Equity for Our Nation's Self-Employed Act of 2009

Mr. Speaker, for those of us who recognize abortion as lethal violence against children and the exploitation of women, nothing less than a comprehensive prohibition on public funding, promotion and facilitation of elective abortion in any federal health program, including the bill under consideration today, satisfies the demands of social justice.

The Stupak-Pitts Amendment which passed 240-194-1 ensures that not some, but all the elements of the Hyde amendment applies to the programs that are both authorized and appropriated in this bill.

By now, I trust that all members fully understand that because programs in Obamacare are both authorized and appropriated in this legislation, the actual Hyde Amendment has no legal affect. It only affects Labor HHS not this massive expansion of government funded health care.

Regrettably the language that emerged from the Senate is weak, duplicitous and ineffective, not by accident, but by design. It will open up the floodgates of public funding for abortion in a myriad of programs resulting in more dead babies and wounded moms than would otherwise have been the case.

Because abortion methods dismember, decapitate, crush, poison, starve to death and induce premature labor, pro-life Members of Congress, and according to every reputable poll, significant majorities of Americans want no complicity whatsoever in this evil. Obamacare forces us to be complicit.

Abortion hurts women's health and puts future children subsequently born to women who aborted at significant risk. At least 102 studies show significant psychological harm, major depression and elevated suicide risk in women who abort.

Recently, the Times of London reported that, ``[S]enior . . . psychiatrists say that new evidence has uncovered a clear link between abortion and mental illness in women with no previous history of psychological problems.'' They found, ``that women who have had abortions have twice the level of psychological problems and three times the level of depression as women who have given birth or who have never been pregnant . . .''

In 2006, a comprehensive New Zealand study found that 78.6 percent of the 15-18 year olds who had abortions displayed symptoms of major depression as compared to 31 percent of their peers. The study also found that 27 percent of the 21-25 year old women who had abortions had suicidal idealizations compared to 8 percent of those who did not have an abortion.

At least 28 studies--including three in 2009--show that abortion increases the risk of breast cancer by some 30-40 percent or more yet the abortion industry has largely succeeded in suppressing these facts. Abortion isn't safe for subsequent children born to women who have had an abortion. At least 113 studies show a significant association between abortion and subsequent premature births. For example a study by researchers Shah and Zoe showed a 36 percent increased risk for preterm birth after one abortion and a staggering 93 percent increased risk after two.

Similarly, the risk of subsequent children being born with low birth weight increases by 35 percent after one and 72 percent after two or more abortions. Another study shows the risk increases 9 times after a woman has had three abortions.

What does this mean for her children? Preterm birth is the leading cause of infant mortality in the industrialized world after congenital anomalies. Preterm infants have a greater risk of suffering from chronic lung disease, sensory deficits, cerebral palsy, cognitive impairments and behavior problems. Low birth weight is similarly associated with neonatal mortality and morbidity.

Unlike both the Hyde Amendment and what would be the effect of the Stupak-Pitts amendment, the Senate passed bill permits health care plans and policies funded with tax credits to pay for abortion, so long as the issuer of the federally subsided plan collects a new, congressionally mandated fee from every enrollee in that plan to pay for other peoples abortions. Requiring the segregation of funds into allocation accounts--a mere bookkeeping exercise touted by some as an improvement to the new pro-abortion funding scheme--does absolutely nothing to protect any victims--baby or mother--from publically funded abortion.

The Senate passed bill creates a new Community Health Center fund and appropriates at least $7 billion for Community Health Centers (CHC). Again recognizing that the Hyde Amendment does not apply to this bill and absent enactment of the Stupak-Pitts amendment, it is clear that the 1,250 CHC clinics (among the most effective means of reaching the poor and underserved with basic health care) will likely be compelled either by the Obama Administration or the courts or both to fund abortion on demand at CHC sites. There is no statutory protection against this abuse in the Senate-passed bill.

Additionally, under the federal employee health benefits plan, which includes Members of Congress, since 1984, no funds may be used for abortion or the administrative expenses in connection with any health plans that provide any benefit or coverage for abortions or even the administrative expense, except in the case of rape, incest or to protect the life of the mother.

The Office of Personnel Management (OPM) administers the program.

The Senate-passed bill on the other hand creates a huge new program administered by OPM that would manage two or more new multi-state or national health plans. The bill stipulates that at least one plan not pay for abortion. Which only begs to question: what about the other new multi-state plans administered by OPM? Why can those federally administered plans include funding abortion on demand? This represents a radical departure from current policy.

Additionally, other appropriated funds in the bill have no Hyde/ Stupak-Pitts type protections either including $5 billion for a temporary high risk health insurance fund and $6 billion in grants and loans for health cover co-ops. Pro-life members who vote for this bill will roll the dice on this one.

When the bill left the House, it contained the Hyde-Weldon language protecting health care providers who refuse to participate in abortion against discrimination by government entities. The Senate passed bill instead only includes more narrow text that prevents discrimination by a ``qualified health plan'' on the Exchange. This narrow language was included in the House bill, but without the additional protections against discrimination by federal and state governmental entities, pro- life health care providers are not fully protected.

Then there's the Mikulski Amendment, Sec. 2713, which empowers the HHS Secretary with broad new authority to compel private health care plans in America to cover ``preventable'' services. When Senator Ben Nelson suggested that abortion not be included in the so-called preventative services mandate, Ms. Mikulski said no--raising a serious red flag that abortion is being postured as ``preventable abortion service in the future''--after all, abortion prevents a live birth.

Abortion as preventative health care isn't new.

And as far back as 1976, Dr. Willard Cates, Jr. and Dr. David Grimes, then with CDC, presented a paper to a Planned Parenthood meeting, entitled: Abortion as a Treatment for Unintended Pregnancy: The Number Two Sexually Transmitted ``Disease''. To call pregnancy sexually transmitted disease; to call abortion a treatment or a means of prevention for this ``disease'' is barbaric.

Abortion isn't health care--preventative or otherwise.

Mr. Speaker, we live in an age of ultrasound imaging--the ultimate window to the womb and its occupant. We are in the midst of a fetal health care revolution, an explosion of benign innovative interventions designed to diagnose, treat and cure disease or illness any unborn child may be suffering.

Unborn children are society's youngest and most vulnerable patients. Obamacare should do them no harm. Tragically, it does the worst harm of all. It kills them.

Mr. Speaker, in a dramatic reversal of current law, ObamaCare, as just passed, authorizes health insurance policies funded with tax credits and cost reduction payments to pay for abortion on demand and forces the issuers of federally subsidized plans to collect a new abortion fee and abortion surtax from every enrollee to pay for other people's abortions. Insurance companies need only segregate the funds--a mere bookkeeping exercise--to subsidize unrestricted, publicly funded abortions.

OPM will also administer multi-State insurance plans with abortion, another radical departure from the status quo. What of the Executive order? With all due respect, what a joke. It does absolutely nothing to mitigate or change in any way the huge expansion of public funding of abortion.

For example--and I ask Members to read it--section 2 only directs officials, pursuant to provisions of the bill just passed, to establish a model set of segregation guidelines. So, in other words, the abortion expansion is unabated.

I ask Members to support Stupak-Pitts and the motion to recommit.

Thank you, my colleagues. I thank the gentleman for yielding. I thank all of you for bringing us to this moment.

Mr. Speaker, it is with great humility and with great pride that tonight we will make history for our country and progress for the American people. Just think, we will be joining those who established Social Security, Medicare, and now tonight health care for all Americans.

In doing so, we will honor the vows of our Founders, who, in the Declaration of Independence, said that we are endowed by our Creator with certain inalienable rights and among these are life, liberty, and the pursuit of happiness.

This legislation will lead to healthier lives, more liberty to pursue hopes and dreams and happiness for the American people. This is an American proposal that honors the traditions of our country.

We would not be here tonight for sure without the extraordinary leadership and vision of President Barack Obama. We thank him for his unwavering commitment to health care for all Americans. This began over a year ago under his leadership in the American Recovery and Reinvestment Act where we had very significant investments in science, technology, and innovation for health care reform.

It continued in the President's budget a few months later, a budget which was a statement of our national values, which allocated resources that were part of our value system and in a way that stabilized our economy, created jobs, lowered taxes for the middle class and did so and reduced the deficit and did so in a way that had pillars of investment, including education and health care reform.

Health care reform and education equal opportunity for the American people. This legislation tonight, if I had one word to describe it, would be opportunity with its investments in education and health care as a continuation of the President's budget.

We all know, and it's been said over and over again, that our economy needs something new, a jolt, and I believe that this legislation will unleash tremendous entrepreneurial power into our economy. Imagine a society and an economy where a person could change jobs without losing health insurance, where they could be self-employed or start a small business.

Imagine an economy where people could follow their passions and their talent without having to worry that their children would not have health insurance, that if they had a child with diabetes who was bipolar or preexisting medical condition in their family, that they would be job locked. Under this bill, their entrepreneurial spirit will be unleashed.

We all know that the present health care system and health insurance system in our country is unsustainable. We simply cannot afford it. It doesn't work for enough people in terms of delivery of service, and it is bankrupting the country with the upward spiral of increasing medical cost. The best action that we can take on behalf of America's family budgets and on behalf of the Federal budget is to pass health care reform.

The best action we can take to strengthen Medicare and improve care and benefits for our seniors is to pass this legislation tonight, pass health care reform. The best action we can do to create jobs and strengthen our economic security is pass health care reform.

The best action we can take to keep America competitive, ignite innovation, again, unleash entrepreneurial spirit is to pass health care reform.

With this action tonight, with this health care reform, 32 million more Americans will have health care insurance and those who have insurance now will be spared of being at the mercy of the health insurance industry with their obscene increases in premiums, their rescinding of policies at the time of illness, their cutting off of policies even if you have been fully paying but become sick. The list goes on and on about the health care reforms that are in this legislation: insure 32 million more people, make it more affordable for the middle class, end insurance company discrimination on preexisting conditions, improve care and benefits under Medicare and extending Medicare solvency for almost a decade, creating a healthier America through prevention, through wellness and innovation, create 4 million jobs in the life of the bill and doing all of that by saving the taxpayer $1.3 trillion.

Another Speaker, Tip O'Neill, once said, All politics is local. I say tonight that when it comes to health care for all Americans, all politics is personal. It's personal for the family that wrote to me, who had to choose between buying groceries and seeing a doctor. It's personal to the family that was refused coverage because their child had a preexisting condition, no coverage, the child got worse, sicker.

It's personal for women. After we pass this bill, being a woman will no longer be a preexisting medical condition.

It's personal for the senior gentleman whom I met in Michigan who told me about his wife who had been bedridden for 16 years. He told me he didn't know how he was going to be able to pay his medical bills. As I said to you before, I saw a grown man cry. He was worried that he might lose his home, that they might lose their home because of his medical bills and he didn't know how he was going to pay them and, most of all, he was too embarrassed to tell his children and ask them for help. How many times have you heard a story like that?

It's personal for millions of families who have gone into bankruptcy under the weight of rising health care costs, and so many, many, many-- a high percentage of the bankruptcy in our country--are caused by medical bills that people cannot pay. It's personal for 45,000 Americans and families who have lost a loved one each year because they didn't and couldn't get health insurance.

That is why we are proud and also humble today to act with the support of millions of Americans who recognize the urgency of passing health care reform and more than 350 organizations representing Americans of every age, every background, every part of the country who have endorsed this legislation. Our coalition ranges from AARP who said that our legislation ``improves efforts to crack down on fraud and waste in Medicare, strengthening the program for today's seniors and future generations.'' I repeat: ``improves efforts to crack down on fraud and waste in Medicare, strengthening the program for today's seniors and future generations.''

To the American Medical Association, the Catholic Health Association, the United Methodist Church and Voices for America's Children, from A to Z, they are sending a clear message to Members of Congress, say ``yes'' to health care reform.

We have also reached this historic moment because of the extraordinary leadership and hard work and dedication of all of the Members of Congress, but I want to especially recognize our esteemed Chairs, Mr. Waxman, Mr. Rangel, Mr. Levin, Mr. Miller, Mr. Spratt, Ms. Slaughter, for bringing this bill to the floor today. Let us acknowledge them.

I want to acknowledge the staff of the committees and of the leadership. They have done a remarkable job, dazzling us with their knowledge and their know-how.

I would like to thank on my own staff Amy Rosenbaum, Wendell Primus and Arshi Siddiqui.

Now I will close by saying it wouldn't be possible to talk about health care without acknowledging the great leadership of Senator Edward Kennedy, who made health care his life's work. In a letter to President Obama before he passed away--he left a letter to be read after he died--Senator Kennedy wrote that access to health care was ``the great unfinished business of our society.'' That is, until today.

After more than a year of debate and, by the way, the legislation that will go forth from here has over 200 Republican amendments, and while it may not get Republican votes and be bipartisan in that respect, it is bipartisan in having over 200 Republican amendments.

After a year of debate and hearing the calls of millions of Americans, we have come to this historic moment. Today we have the opportunity to complete the great unfinished business of our society and pass health insurance reform for all Americans. That is a right and not a privilege.

In that same letter to the President, Senator Kennedy wrote, What is at stake? He said at stake are not just the details of policy, but the character of our country. Americans will look back on this day as one in which we honored the character of our country and honored our commitment to our Nation's Founders for a commitment to life, liberty and the pursuit of happiness.

As our colleague, John Lewis, has said, we may not have chosen the time, but the time has chosen us. We have been given this country, an opportunity to stay right up there with, again, Social Security, Medicare, health care for all Americans.

I urge my colleagues to join together in passing health insurance reform, making history and restoring the American Dream. I urge an ``aye'' vote.

Announcement By the Speaker Pro Tempore

Mr. Speaker, at the outset, let me be very clear: I support health care reform. I just do not support Speaker Nancy Pelosi's version of health care reform.

With respect to controlling costs for New Jersey's families, changing insurance company practices and making coverage more available to more Americans, the status quo is simply unacceptable. We can, and we must, do better, but not at the expense of millions of American families who are worried about a government takeover of their health care decisions!

With that said, the health care package before the House today is wrong on both process and policy.

On process, the American people know instinctively that a change as historic as this will only be successful with full engagement of the American people and bipartisan support in Congress. However, from the beginning, Speaker Nancy Pelosi and Senate Majority Leader Harry Reid adopted a `go-it-alone' strategy and refused to consider Republican ideas in any significant way. Indeed, the Majority today is even refusing to listen to the very valid concerns of the American people.

In addition, this legislation, and all the versions that preceded it, were drafted behind closed doors at the White House or in Capitol backrooms, with no transparency whatsoever as to which organizations were participating and benefitting! In fact, the Majority had to be `shamed' into releasing the contents of the bill 72 hours before a vote to allow Republicans and the American people to review its contents.

To add insult to injury, the President and Speaker Pelosi decided to use the budget 'reconciliation' process solely to deny the Senate Minority the ability to use its traditional practice of the filibuster to block passage of harmful legislation such as this.

Madame Speaker, the process the Majority has used is shameful, but the policy they seek to impose is downright harmful.

Once again, I state without hesitation that I support health reform. However, I cannot support this proposal.

First, this package contains over $523 billion in job-killing, higher taxes. I cannot think of a worse time to tax families and small businessmen and women than in the middle of a serious recession.

The American people need to understand the destructive nature of this bill: $17 billion in new taxes on Americans who do not obey the bill's requirement that individuals must buy health insurance whether they want to or not, and $52 billion in new taxes on employers that do not provide health coverage deemed ``acceptable'' or ``affordable'' by Washington-based government bureaucrats. This provision alone may force the IRS to hire another 16,000 agents and auditors to enforce compliance with the new law.

In addition, the bill contains new taxes on capital gains, dividends and interest that will further stifle economic growth and job creation. The Medicare tax on capital gains, dividends, and other investment income gets bigger, magnifying the destructive power of the tax. The bill increases the tax from 2.9 percent to 3.8 percent and for the first time, this tax will be extended beyond wages to include interest, dividends, capital gains, annuities, royalties, home sales and rents. This new tax will be particularly damaging to New Jersey's seniors, many of whom depend on such income to survive.

Second, this package contains over $569 billion in total cuts to Medicare.

These reductions include $202.3 billion from seniors' Medicare health plans, including massive cuts targeting the extra benefits and reduced cost-sharing seniors receive through Medicare Advantage. 148,000 seniors in New Jersey, including over 35,000 in my Congressional District enjoy the benefits of this innovative program. The Congressional Budget Office predicts that three million seniors nationwide currently receiving health benefits through these Medicare plans will be dropped.

But the Medicare cuts go deeper. The bill slashes $156 billion from hospitals, including long-term care hospitals, skilled nursing facilities, Ambulatory Surgical Centers, hospice, ambulances, dialysis facilities, labs and durable medical equipment (DME) suppliers.

The package also contains $40 billion in cuts to home health reimbursements and $22 billion in additional cuts to hospitals by slashing reimbursements designed to assist hospitals that serve low- income patients. In addition, $65.7 billion in money will be taken from seniors in the form of higher premiums.

My colleagues, I am also shocked that the Majority has not protected our men and women in uniform, military retirees and veterans who could be affected by the new law. The Senate-passed health care bill omitted protections for military health plans that were included in the House bill.

Specifically, the Senate language does not appear to give the Department of Veterans' Affairs (VA) health care system specific protection from interference by other government agencies administering the various authorities contained in the massive bill, as it pertains to ``minimum essential coverage.''

Further, the final bills would leave it up to bureaucrats at the Department of the Treasury to determine whether TRICARE meets the minimum standards under the bill's individual health insurance mandate. If that bureaucrat decides against TRICARE, service members and their families would have to buy some other health coverage or pay a penalty.

Our men and women in uniform, and our veterans, have earned the best health care available. They need to know that they will continue to receive this same level of care. It is truly regrettable that, in a bill stuffed with `backroom' deals and special `arrangements', this group of American heroes is denied the consideration they earn on the battlefield each and every day.

Mr. Speaker, this bill is also notable for what it does not contain. There is no medical lawsuit reform. It fails to promote portability of coverage. It does not allow insurance companies to sell their policies across state lines. It fails to recognize the value of Association Health Plans, which permit small businesses to pool their risk in order to secure lower insurance rates. The bill does not expand Health Savings Accounts which millions of families use to provide protection against catastrophic illness or injury. The package also does very little to enhance medical training for doctors, nurses and technicians. If we are going to expand coverage for tens of millions of Americans, we need to increase graduation rates in these critical medical professions.

I would also add that this bill completely ignores the ongoing crisis in Medicare reimbursement rates for doctors. My colleagues, the question is not whether you can choose your doctor under the Pelosi health care proposal, but whether your doctor will choose you! Many doctors in New Jersey are already questioning their participation in the Medicare program, putting in greater jeopardy our seniors' access to care. Does the Majority actually believe that the pending 22-percent reimbursement reduction will not cause more doctors to `opt out' of Medicare?

Mr. Speaker, I end this statement where I started: I support health care reform. The status quo is unacceptable and I would welcome the opportunity to work with anyone who will work with me to draft and pass single, individual bills that promote portability of coverage, allow individuals to buy health care across state lines, cover people with preexisting conditions, improve access to Health Savings Accounts, and enact `junk lawsuit' reform, among other actions to bring down the cost of coverage for New Jersey families and businesses.

We can do better than this process and this package. America's future economic and security freedoms depend on it.

Mr. Speaker, four and a half months ago when the House first considered health care reform legislation I voted against it saying that it did not represent good public policy.

Nothing in the package of legislation we will consider today and tonight changes my mind. It is still not good public policy, it was not considered under an open process envisioned by the drafters of our Constitution, and it will drive up--not down--the cost of health insurance and medical care for individuals.

This bill cuts Medicare by $523.5 billion. This cannot do anything but compromise the quality and availability of care for older Americans who depend upon the program for their medical care. The Chief Actuary for the Centers for Medicare and Medicaid Services confirmed that in December when he advised Congress that ``providers for whom Medicare constitutes a substantive portion of their business could find it difficult to remain profitable and, absent legislative intervention, might end their participation in the program (possibly jeopardizing access to care for beneficiaries).''

A large percentage of my constituents in the 10th Congressional District rely on Medicare for their health care coverage and a large number of medical providers in my area care for a high percentage of Medicare patients. In a survey I sent to every registered voter last fall in my Congressional District, and to which more than 31,500 responded, 83 percent of the respondents said they were opposed to paying for health care reform by cutting billions from the Medicare program. They are concerned about the cuts in this legislation for inpatient and outpatient hospital services, inpatient rehabilitation services, long term care facilities, skilled nursing programs, hospice services, kidney dialysis facilities, and medical laboratory services.

If this is not of concern enough to our nation's seniors, the legislation we consider today cuts $200 billion from the Medicare Advantage program, through which an estimated 47,000 residents of the 10th Congressional District receive their medical care. The Chief Actuary for Medicare has said that cuts of this magnitude would force more than 60 percent of these Medicare Advantage beneficiaries from the program. Nationally, that totals 4.8 million Americans who would lose their current coverage.

Despite the fact that this legislation makes draconian cuts in Medicare, it will increase, not decrease, overall federal spending on health care. The non-partisan Congressional Budget Office (CBO) estimates that overall federal spending on health care will increase by $390 billion over 10 years. This is at a time when proponents of this legislation say it will save money.

Supporters of this legislation also tout the expansion in health insurance coverage they claim it will bring about. However, this expansion is due in large part to increasing the Medicaid rolls. In fact, the CBO estimates that of the 32 million newly insured Americans under this legislation, half, or 16 million, will receive their insurance through the federally and state sponsored Medicaid program. At the same time, millions of people will be enrolled in subsidized plans on the government run health insurance exchanges and millions will lose their employer sponsored health insurance.

Mr. Speaker, the majority of people I represent like the health care coverage they currently have and do not believe this legislation will improve the quality of their coverage. In my Town Hall by mail survey last fall, 73 percent of those who responded said they are satisfied with their current coverage and 70 percent say this legislation would not improve the quality of their coverage. Furthermore, 75 percent say Congress should not raise taxes to pay for this legislation and 74 percent say individuals should not be required to purchase health insurance.

Many constituents have also expressed their grave concerns about the insertion of the federal government into the precious patient-doctor relationship. A perfect example of this is the creation of 159 new boards, bureaucracies, and programs created in the 2,733 page health care bill.

For example, in an effort to keep Medicare spending below targeted levels the legislation creates the Independent Medicare Advisory Board. This new entity will be required to submit recommendations to Congress to keep Medicare spending below targeted levels. This could result in additional coverage decisions being made by unelected bureaucrats largely or exclusively on cost grounds.

Few issues have divided the American people as much as this health care debate and given the interest and passion they have shown on this matter demands that we give it serious consideration with a lot less politics. Many of us have suggested that we start with legislation in areas that we all agree we can fix now. That includes lowering health insurance costs by allowing small businesses and individuals to pool together in lower priced plans, requiring the coverage of individuals with serious pre-existing medical conditions, prohibiting insurance companies from canceling policies for those who become sick, prohibiting insurance companies from imposing arbitrary spending caps for policyholders, allowing families to purchase health insurance policies across state lines, closing the Medicare Part D doughnut hole, and providing for medical liability tort reform which the Congressional Budget Office says would save $54 billion over 10 years in large part due to lower medical malpractice premiums and the reduction of defensive medicine practices.

In addition to Medicare cuts, the authors of this legislation pay for new big government programs by raising federal taxes by $569 billion over a ten year period. Many of those taxes will impact middle class families. These are families who will pay a penalty if they choose not to carry health insurance, the owners of small businesses who will pay a penalty

if they do not provide health insurance for their employees, a sales tax on medical devices, a tax on prescription drugs, and a tax on health insurance premiums.

This bill also violates the President's promise that if you like your insurance you can keep it. In addition to the 4.8 million seniors who will lose their coverage under the Medicare Advantage program, the CBO estimates that another 8 to 9 million people would lose their employer based coverage when their employers choose to drop their coverage or shift their coverage to the new subsidized policies on the health care exchange.

This legislation would also contradict the President's promise that the cost of health care coverage would go down. Instead, the CBO estimates that the enactment of this legislation will raise private health insurance premiums from 10 to 13 percent.

Mr. Speaker, most Presidents make it a practice of trying to bring the country together in the face of difficult issues. We did this in bipartisan fashion when it came to ensuring the financial solvency of the Social Security system, reforming our nation's welfare programs, and in engaging in an international war on terrorism. Yet this administration has sought to do it their way whether the country agreed or not.

Tonight we are faced with legislation that affects every American, every American family, and every American business. The decision we make tonight could be irreversible and the changes to the Senate passed bill that are promised tonight may never take place. This is no way to conduct our nation's business. It engenders no level of confidence in the people who elected us to serve them.

Mr. Speaker, I rise today in support of H.R. 4872, the Health Care and Education Affordability Reconciliation Act. I urge all my colleagues to support this bill because it will improve the accessibility and affordability of health care for millions of Americans.

Today, there are more than 44 million Americans who lack health care insurance. We must ensure that the needs of these Americans are met. This bill will help us begin to do just that.

While we in Congress have deliberated and debated the costs, challenges, and consequences of health care reform, millions of Americans continue to sacrifice, struggle, and suffer. Hundreds of people have sent me letters and e-mails, called and visited my office, and participated in town hall meetings to express their opinions. The majority of my constituents want and need health care reform. Many are unemployed and struggling to maintain their health care insurance while trying to make sure that there is food on the table, that they have shelter, and that their lights, gas, and water are on. Others are dealing with increases in health care premiums that continue to rise at the will of insurance companies. Still others are trying to get adequate treatment for serious illnesses and to pay for the medicines that can help them.

I am a strong supporter of the single payer health care plan. I also support a strong public option. I support this bill because it begins the process of universal health care coverage for all Americans.

This measure expands coverage to 32 million more people, or more than 95% of Americans, while lowering health care costs over the long term. It prevents insurance companies from discriminating based on pre- existing conditions, health status, and gender. It creates health insurance exchanges--competitive marketplaces where individuals and small businesses can buy affordable health care coverage--and offers premium tax credits and cost-sharing to low and middle income Americans, providing families and small businesses with the largest tax cut for health care in history. It also invests in Community Health Centers to expand access to health care in communities where it is needed most. The bill also empowers the Department of Health and Human Services (HHS) and state insurance commissioners to conduct annual reviews of new plans demanding unjustified, egregious premium increases.

This bill puts patients and doctors in charge of their health care-- not health insurance companies. Children can no longer be discriminated against because of preexisting conditions. Seniors will no longer have to pay deductibles and co-pays. There will be free mandatory preventive health care provided for all under all health care plans. Plus, there will be a ban on lifetime coverage limits under this bill.

The bill cuts taxes to small businesses to help small employers pay for health care coverage for their employees. Small businesses will have tax credits and vouchers so as to be able to afford health care coverage for their employees.

The bill makes key investments in Medicaid and children's health. It expands eligibility for Medicaid to include all non-elderly Americans with income below 133% of the Federal Poverty Level and provides fair assistance to states to help cover the costs of these new Medicaid populations. The measure also maintains current funding levels for the Children's Health Insurance Program (CHIP) through fiscal year 2015 and increases payments to primary care doctors in Medicaid.

The Health Care and Education Affordability Reconciliation Act strengthens Medicare. It adds at least nine years to the solvency of the Medicare Hospital Insurance Fund, fills the Medicare prescription drug donut hole, improves Medicare payments for primary care, and reduces overpayments to private Medicare Advantage plans. It also provides new, free annual wellness visits; eliminates out-of- pocket copayments for preventive benefits under Medicare, such as cancer and diabetes screenings; and provides better chronic care, with doctors collaborating to provide patient-centered care for the 80% of older Americans who have at least one chronic medical condition, such as high blood pressure or diabetes. The bill also encourages reimbursing health care providers on the basis of volume instead of value by including a number of proposals aimed at moving away from the ``a la carte'' Medicare fee-for-service system toward paying for quality and value, while reducing costs for America's seniors.

This legislation reins in the abuse by health insurance companies of arbitrarily increasing premiums and stops insurance companies from dropping individuals from policies when people get sick and need health care insurance. If you change or lose your job, you will still have health care coverage. When you enter a hospital, you and your family can rest assured, knowing that your policy will cover the costs associated with your health care.

Last, this legislation demonstrates fiscal sensibility and responsibility. It will reduce the deficit by $138 billion over the next decade, with an additional $1.2 trillion in additional deficit reduction in the following decade. The bill tightens current health tax incentives, collects industry fees, institutes modest excise taxes, and slightly increases the Medicare Hospital Insurance tax for individuals who earn more than $200,000 and couples who earn more than $250,000. It includes a fee on insurance companies that sell high cost health insurance plans to promote smarter, more cost-effective health coverage choices and changes health care tax incentives by increasing penalties on nonqualified distributions from health savings accounts, capping federal saving account contributions, and standardizing the definition of qualified medical expenses. The cost of health care reform under this legislation is fully paid for, in large part, by eliminating waste, fraud, abuse, and excessive profits for private insurers.

As Democrats promised the American people, this bill is fully paid for. This legislation is the single largest deficit reduction tool in the history of our country. It is not balanced on the backs of our children and our grandchildren.

My family and my faith provide the foundation for my commitment to service. I am honored and humbled to represent the people of the 13th Congressional District. As Members of Congress, we serve others. Through this service, we often provide people with the tools and resources they want and need. Our service not only changes us for the better by giving our lives meaning and fulfillment, but it also creates positive change in the lives of others. Like a raindrop in a river, our service creates ripples that leave an indelible impact on all those it touches.

Today, we will make history by finishing what many Congresses before us started. The debate has gone on long enough. The American people want action. We must reject the status quo. We must stand up and do what is right. We must be a voice for the voiceless, give hope to the hopeless, and provide help to the helpless by supporting health care reform now.

Let us be the light in the darkness by voting in support of the Health Care and Education Affordability Reconciliation Act. It will give much needed assistance to millions of Americans by making health care affordable for the middle class, providing security for our seniors, and guaranteeing access to health insurance for the uninsured. It is common sense for the common good, and I urge all my colleagues to vote yes on this historic measure.

Mr. Speaker, throughout my career of public service, there have been a few critical challenges that have remained at the top of my priority list; protecting our coal miners and our coal jobs and the need to provide our people with access to affordable, quality health care.

Across southern West Virginia, especially in rural areas where senior populations are high, that challenge has been particularly daunting, because so many health insurance companies have been increasingly putting high profit margins above all else, even the compassionate treatment of the sick and the elderly.

I have consistently spoken out against the abuses of and mistreatment by huge, for-profit health insurance companies. And I have advocated for competition, recognizing that it is good for consumers and drives down prices for all buyers, while driving up quality of service.

At the same time, I have consistently stood against the use of federal funds to pay for abortions--a stand I took again when I worked to have anti-abortion language included in the original House-passed health care bill. That was, in fact, one of many issues that I heard a lot about from West Virginians in recent months and that I successfully pressed to have addressed in the House bill.

With the Executive Order strengthening the life protections in this bill, we have achieved a firm anchor for the protection of life in this country, reflecting the principles of the Hyde Amendment, no federal funding for abortions. Administrative chipping away and mischief will be held at bay with this order throughout this administration. Future administrations should be held to this standard.

Health care is a deeply personal issue for all Americans. But it is also true that there are no people in the world more personally generous than Americans when it comes to helping the ill and the injured.

I understand people's frustrations and concerns over coal, jobs, our economy. The rhetoric about health care this year has been emotional, at times angry, and, ultimately divisive. Much of the legitimate debate has been undermined by millions of dollars in advertising, underwritten by massive health insurance companies interested only in protecting their record profits and lucrative salaries. The result has been a polarized public and a polarized Congress.

But underlying the most contentious, most calculatingly advertised issues, there can be found common ground. Certainly the status quo-- where honest, hardworking parents are forced into bankruptcy to afford lifesaving treatments for their child and where longtime, loyal workers lose their health care coverage along with their jobs during tough economic times--does not comport with American values.

One of my constituents, Fred Long, is a Vietnam veteran and a proud West Virginian who has long had private health insurance. Fred, blessed with good health, needed his insurance little until he was 63 years old when he had to have cataracts removed from both eyes.

Fred's brother was born with cerebral palsy. His problems were covered by SSI and Medicaid. He, too, had cataracts removed, but because of Medicaid, it did not cost his family a dime.

The two brothers had the same procedure, used the same hospital, and same doctor, yet Fred's surgery cost him $3,099.36 despite Fred's $480 a month health insurance premiums.

Mr. Long closed his letter to me with this:

``. . . how many thousands of dollars have been paid in insurance premiums over the years . . . I don't know if this will be of any help in changing the thinking of those that can't see where national health care would benefit the working man.

``The insurance companies could have done this, collected from those that weren't sick and paid the heath care cost for those that were sick, just like the government helped my brother when he needed it. He is on Medicare now and I just hope I can get by the next few years when I can sign up for Medicare. (Sincerely, Fred Long)''

Mr. Long's personal story echoes so many others I have heard from all across southern West Virginia--this is just one of the reasons I believe health care reform is necessary.

We must end the polarization of America and find that common ground for the common good. The health care system as it currently exists is not sustainable for the long-term and this Nation has a host of serious challenges that cry out for attention--jobs for our people, renewed transportation funding for our highways, expansion of our technology, and diversification of our economy.

Unfortunately, as long as the needs of the people can be subverted by special interests, financed by donors who operate in secrecy without any accountability to the American public, I worry that we will see little more than the same polarization that has dominated this Nation for months.

Free speech is a wonderful American right that must be protected. But much of the speech we have been witnessing of late has been anything but free. It has been well-financed by special interests whose hands are in the pockets of political operatives, and their motivation is not the preservation of health care for our citizens, but, instead, the preservation of power for themselves. Worse still, to the degree that these operatives are able to bend government to suit their own purposes, you can be sure that others will line up to use the same tactics for their own good.

This is bad for West Virginia. And it is bad for our Nation.

Throughout my years of hard work for the people of West Virginia, I have worked with Republicans, Democrats, and Independents alike, always focused on the needs of southern West Virginia and the Nation. In all that time, I have used my experience, honesty, and integrity to sustain jobs for our coal miners, to ensure their health and safety and that of their homes and their families. I have fought to expand our job base and to build improved infrastructure, to advance technology, ensure veterans care, improve education, and protect our God-given natural resources, including the unborn.

Today, I call for an end to the polarization. We must put away our personal interests, set aside our differences, and do the People's work. We must come together for the common good, using common sense.

Mr. Speaker, whether all Americans should have access to quality health care at a reasonable price is a question a century old. First raised by Teddy Roosevelt in 1912, then repeated by FDR, Harry Truman, and later presidents, the question almost answers itself. No nation can be strong whose citizens are sick and poor. To improve our economy, to care for our people, to fix our expensive and broken healthcare system, the time is now.

Truman argued that the principal reason why people could not receive the care they needed in 1946 was that they could not afford to pay for it. At the time, the cost of health care accounted for 4 percent of the nation's income. Today, the reason people don't receive care most likely remains its unaffordability, but the aggregate cost of health care has since risen to 16 percent of the nation's income.

Having grown up in a working family of seven kids, I know how important health insurance is. My parents couldn't predict which of us might break a leg, need our tonsils out, or worse, but they could predict that without insurance, they couldn't pay to get us the care we needed. There is no reason that hard working Americans should be priced out of needed healthcare.

Without doubt, this is not a perfect bill. It does not contain strong employer responsibility provisions or a public plan to provide real competition to private insurers. It cuts DSH payments for hospitals too much. It benefits states that have left some of their poorest citizens out of Medicaid without rewarding states like California that have been doing the right thing all along.

It contains an Independent Payment Advisory Board, which would severely limit Congressional oversight of the Medicare program and place authority within the executive branch, without Congressional oversight, judicial review, or state or community input. It also does something no bill has ever done before--prohibits undocumented immigrants from spending their own money to buy private health insurance within an insurance exchange or marketplace.

But the bill's strength--that it makes health insurance accessible and affordable for more than 30 million Americans who currently lack insurance--is so much more important than its weaknesses.

After fifteen months of hearings, meetings, debates, and ideas, the time has come for Congress to act to make healthcare better for all Americans.

I take this vote after much thought and consideration, not for any politician, but for my constituents who are anxious about whether they will be able to afford care for themselves and their children when they need it. For a nation as wealthy as America to have tens of millions of people without health insurance is shameful.

Even those who have insurance fear losing their jobs, and with it their insurance. Some are concerned that they will reach their annual or lifetime caps on coverage. Others are anxious that their insurance companies will simply drop them as soon as they get sick.

This bill, which my constituents have told me this Nation desperately needs, will address a number of shortcomings in our current system.

In our current system, those who have insurance pay more to subsidize care for those who don't have insurance. This bill changes that by requiring everyone to have basic health coverage. Everyone has a stake in improving public health. Currently, the uninsured don't get preventive care, and once they're sick, they wind up in the most expensive place to get treatment--the emergency room. The large number of uninsured distorts our system, acting as a hidden tax on the insured. This bill repeals that hidden tax.

In our current system, those with pre-existing conditions are discriminated against. No child asks to be born with muscular dystrophy, juvenile diabetes, asthma, or Down Syndrome. Yet current law allows insurance companies to deny or limit their coverage. This bill fixes that injustice, protecting our children, and ensuring they can access coverage for life.

In our current system, some women pay twice as much as men for insurance simply because they are women. This bill will change that so insurance companies will treat all people equally.

In our current system, Americans who work just as long and just as hard as their fellow citizens often lack insurance simply because they work for a small company instead of a large one. This bill addresses that too, by creating generous tax credits to small businesses to make insurance more affordable, and by creating affordability credits to help self-employed folks buy insurance at an affordable price in an insurance marketplace.

In our current system, healthcare costs are skyrocketing out of control. This bill will help rein in costs by paying doctors for quality, not quantity, and actually reduces the budget deficit, making our Nation more fiscally stable.

Oh, and one more thing, in our current system, millions of Americans like their doctors and insurance companies. This bill allows you to keep them. Millions of Americans will see no change in this bill except for the added peace of mind that occurs when you are no longer at the mercy of an insurance company that can drop or deny coverage at the drop of a hat.

And I haven't even mentioned the improvements to Medicare: closing the donut hole, eliminating co-payments on preventive tests, and reducing fraud and waste to extend the life of the Medicare Trust Fund.

Yes, anyone who looks at this bill can find something wrong with it. But I can't remember the last time I voted on a perfect bill here in Congress. Just about every bill can be improved in one way or another.

On balance, this bill does what I came to Washington to do: to give a voice to average working people, whose voices are too often drowned out by the voices of moneyed interests.

Because I believe this bill would make America a stronger, more stable, healthier, fairer, and more just Nation, I vote yes.

Mr. Speaker and my colleagues, I rise tonight with a sad and heavy heart. Today we should be standing together reflecting on a year of bipartisanship and working to answer our country's call and their challenge to address the rising costs of health insurance in our country.

Today, this body, this institution, enshrined in the first article of the Constitution by our Founding Fathers as a sign of the importance they placed on this House, should be looking with pride on this legislation and our work.

But it is not so.

No, today we're standing here looking at a health care bill that no one in this body believes is satisfactory. Today we stand here amidst the wreckage of what was once the respect and honor that this House was held in by our fellow citizens. And we all know why it is so. We have failed to listen to America. And we have failed to reflect the will of our constituents. And when we fail to reflect that will, we fail ourselves, and we fail our country.

Look at this bill. Ask yourself, do you really believe that if you like the health plan that you have that you can keep it? No, you can't. You can't say that.

In this economy, with this unemployment, with our desperate need for jobs and economic growth, is this really the time to raise taxes, to create bureaucracies, and burden every job creator in our land? The answer is no.

Can you go home and tell your senior citizens that these cuts in Medicare will not limit their access to doctors or further weaken the program instead of strengthening it? No, you cannot.

Can you go home and tell your constituents with confidence that this bill respects the sanctity of all human life and that it won't allow for taxpayer funding of abortions for the first time in 30 years? No, you cannot.

And look at how this bill was written. Can you say it was done openly, with transparency and accountability? Without backroom deals and struck behind closed doors hidden from the people? Hell, no, you can't.

Have you read the bill? Have you read the reconciliation bill? Have you read the manager' s amendment? Hell, no, you haven't.

Announcement by the Speaker Pro Tempore

Mr. Speaker, in a few minutes we will cast some of the most consequential votes that any of us will ever cast in this Chamber. The decision we make will affect every man, woman, and child in this Nation for generations to come. If we're going to vote to defy the will of the American people, then we ought to have the courage to stand before them and announce our votes, one at a time.

I sent a letter to the Speaker this week asking that the ``call of the roll'' be ordered for this vote. Madam Speaker, I ask you, will you, in the interest of this institution, grant my request?

Will you, Mr. Speaker, grant my request that we have a call of the roll?

Mr. Speaker, will you grant my request that we have a call of the roll?

My colleagues, this is the People's House.

When we came here, we each swore an oath to uphold and abide by the Constitution as representatives of the people. But the process here is broken. The institution is broken. And as a result, this bill is not what the American people need nor what our constituents want.

Americans are out there making sacrifices and struggling to make a better future for their kids, and over the last year as the damn-the- torpedoes outline of this legislation became more clear, millions of Americans lifted their voices and many, for the first time, asking us to slow down, not to try to cram through more than this system could handle, not to spend money that we didn't have. In this time of recession, they wanted us to focus on jobs, not more spending, not more government, and certainly not more taxes.

But what they see today frightens them. They're frightened because they don't know what comes next. They're disgusted because what they see is one political party closing out the other from what should be a national solution. And they're angry. They're angry that no matter how they engage in this debate, this body moves forward against their will.

Shame on us. Shame on this body. Shame on each and every one of you who substitutes your will and your desires above those of your fellow countrymen.

Around this Chamber, looking upon us are the lawgivers from Moses, to Gaius, to Blackstone, to Thomas Jefferson. By our actions today, we disgrace their values. We break the ties of history in this Chamber. We break our trust with America.

When I handed the Speaker the gavel in 2007, I said this: ``This is the People's House. And the moment a majority forgets it, it starts writing itself a ticket to minority status.''

If we pass this bill, there will be no turning back. It will be the last straw for the American people. In a democracy, you can only ignore the will of the people for so long and get away with it. And if we defy the will of our fellow citizens and pass this bill, we're going to be held to account by those who have placed us in their trust. We will have shattered those bonds of trust.

I beg you, I beg each and every one of you on both sides of the aisle: Do not further strike at the heart of this country and this institution with arrogance, for surely you will not strike with impunity.

I ask each of you to vow to never let this happen again--this process, this defiance of our citizens. It's not too late to begin to restore the bonds of trust with our Nation and return comity to this institution.

And so join me. Join me in voting against this bill so that we can come together, together anew and addressing the challenge of health care in a manner that brings credit to this body and brings credit to the ideals of this Nation, and most importantly, that reflects the will of the American people.

Mr. Speaker, on that I request a recorded vote and request that the Speaker exercise your discretion to conduct this vote by a rollcall under clause 2 of House rule XX.