory practices that eliminate the people 
that cost money because they need health care. I mean, it's that 
simple.
  And already, and just in the last few weeks, provisions have kicked 
in that go against that. The President announced--or the White House 
announced, I think around Christmastime, new regulations that say that 
any premium increase that's over 10 percent will be scrutinized. And 
under the provisions of this bill and the new regulations, these 
increases are not allowed to go above 10 percent. On January 1, the 
provisions kicked in that said that 80 percent of your premium costs 
had to be used for benefits, couldn't be used for insurance company 
profits, couldn't be used to pay back dividends to the shareholders. So 
all of these initiatives that are already kicking in, they basically 
make it more difficult for the insurance companies to make a big 
profit, and the consequence of that is that health insurance becomes 
more affordable.
  I was up at the Rules Committee earlier. It was interesting because, 
I think you mentioned, my colleague from California, or one of you 
mentioned that we, under this bill, under the health care reform that's 
in place now that they want to repeal, we get the same health 
insurance, as Congressmen, as any other American.
  You know, I still have people write to me and say, well, you know, 
You have your own policy, but you want to give me this lousy coverage 
that I'm going to get under the health care reform. And I have to write 
back and say, No, that's not true. You may hear that on some TV station 
or something, but it's simply not true.
  We specifically wrote into the bill that we have to go into the 
exchanges just like everybody else. We are going to be different from 
other Federal employees, as Congressmen, because we go into the 
exchanges.
  So, at the Rules Committee today, one of the Republican Members who 
is very supportive of repeal said that he specifically wasn't going to 
take health insurance as a Congressman, and he wanted me to know that 
because he was voting for repeal. And I said, Well, that's very nice 
and that's commendable for you, but I, frankly, think that every Member 
of Congress who votes for repeal should say, I don't want health 
insurance from the Federal Government, because if you are going to deny 
it to everyone else, you should deny it to yourself. Just the way we're 
saying that we are going to get the same coverage as everyone else, 
well, if you don't want anyone else to have the coverage, then you 
shouldn't get it yourself.
  And I know that some Members have already taken issue. There was one 
Member from Maryland who came to the orientation, a Republican Member 
from Maryland who apparently was a big advocate for repeal. And he said 
that he was inquiring because his Federal health insurance didn't take 
effect, as a Congressman, until February 1. We were sworn in yesterday, 
but I guess it takes 30 days before the insurance actually kicks in. He 
was complaining about the fact that had he to wait until February 1 to 
get his health insurance, as a Congressman. Well, you know, again, if 
you're going to vote for repeal next week, you shouldn't be worried 
about when it's going to kick in. You shouldn't be taking it at all, in 
my opinion.
  So there is a lot of--I don't know what the phrase is--smoke and 
mirrors or whatever the word is that is going on around here on the 
other side of the aisle in how they are viewing this. And my point is, 
you know, there is a lot of protection here for people. Don't deny them 
that unless you're going to deny it to yourself. But more than that, 
think about who is helped by this repeal--only the big insurance 
companies. They are the only ones that are going to benefit.
  I know you were the insurance commissioner, and so you know exactly 
what I'm talking about.
  Mr. GARAMENDI. I do have some experience on that. I wanted to deal 
with that. It's called the medical loss ratio, and the insurance 
companies have cut a fat check for themselves over the years by taking 
a big premium and then paying a very small amount of it out for the 
medical coverages.
  In this legislation, the Patients' Bill of Rights, and in the 
Affordable Health Care Act, they can't do that. They've got to pay, for 
the individual policies, 80 percent and, for the group policies, 85 
percent for medical services.
  So what was the very first thing they did after this bill was signed 
into law? We passed it last year, and the President signed it. The very 
first thing

[[Page 174]]

they did was to run down to the Health and Human Services Department 
and say, Oh, but our advertising ought to be included as a medical 
expense, and, Oh, these expenses for these kinds of employees, mostly 
statisticians and the like, that's a medical expense. Fortunately, the 
administration said, No, we think not.
  So what we're trying to do with this legislation is make sure that 
when we pay a dollar, at least we get 80 cents back in medical 
services. Our friends on the other side would repeal that and allow the 
insurance companies to take that money--or at least a larger portion of 
that money--put it in their pockets, give it to their CEOs, whatever, 
but not use it for medical services. Medical loss ratio is really 
important.
  And the other thing you mentioned needs to be understood also, and 
that is the ability of the governments to review, not to say ``no,'' 
but to shine that big, bright spotlight onto the insurance company 
premium increases. Is it justified? Yes? No? What are your costs and so 
forth? What ratios are you using in medical losses and the like? So 
that spotlight of information is required under the law. Many, many 
things in the law.
  Mr. Cohen, I see you stood up, anxious to make a comment here, so 
please do. And then I notice behind you our colleague from Maryland has 
joined us. And eventually, I want to start talking about seniors. So 
please, Mr. Cohen, go forth.
  Mr. COHEN. I wanted to ask you a question. Because I had said, and I 
was, I think, incorrect, when I suggested that the first thing the 
Republicans wanted to do was repeal the affordable health care bill. 
It's one of their first major priorities. But the first thing they did 
was today, and we joined with them. It was bipartisan. It was to cut 5 
percent from our Members' representational allowances, a small amount 
of money in the big picture, of course. But the deficit was the issue 
that they were highlighting.
  What would the repeal of the Affordable Health Care Act do to the 
deficit? That's the big issue, because that's one of our big issues.
  Mr. GARAMENDI. Well, Mr. Cohen, it just happens that we prepared this 
little blue chart here. Actually, it probably ought to be in the red. 
The repeal of the Affordable Health Care Act obviously deals with the 
Patients' Bill of Rights, but it also deals with the deficit.

                              {time}  1610

  This week, the Congressional Budget Office, nonpartisan, not 
Democrat, not Republican, they answer to neither party. They answer to 
the general public. They said that the repeal of the Affordable Health 
Care Act will increase the deficit by $230 billion, $230 billion in the 
next 9 years, and in the out years, the next 10 years, well over a $1.2 
trillion increase in the deficit.
  Mr. COHEN. And that's money we owe China; is that right? So it's okay 
to issue these securities and pay the Chinese the interest to be able 
to finance it, and our children and their grandchildren will be paying 
this if they don't have preexisting conditions where they can get 
insurance to cover the illnesses they may have to stay alive to pay 
these taxes.
  Mr. GARAMENDI. Our children, grandchildren, and indeed those of us 
that are living for another 10 to 15, 20 years, we're going to pay 
twice. We're going to pay the insurance cost, the health care cost 
that's not covered by the insurance programs. The example you gave of 
the individual with two bouts of cancer going to pay the full cost of 
that because the limitation goes back into place, so you get to pay for 
your health care, and you're going to have to pay off the deficit also, 
makes no sense whatsoever. But, hey, that's what they want to do, 
without one hearing by any of the relevant committees.
  Mr. COHEN. Consistency is the hobgoblin. Right? Thank you, sir.
  Mr. GARAMENDI. I notice that our colleague from Maryland has joined 
us, Ms. Edwards, Ms. Donna Edwards. I know you were interested in this. 
You were talking about it earlier today on the floor and in committee, 
so please.
  Ms. EDWARDS. I'm so pleased to join you today and to talk about 
health care. And I feel very personally about health care, as somebody 
who went for a long time without any health care coverage and worried 
like Americans do all across this country. They did prior to our really 
investing in reform for the American people. And so I know that 
anxiety.
  And I was thinking about some of our constituents, constituents in 
Maryland's Fourth Congressional District, and around the country, who, 
today because of what we did in the Democratic-led Congress in passing 
landmark health care reform legislation, are better off today. And we 
haven't even fully implemented the benefits for the American people.
  I think about a letter that I got from a gentleman who lives in my 
district in Olney, Maryland, a small town, Olney, Maryland. And he 
writes to me that his son, Mike, was 25 going on 26, and he could 
receive health care insurance coverage. When he wasn't able to get it, 
he needed it and he couldn't get it. And he got a letter from Blue 
Cross/Blue Shield saying to him that his son could continue to be 
covered until his 26 birthday. And what he did was he did what a lot of 
American families do, they're wiping the sweat from their brow because 
they know that they can now keep their young people on their health 
care plan until they're 26. I have a 22-year-old. I was feeling exactly 
the same way.
  I got another letter from a woman who actually does health care 
policy, but she lives in my district; and what she said to me is that 
her daughter had a preexisting condition and she was very concerned, 
but she was an older young person, 20-some years old, 20 years old with 
a preexisting condition, really worried that she wouldn't be able to 
provide health care. And then she got the notice for COBRA coverage, 
which we've all said, you know, the backup is COBRA. It turned out that 
that was going to be an extra $400 to $500 a month for her to have 
COBRA coverage to make sure that she didn't lose her health care when 
she actually lost her job.
  Well, now, this parent, actually, for the cost of about $70 or $80, 
as opposed to $400 or $500 a month, can keep their young person, their 
child, their young person on their health care coverage.
  I think this is a great benefit for America's families, for families 
who work every day and actually have health care coverage.
  I heard us earlier discussing premium increase hikes, and I want to 
tell you something. I know when we were working on health care reform, 
and many of us, very concerned about people who don't have insurance 
and need coverage. But most Americans all across the country actually 
do have some form of health care coverage. And you know what they're 
worried about? They're worried about those premiums going up at 
astronomical rates. And I've heard from my constituents, 20, 30 percent 
premium hikes.
  Well, because of what we did in this health care package, insurance 
commissioners, like you were a commissioner, insurance commissioners 
all across the country now have the power vested in them to be able to 
actually say, you know what? We're going to put a check on these 
companies. And so in States like California, a big State like 
California and Connecticut and Maine and Colorado and Maryland, all 
across the country, that's what these insurance commissioners are 
doing. And they're not saying the Feds do it for them; it's the States.
  And of course we heard here this morning, as we read the 
Constitution, a reminder that States are in a great position to look at 
what insurance companies are doing in their States, to regulate what's 
happening in their States, and to say to them, you have to stop taking 
money away from consumers, away from patients by raising your premiums 
excessively.
  And so these are real accomplishments for the American people and for 
people who go to work every day. And so I'm glad to be here actually 
talking about these benefits with the American people.
  Mr. GARAMENDI. Thank you so very, very much. Before I turn to our

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colleague from Virginia, you reminded me of two very quick stories. 
One, on Monday I was at the inaugural for the Governor of California. 
Jerry Brown is back again. And a lobbyist that I knew when I was 
insurance commissioner representing health insurance companies came up 
to me and he put his finger in my chest and he said, don't let them 
repeal the law. Now, I'm not going to give his name. He'd lose his job 
immediately.
  And I said, I'll do everything I can, but why? You represent them. 
Why?
  And he said, I have two children. Both are type 1 diabetics. They're 
approaching 23 years of age. They will be out of luck. They will never 
be able to get an insurance policy if this bill is repealed. The 
Patient's Bill of Rights gives that lobbyist for the health insurance 
industry an opportunity to see his children get health insurance.
  Now, I have six children of my own. Patty and I do. All six of them 
have gone through that age of 23. It is the scariest time for a parent. 
You graduate, you get a diploma, and you also get an exit from the 
insurance that you've had perhaps for your entire life. This law 
provides another 3 years after you graduate, that period of time where 
it's almost impossible nowadays to find a job that provides insurance 
to give that insurance.
  Mr. Scott, please join us once again.
  Mr. SCOTT of Virginia. Thank you very much. And I appreciate your 
hard work and leadership on this. You've talked about the problems in 
health care with government. It's just not a government problem. If you 
ask any human resources executive about the major problems they have 
and benefits package, it's the ability to afford health care. Health 
care costs are going out of control. If you have an employee with a 
preexisting condition and he's in the group, then they do the actuarial 
study, you start getting bills that you can't pay. You ask any human 
resources what's happened to their insurance costs over the years. It's 
just going through the sky. And if you look at the employee portion of 
health care, it goes from zero participation to a little bit more 
copays, more deductibles, more cost for the family, on and on and on. 
Everyone has a great deal of insecurity about their ability to do 
health care.
  And then you look at the idea, what happens if you lose a job? If you 
have a preexisting condition, you will not be able to get health care 
until this bill passed.
  With all this insecurity, your ability to get health care, your 
ability to be able to afford it in the future, all of these problems, 
all of these problems in the future, what is the response from the 
other side about what to do about that kind of insecurity?
  They say, well, just be strong and go without insurance like me. 
Well, that is not a particularly attractive solution for those that 
don't have an alternative, don't have a spouse where you can just jump, 
you know, you can say I'm not going to take government policy, I'm 
going to use my spouse's policy; we have an alternative. Or if they're 
so wealthy, they don't need the insurance.

                              {time}  1620

  Most Americans aren't in that situation. They need health insurance. 
And this is what is provided. You have access to it, and it is 
affordable.
  Everyone in America will be able to afford health insurance in 2014 
because those that can't afford it will have subsidies to make sure 
that they can. So everybody will be able to get it.
  If you make less than $88,000, you can get health care for less than 
10 percent of your salary. That is not the case now. If you are in the 
$20,000, $40,000, $50,000 a year bracket, if you can get insurance, 
it's going to be a lot more than that.
  So with this bill people have the security of health insurance that 
they don't have now. And the bizarre suggestion, just go without 
insurance, is not particularly nice when you have children that may 
have a little ear infection. Rather than have them lose their hearing, 
you can deal with it when it is a little infection, these problems 
don't grow out of control. We need that security. This bill provides 
it.
  And in terms of seniors, seniors are particularly helped under this 
legislation. Those that can't afford the copays and deductibles can get 
their annual checkups without any copays and deductibles. We are 
helping fill in the doughnut hole. It will take a little time, but 
eventually there will be no doughnut hole where they fall in and have 
to pay all of the drug costs. We provide more community health centers 
so they will have better access. We are training more doctors and 
nurses so they will have more professionals. You have a chart that 
extends Medicare. Medicare is extended. We know that Medicare will go 
broke if we don't do anything. It extends the solvency of Medicare. It 
lowers prescription drug costs. All of these things that seniors have a 
particular interest in, all of that will be lost if this bill is 
repealed.
  Mr. GARAMENDI. If I might interrupt you for just a moment, Mr. Scott. 
You are into an issue, an area that is profoundly important to the 
seniors of America.
  The discussion last year as this bill was passing was that somehow 
this piece of legislation would harm seniors by taking away Medicare 
benefits. It was not true last year. It is not true this year. However, 
if our Republican colleagues are successful in repealing it, they, the 
seniors, will be seriously harmed.
  I want to make this point very, very clear and ask my colleagues to 
join us perhaps from their own personal experience in their districts. 
You started going through this list here. This legislation actually 
extends the solvency of Medicare by reining in the costs and by giving 
seniors specific pre-illness care so that they will be able to get 
preventative care free, free annual checkups. They can't get it today, 
but under this legislation seniors can get free annual checkups, which 
reduces the cost, because you get to the illness quicker.
  Mr. SCOTT of Virginia. You said that people were scared about what 
might happen. They also said things about small business, this would 
bankrupt small businesses.
  First, small businesses are exempt from the requirements under the 
bill, so it can't possibly hurt them. But those small businesses that 
want to provide health care for their employees are given tax credits 
to help them do so. So it can't possibly be hurting small business. But 
for the senior citizens, they have all of the benefits that you have 
listed on the chart that will be lost if this bill is repealed.
  Mr. GARAMENDI. You mentioned the doughnut hole, the prescription drug 
doughnut hole. Every senior that was in the prescription drug doughnut 
hole last year, 2010, received a $250 check to help them pay for their 
drugs. In going forward, the doughnut hole will be lessened and 
lessened, and eventually, 9 years from now, will disappear. There will 
be no doughnut hole.
  You talked about the quality of care. Extremely important, quality of 
care. Thank you for bringing that up. More primary doctors, more 
geriatric care from nurses and doctors, an extraordinary important part 
of the legislation, not just only for seniors. You also mentioned the 
community-based and of course the preventative care. All of these 
things are there, and all of them will disappear if the Republicans are 
successful with their legislation next Wednesday that will be brought 
to this floor without one hearing to discuss any of these issues in a 
relevant policy committee.
  Mr. Cohen, please join us.
  Mr. COHEN. Let me ask a question. I was just thinking here, it's an 
honor to be in the House of Representatives and with a Constitution 
that's so beautiful that it says we are to promote the general welfare.
  We are among other industrialized nations on this earth. What do the 
other industrialized nations on the earth do about health care for 
their citizens?
  Mr. GARAMENDI. Well, I'm not sure I heard your question, so please 
say it again.
  Mr. COHEN. What do the other industrialized nations in the world do 
for health care? Do they program policies like ours, where 32 million 
people don't

[[Page 176]]

have health insurance reform and they are not mandated to get 
insurance? What do they do?
  Mr. GARAMENDI. Well, I think you are asking me a rhetorical question, 
because you know the answer and I think most Americans know the answer, 
that all the industrialized nations--we are not talking about China, 
but we are talking about Korea, Japan, the European countries, the 
European Union. All of those countries provide universal health 
insurance coverage. Universal.
  Everyone, including tourists who happen to show up--and this I know 
from one of my daughters who fell off a stair at the Leaning Tower of 
Pisa. She fell, went into an emergency room, they took an MRI, bandaged 
her up, and said, ``Get out of here.'' And she said, ``Well, I haven't 
paid.'' ``Well, you are covered.'' That was in Italy.
  Mr. COHEN. And does the United States not have one of the greatest 
discrepancies of wealth between the richest and the poorest in the 
industrialized world as well? So are we saying to our wealthy people, 
``You can afford health insurance so you can get it,'' but for those 
people who are poor, ``Too bad''?
  Mr. GARAMENDI. The other countries of the world don't look at it that 
way. They look at it as a right for their citizens to have access to 
health care, and they provide the health insurance. There are different 
ways of doing it. Germany, France, Britain, Canada all do it 
differently, but they all do it.
  Incidentally, the health statistics in all of those countries are 
considerably better than America, and America is placed at the bottom 
of the industrialized countries in terms of our health care, how 
healthy we are, how long we live, how sick we get. We are at the 
bottom. In fact, we are often with developing countries in the 
statistics. We spend almost twice as much as any of those other 
countries.
  So the Affordable Health Care Act goes after many, many things beyond 
the Patients Bill of Rights and the senior issues. Thank you so very 
much for raising that issue.
  We have about maybe 10 more minutes. Mr. Pallone.
  Mr. PALLONE. Well, I just wanted to talk a little bit about 
prevention, and particularly in terms of seniors, which you mentioned, 
and what it means in terms of people's health and also the cost to the 
government, because some of the things that we've mentioned with regard 
to seniors have already taken place.
  This summer under the bill, seniors who fell into the doughnut hole 
got a $250 rebate. Beginning January 1, they get a 50 percent discount 
on brand-name drugs if they fall into the doughnut hole in 2011.
  You mentioned the copays for preventative care, whether it's your 
annual wellness treatment or other kinds of tests like mammograms or 
colonoscopies, for example. The reason that we are eliminating the 20 
percent copay for these things, the reason we are trying to fill up the 
doughnut hole, it all goes back to prevention. Because if people get 
their drugs and they don't end up getting sick and going to the 
hospital, if they get these tests or they have the annual wellness 
checks, they stay healthy, they don't go to the hospital. And when they 
go to the hospital, if they are on Medicare, it just costs the 
government more money.
  So this is the way we save money. We save money. And what does that 
mean? It means that the debt is decreased. It means that the solvency 
of Medicare you have on the chart is extended.
  I don't know if we have talked much about that. One of my amendments 
in the Rules Committee today is--a lot of seniors tell me, they come up 
to me and say they are worried about the fact that Medicare may become 
insolvent and there wouldn't be enough money in the trust fund to pay 
for it. The bottom line is that the health care reform bill extends the 
judgment day, if you will, when the solvency problem becomes an issue 
much further. And if you have the repeal, the solvency problem hits us 
6 years from now, in 2017, from what I understand.
  So another problem with repeal is not only does it increase the 
deficit, but it also is only 6 years from now that we would have to 
deal with this Medicare solvency problem. And what is that going to 
mean? That is going to mean probably cutbacks in benefits for senior 
citizens. Because if you don't have the money, you are going to have to 
cut back on the benefits. It is amazing to me how they can continue to 
talk about this repeal.
  The other thing they keep saying on the other side of the aisle, the 
Republicans say, well, the reason we want the repeal is because this 
health care reform is killing jobs. Nothing could be further from the 
truth.

                              {time}  1630

  The fact of the matter is that under this health care reform because 
the cost of health care premiums for employers will be significantly 
reduced, they will be able to hire more people. Part of the problem 
that we have with competition with other countries, you mentioned all 
these other countries, all these other industrial countries that have 
free health care, universal health care. That means that the employers 
don't carry the burden of that. So when they hire someone if the 
government is paying for it, they don't have to worry about that for 
their employees necessarily. If the cost of premiums go down, then the 
costs of hiring somebody goes down in the United States.
  In addition to that, there are all kinds of jobs created in the 
health care professions because, as everyone gets covered and everybody 
needs a primary care doctor, you're going to need more doctors, more 
nurses, more health aides because people will get that kind of 
preventative care. So there are jobs created with the preventative care 
in handling people, to make sure they stay healthy or they stay well.
  It is unbelievable to me when they talk about repeal. What the 
Republicans should be doing is spending the first few days of this 
session talking about how to improve the economy and create jobs, not 
repealing health care. I think the American people have moved on. They 
don't want to hear this. They want to know what this Congress is going 
to do to create jobs and improve the economy. We've already dealt with 
the health care issue and they want us to move on.
  Mr. GARAMENDI. We have about, maybe 3 minutes, 4 minutes, and I am 
going to turn now to the gentleman from Tennessee (Mr. Cohen).
  Mr. COHEN. I just wanted to add one thing. Thank you.
  The gentleman from New Jersey brought up an issue, and he said that 
it was not true that it was costing jobs. There is some respected 
group, I think it's called PolitiFact. They were on national news 
giving the biggest lies told in politics in the last year. The number 
one biggest lie--this independent group--was the Republican mantra of 
government run or government mandated health care. It's just a fact. 
That's the biggest lie told the American public. And it came from the 
leaders on the other side, it came from these halls where they are 
immune from defamation suits. Because it's not government run health 
care. It's unheard of, unfathomable, that the other side would use the 
fact that they're immune from prosecution in any other jurisdiction or 
court for words that aren't true to do that and in politics to say it 
was government run health care, the biggest lie of 2010, and it comes 
to the floor next week.
  Mr. GARAMENDI. We are going to wrap this one up. I see the gentleman 
from Kentucky is here and he will probably carry on with health 
insurance. Maybe a couple of us will be asked to join him.
  We have really today focused on a broad range of issues: The 
patients' bill of rights; the way in which the repeal would harm 
individuals who have preexisting conditions; young children from 
infancy; the 23- to 26-year-old coverage.
  We also discussed a little bit about how this affects business and, 
of course, we went into some detail about senior citizens. All of these 
are critically important issues. We will be discussing these in the 
days ahead. I do hope the American public will really pay attention, 
because this next week, particularly as we move towards

[[Page 177]]

Wednesday, is going to be absolutely critical to the American people. 
It's a question about will all of us in America be able to get health 
care coverage that is affordable and provides us with the opportunity 
to have the health care that we need.
  Mr. Speaker, I yield back the balance of my time.

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