[Congressional Record (Bound Edition), Volume 163 (2017), Part 3]
[House]
[Pages 3554-3558]
[From the U.S. Government Publishing Office, www.gpo.gov]




                   REPEAL OF THE AFFORDABLE CARE ACT

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2017, the gentleman from California (Mr. Garamendi) is 
recognized for 60 minutes as the designee of the minority leader.
  Mr. GARAMENDI. Mr. Speaker, I rise this evening to cover several 
very, very important points.
  Tomorrow is International Women's Day, and I was going to talk about 
the role of women in our society, talk about my five daughters and what 
they have been doing in their life of service, and my wife, but events 
intervened. And yesterday, our good friends on the Republican side 
introduced a piece of legislation that will dramatically affect women, 
young and old; children. They introduced a repeal of the Affordable 
Care Act.
  We are still trying to figure out all of the details involved in it. 
It is going to be a little hard, since it was changed late in the 
night. But there are some things we do know. I would like to start off 
with what we do know about the Affordable Care Act so that when we come 
to debate on the floor in the days ahead the Republican repeal and 
replacement of the existing Affordable Care Act, we have a foundation.
  If you will indulge me, I will try to lay out some facts, not 
alternative facts, but facts. For example, 20 million Americans have 
gained coverage as a result of the Affordable Care Act. The percentage 
of uninsured in America is the lowest it has ever been. Mr. Speaker, 
6.1 million young adults between the age of 19 and 25 have gained 
insurance coverage by being able to stay on their parents' insurance 
program--6.1 million. Of the Americans who have preexisting conditions, 
and that is 27 percent of us who have some sort of preexisting 
condition--heart issues, diabetes, broken legs, bad backs, whatever--27 
percent of those Americans are guaranteed coverage even though they 
have a preexisting condition.
  I was insurance commissioner in California for 8 years, and I must 
tell you the battles--well, it would take several days to talk about 
the battles that I had with the insurance companies who were denying 
coverage because of preexisting conditions. No longer the case in 
America. The Affordable Care Act said no. And by the way, the lifetime 
limits, they are gone, also.
  California, which I have had the pleasure of being a citizen of, 3.7 
million Californians are now insured under the Medi-Cal program, and 
1.4 million have gained coverage through the exchange, called Covered 
California. About 1.2 million of those have received subsidies, 
averaging over $300 a month. Over 5 million Californians will be 
directly affected by a direct repeal.
  And in the expansion of Medicaid, or Medi-Cal as we call it in 
California, if that is eliminated, that is a $16 billion hit to the 
State of California, and, obviously, an enormous hit to those 3.7 
million Californians who have been covered under the Medi-Cal 
expansion.
  Secondary impacts: employment. Maybe 200,000 jobs would be lost in 
California.
  Individual stories: boy, they abound. Just this evening, I got a call 
from my wife, and she said: You really ought to talk about that young 
family in Woodland, California, whose 2-year-old son was diagnosed with 
some sort of a medical illness. They were able to get coverage before 
that under the covered California program. They went back a year later, 
and the kid had a brain tumor.
  Fortunately, it was resolved because they had insurance. They were 
able to get the early diagnosis. And under the current law, the 
Affordable Care Act, they will be able to keep their coverage, even 
though previous to the Affordable Care Act, this young child and, quite 
probably, the family would be uninsurable.
  It is working. The Affordable Care Act is working. Are there ways to 
improve it? Undoubtably, there are, and we could sit down and talk 
about ways to improve it.
  But yesterday, our Republican colleagues introduced legislation that 
is going to have a profound negative impact on men and women all across 
this Nation. We will spend time in the days ahead to talk about the 
details, but we do know that, in general terms, there will be less 
coverage at a higher cost

[[Page 3555]]

for literally everybody, except for a few special folks. And I would 
like to just put up a chart about that. Let's start with this one.
  You see, in the repeal bill that was introduced, there are very 
serious tax cuts. We are talking about hundreds of billions of dollars 
of tax cuts over the next 2 years. Well, we all want a tax cut. But 
under the repeal, there are some very special people who are going to 
get a really big tax cut. Take a look at this.
  The top 20 percent of taxpayers will receive 74.2 percent of the 
multihundred-billion-dollar tax cut, which is estimated to be somewhere 
in the range of $700 billion to maybe as much as $1 trillion, depending 
upon the final calculations.
  By the way, the Congressional Budget Office has not had time to 
score, that is to tell us what the cost, what the benefits are, of the 
Republican proposal. But we do know from earlier studies of this, 75 
percent of the multihundred-billion-dollar tax cuts go to the wealthy. 
Wow. And where does the money come from? It comes from the poor, it 
comes from the working families, the men and women who are struggling 
here in America. Maybe they are making a good living--$50,000 to 
$60,000 a year. They are going to see their benefit package reduced.
  One more way to look at this is the famous pie chart. So who gets the 
tax breaks? Not the top 20 percent. Let's just focus more clearly here 
on the top one-tenth of 1 percent. What do they get? They are not a 
percentage. This is not the top 1 percent. This is the top one-tenth of 
a percent. What do they get? Well, they get nearly $200,000 a year in 
tax reductions. That is not bad. So the top 1 percent gets 57 percent 
of that 6-, 7-, $800-billion tax cut, and everyone else will get 43 
percent.
  So what we have here is a massive shift of wealth from the working 
men and women of America, from American families, to the very top--you 
know, the 1 percenters. That is who is getting the benefit in this 
massive tax cut that has been proposed. I don't know if that is good 
policy. It is not in my district. I don't think it is good policy for 
America.
  We spent a lot of this last year in the Presidential campaign talking 
about the shift of wealth to the superwealthy and away from the great 
majority of Americans. But, here we go. In the very first big 
legislation of this year, we see the Republicans in a massive effort to 
increase the wealth of the superwealthy at the expense of the rest of 
Americans.
  There are many, many more things to talk about here. But I want to 
just take a deep breath, which I need, because I guess I am getting 
rather excited about what is happening--or maybe angry is a better 
word--and turn to my colleague from the great State of Virginia to 
carry on while I take a deep breath and cool off a bit.
  Mr. Speaker, I yield to the gentleman from Virginia (Mr. Scott).
  Mr. SCOTT of Virginia. Mr. Speaker, I don't blame the gentleman. I 
appreciate the opportunity to discuss the Affordable Care Act. As we 
discuss this, as he has indicated, it helps a little bit to talk about 
what the situation was before the Affordable Care Act passed.
  We knew that costs were going through the roof. We knew that those 
with preexisting conditions, if they could get insurance, would have to 
pay a lot more for that insurance. We knew that women were paying more 
for insurance than men. We knew that millions of people every year were 
losing insurance. That is what was going on before.
  People talk about small businesses. Well, small businesses had 
trouble getting insurance because if they had a person with a chronic 
illness, it would be unlikely that they could afford small-business 
insurance. But now, the costs have continued to go up, but they have 
gone up at half the rate they were going up before.
  Those with preexisting conditions can now get insurance at the 
average rate. Women are no longer paying more than men. And 20 million 
more people have insurance, not millions of people losing insurance 
every year, 20 million more people have insurance.
  Now, the full name of the Affordable Care Act is the Patient 
Protection and Affordable Care Act. There are certain protections, like 
insurance companies can't cut you off after they have paid a certain 
amount. There are no more caps. They can't rescind your policy. After 
you get sick, they can't just decide not to renew your policy. There is 
no copay or deductible for prevention and cancer screening. We are 
closing the doughnut hole. The average senior has saved already about 
$1,000 because of the Affordable Care Act support for closing the 
doughnut hole. Those under age 26 can stay on their parents' policies. 
Those are some of the benefits of the Affordable Care Act.
  Now, we didn't solve all of the problems. There are still problems. 
But if we are going to change the Affordable Care Act, we ought to 
improve the Affordable Care Act. Unfortunately, the bill that was 
introduced in the middle of the night fails on a number of areas.
  Now, we would know precisely how bad a bill it is if they would wait 
a couple of days for the CBO to score the bill. It would point out all 
of the flaws. But there are just a couple.
  One is just a fundamental principle that it purports to cover 
preexisting conditions without a mandate for coverage. We know that if 
you allow people to wait until they get sick before they buy insurance, 
people will wait until they get sick before they buy insurance. The 
average insurance pool is sicker, more expensive. Healthy people drop 
out, and the thing spirals out of control. We don't have to speculate 
how this works because we know.
  New York State tried it, and the cost went up so much that when the 
Affordable Care Act came in with a mandate, the cost for individual 
insurance dropped more than 50 percent. Washington State tried it. It 
got so bad that by the time it got going a couple of years, nobody 
could buy insurance. Nobody could buy insurance in the individual 
market. So we know what happens when you try to cover people with 
preexisting conditions without a mandate.

                              {time}  2000

  So this plan, when it starts off with that policy, we know it is 
bound to fail.
  We also noticed another flaw: that it saves money by allowing people 
to purchase insurance that doesn't cover everything. We have people 
buying insurance now that have to buy the basic essential benefits 
package. When you can start picking and choosing, you might save a 
little money, but things like maternity care, if that becomes an 
optional coverage, then anybody that wants that will not be able to 
afford it.
  It will cost whatever it costs to have a baby. They just have to pay 
the bill. They might as well not have insurance. So that is because, if 
anybody purchases maternity insurance, it is because they expect to 
have a baby in the coming year, and it becomes unaffordable. If 
everybody pays the average, everybody pays everything, then everybody 
can afford the maternity coverage.
  So allowing people to pick and choose what they want, that might help 
a few, but those that need that coverage won't be able to afford it.
  A final flaw, as the gentleman pointed out, is massive tax cuts. 
Well, when you reduce the revenue available, two things happen: there 
is less support for Medicaid, and there is less support for people in 
paying their premiums. So in the fullness of time, fewer people will be 
insured; and so you have a plan with fewer people insured, watered-down 
benefits, and a plan that is ultimately going to fail.
  That is not an improvement. If we are going to deal with the 
Affordable Care Act, we ought to have an improvement; and until we have 
an actual improvement, we ought to leave the Affordable Care Act alone.
  I am delighted to be here discussing the Affordable Care Act with the 
gentleman, warning people that, if they go forward without a 
Congressional Budget Office evaluation so they know what is going on, 
we may have a plan that is a lot worse than even before the Affordable 
Care Act.
  Mr. GARAMENDI. Mr. Scott, thank you so very much. You bring to this 
discussion a very important perspective as the ranking member of the 
Education and the Workforce Committee.

[[Page 3556]]

You have that perspective of understanding the effect of this 
legislation on the working men and women and families of the United 
States.
  I was just looking at some of the early comments that have come out 
about the bill, which is less than--well, it is almost 24 hours old 
now. Families USA said: ``The GOP healthcare proposal would be 
laughable if its consequences weren't so devastating. This bill will 
strip coverage for millions of people and drive up consumer costs.''
  The Catholic Health Association of the United States said: ``This 
proposal would also take many backward steps in the continual effort to 
improve our healthcare system. . . .''
  It goes on and on, and as more and more people come to understand the 
issues that the gentleman was discussing, I think they are going to 
find that, no, we will take the Affordable Care Act as it presently 
exists, and we will make some modifications to it to improve it.
  The gentleman raised a very interesting point. It reminds me of 
another conversation I had earlier this week with my wife. She had gone 
to her hairstylist, who is about 29 years old, has run her own business 
for the last 7, 8 years, and she told me wife: It can't be true. They 
can't do it, can they? They can't kill the Affordable Care Act, the 
ObamaCare?
  She said: For the first time in my life, I was able to get insurance; 
and now that I have insurance, there is this maternity benefit that is 
in my package, and now my husband and I, we can afford to have a child.
  It was directly to the point the gentleman was making. If there is an 
option here on maternity coverage or any coverage for women's health, 
then we are going to find a situation where people will pick and 
choose; they will wait to get their insurance, and then the insurance 
pool is left with very expensive cases and the cost is not spread out.
  The gentleman may have some other examples that may have come along 
or some other comments that he would like to make. I would be delighted 
to have the gentleman share those on the floor, and I will yield to the 
gentleman.
  Mr. SCOTT of Virginia. Shortly after the Affordable Care Act passed 
and went into effect, a young lady approached me in a store--she was a 
clerk in a store--and said: Bobby, don't let them repeal ObamaCare 
because my son is alive today because of ObamaCare.
  I said: Well, what do you mean?
  She said: Late last year, he was diagnosed with a fatal disease for 
which there is a cure, but we couldn't afford the cure. Thankfully, he 
lived to January 1, when ObamaCare kicked in, and we can afford the 
cure. My son is alive today because of the Affordable Care Act.
  If it is repealed, what happens in that case? What happens in all of 
the other cases when people don't have insurance? We have heard it 
represented that, well, anybody can get health care. All they have got 
to do is show up at the emergency room.
  Well, yeah, that is fine. You can show up at the emergency room with 
a stroke, but you can't get blood pressure pills that could have 
avoided the stroke to begin with. They can stabilize you and send you 
home, but in terms of a cure or a surgery that may cure the problem, 
you don't get that. You just get stabilized in the emergency room, and 
that is not health care. We need people with insurance so they can 
obtain the preventive care and the corrective care that will get them 
off on the right track.
  The gentleman talked about stripping coverage. When you take that 
kind of money out of the system, less support for Medicaid, fewer 
people getting Medicaid, less support for premium support so that 
people can actually afford it--if you look at the proposal, a lot of 
people can't use the tax cut because it is insufficient to pay the 
premium and they don't have the rest of the money.
  So we need to make sure that CBO scores this. They will highlight all 
of these problems. They will show that many fewer people will be 
insured and that it is not an improvement. We shouldn't do anything 
unless we are actually improving the Affordable Care Act.
  Mr. GARAMENDI. The gentleman is correct on that. I was just looking 
at some statistics here a moment ago about the shifting of cost.
  Under the Affordable Care Act, there are many, many benefits for 
Medicare. Leaving aside the Medicaid population for a moment, the 
Medicare population, available to every individual 65 and older, there 
have been significant improvements.
  You mentioned the doughnut hole earlier, the drug benefit. If you run 
up heavy expenditures on your drugs, you would come to a point where 
you had to pay 100 percent. Medicare didn't cover it. Well, that 
doughnut hole is collapsing, and in another 2 years, the Medicare 
program will cover all of the drug costs without limitation.
  Also, there is the free annual checkup that is available to everybody 
that is on Medicare. The result of these kinds of things, where drugs 
are available, blood pressure drugs, diabetes and the like, has led 
to--together with the additional taxes that the superwealthy are 
paying--has increased the solvency of Medicare by 11 years.
  Now, the fiddling that is going on with the proposal that our 
Republicans have put through, it is not clear exactly what the result 
would be; but we do know that one of the major tax cuts is the 
elimination of this Medicare tax that the superwealthy have been 
paying, and that is over--together with one other tax is almost $340 
billion. So the support for Medicare and the solvency of Medicare 
becomes a question mark as a result of the proposals.
  We don't have all of the answers to this, but we do know that a 60-
year-old presently getting an insurance policy from the Affordable Care 
Act, from ObamaCare, and making somewhere around $40,000 a year--
perhaps working at Walmart--they are going to see a 57 percent 
reduction in the tax credit that is currently available versus what the 
Republican bill has.
  So a 60-year-old making $40,000 a year under the ACA, ObamaCare, will 
receive somewhere around a $9,000 tax credit to support the purchase of 
insurance. Under the Republican bill, they are looking at $4,000--not 
$9,000, but $4,000--so 57 percent reduction in the support that they 
receive, probably leading to them not being able to afford insurance 
and winding up in your emergency room example.
  Mr. SCOTT of Virginia. To add insult to injury, part of the scheme is 
to allow insurance companies to charge senior citizens even more. Right 
now they are limited to three times what they charge everybody else. 
Their bill allows up to five times. That is a two-thirds increase in 
the cost. So if the tax credit wasn't enough to begin with, it is going 
to get worse.
  Mr. GARAMENDI. Well, let me make sure I understand. I was 60 a while 
ago, but let's say I am 60 and I am getting a health insurance policy 
under ObamaCare, the Affordable Care Act. I may have to pay three times 
what a 25-year-old pays, but under the proposal that has been brought 
to us by the Republicans, I would pay five times?
  Mr. SCOTT of Virginia. That is right.
  When everybody pays an average, if you allow some people to pay more, 
some people are going to pay less, but it is a zero-sum game. Every 
time they show somebody can pay less, then know that somebody will pay 
more. They have a scheme, for example--they call it association plans--
where you get a group of healthy people, they come from out of the 
insurance pool and get a better rate because the insurance company will 
look at the association and say: Those are the young, healthy people, I 
can give them a better rate. They can save money.
  What happens to everybody else? They have to pay more.
  Last time they came up with this idea, the research showed that 80 
percent of the people will pay higher premiums if you allowed people to 
withdraw from the pool, a healthy group. Now, actually, it will always 
work, because the group you pull out, if the bids come in higher than 
average, nobody is going to buy the insurance. They are going to go 
right back into the regular pool. So any time you have one of these 
things, it will only work if

[[Page 3557]]

you are pulling out young, healthy people, and that leaves behind, for 
everybody else, higher rates.
  Mr. GARAMENDI. The fundamental nature of insurance is you gather a 
large population of healthy, not-so-healthy, and perhaps some very sick 
people into a large population, and the cost is spread across the 
entire population.
  What we may be ceding here in this particular proposal is the 
unravelling of that fundamental insurance concept with young people, 
healthy, not bothering to buy insurance, staying out of the market; and 
then, eventually, when they become ill, they will get back into the 
market, leaving everybody else to pay for it.
  There is another piece of this shifting of cost that did occur prior 
to the Affordable Care Act--significantly reduced, as a result of it--
and that is the uninsured still get sick.
  The gentleman mentioned the emergency room a while ago, and for the 
most part, in America, a person can get to an emergency room with or 
without insurance; but if they don't have insurance, there is still a 
cost associated with the visit to the emergency room and any other 
thing they may need. They may need to have their leg repaired, a broken 
leg, or maybe they need an appendectomy or whatever. That is still a 
cost. The question is: Who picks up that cost? That is called 
uncompensated care, and it was a huge problem prior to the Affordable 
Care Act.
  I had hospitals throughout my district and throughout California 
coming to me and saying: We can't afford this because we are not able 
to cover that uncompensated care for people that didn't have insurance 
that showed up at the emergency room.
  Now, we know that from the early analysis done of the proposed 
legislation by our Republican friends that the number of uninsured is 
likely to increase, perhaps as much as 11 million people--maybe more, 
maybe somewhat less. Those people will still get sick. They may have 
money of their own to cover their costs, but the chances are they 
don't. That uncompensated cost will then be borne by the people who do 
buy insurance. It is a cost shift to those who have insurance.
  Mr. SCOTT of Virginia. In fact, when we passed the Affordable Care 
Act, the estimated cost on a family policy was about $1,000 a year on 
the family policy for uncompensated costs shifted on to the insured 
public. In fact, in Virginia, it is estimated that approximately $15 a 
month is paid on everybody with insurance, $15 a month to go to the 
400,000 people that would have had insurance if we had expanded 
Medicaid.
  So if you have 100 employees, you can just figure you are paying 
about $1,500 a month extra because we did not expand Medicaid. 400,000 
people will go to the hospital, won't pay, and when people with 
insurance go, they just have to pay a little extra, about $15 a month 
per person in the Commonwealth of Virginia because of that.
  Mr. GARAMENDI. There are so many pieces to this healthcare system.
  One thing that I want to put on the table here from my experience as 
insurance commissioner in California is that there are two fundamental 
parts to the healthcare system in the United States, and really around 
the world. One of those two parts is how we collect the money and then 
pay for the services. We call that insurance. It is also Medicare, 
Medicaid, veterans' programs, and the like. These are the way in which 
we collect money and pay for the services.

                              {time}  2015

  The other part of the healthcare system is the delivery of services; 
these are the doctors, the clinics, the hospitals, and other providers, 
mental health providers, and the like. We often get confused by putting 
these two things together.
  There has been a lot of talk about what we are doing with the 
Affordable Care Act. It is essentially a mechanism to pay for services. 
It is an insurance mechanism. Using the private insurance system, these 
various exchanges are set up to pool the population of people who do 
not have insurance from their employer, the individual people, 
individual coverage. It pools them so that you have that large 
population so that the cost is spread out across that large pool and 
the insurance becomes affordable. That is an insurance mechanism. That 
is a pooling. It has nothing to do directly with the provision of 
medical services.
  The medical services are then provided out of that pooling 
arrangement by the individual doctors, maybe clinics, maybe hospitals, 
maybe group practices. Some of that will be capitated pay, and others 
will be a fee-for-service.
  We haven't changed directly the way in which services are provided, 
that is, the delivery of services. And this is found in hospitals. In 
the Affordable Care Act, there was a penalty for hospitals that had 
readmissions for infections. What we have seen, as a result of that 
provision dealing directly with the way in which services are delivered 
in hospitals, is a dramatic decline in readmissions for hospital-
acquired infections. What that means is some 60,000 people are still 
alive today because they didn't get a hospital-acquired infection.
  Mr. Speaker, I yield to the gentleman from Virginia (Mr. Scott).
  Mr. SCOTT of Virginia. Mr. Speaker, well, that part of the Affordable 
Care Act has actually improved the quality of service.
  There are other things in the Affordable Care Act, such as funding 
for education of more providers, more doctors and nurses, and other 
providers because we have a lack of professionals. One area, for 
example, is psychiatry. If the Veterans Administration hired all the 
psychiatrists they need, there wouldn't be any for anybody else. We are 
so far behind. And the Affordable Care Act provides for that service.
  As you pointed out, there is a difference between the ability to pay 
for the services and the services that are there. People frequently 
compare the single-payer plan in Canada, which in many areas is a rural 
area. So you don't have the critical mass of population to support a 
high-tech medical system. So if you are going to have a baby, it is 
probably going to be delivered by a family doctor, not an obstetrician. 
In some areas, you have to go 200 miles to find a neurosurgeon. That 
doesn't have anything to do with the fact that they can pay for the 
services. It is just that the services aren't there.
  So when people talk about the health delivery system, as you pointed 
out, that is different. The fact that you can actually pay for services 
doesn't diminish the opportunity to have those services there; it 
actually increases the possibility that those services will be there.
  Mr. GARAMENDI. Mr. Speaker, that is exactly right, and I see that in 
my district. I have a large rural district in California. And, even 
today, there are areas where it is difficult to find a physician to get 
medical services.
  This is one of the things, as you so correctly pointed out, the 
Affordable Care Act had a part of that. One of the titles dealt with 
the education of medical personnel. And so what we have seen, at least 
in California--and I suspect across America--with the Affordable Care 
Act in place, we are seeing that one of the fastest growing areas for 
new jobs is the healthcare sector because we are adding a lot of 
people--we need more--and then the educational programs that you talked 
about, which comes under the jurisdiction, I believe, of your 
committee. That is an important part.
  One of the things that I hope the American public comes to understand 
is this is not just a sound bite that was used in a political campaign. 
We are going to repeal the ObamaCare and we are going to replace it is 
a nice sound bite. But we are talking about the lives of Americans, we 
are talking about their health, their ability to stay healthy, their 
ability to get medical services.
  When you start tinkering with something that is so personal--that is 
what people say in my district: This is about my ability to stay 
healthy, my ability to get medical care. That is what I hear.
  They are saying they are frightened. They are concerned that the 
legislation and all of the discussion in the political campaigns has 
been so heated that

[[Page 3558]]

they are afraid they are going to lose what they presently have.
  A quick look at what has been presented to Congress just in the last 
24 hours indicates that a couple of facts are clear. First of all, 
there is an enormous tax break for the very, very wealthy, probably to 
the tune of 3- to $400 billion over 10 years. That is an incredible tax 
break for the superwealthy and for the health insurance industry. That, 
we are pretty sure, is in this legislation. We don't know the exact 
numbers; but we do know that early indications are that there is a 
shift, tax breaks for the wealthy, and cost increases for everybody 
else. That we know.
  We also know that there are certain elements of support for 
individuals that will be removed. As we go about debating this and 
understanding the full import and get the Congressional Budget Office 
information, I think we are going to find that Americans are going to 
say: Well, wait. Wait, wait, wait. You are doing what to me? What are 
you doing to me? You are taking away my health insurance?
  I suspect that will lead to a rebellion of some sort. Certainly it 
has agitated a lot of people in my communities about the justifiable 
fear of what may be coming to Americans.
  Mr. Speaker, I yield to the gentleman from Virginia (Mr. Scott).
  Mr. SCOTT of Virginia. Mr. Speaker, the gentleman indicated, in rural 
areas, one of the things that we have done is funded community health 
centers, which provides, where there are no professionals, a community 
health center where you can actually go to get comprehensive primary 
health care and then referred to a specialist somewhere if that is 
needed. That funding would be obviously in jeopardy.
  As you pointed out, when you have tax cuts in terms of resources, 
that will translate into fewer people actually insured. They will have 
watered down benefits. And because there is no mandate to ensure that 
everybody is in the pool and they are trying to cover preexisting 
conditions, you have a prescription for disaster. That is not an 
improvement of the Affordable Care Act.
  We need to insist that CBO score the legislation before we start 
taking votes so that people know exactly what they are getting into.
  Mr. GARAMENDI. Mr. Speaker, the gentleman from Virginia is absolutely 
correct about that. Unfortunately, my understanding is that as early as 
tomorrow--that would be Wednesday--that the committees intend to mark 
up the legislation. Normally, that means the version of the legislation 
that will pass out of committee is completed. And, I suspect, usually 
it is associated with a vote that takes place in committee. We don't 
know for sure if it is tomorrow or the next day, but we do know that if 
it is this week, we will not have the Congressional Budget Office 
information.
  The gentleman mentioned something that I probably should have jumped 
on immediately because of my rural district, and those are the clinics. 
As a result of the Affordable Care Act, there are now seven significant 
clinic organizations that provide services to about 23 specific sites 
around my district. They are providing, really for the first time in 
many of the communities that I represent, immediately available 
healthcare services to a variety of people, some of whom have had an 
employer-sponsored health plan and others of whom are on Medi-Cal in 
California.
  The apparent reduction in the Medicaid, Medi-Cal for California, 
support from the Federal Government that will occur over the next 2\1/
2\ to 3 years will eliminate one of the principal ways in which those 
clinics have been able to continue to operate and, that is, the 
expansion of the Medicaid population in California.
  It appears that the legislation that is proposed will shrink the 
Medicaid program across the Nation and severely curtail in California 
the support available for people who are currently on Medi-Cal. That 
will be devastating to these clinics in these rural areas.
  We have had discussions about this. They say: Watch carefully. If 
this is what happens, we are going to be out of business. We are going 
to shut down our doors.
  Mr. Speaker, I yield to the gentleman from Virginia.
  Mr. SCOTT of Virginia. Mr. Speaker, the clinics will shut down. 
Insurance companies will stop writing insurance if people can wait 
until they get sick before they buy insurance. The insurance companies 
reacted to that system in Washington State by selling nobody any 
insurance. So we know what is going to happen.
  The CBO, when they score this, will point that out, and we will know 
exactly what the problems are.
  Mr. GARAMENDI. Mr. Speaker, I thank the gentleman from Virginia (Mr. 
Scott) for joining us this evening. This is a fundamental part of 
American life, that is, our health care. It is about 18 percent of the 
total GDP, gross domestic product. It is extremely important in terms 
of the total well-being of our society and our economy.
  Changes to the Affordable Care Act that are being proposed will have 
a dramatic effect. And what we do know about it is that there will be a 
massive shift of wealth from working men, women, and families to the 
superwealthy. We know that from the tax proposals that have been made 
in the analysis of the tax.
  We also know that there is a very, very high probability that perhaps 
11 million people will lose their insurance coverage, either in the 
private insurance market through the exchanges or through the Medicaid 
programs across the Nation. And the effect on the providers, the 
hospitals, the clinics will be profound.
  So when we have something as important as this, it is just wrong. It 
is wrong for the majority in this House to put this legislation before 
the committees without a full hearing on what the effect will be. But 
it appears that tomorrow, Wednesday, we will have the first markup in 
this process.
  What I want--and I think the gentleman from Virginia (Mr. Scott) 
does, too--is for the American public to hear the debate, to understand 
the implications where we are today with the Affordable Care Act and 
what it has brought to us in terms of quality and accessibility to 
health care and what it would mean with the proposed changes.
  Mr. Speaker, I yield to the gentleman from Virginia (Mr. Scott).
  Mr. SCOTT of Virginia. Mr. Speaker, I thank the gentleman from 
California for organizing the Special Order so that we could actually 
discuss some of the problems with going forward without a CBO score, 
without knowing what we are doing. Certainly, it is not an improvement 
in the Affordable Care Act.
  Mr. GARAMENDI. Mr. Speaker, I thank the gentleman from Virginia (Mr. 
Scott) for expressing Virginia's view. From California, it is, whoa, 
wait a minute, let's be careful.
  Mr. Speaker, I yield back the balance of my time.

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