[Congressional Record (Bound Edition), Volume 158 (2012), Part 8]
[House]
[Pages 11078-11084]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              {time}  1620
                          AFFORDABLE CARE ACT

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 5, 2011, the gentleman from New York (Mr. Tonko) is recognized 
for 60 minutes as the designee of the minority leader.
  Mr. TONKO. This evening we are going to address for the coming hour 
with a couple of our colleagues the issues of affordable health care 
and the

[[Page 11079]]

fact that we see a pattern here that's established by the House that 
seems to walk away from the needs of a middle class, a working class in 
this society. Our country depends upon a thriving middle class, one 
that is given the respect and the dignity it so much deserves. And with 
the attacks on Social Security with its 76-year old history and the 
efforts to privatize Social Security, we understand that that would put 
at risk a number of people.
  Not a single cent of Social Security was lost to its recipients 
during the very painful recession. And likewise, in the mid-sixties we 
saw the emergence of Medicare, which allowed for, again, the dignity 
factor to be presented and found in the midst of our senior households 
where, at that point in time, prior to Medicare, those who would retire 
would anticipate a decline in their income and their economic security 
simply because of the impact that their health care costs would have on 
their retirement years. Since then, not only have we seen a stronger 
sense of security and stability in those senior households, but we have 
seen a strengthening of the response to the health care needs of our 
seniors because of the stability that Medicare produced and the quality 
of the care that has been part and parcel to the Medicare history.
  And so now, in its infancy, the Affordable Care Act is under threats 
with the repeal measure that was just taken on this House floor to undo 
the progress that was achieved for, again, America's health care 
consumers. It is a troubling notion, at best. This hour of discussion 
will be dedicated to the concerns that we have for the economic ripple 
effects that befall the middle class, which needs to be a thriving 
middle class, and the impact of several of these attacks that seem to 
undermine the very foundations upon which security is provided to 
America's great populations.
  So we're concerned. We're concerned about that repeal and what it 
means, what is removed from the equation of success that was brought 
about a couple of years ago as we worked in a bipartisan, bicameral way 
with the White House to make certain that a growing need out there that 
found this country as the only industrialized nation to not have a 
universal health care program, when that is put at risk again because 
of the efforts to repeal.
  We are joined by my colleague from California, Representative John 
Garamendi.
  John, you witnessed this vote just now to repeal health care. The 
Affordable Care Act was providing hope and opportunity and promise to 
all generations in this American mosaic. It is a tragic moment.
  Mr. GARAMENDI. Mr. Tonko, thank you so very much. And thank you for 
beginning this discussion by going back into the history of the United 
States back to the development of Social Security and the extraordinary 
benefit that that has brought to not only seniors but to their 
children, to families, knowing that when retirement age approached--
65--there would be a foundation for whatever retirement program a 
person would have, and also for pointing out that for years now, and 
certainly in the recent decade, our Republican colleagues have called 
for the privatization of Social Security.
  Now if you trust Wall Street, then I guess it's a good idea. If we 
had any lesson, we should have had the lesson of 2008 and 2009, when 
Wall Street turned its back on the American public and simply ripped us 
off to a fare-thee-well and nearly collapsed the world economy. Were it 
not for the efforts of the Obama administration and, frankly, this 
Congress, it may very well have happened.
  And then you pointed out Medicare coming along in 1964, 1965 and the 
way in which that has protected seniors. I remember as a young child--I 
think I was probably 7 or 8--my dad took me down to the county hospital 
to visit one of our neighbor ranchers. I've got to tell you it was 
horrible. That was the only care available for a senior who had no 
money. And then Medicare came along, and 60 percent of America's 
seniors were in poverty prior to Medicare. Now, with Social Security 
and Medicare, it's somewhere around 10, 15 percent. An enormous boost. 
Yet twice this House has voted to terminate Medicare. Not the 
Democrats. Our Republican colleagues twice have voted to terminate 
Medicare so that every American less than 55 years of age would not 
receive Medicare. They would be given a voucher and told to go fight as 
best they could in the private insurance market.
  And then today, another major effort by the Democrats to provide 
health care for all Americans--a health insurance policy that you knew 
was there, that you could count on, that would be affordable. The 31st 
time, today, a full repeal or a partial repeal was taken up and passed 
by our Republican colleagues.
  So what's an American to do? What does it mean to Americans? Let's 
spend some time talking about what this means to Americans if you 
didn't have Medicare. If you don't have the Affordable Care Act, what 
would it mean?
  I'm going to start, if I might, or would you like to start?
  Mr. TONKO. Absolutely. We, I know, are joined by some of our 
colleagues. But if you want to go through your chart.
  Mr. GARAMENDI. Let me just take up the Patient's Bill of Rights very, 
very quickly. I was the insurance commissioner in California for 8 
years. The insurance industry puts people behind profits. Profits 
before people. And they're concerned about making sure that they have a 
healthy group of customers. They don't want sick people. Sick people 
cost money. So over the years they have developed a whole set of 
discriminatory practices to exclude from coverage people they don't 
want to take care of because they might be expensive.
  So in the Affordable Care Act there is the Patient's Bill of Rights 
that forces the insurance companies to end insurance discrimination. 
And here's just some of them:
  Children with preexisting conditions. An example, my chief of staff, 
his son was covered by insurance the day he was born. The second day of 
his life they discovered that kid had very serious renal failure; 
kidney failure. Bam, the insurance was over. That family was off their 
insurance policy; gone, done. No longer. We're talking about I think 14 
million American children that are going to get coverage regardless of 
what their health circumstances might be.
  Young adults. This one is close to home. I've got six children. Every 
one of them have passed through that age of 21 when they were no longer 
on our insurance policy. Most recently, my daughter. Twenty-one years 
of age, covered by an insurance company for 21 years and 9 months. The 
day of her 21st birthday, off the insurance policy. We're now talking 
about every young American 21 to 26 stays on their parents' health 
policy.
  She also happens to be a woman. Women are discriminated against in 
insurance because they have a preexisting condition: They could get 
pregnant. That's expensive. We don't want to cover them, say the 
insurance companies. No, no. Under the Patient's Bill of Rights, the 
discrimination against every woman in America on their insurance policy 
is over. Apparently, our Republican colleagues don't care about these 
very, very important efforts to end insurance discrimination.
  We can go on here. Seniors. Who among us doesn't have a preexisting 
condition? High blood pressure, juvenile diabetics, type II diabetes. 
Try to get insurance without the Affordable Care Act--you're out of 
luck. You won't get insurance.

                              {time}  1630

  So the Patient's Bill of Rights, should today's action become law, is 
repealed, and along with it, the protections that 315 million Americans 
presently have--presently have. No more insurance discrimination. The 
ability to get insurance is guaranteed. No more discrimination.
  Yes, I'm a little passionate about this one because I've watched 
this. I've watched this as insurance commissioner. I fought the 
insurance companies day in and day out as they denied

[[Page 11080]]

coverage, as they refused to provide the coverage, as they told people 
they couldn't get care. But the law is in place now. The law is in 
place, and it's going to stay in place despite the vote today.
  Mr. Tonko, thank you.
  Mr. TONKO. And interestingly, Representative Garamendi, we've been 
reminded I think by the general public that the legislature, the 
legislative body here, Congress, took up the bill. They passed it. It 
went over to the President. He signed it. The highest court in the 
land, a conservative-leaning court, reviewed it, made their decision 
and rendered a decision that said it met with constitutionality.
  People are saying go forward. Move on. Get to the issues that now 
have got to be resolved, and that is the economy, creating the jobs, 
producing the post-recession responsiveness that people so much require 
and deserve, and that's where they're at.
  We've been joined by Representative Eleanor Holmes Norton who has 
joined us.
  Representative, thank you for joining us in the Special Order.
  Ms. NORTON. Well, I want to thank you, Representative Tonko, and my 
other good colleague, Representative Garamendi, for leading this 
special order and for offering the perspective that you've begun this 
hour with, something that our fathers and grandfathers are responsible 
for, the Greatest Generation, and now has been embraced by the American 
people. And as proud Democrats, we are very, very proud of that, of 
these very important reforms.
  I wanted to come to the floor as well to offer some real-life, real-
time evidence as people try to judge what they've heard on the floor 
today and what they heard on the floor yesterday about the health care 
bill. We teach our children fair play, you win some, you lose some. And 
when you lose, then you've lost that one; you try again another time.
  What they've seen in the House this year and last year are the 
Republicans trying to repeal financial reform. They lost that. It's as 
if the law of the land weren't the law of the land. Now they're trying 
to repeal health care reform even when the Supreme Court announces the 
law of the land. They've come to the point where they do not recognize 
the law of the land as announced by passage in the Senate and the 
House, signature of the President, and, in the case of the health care 
reform bill, the imprimatur, which is the last word, of the Supreme 
Court.
  But as I heard the debate, I was concerned that the American people 
would be concerned in the face of this economy about what they hear our 
colleagues on the other side say the health care bill will do to the 
economy, and attempt to essentially frighten people, especially 
yesterday when the Republicans came forward with a usual set of 
horribles, this after the bill was passed, now when we ought to be 
thinking of the best ways to implement it. But none of those horribles 
about what was going to happen because of the health care bill was data 
based.
  We ought to ask ourselves: Why would the Republicans not use the one 
existing experience that we have, the 6-year experience of the 
Massachusetts health care law, which is the very model for the health 
care law we passed? And that, of course, was a law that was engineered 
by their own candidate for President, Mitt Romney.
  Well, I had occasion to look at the experience under that bill 
because, as you may know, our colleagues had hearings all around the 
House yesterday on health care reform as a prelude to the repeal vote 
on the floor. And I was in the Oversight and Government Reform 
Committee, and the hearing was on the impact on jobs. Now, if you want 
to scare the American people, tell them that the bill is going to add 
to the problems in their jobs.
  One of the witnesses was a State senator from Massachusetts, who has 
been a State senator for 2 years. He was not in the senate when 
Governor Romney's bill was passed. He is the CEO of Cape Air. That's a 
1,000-employee company. It's a tough business because it's the airline 
business. It's a regional airline. And he had some real-time experience 
for us.
  And I think it's important just to say a few words about what 
Massachusetts Senator Daniel Wolf said who for 6 years served on the 
Federal Reserve Board's Advisory Council of New England, who was board 
chair of one of the largest chambers of commerce in Massachusetts and 
is a trustee of the largest mutual bank in the Cape and Islands region. 
He is a small businessman of the kind we have in mind when we talk 
about small business. This is what he reported: That his premiums 
today--under the Massachusetts bill which this bill, our bill, is 
patterned after--are roughly 3 percent of his company's gross income. 
And to quote him: ``Health care reform has not stifled business.'' 
Since the passage of the Massachusetts health care reform bill, the 
very bill that is the model for our health care bill, this company has 
added 15 percent more Massachusetts-based jobs.
  He talked about premiums. Importantly, he said that just before the 
passage of the Massachusetts law, premiums were going up 15 to 20 
percent. They are down now--going up 5 percent. And he said last year 
he was able to negotiate a 5 percent decrease. My friends, part of 
this, a great part of this, has to do with the large insurance pool 
that, of course, Massachusetts citizens are in now when you see these 
reductions.
  The State spending for health care reform programs last year 
represented a 1.4 percent increase in the State budget. Two-thirds of 
their residents support the health care reform.
  It was extraordinary testimony from a businessman who had no reason 
to come forward. He's not a politician. Yes, he's in the State senate, 
but he has the credibility of being in the Senate and being a 
quintessential small businessman.
  I want to suggest to my colleagues that there's a reason why our 
colleagues do not point to the only real experience that could tell us 
something about what is going to happen with this law, and that is 
because they are not driven by data, but by some ideology that is not 
understandable. But once you get it in your head that if you're against 
the bill even when it's passed, you've got to do all you can to kill 
it--If it's health care reform, you kill health care reform. If it's 
financial reform, even after the worst recession since the Great 
Depression, then you try to kill that.
  I think that in hearing what has happened in Massachusetts that you 
would think Mitt Romney would be shouting from the hilltops about it. 
When you see what's happened in Massachusetts, what the Republicans, 
what we ourselves should be doing is studying in depth the experience 
of Massachusetts, seeing what their mistakes were, looking at their 
successes, instead of throwing horribles out there based on no data and 
based on nothing.

                              {time}  1640

  I thank you for coming forward to start a discussion that helps give 
the American people some broader sense of what this struggle is about 
and helps them to understand that when they hear the word ``repeal,'' 
it is not what it means. In order to repeal, you have to get both 
Houses and the signature of the President.
  People should be alerted that this law is here to stay. It is almost 
impossible--it will be almost impossible, unless there is a Herculean 
change in the House, the Senate, and the Presidency, to change the 
Congress in the direction of those who oppose the law. Absent that, 
every Member of this House who believes in law and order, who believes 
in the rule of law, has an obligation to sit down together to make this 
law work and not try to undermine it. To the extent that you undermine 
it, you are now undermining the health care of the citizens of the 
United States of America.
  Mr. TONKO. Thank you, Representative Holmes Norton.
  You know, you talk about the struggle and the move to repeal. It 
obviously didn't place consumers first and foremost in that thought 
process. It was probably listening to those deep pockets of interest 
that did not want

[[Page 11081]]

to be pulled to the table to provide better outcomes for our consumers.
  Look at the benefits of the health care law for our seniors: 5.1 
million seniors receiving savings on their prescription drugs. 
Actually, I've seen this number as high as 5.3 million, and probably 
climbing in the short order of time. What an important, significant 
savings. I hear it all the time from seniors in my district who are 
always reaching into their pockets after that doughnut hole is hit, and 
they get the benefit for a while until they hit a certain threshold. As 
we all know, many, in a short order of months, are digging into their 
own pockets. These are medications that are required to stay well, and 
in many cases to stay alive.
  There are 32.5 million seniors receiving free preventative services--
health care screenings, the annual checkup, flu shots--items that are 
brought to their benefit in order to, again, underscore the value added 
of wellness. Strengthening consumer protections for seniors in the part 
D program, something I heard a lot of favorable review about, and 85 
percent of Medicare Advantage plan revenues going toward senior medical 
care rather than profits for the insurance industry.
  So these are big changes. These are changes that were welcomed by the 
senior community. I can tell you, if you close that doughnut hole by 
the year 2020, as the Affordable Care Act is to do, you're providing a 
major benefit for seniors, with the advancement of pharmaceuticals that 
speak to all sorts of illnesses. This is a wonderful opportunity for 
them to understand the attachment that is essential.
  I heard of far too many people adjusting their dosages of medications 
to balance their family's budgets. That is not the best outcome for 
health care. This advances sound decisionmaking, efficiencies, the best 
use, the wisest use of resources and, again, speaking to the dignity 
factor of our country's senior citizens.
  Representative Marcy Kaptur from Ohio, a great Representative, a 
strong voice for consumers in this House, thank you for joining 
Representative Garamendi and me. It's great to have you here. I know 
that you're hearing a lot in the State of Ohio.
  Ms. KAPTUR. I want to thank you, Congressman Tonko, for your 
leadership on so many issues that relate to the well-being of the 
American people and our economy.
  Health care is one-sixth of the leg of the stool that holds up the 
Republic. It is a major industry. When you look at all of our medical 
hospitals, all of our schools, the nursing profession, dentistry, and 
you take it all together, it is a massive employer across our country.
  Congressman Garamendi, coming from California, your experience is so 
vast in terms of your leadership at the State level there, and now here 
as a Member of Congress. So I'm very proud to stand with colleagues 
from New York and California, coastal powerhouses, from the State of 
Ohio right in the middle of the country there.
  I wanted to add to your discussions this evening some real-life 
stories that illustrate what you've been talking about tonight. Here's 
a story from Toledo, Ohio, a real story of a couple that was forced to 
drop their health coverage after the wife got sick and their health 
insurance premiums jumped from $800 a month in 2007 to $1,200 a month 
in 2008. How many families across our country, when somebody gets sick, 
the premium goes up? This bill is wonderful because it doesn't allow 
that to happen.
  For this family, the cost in 2009 would have risen to $1,600 a month, 
with a $2,500 deductible. So what did the couple do? They dropped their 
insurance. They couldn't afford the insurance, even though the wife was 
sick. But because of the law that we passed, the wife received coverage 
through a high-risk insurance pool that was set up within our State 
following the passage of the law. They're paying $400 a month--less 
than they paid before, half of what they paid before--and they have a 
$1,500 deductible. Literally, the new insurance coverage saves them 
$15,000 a year, which for them was unaffordable. That's why they 
dropped their insurance. But just that family alone tells us how 
important this act is. And think of how many cases across this country 
have similarities to theirs.
  From Marblehead, Ohio, which is very central to the district that I'm 
privileged to represent, a small business owner, a woman, was diagnosed 
with lupus. She was turned down by multiple insurance companies because 
she had a preexisting condition. But because of this act and the high-
risk insurance pool in Ohio, she was able to obtain a plan for $315 a 
month, with a $2,500 deductible--that was her choice. But she has 
obtained insurance, even though she has a preexisting condition. How 
many Americans have you said have preexisting conditions? This allows 
them to continue to pay, not be canceled. So they're contributing to 
the pool, the insurance pool; and they're able to take care of 
themselves.
  Finally, the third example I wish to place on the table is a senior 
citizen couple that faced a $3,000 to $4,000 bill, an extra 
prescription drug cost, after the husband developed a staph infection. 
How many families do we know have relatives that develop staph 
infections? That required them to spend a lot more money in 2009 and 
2010 on prescription drugs. Thankfully, the husband's health has 
improved, and they've saved money thanks to the doughnut hole 
provisions you talked about that took effect in 2010. So they didn't 
have to pay that extra money for the prescription drugs necessary that 
you have to take when you get an infection. You have to take those for 
a very long time, and they're very expensive. The wife said of their 
situation:

       For seniors like Paul and me living on limited income 
     through Social Security, these costs were not a joke. Because 
     of the Affordable Care Act, no senior will ever have to go 
     through what Paul and I spent that year doing.

  By the end of this decade, that doughnut hole will be completely 
closed at the rate of $500 a year; $500 a year to a senior citizen is a 
mountain of money--$50 is a lot of money because they're on limited 
incomes. Most people depend on Social Security to hold their lives 
together. So to get bills of $500 or $5,000, it's an impossibility.
  I challenge every American who's listening to my words tonight and 
every young person who has a conscience, go to the supermarket and look 
for some of the people who are staring at the vegetables, or 
raspberries, or fish, and they can't afford to buy it. Maybe you could 
slip them a couple bucks in the supermarket--nobody would even know 
about it. I've done that so many times. And they can buy something they 
want that they can't afford to buy.
  So when you're a senior citizen, limited income is a real fact of 
everyday life. So for all of the millions and millions of Americans, 
Congressman Tonko, that you talked about, this is being lived life by 
life, family by family in the State of Ohio.
  I'm very pleased to join both of you and to thank the President of 
the United States for having the guts to stick with his convictions, 
and our Speaker then, Nancy Pelosi, for fighting so hard for every vote 
in this House and really helping to lift all of America to a different 
plane for the future.
  The last thing I will say is, I come from a small business family. 
Our father was one of those people that had to sell his business 
because he got sick. He had to get health insurance for his family, so 
he went to work for an automotive company.

                              {time}  1650

  And I remember how ill he became, and what a horrible choice that was 
for him back then.
  Half the uninsured in this country are small businesses. The law says 
if you have 50 or under, you don't have to provide insurance; but if 
you're interested, those exchanges will be there for you. And there 
will also be plans that your employees can buy into if they want to.
  Wow, do I wish that had existed in the 1950s when we were growing up 
as young children and our dad could have had that plan so he wouldn't 
have had to sell his business. What a difference that would have made 
in our family.

[[Page 11082]]

  And that story is repeated by the tens of millions across this 
country. Half of those who could potentially benefit are small business 
owners and their workers.
  Thank you for doing this Special Order tonight as we speak on behalf 
of the American people.
  Mr. TONKO. Thank you, Representative Kaptur. Please feel free to 
share more information with us. The anecdotal evidence that you provide 
from your region alone speaks to the empowerment that is part of this 
transition, this progressive policy.
  And to now attempt to repeal, just as you've given people the sense 
of hope that there will be a doable outcome, that they won't have to 
cut medication in half so that they could have enough money to do all 
the other items that are required of them, to pay utility bills, or to 
afford to eat for that given month--the fact that they would cut their 
medication in half is not a sound thing. They're spending money, and 
it's probably ineffective.
  And so tethering people to a system that is sound and secure. You 
know, when people say, well, I don't want to pay for someone's 
insurance, I don't want to pay for this health care program. You're 
paying today through premiums and through taxes. You're paying for the 
worst sort of outcome by putting people into emergency rooms and having 
them visit with a different doctor each time they visit and not having 
the stability and the standardized outcome that is predictable and 
effective and efficient.
  These are the dynamics that are driven by the soundness of a policy 
like this, that, yes, will take investment, but will get far greater 
bang for the buck than what we're getting today with a haphazard sort 
of response that does not provide continuity or direction or 
standardization or predictability and certainty. We will be far better 
off and a much more compassionate response is rendered.
  From a taxpayer perspective, from a consumer perspective, it's a far 
greater, stronger, more intelligent outcome; and it speaks to, I think, 
the core fabric of this wonderful country that we do truly care. And 
this is a way to show it and still be economically sounder in our 
attempts.
  Thank you for sharing the anecdotal evidence.
  Representative Garamendi, you and I have done a number of these 
Special Orders on this House floor, and I find it fascinating to see 
what the response is out there from the public, who always call to 
engage and get more information. And so the fact that we can provide 
more information on what is included in the Affordable Care Act, I 
think, is a good opportunity here.
  And I know you always have a lot to say and a lot to share, and your 
walk in your professional life as insurance commissioner was an 
important bit of strength for all of us in the caucus.
  Mr. GARAMENDI. Our colleague, Marcy Kaptur, reminded me of a personal 
story, personal things.
  My sister-in-law was a juvenile diabetic, and I think of what would 
her circumstances be if she had had this law when she was alive. The 
last 20 years of her life were a struggle. The company she worked for 
folded, and her health insurance was lost. And she spent the last 20 
years of her life struggling financially, medically, and really unable 
to get the kind of continuity of care necessary. She got a lot of help 
from her family; but even so, it was a struggle.
  Under the law today, she would have been able to get insurance. And 
in 2014, in California, or actually next year in California, there will 
be an exchange. So even though she spent those last 20 years as an 
independent contractor, selling various things over those years, she 
could enter into a large pool, that is the exchange, where she would 
have the same opportunity to buy a low-cost policy as though she were 
in Ford Motor Company with hundreds of thousands of employees.
  Our Republican colleagues would abolish the exchanges. And I just 
think about what could have been. There was no exchange, and she wasn't 
able to get that insurance; but had she lived, and had other men and 
women with diabetes or serious heart issues or other kinds of problems, 
medical problems, they could get insurance in the exchange and be part 
of a large pool.
  Simultaneously, if they didn't have the income, they would be able to 
get a subsidy. If their income was less than the poverty level, that 
insurance would be free through the Medicaid program. And if they were 
above the poverty level, it would be subsidized so that it would be 
affordable.
  I guess this is really about compassion. This is about our very moral 
sense of who we are as Americans, do we have compassion, and do we care 
for our fellow citizens.
  On today's floor I heard the most astounding arguments, arguments 
based upon falsehoods, just flat out falsehoods. I heard the Speaker 
here say that the Affordable Care Act cost employment. But since the 
Affordable Care Act has been in place for the last 2 years, private 
sector employment has grown every single month.
  Now, there may have been some company that decided not to employ 
somebody, or maybe they went out of business for any number of reasons. 
But private sector employment has grown every single month for the last 
28 months. So, taken as a whole, the Affordable Health Care Act didn't 
retard employment. It didn't cause the number of private sector 
employees to decline. In fact, they've grown.
  And I also heard the very same person, with the very same argument, 
say that it's driven up health care costs. Well, excuse me, take a look 
at the statistics, the health care statistics. We've actually seen, in 
the last 2 years, since the Affordable Health Care Act went into 
effect, a significant decline in the rate of inflation for health care. 
In fact, the rate of inflation for health care in the last 2 years, 
2010 and 2011, was the lowest rate of growth in every year except one 
in the last 50 years. It was 3.9 percent.
  Those are not my statistics. They're not pulled out of the air. Those 
are government statistics about health care inflation--3.9 percent, 
which was the lowest rate of inflation in general health care in the 
last 50 years, except only one other year.
  How about the cost of premiums?
  Before I get there, the average health care spending in 2000 to 2009 
was 6.8 percent per year. That's the annual growth, 6.8 percent per 
year. In 2010 and 2011, as I just said, it was 3.9 percent, nearly 50 
percent less.
  Let's get our facts right. Put aside the rhetoric and deal with the 
facts. If you're going to come down here, as Speaker or anybody else, 
use facts in your argument. Don't just throw out a number.
  Mr. Speaker, if you'd like to debate it on the floor with me, come on 
down.
  Seniors paying more? No, I don't believe so. No, they don't pay more. 
Medicare Advantage enrollees, the cost of premiums for Medicare 
Advantage was 16 percent less in 2012 than in 2010. The Affordable 
Health Care Act, was it responsible for that? Partly, yes, because the 
Affordable Health Care Act took $150 billion, $15 billion a year, away 
from the insurance companies and plowed it back into Medicare benefits.
  The drug benefit that you were talking about--free medical services, 
preventative services.

                              {time}  1700

  The result was a 16 percent reduction--an overall average--across the 
United States for Medicare Advantage. Oh, by the way, these are 
statistics from Mercer, one of the health care consulting companies. I 
think I'll let it go at that. There are more statistics about that.
  Mr. Speaker and my colleagues on the Republican side, if you want to 
come down and debate the issue of health care inflation, then you'd 
better come down here with real facts. Don't come down here with a lot 
of just talk. Health care inflation has gone down since the Affordable 
Care Act has been put in place.
  Mr. Tonko, why don't you pick it up from here. Maybe I'll have a 
challenge on the floor from the Speaker. We'll see.
  Mr. TONKO. The gentleman from California speaks of the Medicare 
Advantage programs. Obviously, they

[[Page 11083]]

came about because there were those who suggested they could do it 
cheaper. Give us a special model out there and launch it as a pilot, 
and we'll show you how we can do this special programming and give us a 
return.
  After reviewing now what is the history of all of that, it was deemed 
that there were overpayments of anywhere from 10 to 14 percent. So the 
dollars were slid over to programs like filling the doughnut hole and 
providing for screenings for our seniors, not taking it away from a 
category of health care consumers--in this case, an age demographic of 
seniors--but taking those savings, as we sweep those savings, and then 
reinvesting them in a way that provides balance and more sensitivity 
for the consumer rather than having record profits developed for an 
industry. To me, that was progressive policy. And for people to then 
take those savings and use them in their own budget presentations for 
other purposes was disingenuous.
  Now, when you talk about the efforts today of the Affordable Care Act 
to include an exchange, what I think is oftentimes lost, Representative 
Garamendi, is people see this as some sort of public exchange that is 
going to be run by the government. In fact, when we set up an exchange 
and when private sector sources come to the table, if they're willing 
to abide by the rules, if they're going to govern themselves by the 
parameters that have been established in the legislation, they can then 
offer services through the exchange. So it's a private sector solution 
but with new caveats of parameters that are established so as to 
provide benefit for the consumer.
  When you think of it, if there are firms that hire 10 people and one 
of those 10 becomes catastrophically ill, the actuarial impact of that 
one individual circumstance can drive premiums up for that small 
business in very high order. That kind of impact is unacceptable for 
the small business community that today pays some 18 percent more for 
its insurance and oftentimes gets weaker coverage.
  With the benefits of an exchange that is private sector-driven, you 
now have the opportunities that people can have that actuarial 
measurement made in a pool of perhaps millions so that the unsteady and 
unpredictable kind of outcome for small business is now rendered more 
efficient and more sensitive by shaving the peaks that may occur in a 
universe as small as 10 people.
  So there is a science to this. There is thoughtfulness that has been 
pumped into the discussion; and by inserting that thoughtfulness, we 
have come up with reforms that really speak to a wiser use of this 
country's health care dollars. It was a folding in of progress over the 
course of several years that was initiated with its passage a couple of 
years ago that needed time to work. To then move to repeal before a 
number of these programs are even implemented and for people to just 
play politics with the lives of individuals, with the health care 
quality of individuals, is regrettable, and then for us to be asked to 
visit for the 31st time a repeal exercise in some 19 consecutive 
months.
  We used this week of session in Congress to debate for hours, to 
message for hours, to come to the floor for votes. These were session 
days that were used up for the repeat of an exercise that time and time 
and time again has been conducted just to politically posture when, in 
fact, the American public is saying, Look, you voted on this. Look, the 
President signed it into law. Look, the Supreme Court--the highest law 
in the land, the conservative-leaning Court--has ruled 
constitutionality.
  They want us to move forward with job creation, with responding to 
the cures this economy needs. We started with a terrible pit of a 
recession: 8.2 million jobs lost and 800,000 jobs being lost per month 
as this administration started and, ironically, when I started my 
service in the House of Representatives. We were in a dark, deep hole. 
To come out of that with 29 consecutive months of private sector job 
growth and to come out of that with over 4 million jobs created in the 
private sector and to go forward with an effort to reform our health 
care system in a way that extends greater opportunity and beacons of 
hope to families, individuals, those who are catastrophically ill, 
those denied because of preexisting conditions, pharmaceuticals 
unaffordable for many seniors, to have all that turned around and to 
have all of this progress of the comeback trail from the recessionary 
period that was far too long and far too deep and far too painful than 
anyone ever forecasted--to strike that kind of progress and then have 
it met with 31 consecutive efforts to repeal the situation is 
regrettable. It's regrettable.
  Representative Garamendi, you've been here for those 31 efforts. Has 
anything changed? It's the same old, same old that is being expressed 
out there that does not, I think, meet the concerns of individuals out 
there from coast to coast.
  Mr. GARAMENDI. You are absolutely correct. We really need to get to 
jobs.
  I notice some of our Republican colleagues are here. They'll be 
taking the next hour, and I suspect they are going to pick up something 
that was said over and over again over the last 2 days. I just want to 
put on the table some facts, some facts about what is really going on 
here.
  I heard speakers come to the floor, including the Speaker of the 
House, saying the Affordable Care Act was the largest middle class tax 
increase ever. Well, I'm sorry. The Washington Post Fact Checker said 
the health care law will provide more tax relief than tax burden for 
middle class families. A report from the nonpartisan Congressional 
Budget Office shows that an estimated 4 million individuals will likely 
pay the penalty because they're not going to buy insurance. Okay? 
That's about 1.2 percent of the total population.
  They also estimated that 16 million Americans--that's four times 
more--will receive tax credits, or subsidies, to help them pay for 
insurance coverage through the new exchanges. Now, that's 5 percent of 
the population. The CBO estimates that the government will provide $630 
billion in tax credits and subsidies for insurance over the next 11 
years and only $54 billion in penalties--taxes or tax increases--on the 
middle class.
  So the fact of the matter is the middle class is going to get an 
enormous tax benefit as a result of this. Those who buy insurance are 
actually going to see their taxes reduced as they buy insurance. 
They'll have health care coverage at an affordable cost, their taxes 
will go down, they'll receive subsidies. The essential point here is 
that it is not a tax increase, the overwhelming, largest-ever on the 
middle class. In fact, it is a huge tax reduction.
  Secondarily, there is a decreased cost to every American who buys 
health insurance today because there will not be a shift of cost from 
the uninsured to the insured and to the taxpayer. That's precisely what 
happens when you have some 40 million Americans uninsured. They get 
sick. Fortunately, in this Nation, we have not yet come to the point 
when we do not provide health care to people who are sick and in need 
of care. They get it at the emergency room, and they get it at the 
community clinics.

                              {time}  1710

  It becomes what is known as uncompensated care. In other words, it is 
not paid for directly by the individual, but indirectly by every single 
American that buys a health insurance policy and every company that 
buys a health insurance policy and the American taxpayers.
  The Affordable Health Care Act does not increase the cost of health 
care in America. In fact, it has the significant potential of 
decreasing the cost. In the last 2 years, we've seen the health care 
costs in America decline to the lowest inflation rate ever in the last 
50 years except 1 year.
  Let's get the facts correct, my colleagues. If we're going to talk 
about tax increases, get the facts correct. Talk about the tax 
reductions at the same time. Talk about the fact that the Affordable 
Health Care Act, in effect, has actually been part of an overall 
reduction in the inflation rate of health care.

[[Page 11084]]

  And in the Affordable Health Care Act, there are very significant, 
long-lasting, and powerful reforms that will bend the cost curve of 
health care, such as electronic medical records. The repeal would wipe 
that out. It would be gone.
  Primary care clinics across this Nation are funded through the 
Affordable Health Care Act. Where do you think people get care today? 
In those clinics. If they don't get care there, they're going to the 
emergency room at 5 or 10 times the cost.
  There are vaccinations for our children, which, incidentally, in the 
appropriations bill, our Republican friends tried to eliminate many of 
these vaccinations. Fortunately, it didn't happen.
  There is preventive care for seniors so that their blood pressure and 
diabetes is controlled. Today, our Republican colleagues voted to wipe 
out preventive care not only for seniors, but beginning this August, a 
month from now, every woman in America will be able to get preventive 
screening. Mammograms, pap smears, blood pressure testing. That's 
what's being lost here, all in the name of some political opportunistic 
effort to try to run out once again what you thought was successful in 
the last election period.
  Well, the American public isn't going to be fooled twice. The 
American public will come to know that in the Affordable Health Care 
Act there is real benefit for Americans.
  Mr. Tonko, thank you for bringing us to this floor. Thank you for 
bringing us the opportunity to talk about what is real.
  Mr. TONKO. Representative Garamendi, I couldn't agree more with the 
need to exchange statistics here, the real stats on what is happening. 
We only have a short history, but already it's a powerful statement.
  When you look at healthy pregnancies, that front-end life investment 
which this embraces, what a soundness to the rationale for progressive 
policy.
  When you think of the dignity factor for those senior years so that 
people aren't chopping a pill in half so as to meet their family budget 
and take care of half of their medical needs, this is an exercise of 
foolishness to repeal at a time when we've just started the engine of 
recovery and transformation and transition and reform.
  We also know that--and I hear it from my constituents all the time--
repeal. What's the replacement? There is no hint of a replacement 
because you took it halfway and said, We're just going to repeal this. 
That's the political posturing that is so painful, because you have now 
delivered to society a new opportunity to better steward our resources, 
to better provide for the dignity in the equation so that people can 
have that comfort zone, knowing that if they get impacted by some sort 
of catastrophic illness--and we've seen it in our communities, in our 
neighborhoods, in our families where peoples' lives are turned around 
in an instant. To those who you suggested might not buy the insurance, 
who then bears the burden if there is a catastrophic outcome?
  They're saying, Oh, you're asking them to pay a tax if they don't 
want insurance.
  If they don't have insurance and they get a catastrophic illness, 
they fall into some sort of huge accident, who's going to pay? You're 
right, Representative Garamendi, there are those that get in charity 
situations where premiums cover it, taxpayers cover it.
  This has been thought out in a very meaningful way. We talk about a 
global competitiveness. We talk about our industries going to the 
marketplace, international marketplace, wind contracts, produce in 
America, and grow jobs. Part of the price that they have to calculate 
is the cost of health care. If we're providing a benefit to our 
business community, if we're having a smarter approach taken to the 
health care dollars being utilized in best fashion, there's a 
corresponding benefit that befalls the economic recovery opportunities 
because our businesses will be able to have the benefit of the 
soundness of that universal health care system to more effectively 
compete in the international marketplace, to secure those contracts 
that then translate into jobs.
  There is an interconnectedness here that goes well beyond health care 
policy. It falls into the realm of economic recovery and business 
creation and all sorts of quality-of-life issues that market our 
neighborhoods, our States, and our Nation for jobs.
  We know what's happening in other Nations. They have taken the bull 
by the horns, and they have put together a good, sound system, and we 
were comfortable to have status quo be our rule, our guiding light. It 
was the boldness of those leaders that came forward and said: There is 
a better way to use those dollars out there. There are better ways to 
reach people. There is a need for preventive and wellness programs, for 
screenings and for those annual checkups, making certain that 
pharmaceutical needs are something that are within the grasp of our 
senior community and our middle-income community and our middle-aged 
community.
  To cite scenarios like that of your staffer and his child, to provide 
that hope in the middle of despair where people have abandoned the hope 
for a better tomorrow for their children because of lack of 
affordability, to cover those health care situations, that's what this 
is about.
  This is the old American spirit coming forward. It's about speaking 
as a community, not as individuals disconnected from one another. It's 
about thinking as a society, of a greatness of America at her best: 
compassionate, resolved to make a difference, determined to use our 
resources in a way that is most effective, most efficient, most smart. 
It is America at a great, shining moment. And to denounce all of that 
progress and to move for repeal speaks volumes about greed and about 
injustice and the desire to turn progress around.
  Representative Garamendi, we close in the next minute or two. Any 
closing thoughts from you? I thank you for joining us this evening.
  Mr. GARAMENDI. I thank you, and I suspect we're going to hear once 
again this is a government takeover. That's not true. It's not true at 
all. This is built upon the private delivery system that we presently 
have. Talk about the government designing or taking over the policy is 
just not true. I know this. I was the insurance commissioner. I know 
that it is actually the insurance companies heretofore before this bill 
that actually did that.
  Mr. Tonko, thank you so very much for your leadership on this and 
your passion for it. We are out of time.
  This issue is not going to go away. This issue will be around. I 
would hope, as it is discussed in the months ahead, that we actually 
get down past the rhetoric and talk about the real facts of what is in 
the Affordable Health Care Act. It's an extraordinary improvement for 
America's health care.
  Thank you very much, Mr. Tonko.
  Mr. TONKO. Thank you.
  Mr. Speaker, I yield back the balance of my time.

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