[Congressional Record (Bound Edition), Volume 157 (2011), Part 1]
[House]
[Pages 186-189]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              {time}  1800
                      HEALTH CARE AND THE DEFICIT

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 5, 2011, the gentleman from Vermont (Mr. Welch) is recognized 
for 30 minutes.
  Mr. WELCH. Thank you, Mr. Speaker, and welcome. I want to also thank 
the gentleman from New Mexico and welcome him back. Your comments about 
trying to work together and bipartisanship, that all makes an awful lot 
of sense to me and I hope to all of us. But welcome back, sir.
  We are going to have an opportunity, Mr. Speaker, to use this Special 
Order half-hour to talk about health care and also about the deficit. 
We do want to be bipartisan, but we also want to be real. Our job, as 
you know, is to legislate, and we will be judged by our actions, by our 
deeds, more than by our rhetoric.
  Let me just say that the aspirations that have been enunciated by 
many of our Republican leaders are ones I quite admire; an open and 
transparent Congress, more open rules, fiscal discipline, things that 
are absolutely, fundamentally important to this country, and the 
question now is whether there

[[Page 187]]

is going to be a follow-through on those stated goals. The best way to 
start looking at it is what is going on with the health care bill, and 
the decision of the leadership is to repeal health care.
  Now, that is a very radical decision, because as much as there are 
legitimate issues, many legitimate issues about that health care bill, 
a wholesale repeal as a policy is going to do real damage to real 
families in this country, in every district in this country, and it is 
also going to immediately increase the deficit by $230 billion.
  As is known, that is not the opinion of a Democrat or Republican; 
that is the conclusion of the impartial arbiter, the Congressional 
Budget Office. So if we are dedicated to fiscal discipline, if we have 
got to bring down spending, how can we have as our first act as a 
Congress passing a bill that the Congressional Budget Office says will 
increase the deficit by $230 billion? It doesn't add up, obviously.
  I am going to pause here because I have some of my colleagues who are 
going to be called to other locations. I want to start, if I could, 
with the gentleman from Colorado, Mr. Perlmutter.
  Mr. PERLMUTTER. I thank my friend from Vermont.
  I want to piggyback on something that you just said. I hope that we 
can and we will work with the Republican majority on a lot of issues to 
get people back to work in America, to stop outsourcing jobs to other 
countries, to stop importing oil at tremendous price to this country so 
that money continues to flow away from the U.S. instead of into the 
U.S. I want to work with them on those kinds of things.
  But what I am concerned about is something you just mentioned. The 
ideology and the radical approach that they are taking to repeal 
something that was put into place over the last 2 years but has been 
needed by this country for decades is something that I will fight. 
Ideological, radical extreme positions are not what the American people 
want. They want practical, solid solutions where people are treated 
fairly and equally.
  In the health legislation, the Affordable Health Care Act that we 
passed, the guts of that legislation is about treating people equally. 
What I mean by that is we stop discriminating against people with 
preexisting conditions. They are now free from that kind of 
discrimination. That is so important.
  We talked a lot today about the Constitution. Well, prior to the 
Constitution we had the Declaration of Independence, and the 
Declaration of Independence starts off, ``We hold these truths to be 
self-evident, that all men are created equal.'' It probably should have 
added ``women'' at that point, but back then it was ``all men are 
created equal.''
  That is carried forward in the 14th Amendment to the Constitution, 
and I have prepared a chart of this, of the language, which says no 
State shall deny to any person within its jurisdiction the equal 
protection of the laws.
  People with prior illnesses, with physical conditions, have been 
discriminated against because of those conditions and illnesses. That 
is wrong, it is immoral, and in my opinion it is unconstitutional.
  In my district, I was standing at a gas station. A guy comes up to me 
and he says, You all have to pass that legislation. My daughter has 
Crohn's disease. I am in a roofing company. I want to start my own 
roofing company, but because she has this disease, I have to stay here. 
Otherwise, she will be uninsurable because of her prior condition, and 
I am stuck in that job.
  Well, this bill, the heart of this bill is to give freedom from that 
kind of discrimination against her prior illness, freedom to that 
roofer so he can go start his business. That is at the heart of the 
American way.
  In my own situation, I have a daughter with epilepsy. She didn't ask 
to have epilepsy; that is just part of her makeup. But because of the 
epilepsy, she is uninsurable, unless she is part of some big group 
policy.
  So in the Affordable Health Care Act, we have done away with that 
kind of discrimination. We have freed people from that kind of 
discrimination. The Republican majority, ideologically, radically 
driven, wants to take that freedom away, and I will fight that today, 
tomorrow, and next week.
  With that, I yield back to my friend from Vermont.
  Mr. WELCH. I welcome the gentlelady from Maryland, Congresswoman 
Edwards.
  Ms. EDWARDS. I thank the gentleman. I am so pleased to be here again. 
I have been here in the House on this floor for the last hour and a 
half because I feel passionately, as we all do, about health care. 
There is not one among us, either personally, as the gentleman from 
Colorado has expressed, or one of our constituents, who doesn't have a 
health care story to share.
  So I thought that I would actually share with you a story today, Mr. 
Speaker, from a constituent of mine who lives in the Fourth 
Congressional District in Maryland. She writes to me that her daughter 
graduated from college in 2008 and lost coverage under my--this is from 
her--my health insurance.
  She got a job in August 2008 that provided her with health insurance 
coverage. When she lost that job in June 2009, as millions of Americans 
have lost their jobs, she was eligible for COBRA, the continuation of 
her health care. Mr. Speaker, she writes that the COBRA subsidy made it 
possible for her to continue with that insurance. But then when that 
subsidy ended in September of 2010, they had to make a family decision, 
she says, to continue to pay for her COBRA coverage until the end of 
2010 when it expired. It was an affordability question.
  She continues on: We knew she would become eligible for my insurance 
at the start of the plan year in January 2011.
  And why is that? Because under the Affordable Care Act, she would be 
able to cover her daughter for her health insurance and would no longer 
have to COBRA that care.
  She continues on: The unsubsidized COBRA premium was over $400 a 
month, actually closer to $500 a month, and it is going to cost me only 
$60 to $70 to add my daughter, now 24, to my employer plan. And some of 
her doctors who were not in the network under her COBRA plan are in 
network for my plan, meaning we will not have to pay for their full 
cost of out-of-pocket costs.
  Vicki--I won't say her last name--says to me: I am in the sandwich 
generation and help with the care of my stepmother who lives in 
Florida. She falls into the part D prescription doughnut hole every 
year, so now on January 1 her costs will be reduced because of the 
health reform legislation as well.
  Mr. Speaker, what I am saying to you and what we say to the American 
people today is that this isn't about numbers and statistics; it is 
about real people like Vicki and her daughter and her stepmother that 
she cares for. It is about real people who, in their lives, work every 
single day or are trying to find work and they don't have health care 
coverage.
  We cannot repeal the Affordable Care Act, because that would be like 
throwing ice water on the American people.
  With that, I yield back.

                              {time}  1810

  Mr. WELCH. I want to talk about this question of will promises made 
be promises kept. It was the recurring question that was asked by our 
colleagues on the other side of the aisle when we were in the majority. 
Sometimes it may be uncomfortable because it's a legitimate question. 
And we have had to be judged according to our deeds and whether they 
matched our promises.
  But there's this rules process under way on this health care bill. 
There are three issues that have come up. Number one, the fiscal issue. 
The Congressional Budget Office has said that this legislation will 
increase the deficit by $230 billion. And the Congressional Budget 
Office is the neutral arbiter. And we either--both sides--go by the CBO 
estimates, or we just say we're going to play this game without a 
referee and we're going to make up whatever numbers suit our political 
agenda.

[[Page 188]]

That is absolutely wrong. We cannot afford to add $230 billion to the 
deficit. My colleagues on the Republican side agree with us on the 
Democratic side that we cannot do that. It's irresponsible to do it. 
And this legislation that repeals health care will add $230 billion to 
the deficit.
  Secondly, there's this question of the open process. As the Member 
from Maryland said, if we're going to have an open process, there has 
to be an opportunity for you, for the Member of Colorado, for every 
Member to offer their amendments, yes-or-no, on whether we can continue 
protection to folks whether they have a preexisting condition or not.
  Right now, the law is if you have cancer, you can go out and buy 
insurance. Right now, the law is if you have a son or daughter getting 
out of college or getting out of high school, going into the labor 
force, they can stay on your policy. Right now, the law is if you have 
a mom or dad who's on Medicare and you're trying to get preventive 
care, they can get it for free. Right now, the law is that if you have 
diabetes or you have cancer, you have a serious long-term medical 
condition, there's no lifetime cap to cover the medical care that you 
need.
  The repeal legislation would take away from every single American who 
now enjoys those insurance protections. It would take it away from them 
suddenly, abruptly, and with nothing to replace it. That's not right.
  Now, this is real, by the way. Congresswoman Edwards gave a couple of 
stories--and we all have them in all of the districts, including those 
who are advocating for repeal. I spoke to Donna Watts who's from 
Plainfield, Vermont. She works in Burlington, Vermont, with 20 other 
employees. Four of those people that she works with, along with her, 
now have their children on their health care policies. Her son got out 
of high school, got a $10-an-hour job that came without health care, as 
most entry-level jobs do.
  And the worst happened. He had a car crash: $20,000 in medical bills. 
Those are still largely unpaid--and this family takes seriously their 
obligation to pay their bills. They didn't have insurance. With the 
passage of the legislation last year on health care reform, Donna Watts 
was able to put her son, still uninsured, on her insurance. And she is 
asking me, Peter, does this really mean if we repeal health care that 
my son loses insurance? And the answer is: Yes. That's not right. We do 
not need to do this.
  And it raises the other question, If this has not got a political 
agenda attached to it, we have gone from a campaign to governing. And 
the majority did a great job in the campaign and beat us up pretty good 
and have the majority now. But with that, of course, comes the 
responsibility of governing in a responsible way. If you're acting 
responsibly when you see a problem, you fix it. You don't abolish 
everything. You don't abolish a banking system in order to correct the 
problems in the financial world. You don't abolish all of the good 
things in this health care bill to deal with the things that need to be 
addressed.
  So this is a very, very serious decision that's being made. It's 
going to be a template for the future of this 112th Congress. Are we 
going to actually deal with fiscal discipline even when that's 
inconvenient with our political agenda? The answer to that for the 
American people has to be: Yes. Are we going to protect the progress 
that we have made that benefits all of our constituents when it comes 
to these insurance reforms, and are we going to have an open process in 
this body so that those of us who have a different point of view are 
going to have an opportunity for an up-or-down vote?
  By the way, that's not about giving us the opportunity to present our 
amendments. That's about letting our constituents know where we stand. 
Because at the end of the day that's the only basis upon which they can 
decide whether to send us back here or send us packing.
  At this time I would like to recognize the gentleman from North 
Carolina, Representative Price.
  Mr. PRICE of North Carolina. I thank the gentleman for yielding and 
also for engaging in this dialogue with other Members about the 
challenge that we're facing to reduce this country's deficit spending 
and reduce the accumulating debt and at the same time to make certain 
that quality, affordable health care are available to all of our 
citizens.
  As the gentleman has pointed out very, very ably, those two 
challenges are intricately related. In fact, one of the main reasons 
for supporting health insurance reform is because we simply must reduce 
our deficit spending and must reduce this country's debt. One of the 
main contributors to our country's escalating debt is the kind of 
increasing of health care costs that we have seen in recent years. It's 
one of the greatest threats to families, to businesses, to the overall 
economy. Health care has become the fastest growing component of the 
Federal budget, as the gentleman well knows. Last year, health care 
accounted for 17 percent of GDP. That's more than twice the average of 
other developed nations.
  Now, the Patient Protection and Affordable Care Act corrects the 
failures of the current system without compromising the many strengths 
that we know that it has. And so it's very disconcerting here in this 
first week of the new Congress to see our Republican colleagues not 
only going after the protections in the health care law, but also 
almost immediately abandoning their commitment to fiscal discipline.
  Now, the figures that I saw this morning show that the Congressional 
Budget Office, the nonpartisan arbiter of budgets decisions for this 
body, the Congressional Budget Office has said that the repeal of 
health insurance reform as proposed by the Republicans would cost the 
Federal budget $230 billion over the next 10 years. That's a revised 
estimate, I understand--even greater than was earlier thought. That is 
an astounding figure.
  Our Republican friends have made a big show out of their commitment 
to deficit reduction, but they have made an exception. They have 
clearly made an exception for the repeal of health insurance reform. So 
not only is this bad health care; not only would it, for example, say 
to families who only now are being able to insure their children with 
preexisting conditions, No, we're going to go back to the old way where 
the insurance companies can deny coverage to your children. What about 
those families that now are able to include their 24-, 25-year-olds on 
their families' policies? No, they're saying go back to the old way 
where that wasn't possible. What about our Medicare recipients who 
finally are going to get some relief from these uncovered drug 
expenses, the so-called doughnut hole? They're saying, Oh, no, you're 
going to have to once again pay those full expenses.
  So it's certainly bad policy in terms of health care. But then, to 
add insult to injury, adding $230 billion to this country's debt burden 
over the next 10 years, and to do that without batting an eye, without 
any kind of recognition that this has an impact on the budget deficit, 
that's just almost unbelievable that the Republicans would be so 
audacious as to propose this in the first week of a new Congress.
  And then to add another insult to injury, they're violating their 
very own pledge of openness in the way this is going to be considered. 
I'm sure this gentleman has been watching, as I have, the Rules 
Committee all day today. It's astounding. Yesterday, there was this 
commitment to open rules, to open debate, to the offering of 
amendments. Today, they're saying, We're going to shut it down. It's an 
up- or-down vote. Maybe we'll get around later to some of these other 
questions, some of the repair aspect of repeal and repair, but right 
now we're just going to repeal it and let the chips fall.

                              {time}  1820

  That is horrible procedure. It's a shutting down of this Congress 
before we even start. It's horrible budget policy. It's horrible health 
policy. It's a very, very bad way to start this Congress.
  I appreciate the gentleman for calling us together tonight to talk 
about this, because we need to talk about it. We need to think about 
it. We need to fight it in every way we can.

[[Page 189]]


  Mr. WELCH. Thank you very much, Mr. Price.
  I recognize the gentleman again from Colorado.
  Mr. PERLMUTTER. Well, I'd say to my friend from North Carolina that 
he was talking about the fact that seniors will see this doughnut hole, 
their prescription drug prices go back up, the costs go back up; but 
even, I think, more worrisome than that is the fact that, under the 
Affordable Care Act, those same seniors receive $250.
  In my district in Colorado, the suburbs of Denver, 31,000 seniors 
received this past fall $250 in assistance to payments of their 
prescription drugs. Even with that, we still save the $230 billion that 
you were talking about. Yet, when the Republicans repeal this in kind 
of an ``all or nothing'' situation, do those seniors have to pay that 
$250 back, each of them? I don't know. I think they ought to be worried 
about that, and that's why this is such an extreme measure.
  They are taking away freedoms that belong to the people, that belong 
to Americans. They are doing it in a radical and ideological way. When 
they said during the campaign, you know, Let's put people back to work, 
and let's not spend too much money, they're spending more. They're 
taking away freedoms, and I am concerned that those seniors are going 
to have to pay that $250 back, per senior. The seniors should be 
concerned as well.
  This is a radical act, Mr. Speaker and Mr. Price. We have got to 
fight it. I hate fighting these battles right out of the box, but if 
they're going to take these kinds of radical positions, we have no 
choice.
  With that, I would yield to my friend from Oregon (Mr. Blumenauer).
  Mr. BLUMENAUER. Thank you. I appreciate the gentleman's courtesy for 
permitting me to speak just as I appreciate my colleagues coming to the 
floor to spotlight something that each and every American needs to be 
deeply concerned about.
  I listened, for example, for the last 4 years, as a member of the 
Budget Committee, to my dear friend and colleague Mr. Ryan talk about 
the skyrocketing problem of escalating entitlement under Medicare. 
Absolutely right. There are 79 million of the geezer baby boomers like 
me who are going to start collecting Medicare--10,000 a day starting 
this week and continuing for 19 years--and because of the development 
of more improvements in health care, not only are there more of us, but 
we are going to want more complex and expensive care.
  My Republican friends were talking about an entitlement crisis. The 
irony was--and we all heard it on the campaign trail--they talked about 
slashing Medicare, which they want to repeal starting next week. A 
great deal of irony. As the independent scorekeeper--the Congressional 
Budget Office--has pointed out and as you have repeated on the House 
floor, the legislation will, in fact, save several hundred billion 
dollars. More important than that, it puts in place reforms that will 
further reduce entitlement spending.
  I know my good friend from Vermont is well familiar with the 
Dartmouth Atlas in dealing with health care disparities around the 
country. I come from a part of the country where one of the problems we 
have is that Medicare needs to be reformed, which is what we started in 
this legislation. They're relatively modest steps, but they're going to 
save a couple hundred billion dollars. We need to do more. Rather than 
repealing these reforms, like stopping unnecessary hospital re-
admissions--just that item costs over $12 billion a year--these reforms 
could enable us to bend the cost curve. If everybody practiced medicine 
the way it's practiced in metropolitan Portland, Oregon, which is half 
the price of McAllen, Texas, or Miami, Florida, there wouldn't be an 
entitlement crisis for decades to come.
  I appreciate my colleagues focusing on the hypocrisy and on the 
recklessness of trying to repeal health care reform that makes a 
difference for 32 million uninsured Americans and that provides more 
benefit for the seniors with their prescription drugs. Most important 
and under-appreciated is that it would reform Medicare so that, instead 
of driving us off a cliff over the next 20 years, it would, in fact, 
help us change how medicine is practiced to provide incentives for 
value, medical value, rather than just volume.
  Mr. WELCH. Thank you, the gentleman from Oregon.
  Mr. Speaker, may I inquire as to how much time I have?
  The SPEAKER pro tempore. The gentleman has 3 minutes remaining.
  Mr. WELCH. All right. Let me just ask the gentleman from North 
Carolina, Would you like to make any closing remarks and then yield to 
the gentleman from Colorado?
  Mr. PRICE of North Carolina. I thank the gentleman.
  I would like to just underscore what our colleague from Oregon has 
just said.
  There is so much concern, obviously--and for good reason--about the 
future of Medicare. The most conservative estimate I have seen is that 
health care reform extends the fiscal solvency of Medicare by 8 years, 
and some estimates are much more than that. So to simply throw that 
overboard as well as to talk about this doughnut hole--these thousands 
of dollars that senior citizens are paying full freight on for 
medicines they simply must have--and this gap in coverage is 
ridiculous, and we are finally fixing it. What insurance policy do any 
of us know about that would have that kind of gap in coverage?
  As the gentleman from Colorado said, $250 payments this year. I mean, 
I guess this raises the question as to whether even that might be taken 
back; but in future years, we are going to close that doughnut hole, 
and we are going to extend the solvency of Medicare. Anybody concerned 
about the health care for this country's senior citizens simply has to 
be very, very alarmed about what is going on in this House right now.
  Mr. WELCH. Thank you, the gentleman from North Carolina.
  I yield for the final word from the gentleman from Colorado.
  Mr. PERLMUTTER. Sure. I appreciate my friends.
  You know, instead of amending or repairing, as Mr. Price from North 
Carolina described it, they want to repeal, just take it away.
  Well, they're taking away freedoms. They're taking away the freedom 
from discrimination for prior illnesses, like my daughter with 
epilepsy, like the daughter who had Crohn's disease, or the friend at 
the gas station. It's taking away the freedom from cancellation because 
you get sick, you know, and lose your insurance. You know, it's taking 
away the freedom to move jobs so you're not stuck in a job, so you can 
move jobs and not fear losing your insurance. I mean, they're taking 
away a lot--and maybe this $250 that went to the seniors. It is a 
radical move to take these freedoms away, and I hope they think twice 
and don't vote to repeal.
  With that, I would yield back to my friend from Vermont for his final 
remarks.
  Mr. WELCH. Well, I thank my colleagues for being here.
  The bottom line is, anytime we pass a major piece of legislation, we 
should have the humility to acknowledge it can be improved--and we all 
do. We can make it better. We can make it stronger. But this totally 
destroys things that we have been fighting for decades to achieve on 
behalf of the American people: help for seniors with their prescription 
drugs, extending the financial viability of Medicare, changing and 
encouraging a new way of delivering health care services, moving away 
from fee-for-service, volume-driven to patient-centered, performance-
based care, and then insurance reforms that put the patients in charge, 
which acknowledge that we are all in it together. This takes away the 
absolute unilateral power of for-profit insurance companies to decide 
whether your daughter or mine has health care.
  Thank you, Mr. Speaker. I appreciate your consideration.

                          ____________________