[Congressional Record (Bound Edition), Volume 157 (2011), Part 6]
[House]
[Pages 7758-7763]
[From the U.S. Government Publishing Office, www.gpo.gov]




       REPEALING MANDATORY FUNDING FOR GRADUATE MEDICAL EDUCATION

  The SPEAKER pro tempore. Pursuant to House Resolution 269 and rule 
XVIII, the Chair declares the House in the Committee of the Whole House 
on the state of the Union for the further consideration of the bill, 
H.R. 1216.

                              {time}  2001


                     In the Committee of the Whole

  Accordingly, the House resolved itself into the Committee of the 
Whole House on the state of the Union for the further consideration of 
the bill (H.R. 1216) to amend the Public Health Service Act to convert 
funding for graduate medical education in qualified teaching health 
centers from direct appropriations to an authorization of 
appropriations, with Mr. Womack (Acting Chair) in the chair.
  The Clerk read the title of the bill.
  The Acting CHAIR. When the Committee of the Whole rose earlier today, 
pending was amendment No. 7 printed in the Congressional Record, 
offered by the gentlewoman from North Carolina (Ms. Foxx).
  Mr. WEINER. I move to strike the last word, Mr. Chairman.
  The Acting CHAIR. The gentleman from New York is recognized for 5 
minutes.
  Mr. WEINER. Mr. Chairman, you may recall, I was standing here 
approximately 2 hours ago waiting to speak with several other Members 
on the efforts of my Republican friends to eliminate Medicare as we 
know it, and for reasons that are known only to the Chair, I was denied 
the ability to do that. Well, I am back.
  And just to review the bidding, here is where it was before that 
order was made. We had the chairman of the Republican Congressional 
Campaign Committee, a good man, a guy I like, stand down in the well 
and say, oh, no--and this, by the way, is someone who was elected by 
the Republican Members to represent him in races all around the 
country, saying that the Ryan plan wasn't a plan. It was--and I am 
quoting here--a construct to develop a plan. And he said that the 
proposal was not a voucher program. And then he said it was a one-size-
fits-all, that Medicare was draining our economy is what he said.
  Well, ladies and gentlemen, that might be the rationale for our 
Republican friends wanting to eliminate Medicare, but none of those 
things are true. It is not a construct to develop a plan. It is the 
proposal of the Republican Party of the United States of America to 
eliminate Medicare as a guaranteed entitlement. If you don't believe 
me, go get the book that they wrote. Go get the budget that they wrote, 
go get the bill that they wrote.
  And if you believe that it's not a voucher program, listen to their 
own Members talk about it. The Medicare program today is not, I say to 
my friends, one size fits all. My good friend from Georgia (Mr. 
Gingrey) was on the floor before talking about how it's one size fits 
all. How can it possibly be you can be a Member of the United States 
House of Representatives and not understand how Medicare works?
  Each individual senior gets to go to the doctor of their choosing, 
gets to go to the clinic of their choosing, gets to decide for 
themselves where they go, and then the doctor and the patient make 
decisions.
  The only question is: Are we going to say to citizens who are 65 and 
older, Here is a coupon. Go buy private insurance at 25 and 30 percent 
overhead rather than the Medicare program, which the actuaries say cost 
1.05 percent in overhead?
  We have also heard them say, You are demagogueing. We don't really 
want to get rid of it. You do.
  Now, there is a saying here in Washington that a gaffe is when the 
Republicans actually say what they think. So there have been plenty of 
opportunities to see this gaffe in full play. Now, they have been tying 
themselves in intellectual knots trying to get out from under the basic 
facts.
  By the way, I hope your insurance plan, the Ryan plan, covers the 
twisted arms and limbs you get tying yourselves in knots explaining 
this.
  It is a radical departure from where we are today. Mr. Gingrich was 
right, even the blind squirrel can find a nut once in a while. He was 
right. It's a radical departure, but it's yours. Own it. Show a little 
gumption. Show that you are prepared to own your own proposals. But now 
that you want to do it and the American people are seeing the 
difference between Democrats and Republicans, now you are trying to 
squirrel your way out of it, with no disrespect to squirrels.

[[Page 7759]]

  You say we don't have a plan. Not only did we pass a health care plan 
a year ago that extended 10 years the life expectancy of Medicare, but 
I will go one better. I will give you a plan. How about Medicare not 
starting at 65? What about 55 or 45 or 35? What is it that health 
insurance companies do in this country?
  Now, I know that my Republican friends are wholly owned subsidiaries 
of the insurance industry, but that should not mean that our seniors 
lose their Medicare because of it. So, my friends Mr. Sessions and Mr. 
Gingrey were trying desperately to try to figure out how to get out 
from under your own beliefs. We believe in Medicare. We created it. We 
believe in Social Security. We created it. We believe in the health 
care act. We created it.
  As a matter of fact, every improvement to health care in this 
country, Democrats propose, Republicans oppose. And now they have a 
chance to get rid of it, and they are doing it. But at least if you are 
going to do it, at least if you are going to try to do it, don't try to 
silence people who point it out.
  And I think the lesson here is it might be later. If you had me come 
back at midnight, I would have said it. If I came back at 2 a.m., I 
would have said it, because the American people are going to see what's 
going on here.
  You have a proposal to eliminate Medicare, a proposal to privatize a 
portion of Social Security by investing in the stock market, a proposal 
to roll back the expansion of prescription drug coverage for seniors. 
You have a proposal to take away the benefits of those 25 and younger 
to be able to get health insurance. That is your proposal. Own it. Live 
with it. Embrace it, because we are not going to let you get out from 
under it.
  And you may delay me, you may gavel me, you may tell me you have got 
to come back at 2 o'clock in the morning. It's not going to change the 
fundamentals of this debate, that if you believe fundamentally in 
Medicare, at this point you have got two choices: Tear up your 
Republican Party membership or give up control of Congress, and, 
frankly, some of you are going to have to do both.
  Mr. PALLONE. Mr. Chairman, I move to strike the last word.
  The Acting CHAIR. The gentleman from New Jersey is recognized for 5 
minutes.
  Mr. PALLONE. I want to continue this debate on the Medicare issue 
because I do believe, from looking at the Republican budget, that they 
do intend to end Medicare, it's quite clear. And, you know, the irony 
of this is that, when the Democrats were in the majority, we were 
trying to expand health care options, provide everybody with health 
insurance. And now what we see is just the Republicans, when they take 
the majority, are trying to get rid of, really, the best health 
insurance program that the Nation has ever seen, and that's Medicare.
  No one would argue that Medicare has not been successful. The fact of 
the matter is that before we had Medicare--which, as my colleague from 
New York mentioned, was a Democratic initiative--what would seniors do? 
Well, seniors couldn't get health insurance because, as you know, when 
you get to be over 65, or if you are disabled, people don't want to 
give you health insurance because it costs too much. You are in the 
hospital too much. You have too many health care needs. And so seniors 
basically couldn't find health insurance. They were really at the 
mercy, if you will, of whatever they could find, or if they got sick, 
they had to go to a hospital or they had to go to a doctor and pay out 
of pocket in many cases.
  And so when the Democrats came along and Lyndon Johnson said, look, 
this is something that we need because seniors can't get health 
insurance, well, they initiated Medicare. And the fact of the matter is 
that almost every Republican voted against Medicare then, and they have 
never liked it because they know it's a government program. They don't 
like government programs.
  So if anyone on the other side of the aisle is trying to tell me, I 
don't know that they are, but if they are trying to suggest that if 
somehow by voting for this budget that ends Medicare that they didn't 
really mean it, I would say look at their history, look at the history 
of opposing Medicare, of opposing Medicaid, of opposing even Social 
Security when Franklin Roosevelt and the Democratic Congress put it 
together.

                              {time}  2010

  Now, I want to point out what happens when seniors don't have 
Medicare anymore and they have to go buy insurance on the private 
market. Well, basically, what that does is it puts the insurance 
companies back in charge again. And that's no surprise. This is what 
the Republicans want. They always stand with the special interests--Big 
Oil, big banks, Wall Street and, of course, the insurance companies.
  And the insurance companies don't like Medicare because they can't 
make any money. They want to be able to make money. They want to take, 
cherry-pick, if you will. If you're over 65 and they figure you're in 
good health, then maybe they'll give you insurance if you want to go 
and buy it because they figure you might be a good risk and they can 
charge you a lot of money and they can give you a barebones policy that 
doesn't cover anything.
  Remember that Medicare not only provides a guaranteed insurance 
policy that you can buy, that you get, I should say, from the 
government when you are over 65 regardless of your health status or of 
your income, but you also get a pretty generous insurance plan that 
covers a lot of things. You put the insurance companies back in charge, 
and not only will they not offer insurance to a lot of seniors at a 
decent price, but for those who they do sell the insurance to, it's not 
going to be a package that covers what most seniors are going to need. 
So it's not only that Medicare is important because it guarantees you 
coverage, but it also guarantees you a pretty generous coverage which 
you need when you're 65 or when you're disabled.
  Some of the Republicans I hear say, well, don't worry senior 
citizens, we may be ending Medicare, but it's only going to be ending 
for those who are now 55. If you're 65 years old, you can continue to 
have it. But if you're 55 or under, when you get to be 65, it's no 
longer going to be available. So if you're a senior citizen now, don't 
worry about it. Well, I don't know too many seniors who think that way, 
because I know they worry about everybody including not just 
themselves, but their children and their grandchildren.
  But besides that, I would also point out that this Republican budget 
eliminates two other things. First of all, we, as Democrats, when we 
were in charge of the House, we put in place a program to close the 
prescription drug doughnut hole. So that if you reach the doughnut hole 
now, as of January 1, 50 percent of your costs are covered, and 
eventually you are going to have no costs in the doughnut hole. It's 
going to be eliminated completely.
  Well, the Republican budget repeals that. So it goes back to leaving 
this gaping hole; whereas, if your out-of-pocket drug costs in the 
course of a year are $2,500 or more, then you're not going to get your 
prescription drugs covered. So, also for current Medicare holders, 
senior citizens, it opens up that doughnut hole again so you are going 
to pay all this money out of pocket.
  In addition to that, it repeals a Democratic provision that's now law 
that says that you don't have copays for preventative care. So if 
you're a senior or disabled and you need a mammogram, you need a 
certain kind of testing done, you don't pay a copay. The Republican 
budget also abolishes that. This is devastating for senior citizens, 
current and future.
  Mr. THOMPSON of Pennsylvania. I move to strike the last word.
  The Acting CHAIR. The gentleman is recognized for 5 minutes.
  Mr. THOMPSON of Pennsylvania. Mr. Chairman, I do support the Foxx 
amendment.
  I've listened to all the discussion on the floor, much of it dealing, 
most recently, with not the Foxx amendment, but actually with Medicare, 
which always catches my attention. You see,

[[Page 7760]]

Mr. Chairman, I actually have, before I came into this position in 
Congress just a little over 2 years ago, 3 years ago now, I actually 
worked in the health care field. I worked specifically serving 
individuals that utilize Medicare. I was a therapist, a licensed 
nursing home administrator and manager of rehabilitative services.
  At the time of the Balanced Budget Act of 1997, I actually was 
recruited by the Medicare agency--it was the Health Care Financing 
Administration then. Now it is the Centers for Medicare and Medicaid 
Services--to serve on the technical expert panel. So that's why, when I 
hear this rhetoric on the other side that the Republicans are trying to 
end Medicare, I find that just not accurate. And that's based on 30 
years of experience of working with Medicare and developing an 
expertise with the Medicare policy, to be invited to be a part of the 
technical expert panel on Medicare.
  The fact is, when I came to Washington in January 2009, I thought all 
435 Members of Congress understood that the looming crisis in 
Washington was Medicare, Medicare was one of them, and that Medicare, 
frankly, was going to go bankrupt. It was going to become insolvent, 
and if we didn't reform Medicare, it would go away. And how immoral is 
that, for all the Americans out there that contribute to Medicare, pay 
for their Medicare, invest in their Medicare, and that it would not be 
there when it came time for them to get Medicare?
  And so I'm actually just a little shocked, Mr. Chairman, by the 
rhetoric.
  And the fact is, if we want to save Medicare, we need to do exactly 
what the Republicans are proposing, and that is to reform it, to save 
it. Even the Medicare trustees just 2 weeks ago came out and they said 
that the Medicare program was going to be insolvent 5 years sooner than 
what they originally predicted.
  Now, what does insolvent mean, Mr. Chairman? Insolvent means going 
bankrupt. Insolvent means going away. Insolvent means that for all the 
seniors that have paid into the system, it won't be there for them.
  We have a duty and an obligation, a fiduciary responsibility to make 
sure that Medicare is there. This side of the aisle is the only one 
that is working on keeping Medicare for our seniors. What we're 
proposing, really, is premium support. It's not vouchers. It's not 
privatizing. It's premium support. And premium support is the best 
model that you can look at, for that is Medicare part D, the 
pharmaceutical program.
  Medicare part D gives seniors the opportunity to pick from plans that 
work for them that are customized to their needs. Medicare part D, for 
those who don't know it, has to do with prescriptions for 
pharmaceuticals. And we provide premium support so that they can pick 
the plans that work for them, so they can make sure they get the 
prescriptions that they need to have.
  Frankly, it is one of the few government plans that has ever come in 
under budget. Most government plans don't come in under budget. They 
come in way over budget. Medicare part D did.
  It also speaks to me as Medicare part C, which is Medicare managed 
care. Medicare managed care, Medicare Advantage, which unfortunately 
the Patient Protection Affordable Care Act attacked and went after, 
that Medicare part C program provides for wellness and prevention. 
Medicare part C has been a program that has been allowed to emphasize 
prevention and wellness. And the statistics show that the people 
engaged in that program have been hospitalized fewer times and that 
those hospitalizations have been for fewer days. And do you know what? 
It keeps them well. It keeps them healthy. And that's what health care 
should be all about, keeping people healthy. And the other thing it 
does is it saves taxpayer dollars. That's a win-win, as far as I'm 
concerned.
  So we're talking about premium supports that take concepts from 
Medicare part D and Medicare part C, and we're going to apply those 
premium supports to the Medicare program.
  Mr. Chairman, I think it is important that people understand that if 
we do not reform Medicare, Medicare will go bankrupt, Medicare will be 
insolvent, and Medicare won't be there. If we don't do this, the fact 
is that Medicare will go bankrupt. Medicare will be insolvent. And in 
the end, that is just immoral.
  We have a great opportunity here, and we need to address Medicare. I 
think premium supports are a great way to do that. And I appreciate the 
opportunity to be able to speak.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from North Carolina (Ms. Foxx).
  The question was taken; and the Acting Chair announced that the ayes 
appeared to have it.
  Mr. PALLONE. Mr. Chairman, I demand a recorded vote.
  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further 
proceedings on the amendment offered by the gentlewoman from North 
Carolina will be postponed.


                 Amendment No. 1 Offered by Mr. Weiner

  Mr. WEINER. I rise as the designee of the gentlelady from Florida 
(Ms. Castor) to offer an amendment that is satisfied by the preprinting 
requirement.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 4, after line 12, add the following:
       (d) Effective Date.--Subsections (a), (b), and (c) shall 
     not take effect until the date that the Comptroller General 
     of the United States determines there is no primary care 
     physician shortage in the United States.

  Mr. GUTHRIE. Mr. Chairman, I reserve a point of order against the 
amendment.
  The Acting CHAIR. A point of order is reserved.
  The gentleman from New York is recognized for 5 minutes.
  Mr. WEINER. Mr. Chairman, I support this amendment and hope we all 
vote for it.
  I just do want to take an opportunity to respond to the gentleman who 
was just at the microphone. It is one thing to say you're saving 
Medicare, but if you leave a different Medicare when you're done than 
today, if it is entirely different, how have you saved it?

                              {time}  2020

  I know ``premium support'' or ``price support'' is the term of art 
that is now trying to take hold as you desperately try to figure out 
how to explain what you are doing, but let me make it very clear, and 
if I say anything incorrect, the gentleman can rise and I will permit 
him to correct me.
  Under the proposal of the gentleman from Wisconsin, under the 
proposal of the Republicans in Congress, that at a certain point in the 
future, Medicare as we have it today, as a guaranteed entitlement 
safety net program for seniors, will cease to exist. That is the Ryan 
plan. I will pause while anyone seeks to correct that.
  That silence you hear, ladies and gentlemen of the United States of 
America, is because I just said something that is factually correct. 
The Ryan plan, which is now the Republican plan, which is now the plan 
that has passed the House, would end Medicare as we know it. Now, that 
has never been something that they have hidden from before. They even 
had a book, ``The Young Guns,'' or something. Does the gentleman from 
New Jersey remember what it was called? It was like ``The Young Guns.'' 
They were parading them all around the country with this book that 
explained it, this is the way Medicare is going to look.
  You say it is price support. Okay. It is price support unless you 
can't be supported by the price of the voucher. If you are a senior 
citizen, I say to the previous speaker, if you are a senior citizen and 
you are given this thing, call it what you want, a coupon, a voucher, a 
price support document, and you go around and look for insurance in 
your neighborhood and you can't find it, under the law that you passed, 
you are out of luck. But you are not entirely out of luck. Your family 
can go pay out of their own pocket and may be able to buy insurance.
  Now, you are a good, fit, healthy man, God bless you, and you should 
be so for many years to come. But the fact is that many senior citizens 
cannot go into the private market and buy

[[Page 7761]]

insurance with a price support document or voucher or coupon. They 
won't be able to get it, which is why Medicare was created in the first 
place, because the conventional way of saying, ``You know what; each 
and every person for themselves is the way we are going to get health 
care'' was leaving senior citizens out.
  I want to explain to my Republican colleagues a little something 
about economics. When we join together as a society, as a large buying 
pool, we get better treatment as consumers. We get a lower price. Fewer 
people buying car insurance, prices go up. All of us in a pari-mutuel 
relationship, prices come down. That is basic economics, but it is 
being violated by the Ryan plan, which is the Republican plan, which is 
the plan you now own and have to defend.
  But to say, you know, We don't really want to defend it because we 
are uncomfortable with it, it is yours now. And you say, We are trying 
to save Medicare. We are trying to save it. If you want to save it, 
then it has to be a Medicare program. It can't just be some kind of a 
coupon.
  But I want to talk very briefly in my remaining time about this idea 
that we don't have plans. I have a plan that I want you all to 
consider. It is taking the efficient program of Medicare, which has 
managed to keep administrative costs far below any insurance plan in 
the country, any one of them. If any one of them can come even close to 
Medicare efficiency, then I would say let's go get that one, but they 
can't.
  Why is it that we say that only people 65 and above should get that 
efficiency? Why don't we say to the roughly 30 percent profits and 
overhead insurance companies are taking, Who needs you guys? You are 
taking our money.
  We are giving it to insurance companies. They are not doing any 
exams. They are not doing any checkups. They are not operating on any 
people. All they are doing is taking our money, taking 20 percent off 
the top and then passing some of it along to doctors and hospitals. 
What are they performing in the economy? Let's take them out of the 
formula.
  Now, we didn't go this way in the ObamaCare plan, which I proudly 
call it. But I have to tell you, there is a competition going on in 
this country right now between the for-profit, employer-based model 
with a 30 percent overhead and Medicare with 1.05 percent overhead. I 
say Medicare for all Americans. It is an American Democratic plan that 
we should extend to more people. You want efficiency? Get more people 
into that buying pool. Let's take advantage of the large numbers of 
people that we have and cover them with insurance at a lower rate.
  But we didn't go that way. We went a Republican way. In the Obama 
proposal, it was essentially a Republican proposal that said let's give 
them all health insurance. Now what you are saying is let's see if we 
can do that for senior citizens and still call it Medicare. You can't. 
You can't.
  You say you are saving Medicare. You are destroying Medicare, and we 
Democrats and the people of this country are going to stop you.


                             Point of Order

  Mr. GUTHRIE. Mr. Chairman, I insist on my point of order.
  The Acting CHAIR. The gentleman from Kentucky may state his point of 
order.
  Mr. GUTHRIE. The amendment violates clause 10 of rule XXI of the 
rules of the House because it has the net effect of increasing 
mandatory spending.
  The Acting CHAIR. Does any other Member wish to be heard on the point 
of order?
  Mr. WEINER. I ask to be heard on the point of order.
  The Acting CHAIR. The gentleman from New York is recognized.
  Mr. WEINER. It is arguable whether or not this does increase spending 
because all this does is change the effective date. But I can tell you 
this: This is the exact same argument we heard today from Mr. Cantor, 
who said they would not authorize any spending to help the people who 
were the victims of that horrible tornado recently because that, too, 
would need to be paid for.
  Sometimes you have things that are emergencies in this country. 
Sometimes you have things that, frankly, under the emergency powers of 
this Congress, we should be able to implement.
  I believe that while it is arguable that the effective date changes 
the net expense of this bill, because all this really does, the fact of 
the matter is that we have a responsibility to seniors in this country. 
We have a responsibility to those on Medicare to try to save it, just 
the same way I would say we have a responsibility to the citizens of 
this country who were ravaged by storm. And to hear your leadership say 
we would not allocate any funds for that purpose without going through 
a budget debate is outrageous.
  The Acting CHAIR. The Chair is prepared to rule.
  The gentleman from Kentucky makes a point of order that the amendment 
offered by the gentleman from New York violates clause 10 of rule XXI 
by proposing an increase in mandatory spending over a relevant period 
of time.
  Pursuant to clause 10 of rule XXI and clause 4 of rule XXIX, the 
Chair is authoritatively guided by estimates from the chair of the 
Committee on the Budget that the net effect of the provisions in the 
amendment would increase mandatory spending over a relevant period as 
compared to the bill.
  Accordingly, the point of order is sustained and the amendment is not 
in order.
  Mr. PALLONE. I move to strike the last word.
  The Acting CHAIR. The gentleman from New Jersey is recognized for 5 
minutes.
  Mr. PALLONE. Mr. Chairman, I wanted to go back to the issue of 
Medicare, but I also wanted to respond to the gentleman from 
Pennsylvania because he also brought up the issue of Medicaid. I would 
point out that the Republican budget not only devastates and ends 
Medicare, but it essentially does the same thing to Medicaid because of 
the level of cuts that are put in place for Medicaid.
  Now, senior citizens are very much aware of the fact, I think, that 
if Medicare ends, then they are thrown out in the private insurance 
market, and if they have to buy insurance on the private market at the 
whim of the insurance companies, that they will be in bad shape. They 
may not be able to get insurance. If they get it, it will be a very 
skeletal package. It won't cover and guarantee their benefits.
  I think they also realize that the budget, if it repeals the health 
care reform, will go back to having this huge doughnut hole, which will 
cause them to pay a lot out of pocket and also will eliminate the lack 
of copays that now exist for preventive care, such as mammograms and 
other diagnostic tests that now are free without a copay. So they will 
pay a huge amount of money out of pocket if the Republicans get their 
way by ending Medicare.
  But the gentleman from Pennsylvania also brought up Medicaid, and I 
would point out that many seniors are not aware of the fact that most 
of the money spent on Medicaid actually pays for nursing home care 
because Medicare doesn't cover nursing home care. Seniors, when they 
pay out of pocket for nursing home care, usually run out of their money 
very quickly and end up staying in the nursing home because of 
Medicaid.
  Well, what this budget does is to basically cut Medicaid by almost 
$800 billion over the next decade and essentially in half by 2022. That 
is not sustainable. What that is going to mean is, as I said before, 
when we didn't have Medicare, seniors couldn't get insurance and they 
just basically got no health care unless they went to an emergency 
room. But if you cut Medicaid in half, what is going to happen is there 
isn't going to be money for the States to pay for nursing home care, 
and either seniors won't be able to find a nursing home or, if they get 
one, it is going to be a nursing home that, because it is not getting 
an adequate payment rate, it is going to be really awful.
  In my home State of New Jersey, I remember in the 1970s, going back 
30 years ago, when nursing homes were just awful. We had fires. We had 
people with horrible bedsores.

[[Page 7762]]



                              {time}  2030

  The bottom line is that, if you really devastate Medicaid, which pays 
for nursing home care, you're going to also go back to the days when 
seniors couldn't find nursing homes.
  Mr. WEINER. Will the gentleman yield?
  Mr. PALLONE. I yield to the gentleman from New York.
  Mr. WEINER. I just want to point out something else. Who is going to 
be left to pay for it?
  Obviously, localities in New Jersey, Pennsylvania, and New York are 
not going to let people lie sick in the streets. It's just going to 
mean local taxes are going to get raised and that State taxes are going 
to get raised because, ultimately, it's not whether people get health 
care; it's just how it's paid for. Frankly, by cutting it off, it 
doesn't mean that. It just means that we're passing it along in an 
unfunded mandate to localities.
  I thank the gentleman for yielding.
  Mr. PALLONE. I agree.
  I also would point out that, many times, the localities, because they 
have budget problems, may not even pay for it at all, and so we'll end 
up with awful nursing homes or we'll not even have nursing homes.
  The other thing, too, is that Medicaid also has waivers that pay for 
a lot of senior citizens to stay home and that pay for their personal 
care when they stay home: for somebody to come in and dress them, to 
cook meals, to clean the house, that type of thing. That would also be 
gone or it would be cut in half when you cut Medicaid in half.
  Again, as Mr. Weiner said, unless the States stepped in and paid for 
that, a lot of those senior citizens who don't have to go to nursing 
homes end up staying home and getting the personal care in their homes 
or apartments, and those programs are going to be eliminated as well.
  So it is amazing what the Republicans are doing in this budget: 
ending Medicare and cutting Medicaid. What that means for senior 
citizens is just an awful thing. These cuts to Medicaid go into effect 
immediately, so they impact seniors immediately, and just get worse and 
worse over the next 10 years. It also applies to the disabled because 
these are programs that are paying for the disabled. Everything that I 
said about people over 65, whether it's regarding Medicare or Medicaid, 
also applies to people who have disabilities.
  I just don't understand. Again, Medicare, Medicaid, Social Security, 
these are programs that the Republicans never liked, never voted for, 
never supported, and I'll mention one more. Because of the cuts in 
Medicaid and also because of the cuts in the SCHIP, which is the family 
care premium, the budget also makes it so a lot of children who now get 
health care coverage are not going to get health care coverage.
  Again, the Republicans are walking away from the seniors, walking 
away from the disabled, and walking away from the children.
  Mr. WEINER. I move to strike the requisite number of words.
  The Acting CHAIR. The gentleman from New York is recognized for 5 
minutes.
  Mr. WEINER. I say to the Chair, when I was here at 6 o'clock and was 
cut off by the Chair and was taken off my feet and lost my ability to 
speak for reasons that are only known to the Chair, I was prepared to 
make my 5-minute remarks, and the other Members were prepared to do the 
same.
  I want to say that, just as a matter of comity and as a matter of our 
all getting along, this is an important debate, and if the effort were 
to try to figure out a way to stymie the debate and to silence some of 
us, I just want to remind you that it's not going to work and that 
we're going to find a way to make this debate happen even if it's late 
into the evening. But I just want to continue on a point that the 
gentleman from New Jersey made, and I want us to understand a little 
bit about the basic tenets of how Medicare works.
  Many Members on the other side of the aisle came to the floor today 
and talked about Medicare as being a one-size-fits-all plan. Medicare 
works because of its flexibility. My father is a member of an HMO. He 
chose that option. People can go to individual pay-per-service doctors.
  Now, there is no disputing that health care--all health care--is on a 
rising arc that is unsustainable. That's why the Republican strategy of 
doing nothing and drilling its head into the sand for years was no 
longer sustainable, and that's why we Democrats, without a single 
Republican vote, had to do something about it. The arc of cost is 
strangling our economy. The arc of cost of not having people insured 
and of passing along the bills to all of us was an unsustainable model. 
That's why we made changes that made Medicare more efficient.
  For example, one of the things that my friends want to eliminate is 
the idea that, under Medicare now, under the Affordable Care Act, under 
ObamaCare, preventative services for seniors are reimbursed 100 
percent--no copayment. Why do we do that, and how does that save money? 
It's because of what our parents and grandparents have taught us time 
immemorial, that an ounce of prevention is worth a pound of cure, and 
that by providing coverage for that you actually save money in 
Medicare. How did we extend Medicare by 10 years? That's one of the 
ways that we did it.
  What my colleagues fail to understand is that we acted just last 
year. You ask, Where is your plan? We acted just last year to extend 
the life of Medicare; to expand services provided under Medicare; to 
reduce the cost to the economy; to provide coverage for the uninsured; 
to reduce the burden on localities and cities that have to pay for the 
uninsured now. That's what we did.
  What are you doing? You're saying let's take not only the Affordable 
Care Act and eliminate all of those protections, but let's go back 40-
some-odd years, and let's eliminate the Medicare Act, and let's replace 
it with something that, oh, lo and behold, takes taxpayer dollars and 
gives it to insurance companies.
  Now, anyone watching this movie from the beginning knows that that's 
your basic modus operandi, that that's what you always seek to do--to 
enrich insurance companies. But if you want to provide care for 
seniors--Democrat seniors, Republican seniors, seniors with no party 
affiliation--Medicare has turned out to be a very efficient way to do 
it. Does that mean there are not rising health care costs across the 
board? Yes, but I'm going to tell you something. Here's this for an 
interesting little fact:
  Medicare's rising cost is actually less than that of the private 
insurance market. Well, how can that be? Because, as I said, Medicare 
doesn't take money for profits. Medicare doesn't take money for 
shareholders. Medicare doesn't take money for advertisements. Medicare 
doesn't take money for giant call centers, where you call them, and 
they put you on hold and then ultimately don't give you their service. 
They don't give giant bonuses to their CEOs. Medicare is an efficient 
program that's well run because that's how we roll, we Democrats. We do 
efficient programs that are well run.
  What do you do? You want to eliminate them. You like that.
  That's how they roll. They want to eliminate these programs. We're 
standing in the way, but we're not standing alone because seniors of 
all stripes and even people who are young people who want to someday 
become seniors understand a program that works when they see it. They 
also understand a party in retreat when they see it, I say to my good 
friend. We see how you guys are coming down here. Well, it's not a 
voucher; it's a coupon. It's not a coupon; it's a price support. 
Earlier in the day, someone said you're draining the Federal 
Government. One size fits all.
  You guys, I have not seen so much defensive talk in years. But you 
ought to be a little bit defensive about this because we found out what 
you believe in. You campaigned on what you were against, and this is 
apparently it. But here it is. Now you've got to defend it. You should 
do a better job than simply saying, Oh, no, no, no, no. We love this

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Democratic program. We're not trying to hurt it.
  The American people are much too smart for this. They know if you say 
we're taking away a guaranteed protection and we're replacing it with a 
price support document, or whatever euphemism you're going to work, 
that we Democrats are going to stand up and call you on it every day. 
You can huff and you can puff, but eventually, it's going to be us 
blowing your house down. Ultimately, it's going to be the citizens of 
this country saying, You know what? I remember now why we put Democrats 
in charge when we wanted to take care of people, because they create 
programs like Medicare, and Republicans want to eliminate them.
  The Acting CHAIR. The time of the gentleman has expired.
  Mr. GUTHRIE. Mr. Chairman, I move that the Committee do now rise.
  The motion was agreed to.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Canseco) having assumed the chair, Mr. Womack, Acting Chair of the 
Committee of the Whole House on the state of the Union, reported that 
that Committee, having had under consideration the bill (H.R. 1216) to 
amend the Public Health Service Act to convert funding for graduate 
medical education in qualified teaching health centers from direct 
appropriations to an authorization of appropriations, had come to no 
resolution thereon.

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