[Congressional Record (Bound Edition), Volume 163 (2017), Part 4]
[House]
[Pages 4554-4560]
[From the U.S. Government Publishing Office, www.gpo.gov]




     BRINGING DOWN THE COST OF HEALTH INSURANCE PREMIUMS IN AMERICA

  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 thank the Speaker for this opportunity 
to continue the discussion. My colleague from Texas really left here a 
moment ago with a plea about bringing down the cost of health care in 
America. Actually, it was the cost of premiums in America. That is a 
plea that I think all 435 of us would echo. It would certainly be our 
goal, as representatives of the American people, to find some way to 
accomplish that, some way to bring down the cost of premiums.
  I would like just to make a point right at the outset. When 
discussing health care, there are really two connected, but very 
separate, parts to the healthcare system.
  One part is the delivery of medical services. These are the doctors, 
some of whom are in organizations of doctors of various specialties. 
Some are in large practices, such as the Kaiser practice. Some are in 
hospitals disconnected from doctors. But there is just a plethora of 
different ways in which medical services are delivered. That is the 
delivery of medical services. That is one part of it.
  The other part of the healthcare system in America, and really 
anywhere in the world, is the collection of money to pay for the 
services. Now, in the United States, we have many different ways to 
collect the money. One of them is through taxes. And this is how we pay 
for Medicare and Medicaid, what we call MediCal in California. We pay 
for the veterans' medical services through the collection of taxes, 
children's health services, and some other programs that are much 
smaller. So that is one way in which we collect the money to pay for 
services. You might call those single-payer taxpayer services, 
taxpayers' money being spent on services delivered by that whole range 
of providers, some of which happen to be government providers, for 
example, the Veterans Administration and military medical services.
  Now, the other way in which we collect money to pay for services are 
premiums, health insurance premiums that are charged by health 
insurance companies. The largest single part of that is from 
corporations, businesses, that buy health insurance and pay the 
premiums. And the others are individuals, and this is the individual 
insurance market. There are some small group markets out there, also. 
But these two systems, we need to understand that they are different. 
They are connected, obviously.
  Now, if we are going to deal with the cost of premiums, you have to 
go over and deal with the cost of health care, because the health care 
drives the premiums and also drives the amount of money that we need to 
raise to pay for the services that are provided by the various 
governmental programs.
  Now, in the Affordable Care Act, which is now some 7 years old 
Thursday of this week, the seventh anniversary of the passage of the 
Affordable Care Act, there are some very powerful mechanisms to reduce 
the cost of health care--doctors, hospitals, and the rest. Some of 
these are electronic medical records so that there is a continuity of 
knowledge as to what happened, what was provided, what services were 
provided to the individual.

                              {time}  1730

  Another one happens to be a penalty assessed on hospitals for 
hospital readmissions on hospital-acquired infections--profound in 
driving down the cost; also extremely important for individuals because 
hospital infection rates dramatically dropped.
  There are also ways in which we pay for the services. It is very 
clear that the utilization of fee-for-service drove up the cost.
  Anyway, as we go through this discussion today on the Affordable Care 
Act, and I see I am being joined by my colleagues here, I just want us 
to keep in mind that in order to deal with the cost of premiums, you 
have got to deal with the cost of services that are provided.
  Now, in the Affordable Care Act, we actually saw, over the last 5 
years as the Affordable Care Act, ObamaCare, went into effect, a 
decrease in the rate of increase. We haven't seen a decrease in the 
cost of medical services, but what we have seen is that the inflation 
rate has significantly reduced, so much so that the financial security 
of the Medicare program, which is the single biggest expenditure, has 
been extended by some 11 years because the inflation rate has 
declined--not decreased, but the rate of inflation has declined almost 
50 percent from what it was before the Affordable Care Act.
  That is a direct result of the many reforms that went into the way in 
which medical services were delivered. That allowed for a lower 
inflation rate for premiums and an extension of the financial viability 
of Medicare and other medical programs.
  Now, unfortunately, we are now faced with a repeal or a partial 
repeal of the Affordable Care Act, and the promise has been made by my 
Republican colleagues that somehow this will reduce the premiums. Well, 
that is interesting. Now, exactly how are you going to reduce the 
premiums unless you are dealing with the cost of medical care?
  In their reforms, there is--as best I can determine and everybody 
else--no effective way to reduce the cost of medical services and, in 
fact, the high probability that the cost of medical services will 
increase, specifically, because, in their proposed reform, men and 
women that are 45, 50 to 65 are going to find it virtually impossible 
to continue to buy insurance. They will drop their insurance. That is 
part of those 14 million Americans that will lose their insurance next 
year and part of the 24 million Americans that will not have insurance 
9 years from now.
  That population, before they get to Medicare, when they begin to get 
ill, 40, 50, 60, they will not be able to afford insurance. It is 
something like a $12,000 increase in cost to them. It is what is known 
as the senior tax.
  Now, that will drive up the cost of medical services. Because they 
will not be able to have continuity of care, their diabetes, their 
heart issues, their high blood pressure, and on and on will not be 
treated.
  Similarly, in the proposed reform, there is a significant reduction 
in the number of men and women across this Nation--and we are talking 
probably in the range of 4 to 6 million in the next 2 years that will 
not be covered under

[[Page 4555]]

the Medicaid program. Those people, not having access to continuous 
medical services, will not seek treatment for those illnesses that can 
be treated effectively or held in abeyance, such as diabetes, heart 
disease, and the like. That means that the cost of medical care for 
them will rise.
  Where will they go to get medical care? Not to worry, say our 
Republican colleagues. They can go to the emergency room. We have been 
there. We have seen what that means.
  The expansion of the Medicaid program is unraveled by the proposed 
TrumpCare. I am going to come back to this.
  I would like to ask my colleague from Texas to carry on here, if you 
would. I yield to the gentlewoman from Texas.
  Ms. JACKSON LEE. Mr. Speaker, I am going to take just a moment.
  This is an excellent presentation. I think our constituents should be 
aware, and our colleagues, of your enormous knowledge as the former 
State insurance administrator in California, years of service to the 
people of California, and we are grateful for that analysis because you 
are right on the money, if you will, on the disaster or the questioning 
that comes about through two points: the existing bill, and then now an 
amendment which has been called meaningless that will be on the floor 
on Thursday, meaning that this bill has been amended by those who want 
to make it worse.
  We sat in the Budget Committee on Thursday with Ranking Member 
Yarmuth most of the day trying to debate these numbers. So I just want 
to make points about wellness, about some of the criteria that maybe is 
misrepresented as making the insurance product more expensive.
  To the Republicans, 10, 20 years ago, the product you had may not 
have been worth what you paid. In the product we have now, preexisting 
condition, stay on your parents insurance until you are 26, certain 
criteria that the insurance companies must have, by the nature of the 
market, premiums go up to take in the idea that there are ``better 
benefits.'' I would argue that those benefits should have been there, 
but they are better benefits.
  The other thing is that there was a formula which pushed millennials 
into the market or into the pool of people and persons that will 
purchase insurance.
  Now, let me be very clear. I think we have not seen the end of the 
story. I believe that 10 years, 15 years, the young population will buy 
insurance. It is an educational curve. And so as they buy insurance, 
they will create that cushion.
  Now, let me make this other point. Premiums are raised under this 
Republican bill, really raised, and then there are smoke and mirrors to 
say, oh, at a certain point it will go down 10 percent. But it goes 
down on the raised amount.
  If you allow the Affordable Care Act to continue, we have a very 
large piece of wellness. Talk to your doctors. It is working.
  Individuals are coming in, taking advantage of the wellness check. So 
they are not coming in with metastasized cancer, with thyroid 
conditions. They are not coming in on a stretcher with strokes or a 
heart attack because they are getting wellness care. When you get 
wellness care, on the other side of the curve, premiums go down because 
you get more well people.
  I want to finish on this point of Medicaid that we were just 
debating.
  Over and over again, it doesn't seem like there was any understanding 
that Medicaid is now part of people's insurance. And it is not a 
situation where I have seen many of my constituents stand on the street 
corner with a sign, saying, ``Give me Medicaid.'' You get Medicaid 
either through the expanded Medicaid.
  And for our colleagues, that means that you are in a State where your 
insurance comes through expanded Medicaid; or you are a sick and 
elderly person in a nursing home or a disabled person; or you are 
blind; or you are a pregnant woman; or you are a mother with children; 
or you are on the children's health insurance program, which I was here 
in 1997 when this miraculous bill came forward and we established the 
Children's Health Insurance Program, which is a Medicaid-based program 
that gives millions of children insurance.
  But under this bill, all of that will be capped. It will be per 
capita. So the $880 billion is being cut, my fellow Americans, ladies 
and gentleman, from your insurance.
  Then, finally, this bill could not be more cruel. Besides the ailing 
that are in nursing homes--and I do want to tell one story of an 
individual who got into the nursing home, Mr. Speaker, because they 
didn't have insurance to take their medicine, and it resulted in heart 
attack and stroke. They are not an old person, but they are totally 
disabled, and they are in the nursing home on Medicaid now.
  But in the Budget Committee, two amendments came up that I was just 
stunned. You worked very hard on the opioid legislation. Some of it 
came out of my committee, Judiciary Committee. Many Members have worked 
hard on this.
  They had an amendment saying no able-bodied man or person should get 
Medicaid. I don't know what that definition is. Are you an addicted 
young person, wholly addicted on opioids, that needs medical treatment? 
Are you an able-bodied person because you have all of your faculties 
and limbs but you are sick and addicted?
  And then, don't incentivize Medicaid. I am trying to find out what 
that means because all of my hospitals--and I think one of the things 
the Affordable Care Act has done is to question costs and to work hard 
to bring costs down in hospital care and to have an accountability 
assessment on that.
  But to finish, I have not heard my rural hospitals, I have not heard 
my public hospitals, I have not heard the Texas Medical Center talk 
about people being incentivized to get Medicaid. They are sick and they 
come in for whatever they have.
  The last point is someone gave an example that they were able to have 
a transplant because they were under the Affordable Care Act with 
expanded Medicaid.
  So I want to thank the gentleman for raising these very important 
points, but it baffles me that there is such a skewing of a very 
successful legislation, very difficult. It was a very difficult piece 
of legislation. It took years, the Affordable Care Act, and it is doing 
what it is supposed to do.
  As we have heard before, you can get more insurance companies. We 
have to do something with the premiums, and that is fixing or 
improving. But that is not what we are doing here. We are literally 
cutting people off of insurance.
  I will give you the number that I keep using: 2026, 52 million 
Americans will be uninsured, and that will be our constituents all over 
the Nation. That is because of the underlying bill, this bill that is 
coming up now--which there are those who want it to be even worse. I 
just heard a gentleman say he wants to take away all the mandates. It 
will be worse on the American people, and I don't want to make America 
sick again.
  Mr. GARAMENDI. I want to thank the gentlewoman from Texas, Sheila 
Jackson Lee, for her consistent and constant caring for men and women 
in this Nation that are on the outside, that are not among the wealthy, 
that are struggling with their families to improve their situation. You 
are always there. And here you are once again this evening laying out 
the problems that we are going to see with TrumpCare.
  Let me just very quickly run through this, and then I would like to 
turn back to my colleague from Rhode Island, Mr. Cicilline.
  The proposal that is on the floor, we could just lay out five very 
succinct arguments on why it doesn't work.
  I was going through a rather complete explanation of how the 
healthcare system works because it is kind of a basic understanding, 
but clearly, under the legislation that is going to be taken up this 
Thursday, Americans are going to pay more for less. And it is not just 
a few.
  The senior citizens in Medicare are going to see a diminution in 
their benefits. We are looking at the 40-to 50-

[[Page 4556]]

years-olds, which I have already discussed. We are looking at other 
individuals.
  Pay more for less, we are looking, over the next 9 years, that 24 
million Americans will lose their insurance or their opportunity to get 
insurance. And just this next year, just 18 months from now--excuse me, 
not 18 months from now. Nine months from now, we are going to see 14 
million people begin to lose their insurance.
  I talked earlier about this age tax, which speaks to those people 
that are 50 to 65 years of age. They are, under this legislation, going 
to pay up to five times more than someone who is between 20 and 30 
years of age.

                              {time}  1745

  Present law says they can be charged no more than three times what a 
20- to 30-year-old pays, and so this is what is known as an age tax. It 
simply shifts the cost to those 40-, 50-, 60-year-old people who happen 
to be the most expensive. And I talked about the $12,000 that they will 
have to pay in addition to that.
  It guts Medicaid. We call it Medi-Cal in California and Medicaid 
across the Nation. The expansion of Medicaid was an extraordinarily 
important event that provided insurance not only to men and women who 
had no income, but to 85 percent of the people on Medicaid across this 
Nation who are elderly, in nursing homes, or elderly poor, unable to 
provide sufficient income from just their Social Security--those are 
called the dual eligible--or children.
  Now, in the Affordable Care Act, there was what was known as Medicaid 
expansion; and those are the working men and women, families, who have 
less than 138 percent of the poverty rate. So those are the low-income 
working men and women who are able to get Medicaid, or Medi-Cal 
insurance in California. It simply guts it in a variety of ways, which 
we will come back and discuss a little later.
  You can bet and you can count on there being less support for the 
elderly that are in nursing homes. There will be less support for the 
young families; the single-mother families who are struggling to get 
along, probably going to school, trying to learn skills; and for the 
working families who are at $10 an hour minimum wage.
  Finally, this is the one that ought to drive Americans right off the 
rails. This is a whopping $270 billion tax reduction for the top 1 
percent of Americans. It is for 400 families in America, the richest 
400, four of which are in the current Trump administration, including 
the President himself. They will see a $7 million a year decrease in 
their taxes.
  Now, that is great. I am sure the President will enjoy that $7 
million tax reduction, along with the $3 million or $4 million he is 
getting from the taxpayers every year so he can go to his home in 
Florida.
  This is obscene. This is obscene because the way in which this thing 
works, working men and women and families across America at every 
income level are going to get less. They are going to pay for more, and 
yet the superwealthy in America are going to get a whopping tax 
reduction. This is the income distribution that we should never have, 
to take from the poor, to take from the middle class, and give to the 
superwealthy. I will come back and discuss this.
  Mr. Speaker, I yield to the gentleman from Rhode Island (Mr. 
Cicilline).
  Mr. CICILLINE. Mr. Speaker, I thank the gentleman from California 
(Mr. Garamendi) for leading this Special Order hour where we can really 
talk about the impact of what is about to happen if the Republicans get 
their way and pass TrumpCare.
  I think it is important to recognize that this proposal that is 
currently before the House will substantially hurt the American people, 
beginning with, as your chart demonstrates, the loss of coverage, when 
fully implemented, for 24 million Americans who will no longer have 
access to affordable health care and will be uninsured by 2026. Those 
are our friends, our neighbors, our family members who no longer will 
have health coverage.
  In addition, it provides an enormous tax break for the wealthiest 
people in this country. In fact, the total value of these tax breaks 
over the decade is $600 billion to the richest individuals and the 
biggest corporations. It is the largest transfer of wealth for working 
families to the very rich in our Nation's history.
  To accommodate this tax break, to give this huge tax benefit to the 
richest Americans and the largest corporations, they achieve this by 
stealing health care from millions of families all across this country 
and by cutting billions of dollars from Medicaid and Medicare. As the 
gentleman from California (Mr. Garamendi) said, the 400 richest 
families will each enjoy a $7 million tax cut; and the way they paid 
for that is they take away health care from millions of Americans.
  There is also the impact on our economy. There is a new analysis from 
the Center for American Progress, and they conclude that TrumpCare will 
destroy 1.8 million jobs.
  We are all focused on: How do we get people back to work? How do we 
create good-paying jobs?
  This is a job killer. TrumpCare will cost 1.8 million jobs, a loss of 
an ability to provide for yourself, for your family, and for your 
future.
  As you said, people will be paying more money for less quality care. 
Deductibles and out-of-pocket expenses will skyrocket, leaving sick 
people unable to afford the care they need.
  Particularly, as you mentioned, there will be an age tax because 
older Americans will pay more. Their premiums will go up at an even 
faster pace because they are allowed to charge even more based on their 
age.
  Young people are also hurt. Young people are hit with a millennial 
tax. They put a 30 percent premium surcharge on those reenrolling after 
a lapse in coverage, which is often the case, particularly with young 
people where people may have lost a job and be out of work. So they are 
going to be penalized with a 30 percent premium.
  The impact of the Republican proposal, this TrumpCare proposal, on 
women is devastating. In addition to new restrictions on comprehensive 
health care for women, this Republican bill, TrumpCare, defunds Planned 
Parenthood and will make it much more difficult for women to access 
essential preventative care and affordable contraception.
  As I mentioned, the middle-aged American--the age tax--will pay more. 
For example, a 64-year-old individual with an income of $26,000 in the 
individual market will pay $12,900 more in their premiums each year. 
That is almost half their income under the Republican plan. So it is 
going to really get those who are above 55 but haven't yet hit the age 
to receive Medicare especially hard.
  Also, TrumpCare hurts our seniors by weakening Medicaid and Medicare. 
It shortens the life of the Medicare trust fund by 3 years. It steals 
$880 billion from Medicaid, which, as you mentioned, is the principal 
source of long-term care for seniors.
  Also, it does damage to the protection for people who have 
preexisting conditions, because someone who has a lapse in coverage 
will be subjected to a 30 percent premium on top of their base premium. 
So there is another penalty for people who have preexisting conditions.
  If you take all of this together, it is worse coverage, worse care, 
higher costs, huge tax cut for the richest people in this country--for 
drug companies, for insurance companies, CEOs. To pay for their tax 
cut, we take away insurance from the most vulnerable and working people 
in this country.
  We have all received both emails and phone calls and had 
conversations with those whom we have the privilege of representing, 
and they have shared with us these heart-wrenching stories of what it 
would mean to lose their health care.
  In my State, I am proud to say that, with the implementation of the 
Affordable Care Act, ObamaCare, we have the highest rate of coverage 
that we have ever had in our State's history. Ninety-seven percent of 
Rhode Islanders have access to quality, affordable health care. It is 
great. It makes a difference in the lives and quality of the lives of 
everyone.

[[Page 4557]]

  I want to share with the gentleman from California (Mr. Garamendi) an 
email that I got from a constituent, just recently, from Lincoln, Rhode 
Island. Brenda said:

       If all goes well, I am literally going into surgery for hip 
     replacement on March 16 of this year. Though hip replacement 
     is seen as elective, the pain I deal with now interferes with 
     my quality of life. Without it, I will end up in a wheelchair 
     in a few years once I can't handle the persistent pain.
       Without the ACA, I would not be able to have this 
     operation. I do not own a home for collateral and have a 19-
     year-old car. I work full-time in a hotel for $12 an hour. I 
     have not had a raise in 4 years. We have no benefits at all, 
     including health care. We have no paid time off at all for 
     sick days, personal days, or vacation.
       I am not confident enough to move to another job with my 
     current physical limitations, which have reached a point 
     where it interferes with every activity, including sleeping.
       My doctors, who are aware that I get my medical through the 
     ACA, have been helpful and diligent about getting me in soon, 
     knowing there is a major threat for those whose only way for 
     medical coverage is through the ACA. My condition may not be 
     life-threatening, but left untreated, it would limit where I 
     can live, if and where I can work, and, most likely, leave me 
     on permanent disability or Social Security, which most people 
     can't live on.
       I am only 52. I still have several functional, productive 
     years ahead of me, and I receive a subsidy to help make my 
     coverage affordable.

  Brenda is just one example of someone whose life is literally being 
preserved. Her quality of life is being protected because she has 
access to health care. She can have the surgery she needs. She can 
eliminate the pain she is suffering and lead a productive life.
  There are millions and millions of Americans who have the same kinds 
of stories, who have benefited from the Affordable Care Act, who will 
be deeply harmed when that insurance is ripped away if Republicans get 
their way and pass TrumpCare.
  I want to end by just saying thank you again to the gentleman from 
California (Mr. Garamendi) and to also mention that he referenced, in 
his remarks, the process that has produced this very, very troubling 
piece of legislation, unlike the process that produced the Affordable 
Care Act that occurred over many, many months and many hearings, where 
121 Republican amendments were accepted into the bill and it still 
didn't earn a single Republican vote. Yet, through TrumpCare, over 100 
Democratic amendments were offered in three committees of jurisdiction 
and not a single Democratic amendment was accepted.
  So even efforts to try to improve a terrible bill were rejected in 
the committee process, and that is because they are intent on making 
sure they deliver this big tax cut to the special interests who sent 
them here to Washington, and they are going to try to do it on the 
backs of the hardworking people of this country. We have to continue to 
stand up and fight and do everything we can to prevent it from 
happening.
  Mr. GARAMENDI. Mr. Speaker, there is no better fighter than the 
gentleman from Rhode Island (Mr. Cicilline) in the representation that 
he gives to the people of Rhode Island and beyond. The gentleman 
couldn't be more accurate about all that he said.
  I was listening carefully to the story the gentleman from Rhode 
Island told of the individual who wrote him an email. I, too, have 
received many, many emails.
  I was thinking, as he was describing the situation, of a woman who 
runs her own small farm near Marysville, California, in my district. 
For years, she could not afford insurance. She had a small orchard 
farm. She couldn't afford insurance. When she got sick, she went to the 
emergency room. She was able to get along.
  But she knew that, as she approached 50 years of age, she would be 
facing a bad medical situation, and she did. She had cancer. She 
couldn't get a policy prior to the Affordable Care Act because she had 
a preexisting condition: she had cancer. Emergency rooms are not 
treating that. She wasn't able to get on a program, and she was going 
to die.
  About that time, we established, in California, a covered California 
program that is an exchange based upon the Affordable Care Act. She, 
because of her income, was able to get a comprehensive insurance policy 
and a subsidy for her premium. She then had quality insurance, and she 
was able to get the cancer treatment because her insurance had no 
preexisting conditions and she was able to afford it. She had to pay a 
little bit, but she had a subsidy that made up the difference.
  She is now looking at a situation, because she is in that age 50 to 
65, where she will not be able to afford a $12,000- or $14,000-a-year 
premium because the subsidies were taken out and because of this age 
tax, the 1-to-5 ratio rather than the 1-to-3 ratio. It is horrific. She 
knows what she is facing. She is facing the loss of her insurance and, 
quite possibly, the loss of her life.
  This is wrong. This is wrong.
  I thank the gentleman from Rhode Island for joining us tonight. I 
yield to the gentleman from Rhode Island (Mr. Cicilline).
  Mr. CICILLINE. Mr. Speaker, there are so many people that I have 
heard from in my own district, and I know colleagues have heard the 
same thing when we talk about these numbers: 24 million people will 
lose their insurance and billions of dollars in tax breaks for the 
richest people in this country. Behind every one of these numbers is a 
real person whose life will be destroyed or devastated because they 
don't have access to quality, affordable health care.
  This is the richest, most powerful country in the world. We are well 
on the way to having a system in which everyone can afford and have 
access to quality, affordable health care. We made huge progress in the 
Affordable Care Act. It is not perfect. We have always been willing to 
say: How do we make it better? How do we build on the success of it?
  The notion, in the midst of this progress, that we would deprive or 
pass a piece of legislation, this TrumpCare, that will take away 
insurance from 24 million people, that will raise premiums, raise out-
of-pocket costs, undermine Medicaid and Medicare, and also give a big 
tax cut to the richest people in this country is just so wrong.

                              {time}  1800

  I just think it is very important, as we speak about this, to 
remember, behind every one of these numbers is a story of a real 
person, a real family, just like the woman you described, just like 
Brenda in Lincoln, Rhode Island, whose lives are going to be really 
hurt and who are going to face devastating consequences because they 
don't have access to basic quality health care, which is a right in 
this country every American should have access to.
  This sets us back so far it is difficult to imagine what our 
colleagues on the other side of the aisle are thinking.
  Mr. GARAMENDI. Mr. Speaker, I see that my colleague from the great 
State of Ohio (Ms. Kaptur) has arrived. Often we have shared time on 
the floor. Ms. Kaptur, if you would care to share with us your thoughts 
on the Affordable Care Act as it exists. I know in your area it is a 
very important attribute in an area that has been known as the Rust 
Belt, and the effect of TrumpCare, RyanCare, on your citizens.
  I yield to the gentlewoman from Ohio (Ms. Kaptur).
  Ms. KAPTUR. I thank the gentleman so very much for taking the time, 
after formal votes have occurred today, to help us enlighten the 
American people on what is really at stake here.
  I have to say, President Trump carried the State of Ohio by about 
450,000 votes out of all the votes that were cast. And there was this 
slim hope, I think, on behalf of some of the people who voted for him, 
that though he was a billionaire, that there was perhaps a kind heart 
that would minister to the people of our country, helping them get more 
jobs, helping them deal with their everyday challenges, including 
health care.
  Unfortunately, this bill is cruel, and it is dangerous. It helps the 
billionaire class. Why in heaven's name, of the people that are 
drafting this bill on the Republican side of the aisle, would they be 
giving billions and billions and billions of tax giveaways to the 
wealthiest people in our country; to

[[Page 4558]]

those that, frankly, if you take away a couple of million, they 
wouldn't miss it anyway. You know, when you have that much money, 
normal life is kind of distant from your world.
  But what TrumpCare is giving to the rank and file, people are going 
to have to pay more for less coverage, and millions and millions of 
people are going to lose their coverage completely.
  Now, you know, 75 percent of the people who go bankrupt in this 
country go bankrupt because of health bills that they can't pay for. 
And so when you start tinkering around with people's health insurance 
and their coverage, you are playing with wildfire, and that is what is 
happening on the Republican side of the aisle.
  Now, it used to be that most Americans received their health 
insurance through employment, just like in Germany. We had an 
employment-based health insurance system. I like that system. I like 
for workers to share in the profits of the companies that they help 
make money for.
  But what has been happening over the years, with so much outsourcing 
that Wall Street is more than happy to finance, right, companies are 
plucked up from Ohio and put in Mexico, put in China, put in all these 
other places around the world. People lose their health insurance. They 
lose everything. They are lucky if they can hang on to their houses.
  Then what happens? What happens to them? Well, if they are lucky, 
they might get a job that pays a third of what they earned before in a 
company that doesn't pay health insurance.
  Take Walmart, the biggest employer in the country. Go take a look at 
their employees and what happens. What is happening is the corporations 
are throwing on to the back of the public sector, the Federal 
Government, the responsibility to pay for health insurance. So all the 
profits that Walmart makes, it doesn't benefit the workers there with 
any health insurance. The companies have ceded their responsibility to 
provide health insurance as a condition of employment, and they have 
transferred that to, guess what, the taxpayer. So what is going on here 
is a big shift in responsibility.
  The Congressional Budget Office, which is nonpartisan, and the head 
of it is a Republican, I might say, but it is the nonpartisan 
Congressional Budget Office reports that with TrumpCare, next year 
alone, 14 million fewer Americans will have health insurance.
  Some of those currently on the Affordable Care will drop off, and I 
am very worried about the 900,000 Ohioans who were finally able to get 
insurance, some of whom work for Walmart, some of whom work for small 
employers who couldn't afford health insurance, some of them who worked 
for big corporations that spit them out when they moved and outsourced 
their jobs, that they are going to be among these numbers.
  We are told by 2020, 21 million people will lose their coverage in 
the country; 24 million by 2026, and perhaps the total number of 
uninsured Americans rising to reach 52 million. That is going 
backwards.
  In this bill, they expect 70 million people who are currently on 
Medicaid--all right, guess what? They are in nursing homes.
  The Republican Party always says they are the pro-life party. 
Baloney. This is an anti-life bill. This is going to cost illness and 
death across this country.
  Here is a story already in my district in Ohio. A man named Joseph is 
self-employed, and he used to get his insurance from his wife's 
employer. Thank God she had employer-provided health insurance. She 
retired, and now the family faced a choice, forced upon them by the 
Republican leaders in Congress and President Trump.
  They faced the threat of no health coverage, so Joseph heard all this 
debate here. He wasn't sure what was going to happen to him in this 
fiscal year of 2017, so his choice was to go on the healthcare exchange 
and risk losing coverage if the Republicans repeal the Affordable Care 
Act and pull the rug out from under him; or he could opt for the 
guarantee of 18 months of expensive COBRA insurance. So he opted for 
the expensive choice of COBRA, which cost him and his family hundreds 
and hundreds and hundreds of dollars in additional costs per month, and 
he is putting off a knee replacement because of the uncertainty even 
consideration of this bill is causing.
  Don't tell me that this isn't cruel and dangerous. And this family 
isn't the only one in America that is facing that kind of terrible 
health choice.
  The TrumpCare proposal in States like Ohio, where we have a lot of 
rural counties, we are going to have hundreds of thousands of people 
out of work, nurses, long-term care aides.
  I just had people from Hospice in my office this afternoon, and we 
were talking about home-health care for Hospice patients versus 
institutional care, the rising numbers of Vietnam veterans coming into 
Hospice facilities.
  Well, guess what? Who is going to pay for all of that in the 
TrumpCare? These people will be dropped. They will say to the States: 
well, we will give you a little bit of money, but we will cap the 
money, you know.
  And then what happens after 2020? Hey, it is like dropping you out of 
an airplane with no parachute. Good luck.
  We can't do this. This is a death bill. This is a death knell for the 
American people. We can't allow the American people to be treated in 
this manner. So we ought to be repairing and fixing and looking in the 
windshield, not the rearview mirror of where we need to take health 
insurance in this country, but not put so many millions, ten and tens 
of millions of Americans at risk, and doling out--Congressman 
Garamendi, maybe you could repeat those numbers--over $600 billion in 
tax giveaways to the richest people in this country, many of whom 
caused the financial crash of 2008. They owe the Republic. They owe the 
people of this Republic for what they did.
  I have families in my district still underwater on their mortgages, 
if they were able to hang on to their homes at all.
  The wealthy of this country, starting with Wall Street, owe the 
American people a lot. And all those employers who abandoned their 
responsibilities and pushed the cost of health insurance on the public 
sector because they didn't have the decency to help ensure their own 
workers, well, shame on you. Shame on you.
  For all the small businesses that finally got health insurance 
through this program, thank you for respecting your workers. Thank you 
for respecting the Affordable Care Act.
  We can do a whole lot better than TrumpCare. And I really feel sorry 
that this new President, for whom many of the people in Ohio voted, 
doled up this kind of a flawed piece of legislation that is cruel and, 
honestly, will result in so many more illnesses across this country, 
because people worry about health insurance. They worry about the 
affordability of health insurance.
  Congressman Garamendi, thank you so very much for having this Special 
Order this evening and for inviting me to participate. It has been a 
great privilege.
  Mr. GARAMENDI. I thank the gentlewoman so very much for joining us. 
She asked a little bit about the health care. I am going to do this 
very quickly, then I want to turn to my colleague from the State of 
Arizona (Mr. O'Halleran).
  Under TrumpCare, or Ryan-TrumpCare, as I would like to call it, these 
huge tax cuts for millions of families, let's just focus on that for a 
second. It is the largest shift of wealth from the working men and 
women of America, poor and up through the middle class, to the 
wealthiest that has ever occurred in any tax break. The Reagan taxes, 
you name the taxes, including the Bush W. taxes, this is the largest 
single shift of wealth. It is well over $300 billion in the next 9 
years.
  As I have said before, the 400 wealthiest families, as I said, four 
of whom are now the President and three in the Trump cabinet, will get 
over $7 million a year in reductions in their taxes. In addition to 
that, the top one-tenth of 1 percent will receive over--well, nearly a 
$200,000 reduction in their taxes. That is the top one-tenth of 1 
percent.
  Beyond that, $300 billion will go to the wealthy. The top 20 percent 
of

[[Page 4559]]

Americans will get 75 percent of the tax breaks. The remaining 80 
percent of Americans will then share the remaining very small 
percentage.
  So it is part of this enormous shift of wealth, and this does not 
take into account the fact that Americans are going to pay a whole lot 
more for their insurance. So, in addition to the tax cuts, there is 
also this issue of having higher rates, less benefits going forward.
  So just to repeat again, the top one-tenth of 1 percent will receive 
nearly $200,000 a year in tax breaks. The top 1 percent will get 57 
percent. The top 20 percent get 75 percent of the 300-plus billion 
dollar tax cut, and everybody else, in this case, the lower 90 percent, 
will then share in the remaining 43 percent. Different ways of looking 
at these numbers.
  The fact of the matter is, it is a tax cut that guts the money 
necessary for Medicare expansion and for the tax subsidies that people 
count on in order to survive. It is obscene.
  Mr. Speaker, I yield to the gentlewoman from Ohio (Ms. Kaptur).
  Ms. KAPTUR. Congressman Garamendi, may I just inject, and I won't 
take up much time. But, you know, in this job, you meet everybody. I 
come from a working class family. We had to work for everything we ever 
had.
  I thank the people of my district for allowing me to serve and kind 
of learn a whole lot more about our country and the world. And one of 
the things I have learned is that when you are that wealthy, these 
billionaires, they purchase their own doctors, they purchase their own 
nurses. They have special houses where they put them in on their 
property.
  So, you know, it isn't just the tax cut that goes to the wealthiest 
among us, but the imbalance between those who have much and those who 
eke out a living is growing greater and greater and greater in our 
society.
  Now, I think everybody should have good health care. But, honestly, 
when you can do that, you are not living in the real world that the 
vast majority of Americans live in. I thank the gentleman for allowing 
me to put that on the Record.
  Mr. GARAMENDI. I thank the gentlewoman for bringing us the view from 
Ohio. Let's now talk about the view from Arizona. Mr. O'Halleran, this 
being your first year in Congress, welcome. I am delighted to have you 
join us on the floor.
  Mr. Speaker, I yield to the gentleman from Arizona (Mr. O'Halleran).
  Mr. O'HALLERAN. Mr. Speaker, I rise today to share the story of a 
young boy who lives in my district named Cameron. Cameron was born with 
a congenital heart defect, but a successful surgery at 5 weeks of age 
has given him a shot at a vibrant life.
  He is like most 8-year-olds, fearless, curious, and full of life, but 
Cameron will live with this for the rest of his life.
  His parents shared this story with me recently and expressed their 
concerns, not just about Cameron, but about the children of America who 
are under this type of a process. They have affordable coverage under 
the Affordable Care Act, despite Cameron's preexisting conditions.
  But, Mr. Speaker, they are concerned that future coverage will be 
unaffordable and unattainable as he grows up under the American Health 
Care Act, also known as TrumpCare.
  I share these concerns. I cannot support legislation that will 
drastically raise premiums for families like Cameron's and 
disproportionately impact rural communities in my district.

                              {time}  1815

  It is my hope that, moving forward, Congress can work on a bipartisan 
solution to improve the health and well-being of Americans and their 
children and protect those who need it most. We cannot continue to play 
partisan politics with the lives of our constituents, our children, our 
small businesses, and the people of America.
  Mr. GARAMENDI. Mr. Speaker, I thank the gentleman from Arizona (Mr. 
O'Halleran) so very much. The stories from the gentleman's constituents 
echoed across all of our constituencies, all across America.
  Mr. Speaker, I yield to the gentleman from California (Mr. Costa), 
who is from the Central Valley.
  Mr. COSTA. Mr. Speaker, I thank the gentleman from California (Mr. 
Garamendi) very much not only for the focus and the passion that he 
shows for this very important issue of trying to ensure that we have 
health care for all Americans, but also for the leadership he has 
demonstrated over the years. He and I have worked together in 
California on so many different issues.
  The Affordable Care Act, as we know, has provided health care for 
over 20 million Americans. Since its implementation over 6 years ago, 
the ACA in my district, which is Fresno, Madera, and Merced Counties, 
located in the San Joaquin Valley, has decreased the uninsured rate 
from 22 percent to 11 percent. It is cut in half.
  I have a marvelous, wonderful district that I take great pride in 
representing. It is one of the largest agricultural areas in the 
country. It has significant wealth, but, sadly, it has significant 
poverty. It is the combination of those two that make it a place where 
immigrants have come for decades--immigrants past and immigrants 
present--to make a better life for themselves.
  Mr. Speaker, 19,000 individuals in my district have received 
financial assistance and have been able to purchase coverage through 
the Covered California marketplace, and 121,000 individuals in my 
district are now covered by the Affordable Care Act's Medicaid 
expansion.
  The cuts that are proposed in this Republican proposal would 
devastate those individuals not only in my district, but in Congressman 
Garamendi's district and throughout the valley. My Republican 
colleagues, the five of us from Modesto down to Bakersfield, almost 
500,000 people today have insurance coverage that did not have it 6 
years ago.
  Let me give you some real examples. Tom lives in Fresno, California. 
He is 57 years old. In 2015, due to a major heart attack, he had to 
leave his job of 29 years. Tom's health insurance, though, did not 
lapse because, as a result of the Affordable Care Act, he gained 
affordable health coverage insurance through the Covered California 
marketplace. In addition, his family wrote to my office saying that 
they cannot envision his recovery being a success had it not been for 
the ACA.
  Another one of my constituents, John, who lives in Fresno, told my 
office that without the ACA, he and his wife would not have been able 
to afford cancer surgery for his wife. She is now cancer-free. And we 
know how expensive that can be.
  Austin, one of those Americans who volunteered to serve his Nation, a 
Vietnam veteran who lives in my district, told my office that his wife 
was paying $830 a month before the Affordable Care Act. Now she can 
afford health care at $400 a month--cut in half.
  Not every story with the ACA is a success story. It is not perfect. 
There are problems with the act. We should be working on it.
  I remember, Congressman Garamendi, when you were the insurance 
commissioner of California, and one of the areas that you developed a 
lot of expertise and experience on was how to deal with the insurance 
industry. Certainly there are improvements that can be made. There are 
small-business owners in my district who say that the ACA raises costs 
and does not provide enough insurance options for themselves or their 
employees. So we need to work together to fix the provisions in the law 
that drive up the costs and weaken the insurance marketplace.
  This month, the American Health Care Act was introduced to repeal and 
replace the ACA by our Republican colleagues. I do not believe the 
American Health Care Act is a serious solution to fixing the problems 
we have in the ACA. The legislation we know would provide less 
financial help to low-income families and seniors whom we both 
represent. The American Health Care Act would dramatically change the 
way we finance Medicaid by shifting from an open-ended reimbursement

[[Page 4560]]

system to a person allotment or block grant which will cap the amount 
of money in California that receive Medicaid, and that is dramatic and 
devastating.
  This would force California to choose how to allocate increasingly a 
smaller number of Medicaid dollars and would decrease the care 
available to Medicaid beneficiaries which Congressman Garamendi and I 
care deeply about. Thousands of individuals in the San Joaquin Valley 
would be impacted.
  Additionally, the legislation will not mandate individuals to 
purchase health insurance. Instead, insurers would be able to attach a 
30 percent surcharge--think about that--on individuals who have a lapse 
in coverage. I don't think that is going to play well in Peoria or in 
California. So this will provide a disincentive for young and healthy 
people to buy insurance. It is important to note that in order for the 
insurance marketplace to work, there needs to be healthy people in the 
system to help pay for sick people. When the Speaker said that healthy 
people are subsidizing sick people, well, I am not an insurance expert, 
but isn't that the way insurance works? Good drivers pay for poor 
drivers, right? If you don't have a pool, a balanced pool, it doesn't 
work.
  One last point I want to make: passing the Affordable Care Act, I was 
here in 2010, and it wasn't pretty. It took 1 year, dozens of committee 
hearings in several committees, multiple versions of the bill in the 
House and the Senate, and various revisions of it. We tried to get the 
Republicans involved. We tried to get them to participate, and we took 
amendments that they gave. But at some point, they decided that, no, 
they were going to go it alone or force us to go it alone. I think they 
are making the same mistake that possibly we made 6 years ago. I think 
that is sad because I think the American public wants us to work 
together.
  Less than 1 month after introducing their repeal-and-replace bill, 
which will be before us this week--and, clearly, the replace is still a 
work in progress--the House is going to pass a bill on a party line 
vote on Thursday maybe without an updated CBO score. I thought we were 
going to have transparency, the light of day, know what taxpayers are 
paying, what they are getting, and what they are not getting. I guess 
not on Thursday. The CBO scores are how Congress and the public 
analyzes how legislation would impact States and citizens. But we are 
not working to get that vital information.
  This last week I hosted a healthcare workshop to hear from all of my 
hospitals, healthcare providers, clinics, doctors, and nurses to ask 
what they thought of the Affordable Care Act and what we can do to fix 
the law. What they told me is there are a lot of things we can do to 
fix the current law to make it better. But they said the healthcare act 
that is being offered as a repeal and replace is not a solution to 
providing the much-needed health care we need in the San Joaquin 
Valley, that we need in California, and that we need in our country.
  At the end of the day, Mr. Speaker, we know that working together is 
how you get things done. On a bipartisan basis, we can make a 
difference, but not the way we are going. So I think that the gentleman 
from California's efforts and my efforts as we continue to try to urge 
common sense to prevail is what we need to do. I will, unfortunately, 
not be able to vote for this measure on Thursday because it really is 
going to negatively impact hundreds and thousands of people in the San 
Joaquin Valley that will lose their coverage as a result of this repeal 
and replace.
  Mr. Speaker, I thank the gentleman for his passion and his efforts.
  Mr. GARAMENDI. Mr. Speaker, I thank the gentleman from California 
(Mr. Costa) very much for his excellent presentation. The gentleman 
covered many of the issues.
  I want to wrap up with just a couple of thoughts.
  One of my Republican friends came up to me earlier today. He said: I 
don't understand. I don't understand what our team is doing. All we are 
doing is changing the name and hurting people.
  I thought about that for a few moments, and, yes, it is Ryan or 
TrumpCare, but people are going to be hurt all across this Nation.
  One more story, and I think we will probably wrap up here, and that 
is of my wife's hairstylist. She is a young lady, married, private 
businessowner, trying to get along, and not enough money to buy 
insurance. The Affordable Care Act goes into place. She looks at the 
exchange, and she is able to get comprehensive insurance, maternity 
care, and at an affordable price because of the subsidies that are 
built into it. She was so happy when she talked to my wife.
  She said: I have insurance. For the first time in my life, I am able 
to buy insurance, and I am going to get pregnant. I am going to have 
the baby that my husband and I have always wanted because now we have 
insurance--not just for myself, but for my child and my husband.
  The next visit, she is asking: They are not going to take it away, 
are they? They are not going to take it away, are they?
  Well, yes, for 14 million Americans--next year, 2018, 9 months from 
now, 14 million Americans will begin to lose their insurance. I am not 
sure if this young lady will be among them or the farm lady that I 
talked about earlier, but they are at risk all across America--14 
million people in less than 1 year, and then, beyond that, over the 
ensuing years, 24 million Americans.
  It has been argued that the Affordable Care Act is in a death spiral. 
I was an insurance commissioner in California for 8 years, and that is 
not true. It is an alternate fact. The fact of the matter is that the 
Affordable Care Act is working--not without some problems here and 
there, but it is working. It is not in a death spiral.
  That is probably a good place to leave it, except this TrumpCare--
RyanCare--is a problem. You are going to pay more and you are going to 
get less--24 million people, an age tax on seniors, and a huge tax 
break for the superwealthy in America.
  Mr. Speaker, I yield back the balance of my time.

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