[Congressional Record (Bound Edition), Volume 163 (2017), Part 7]
[House]
[Pages 10350-10354]
[From the U.S. Government Publishing Office, www.gpo.gov]




                        THE TEST OF OUR PROGRESS

  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 look forward to this hour, although I 
will probably take something less than that.

[[Page 10351]]

  I want to bring to the attention of the House and, more beyond that, 
the citizens of the United States what is happening here with all this 
talk about the repeal of the Affordable Care Act. I want to spend some 
time on that issue. I want to review exactly what the Affordable Care 
Act has done for Americans and what the repeal would do to Americans. 
Those are really two different ways to look at this.
  I want to start someplace else that has been a very special part of 
my thinking about government issues, about policies of all kinds, and 
it was something that Franklin Delano Roosevelt said during the height 
of the Depression as the American government and Mr. Roosevelt were 
talking about the various policies that were being discussed at the 
time. He laid out a test to which he would apply his judgment of a 
policy. It reads this way: ``The test of our progress is not whether we 
add more to the abundance of those who have much; it is rather we 
provide enough for those who have too little.''
  I see this as a profound and extremely important criteria upon which 
to judge many policies that come before us in bills, but it is also, I 
think, an extremely valuable way to judge the question of the 
Affordable Care Act: Has it added much to those who have little?
  I will try to answer that in a few moments.
  Similarly, in looking at the repeal of the Affordable Care Act, the 
test of our progress is not whether we add more to the abundance of 
those who have much. When we consider the repeal of the Affordable Care 
Act--ObamaCare--does it add to those who have much? Does it add to 
those who have little?
  I will try to answer these questions in just a few moments.
  So does the Affordable Care Act add much to those who have little?
  The answer is: Categorically, it does. There is absolutely no doubt 
that the Affordable Care Act has helped those who have little. I will 
give a couple of examples. Just a couple.
  One, a beauty salon operator in Sacramento, California, around the 
age of 30, married, wanting to have children but not able to do so 
because she had no insurance. A small-business operator, herself, maybe 
one part-time employee, unable to get insurance prior to the Affordable 
Care Act.
  My wife visited her after the Affordable Care Act went into place, 
and she was able to purchase private insurance through the subsidized 
market, and she happily, excitedly told my wife: And now my husband and 
I, we are going to have a baby. At last I have the insurance. And I 
want you to tell your husband ``thank you.''
  That thanks is not to me. It is to the men and women of the Congress 
in 2010, myself included, and the Senate, and President Obama that 
signed the Affordable Care Act that set up a situation in which, 
through the California exchange, similar to other State exchanges, she 
was able to purchase insurance. Subsidized to be sure, but nonetheless, 
she was on her way to having a baby, or at least thinking about having 
a baby. I will come back to her in a few moments.
  A second person, small family farmer in my district unable to have 
insurance throughout her entire adult life. In and out of hospitals for 
everything from an accident on the farm to some more serious things. 
Facing bankruptcy. The Affordable Care Act gave her the opportunity to 
have insurance, to stabilize her life, her healthcare, and, 
importantly, be able to avoid the financial disaster of a major medical 
bill that would have clearly bankrupted her and put her out on the 
street.
  That is what the Affordable Care Act did to two constituents in my 
district. And that story is repeated over 20 million times around this 
Nation. More than 20 million Americans have been able to get health 
insurance as a result of Affordable Care Act. And 6.1 million young 
Americans have been able to stay on their parents' insurance policies, 
not thrown off at the age of 18, but able to stay on until the age of 
25. And 27 percent of Americans who have preexisting conditions--27 
percent of us have some sort of preexisting condition--no longer a bar 
to being able to get insurance.
  I was the insurance commissioner in California for 8 years, and I saw 
the forms that the insurance companies would require be filled out. 
Everything in their life from the moment of their birth--in fact, 
before their birth, they needed to disclose every single event. Did you 
have pneumonia? Did you have an illness of this or that? All the way 
down the line.
  And if you answered ``yes'' to any one of those, you would probably 
not be able to get insurance. And 27 percent of the American public 
unable to buy insurance because of preexisting conditions, no longer 
the case in America today. It is gone. That is history.
  This is my experience. Thousands of times I saw this. If a person 
went through that entire checklist and there was some inaccuracy in the 
way they answered those questions and they went to the hospital with a 
serious illness that was supposed to be covered, it was common for the 
insurance companies to go back and do medical underwriting after the 
event and deny the coverage. Common practice.
  Something as mundane as: I did not have mumps when I was a child. 
Check, check, check. Oh, you had mumps? I am sorry, we are not going to 
pay for this operation.
  Those days are gone. The Affordable Care Act did that.
  In my own State of California, 3.7 million Californians are now 
insured due to the Medicaid expansion program, which we call Medi-Cal 
in California. And 1.4 million people now have insurance through the 
exchange. The two examples I gave are but two of 1.4 million 
Californians that have insurance. So it works. And it is not just that. 
There are other things.
  Seniors, the infamous doughnut hole in which, under Medicare part D, 
the first couple of thousand dollars of drug expenses would be covered. 
And then serious illnesses, you blow through that quickly, and then you 
faced the doughnut hole, and it was out of your pocket.
  So you found seniors all across this country unable to afford the 
continuation of the drugs that kept them alive. It is gone--or will 
soon be gone. The Affordable Care Act collapses that doughnut hole so 
that in another 1\1/2\ years, 2 years from now it would be gone and the 
Medicare part D would provide the drugs that are necessary to keep 
seniors alive.
  The repeal of the Affordable Care Act would end that and send those 
seniors back where they were before, facing the ominous doughnut hole. 
It goes on and on.
  Medicaid expansion, 20 million Americans covered; 3.7 million in 
California. The drop in insurance rates. Due to the Affordable Care 
Act, the uninsured rate is now the lowest in history.
  Consider this: 16 percent of Americans in 2010, before the Affordable 
Care Act, did not have insurance--16 percent of the 380 million of us.

                              {time}  1945

  Today, it is down to just about 8 percent--excuse me, that is in 
2016. There has been continued improvements since then, 8 percent. That 
is where those 22 million Americans are.
  So we have seen this over time. As a result of the Affordable Care 
Act, the uninsured in America have steadily decreased as the Affordable 
Care Act has taken hold.
  Hospital-acquired infections significantly reduced. Under the 
Affordable Care Act, unnecessary hospital readmissions due to 
infections, have fallen for the first time on record, dropping 8 
percent between 2010 and 2015. Why has this happened, you ask? Because 
in the Affordable Care Act, there was a serious financial penalty to 
hospitals when there was a readmission as a result of a hospital-
acquired infection.
  Is that important? It certainly is, for those who are not readmitted 
for infections.
  The annual lifetime benefits, you have heard about this. You know 
somebody in your family, in your community, who had a limit on their 
insurance policy, $100,000 a year, or maybe a lifetime exclusion or 
limit of $200,000, or $300,000, or some number. If you have a serious 
illness, you blow right up

[[Page 10352]]

through that barrier, and your coverage, it is on your account. 
Hospital coverage and expenses are no longer covered by the insurance 
policy.
  That is gone. It is over. It doesn't exist any longer in the United 
States. So the end to annual and lifetime limits is a direct result of 
the Affordable Care Act.
  Slower premium growth and a cap on out-of-pocket expenses. Due to the 
Affordable Care Act, all health policies now have a limit on out-of-
pocket costs, which benefits all Americans.
  Free preventative care. Have you talked to any seniors recently? If 
you are on Medicare, you have an annual free checkup. What does that 
mean? It means that your high blood pressure that you didn't know 
about, your onset for diabetes and other illnesses, you find out about 
it, deal with it, live longer, reduce the costs.
  In part, that is the reason that we have now seen that the Medicare 
viability, the financial viability of Medicare has been extended by 
nearly a decade as a result of the Affordable Care Act and the kind of 
policies that were built in it--for example, free preventative care.
  I have already talked about young adults being able to stay, and that 
is 2.3 million young adults.
  Lives saved from reductions in hospital-acquired conditions. Eighty-
seven thousand Americans are alive today because of better healthcare 
in the hospitals.
  Public satisfaction. Eighty-two percent of the consumers in the 
marketplace plans or newly insured under Medicare due to the ACA, the 
Affordable Care Act, ObamaCare, have expressed satisfaction with their 
coverages.
  Tax credits. Seven in 10 consumers in the marketplace got coverage 
through their tax credits.
  I already talked about preexisting conditions.
  Mental health and maternity care. Family values, well, we hear that 
all the time here on the floor. Family values, this is a family value. 
This is a family value, yes. And the Affordable Care Act is a family 
value because maternity coverage is guaranteed. The most basic element 
of family, babies are now covered.
  Maternity care is now guaranteed coverage under the Affordable Care 
Act. And from the moment that baby is born, through their life under 
the Affordable Care Act, they have a guaranteed coverage, regardless of 
any illness that they may have at birth.
  I can give you story after story that I found when I was an insurance 
commissioner in California. The family had coverage. The family 
actually had maternity coverage. The baby is born with a serious defect 
of some sort. There was no coverage for that baby because of a 
preexisting condition from the very moment of birth. That is not the 
case any longer in America as a result of the Affordable Care Act.
  We can go on and on, and probably we ought to. We have heard a lot. I 
am just going to keep this up here to remind all of us about a test of 
what good public policy can and should be.
  There has been a lot of talk now about the collapse of the insurance 
market. We have heard the President talk about the collapse of the 
insurance market. Any time he brings up the issue of the repeal of 
ObamaCare, the Affordable Care Act, he always prefaces it or follows 
his comments with: The insurance market is imploding. It is collapsing.
  We have heard that discussion here on the floor from the leaders of 
the majority party. The Affordable Care Act is collapsing. The 
insurance markets are collapsing. Oh, my, my. Interesting.
  Let's see, this is the 10th of July. A report was issued by The Henry 
J. Kaiser Family Foundation--not a liberal organization, not a 
conservative organization, but one of the best-known research 
organizations on healthcare in America. The Henry J. Kaiser Family 
Foundation issued a report on July 10, 2017, by Cynthia Cox and Larry 
Levitt. I won't read it all to you, but I will read the discussion 
point.
  Early results from 2017 suggest the individual market is stabilizing 
and insurers in this market are regaining profitability. Insurance 
financial results show no signs of a market collapse. Hello. Anybody 
listening?
  Early results from 2017 suggest the individual market is stabilizing 
and insurers in this market are regaining profitability. Insurer 
financial results show no sign of market collapse.
  First quarter premium and claims data from 2017. First quarter 
premium and claims data--this is from the insurance companies--from 
2017 support the notion that 2017 premium increases were necessary as a 
one-time market correction to adjust for a sicker than expected risk 
pool.
  Although individual market enrollees appear, on average, to be sicker 
than the market pre-ACA, data on hospitalization in this market 
suggests that the risk pool is stable, on average, and not getting 
progressively sicker, as of early 2017.
  Some insurers have exited the market in recent years, but others have 
successfully expanded their footprints, as would be expected in a 
competitive market.
  Now the caveats. While the market, on average, is stabilizing, there 
remain some areas of the country that are more fragile. In addition--
and here is the important point for any policymaker in Washington, 
D.C., from the President to the rest of us. In addition, policy 
uncertainty has the potential to destabilize the individual market 
generally.
  Mixed signals from the administration and Congress as to whether 
cost-sharing subsidies under the Affordable Care Act and cost-sharing 
reduction payments will continue, or whether the individual mandate 
will be enforced, have led some insurers to leave the market or request 
larger premium increases than they would otherwise.
  Few parts of the country may now be at risk of having no insurers. If 
you don't mind, I would like to go back over that again. Mixed signals 
from the administration--hello, President Trump and Congress. Hello, my 
colleagues--who have voted to repeal the Affordable Care Act, mixed 
signals from the administration and Congress as to whether cost-sharing 
subsidy payments will continue, or whether the individual mandate will 
be enforced, have led some insurers to leave the market or request 
larger premium increases than they would otherwise.
  So who is responsible for the collapse? Well, we can do some finger-
pointing, but then I would be admonishing--Mr. Speaker, I should do 
some finger-pointing, but I am not going to do it right now.
  I am going to go back here. ``The test of our progress is not whether 
we add more to the abundance of those who have much.''
  Okay. Let's look at the repeal. Let's judge the repeal based on that 
criteria. Maybe you don't believe Franklin Delano Roosevelt was 
correct, but maybe we ought to just see what we are talking about here.
  The repeal of the Affordable Care Act, the legislation that passed 
this House, the tax provisions in the Affordable Care Act, it is 
somewhere north of a $700 billion to $800 billion reduction in taxes. 
That is a lot of tax reduction. That was in the legislation.
  I have argued repeatedly here on the floor and other places that it 
is the largest single transfer of wealth from the poor and the middle 
class to the super wealthy. That argument is factual because, what are 
the benefits? Who wins in the repeal of the Affordable Care Act, the 
poor, or the 22 million to 24 million people who will lose their 
insurance as a result of the repeal of the Affordable Care Act? That 
was in the House bill.
  In the Senate bill, they are talking about similar numbers, 23 
million, 24 million, 25 million people. That is a lot of Americans who 
are going to lose their insurance and are going to be personally, 
physically harmed as a result of the repeal.
  So who benefits? The other side of this piece of legislation is one 
of the largest tax reductions ever--not for the poor, small for the 
middle class, but oh, my, for the wealthy, the top 1 percent of 
Americans--excuse me--the top one-tenth of 1 percent of Americans would 
have their taxes cut, on average, by $197,490 per year. That is the top 
one-tenth of 1 percent.

[[Page 10353]]

  How about the top 100 wealthy families in America, five of whom are 
in this administration, the super wealthy, what does it mean to them? 
$4 million to $6 million a year reduction, on average, in their taxes. 
The test of our progress is not whether we add more to the abundance of 
those who have much.
  Need I stand here on the floor for hours driving home the point that 
the repeal of the Affordable Care Act is more than a taking away of 
healthcare benefits in which, if we were to believe the Senate and the 
Senate bill were to become law, 18 million Americans next year would 
lose their health insurance, and then beyond, another 5 million 
Americans in the years ahead.
  It is a test of our progress. It is whether we provide enough for 
those who have too little. It is pretty easy, a pretty easy criteria 
when applied against the repeal. Are we providing anything for them? 
No, you are taking away their healthcare, their health insurance, and, 
undoubtedly, their health and their lives. It doesn't meet this test at 
all.
  On the tax side, oh, my, the bottom 80 percent of taxpayers in this 
Nation would receive the awesome, extraordinary benefit of a reduction 
of $160 a year in their taxes.

                              {time}  2000

  That is what our Republicans have offered us with the repeal of the 
Affordable Care Act. Eighty percent of American taxpayers would receive 
the awesome, extraordinary benefit of a $160 annual reduction in their 
taxes, while the superwealthy, the top 100 families, a $4 million to $6 
million annual reduction, and the top one-tenth of 1 percent of 
Americans--wealthy--would receive a $197,490 reduction, on average.
  Mr. Roosevelt, President Roosevelt, laid out a clear criteria.
  So where are we? Where are we? We have the Henry J. Kaiser Family 
Foundation report yesterday. The insurance market is not collapsing, 
and where it is is the result of what this administration and Congress 
are doing. They are destabilizing the market. That is what is 
happening. That is why these insurers are leaving certain communities 
and certain States because they simply do not know what is going to 
happen.
  Insurance companies have to plan now--actually, a month or two ago--
for the insurance policy that they will be selling in the fall and in 
the early winter, October, November, December, for the next year, the 
2018 year. And they do not know because of what this Congress is doing; 
they don't know how to price, and therefore market instability is the 
result.
  There is more to it than that. Under the law today, the Federal 
Government is supposed to be providing money for the exchanges. That 
money has been withheld under this administration in numerous ways, 
actively and proactively taking steps to undermine the insurance market 
so, presumably, they can say: ``Oh, my, it is collapsing.''
  Well, if it is, it is the President's fault, and it is the fault of 
this Congress in passing such legislation.
  Now, I hear a lot of talk, and it is correct, a lot of discussion 
about what we can do together. Let's not fight. Let's work together. 
Let's improve the Affordable Care Act. We ought to, and we can. There 
are many ways it can be done.
  So what can we do?
  Well, we could immediately end the efforts to destabilize the market. 
That would be a good start, wouldn't it? All that takes is an end to 
this effort to repeal and, rather, to do what the President asked us to 
do, and that is to work together as he drives forward policies that 
destabilize the market as he continually talks about repeal. But he 
also says, ``Let's work together.'' I agree with him. Let's work 
together. I ask the President to please stop his efforts to destabilize 
the market.
  So what can we do?
  How about if we allow the Federal Government to negotiate the price 
of drugs? We can't do it now, but what if we did? Would that help 
stabilize the market? It would certainly help reduce the cost. That is 
not a bad idea. So idea one. Let's allow the Federal and State 
governments to negotiate the price of prescription drugs and allow 
individuals to buy certain medications in Canada, for example, which 
they cannot, now, legally do.
  We might think about expanding programs that are proven to enhance 
quality and reduce costs, such as streamlining care coordination. 
Coordinate the care and medical services that an individual has, 
particularly for those with chronic conditions, where most of the 
healthcare dollars are spent. It has been proven.
  There are programs out there, pilot programs, and some are more 
permanent, that allow for coordination of benefits--that is, services--
for those who have chronic illnesses. Part of that is found in the 
current Affordable Care Act. It is being done. It needs to be expanded.
  And we can dramatically improve the care and the health of 
individuals by coordinating their care, making sure, for example, that 
people with diabetes are able to get the drugs, get the treatment, work 
on their healthcare, work on the food they eat, and work on exercises, 
coordinate all of that. If you want to drive down the cost of 
healthcare, take the six chronic illnesses and coordinate the care. 
Keep people healthy. Keep them out of the hospital by being healthy. We 
can do that. We do, but not everywhere.
  Allow States greater flexibility in administering the Medicaid 
program. Our Republican colleagues talk about this. We should do it. I 
am in favor of it.
  I know from my experience as insurance commissioner in California 
that there are many things that can be done by the States as they deal 
with the peculiar and individual circumstances of the citizens of their 
State in altering the Medicaid program so that it can meet the needs of 
the State. Let's do it, but not with the repeal of the Affordable Care 
Act and stripping out of the program billions upon billions of dollars 
so there really is no money to do anything. That is flexibility in the 
Medicaid program.
  We have a national health insurance exchange program. It is there, 
but it has been reined in. It has not been allowed to grow as it could 
by the actions of Congress. Since the Republicans took control of 
Congress, they have withheld, they have reined in, the national health 
insurance exchange program. This is in States that refused to establish 
their own exchanges. Individuals can then go to the national exchange. 
But they don't even know it is there because the advertising for the 
national exchange has been eliminated. So we can do that. It is pretty 
simple.
  Hey, folks across America, you don't have a State exchange? You can 
come to the national exchange. You haven't heard about it? I am not 
surprised because there is no advertising. There is no knowledge 
available to individuals. It is a pretty simple thing we can do. As 
that exchange grows, we begin to spread the risk across a wider 
population.
  In the early version of the Affordable Care Act here in the House of 
Representatives, we passed and I voted for what was known as the public 
option, a national public insurance option. The Senate removed it--
mostly Republicans, but some Democrats didn't think that was a good 
idea. I thought it was a good idea in 2009 when the issue came before 
us because I saw an advantage in a national insurance program.
  So there are five things that we can do right there, and there are 
many, many more.
  When the repeal of the Affordable Care Act passed through this House 
on the floor, my Democratic colleagues offered 22 amendments to improve 
the Affordable Care Act, to improve ObamaCare. They were all rejected. 
So much for working together.
  But let me make a baseline statement: Don't repeal the Affordable 
Care Act; improve the Affordable Care Act. If you are determined to 
repeal the Affordable Care Act, there is not much we can work with. 
That is why I took the time to talk about the Americans that are now 
covered, the seniors that now have drug coverages, the end of 
discrimination based upon preexisting conditions. That is why I talked 
about those things.
  In a repeal--and the President called for a flat-out repeal--that is 
gone. It is

[[Page 10354]]

gone. If you want to do that, don't count on me. I won't be there. But 
if you want to take the Affordable Care Act and if you want to deal 
with the problems that we know are there, then let's work together.
  I just laid out five things. There are 17 more that have been 
suggested by my Democratic colleagues. We can improve the well-being of 
Americans. We can help those people.
  As for my wife's hairdresser, I don't know if she is going to get 
pregnant because she doesn't know if she is going to continue to have 
coverage. For that farmer, that woman who is running her own family 
farm, she doesn't know either. There are 23 million Americans who are 
in that position--23, and quite possibly more--who don't know if a year 
from now, 2 years from now, they will have health insurance.
  So, President Roosevelt: ``The test of our progress is not whether we 
add more to the abundance of those who have much; it is whether we 
provide enough for those who have too little.''
  I yield back the balance of my time, Mr. Speaker.

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