[Congressional Record (Bound Edition), Volume 157 (2011), Part 4]
[House]
[Pages 5064-5069]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           GOP DOCTORS CAUCUS

  The SPEAKER pro tempore (Mr. Gibbs). Under the Speaker's announced 
policy of January 5, 2011, the gentleman from Georgia (Mr. Gingrey) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. GINGREY of Georgia. Mr. Speaker, what we are going to do here for 
the next hour is talk about why we feel so strongly the need to repeal, 
and if not successful, to defund so many provisions of the Patient 
Protection and Affordable Care Act.
  But, Mr. Speaker, before I get started in the subject at hand, I do 
want to join my colleagues, particularly my colleagues on the 
Democratic side of the aisle, in remembering our colleague John Adler. 
I didn't realize that John had been sick. I didn't realize that John 
had had surgery. I didn't realize until just moments ago that our 
colleague from New Jersey had died. As I sat here listening to the New 
Jersey delegation on both sides of the aisle talk about John, it helped 
me understand a little bit better about him.
  All I know about John is that he was a great guy and a really, really 
nice Member of this body and someone that I respected. I got to know 
him, Mr. Speaker, in the House gym at 6 o'clock in the morning usually. 
He would be working out, and I would be working out--I am 15 years 
older than John was--and we just struck up a good friendship. I truly 
will miss him, as well as my other colleagues, as they express their 
sympathy to his wife and his four sons. But truly a great Member.
  It reminds me too, Mr. Speaker, that as we do our work, as we do our 
work with 1-minutes, and we do our work with 5-minute Special Orders, 
and now this leadership hour talking about a very important issue that 
our colleagues on the other side of the aisle for the most part, almost 
100 percent of them feel very differently about this issue, we differ 
on a lot of things, and we will continue to do that. It has gone on 
forever.
  But the point I would like to make, and I will conclude with this, is 
that there are 435 people in this House of Representatives. And 
sometimes we Republicans are in the majority and sometimes the 
Democrats are in the majority, and the worm turns, and nothing is 
forever.
  But we have good, decent men and women serving here representing 
their districts and doing the work of the people. And God bless them. 
God bless each and every one of them. God bless a Member like John 
Adler, who died much too young, as my colleagues have said already.
  But we want to always keep in mind that as we argue and debate and 
make points and feel very strongly about an issue, that doesn't mean we 
don't love one another. And we do. And I loved John Adler. He was a 
great Member of this body.
  Mr. Speaker, again here we are, though, getting right back into the 
business at hand. And this is a hugely important week, a hugely 
important week as we try to come to some conclusion in regard to how 
much money we need to cut out of, not this fiscal year we are in right 
now, but the last fiscal year, which started--well, actually we are in 
the fiscal year, but it started on October 1 of 2010.

                              {time}  1920

  Here we are, what is it, the 4th of April, 2011, so half of the 
fiscal year has already expired and we have not funded the government 
except in this piecemeal fashion.
  We didn't have a budget, we didn't have spending bills, and we put 
these little 2-week Band-Aids, 2, 3 weeks, a little bit of cutting, but 
from my perspective and from my side of the aisle and our leadership 
not nearly, nearly enough. And we are faced with this tremendous issue 
of trying to reach a compromise and an agreement to lower spending.
  The American people certainly gave a mandate, I think, to 87 new 
Republicans and 9 new Democrats to come up here and quit all this 
spending. Let's not have $1.5 trillion deficits year after year after 
year. That's how you get to $14 trillion worth of debt, and that's what 
we are facing right now; and, indeed, in a month or so, we are going to 
be asked to even raise that debt ceiling statutorily to say, well, we 
will continue to borrow and kick the can down the road.
  Obviously, Mr. Speaker, these are times that try men and women's 
souls, and we all feel very strongly about our position. But I know my 
leadership and Members on this side of the aisle, and I hope our 
Democrat colleagues, feel the same way. We hope and pray that we can do 
the people's work and cut this spending and get this country back on a 
sound fiscal footing so that as we go forward to the 2012 budget, which 
we will hear about tomorrow, that we will continue to work hard to 
finally balance this budget and get our country out of this significant 
debt.
  Speaking of debt, Mr. Speaker, the reason I am here tonight, I 
represent the caucus on the Republican side of the aisle known as the 
House GOP Doctors Caucus. There are, I think, 21 of us now, doctors and 
nurses on this side of the aisle, with just years and years of clinical 
experience.
  As an example, I spent 26 years practicing my specialty of obstetrics 
and gynecology. We have registered nurses that are part of the Doctors 
Caucus. We have specialists, general surgeons, cardiothoracic surgeons, 
family practitioners, gastroenterologists. I could go on and on, but 
some of them, hopefully, will be with me during this hour, will join me 
in a few minutes to talk a little bit more about our concerns, their 
concerns, Mr. Speaker, with the Patient Protection and Affordable Care 
Act of 2010.
  This was a bill, a law, that was finally passed and signed by 
President Obama on March 23, 2010, after about a year and a half of 
debating the issue in both this Chamber and in the Senate Chamber; and 
when it finally came down to the reality that there weren't enough 
votes on the Senate side, it was passed by something called 
reconciliation which, to this day, I don't think the American people 
understand. But, Mr. Speaker, I will tell you this, what they do 
understand is they don't like it, they didn't like the process, and 
they don't like the policy.
  Now, I have heard the President say, and I have heard the Democratic 
leadership in the 111th Congress, when this bill was passed, talk about 
how Congress and particularly the Democratic Members have been trying 
to pass a comprehensive massive health care reform law for almost 100 
years. They talked about Franklin Delano Roosevelt, and they talked 
about John Fitzgerald Kennedy and they talked about, of course, 
President Bill Clinton and saying, you know, we finally got there, we 
finally did it, we finally accomplished what we were trying to do for 
almost 100 years.
  Well, they missed the point, Mr. Speaker, because the reason why that 
type of legislation was not passed in 100 years is because the American 
people back then didn't want it anymore than they do today; and some 62 
percent still say, very loudly and very clearly, in poll after poll 
after poll, we don't want the Federal Government taking over health 
care, one-sixth of our economy, lock, stock and barrel. We don't want 
that.
  We want improvement in our health care; and no matter how good 
something might be, there is always room for improvement and, clearly, 
our health care system is too expensive. We agree with that. I think 
Members on both sides of the aisle can reach that conclusion pretty 
clearly.
  So there is agreement to try to do everything we can to continue to 
provide the best health care in the world. It's not true when people 
say our health care system is like that of a Third World country. 
Nothing could be further from the truth. We have the greatest health 
care system in the world, and some of the doctors in the House GOP 
caucus will be with me tonight to talk about that.
  You know the old expression, don't throw the baby out with the bath 
water, I think that's what we have

[[Page 5065]]

tended to do here. We have enacted into law--on March 23 of last year, 
it's already had its 1-year anniversary a couple of weeks ago--we have 
done something that I think is not only opposed to what the American 
people want, you should never do that, but it's bad, it's bad medicine.
  It's bad for consumers, it's bad for patients, it's certainly bad for 
corporate America. And it's absolutely bad for the taxpayer. It's a 
top-down sort of system where a bureaucracy comes between literally and 
figuratively a doctor and his or her patient. That's not a prescription 
for improving our health care system.
  I have got a couple of posters here with me, and I wanted to 
reference these to my colleagues. In fact, I will have several more, 
but I am going to keep this one up on my far left, that one that shows 
the picture, I forget what his name is. Maybe one of my colleagues will 
remember.
  Mr. BROUN of Georgia. Boss Hogg.
  Mr. GINGREY of Georgia. Well, I remember Boss Hogg, but I was trying 
to remember what the actor's name is; I don't think he is still living. 
But I think most of my colleagues do remember Boss Hogg from that old 
series ``The Dukes of Hazzard.'' It was one of my favorites, kind of 
like poking fun at ourselves, really; sort of like Archie Bunker and 
``All in the Family'' and things like that that those of us who have 
been around awhile can look back on and laugh and get a chuckle out of 
it.
  But Boss Hogg sort of represents the boss, the bureaucracy, if you 
will, of the government, Big Government, running health care. Under old 
Boss Hogg's picture, there he is with that cigar in his hand: you can 
have whatever you like as long as the boss approves it.
  And that's really the way it has turned out, what we talked about in 
the House. I think it was H.R., House of Representatives, bill No. 
3200. It was Senate bill 3590 or H.R. 3590, a shell bill that came over 
from the Senate and finally was passed into law and became known as the 
Patient Protection and Affordable Care Act.
  But that law has so much bureaucracy, and I will get into some of the 
numbers on that in regard to all of the new folks in the government 
that would control health care, but all under this giant government 
takeover, and Boss Hogg sort of represents that to me as a way of 
communicating with the public.
  But in any regard, before I continue with some of the statistics on 
the bill, I see that I am joined by my colleague from Georgia, a fellow 
physician and a member of the House GOP Doctors Caucus, who is a family 
practice physician from the Athens area where the great University of 
Georgia is located. Dr. Paul Broun is actually a doctor who makes house 
calls, which is really unique and refreshing. He has been a welcome 
addition to not only our Georgia delegation but this body.
  I yield to the gentleman from Athens and Augusta and my hometown, Dr. 
Paul Broun.
  Mr. BROUN of Georgia. Thank you, Dr. Gingrey.
  Dr. Gingrey, I have taken a history and physical of ObamaCare. I have 
looked at all the laboratory results, I have looked at all the X-ray 
results, and I have got a diagnosis:
  ObamaCare is a destroyer. It's going to destroy jobs in America. In 
fact, already, it has destroyed jobs. I have got a lady in my district 
that right now today has eight people in her employment. She 
desperately wants to expand her business, she would like to hire at 
least one or two people for her small business, but she is not going to 
do it because of the onerous effect of ObamaCare on her business.

                              {time}  1930

  So it is destroying at least one or two jobs in that one lady's 
business. I have got another businessman in my district that wants to 
make a $31 million expansion of his business. He has the cash in the 
bank. He doesn't even have to borrow it with all the regulations and 
all the problems that we are facing with the financial problems that 
the Dodd-Frank bill has placed on banks as well as small businesses. He 
wants to make a $31 million expansion of his business. But he is not 
going to do it because of ObamaCare and because of the increased taxes 
and also the increased burden that this is going to place on him. That 
is killing hundreds of jobs just in two businesses within my district.
  So it's going to destroy jobs.
  But it's also going to destroy budgets. It expands Medicaid. In fact, 
the State of Georgia has a balanced budget amendment to our State 
constitution, and our general assembly is just going through the 
process of trying to balance its budget with a $2 billion shortfall 
because of the downturn of the economy, the downturn of the economy 
that was created basically because of policy that was put in place by 
Democrats. Barney Frank was a big part of that, too.
  But ObamaCare expands Medicaid markedly. In fact, the State of 
Georgia is going to have to add at least about half again as many 
people to the Medicaid rolls in Georgia, and the State budget is going 
to have to pick that up, and it's going to destroy the State of 
Georgia's budget. It's going to destroy every State budget in this 
country. And it's going to destroy our budget. It's certainly not 
affordable.
  In fact, we see this administration has already, I think it is 1,168 
waivers that they've already given to unions and businesses and 
different entities just because of the onerous financial effects it's 
going to cost all those people.
  And it's going to destroy family budgets. I had a lady tell me about 
her 26-year-old son recently, that his insurance doubled from last year 
to this because of ObamaCare. He is paying for his insurance himself. 
He's self-employed. And he can't afford it.
  So it's going to destroy budgets. It's going to destroy family 
budgets, it's going to destroy State budgets, and it's going to destroy 
the Federal budget. Not only is it going to destroy jobs and destroy 
budgets, but it's also going to destroy the quality of health care. In 
fact, Dr. Gingrey, we were told, and I'm sure you're going to bring 
this up, the American people were told by the President, if you like 
your insurance you can keep it. Nothing could be further from the 
truth. The American people need to understand it. The American people 
need to understand ObamaCare was designed to force everybody out of 
their private insurance into a single-payer, socialized health care 
system that the President himself said that he wanted just before 
ObamaCare was passed into law.
  So my diagnosis is that it's a destroyer. It's going to destroy jobs, 
it's going to destroy budgets, and it's going to destroy the quality of 
health care. And also we need to have a plan of action. So I made the 
assessment, so we need to have a plan of action, and our plan of 
action, Dr. Gingrey, is--and the American people need to understand 
this--it's absolutely critical that we repeal ObamaCare and replace 
that law with something that makes sense, that truly lowers the cost of 
health care.
  There have been numerous Republican bills introduced here in this 
Congress, in the last Congress, that would lower the cost of health 
care. I introduced two that would repeal ObamaCare and would replace it 
with something else. One is a comprehensive bill. I call it the Patient 
Option Act. It's 106 pages, not almost 3,000. And then I introduced 
another act that Democrat after Democrat colleagues told me, Paul, this 
makes sense, more so than ObamaCare. It's a good first step. The 
American people want us to do it in a step-by-step process. It would 
allow purchases for individuals and businesses across State lines. It 
would allow anybody in this country to buy insurance through an 
association. They would have multiple insurance products at a much 
lower cost. It would stimulate the States to set up high-risk pools. 
Several States have already done that. Mississippi, I talked to 
Governor Haley Barbour about his plan. Their high-risk pool that they 
have in Mississippi has been very successful. Colorado has done the 
same thing I understand.
  And the fourth thing that it would do is it would allow everybody to 
deduct

[[Page 5066]]

100 percent of their health care costs off their income taxes. That 
would change the dynamics of health care. So, Dr. Gingrey, I have done 
that physical examination and history, history and physical, my 
subjective, objective assessment, and the plan. The plan is, we must, 
absolutely must, repeal ObamaCare and replace it with something else, a 
market-based system that literally lowers the cost of health care and 
keeps all decisions in the doctor-patient relationship.
  ObamaCare does none of those. It's not affordable for the government 
nor individuals nor businesses. It's certainly not going to preserve 
the quality of care, because it is a destroyer. So I have made that 
diagnosis, Dr. Gingrey, and I would yield back to you for our further 
discussion.
  Mr. GINGREY of Georgia. Mr. Speaker, I thank the gentleman for his 
contribution and for being with us this evening. I realize there are 
conflicting things going on on Capitol Hill this evening, very 
important things. But I really appreciate Dr. Broun being with us.
  We have also been joined by another member of the Doctors Caucus, 
that is our good friend and new Member, freshman Member from the great, 
great State of New York, where my daughter and son-in-law reside. Ann 
Marie Buerkle is a registered nurse, Mr. Speaker, by profession and 
certainly knows of what she speaks in regard to health care, 
representing the Angels of Mercy, if you will.
  She is concerned, Mr. Speaker, about the health insurance industry 
and the complexity of such, and maybe even wants to discuss some ways 
that we could change and improve, certainly improvement is called for, 
and it doesn't have to be within a 2,400-page bill, as Dr. Broun was 
mentioning ObamaCare entails.
  So at this time, I'm proud to yield to Representative Ann Marie 
Buerkle.

                              {time}  1940

  Ms. BUERKLE. Mr. Speaker, it is good to be here. I thank the 
distinguished gentleman, my colleague from Georgia. I am very honored 
to be here to speak about health care in the United States of America.
  As was said, I am a registered nurse. I have been a registered nurse 
since 1972, a time in our Nation's health history where the physician 
and the patient had a relationship, and the government had not injected 
itself into that relationship. And then after awhile, I went into law. 
And for the last 13 years, Mr. Speaker, I have been a health care 
attorney for a large teaching hospital in upstate New York, for the 
last 13 years.
  What we did in that hospital and in my role as an assistant attorney 
general, we looked at money, money that was owed to the State of New 
York. So I had a very up close and personal look at the complexity of 
health care in our country today.
  I contend that this bill, this piece of legislation that does 
anything but reform health care, will only increase the complexity of 
health care in this country. It will only make it more complicated. It 
will once again put the government right in the middle of the patient-
physician relationship. I contend that is not what the United States of 
America is about. We need to let the free market play here in our 
health care system.
  I have spoken in my district to many, many people. I have done all 
kinds of talks, but there is nothing more up close and personal and of 
great concern to me than the health care system in our country. It is 
an issue that affects every American in one way, shape or form. This 
health care bill does not improve the health care system in this 
country.
  I came to Washington with a wide range of goals as a freshman, as my 
colleague has mentioned, but nothing more important to me than 
repealing this health care bill; this 2,000-plus-page bill that does 
anything but reform health care. It adds to the complexity of an 
already complex system. It puts the government in places where it 
shouldn't be, and it doesn't protect that patient-physician 
relationship.
  Last week when I was in the district, I had my very first health care 
advisory council meeting. I spoke with a group of physicians, a group 
of health care providers, hospital administrators, and we had a 
conversation. I said to them: What are your concerns as health care 
providers? You are on the front line. What can we do down in Washington 
on health care to make the delivery system better and more affordable?
  They looked at me, and interestingly enough, all of the people on the 
front lines came up with different solutions because, as you can 
imagine, doctors and health care providers are good at diagnosing. The 
question is now about the solution. What are we going to do for health 
care in this country?
  We are here tonight to say this bill is the wrong bill for this 
country, but we are not willing to leave it go at that. We understand 
that true health care reform will include medical malpractice reform. 
We need tort reform in this country. We need to increase the use of 
health savings accounts. We need to make insurance portable so when a 
person loses their job, they don't necessarily lose their health care 
coverage. We need to allow for the purchase of health care across State 
lines. We need to put the patient back in the center of health care. 
And I contend that this health care bill does not do that.
  So as we sat around, I said to my group of health care advisors, I 
said to them, What is it that concerns you most regarding health care 
in this country? The first thing was our health care, this health care 
bill that was just passed. And when you get into why does it concern 
you, because it adds so many layers of bureaucracy and regulations to 
an already ladened bureaucracy, already an industry and system that is 
ladened with regulations. If you talk to a hospital or a physician, the 
regulations and the impediments they have to access that patient for 
health care are incredible.
  So the concern with this bill is it adds so many more layers. It 
takes this health care bill, and one of the biggest problems with this 
health care bill is that it takes a piece of legislation and it hands 
it off to the regulators. Then, with the regulators, they are left to 
interpret and to deal with and come up with regulations that affect our 
health care providers.
  Beyond that, they recognize the need for tort reform. We need medical 
malpractice liability reform. If we are going to talk about reducing 
the cost of health care, we must consider that. And then they talked 
about the increased regulations on the health care profession.
  What we all agreed upon in that meeting was that the health care in 
this country, it is a good health care system. We have good health 
care. The quality of health care is not the issue. The issue is the 
system of health care. And this bill that was passed in 2010 does 
nothing to make that health care system better. It only complicates it. 
It only ladens it with more regulations and once again puts the 
government back in between the physician and the patient relationship.
  I thank my colleague who has an esteemed history of being a medical 
provider in the health care industry. He understands these issues. He 
understands what good health care is and what a good health care system 
would look like. And so I commend him and thank him for this 
opportunity to speak.
  I think what we need to do in Washington is to repeal this health 
care bill. We need to put our heads together collectively and talk to 
the professionals, talk to the health care providers, talk to the 
patients, and get together and come up with a systemic plan that will 
reduce the cost of health care, help to improve access to health care, 
and not affect the quality of the wonderful health care that the United 
States of America offers.
  In my years in the attorney general's office representing a large 
teaching hospital, I know how many people wanted to come to this 
country for health care--I know people from Canada and from Europe--
because they knew they had access to good, quality care. They knew they 
wouldn't have a 6- or 9-month wait. I think with this

[[Page 5067]]

system, if we allow it to go on, this health care bill, we will see 
those 6- and 9-month waits while patients are waiting for the 
government to make a decision about their health care access.
  So we need to repeal this bill. We need to enact true health care 
reform so we can improve access, we can reduce the cost of health care, 
and we can maintain the fine quality of health care in this system.
  I thank my colleague.
  Mr. GINGREY of Georgia. Mr. Speaker, I thank the gentlewoman from New 
York for sharing her thoughts. Certainly, I agree completely with her. 
She clearly knows of what she speaks.
  This law, it is no longer a bill, it is now the law. Patient 
Protection Affordable Care Act, it has been the law for a little more 
than a year, as I said earlier. Of course, the Congressional Budget 
Office that estimates the cost of laws that we put into effect, they 
give us an estimate when it is in the bill form so Members can decide 
whether or not what we are about to do is something that is affordable. 
And the estimate of this law costing $900 billion, Mr. Speaker, the 
true cost over the next 20 years is probably in the neighborhood of $3 
trillion, not $900 billion.
  But I do want to just talk about that number and remind my colleagues 
about the pay-for provision that the Democratic Party, the former 
majority party in the 111th Congress, had in place at the time this 
bill was passed. Everything had to be paid for, so you had to figure 
out a way to come up with the money.
  In passing this bill and paying for it, Mr. Speaker, some $570 
billion was taken out of the current Medicare program. The Medicare 
program, which serves something like 47 million of our seniors, 5 or 6 
million of them are younger people who are on disability that are 
covered under Medicare. And we literally, to help pay for this new 
entitlement, this new entitlement which has very little to do with 
Medicare except that half of the money, half of the pay-for in this 
$900 billion was taken from a program, Medicare, servicing our disabled 
and our elderly, providing them health care, half of the money was 
taken out of that system. The actuaries and the Medicare trustees tell 
us that over the next 75 years, the unfunded liability, Mr. Speaker, of 
Medicare is something like $35 trillion, with a ``t,'' $35 trillion. 
And yet we took the money by cutting Medicare Advantage something like 
$120 billion. We cut money out of hospice. We cut money out of long-
term care, skilled nursing homes.

                              {time}  1950

  We cut money out of home health care. We taxed everything that even 
looked like it had anything to do with health care: durable medical 
equipment, supplying oxygen for people who were and are continuing to 
struggle from chronic obstructive pulmonary disease. ``Emphysema'' is a 
term we use a lot, and I think most people would recognize that.
  Finally, we came up and said, okay, we've paid for this; but at the 
same time, Mr. Speaker, we did absolutely nothing in regard to medical 
liability reform, something that probably if we enacted it--and if 
there were something in this bill, ObamaCare, as the President did 
promise that there would be--could save $200 billion a year, according 
to the RAND Corporation and other think tanks, from the overall cost of 
health care, which is one-sixth of our entire economy, of our gross 
domestic product in a year. That's how big this industry is. So there 
is essentially nothing in the bill about medical liability reform.
  Why do I say that, Mr. Speaker?
  My colleagues, I think you understand that it's not about the high 
insurance premiums that doctors have to pay on an annual basis so that 
they can practice and be protected from liability if something goes 
wrong. Obviously, they need that protection and those health insurance 
premiums for the high-risk specialties like the one that I enjoyed for 
26 years, OB/GYN, and neurosurgery.
  Mr. Speaker, think about that doctor at the Tucson Medical Center who 
was there in that emergency room when our colleague, Representative 
Gabrielle Giffords, was taken there literally near death. I think Dr. 
Rhee was his name, R-H-E-E. In fact, Dr. Rhee, I learned later, was a 
graduate of the great school that I went to, Georgia Tech, the Georgia 
Institute of Technology. Dr. Rhee spent his career in the military 
after completing medical school. He served his country for something 
like 22, 23 years, and he happened to be in that emergency room as head 
of the trauma center and had had all that specialty training and all 
those years of treating our wounded warriors in many conflicts--I'm 
sure in Afghanistan and Iraq.
  If he had not been there for our colleague Gabrielle Giffords--God 
bless her--we would be talking about her today as we were talking 
earlier about John Adler, our former colleague from the great State of 
New Jersey who died today. But that doctor was there. He was there.
  I fear, as I talk about this new health care law, there is hardly any 
provision in there that would provide for doctors, even for primary 
care physicians. There is some attempt, but when you take all the 
additional Medicaid-eligible patients, increasing the minimum 
eligibility at 138 percent of the Federal poverty level, you add just 
millions of additional patients to be seen and literally hundreds of 
billions of dollars of additional cost onto the backs of our States 
that have to have balanced budgets, unlike here in the Federal 
Government where we just keep borrowing money and where we're now up to 
$14 trillion worth of debt.
  So we have a huge problem in regard to this law that the CBO says 
costs $900 billion over 10 years. I say--and this poster points it 
out--the true cost, which is the last bullet point with the red dot, is 
$2.2 trillion and counting; but as Ms. Pelosi said--and I quote her in 
the third bullet point here--``we have to pass the bill to find out 
what's in it.'' That was before the bill passed. Clearly, we are 
finding out now, unfortunately, what the true cost is.
  Mr. Speaker, I want to yield additional time to my colleague from New 
York.
  Ms. BUERKLE. Thank you.
  Mr. Speaker, my colleague just brought up the cost of this health 
care bill. I think it's interesting to talk about and insert what I 
have heard from the health care community throughout the course of this 
discussion.
  For many hospitals which have a high level of indigent patients, 
there is what is called a disproportionate share of money that is paid 
to those hospitals to help them offset the cost of treating folks who 
are on Medicaid and who are not able to afford their own health care 
coverage. This health care bill removes the disproportionate share. It 
phases out that payment to hospitals so that they can afford to treat 
indigent patients who cannot afford health care. I think that's a very 
significant piece of this bill--of this law--that was not discussed nor 
how it will impact and how it will hurt hospitals.
  I think, beyond that, we need to talk about seniors and the choices 
that this health care bill takes away from seniors--again, that wasn't 
discussed--which are the Medicare Advantage programs and all of the 
disadvantages that this bill will cause to seniors. We need to keep our 
health care system intact so those who need the system, such as the 
seniors, have access to good health care and so their coverage is not 
hurt. This bill does hurt the senior coverage.
  Mr. GINGREY of Georgia. Mr. Speaker, the gentlewoman is absolutely 
right.
  As I pointed out in that $500 billion-plus cut-out of the Medicare 
program to help pay for this new entitlement of the Patient Protection 
and Affordable Care Act, $120 billion of the $500 billion-plus was 
taken from the Medicare Advantage program. The Medicare Advantage 
program enrolls about 20 to 25 percent of our Medicare beneficiaries.
  Why so many?
  We are talking about, maybe, 11 million or 12 million who sign up and 
decide that, rather than the traditional fee-for-service and just pick 
a doctor out of the Yellow Pages who accepts

[[Page 5068]]

Medicare, it's more like a health maintenance organization that 
emphasizes wellness, that emphasizes prevention, tests that are not 
typically covered under traditional fee-for-service Medicare, like 
colon cancer screening, breast cancer screening, mammograms for women, 
especially between the ages of 40 and 60, prostate cancer screening for 
men, annual physical examinations, follow-ups from a nurse practitioner 
within the doctor's office, maybe even on a monthly basis to make sure 
that the senior is taking the medication that was prescribed by the 
primary care doctor.
  All of these things are included with Medicare Advantage. That's why 
it's called Medicare Advantage. It is an advantage with very little 
additional cost. In fact, people who are under those programs typically 
don't have to buy supplemental insurance to cover co-pays and 
deductibles and hospital care after they've exhausted their benefits. 
So that's why so many choose that.
  Yet what we have done is we've stripped--we've gutted--that program 
so badly that, of those 12 million, it's estimated 7 million of them 
will lose that coverage under Medicare Advantage. They'll have to get 
it under the traditional Medicare, and they'll have to pay $130 a month 
extra for that supplemental whether they get it through a plan that's 
endorsed by the American Association of Retired Persons or through some 
health insurance company, but the average cost is going to be an 
additional $130 a month for those folks.

                              {time}  2000

  So as we talk about the cost, I do want to shift, Mr. Speaker, to the 
cost to employers. In this next slide, where the title says, 
``ObamaCare Hurts Workers, Increases Costs,'' the majority of employers 
anticipate health care reform will increase health costs. And most say 
they plan to pass the increases on to their employees--88 percent plan 
to do that--or reduce health benefits and programs, 74 percent.
  This idea of setting up these exchanges throughout the 50 States and 
territories and that only 6 million people who have employer-provided 
health insurance can keep it, they won't need to be on the exchanges, 
Mr. Speaker, that is absolute poppycock. It's probably going to end up 
being about 130 million people who get their health care provided today 
by their employer will end up in those exchanges. And that's why I say 
this cost that was estimated by the CBO of $900 billion will be in the 
trillions, because when all of these people morph out of the employer-
provided health care onto these exchanges, think how many of them will 
be eligible for a Federal subsidy to help them pay for that insurance. 
Because the law says, the so-called ``Affordable Care Act,'' that 
anybody with an income of less than 400 percent--not 100 percent, not 
200 percent, not 300--400 percent of the Federal poverty level--which 
is getting close to $90,000 for a family of four--I think of my four 
children and their families of two and three and four, and I know what 
their incomes are--the Federal Government will be subsidizing so many 
people that the cost, the true cost will be astronomical, and it is 
something that we cannot afford. That's why our representative from New 
York and our other representative from Georgia spoke earlier about we 
can't do this, we can't afford to do this. We need to repeal this law. 
It is a bad law.
  I've said before, Mr. Speaker, that in my humble opinion I think it's 
the worst law that has ever been passed in this Congress. There have 
been some folks on the other side of the aisle--well, not on the other 
side of the aisle, but the more liberal media who took me to task for 
saying that, but I truly believe it. I truly believe it's one of the 
worst laws that was ever passed. And we have made every effort to 
repeal it.
  One of the first things we did in the 112th Congress was pass H.R. 2 
to repeal ObamaCare. We sent it over to the Senate, and the Senate--
which is controlled by the Democratic majority and led by the Senator 
from Nevada, Harry Reid--just simply, I guess, put that in file 13, and 
H.R. 2 is sort of dead in the water over on the Senate side.
  So what we are doing now, it is our obligation because of what the 
American people have told us: Over 60 percent of them a year after 
passage of the bill, despite the fact that Ms. Pelosi said, once we 
pass it and you find out what's in it, you'll like it. No, they don't. 
They don't like it. They don't like it one darn bit better, and they 
wanted us to repeal. We made every effort at repeal.
  And now we're into Plan B, Mr. Speaker. Plan B, of course, is to try 
to defund especially the parts of the bill that are on automatic pilot, 
that we have no control over. And when I say ``we,'' I don't mean the 
new Republican majority in the House of Representatives; I mean every 
Member of Congress--100 Senators, 435 Members of the House, both sides 
of the aisle. For goodness sakes, we ought to have control over the 
spending.
  This is not a poster. I don't have a poster on this one. But 
tomorrow, in the Energy and Commerce Committee, Mr. Speaker, the 
committee on which I am proud to serve, along with several of our other 
House GOP doctor members, we are going to have a markup on several 
bills to change this automatic pilot spending under ObamaCare and put 
it into the more typical discretionary spending where Members of 
Congress can say, do we want to spend that money? And if we do want to 
spend the money, how much do we want to spend? And that we have 
oversight and we can make sure every year that we look at the program, 
and if it's not working then defund it.
  And these bills--and I'll just mention them real quickly--H.R. 1217, 
a bill to repeal the prevention and public health fund, $17.5 billion 
that the Secretary of Health and Human Services has control over, a 
fund of money that she can spend in any way she wants to. You think 
back to the ads that we saw with Andy Griffith as the pitchman on 
television last year about the great value of this new law and how it's 
going to strengthen and improve Medicare. How you do that by cutting 
$500 billion out of a program is beyond me. But that money, that $17.5 
billion in this prevention and public health fund, can be spent 
indiscriminately by a decision made by whoever the Secretary of Health 
and Human Services might be. H.R. 1216, H.R. 1215, H.R. 1214 and H.R. 
1213, in the aggregate, this is over $18 billion worth of spending that 
we Members of Congress have no control over. We're going to get control 
over it, though, and we're going to defund anywhere we feel that it is 
wasted, duplicative spending that the American people can ill afford.
  I want to go ahead and point out a few other things that are on the 
slides, Mr. Speaker. I mentioned, of course, the $575 billion in cuts 
from the Medicare program. I mentioned the 7.4 million people who will 
lose that coverage under Medicare Advantage because of that $126 
billion pay-for. I didn't mention, though, on this slide the third 
bullet point.
  Many physicians may stop taking Medicare patients because 
reimbursements will be below the cost of providing the care. Now, is 
that Representative Phil Gingrey from the 11th of Georgia, is that a 
statement that I've made? Well, maybe I have made it. But I'm quoting 
the Actuary of Medicare, Richard Foster, who we had last week as a 
witness before the Energy and Commerce Committee talking about some of 
these things. This bears repeating, Mr. Speaker; ``Many physicians may 
stop taking Medicare patients because reimbursements will be below the 
cost of providing the care'' Richard Foster, Committee on Medicare and 
Medicaid Services, Chief Actuary.
  Today, doctors are reimbursed under the Medicare program by a 
formula, an arcane, very difficult--you talk about calculus being 
difficult; understanding the sustainable growth rate formula to 
determine how doctors are reimbursed for providing their service, 
whether it's their brain power or their surgical skills, is beyond 
anybody's comprehension. And every year, for the last 6 or 7 years, 
when you apply that formula to the next year's reimbursement level, 
there is a cut from the last year's reimbursement--2 percent, 3 
percent, 4 percent--to the point now, Mr. Speaker,

[[Page 5069]]

what we have done, of course, we here in the Congress have mitigated 
those cuts and said we're not going to enact those cuts because these 
doctors will not be able to provide the care, just as Mr. Foster, the 
Actuary, said. And if we don't put a bandaid on these cuts and mitigate 
them, then the doctors will just drop out of the program. And I don't 
care how much you expand access and hand out more insurance cards, if 
there are no doctors there to see you, you're not going to have care. 
You do not have decent care--you don't have any care.

                              {time}  2010

  So in this bill, in this new law, not only is that formula still 
there, and the doctors are facing a 31-percent cut in their 
reimbursement if we don't mitigate it once again come December 31 of 
this year, not only is that on their backs, but in ObamaCare, there's 
this new provision called IPAB, this new bureaucracy--Independent 
Payment Advisory Board--that's going to actually cut the doctors even 
more. The Actuary is right: We're not going to have doctors providing 
the care.
  And that's because we've taken money out of this program and put it 
into an entirely new entitlement program for the most part for young 
people. Some entitlement, when you force them to buy health insurance 
in many instances when they don't need it and they don't want it.
  Mr. Speaker, I see we've been joined by the cochairman, along with 
myself, the cochairman of the House GOP Doctors Caucus, my classmate 
from the 108th Congress, the Member from Pennsylvania, my friend and 
colleague, Dr. Tim Murphy.
  I yield to the gentleman from Pennsylvania.
  Mr. MURPHY of Pennsylvania. I thank you for yielding, Dr. Gingrey.
  You know, all of us in the Doctors Caucus are people who have treated 
patients, and we know full well the value of quality health care. We 
also know what happens when bureaucracy gets between the patient and 
the doctor, and you find yourself spending as much time worried about 
paperwork and forms and what the government is going to do than 
sometimes your dealing with your patient. That's not good health care. 
And that certainly isn't good health care reform.
  All of us who are health care professionals know that the treatment 
should not be more harmful than the illness itself. And what happens 
with the health care bill that was passed, when you look at some of the 
parts of this and realize what it does to the patient, to taxes, to 
employers, to hospitals, to community health centers, to the cost of 
drugs, you have to conclude that we did not fix the problem; we 
financed the problem and it is growing and growing. And that's not the 
right direction.
  Let me give you a couple of examples.
  This bill, this act, actually creates about 1,900-plus new duties and 
responsibilities for the Secretary of Health. It has a hundred or more 
boards, panels, and commissions of people that we don't yet know who 
they are to write regulations that we don't yet know what they are.
  We also know that despite the words about the goal, the actual means 
to get there and what happens isn't what is purported to be doing.
  Let's look at, for example, we keep hearing about 35 million 
Americans will be covered. And yet, we also hear from various 
consulting firms that it won't be 9 million Americans that will lose 
their health insurance, it may be tens of millions of people who will 
lose their private insurance. So covering 35 million but perhaps the 
same or double that losing their insurance doesn't get us to where we 
need to be.
  We also heard that health care costs were going to go down. I had 
someone from HHS from Philadelphia come to my office and they told me 
with a smile that wasn't it great that health care costs were only 
going up 2 or 3 percent. I asked this person if they bothered to talk 
to some of the employers in the State of Pennsylvania, because a lot of 
them told me their health care costs are going up 20 and 30 and 40 
percent. I asked if they'd talked to some of the families whose 
children were covered on plans before that exclusively cover children 
to find out that those plans were not going to cover children any more 
because of the way the government decided to design those.
  Our goal should be to treat. Our goal should be to help. Our goal 
should not be to stop at just rhetoric and say, ``We have good 
intentions, and therefore we have good outcomes.'' But good intentions 
don't make good outcomes.
  Where we could be spending money is on some real reforms. One of the 
issues that we've been united on has been to help community health 
centers. One community health center in Pittsburgh that I visited with, 
the Squirrel Hill Health Center, treats about 700,000 individuals 
through more than 2.3 million visits annually. These community health 
centers in Pennsylvania, there are 45 in 67 counties--60 percent urban 
and 40 percent rural. Their patient base is 68 percent Medicaid, 
uninsured, and 93 percent of patients of incomes at or below the 200 
percent of the Federal poverty level.
  What is interesting is how much lower in costs those clinics 
throughout Pennsylvania, quite frankly throughout the Nation, could 
provide high-quality health care.
  But what we've created is a couple of burdens. I found it interesting 
as part of the health care bill that one of the things we passed was an 
amendment that Congressman Gene Green, a Democrat from Texas, and I had 
authored to allow doctors to volunteer at community health centers. If 
Dr. Gingrey wanted to go to a community health center and volunteer, 
and if I wanted to and any of the other ones, we couldn't do it. And 
the reason being that those community health centers say, ``We can't 
afford to have you volunteer.'' Because in order to volunteer, they'd 
have to pay the medical malpractice costs instead of having them in the 
Federal Torts Claims Act--employees of those clinics can do that--and 
that adds to their costs. In the meantime, those clinics are short 10, 
15, 20 percent of what they need in providers.
  They are a tried and true method of bringing people together, people 
from a wide range of disciplines: OBGYNs, family practitioners, 
dentists, podiatrists, social workers, psychologists, to work. That's 
one of the many things we could be doing. But along those lines, there 
are a great many things that we can be doing.
  Mr. GINGREY of Georgia. I want to thank you, Dr. Murphy, and I 
appreciate you coming.
  Mr. Speaker, I thank you for the time. I know our time is up.
  I just refer to our last poster in conclusion: Repeal and Replace 
ObamaCare.

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