[Congressional Record (Bound Edition), Volume 160 (2014), Part 4]
[House]
[Pages 4891-4895]
[From the U.S. Government Publishing Office, www.gpo.gov]




                          AFFORDABLE CARE ACT

  The SPEAKER pro tempore (Mr. Massie). Under the Speaker's announced 
policy of January 3, 2013, the Chair recognizes the gentleman from 
Texas (Mr. Castro) for 30 minutes.


                             General Leave

  Mr. CASTRO of Texas. Mr. Speaker, I ask unanimous consent that all 
Members have 5 legislative days to revise and extend their remarks and 
include extraneous material on the subject of my Special Order.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. CASTRO of Texas. Mr. Speaker, today, we are here to talk about 
the Affordable Care Act, about some of its milestones and the benefits 
to the people of the United States, also about some of the critiques 
that have come up over the last few years and in the last few months.
  The Affordable Care Act has succeeded in doing a few things. The 
United States, for a long time, has been the wealthiest nation on 
Earth; however, millions and millions of Americans, despite our 
country's wealth, have been unable to get health care insurance. Many 
folks have suffered a very long time, either themselves or their family 
members, in not being able to see a doctor when they have needed to and 
in being kicked off of insurance because they have hit lifetime caps. 
College students have gone without insurance for years because they 
could no longer stay on their parents' plans.
  There was, I know, a discussion earlier on the floor--I think during 
the lunch hour--and there was a question raised by one of the 
Republican Members. Essentially, his question was: What has the 
Affordable Care Act done?

                              {time}  1800

  Well, there are several concrete things that it has done for the 
United States. The first is that 3 million students have been able to 
stay on their parents' insurance plans, where they otherwise would have 
been kicked off before. The average age where students were kicked off 
before was about 19. Under the Affordable Care Act, millions of college 
students can now stay on until the age of 26.

[[Page 4892]]

  We know this number--5 million people, so far, and growing--have 
signed up for health care through the exchanges. Five million people. 
That is very significant. That number continues to grow, as some of the 
busiest days for the health care Web site and for the call-in number 
have been over the last few weeks.
  Also, 4.4 million Americans have signed up for health care through 
Medicaid. They have been covered through Medicaid expansion.
  We can talk about the fact that some States have decided not to 
expand Medicaid. So millions of these people, including in my home 
State of Texas, low-income Americans, most of these people going to 
work every day, working hard to support themselves and their family 
members who are still low-income Americans, but because the State 
governments have not expanded Medicaid in many States, they have not 
been able to get covered. So we are going to talk about that.
  Another issue I want to talk a little bit about is something that is 
very significant for millions and millions of Americans, and that is 
mental health parity with physical health.
  For years, we tried in State legislatures--I know I tried in Texas, 
as well as people across the United States--to make sure that mental 
health issues are covered by insurance in the same way that you would 
cover a broken arm or broken leg or even cancer. Millions of Americans 
suffer from anxiety, depression, and a slew of mental health issues. 
Previously, they were unable to get covered.
  So those are some of the issues that we are going to talk about this 
evening.
  I now yield to my good friend Congressman, Gene Green from Texas.
  Mr. GENE GREEN of Texas. First of all, I thank my colleague from San 
Antonio. We are both Texans, and we know the problems. You served a lot 
of years in the State legislature. I did, too. Frankly, I think a lot 
of our problems could have been dealt with if Texas would have expanded 
Medicaid. We are actually giving back money to the Federal Government 
and not covering children and families in our community because of 
that.
  Frankly, even with the problems with the rollout of the Affordable 
Care Act, I know some States have done a great job, like Kentucky and 
California. Some States haven't. But I would think that if Texas did 
their own exchange, we could be the ones making those decisions, I 
think particularly with the Medicaid expansion.
  I appreciate you asking for the Special Order tonight because we are 
coming down up to the deadline of March 31. In fact, I have to do a 
commercial first.
  A lot of us have done these events on how people can sign up for the 
Affordable Care Act. I have one that we are sponsoring this Saturday at 
the Harris County Department of Education building. It is at 6300 
Irvington Boulevard in our district. I am partnering with some of your 
former colleagues: State Representative Armando Walle; State 
Representative Jessica Farrar; our relatively new State senator, Sylvia 
Garcia; and our city council member, Ed Gonzalez. We are doing that 
this Saturday from 9 to 1 so people can come in and sign up.
  The success, though, is that the Web site was down for 2 months, but 
we have seen a huge number of people signing up--5 million as of last 
week. I hear on Monday of this week they had 1 million contacts, both 
by phone and to the Web site.
  So there is a need out there for the Affordable Care Act. It is 
landmark health care reform.
  I was on the subcommittee and the Committee of Energy and Commerce to 
help draft part of it. We did days and nights of drafting amendments. 
We had both bipartisan amendments adopted, including one on mental 
health that Congressman Murphy from Pennsylvania and I had worked out 
to expand mental health coverage.
  Of course, we live in a bicameral Congress and sometimes the Senate 
doesn't always do what we would like to do on the House side. That is 
the nature of it. But the Affordable Care Act is expanding health care 
access.
  You mentioned some of the successes that we have. I know as a State 
legislator I would have loved to have a State law that required 
insurance companies to pay 80 percent of their premiums they received 
back as benefits. I don't know of any State that does that. I would 
have loved to have that in Texas.
  Somebody who pays an insurance premium, whether it is employer health 
care or an individual health policy, they can be guaranteed that 80 
percent of their premium will come back in benefits. That is what the 
Federal law is.
  We hear our Republican colleagues say they still haven't come up to 
an alternative to the Affordable Care Act--because they can't.
  That is one of the successes in there, and there are a lot of 
successes. In fact, some of that law is actually Republican ideas that 
have been built up over the last 20 or 30 years, saying, How can we 
cover the uninsured in our country?
  Mr. CASTRO of Texas. That is right.
  Congressman, once upon a time, these were the ideas of the Heritage 
Foundation. This was a conservative movement, conservative ideas, about 
how folks would take individual responsibility. Because, as you know, 
being in Harris County, our large hospitals systems end up with 
millions of dollars in uncompensated care every year.
  Mr. GENE GREEN of Texas. Our Harris County Hospital district is our 
catchment. But not all counties in the State of Texas have that option 
to have a hospital district.
  Even in our area, I have a district that is one of the highest in the 
country of people who work who don't get insurance through their 
employer. That is why the Affordable Care Act is important. In our 
district, we have an estimated 261,000 people who would have the 
opportunity to get health care through the Affordable Care Act. And we 
are hoping to sign them up. We started in November, and we have had 
these workshops literally all over our district, in partnership with 
lots of different groups.
  The Affordable Care Act is particularly important in our districts 
because we have one of the highest rates in the country of people who 
are uninsured. It is essential people know that the financial 
assistance is available under the Affordable Care Act that can lower 
their health care costs. In fact, nearly 6 of the 10 uninsured people 
will find that they can find health coverage for $100 or less a month.
  Like I said, this Saturday we are having a forum. This forum is a 
great opportunity for people to come and actually learn about health 
care options, because health care insurance is important.
  After World War II, our country made a decision. The countries we 
rebuilt in Western Europe had government-run insurance. Canada has 
government-run insurance. Our country decided to go with employer-based 
insurance. And that worked well up until about 10 or 12 years ago, 
where we started seeing employers drop that coverage.
  At one time in our country, 80 percent of the people who worked had 
insurance through their employer. Now it is below 60 percent, and it is 
getting worse. Although with the Affordable Care Act, we are actually 
seeing increases. Because even a small business can be eligible for 
subsidies to cover their employees under the Affordable Care Act.
  Like I said, as a member the Energy and Commerce Committee, I am 
proud of us passing something. It is not perfect, but it is a step in 
the right direction. I would hope that this Congress and maybe a future 
Congress can say, Okay, let's see what is wrong with the Affordable 
Care Act. It is just like we had to go back and fix Medicare on a 
number of occasions.
  Nobody wants to abolish Medicare. It is one of the greatest pieces of 
legislation that we have ever passed. I would hope that over the years 
we would not only build on the Affordable Care Act to make people--just 
like with Medicare--know that they don't have to worry about putting 
their families in

[[Page 4893]]

bankruptcy because they have an illness. The Affordable Care Act will 
help us on the road to protect that.
  I appreciate your leadership tonight on this. I know I have a 
colleague from California from my class who is up next. I thank you for 
your time.
  Mr. CASTRO of Texas. Thank you, Congressman.
  A few things that you pointed out that I think are especially 
noteworthy. The first is that there is no perfect bill that we pass 
here. And especially, the larger the bill is, the more you are going to 
have to come back and change it and tweak it. That is what you have 
seen with the Affordable Care Act. So there is no surprise that we are 
going to have to have some changes to it. Quite frankly, there have 
been some changes in deadlines. There have been some other changes. 
Americans rightly ask, Well, why is the President or the administration 
doing that?
  Well, it is very simple. Last year, for example, Congress passed the 
least amount of legislation of any year on record. The President is 
taking action to improve the law because the Congress will not or 
cannot. Somebody has got to be doing something here in Washington. 
Unfortunately, in the House of Representatives, we have hit a 
standstill. So the administration is making sure and listening to 
Americans and making the changes that are necessary.
  No bill is ever going to be perfect. Social Security was deeply 
criticized when it was enacted. For several years, Medicare was deeply 
criticized when it was enacted.
  So this is no surprise. Americans in previous generations have seen 
this before, have lived through this before, and this program has been 
a successful one. It will be even more successful as we go forward, and 
we will continue to talk a bit about some of the benefits to millions 
of Americans.
  Before I yield to my colleague from California, Lucille Roybal-
Allard, I want to point out that there are a few ways people can get 
information and sign up. We have been talking a lot about the Web site 
and asking people to go online, but there is also the traditional 
method.
  We have the online Web site at healthcare.gov, of course. Also, by 
mail. You can download an application and send it in by mail. You can 
go in person here. You can also call by phone at 1-800-318-2596. I know 
there has been a lot of emphasis on the Web site, but you can also 
enroll by these traditional methods. That means a lot to a lot of folks 
in different communities.
  I was at an enrollment fair on Saturday, and there was a woman who 
looked to be somewhere between 55 and 60. Quite honestly, she was a bit 
baffled by having to get on the computer, even thought she was being 
assisted, and she asked, Is there another way I can do it where I don't 
have to use a computer? The answer to that is yes, there are 
traditional methods.
  With that, I want to yield to Congresswoman Roybal-Allard from the 
wonderful city of Los Angeles.
  Ms. ROYBAL-ALLARD. I thank the gentleman for yielding and for 
organizing tonight's Special Order on the Affordable Care Act, which is 
helping to make health care a reality for millions of Americans across 
our Nation.
  Luckily, California is one of the States that has a plan. It has 
bought into the Affordable Care Act. As a result, thousands of 
California are now benefiting from what we in California call Covered 
California, which is the ACA plan there.
  By enrolling in the Affordable Care Act, parents and their children 
no longer have to endure illnesses or painful injuries because they 
can't afford a doctor. Parent don't have to worry about their children 
getting a preventable illness because they can't afford to have them 
vaccinated or treated for a chronic preventable disease.
  Why? Because under the ACA, many immunizations and preventative 
services are free.
  Seniors and adults are also eligible for free preventive services, 
including annual checkups, annual mammograms, prostate cancer 
screenings, and immunizations. Young adults, including 435,000 young 
Californians, don't have to worry about being a burden on their family 
if they get sick or are in an accident because they can remain on their 
parents' insurance until age 26, and get affordable insurance after 
that.
  Also critical is the fact that under the Affordable Care Act, no one 
can be denied health care coverage because of a preexisting condition.
  The ACA is a wonderful opportunity, as you have pointed out, for 
uninsured Americans to get the health care that they need to improve 
the quality of life for themselves and for that of their family. And I 
would like to just give one example of that.
  A constituent of mine from the city of Bell by the name of Roberto 
Rivas is in his mid-twenties. On December 21, 2013, he arrived at 6 
a.m. to enroll in a health insurance plan before going to work at KFC, 
where he is not offered any health insurance. He is also a full-time 
student at Trade Tech studying chemistry. He would like to use his 
education to study proteins and to research viruses such as hepatitis 
and other infectious diseases.
  Until the age of 21, along with his 10-year-old sister, he was 
covered by his mother under Medi-Cal. When he turned 21, he was no 
longer eligible for Medi-Cal. He lost that insurance and was left 
completely without any health insurance whatsoever.
  Shortly after, he began suffering from breathing problems. He went to 
a doctor and found out that he had pneumonia. Later, after being 
treated for that pneumonia, he received a medical bill for $4,663. He 
had no insurance to cover that. He even asked for charity care services 
to help cover his expenses, but was denied that request.
  Robert said:

       As a minimum wage worker and a full-time student, it is 
     hard to get health insurance.

  Thanks to ObamaCare:

       Now I can go to school and not stress about getting sick 
     and ending up in the hospital.
       I'm calling everybody in my family to tell them I'm 
     enrolled in health care and that they need to come out and 
     get covered, too.

                              {time}  1815

  Robert Rivas was also astounded by the service, the friendly faces, 
and the applause he received when he enrolled; and he says:

       To know so many people actually care about me getting 
     health insurance is great.

  This is just one example of the millions of Americans who are 
benefitting from what we call ObamaCare, or the Affordable Care Act.
  I am hoping that more Californians who have not applied, and 
Americans across the country who are uninsured and can benefit greatly 
by enrolling in health care, that they don't miss out.
  There are only 5 days left until the enrollment deadline of March 31. 
I hope that, today, they will visit healthcare.gov or use any services 
which you have already outlined to enroll in the Affordable Care Act 
for themselves and for their families.
  Mr. CASTRO of Texas. Thank you, Congresswoman. And what a powerful 
story that you have told. I am glad to hear that California has done 
such an incredible job in making health care available to its 
constituents and to its residents. Thank you.
  I would also point out, Congresswoman Roybal-Allard mentioned 
something that is very significant because Republicans have tried to 
repeal the Affordable Care Act now--I think it is about 51 times--50, 
51 times.
  We make no bones about it. There are a lot of Americans--a decent 
number of Americans who agree with that argument, who say repeal it; 
but let's understand, if your argument is repeal it, then understand 
exactly what you are repealing.
  First, there is no plan that has been offered by the other side--no 
alternative. Also, if you repeal it, what you are saying now is you are 
going to, again, allow insurance companies to kick off cancer patients 
because they hit a lifetime limit, send them out of the hospital, send 
them home.
  You are not going to allow recent college graduates to stay on their 
parents' insurance until they are 26 years old.
  Remember, health care problems and big hospital bills, for years now, 
have been the number one reason for personal bankruptcies. People would 
run out of insurance money.

[[Page 4894]]

  They would have to take out all of their savings from their bank 
accounts to pay their hospital bills; and then, they could no longer 
make their mortgage payment, their car payment. They couldn't help 
their kids go to college. They essentially became broke.
  If you are talking about repealing the Affordable Care Act, then you 
have to accept and be upfront about the kind of future that you are 
inviting, which is a travel back to the past.
  I have been surprised in my time here that Republicans have tried to 
repeal this law 51 times, and what is more surprising is that there is 
no alternative plan to the Affordable Care Act.
  That is why, in the surveys, you see over 60 percent of Americans 
that say: Yeah, I may have an issue with it. I didn't like the way the 
Web site was done. I disagree with some parts of it, but I don't want 
it repealed. I want it improved.
  Unfortunately, on the other side of the aisle, the strategy has not 
been to improve this thing and work with us to make it better. Like I 
said, any big law--any big law--whether it is about health care or 
mortgages or financial services or anything, any big law is going to 
require some tweaks and some changes.
  So I hope that they will listen to the voice of Americans and take a 
different tack.
  Mr. Speaker, I yield to my friend, the gentleman from California (Mr. 
Cardenas).
  Mr. CARDENAS. I thank my good friend from San Antonio, Texas.
  Congressman Castro, you are absolutely right. To go back away from 
the Affordable Care Act means to go back to the old system, and the old 
system is not the good old days.
  When we are looking at families who are fortunate to even have 
insurance, their insurance is going up seven to 17 percent, year over 
year over year. That is unsustainable.
  People's income does not go up that high, that fast. People's 
opportunity to find other ways to find that money somewhere else in 
their budget doesn't go up that fast, so those were not the good old 
days. Actually, the best days are yet to come.
  What we have seen 52 times here is an opportunity--or a tried 
opportunity to sabotage the Affordable Care Act, and by calling it by 
another name doesn't make it bad.
  Yes, the rollout could have happened better, but the bottom line is 
the good days are yet to come. They are here now. The past are not the 
good old days.
  I would like to thank you for this opportunity to speak. I think it 
is important for us to understand that what we are talking about here 
is high quality affordable health care, which is something that was 
denied and out of reach for so many seniors and families in my district 
in the San Fernando Valley and across the country.
  One in three people in my district were uninsured, but Covered 
California is giving those people the opportunity to purchase 
affordable plans that will give them the care they need when they get 
sick and the preventative services they will need to stay healthy.
  While the rollout of the Affordable Care Act hasn't been perfect, 
Covered California has been very successful in providing a simple, 
straightforward way to enroll.
  I feel really bad for those States where their State legislatures and 
their Republican Representatives have denied them the opportunity to 
experience good affordable health care. I hope that they can catch up.
  Last week, Covered California announced that they had enrolled over 1 
million people through the State-run exchange. That is in California 
alone. Their critical work has helped hundreds of thousands of 
California families, seniors, small businesses to gain access to high 
quality affordable health care that was once denied to them for too 
long.
  My staff and I have been working alongside Covered California to help 
enroll residents in the San Fernando Valley. Over the last few months, 
I have been hosting a series of successful enrollment workshops for the 
Affordable Care Act; and as a matter of fact, we will reach 30 events 
by this weekend.
  This is where families learn about the options available to them 
under the new health care law, including learning about insurance 
policies that can be purchased through the Covered California health 
insurance exchange, which has been successful in getting folks 
enrolled.
  More than 500 families have taken advantage of these workshops just 
in my district alone.
  Wow. Can you imagine, Congressman Castro, if every single one of the 
435 Congressional Members rolled up their sleeves and helped people get 
enrolled? That would be millions upon millions of more American 
families that would be enrolled in affordable health care.
  In the last week before the deadline, every Representative should 
take this opportunity to do the same job that we have been able to do 
in my district. We must help families sign up for the Affordable Health 
Care Act.
  The day will come very soon when the truth will overcome the lies 
that have scared so many people. Billions of dollars have been spent 
scaring people away from trying to even enroll in the Affordable Care 
Act.
  Let me give you an example. I have met with parents who have come to 
workshops to sign up, and they have anxiety and fear in their eyes; but 
thank God, just moments later, their fears go away when they find out 
that they now have affordable, reliable health care.
  People with mild asthma that were once denied health care can no 
longer be discriminated against. They are no longer denied health care, 
and they can breathe easy knowing that they can now see a doctor, and 
they can actually get the medicines that they need just to breathe.
  I met with a gentleman who was sitting there with his wife and his 
daughter, the sole income earner for that family. I don't know how he 
does it, but with $9 an hour, he manages to feed a family of three; and 
he was worried that he couldn't afford maybe $30, $40, $50 a month.
  When the person turned the computer around and showed him what his 
eligibility was, he almost came to tears, realizing that, once and for 
all, himself, his wife, and his teenage daughter can now have health 
care.
  I will tell you what. This is serious business. America, it is time 
that you sign up for affordable health care. Just try it. Don't worry; 
be happy.
  Sign up for the insurance that you deserve.
  Mr. CASTRO of Texas. Thank you, Congressman Cardenas. Thank you for 
all of your work.
  You also raise a great point, which is folks will often see the 
sticker price of the insurance on the exchanges.
  By the way, I, as well as many other Members of Congress, bought our 
insurance off of the exchanges. We were getting asked that question a 
lot. You know, are you going to buy ObamaCare?
  The answer is yes. I bought my insurance off the exchanges, and I 
saved money.
  Folks should make sure that they also check, besides the sticker 
price, what kind of subsidy they get because it is meant to make 
insurance affordable for middle class Americans and others.
  Mr. Speaker, I yield to the gentlewoman from New Mexico (Ms. Michelle 
Lujan Grisham).
  Ms. MICHELLE LUJAN GRISHAM of New Mexico. Thank you very much, 
Congressman Joaquin Castro.
  Muchas gracias, al congresista Joaquin Castro.
  Thank you so much for calling us together to talk about this 
critically important issue for our families.
  Twenty years ago, when I was running the New Mexico Department on 
Aging, I remember an incredibly tragic call from a family of a 60-year-
old woman who had fallen and broken her hip. She was in a hospital in 
Albuquerque.
  Now, of course, hospitals are required to provide stabilizing 
emergency treatment and even surgery if that is required in that 
instance; but unfortunately, this 60-year-old woman didn't have 
insurance, and she was rolled out

[[Page 4895]]

of the hospital in a wheelchair without the required surgery for her 
hip fracture.
  If the Affordable Care Act was in place when this happened, this 60-
year-old woman could have simply provided her health insurance card to 
someone at the hospital, and the hospital would have stabilized her 
hip, performed the surgery, and then provided follow-up rehabilitation 
care. This would allow this woman to walk again.
  The required stabilization is critical for successful recovery of 
that particular hip injury, and the long-term consequences of not 
receiving the care, in addition to the pain and suffering of this 
woman, are significant. Quite frankly, she would never have walked 
again without that surgery.
  Now, thankfully, in her case, the whole community came together to 
gather enough money to pay for her treatment; but if this were to 
happen today, she could have already purchased subsidized insurance in 
the health insurance marketplace or qualified for Medicaid, and she 
would have been able to receive treatment without the scare and the 
subsequent fundraising by her family in that instance.
  People across the country face situations like this every single day. 
That is why it is critical that we tell our friends and neighbors that 
they only have 5 days left to enroll in health insurance through the 
marketplace--5 days. There is absolutely no time to waste.
  Like many of my colleagues, I have been working with groups in my 
district and have been participating in enrollment events to help 
provide information and to assist New Mexicans to enroll.
  Two of my constituents, Mark and Elizabeth Horst from Albuquerque, 
signed up for bronze plans through the exchange last fall. They make 
$24,000 a year between them and have qualified for $612 in subsidies, 
which covers the cost of the bronze plan.
  Thousands more New Mexicans are still eligible. New Mexico had the 
third highest uninsured of any State before the Affordable Care Act 
went into effect this year. In the Hispanic community, more than 25 
percent are uninsured, and more than that are underinsured.
  Today, more than 360,000 in New Mexico are still eligible for 
enrollment. By enrolling in a plan, you don't have to risk injury or a 
lifetime of debt. You can get your family covered; and, by having 
access to primary care, your family can stay healthier longer.
  I appreciate my colleague's effort today. I thank you very much.
  Mr. CASTRO of Texas. Thank you, Congresswoman.
  We only have a few minutes left, and I would like to yield to the 
gentleman from Texas (Mr. Doggett).
  Mr. DOGGETT. I would just like to thank you for the work that you are 
doing on this, and I believe our real message is to the many people out 
there--some of whom may even think that this law has been repealed. 
They have tried so many times.
  As you pointed out a little earlier, this is an opportunity that is 
there for the next 5 days. Get beyond all the political chatter. Turn 
to a group like the American Cancer Society or the American Diabetes 
Association. Look at the information that is there.
  Then go to one of the many enrollment fairs we are having across San 
Antonio this weekend. There is one up in Austin that is going to go 
almost 24 hours straight. These are opportunities to get out and do 
this.
  I know you had a very successful enrollment fair in San Antonio. I 
had one over at Progreso Hall. Our colleague, Pete Gallego, had one out 
at Palo Alto. These have been opportunities for a wide range of our 
neighbors to come out and participate. We just want to encourage them 
to do more.
  Mr. CASTRO of Texas. Thank you, Congressman Doggett, and thank you 
for your work when this bill was being worked on and drafted. Thank you 
for helping to pass it and, since then, passionately making sure that 
people get on to the ACA.
  Mr. DOGGETT. I think, if we keep working together, we can find ways 
to strengthen and improve this, but the main thing is for our families 
to get out there now.
  I think, increasingly, most folks are realizing, as you pointed out, 
with so many efforts to repeal, that the only alternative that they 
offer is ``Nothing Care.''
  Mr. CASTRO of Texas. Mr. Speaker, I yield back the balance of my 
time.

                          ____________________