[Congressional Record (Bound Edition), Volume 160 (2014), Part 2]
[House]
[Pages 2437-2440]
[From the U.S. Government Publishing Office, www.gpo.gov]




            THE GOP DOCTORS CAUCUS: THE AFFORDABLE CARE ACT

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2013, the gentleman from Georgia (Mr. Gingrey) is recognized 
for 60 minutes as the designee of the majority leader.
  Mr. GINGREY of Georgia. Mr. Speaker, here we are now in February 
2014, and the second session of the 113th Congress has begun. The 
administration still has to deal with daily headlines speaking of the 
disaster of--you guessed it--the Affordable Care Act. I have to 
sometimes refer to that as the ``Unaffordable Care Act.''
  Today, the news came from the nonpartisan CBO, the Congressional 
Budget Office. My colleagues are all familiar with that. Their report 
states that the administration's rosy projections are a mere fairy 
tale. If you take a dive into these numbers from the CBO, Mr. Speaker, 
you will see last year's goals amended lower as the low participation 
and atrocious rollout of the exchanges have finally caught up with 
those estimates.
  Let me just give you, colleagues, a few highlights:
  The CBO lowered the estimate of exchange enrollees to 6 million. That 
is 1 million less than they estimated at this time last year. Now, this 
isn't all that surprising given the problems with the Web site--
healthcare.gov--and the rest of the implementation of ObamaCare, but it 
definitely reinforces the notion that this plan is not working.
  The CBO estimates that 31 million Americans will still be uninsured 
in 2024. Colleagues, when this bill was being discussed in Energy and 
Commerce way back in 2009--in 2008 even--the Democratic majority at the 
time said there were 45 million people who were uninsured. That number 
really shrunk down considerably when you realized that there were a 
number of people who were eligible for Medicaid who just didn't know 
it. It could have been as many as 10 or 11 or 12 million. Obviously, 
there are a lot of people in this country illegally uninsured but who 
are not eligible. Then there were the people making $75,000 a year in 
their households who could afford health insurance but who just chose, 
because of the Constitution--their personal liberty--to pay as they 
went. It is not something I recommend. The CBO estimates now that in 
2024--10 years later--after its passage and full implementation on 
October 1 of this year, 2014, that there will still be 31 million 
Americans uninsured. What have we really solved here? It doesn't sound 
like we have really helped very much.
  Now, this bill was sold to the American people as the solution to 
eliminating the uninsured. Instead, the bill only, really, adds cost in 
the form of very expensive mandates to everyone who already had 
insurance. A lot of them now are just saying, Heck, I will be one of 
these who will go bare. I will, maybe, set up my own savings account

[[Page 2438]]

for health care, and will put $100 a month--or whatever--in a checking 
account and get a physical when I need it annually or biannually, and I 
will pay my own way--that has happened--and pay the little fine of $95.
  So that is what is happening, and it is quite a legacy for the 
President's signature piece of legislation. I don't think it is the 
legacy that he anticipated, and it is certainly not the one that he 
wants today.
  Finally, there is the headline from the newspaper, The Hill. Most of 
us read that, don't we, colleagues? We read all of these newspapers if 
we don't run out of time. In The Hill today, here is its headline: 
``CBO: O-Care Slowing Growth, Contributing to Job Losses''--with ``O'' 
standing for ``ObamaCare.''
  The CBO projects that the law will reduce labor force compensation by 
1 percent from 2017 to 2024, twice the reduction it previously had 
projected. This will decrease the number of full-time equivalent jobs 
by 2.3 million in 2021, and this is up from the previous estimate of 
800,000. There is a big difference, my colleagues, between 2.3 million 
and 800,000. This is remarkable. Through a combination of higher health 
care costs, resulting in lower compensation and perverse incentives for 
folks to not work as much in order to preserve their subsidies, it is 
truly not the American Dream.
  The administration, Mr. Speaker, continues to push for more money for 
jobs programs, yet, at the same time, it continues to fight for a bill 
that has yet to work and will lead to rewarding people for working 
less. What were these jobs programs? Just get rid of--what can I call 
it?--the worst bill, maybe, that has ever been passed in the history of 
this body, of this Congress. The Affordable Care Act has given us 
higher costs, not lower. It has performed much worse than was promised, 
and it will incent our citizens to work less. That is not what we want. 
That is really not what they want.
  Mr. Speaker, it is time for the administration to give in to reality 
and to let us repeal this bill. I don't think it is the first choice to 
just sit back and see it collapse under its own weight. You hear that 
expression a lot. I think that very well could happen, but let's take, 
maybe, a more responsible approach.
  Mr. Speaker, I would say this to the President:
  Mr. President, let's take a more responsible approach, and you work 
with the Congress--with Republicans and Democrats, with the House and 
the Senate. You get more engaged than you have ever been before, and 
work with us. Let's repeal it, and let's start over with something that 
truly does work, because we all agree that we have the greatest health 
care on the face of this Earth. Why is it that people pay thousands of 
dollars to get on a jet plane to fly from other countries to go to the 
Mayo Clinic or to Sloan-Kettering or to the WellStar Health System in 
my district, the 11th of Georgia, to get their health care, to get 
their surgery, to get their treatment for cancer? You don't see people 
from this country going in the opposite direction, because they get 
that good care here. So, Mr. President, we can work together. We can. 
The American people want us to. They don't want one side jamming the 
other. They do want us to work together.
  I want to take some time during this Special Order hour that our 
Republican leadership has afforded us. I hope some of my colleagues 
from the House GOP Doctors Caucus will be joining me momentarily, and I 
will yield to them as this is the opportunity for us to explain to our 
colleagues on both sides of the aisle what needs to be done and how we 
can work together and clearly get this done and get it done in a timely 
fashion, if not this year, certainly in the 114th Congress.
  This Doctors Caucus that I mentioned, Mr. Speaker, is something that 
I put together a number of years ago, and we are now up to about 22 
members. I say ``doctors.'' There are a lot of categories of doctors, 
but I am talking about doctors who work specifically in the health care 
space, which is one-sixth of the economy of this country. These doctors 
can be medical doctors. They can be dentists. They can be 
psychologists. They can be advanced practice nurses. Indeed, even 
hospital administrators are part of this group because they know. They 
understand that in our caucus we have, probably, 600 years of 
accumulated clinical experience. That means there is a little gray 
around the sideburns on a few of us.
  This knowledge--this expertise--our leadership on the Republican side 
recognizes that. Our committee chairs on Energy and Commerce and on 
Ways and Means and Education and the Workforce--every one of those 
committees that has any jurisdiction over health care--understand that, 
and they look to us. They look to us for expertise and guidance and 
explanations just as we who have worked in the health care sector 
before we got elected to the Congress look to educators, look to 
accountants, look to attorneys in their previous lives to help us on 
issues that we are not so up to date on or on which we don't have that 
level of expertise. That is the way it should be, and that is the way 
it should be, in my opinion, on both sides of the aisle.

                              {time}  1630

  So we Doctors Caucus meet, if not weekly, at least every 2 weeks. We 
talk about issues. We have been talking about this Affordable Care Act 
for the last 3 years and going through it section by section and trying 
to have a thorough understanding. We bring understanding to the table, 
but everybody can learn something that they didn't know in a 2,700-page 
bill. That is the due diligence that we have done over these last 
several years.
  When we read in the media or we hear from the Democratic side of the 
aisle, or either in the House of Representatives or from the Majority 
Leader Harry Reid and the Democratic majority in the Senate, saying, 
well--or even, Mr. Speaker, the President of the United States. How 
many times have we heard him say: If you have an idea, if you have a 
better plan, bring it to me, bring it to me; I am all ears; I want to 
listen? And we have done that.
  I value the opportunity to be here today to explain some of the 
things that have been done and that they have really come through the 
House GOP Doctors Caucus. One of our members is my colleague from 
Georgia, an orthopaedic surgeon, Dr. Tom Price. Dr. Tom Price and I 
served in the Georgia Senate. We are medical colleagues: he, an 
orthopaedic surgeon; I, an obstetrician. Now we have been in the 
Congress together for 10 years. And so he is a very active member of 
this House GOP Doctors Caucus, and he has a bill.
  To just set the record straight, colleagues, let me tell you about 
Dr. Tom Price's bill, H.R. 2300, Empowering Patients First Act. Well, 
that bill is not 2,700 pages, but it is a comprehensive bill. A lot of 
the sections in that bill are individual ideas that have come from the 
Doctors Caucus. I am proud that he has included a number of my 
suggestions in regard to medical liability reform and other things. And 
so, it is a compendium of ideas.
  It is a very good bill, a very good alternative. It is market driven. 
It does not interfere with the doctor-patient relationship, that 
sanctity, and it is a sanctity. Dr. Price understands that, and every 
member of the House GOP Doctors Caucus understands that. This bill, 
believe me, has the opportunity to get traction and, when it is brought 
to this House floor, to pass this Chamber.
  Now, at the same time, we just heard, Mr. Speaker, in recent days 
that the Senate has drafted a bill. It doesn't have a number yet, but 
Dr. Tom Coburn, the OB/GYN family practitioner from Muskogee, Oklahoma, 
whom I have worked very closely with, the Doctors Caucus has worked 
very closely with, and Dr. Barrasso and Dr. John Boozman. So, the 
Senate Republican doctors and the House Republican Doctors Caucus have 
worked together.
  Dr. Coburn, along with Senator Burr from North Carolina and Senator 
Orrin Hatch, one of the most senior and thoughtful and brilliant 
Members of the Senate from the State of Utah, they have this bill. They 
call it the Patient Choice, Affordability, Responsibility, and 
Empowerment Act, the acronym, Patient CARE Act from the Senate.

[[Page 2439]]

  So, we are right there, Mr. President. With all due respect, we have 
ideas. We have Dr. Price's bill. We have Dr. Coburn's bill. We have 
other members of the Doctors Caucus. And the Doctors Caucus in the 
Senate is smaller, but we are here to help. We want to help. We truly 
want to bring down the cost of health care and maintain that quality 
that we are so proud of. It can be done. It can, indeed, be done.
  Let me talk a little bit about the economy in regard to current law, 
PPACA, ObamaCare, Patient Protection and Affordable Care Act. ObamaCare 
has forced employers to cut hours, and as a result, part-time 
employment has gone through the roof. It has already forced many 
businesses to choose between, on the one hand, hiring new workers or 
providing health coverage. Mr. Speaker, they just can't do both.
  President Obama always says health costs are rising at the lowest 
rates ever. Well, that is not because of his bill. That is because the 
economy is dragging. His bill has not helped the health care industry. 
The costs are lower because people are not seeking care; they don't 
have the money. And so, yeah, sure, the overall costs of health care 
are going down, but that is not a good thing. That is a bad thing.
  The Obama administration delayed the job-killing employer mandate for 
a full year so that doesn't go into effect, colleagues, until January 1 
of 2015, 11 months from now. It has left the rest of Americans on the 
hook for this massive tax hike. The bill adds costs to running a 
business, massive tax increases, and of course, as I said at the 
outset, higher monthly premiums.
  You know, one of the promises the President made, among many that he 
failed to keep, was that the average cost, of a health insurance 
premiums would be $2,500 a year lower than pre-ObamaCare.
  Just the opposite has happened. And I don't think he ever said 
anything about what the deductible would be, Mr. Speaker. But in some 
of these policies, an individual deductible might go from $1,000 a year 
to $3,000 a year, and a family deductible from $3,000 a year to $8,000 
a year. That is a 200 percent increase, a doubling of the monthly 
premiums. It creates just enormous uncertainty across large 
corporations, small businesses, and, of course, particularly the one-
sixth of our economy that is the health care industry.
  Think about the medical device tax and what it is doing to jobs in 
that industry. The medical device tax has already forced companies like 
Michigan-based Stryker Corporation to cut a thousand jobs. Boston 
Scientific canceled plans to build new facilities in the United States, 
instead moving these high-paying, highly technical, and innovative 
research jobs across the pond, overseas.
  Let's look for a moment at the effect on small businesses. I speak 
often, and I know all of you do, too, on both sides of the aisle, 
because we go back home and we face our constituents; we have to, and 
we should. But I speak with these small business owners in the 11th 
District of Georgia, northwest Georgia, and my four counties. I want to 
know how President Obama's health care law has affected the day-to-day 
operations of their companies.
  Well, ObamaCare has not even been fully implemented because of all 
these executive orders and the fiats that come down and the waivers 
that are granted to certain ones but not others. So ObamaCare really 
has not been fully implemented, even though the date is passed, but job 
creators and employees in Georgia and nationwide are already feeling 
the pain. Across the board, they have expressed frustration with its 
new rules and the ``moving target'' regulations, the increase in health 
care costs, and, of course, the uncertainty that they hate. This law 
has certainly created a heck of a lot of that, hasn't it, colleagues?
  ObamaCare has forced employers to cut hours; and as a result of that, 
part-time employment has gone up, as I said a few minutes ago. It has 
already forced many businesses to choose, again, do I hire that 50th 
worker or do I just say no, I am going to take two part-time workers 
instead of one full-time? Or, even worse, I am going to hire that 50th 
worker, but I am going to drop health care coverage, Mr. Speaker, for 
all of my employees. And while I get a waiver for the first 30, for the 
next 20, I am going to pay $2,000 a year per employee that will go into 
the exchange.
  One Georgia businessman who employs 47 people told me that ObamaCare 
has forced him to hire subcontractors instead of hiring new full-time 
employees. Another owner who has 49 workers recently purchased a robot 
instead of hiring new welders. That robot doesn't have to feed a family 
of four. It may be very efficient, but the robot doesn't have a heart 
and doesn't have anxiety.
  On Main Street, uncertainty and higher costs get even worse when a 
company needs to create more than 50 jobs, as I just mentioned, 
creating a barrier to job creation and the expansion of their business.
  ObamaCare forces employees to work fewer hours to stay on as part-
time workers. It is estimated that ObamaCare will require American job 
creators, families, and health care providers to spend--get this, 
colleagues--more than 127 million hours a year on compliance. The EPA 
couldn't have been more onerous than this bill, and they are pretty 
darned onerous.
  One Georgia businesswoman has been forced to hold numerous meetings 
on company time for her employees to help them understand the paperwork 
involved in trying to get health care. Besides a loss in productivity, 
these new rules are costing her. She recently hired an outside health 
care expert just to ensure she is running her company ``by the books.''
  Mitzi Smith's small plumbing company in Marietta, Georgia, is known 
for its quality and its compassion and the excellence of its workers; 
and yet they are struggling to hold on, even with a wonderful 
reputation, because of this law.
  Providing relief for taxpayers by delaying these costly mandates for 
1 year is not enough, and I will continue fighting to dismantle every 
single piece of this train wreck law. I pledge to the people of Georgia 
that that is what I am going to do. It is an accountability pledge. It 
is not a term limit pledge. It is just to say, Look, I am not up here 
to be a potted plant. You have hired me to be your voice to speak for 
you on issues like this one. There are others. But I think now, as we 
approach the elections of 2014, what is more important than putting 
people back to work and providing them assurance that they can keep 
their doctor, they can keep their hospital, they can keep the health 
care that they want, not larded up with a bunch of funded mandates, 
really, that are causing those premiums to go up that they don't need 
and they don't want?

                              {time}  1645

  It is a one-size-fits-all. And in health care, one size, colleagues, 
and you know this, one size doesn't fit all.
  I mentioned a few minutes ago about the excise tax, the 2.3 percent 
on medical devices. Let me mention a couple of companies that have been 
in touch with my office concerning this issue.
  Smith & Nephew medical company announced in February that it will lay 
off almost 100 workers in their Tennessee and Massachusetts plants.
  Cook Medical, a very familiar name, has canceled plans to open five, 
count them, five United States factories because the tax, this medical 
device tax, would cost them $20 million a year in the coming years. And 
remember, colleagues, this medical device tax is not on their profits. 
This is a tax on their revenue, so it is much more onerous than if it 
were just a tax on their profit.
  Boston Scientific, planning for a more than $100 million charge 
against earnings in 2013, has now built, get this, a $35 million 
research facility in not Boston, but in Ireland, and is building a $150 
million factory in China.
  Stryker Corporation, based in Michigan, blames the tax for 1,000 
layoffs.
  Zimmer, based in Indiana, is laying off 450 people and taking a $50 
million charge against earnings.
  Medtronic, one of my classmates from Georgia Tech was the CEO of

[[Page 2440]]

Medtronic, brilliant man, retired now, but I will never forget him. He 
was brilliant at Georgia Tech and throughout his entire career, and he 
was the CEO at a time for Medtronic. They make heart valves and many 
lifesaving medical devices. They expect an annual charge against 
earnings of $175 million.
  Covidien has cited the tax in explaining 200 layoffs and a decision 
to move some production to Costa Rica and Mexico. I have nothing 
against Costa Rica or Mexico, great countries, great people, but, you 
know, when we are looking at an unemployment rate of 6.7 percent--if 
you believe that, it is probably closer to 15 percent when you count 
all the people that have just given up. They have been unemployed for 
over a year and they are just out of it, they are not even counted 
anymore.
  So, I could go on and on and on and give you examples. I will give 
you one more.
  A Guthrie, Oklahoma, Taco Bell has cut its full-time employees' hours 
to 28 per week or less. If you had a job and you got to work 28 hours a 
week, colleagues, I don't know about y'all, but I would need three of 
those jobs to support my family and my children and help support my 
grandchildren.
  Former employee Johnna Davis said, and I quote Johnna, ``They 
informed everybody,'' the company, ``that nobody was considered full-
time any longer . . . that everybody was now considered part-time, and 
they would be cutting hours back to 28 or less due to ObamaCare.''
  Spiritwear, an Idaho-based clothes company that specializes in 
licensed college and football team colors and logo apparel is poised to 
more than double their business this year.
  Mr. Speaker, that is great news, isn't it?
  However, the company is on the cusp of having 50 full-time employees. 
She is upset that what seems to be her best solution, hiring 
independent contractors, would give her less control--and it would--
over worker hours and how much involvement they can have in other parts 
of the company.
  Darden Restaurants, parent company of such well-known and very good 
restaurants as Olive Garden and Red Lobster and Longhorn Steakhouse, 
they tested making some workers part-time last year. The chain has 
decided not to make all full-time workers part-time, but it has not 
ruled out a broader shift toward that very thing, part-time work.
  Then in January 2014, Target announced that they would no longer 
provide health care coverage for their part-time employees.
  Mr. Speaker, how much time do we have left?
  The SPEAKER pro tempore. The gentleman has 29 minutes remaining.
  Mr. GINGREY of Georgia. Mr. Speaker, we have some time left, but I 
think, colleagues, that you get the picture here. We have a real 
problem right here in River City--and by that, I mean the Nation's 
Capitol, but I also mean the entire country--and we have to do 
something about it.
  We can't just keep kicking the can down the road, as we have done 
with Medicare and Social Security, needed reforms, protections, 
strengthening to make sure that these programs are there for our 
children and our grandchildren.
  But here we have created a whole new entitlement program that really, 
when you look at it, it is punishing both our seniors and our young 
because it is forcing the young people who finally reach that 27th 
birthday, and they can no longer, now, be on their parents' health 
insurance plan. Maybe they have been living at home, post-college, and 
the parents have finally just said, Honey, you are just going to have 
to move out. We need our space. We need a little privacy.
  These young people have a job, and they want to move out with a 
friend or someone that they went to school with. They want to move on 
with their lives. They are adults now, and they have got a job, and 
they find that, to get health insurance, it is astronomical. Yet the 
salary that they make, their entry-level salary, is too much to make 
them eligible for a subsidy.
  So what are they going to do? They are going to pay that fine, that 
$95 fine, and maybe even when it gets to $600, they are going to pay 
that, and they are going to go bare. I use that as an expression of 
being not having health insurance coverage. They may be 10-foot tall 
and bulletproof. They may take care of themselves. They may not do 
skydiving and some risky sort of behavior. But you never know when that 
Mack truck is going to run you down and you are going to end up in the 
emergency room.
  So we want to make sure we get this right. So far we have gotten it 
totally wrong. But we can do better. We will do better. We need to do 
it in a bicameral, bipartisan way.
  I mentioned my colleague, Dr. Price, and his bill. I mentioned my 
other colleagues on the House GOP Doctors Caucus as we continue to work 
on things, my cochair, Dr. Phil Roe, a fellow OB/GYN from Tri-Cities, 
Tennessee, former mayor of Kingsport or Johnson City. We can do it and 
we will do it.
  But, Mr. President, you said, if you like what you have, you can keep 
it. You also said, if anybody, Member of Congress, has a better idea, 
bring it to you and you will consider it. Well, I have mentioned two 
bills here tonight. We have other ideas, and you have 2\1/2\, almost 3 
years left in your second term. You want a legacy? We are going to help 
you have a legacy, and a good one, but you have got to work with us. It 
is a two-way street.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. Members are reminded to direct their remarks 
to the Chair.

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