[Congressional Record (Bound Edition), Volume 163 (2017), Part 3]
[House]
[Pages 4455-4458]
[From the U.S. Government Publishing Office, www.gpo.gov]




             HISTORICAL CONTEXT OF THE AFFORDABLE CARE ACT

  The SPEAKER pro tempore (Mr. Hollingsworth). Under the Speaker's 
announced policy of January 3, 2017, the gentleman from Texas (Mr. 
Burgess) is recognized for 60 minutes as the designee of the majority 
leader.


                             General Leave

  Mr. BURGESS. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and include extraneous materials on the topic of the Special Order.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. BURGESS. I thank the Speaker for the recognition.
  Mr. Speaker, October of last year, October of 2016, Bill Clinton, 
speaking in front of a group of people in Michigan, said:

       So you have got this crazy system. There are all these 
     people out there who are busting it sometimes 60 hours a 
     week, and they wind up with their premiums doubled and their 
     coverage cut in half. It is the craziest thing in the world.

  Mr. Speaker, I don't often agree with former President Bill Clinton, 
but that quote pretty much sums up why we are here doing what we are 
doing this week with trying to fix the problems inherent in the 
Affordable Care Act.
  Now, sometimes people turning in and watching these hours must wonder 
how can it be we are talking about the same thing where one side says 
it is good and one side says it is not. Mr. Speaker, it may help to set 
some of the historical context. I would like to do that tonight. I 
would like to talk about the beginnings of what we now know as the 
Affordable Care Act. Some people refer to it as ObamaCare.
  This is a bill that was signed into law 7 years ago this month, but 
it didn't just spring forth. There was a lot of work involved in 
bringing it forward and getting it heard and getting it voted on on the 
floor of this House. I was part of the Energy and Commerce Committee 
that summer, as I still am today. The Energy and Commerce Committee did 
hear what was then H.R. 3100, several hours of markup in the committee, 
several days of markup. Other committees marked it up, and H.R. 3100 
was a 1,000-page bill that left our committee. I didn't vote for the 
bill. I didn't think it was a good idea, but it did have Republican 
amendments at the end of that process.
  That bill then went to the Speaker's Office--not to the Budget 
Committee, but to the Speaker's Office. Speaker Pelosi put it together, 
and when it emerged, it was a 2,000-page bill that really didn't have 
much to do with the bill that was marked up in the committee. But, 
nevertheless, the bill came to the floor of this House; and in November 
of 2009, after a significant amount of debate, a significant amount of 
anxiety expressed on the Republican side and even some on the 
Democratic side, the bill was passed by a very slim majority. The bill 
went over to the Senate, and that was the end of that bill.
  What happened next was there were--it was not exactly a bill--several 
drafts of several ideas that people had over on the Senate side; and 
the Senate took up a bill that the House had previously passed, H.R. 
3590 was the number of that bill, and the Senate debated and passed 
that bill on Christmas Eve of 2009. You may remember there was a 
snowstorm that was descending upon Washington, kind of a familiar 
story, a snowstorm that was coming to town. The Senators wanted to get 
home before the snowstorm hit, and they passed H.R. 3590.
  Remember, back in those days, the Democrats had a 60-vote majority in 
the Senate. They were able to cut off debate and pass the bill on a 
party-line vote with 60 Democratic Senators voting in favor of that 
bill.
  Then something strange happened. The Democrats actually lost a Senate 
seat in a special election in the State of Massachusetts that they 
weren't expecting to lose. As a consequence of losing that Senate seat, 
now, instead of a 60-vote majority, they had a 59-vote majority, so 
they actually could not cut off debate. It was not a filibuster-proof 
majority.
  Harry Reid told Nancy Pelosi, who was then the Speaker of the House: 
Well, I have done everything I can do. You are just going to have to 
pass our bill as it is. I can't make any changes to it.
  Speaker Pelosi wisely said--I am paraphrasing here because I don't 
remember the exact quote--but I think she said: I haven't got 100 votes 
for that thing over here in the House.
  I think she was right. But they worked on it, and President Obama 
worked on it, and 3 months later, in March of 2010, indeed, they did 
bring that vote up in the House, passed exactly what had passed in the 
Senate. As a consequence, since the Senate bill was actually an 
amendment to a House bill that didn't have anything to do with health 
care in the first place, but since it was only an amendment to a House 
bill that had passed the House, so many as are in favor agree with the 
amendment to the Senate bill, the number being 218, that bill went down 
to the President for a signing ceremony that very same week. Thus was 
born the Affordable Care Act.
  Now, what has led us to the point where former President Bill Clinton 
would say that it is a crazy system? Well, there is a lot of discussion 
back and forth.
  Certainly, Republicans took the majority shortly after that bill was 
signed into law. I would submit that because that bill was signed into 
law, Republicans regained the majority in the House of Representatives 
in 2011 and since that time have had a number of votes either trying to 
repeal the Affordable Care Act or improve the Affordable Care Act. A 
number of those votes have, indeed, been bipartisan votes, that is, 
Democrats have voted with Republicans.

                              {time}  2030

  I think the total count is there have been 47 Democratic votes to 
either repeal, replace, reform, or repair the Affordable Care Act. It 
really has been a bipartisan effort these past 7 years.
  We are where we are today because of the problems that exist in the 
bill. Despite the talk that we heard in the last hour, people are 
suffering under this.
  There is a gentleman back home in my district. I think he is a 
plumber by profession. He has previously been diagnosed with bladder 
cancer. He says, under his Affordable Care Act policy, he gets to go 
see his primary care doctor once a year. His primary care doctor says, 
Well, you need to go to a urologist to have your cystoscopy, but his 
deductible is so high, he doesn't do it. He has got access to 
insurance, but he doesn't really have access to the kind of care that 
he needs that could be lifesaving and could prevent him from

[[Page 4456]]

having a much greater problem down the road.
  We can all bring our individual stories out, but the fact of the 
matter is, access to coverage is not the same thing as access to care.
  During the course of the campaign this last fall--and I remember this 
very specifically because November 1 was the day that the new rates 
came out--the open enrollment period for the Affordable Care Act opened 
up on November 1, and people got a glimpse of what their marketplace 
rates were.
  As a consequence of those marketplace rates, people started to pay 
attention. There was still another week to go before election day, and 
people started to pay a significant amount of attention to what the 
rates were.
  It isn't just the rates. It is the access. One-third of U.S. counties 
have only one insurer willing to sell in marketplace in those counties. 
I think the number is either five or seven States that have entire 
States with only one insurance company. That is not really choice. That 
is not really access. That, in fact, is a monopoly.
  2017 was a year marked by a sharp rise in premium increases across 
the country. Seven States saw premium increases of more than 50 
percent. Texas was about 25 percent. Some States went up over 100 
percent.
  The individual mandate, which was part and parcel of the Affordable 
Care Act, the most coercive Federal legislation passed since the income 
tax passed 100 years ago--the individual mandate is the reason that the 
Affordable Care Act has never achieved widespread popularity. But even 
with the individual mandate--that is, we are going to send the Internal 
Revenue Service out and make them make you buy health insurance--over 
19 million taxpayers elected to pay the mandate penalty or claim a 
hardship exemption.
  There were 6.5 million individuals who paid the penalty and over 12.5 
million people claimed a hardship exemption, according to the Internal 
Revenue Service's own files.
  The Centers for Medicare and Medicaid Services reported that 10.5 
million individuals enrolled in an exchange plan through the first half 
of 2016. More than twice that number chose to either exempt themselves 
through a hardship waiver or just simply pay the fine and walk away 
from the obligation to purchase insurance.
  I am firmly of the belief that the individual mandate has no place in 
a free society. The one central thesis of the Affordable Care Act that 
I long to see repealed is the repeal of the individual mandate. While 
we are at it, we might as well take care of the employer mandate.
  By the way, President Obama delayed the employer mandate for 2 full 
years, not by a House passed bill, but by administrative fiat. He 
simply decided, prior to the Fourth of July in 2013: You know what? The 
employer mandate is going to cause trouble in the next congressional 
election, so I will just suspend it.
  In a blog post put up by Valerie Jarrett on the evening of July 2, 
2013, the employer mandate was simply suspended for a couple of years 
because it was felt to be too onerous and because of the effect that 
they feared it would have on the midterm elections in 2014.
  Time after time, the Obama administration took it upon themselves to 
delay or turn back a portion of their own law, and there were multiple 
times where there were votes taken on this floor.
  I think of the 1099, the paperwork that was going to be required in 
the business-to-business transactions; the 1099 forms that were 
required under ObamaCare that were repealed by this House in a 
bipartisan fashion because it did pass in the Senate, and the Senate 
was controlled by Democrats at the time.
  Also, the CLASS Act, a particularly onerous part of the community 
living access ostensibly to provide some help with long-term care, 
except it really didn't. It was in an actuarial death spiral even 
before it was enacted. It was one of those things in the Affordable 
Care Act where you paid for 10 years of taxes and got 6 years of 
benefits. When they got finished collecting the taxes, it was decided 
they better do away with the benefit because, in fact, there was no 
benefit there at all.
  Time after time, in a bipartisan fashion, this House has taken action 
to restrict or remodel or repair or repeal portions of the Affordable 
Care Act. We are now coming up on a time where significant change is 
going to occur in the issuance of health care in this country. The 
change is going to be tough. We always knew it would be, but it is the 
right change.
  The Energy and Commerce Committee, the Ways and Means Committee, and 
the Budget Committee have put together legislation that we will be 
hearing up in the Rules Committee later this week; the American Health 
Care Act, which will come to the floor before the end of this week. Let 
me just make a prediction: it will pass the floor of this House.
  I see that I am joined by a colleague this evening. I yield to the 
gentleman from Georgia (Mr. Carter) to talk on this issue or any issue 
that may come to his mind.
  Mr. CARTER of Georgia. I thank the gentleman for yielding, my good 
friend, Representative Burgess from Texas.
  We are very blessed to have Representative Burgess' leadership on the 
Energy and Commerce Subcommittee, as he chairs the Health Subcommittee 
and brings his years of experience. I want to thank him for his 
leadership and for holding this tonight.
  Mr. Speaker, every day, I hear stories from folks all across my 
district in the First Congressional District of Georgia, in southeast 
Georgia, who have been forced to choose. They have been forced to 
choose between paying their monthly insurance premium or buying other 
essentials for their families.
  I want to give you an example of someone who I am talking about--a 
real life example, someone who has experienced this.
  Consider the case of Bob Joiner. Bob Joiner is an independent adviser 
in south Georgia. His wife, Kim, is an audiologist who works in a small 
practice that does not provide healthcare benefits.
  Bob and Kim exercise regularly. They watch their nutrition. They are 
fortunate to have no health problems. They also have a 28-year-old son, 
Wesley. In 2016, Bob's monthly healthcare premium increased 134 
percent, and his son's healthcare insurance climbed to an astonishing 
190 percent. In total, their 2016 annual premiums were $4,285 for their 
son Wesley, and for them it was $19,026.
  The Joiners should have been hopeful that in 2017 they could change 
their plan for something more affordable. But thanks to ObamaCare, that 
wasn't the case. You see, what ObamaCare has done is to limit choices.
  In 2017, there was only one ObamaCare-compliant plan that was 
accessible to the Joiners on the healthcare.gov website. An additional 
policy featuring a higher deductible with lower premiums was available; 
however, the plan was not ObamaCare compliant, leaving the Joiners 
subjected to the penalty. Before ObamaCare, the Joiner family's annual 
premium was $7,400. At the time, they had access to multiple providers 
and dozens of plan designs.
  Unfortunately, ObamaCare has brought chaos into the healthcare 
system. The Joiners are not alone. This is just one example of many 
throughout my district and throughout America of what ObamaCare has 
done.
  ObamaCare has done, essentially, three things. First of all, it has 
taken away choice. It has limited choices.
  Representative Burgess mentioned the fact that a third of the 
counties in America right now only have one provider. Only one 
provider. That is not a choice. Five States only have one provider. 
That is not a choice. Sixteen counties in Tennessee have no provider. 
No one. That is not sustainable.
  We have a situation that faced us here in the majority party, the 
Republican Party. We had to decide: What are we going to do? Should we 
even touch health care or should we just leave it alone?
  We did the right thing. We said: We need to rescue the healthcare 
system here in America. We have got to act, and we have got to act now.

[[Page 4457]]

ObamaCare is imploding. We know that. Premiums have gone up, on average 
this year, 25 percent. In seven States, they have gone up over 50 
percent. It is simply not sustainable.
  It has decreased choices and increased cost. It has also caused much 
red tape and many obstacles between patients and their healthcare 
providers, between patients and physicians, between patients and 
pharmacists. That is not the way health care is supposed to be in 
America.
  I am a strong believer in health care. I am the only pharmacist 
currently serving in Congress. My professional career, like 
Representative Burgess, has been dedicated to health care. I am just 
not going to sit around and watch the greatest healthcare system in the 
world be ruined. That is why we have passed out of three committees 
thus far the American Health Care Act.
  Representative Burgess mentioned the fact that it has been through 
the Energy and Commerce Committee, it has been through the Ways and 
Means Committee, it has been through the Budget Committee. Now it will 
be on the floor this week.
  Thursday will be a historical day for our country. It will be a 
historical day for health care in America. What are we going to be 
offering? We are going to be offering a plan that increases choices, 
that increases accessibility, that cuts red tape, that removes barriers 
between patients and healthcare professionals, that empowers people. It 
empowers citizens to be able to make their own healthcare choices.
  Instead of having Washington, D.C., in their infinite wisdom, 
infinite knowledge, tell you what you need to have, you now will decide 
what you need to have, what is best for you, what is best for your 
family. That is what it is all about. That is one of the many reasons 
it is so good.
  This plan offers so many good things in it. Health savings accounts. 
To be able to put more into a health savings account, to be able to 
roll it over from year to year, to be able to increase the amount in 
there, and even pass it on to survivors.
  We utilize tax credits to make sure that, no, unlike ObamaCare, you 
are not penalized for not having insurance, but instead, you are 
rewarded for having insurance. That is what we are going to do.
  Of all the bad things that I think ObamaCare has done to the 
healthcare system in America, first of all, it has taken the free 
market out of health care. No more competition, as we noted earlier. 
But the second thing has been this Medicaid expansion. That really is 
something that I take offense to.
  Medicaid is a great program. It is a program that is necessary. It is 
a safety net program. It is intended to take care of the aged, the 
blind, the disabled, children and mothers. It was never intended to be 
for able-bodied adults. This is not what a safety net program is about.
  Under ObamaCare, I hear the other party say: Well, we have added 20 
million people onto the insurance roles. Well, let's look at that. 14.5 
million of those people were added on to Medicaid expansion. We 
shouldn't be calling this ObamaCare. We should be calling it ObamaCaid. 
Able-bodied adults added on to a safety net program. We are revising 
Medicaid. We are reforming Medicaid.

                              {time}  2045

  Medicaid is going to be even better for those people who need it. 
Instead of diluting that program, we are going to make sure that those 
people who truly need it--the aged, the blind, the disabled, children, 
mothers--have more access to it, as they should.
  We promised three things among many things, but we promised, hey, we 
are going to keep a couple of things in here. We are going to make sure 
that parents can continue to have their children up to age 26 on their 
insurance. We promised that we were going to make sure that preexisting 
conditions were going to be included and that you would not be kicked 
off of your health insurance. We promised that we were going to have a 
stable transition. We are doing just that.
  We are delivering on those promises. We are making sure--I often get 
asked: What about that 100 to 138 percent of the Federal poverty level? 
What are you doing for them?
  Well, we came up with a refundable tax credit that is actually going 
to pay their insurance. That will go directly to pay their insurance.
  The American Health Care Act delivers on what we promised. What we 
promised is that we would have more choices. What we promised is that 
we would have more accessibility. What we promised is that we would 
empower patients. We are doing that. We are empowering people. We are 
rescuing health care in America. I intend to vote for this plan 
Thursday night, and I am going to be very proud to vote for it.
  We are going to rescue the healthcare system that I practiced in for 
over 30 years. I have seen how competition works in the healthcare 
system. I practiced in it. I have competed in it. I have seen how it 
lowers costs, and it will lower costs. People now will be empowered to 
have the ability to choose their own insurance instead of being 
mandated from Washington, D.C., what kind of insurance they should 
have.
  I thank leadership for what they have done to pull this together. I 
thank the President. The President is behind this. President Trump made 
it one of his campaign promises: We are going to repeal and we are 
going to replace ObamaCare.
  You know, it amazes me the media seems to--I get asked quite often: 
Can you believe he is doing this? Can you believe he is doing that?
  I just think: Didn't he tell you he was going to do this? Didn't he 
tell you he was going to do that?
  I think they are just amazed that we actually have somebody in the 
White House who is delivering on promises that he made, and he is doing 
just that.
  This is a historical week in Congress. Thursday will be a historical 
day. We are rescuing health care. I am going to be proud to vote for 
this bill. Again, I thank leadership. I thank the White House. I thank 
Representative Burgess, who has been a great leader through all this 
and has had a big part in this. I thank him for his part in this as 
well.
  Mr. BURGESS. Well, as the gentleman knows, he and I spent--what was 
it--27\1/2\ hours in a committee markup 2 weeks ago getting us to this 
point. So the gentleman from Texas thanks the gentleman from Georgia 
for his part and his participation. That was a very long markup, but he 
stayed attentive and asked good questions and offered good insights all 
the way to the end. We were very fortunate to have him on the 
committee. I have been on the committee a few more years, but it was 
certainly one of the nights on that committee that I will long 
remember.
  Mr. Speaker, I yield to the gentleman.
  Mr. CARTER of Georgia. Again, I thank the gentleman from Texas for 
leading this Special Order here tonight, and I thank everyone who has 
been involved in this.
  Mr. BURGESS. Will the gentleman maintain his position for just a 
moment so perhaps we can engage in a brief colloquy?
  Mr. CARTER of Georgia. Absolutely.
  Mr. BURGESS. Of course, the gentleman was not here in 2009-2010 when 
this thing came down the pike, but you may remember the townhall 
meetings from that summer, that August of 2009, and they were pretty 
intense. We hear a lot about townhall meetings today, but I promise you 
they were every bit, if not more so, intense during August of 2009.
  When I look back on that, Mr. Carter, what I remember is really two 
things that people were asking. Yes, it wasn't nearly as long as what 
the Affordable Care Act ended up being, but still a thousand-page bill, 
people have to dig through it, have to understand it. And the two 
things that I took away from those townhall meetings back in the 
district were people were telling us, number one: Don't mess up what we 
have got. We have something, and it may be imperfect, but by golly, it 
is working for us and our families right now, so don't hurt that.
  The other thing they would ask is: If you are going to do anything at 
all,

[[Page 4458]]

could you please help us with cost, because we are concerned about the 
cost of these products and we are concerned what the trajectory may be 
for the costs going up over time?
  I will just ask the gentleman from Georgia--since he was a citizen at 
that time, how does the gentleman from Georgia think we did with those 
two requests that were coming to us from our constituents?
  I use the term ``we'' advisedly. Obviously, I voted against that 
bill.
  But as things turned out with the Affordable Care Act, how did that 
turn out for the American healthcare consumer?
  Mr. CARTER of Georgia. Well, as we say in south Georgia, the proof is 
in the pudding, and the proof is right here. Premiums have gone up this 
year. Look, one thing that amazes me is we have almost created two new 
classes of uninsured. First of all, through ObamaCare, it has mandated 
that people have insurance. So you have got a class who have insurance, 
but their deductibles are so high they can't afford to use it. So there 
you have a new class of literally uninsured. Then you have another 
class of people who were able to afford insurance before, but now it 
has gotten so expensive, they just pay the penalty. They cannot even 
afford it. I think it has done just the opposite of what it was 
intended to do.
  I have heard this same argument, that we had to do something, that 
costs were rising. I will agree that we have to address healthcare 
costs. We do. We are. In fact, we are doing it this week. Remember, 
this is the first phase. As you pointed out, what we vote on this week 
is only the first phase. We have got two more phases to go. In those 
two phases, we intend to do a lot that is going to help control 
healthcare costs.
  I like to give the example, if you will indulge me for just a minute, 
when I was still practicing pharmacy--and I tell you this to explain 
just how competition works. When I was still practicing pharmacy, I 
still had my pharmacy, and I still owned it at the time. This drugstore 
opened down the street, a tiny company. I am trying to remember the 
name. Oh, yeah, it was Walmart.
  They decided they wanted to be a player in the healthcare system, in 
the pharmacy system, in the pharmacy market. So they came out with this 
idea that they were going to sell a 30-day supply of generics for $4. I 
thought to myself, they must be crazy, I can't even buy it for that 
much. I bowed my back and I said: I am not going to do that. I am not 
going to do that.
  Well, guess what. A week later, I was doing it.
  I had people leaving my store. And I called my supplier up and I 
said: You have got to do something here, you have got to help me.
  That is the way competition in health care works. When you have got 
choices, when you have got competition, prices go down, quality goes 
up. Sometimes we get caught up too much in the numbers game, thinking, 
oh, we have got all these lives covered. Coverage does not necessarily 
equate quality health care, as you well understand. We have to be very 
careful with that.
  Now, we want people to have coverage, and we want them more so to 
have quality health care. This plan addresses that. It addresses it by 
increasing choices, by increasing competition, by increasing 
accessibility, and by empowering people. I am very proud. I am going to 
be very proud to vote for this bill on Thursday.
  Mr. BURGESS. Mr. Speaker, I thank the gentleman for participating 
this evening. It means a lot to me individually that he was willing to 
come up and stay up late with us tonight yet one more night dealing 
with the Affordable Care Act.
  But the gentleman is quite direct. The journey of a thousand miles 
starts with the first step. It is a three-part program. This was the 
first part, the first phase that will happen on Thursday night. This 
deals with some of the more egregious aspects of the Affordable Care 
Act, those things that can be tackled through Senate rules of 
reconciliation that only require 51 Senators to get passed. So that is 
one part of this.
  Another part is the administrative part. And our former colleague 
from Georgia, Tom Price, a physician, who is now Secretary Tom Price 
for the Department of Health and Human Services, he has an 
administrative part that is actually already underway. We don't have to 
wait for that to happen. It is already occurring.
  Then there is the third part, the so-called regular order part, the 
part that will require 60 votes on the Senate side, the part that is, 
by its very nature, going to be bipartisan. We have reported two rules 
out of the Committee on Rules tonight, one on the McCarran-Ferguson 
changes that I think the gentleman is well aware of. There are already 
additional bills that will be coming to the floor of the House that are 
separate and apart from this reconciliation bill, which is just the 
first step in repealing the Affordable Care Act.
  I do want to point out that Secretary Price sent a letter to the 
Governors last week or a week and a half ago now talking about some of 
the waivers that he is bringing forward right now, the 1332 waivers, 
which are waivers for parts of the Affordable Care Act.
  Quoting from his letter here: ``Under Section 1332 of the ACA, states 
can apply for State Innovation Waivers and pursue innovative strategies 
to adapt many of the law's requirements to suit the state's specific 
needs.''
  So many details to receive approval, what a State has to do, but he 
really stresses in this letter and in one of the last paragraphs: ``We 
encourage states interested in applying for Section 1332 waivers to 
reach out to the Departments promptly for assistance in formulating an 
approach that meets the requirements of Section 1332.''
  I know the gentleman hasn't served here that long, but I will just 
tell you, that is a sea change of difference from the Federal agency 
which time after time told our Governors: No. Stop. Go back to go. Do 
not collect $200. You can't do that.
  Now we have a Secretary at the agency who is reaching out to the 
Governors: Governor, we want to help you make this work for you. We are 
going to provide the flexibility that you need.
  One of the things that I think is perhaps most promising is the 
hybrid, high-risk pool, State-operated reinsurance programs that have 
been proven in several States already. States that were in a so-called 
death spiral because of guaranteed issue community rating, the premiums 
were going up, people were dropping their coverage. And now these 
States have expanding coverage even without the things that we are 
providing in the American Health Care Act that we are going to be doing 
later this week. But already by providing that flexibility at the 
agency level, States are able to provide some relief for their 
citizens.
  Then, finally, the part three of this. There are going to be some 
must-pass healthcare bills that will be coming up through our 
committee. We will have an opportunity to work on those things. We are 
going to work on the Food and Drug Administration user fee agreement 
reauthorization. So we will have that, which can happen as a bipartisan 
exercise in our committee.
  I will just stress, the Committee on Energy and Commerce has a 
history of doing things in a bipartisan fashion. One of the reasons why 
I enjoy serving on that committee is it is a thoughtful committee and 
it does do things in a bipartisan fashion. Generally, that is one of 
the strengths of the committee as it brings legislation to the floor.
  This is an important first step. It is a necessary first step. This 
is the key that gets us through the door of actually making a 
meaningful impact on cost and coverage in these United States. It has 
been 7 long years, but I am anxious and eager to get started on the 
next part of the process.
  I thank the gentleman from Georgia for joining me here this evening.
  Mr. Speaker, I yield back the balance of my time.

                          ____________________