[Congressional Record (Bound Edition), Volume 157 (2011), Part 1]
[House]
[Pages 376-383]
[From the U.S. Government Publishing Office, www.gpo.gov]




                HONORING SARGENT SHRIVER AND HEALTH CARE

  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. Mr. Speaker, thank you for this opportunity to discuss 
health care this evening.
  But before I get to health care, I was notified early this afternoon 
that a unique, iconic American had died today; Sargent Shriver is no 
longer with us.
  This individual has had an impact on America and the world around us 
that will last for centuries. He literally created the United States 
Peace Corps. The idea was developed by him and his brother-in-law, JFK, 
and put into effect in the first year of the Jack Kennedy 
administration.
  Thousands, indeed over nearly 200,000 Americans, have joined the 
Peace Corps in the ensuing years. For my wife and I, it changed our 
life; it changed the path upon which we have traveled. We were the 
third iteration of the Peace Corps back in the 1960s. We were sent to 
Ethiopia. We served in a village out in the boondocks of southwestern 
Ethiopia, and it put in place in

[[Page 377]]

our lives the vision that we could and should continue to serve.
  We are not alone. Thousands upon thousands of Americans, those that 
were in the Peace Corps and those that were affected by the Peace Corps 
here in this Nation, found that same mission of being a life of 
service.
  In the 1990s, Sargent Shriver returned once again to assist the Peace 
Corps as the Clinton administration undertook the rebuilding and 
expansion of the Peace Corps. My wife was then working at the Peace 
Corps as the associate director, and together they and the other staff 
opened the Peace Corps to the former Soviet Union nations, Eastern 
Europe and beyond and also to South Africa. It was a period of growth, 
and once again it was a period in which the Shriver enthusiasm and the 
Shriver determination to reach out to everyone in this world so that 
they could have a better life created these opportunities.
  We mourn his passage. Our prayers go out to his family and to remind 
all of us that we too in any way possible should be serving our fellow 
man.
  Sergeant Shriver, we miss you and we know that America and millions 
of people around the world that were affected by your programs will 
miss you also.
  Let me now turn to another issue that affects every American, their 
well being, their lives, their ability to get the care that they need 
when they have health care problems.
  On this floor today we began the debate of the repeal of the 
Affordable Health Care Act, an extraordinary law that will affect each 
and every one of us in this Nation; and as it affects us, it will also 
affect people around the world because this law will help America 
finally join the other industrialized nations in the world and provide 
health care to all of our people, not just those who are fortunate 
enough to be employed by an employer who has found it useful, wise or 
even correct to provide health care for their employees, but for those 
individuals that are not so fortunate to be with an employer that does 
not provide health care, and for those who are unemployed.
  This is an extremely important debate going on here on the floor of 
the House. It's a debate about all of our lives.
  It was estimated before this law went into effect that some 30,000 to 
40,000 Americans every year lost their lives because they did not have 
health care. It was too late for them to get their blood pressure under 
control. It was too late for them to deal with their diabetic situation 
or their cancer had run its course so that it was not treatable, 30,000 
to 40,000 Americans every year.

                              {time}  2020

  That is not the way America should be. We should be providing 
insurance to all Americans.
  On the floor today, the debate commenced, and I was pleased and a bit 
curious to hear my colleagues on the Republican side talk about repeal 
and replace. And as they talked about what they would replace, I began 
to say, Excuse me. Wait a minute. What you're replacing is already the 
law in America. The health care bill that became law this year deals 
with every American from birth through their school years, through 
their years of building a family, in their employment and through their 
retirement. It deals with the entire cycle of life by providing the 
opportunity for health insurance, improved health insurance, at every 
stage of life.
  Let me show you how that works. It's the Patient's Bill of Rights, 
which apparently our Republican colleagues want to repeal. The 
Patient's Bill of Rights is a fundamental reform of the insurance 
industry. I was insurance commissioner for 8 years in California, and I 
understand the insurance industry very, very well. And it's about 
profit. All too often, the health insurance industry puts profit before 
people. In doing so, they deny coverage. The Patient's Bill of Rights 
goes directly to this issue of insurance companies putting profit 
before people.
  Let me show you where this works. Children. My very first speech here 
on the floor as the health care debate came up in 2009, in November of 
2009, I spoke to an individual, a friend of ours who lives here in 
Washington, whose child was born with a very serious kidney problem. 
The mother was covered by insurance through the pregnancy and through 
the delivery. The moment it was discovered that that child had this 
preexisting kidney ailment, they dropped the coverage on the child. The 
family struggled and continues to struggle to provide care for that 
child, limping along trying to get the money together for the next 
procedure to provide the services that are necessary--the transplant.
  All of those things should have been covered by insurance, but with 
the insurance company putting profit before people, they denied that 
child coverage. The Patient's Bill of Rights stops that and says that 
every child has a right to coverage, no longer the kind of 
discrimination that took place here with my friend's family.
  Secondly, young adults. I happen to have had six young adults. All of 
them have passed through the age 23, and that period where their 
coverage stopped was the scary time for us in our family, and it is for 
every other family in America. At the age of 23, insurance companies 
were allowed to drop patients' coverage. And if you're a 23-year-old 
and you have any kind of a preexisting condition, you're out of luck. 
The Patient's Bill of Rights guarantees that that young woman or man 
will be able to get coverage until the age of 26. And if they have a 
preexisting condition, that can no longer be a reason to deny coverage. 
The Patient's Bill of Rights would be repealed by the piece of 
legislation that will be brought to this floor tomorrow.
  If you are a woman, you have a preexisting condition. It is called 
being a female. And routinely--and I've seen this during my tenure as 
insurance commissioner. Routinely, the insurance companies would deny 
coverage because you are a woman and you might get pregnant or you 
might have any number of conditions. That will no longer be the case.
  If you happen to have cancer, you cannot be denied coverage. The 
Patient's Bill of Rights protects every single American when it comes 
to getting insurance and keeping insurance.
  Many other provisions are in this bill, and I find it astounding that 
our colleagues on the Republican side would repeal the Patient's Bill 
of Rights and literally open every single American up to the gross 
discrimination that the insurance companies have foisted upon Americans 
for decades putting profits before people.
  There are many other parts of the Patient's Bill of Rights, but I 
want to just take a moment and invite to this conversation my colleague 
from the great State of New Jersey, Frank Pallone, who has been 
fighting this fight for decades both as a Member of Congress and as a 
concerned citizen.
  Mr. Pallone, if you will join with us, share with us your thoughts 
and your experiences, and we will continue on with this discussion. I 
yield.
  Mr. PALLONE. Thank you. I want to thank you for all that you do on 
this issue. I have seen you come to the floor so many times over the 
last year or more talking about the importance of the health care 
reform and now, of course, pointing out how ridiculous it is to try to 
repeal it, which is what the Republicans are going to try to do 
tomorrow.
  I just want to start out by saying that we were just home for the 
Martin Luther King weekend, and so there was an opportunity to talk to 
a lot of people at the various Martin Luther King events over the 3 or 
4 days that we were home, and the issue is jobs. That's all people want 
to talk about. Everyone comes up to me and says, What are you going to 
do about the economy? What are you going to do about jobs? Nobody talks 
about repealing the health reform bill.
  And what I get basically from my constituents is they know the health 
reform bill passed. They know that it's kicking in. A lot of the 
patients' protections that you mentioned have already kicked in, and 
they want to see how it goes. Even those who were not necessarily for 
it in the beginning think it is a complete waste of time for us to be 
rehashing the debate and talking about repeal because they want to

[[Page 378]]

see what is actually going to happen with the health care reform. And 
to the extent that they have seen certain things, protections, kick in, 
they're happy with it. And what they say to me is, Look, if over the 
next few years if certain aspects don't work out, then you can go back 
and revisit it and maybe make some changes. Nobody is suggesting we 
can't make changes on a bipartisan basis. But this idea of just 
repealing it outright when it just went into effect a few months ago, 
almost no one I talked to is in favor of that. They just don't think 
that makes sense.
  The other thing that I wanted to say, and I keep stressing over and 
over again--I actually have this chart, and I know you pointed to it as 
well--is: Who is going to actually gain from the repeal? We know that 
insurance companies keep raising their prices. We know that 
historically they try to discriminate by eliminating people who have 
preexisting conditions or by having lifetime caps on insurance 
policies. The only ones that gain from this repeal are the insurance 
companies because essentially they can go back to the situation, to the 
status quo where they can have double-digit premium increases. You 
know, in your own State of California, it wasn't unusual to have a 30 
percent increase. I think Blue Cross just announced a 50-something 
percent increase. And so they make money by constantly raising premiums 
and also by discrimination.
  In other words, if you have a policy, a woman, for example, that has 
breast cancer and then she has a recurrence, well, if she reaches the 
cap on coverage for the year or the cap on coverage for a lifetime, 
then she has no insurance to cover her reoccurring cancer.
  Or the other thing is that sometimes they even rescind a policy. If 
they can find some way to say that it didn't apply to you, they would 
simply rescind it altogether, and you'd get sick and wouldn't have 
insurance at all, even when you thought you had the greatest need for 
it.
  So I just want to stress, this chart says GOP patients' rights repeal 
would put insurance companies back in charge where children with 
preexisting conditions are denied coverage, young people aged 26 can't 
stay on their parents' plan, pregnant women and breast and prostate 
cancer patients could be thrown off insurance rolls--that's the 
rescission--seniors pay more for their drugs.
  The bill, as you know, has, for those in the doughnut hole, until 
this bill went into effect, if you reached the doughnut hole, then you 
had to pay 100 percent for your prescription drugs. You got a $250 
rebate last year. As of January 1, you have a 50 percent reduction, and 
that's going to eventually become zero so you will have complete 
coverage under Medicare part D.
  So, if you repeal it, seniors are going to pay more for their drugs. 
And that's the other thing that is amazing. They talk about how this is 
going to, I guess they're not using the term ``killing jobs'' anymore. 
They got away from that.
  Mr. GARAMENDI. Crush. Crush jobs.
  Mr. PALLONE. What is it now? Crush jobs.
  The fact of the matter is that the bill actually decreases the 
deficit by $230 billion, so you'd be increasing the deficit if you 
repealed the bill.
  And with regard to jobs, I mean, look, if you think about what's in 
the bill, because everybody gets coverage, you're going to have to have 
a lot more health professionals, so that creates jobs, because premiums 
will stabilize, employers won't have the double-digit inflation that 
comes and makes it harder for them to hire people. So just the fact 
that your premiums stabilize makes it easier for employers to hire 
people.

                              {time}  2030

  And then we have all kinds of funding for research at labs and 
hospitals and institutions around the country; even the R&D creates 
jobs. It creates jobs is the bottom line.
  But I would really like to go back to where I started from, and, that 
is, most people just say to me, ``Why are the Republicans doing this? 
Let this bill kick in. Let us get to the point where everyone's 
covered. Let's see how it works.''
  We know the Senate's not going to pass the repeal. The President's 
not going to sign the repeal. So rather than spend our time trying to 
figure out ways of creating jobs, we'll just debate this for another 
week for no purpose, just as a waste of time.
  Mr. GARAMENDI. Thank you very much, Mr. Pallone.
  If it's about jobs, then why are we doing all of this? It's 
interesting to note, and I heard this debate earlier on the floor here, 
that this is a job crusher, to be politically correct now, and that 
businesses are going to lose jobs, when in fact since the bill became 
law, over 932,000 private sector jobs have been created. So there's no 
evidence in the large job market that this legislation, the health care 
reform, has harmed jobs, crushed jobs. It hasn't happened. In fact 
nearly a million new jobs have been created; 932,000.
  In addition to that, this is an extremely important bill for small 
businesses. This bill, as you said, actually subsidizes the cost of 
health care for small businesses. If you have less than 50 employees, 
you can get a subsidy, up to 35 percent, for buying health care for 
your employees. And if you don't want to buy health care, you don't 
have to if you have less than 50 employees.
  I don't understand this debate about small businesses being harmed. 
In fact, the Kaiser Family Foundation has shown that in the last year, 
probably as a result of this bill--that's their conclusion--the number 
of small businesses providing health insurance has grown from 46 
percent to 59 percent.
  Mr. PALLONE. If the gentleman would yield, one of the things that I 
wanted to point out and I am going to certainly talk about it, I'll 
talk about it more a little tonight, is my committee, the Energy and 
Commerce Committee today, put out a report essentially that talks about 
the impact of repealing the health care reform law in each 
congressional district, district by district. I have the information on 
my congressional district, the Sixth in New Jersey, that talks about 
the tax credits for small businesses, and it says in this report that 
the health reform law provides tax credits to small businesses worth up 
to 35 percent of the cost of providing health insurance. There are up 
to 18,200 small businesses in my district alone that are eligible for 
the tax credit. And, of course, repeal would force these small 
businesses to drop coverage or bear the full cost of coverage 
themselves.
  The bottom line, every small business owner I know wants to provide 
coverage. It's just a question of whether they can afford it. And what 
we do in the bill is make it affordable by giving them this major tax 
credit. Eighteen thousand two hundred small businesses in my district 
alone can benefit from it and would lose that if we repealed the bill.
  Mr. GARAMENDI. That is similar in every district, Republican or 
Democrat, across the Nation. The number of small businesses may vary 
district to district, but the point is that every small business has an 
opportunity to reduce by more than one-third the cost of health care by 
simply providing health care. And that will grow to 50 percent in just 
3 years. It climbs up 35 and then 50 percent in 2014. And in 2014, 
every State will have an exchange, an insurance marketplace, where 
small businesses, individuals, can buy health insurance on a 
marketplace that talks about the quality and the cost so there is 
competition.
  Once again, why would you want to repeal that, where individuals can 
shop for health insurance in a competitive market? We talk about 
competition here. Well, let's let it happen. Right now it doesn't 
really occur because many insurance companies don't compete. There are 
many, many aspects of this.
  I notice that our friend from the great State of Tennessee has joined 
us. Mr. Cohen, if you will, what is going on in Tennessee? Do they want 
to repeal this? Do they really want to do away with the patients' bill 
of rights? The preventative care that seniors are able to get under 
this bill? The closing of the doughnut hole? Is that what the Tennessee 
folks want?

[[Page 379]]


  Mr. COHEN. Thank you, sir.
  I don't think so. And the tide has been turning. The national polls, 
which I think are reflective of Tennessee at least on a percentage 
basis, have shown that it's gone from 10 points up on people that want 
to repeal this bill to where it's even, as many people for it as 
against it in this country. There's been a 10-point switch in the last 
2 weeks as people have looked at the possibilities of the repeal of the 
law and seen the benefit.
  What I thought about, Mr. Garamendi, I was in New York, New York 
City, about 2 weeks ago, and I went in the Time Warner Building. They 
had an exhibit there of Salvador Dali; surreal, things looking out of 
space. Strange, strange pictures and thoughts. It's hard to think of 
this Congress and the Republican majority that's come in trying to 
repeal a bill that's going to become as popular, once it gets 
implemented, as Social Security and Medicaid and Medicare have over the 
years, that they are so out of touch with America today and its needs 
and the future. Because while this may seem to be important to the 
minority, the tail wagging the dog in that party, the tea party that's 
wagging the dog, saying repeal health care, the fact is down the line, 
people are going to embrace this bill like they embraced the Great 
Society's Medicaid and Medicare and the New Deal's Social Security. 
It's going to be a short-term possible victory but a long-term defeat. 
And the myopia of the other side, let alone the hypocrisy of some of 
its members, is hard to fathom. But you can only see it through the 
eyes of Salvador Dali, because obviously they are Salvador Dali, and 
they're saying things in a surreal way.
  The nonpartisan, bipartisan Congressional Budget Office says it's 
going to save us $230 billion the first decade and $1.2 trillion 
thereafter, and they say, ``Well, they can have their opinion.'' Those 
are facts. Those are nonpartisan facts of people we hire to give us the 
truth. They don't like the truth so they summarily dismiss it.
  They say it's a government takeover of health care, a big lie. Just 
like Goebbels; you say it enough, you repeat the lie, you repeat the 
lie, you repeat the lie, and eventually people believe it. Like blood 
libel. That's the same kind of thing. The Germans said enough about the 
Jews and the people believed it and you had the Holocaust. You tell a 
lie over and over again. And we've heard it on this floor; government 
takeover of health care.
  PolitiFact, nonpartisan, Pulitzer prize-winning, 2009, St. Petersburg 
Times, said the biggest lie of 2010 was government takeover of health 
care, because there is no government takeover. It's insurance.
  I look at my Facebook regularly and I've got some people I 
communicate with on different issues on Facebook. I respond to them 
whether they take my side or not, obviously. And one lady has been 
constantly talking negatively about health care. I responded. She keeps 
going on with the line that obviously she hears and she's taken as her 
mantra; and that is that this is a government takeover of health care. 
Well, she's drunken the Kool-Aid, and that's just not true.
  We heard in August 2009 that there were death panels and killing 
grandmother. Everybody agrees now, that was a big lie; just like 
government takeover of health care is a big lie. And it's amazing the 
lies: denying the effect on the deficit, claiming it's a government 
takeover, claiming there were death panels.
  This lady on my Facebook page talked about the fact that it was going 
to take insurance companies out and there was a public option. Well, 
there is no public option. And the exchanges aren't a public option but 
the exchanges are private insurance where people can come together and 
get better rates that they couldn't get if they were dealing as 
individuals on the open market.
  People don't understand. If you read Paul Krugman today, or 
yesterday--today in Memphis, we get it a day late--but yesterday in the 
New York Times, he talked about the errors in arithmetic, basically the 
lies that are being put out about how it will affect the budget. And 
Krugman, who's only a Nobel prize winner, says it's just not true, and 
what it comes down to, the bottom line, is there is a group in America 
that don't feel like they have a responsibility, a social 
responsibility, a moral responsibility, to those 32 million Americans 
who can't afford health care and right now are seeing death panels, the 
death panels that say you won't have insurance and you won't have 
health care.

                              {time}  2040

  As we are just one day beyond Dr. Martin Luther King's holiday, 
America's holiday celebrating Dr. Martin Luther King, Dr. King was not 
only for social justice, which everybody embraces today and talks about 
kumbayah and integration, but it was also economic justice. And 
economic justice involves health care, and it involves giving everybody 
an opportunity to stay alive, to get educated, and to get a job.
  The first priority I have always believed of government is to keep 
people alive, their health care. The second is to get them educated. 
And the third is to get them a job. This rhetoric on the other side of 
the aisle about whatever they want to call it is not only false--read 
Krugman, a Nobel Prize winner--but it is the third priority. The first 
thing is keeping people alive. And you want to tell those 32 million 
Americans we don't want you to have insurance, we don't care about you. 
That is wrong. Dr. King wouldn't approve of it. I don't approve of it. 
America won't approve of it.
  And it is as I started with, surreal to think that the first thing 
that this Republican Congress is doing is trying to repeal what will be 
known down the years as one of the great acts ever passed by this 
United States Congress. It will be to the fortune of the Democrats 
because like Social Security and Medicare and Medicaid and voting 
rights and civil rights, they are Democratic initiatives that brought 
America forward, progressive initiatives that have been brought forth 
by this side of the aisle. And the myopia of the other side is 
politically welcomed, if not policy-wise sad.
  Mr. GARAMENDI. Mr. Cohen, thank you very much. You pointed out the 
nature of the debate taking place on the floor. I listened to much of 
the debate this afternoon as it was going on, and tomorrow it is 
probably going to be the same. Like you, I was surprised and in many 
cases disappointed with the rhetoric that I heard. It simply wasn't 
based on fact.
  They talked about the government takeover of health care. You used 
the word ``big lie.'' Well, in fact it is not going to happen. This is 
not the government takeover of health care. There are many who said we 
simply should take Medicare and expand it to all. Now that is a program 
that is government collection of the money, but the services are 
provided by individual doctors, hospitals, and other provider groups. 
It is not a government takeover; it is a government finance program.
  You mentioned the uninsured. Actually, it is about 42 million 
uninsured in America. They get sick. Who pays for them when they go to 
the emergency room? They don't have an insurance policy. They are 
certainly not going to be able to afford the cost of an emergency room 
and any procedure. Those people who are uninsured do get sick. They do 
go to the emergency room, and they do get medical care. And who pays, 
the taxpayer.
  Mr. COHEN. Property taxes.
  Mr. GARAMENDI. In Tennessee, the property tax base. In California, 
the general tax base and the Federal Government. Here is the clincher: 
every health insurance policy in the Nation pays for the uninsured. So 
we have health care coverage. In fact, this law requires that the three 
of us and all 435 Members of Congress and 100 Members of the Senate 
will get the exact same kind of insurance that every American gets. We 
don't get a special deal. In fact, we get to pay for part of it 
ourselves. That is a fact.
  So what about those people that are out there uninsured that get 
sick. We get to pay for it through our health insurance policies 
because that cost is

[[Page 380]]

shifted over to us, the taxpayer. There is no free lunch here. The 
question we have is should everybody participate in this insurance 
pool. I think it is only fair to say that we all participate.
  I don't know what I said, Mr. Pallone, that made you come to your 
feet, but please proceed.
  Mr. PALLONE. Everything you said is absolutely true. I know in my 
State we estimate that every insurance policy, for those who have 
insurance and are paying their premiums, there is built into it 
something like $1,000 to $1,500 per year in your premium that pays for 
uncompensated care for others. And I actually have a statistic in that 
Energy and Commerce study that I mentioned that says in my district 
alone repeal would increase the cost of uncompensated care by $54 
million annually for hospitals in my district.
  But what I wanted to point out was you can actually eliminate a lot 
of the uncompensated care because what happens, people don't have 
health insurance and so they don't see a primary care doctor on a 
regular basis. And they get sicker, and their only recourse is to go to 
an emergency room. I tried to get the CBO to build into this the 
savings that would come about because of preventive care. In other 
words, the fact that all of these people who are uninsured go to the 
emergency room, don't see a doctor, and all of a sudden they see a 
doctor and they stay well because they take preventive care of 
themselves and they do wellness and then they don't end up getting sick 
and going to the hospital. But that was never built into the system. 
The CBO won't score prevention, so to speak.
  But I would maintain there is huge savings. We talk about a $230 
billion savings from the deficit, but in my opinion it is trillions of 
dollars because not built into this is the fact that all of these 
people who don't have primary care and end up in an emergency room now 
will have a doctor. They won't get sick, and you won't have to pay for 
all that care. So the system as a whole saves a tremendous amount of 
money, which is not really calculated here, in my opinion. That is what 
you made me think of.
  Mr. GARAMENDI. You are quite correct. It is some very simple things 
which I think all Americans understand. Blood pressure, high blood 
pressure, the silent killer, people don't know that they have high 
blood pressure until they get the stroke. And then if they survive, 
they may very well be paralyzed or incapacitated the rest of their life 
and take an enormous expenditure every day, every month, every year 
caring for them in a nursing home or in an extended care situation. 
That is a very simple thing to understand.
  And this piece of legislation provides free preventive care for 
seniors. Is that what they really want to repeal, that free preventive 
care for seniors where most high blood pressure cases are found and 
where most strokes are found? It is a preventive cost.
  Mr. PALLONE. Exactly. As you know, on January 1 there were a whole 
new set of patient protections that went into effect and one was 
elimination of the 20 percent copay for seniors. They get a 1-year 
wellness exam for which they don't have a copay, mammogram, all kinds 
of tests for which they would have paid 20 percent copay. All of that 
is out now. The reason it was done is exactly what you said: a lot of 
seniors would not go and have those tests done because they didn't want 
to put up the 20 percent. Now they get it free.
  The Republicans say that costs money. It doesn't. It may cost money 
up front; but in the long run because the people get the wellness check 
and they have the mammogram, they don't get sicker. So we actually 
recoup the money because they don't get sick. I think it is a very 
important point that you are making.
  Mr. GARAMENDI. Mr. Cohen.
  Mr. COHEN. Sir, I appreciate your leading this. You have been an 
outstanding Member; and your first vote, I think, was for this bill. 
You have a lot of experience of this issue. You were commissioner of 
insurance, if I am correct, of the largest State in the country, 
California. So you have knowledge here.
  Mr. Pallone worked very hard on this bill, too, as I did; but Mr. 
Pallone was in a senior position.
  As I think back on the passage of this bill, I remember a lot of 
criticism; and the other side and the people who were critical said we 
didn't take enough time to pass the bill. We only took a year, a year 
and a half to pass the bill. And they are going to take 2 days to 
repeal it. Take enough time? Where are the people who think we should 
take enough time for the legislative process to work, to have hearings, 
to have thoughtful discussion, to have analysis of expert opinion 
today? Two days and it is going to be voted on, and that's it. And the 
old mantra which we heard from so many people, ``read the bill.'' And 
yet so many people think it is a government takeover of health care. I 
say to them: read the bill.
  And people who think Congresspeople are going to get something 
special, we get the same as everybody else. Read the bill.
  Mr. GARAMENDI. If you will yield for a moment, there is a place where 
the bill can be read, the Web site www.healthcare.gov. It gives the 
bill. It gives a detailed description of every item in the bill. We 
have only talked about maybe one-third of the bill here today, and 
maybe we will go into some of the other parts.

                              {time}  2050

  It also talks about the timeline in which the various elements of the 
bill will go into effect. For example, the senior population: The 
doughnut hole begins to close. Last year a $250 rebate check to those 
seniors who are in the doughnut hole, and then, in the next 8 years, 
that doughnut hole is squeezed shut. And, as Mr. Pallone said earlier, 
seniors would then have all of their prescriptions covered. It also 
shrinks the cost of prescription drugs.
  That wasn't talked about here earlier today. And if they want to read 
the bill, they can talk about the coverage options in every part of 
America--in California, Tennessee, New Jersey, wherever--and specific 
detail about seniors, about women, those kinds of pieces of 
information: www.healthcare.gov. You want to read the bill? You want to 
understand it? I would suggest that our colleagues on the other side, 
the Republicans, take a look at the bill, itself, and what it does.
  Please continue, Mr. Cohen.
  Mr. COHEN. Well, thank you.
  Today, when I came on the floor, Ms. Slaughter--one of the senior 
Members of this Congress, an outstanding Member and the former 
chairperson of the Rules Committee, now the ranking member--told me of 
a Member on the other side, a Member in her fourth term--I guess it was 
in the Rules Committee, but it might have been on the floor--who 
expressed for the first time astonishment, amazement, that the 
insurance provided for Members of Congress was subsidized by the 
Federal Government. She had no idea it was subsidized. She hasn't read 
the bill. She doesn't even know what her policy is and what her 
benefits are.
  The fact is people should want for others what they want for 
themselves. I don't have Federal congressional insurance--I don't have 
it--but nearly everybody else in this Chamber does. Yet they don't want 
their constituents to have it. Now that's hypocrisy.
  Mr. GARAMENDI. Last week, on this floor, many of us tried to put an 
amendment on this piece of legislation that would read: If the repeal 
occurs, then every Member of Congress would lose his health care, 
keeping in mind that 31 million Americans will not have health 
insurance if the repeal takes place.
  So, 435 of us. If the bill is repealed, we should join the 31 million 
Americans who will not have health insurance if the bill is repealed. 
It seems to be the least we could do. If we want to harm 31 million 
Americans, if we want to take away the insurance from 31 million 
Americans, then, surely, 435 of us should be willing to go without 
insurance also. It turns out that not one Republican voted for that 
amendment. I wonder why. They want something that they are going to 
deny to 31 million Americans.

[[Page 381]]


  Mr. COHEN. What is good for the goose should be good for the gander. 
There but for the grace of God go I. You should care about your brother 
and your sister.
  And this is going to be repealed in the same week as Dr. King's 
holiday?
  I mean, I know it took a while for Dr. King's holiday to come about. 
It was John Conyers' steadfastness for 15 years to make it become law, 
and even then there were people in this House who voted against it, and 
there were people in the Senate who voted against it, but there is 
nobody who has given a better philosophy of life over 2,000 years than 
Dr. King.
  Mr. GARAMENDI. Mr. Pallone.
  Mr. PALLONE. I was going to ask you to go over that chart about 
security and stability for America's seniors because, frankly, you 
know, as the gentleman from Tennessee was pointing out, there is a lot 
of misinformation that the Republicans give out in terms of Medicare 
and the benefits of this program.
  I mean, the bottom line is that all that we have done with Medicare 
is extend benefits. A lot of seniors think that somehow, you know, 
Medicare is going to be negatively impacted, which is simply not true. 
So, if you could go through that, I'd appreciate it.
  Mr. GARAMENDI. Well, I will do my best, and along the way, if my 
colleagues would join in on any one of these issues, I'd appreciate it.
  Health care reform means security and stability for America's 
seniors.
  First of all, despite all the rhetoric on the floor, this legislation 
actually improves the financial status of Medicare. It extends the 
solvency of Medicare, I think, by almost a decade.
  Mr. PALLONE. You know, on the first point that you have there, I 
actually went before the Rules Committee--I guess it wasn't last week. 
It was 2 weeks ago now because last week we had the tragedy of our 
colleague from Arizona--and I had an amendment that actually said that 
the repeal would not go into effect if it actually negatively impacted 
solvency. It actually is 12 years. In other words, the bill, the health 
care reform, added 12 years of solvency to the Medicare trust fund. In 
other words, with the repeal, insolvency would begin in 2017. So this 
pushes that day of reckoning back, when there is not enough money to 
pay out, another 12 years.
  Mr. GARAMENDI. So it pushes it back to 2023.
  Mr. PALLONE. Yes. Exactly. So, I mean, that's an important point. 
Again, everything that we do shores up Medicare, provides more 
Medicare, provides more benefits under Medicare for seniors, expands 
their benefits.
  Go ahead. I didn't mean to interrupt.
  Mr. GARAMENDI. Let's just continue on here.
  We talked about prescription drugs. It's not only the doughnut hole, 
but there are certain kinds of generic prescription drugs that would 
also benefit as a result of this legislation and, of course, the 
doughnut hole issue, which we've discussed here in some detail.
  The doughnut hole is squeezed shut, and initially, this last year, 
$250. Now, I don't imagine the repeal would force the seniors to refund 
the $250 check they had. Nonetheless, that doughnut hole would remain 
wide open if the repeal were to take place. We've talked about the 
improvement of the quality of senior care, and both of my colleagues 
here have spoken to this, I think, very correctly.
  Preventative care.
  Now, we talked a moment ago about high blood pressure--clearly, the 
silent killer and a major problem for seniors. Okay. You're going to 
get, free of charge, an annual blood pressure test. You know, it's very 
simple, very cheap, and the drugs to treat high blood pressure are 
cheap also, but the cost of not treating it is extraordinary.
  There is another one that affects not only seniors but others around 
this Nation, and that is diabetes. This is an enormous cost. It can be 
treated. It can be taken care of, but if you ignore it, you are in for 
a world of harm and a very, very great expense to all of the people, 
including, in this case, to the taxpayers.
  This is an interesting one. Primary care doctors.
  Nobody has really talked about this much on the floor, but in the 
legislation, there is a significant increase in medical education 
opportunities, not only for doctors but also for others in primary 
care--nurse practitioners, physician assistants, and nurses. There is 
an enormous increase.
  This one happens to be really, really important to me. Our daughter 
graduated from medical school just 3 days ago, and we go, Yes.
  She says, I want to do primary care.
  I'm going, Terrific. How about geriatric care?--my wife and I are 
looking to the future here.
  This is really important. She has an opportunity under this piece of 
legislation, as do all other primary care doctors who choose to serve 
in underserved areas--and she may very well decide to do that--to have 
their medical loans reduced as they provide service in underserved 
areas, and some of those underserved areas are in our urban 
communities.
  Now, that brought Mr. Cohen to his feet and Mr. Pallone, so please 
share, gentlemen.
  Mr. PALLONE. I'll let my colleague from Tennessee go first.
  Mr. COHEN. Well, there are so many problems.
  I represent an urban district in Memphis, and we do have a lack of 
health care in the urban areas. We need more primary care doctors, and 
we also need more community health centers. That's something else the 
bill is going to provide for, more community health centers. There are 
large areas in my community where there are very few doctors who are 
available and where there are not community health centers. So that's 
another portion. It's not just the primary care doctors who are so 
important--and we've got some of the greatest in Memphis--but it's the 
difficulty in not having community health centers.
  Mr. GARAMENDI. That has not been discussed.
  In every part of America, people need to know about the enormous 
increase in the community clinics that will be available. That's in the 
legislation. It costs money, but it saves money because, once again, 
people will be able to get care early.

                              {time}  2100

  Mr. PALLONE. Could I ask the gentleman to yield?
  Mr. GARAMENDI. Please.
  Mr. PALLONE. This is true in the health reform, that there's a lot 
more money for community-based health care clinics, but we also have 
that in the stimulus, the Recovery Act.
  Actually, I had two clinics that were funded under the Recovery Act 
that had not received Federal funds before. And just to give you an 
idea of what they did, one of them is in my hometown of Long Branch. 
They coordinated with the emergency room at Monmouth Medical Center so 
that every time someone comes to the emergency room who's eligible for 
the community health center--because they probably, many of them are 
uncompensated, have no insurance--now they go back and coordinate so 
that that person doesn't come back to the emergency room again--which, 
of course, is a tremendous expense--and instead goes to the community 
health center where they get primary care. So that is an example of 
where some Federal dollars that are going to community health centers 
are now being used to make it so that people don't have to go to the 
emergency room because they're getting the primary care in the clinic 
for probably maybe a hundredth of the cost of an emergency room.
  Mr. GARAMENDI. You raised another point. And I recall a conversation 
with Mr. Cohen in the past where we talked about medical technology, 
which is also not only in the Affordable Health Care Act, the health 
care reform, but also in the stimulus bill. And part of what you talked 
about is the use of electronic medical technology to provide continuity 
of care; whether you are in this clinic or that hospital, you could be 
able to get that information across from one to another.
  Mr. Cohen, do you want to carry on? You talked to me about this some 
time ago, and you had some pretty good notions of what would happen in 
Tennessee.

[[Page 382]]


  Mr. COHEN. Well, just the idea--and I will yield to Ms. Jackson Lee 
in just a second--but the idea of having medical records on computers 
rather than having them on notes. My father was a doctor. I inherited 
his penmanship. I got a C in penmanship. The teacher was kind to me.
  Doctors don't write real well. If you have to go from written 
records, it's difficult, and they don't get transposed well. But if you 
have them on computers, it's very easy to see what shots and 
inoculations the patient has had in the past, what treatments they've 
had. It makes it easier to render a diagnosis and not have to repeat 
tests that are unnecessary and costly. It is so important. And part of 
this bill is to see to it that the records are put on electronic 
devices so that they're available throughout the Worldwide Web and 
everywhere. That saves medical costs in the long run.
  Mr. GARAMENDI. Some of this, if I might for a moment, sir, already 
exists.
  I've been with Kaiser for three decades. They have put all of the 
records, all of my history, all of their patients, millions of 
patients, on the electronic information system. I could present myself 
at any Kaiser facility across this Nation in an emergency situation and 
they could take my number and immediately call up my entire history so 
that they don't have to start at the beginning with blood tests and all 
of the other procedures that are common in today's emergency room 
simply to know about the individual's health circumstances. All they 
need to do is enter that number, bingo, they've got my information. 
That's where the electronic medical records would be found. And it's 
interesting that our Republican colleagues want to repeal that? I don't 
think so.
  Finally, at last we're going to hear from a woman. We need that 
perspective here. Please join us. Thank you so very much for coming in.
  Ms. JACKSON LEE of Texas. I thank the gentleman from California, but 
more importantly I thank him for really turning the light bulb on. We 
worked so hard on this legislation that we probably have forgotten to 
articulate all of the nuances of this bill. It is unbelievable.
  I hesitated to use the term ``frivolous'' today, but, frankly, I'm 
saddened by the fact that we had to engage in a frivolous debate. So I 
just wanted to say to the gentleman, some years ago under the Bush 
administration I took note of the fact that we did not have enough 
community health clinics, frankly, and I am so glad that our collective 
research caused us to put that legislation in the bill.
  Last Monday, I convened my community health clinics. It was amazing 
the expanded work they do because some of them received stimulus 
dollars. One of my clinics was able to open up 21 legacy, and one of my 
community health clinics was able to open up 21 new patient rooms 
because of stimulus dollars.
  But what I want to say on that point is three things:
  Community health clinics help seniors and families. And to seniors, 
this gives you, in addition to the comfort of being nearby your home, 
but you get, in addition, a primary home or a medical home. You can use 
that clinic, that doctor to be part of your medical home. The community 
health clinics can then multiply themselves or improve themselves by 
having electronic records where, as a senior who has extended medical 
records, can you imagine in the future what happens with seniors when 
they can put all their data into electronic records to be able to track 
seniors and to assure their good health? So contrary to frightening 
seniors and talking about death panels, this bill provides community 
clinics, a medical home, electronic records, and the inevitable closing 
of the doughnut hole so that seniors do not have to choose between 
paying rent and buying food and getting their brand drugs that they 
need.
  So I just wanted to say there's so much. And then as you mentioned 
your daughter and the training. That's creating jobs. How do they talk 
about losing jobs--which I think, by the way, again, is frivolous 
because we created 1.1 million jobs.
  And, frankly, I would just say to you that this is about saving 
lives. Jobs are very important. We've created jobs. But even the title 
of their legislation, H.R. 2, ``job-killing''? This is killing 
Americans if we take this bill away, if we repeal this bill.
  So I would argue that maybe my good friends--who some of them are new 
and I appreciate their newness; I appreciate their desire to keep a 
commitment to constituents. But when you come to the Congress, you have 
to govern. You have to look at the whole of America. And therefore, 
looking at the whole of America, you need to look at the crux. The crux 
is saving lives.
  So I thank the gentleman for bringing us to this point. I know that 
we will be getting another hour that I hope maybe I will have an 
opportunity to share some thoughts. But again, I will yield back my 
time and just say this is about saving lives.
  Mr. GARAMENDI. I thank the gentlewoman for her insight into the way 
in which the bill affects her home and her community because that's 
what all this is about; it's really about the community.
  Mr. Pallone, if you would like to take a few moments and wrap, and 
then I will provide the final wrap here as we close down this 1-hour 
discussion.
  Mr. PALLONE. I mentioned before how the money that was going to the 
community health center in Long Branch, in my home town, was being used 
to coordinate with Monmouth Medical Center so that people didn't have 
to go to the emergency room. When they came once, they were put into a 
computer, and it was exactly the electronic system that you talked 
about.
  I went to Monmouth Medical Center one day because they had expanded 
their emergency room because they had so many people flooding the 
emergency room. Particularly in these tough economic times, a lot of 
people don't have health insurance, more and more people, so they had 
actually doubled, I think, the capacity of their emergency room. But 
they coordinated electronically with the community health center with 
this money that came in. So they showed me how a person would come in, 
and then they would be put into the system electronically with the 
community health center and they wouldn't come back to the emergency 
room.
  One of the big issues now across the country--in fact, I just did an 
opinion piece about it in my local newspaper, the Asbury Park Press--is 
how emergency rooms are being flooded with more and more patients 
because more and more people don't have insurance. So we have to figure 
out a way to deal with that. Obviously, the health care reform does 
that, because once everybody gets insurance, sees a doctor and gets 
primary care, you won't have the need for as many people to go to the 
emergency room.
  When you expand an emergency room and add on all this additional 
capacity, it's millions and millions of dollars. That money isn't 
necessary if people see a primary care doctor. An emergency room should 
just be for an emergency, when people are trauma or something else that 
happens. It shouldn't be a place where people have to go because they 
can't get a doctor.
  I yield back to the gentleman.
  Mr. GARAMENDI. Well, it has become just that.
  I think I will wrap with where I started. The health care reform, the 
Affordable Health Care Act, really is about making life better for 
every American. From the moment they're born, that young baby, that 
newborn baby cannot be denied insurance, from the moment they're born, 
whatever their circumstance is. That's part of the Patient's Bill of 
Rights, and it starts right at birth. This is where a student, when you 
graduate from college, you are not only getting a diploma; you are also 
likely to be losing your health care benefit that you were covered by 
under your parents.

                              {time}  2110

  So it extends coverage to the age of 26. And into a marriage, into a 
family when you're building a family, you

[[Page 383]]

know that you'll be able to get insurance. Thirty-one million Americans 
are going to be able to get health care insurance as a result of this 
legislation.
  And in the workplace, a lot of talk about this being a job crusher, 
when in fact it actually creates jobs. And for small businesses, this 
is an enormous benefit because they will get a subsidy reducing the 
cost if they choose to provide insurance. If they have 50 employees or 
less, they don't have to buy insurance. And then later, they'll be able 
to get insurance through an exchange in 2014. California is probably 
going to set one up next year.
  And for seniors, I've never heard so many inaccurate statements as 
concerns Medicare and the way in which this bill actually works. It 
extends Medicare. As you said, Mr. Pallone, for 12 years--the financial 
solvency's extended for 12 years. Otherwise, it would be just 7 years, 
and it would be in financial trouble. So this really helps. And for 
individual seniors, they'll be able to get preventive care; their drug 
costs are going to be reduced. It is a very, very important part.
  So for the circle of life--and all of us would want to go through 
that circle of life--this health care reform provides a benefit at 
every stage.
  And I'll point out this final thing--and this is an estimate that was 
made in the last year--some 30,000 to 40,000 Americans every year die 
because they don't have health insurance. What is that? A stain upon 
America. Every other industrialized country in the world would do it.
  Our Republican friends talk about repeal and replace, but everything 
I've heard on this floor about replacement is already the law in 
America. It's already the law.
  They talk about lifetime caps; they talk about putting in no 
rescissions; they talk about no preexisting conditions. That's the law, 
folks. Our Republican colleagues, read the bill. Go to healthcare.gov. 
Read the bill. That is already the law. Why in the world would you 
repeal what is already the law and put this whole thing back at risk?
  Don't forget, Americans, the insurance industry, the health insurance 
industry has dominated American health care for decades. And you think 
for a moment they're going to let the Republican majority write a bill 
that is not in their interest; that will force them to provide care; 
that will force them to pay the bills; that will force the insurance 
companies to no longer be the death panel? In fact, that's where the 
death panel is--and this I know.
  I was the insurance commissioner. I fought the insurance companies 
for 8 years of my life when they denied coverage; when they said, You 
have run out of benefits; when they said, Your policy is going to be 
rescinded. I fought them. And I know the result when they won that 
fight: people died.
  We need the Patients' Bill of Rights. It should not be repealed.
  Tomorrow, our Republican colleagues in H.R. 2--without one committee 
hearing, with only 2 days of debate on this floor and no committee 
hearings at all--put Americans at risk. Thirty-one million Americans 
will not get coverage. That's what this is about.
  I look forward to tomorrow's debate, and we will see what happens.

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