To amend the Public Health Service Act to limit preexisting condition exclusions in the individual health insurance market to those permitted in the group health insurance market.

The last hour just ended, and you heard the admonition at the end of the hour that it is extremely important for people to pay attention. And during this hour, I am going to echo that thought. It is important for people to pay attention, Mr. Speaker, and, yes, I will direct my remarks to the Chair. But, Mr. Speaker, if I could talk to the American people, what I would tell them is now is the time, it is late at night, but now is the time for you to be keeping this House under intense scrutiny and watch what happens here over the next 72 hours as we drag this carcass of a health care bill across the finish line.

Now, how did we get here? It's probably useful to think about things for just a moment. We had a big election in 2008. People said they voted for change. Right before that election in 2008, in the other body, the chairman of the Senate Finance Committee held a big meeting over in the Library of Congress and had all the big players and the stakeholders in health care in the room, and came up with what was called a white paper on health care reform. For all the world, it looked like a bill. For all the world, it looked like it would be the bill that was brought forth in the Senate should the Democrats take control of the White House, the House and the Senate. Indeed, the election was held, and they did.

I will tell you, Mr. Speaker, I was somewhat surprised that there was not a health care bill, no health care bill came forth in those early days after the election. I thought perhaps we would see one in December of 2008 during the holiday season, but no health care bill. No health care bill in the weeks that the Congress was getting organized. We had a big inauguration, no health care bill. We had a designee named to be Secretary of Health and Human Services. Still no health care bill was forthcoming. Well, surely it will come along right after that confirmation for Health and Human Services. But as it turns out, that individual had some tax problems and that nomination was withdrawn before it ever got to the confirmation vote in the full Senate. So we were left without a Secretary of Health and Human Services for several months, no health care bill.

Suddenly, it was early summer. There was a letter sent from the other body from the two committees of jurisdiction, the Health, Education, Labor and Pensions Committee over in the other body, and the Senate Finance Committee in the other body, they sent a letter to the President and said, We will be producing a health care bill within the next couple of weeks. In fact, the Health, Education, Labor and Pensions Committee did produce a bill. The coverage and cost numbers were quite startling when they were revealed: A cost of $1 trillion. It left a lot of people uncovered as the original plan was unveiled, and then several weeks were spent in what was called the markup of that bill over in that committee over in the Senate.

Then the three committees of jurisdiction in the House had a health care bill that was rapidly brought forward. We didn't really get a lot of time to look at it. There was certainly no subcommittee markup. It came straight to our Committee on Energy and Commerce for a markup. And to give credit to the chairman of the Energy and Commerce Committee, we did get a little more time than the other two committees, the Committee on Education and Labor and the Committee on Ways and Means. They each had a day, a 24-hour period, to mark up this bill. Think of that. This bill, this legislation that's going to affect the lives and livelihood of Americans for the next three generations was allowed 1 day in markup in Ways and Means, 1 day in markup in Education and Labor. We at least had 8 days in Energy and Commerce. Four of those days were spent recessed because we couldn't agree on some things, but we did have more time in the Committee on Energy and Commerce than in any other committee in the House.

Think back, Mr. Speaker, to the Clean Air Act in the early 1990s. I'm told it was an 8-month markup for the Clean Air Act, 8-month. Think how the people on those committees must have hated each other at the end of those 8 months. But what did they get? What did they get for that 8 month investment? They got a bill that had support from both Republicans and Democrats, eventually passed the House, eventually passed the Senate, eventually was signed into law by George Herbert Walker Bush, and the Clean Air Act became the law of the land and arguably has been successful since that time. So that's the way the process is supposed to work.

Let me take one step back. The House passed a bill, the Senate passed a bill, they went to a conference committee, had a continuation of that long and drawn-out process, but the conference committee produced a conference report that was endorsed by the Senate, endorsed by the House, again bipartisan majorities on either side, the bill then went to the President for his signature, and that's what we now know as the Clean Air Act.

But think of the difference between that major piece of legislation that had a great and far and reaching affect on the lives and livelihood of every American, contrasted with what we've done over the past year.

And quite honestly, Mr. Speaker, it's not that we didn't have time. It's not that we didn't have time. After all, we have been working on this thing nearly 15 months. We actually had time to do a real markup in each of the three House committees. We had time to do a real markup. We had time to do a real conference committee.

Look at the timeline of this bill. We got it in Energy and Commerce in the middle in July. We didn't have a lot of time to deal with it before, but when we got it, we worked on it, we worked hard. I offered a multitude of amendments. I had 50 amendments prepared in committee. Five of those were accepted by the time the bill passed out of committee, all of those on a voice vote, so presumably a unanimous vote, and every one of those amendments was stripped out when the bill went to the Speaker's Office before it came back to the House, to the House floor in late October, and then we had the vote in the House in early November.

The Senate had their bill. The Senate Finance Committee completed their work in the fall. They brought their bill to the Senate in the month of December. It was voted upon, famously, on Christmas Eve, and then the normal sequence of events would be for the bill to go to a conference committee. And there in the conference committee, yes, the Democrats have substantial majorities in the House and the Senate. The Democrats would have had a significant advantage in the conference committee. The idea of the conference committee is to meld the differences of those two bills to create a product that can be endorsed by both Houses in the Capitol.

But they didn't do that. They thought, well, that was hard to get that one through the Senate. Let's not go through regular order. Let's try something different. And that something different was, maybe we can just get the House to pass the Senate bill because the Senate bill was, in fact, a House bill. It has a House bill number. In fact, it was our appropriations bill, I think, for Treasury Department appropriations last year. It did pass the House as an appropriations bill, went over to the Senate for work on their appropriations bills. That never happened, but the bill was then used as a shell. The legislative language for appropriations was stripped out, the health care language was put in, so the Senate passed a House bill on Christmas Eve, and then that bill can come back through those doors, come into the House, and the Speaker of the House will say, the business of the House is now, will the House concur with the Senate amendment to H.R. whatever it is, the House agrees by a simple majority, at that time 218 votes, and the bill goes to the President's desk.

But House Members didn't want to do that. They didn't like the Senate bill. For some it didn't go far enough. For some it went way too far. But the Senate bill was not seen to be an acceptable product. So while all of that discussion was going on, there was a little-noticed, to that point, election that took place in the State of Massachusetts, and the election was to fill the vacancy that was created when Senator Kennedy died. And that election was won by Scott Brown, who is a Republican who said he would be the 41st Republican vote against this health care bill.

Whoa. Now, a lot of doors are closed over in the other body. They can no longer go to a conference committee and expect that they will have their 60-vote majority to pass anything they want. In fact, to take any bill back to the Senate now, and under Senate rules where you need to have 60 votes to cut off debate, that is going to be a pretty tall order because they only have 59 votes, 41 votes on the Republican side.

So what to do? We do still have the bill that was passed by the Senate. That Senate bill passed with a 60-vote margin, so it is still quite viable. If there is just some way to convince the House to vote for that bill. Now the Republican side, we didn't vote for it in the first place, we are not likely to vote for it in the second place. But on the Democratic side, if they can put together enough coalitions and enough votes, now the number is only 216, with some unfortunate deaths we have had on this side and some people who have left the House of Representatives, so 216 is the simple majority in the House. That is all that is required. So, well, look, maybe if we could do some technical corrections, we can't really do them to the bill because the bill has already passed the Senate, and if we took those corrections back to the Senate, we would have to have 60 votes to cut off debate. But there is a Senate process called reconciliation to deal with budgetary and fiscal matters. And under reconciliation, only a simple majority is required in the Senate. Maybe we could do those technical considerations in the Senate under reconciliation and pass that through the Senate with 51 votes.

And if we, the Senate, do that, will the House then agree to pass our bill with the understanding that these technical corrections would quickly be instituted? That is the big question right now. And are there going to be any problems with any of those technical corrections to be done under reconciliation?

Well, there might be. There might be. Because, remember, reconciliation is to pass those very tough budget and fiscal bills that are really hard to get the number of votes because sometimes you are actually cutting spending, sometimes you are actually irritating a constituency back home because we are reducing Federal spending in some of those reconciliation bills.

If it deals with budgetary issues and spending issues, then it could pass under reconciliation with 51 votes. The Vice President gets to vote in the case of a tie over in the Senate. So 50 Senators plus the Vice President would actually pass any of those reconciliation provisions, unless, unless someone makes a point of order over in the Senate that they don't deal exclusively with budgetary issues, that they are in fact changes in policy that are outside the budgetary process. Then the Senate has rules that say if a point of order is made, that it would require 60 votes to put that provision into the reconciliation bill, the so-called Byrd rule initiated by Robert Byrd, the dean of the Senate many, many years ago, to keep just this type of problem from happening. Didn't want the Republicans if they got in charge to be able to do things like this.

So the Byrd rule has been in effect for a number of years; and the Byrd rule would say, well, say you have a contentious issue in the House bill. Say there is some issue with the language regulating the Federal funding of abortion. Say there is some question of what do we do as far as dealing with people whose legal status in this country may be in some question. Well, those issues are beyond budget and may in fact be subject to a point of order and may require 60 votes to then be included in the reconciliation bill.

So it is not a given that everything that is wanted by House Democrats in changes in the Senate bill for the House to agree to pass the Senate bill, they may not be there when those technical corrections are finally voted on in the Senate. And that will take some time, because every amendment in the Senate may not necessarily be debated, but every one will be voted on; and all of that is going to take some significant time.

So where we are in the House tonight is that my understanding is the Rules Committee is to meet soon, if they are not already meeting, and the Rules Committee will come up with the language for that reconciliation bill. None of us have seen that yet. It hasn't really been scored by the Congressional Budget Office, so no one really knows what this bill will cost yet. So all of that is still hanging out there.

Then there is one more wrinkle thrown in. The Speaker of the House said it very well the other day: no one wants to vote for the Senate bill.

Well, that is a problem if you are going to need to get 216 votes in the House for the Senate bill to allow the reconciliation bill to then go forward to fix the technical problems in the Senate bill. I know this gets a little confusing, but no one wants to vote for the Senate bill.

Is there a way around voting for the Senate bill? Probably not. But, wait. What if we voted on a rule that allowed us to go forward with reconciliation, and within that rule we kind of made it like the Senate bill had already passed without actually having to vote on it?

Mr. Speaker, I would just ask the question: Do you really think the American people are not paying attention? The last Democrat who spoke here in the well of the House said it is time for the American people to pay attention to this process. I would submit that is exactly right.

Now, many people will recognize this icon, the Capitol Rock figure from when my children were young. This was the individual who was just a bill, and one day he hoped to be a law but today he was just a bill. But you can see today he is mad. He is angry. And why is he angry? He is still a bill. He wants to be a law. But he doesn't want to be deemed, and he doesn't want to be ``slaughtered,'' referring to the Slaughter rule that the House may vote on. By this time on Sunday the House may vote on the Slaughter rule which would deem acceptance of the Senate product.

Well, you can see why Mr. Bill is upset. He wants to go through regular order. He wants to go through committee, he wants to be voted on by the House, he wants to be voted on by the Senate. He really would have liked to have gone to a conference committee and have those two products melded together and then come back for an up-or-down vote in the House or the Senate. But as it appears tonight, he may not get his wish.

And is there a consequence to doing this? Now, you are going to hear people say that, oh, things have been deemed for a long time. This is nothing new. I will tell you, this is different. This is new. This is not something that, certainly in my short tenure, I have seen.

In fact, I recall a reconciliation bill in 2005 when the Republicans were in charge, it was called the Deficit Reduction Act, a very contentious bill, because we were trying to bend the cost curve on Medicaid spending. Does that sound familiar? You have heard the term ``bending the cost curve.'' We were trying to bend the cost curve on Medicaid spending from an increase of 7.7 percent year over year to 7.3 percent growth year over year. Not a heavy lift in anyone's book, but it was a big lift here in the United States House of Representatives.

Now, we were coming to the end of the calendar year 2005. In fact, it was coming up on to the Christmas holidays. People were anxious to get home and be with their families. We voted on that bill, as I recall, early on a Monday morning. We had been here through the weekend, up all night, debates, debates, debates. A lot of changes, a lot of moving things around on the chessboard. And then, in the final analysis, the bill passed very early in the morning on a Monday morning. I think it was December 19, so it was getting very close to that cutoff for Christmas.

Later in the week, that bill was voted on in the Senate. And this was a

conference report. We had voted on the regular bills, it had gone to a conference, so these were the conference reports that we were voting up or down on.

The House passed its version. The Senate passed its version on Tuesday or Wednesday, quickly left town, and were gone. The House had already vacated the premises. And it was found that there was a little discrepancy. There were some differences in wording between the two bills.

Well, as they should have done, the Democrats that were then in the majority went nuts and they said, You cannot send that bill down to the White House for a signature because the House and the Senate did not pass the same bill, the same identical language. And it was a big deal.

The reason I remember this so well is, remember the doctor fix that we talked about a lot? In fact, we did a little doctor fix today. We extended the time before the doctors get their big pay cut; we moved that from April 1 to May 1. Well, there was a doc fix in the Deficit Reduction Act. At that point, I think the doctors were facing a 6 percent reduction in Medicare reimbursement, and that clock ran out at midnight on December 31.

We fixed it in the Deficit Reduction Act, but there was a problem. The House bill and the Senate bill were not word for word identical. I don't even remember the number of words that were different. It was not many. It seemed like an awfully picky process. But in order to comport with all of the laws in our Constitution, the House and the Senate had to pass identical bills for the bill to be regarded as passed and be available to go down to the President for his signature. So the clock ran out on Medicare and the doc fix.

Now, everything else that was in the bill was not perishable, and it would keep until the House came back in January of 2006 and could fix the damage. In the meantime, there was much wailing and gnashing of teeth here in the House on the then-minority Democratic side: this is unconstitutional. We will go to court. We will take this down. So the bill did not go to the President for his signature. It stayed and languished. And then, when the House came back, they passed identical language to the Senate. The bill was passed and went off to the President for his signature. The doc fix was taken care of a month late.

Dr. Mark McClellan, who was then the administrator for the Center for Medicare and Medicaid Services, told the country's doctors that he would make good and retroactively supply that difference in the bills that they had submitted; they would not have to resubmit. He tried to paper over the problem and make it as painless as possible.

But it was a big deal. It was a painful deal for the country's doctors. That is why I remember it so well, because so many were calling me in my district office and my staff here in Washington and voicing their displeasure that Congress really couldn't have gotten this right and passed the identical bill through the House and the Senate. But the fact is they didn't. And the fact is that that was a problem as far as passing a bill and getting it signed by the Senate.

Well, what are we doing today or this weekend? What are we doing? We are not even going to pass the bill. We just deem it as having passed. Because, you know, a lot of the things that are in the Senate bill are things that we have talked about a lot here in the past 14 or 15 months, and some of them we may have even voted on a time or two. So we can just deem it as having passed.

Well, no wonder, no wonder Mr. Bill is so mad. That is not what he signed up to do. He didn't want to be deemed or Slaughtered. Slaughtered refers to the chairwoman of the Rules Committee who has created the so-called Slaughter rule, which means that the rule that allows us to take up the reconciliation bill is a self-executing rule and will deem passage of the Senate product that passed on Christmas Eve.

Do you think the American people can't see through that, Mr. Speaker? Do you think there are many phone calls going into Members' offices over the past couple of days about this? I think so, because I have heard from a lot of people. They are not happy about a lot of things right now, but they are really upset about this, and I think rightly so.

We are supposed to do things by the book. That book is called the Constitution. And when we stray from that on something like this--and this is no small matter--this is going to affect one-seventh of the Nation's economy. This is going to affect the lives and livelihood of every American not just this month, not next month, not the month after that, but for the next three generations.

Think of Medicare, passed in 1965. How has that affected people's lives, for good or for ill? But this is sweeping legislation that has a long half-life and is going to affect the way of life in this country from this day forward, really long past my time on this Earth, and I suspect a long time past the life expectancy of almost everyone who is serving in this body.

So it is so important that we get this right. It is our obligation. It is the oath that we swore on this floor the early part of January of 2009 after those very famous elections, those historic elections that created the new Presidency, created a supermajority for Democrats in the House, created almost a filibuster-proof majority in the other body. A historic election.

We were signed in, we put our hands on our hearts, we put our hands on the Bible, we swore an oath to protect and defend and uphold the Constitution.

What happened to that, men and women who are here with me tonight? What happened to that oath? Did you not believe it then, or has something happened that you don't believe it now?

This is critical. I know it looks lighthearted. I know I have copied a figure from a children's musical. But this is critical. This is going to change the way of life for every American, not just now, but for far into the future.

Now, we don't even know yet the cost of this bill. There are multiple iterations of the reconciliation package that have been floated around the Congressional Budget Office. You call them up and try to get them to do anything at all and they will not because they are working on health care. Unfortunately, it has been that way now for well over a year. It is almost impossible to get any piece of legislation scored by the Congressional Budget Office, but we don't even know what this thing is going to cost.

We talk about bending the cost curve. The Commonwealth Foundation, the good folks at the Commonwealth Foundation, I attend a number of their seminars. I think they do a good job of trying to educate Members of Congress. They will talk in lofty terms about bending the cost curve. Well, we are just bending the cost curve, all right. We are just bending it in the wrong direction.

Now, this bill is supposed to cost on the order of $800 billion and change. I think it was $824 billion. But anyone will tell you that is not the real cost. In fact, when this reconciliation stuff gets scored, it is very likely that we are going to see a number in excess of $1 trillion.

You know, just a lot of this stuff people look at it and say, What is the plain truth here? You say that you are going to raise taxes by $500 million, you are going to cut expenses in Medicare by $500 billion, and you are going to cover 30 million more people. How is that not going to affect me? You say if I like what I have, I can keep it, but how in the world is it possible to do all of those things and it won't affect me?

And the President said this several times during the summer. He said: Many people look at this bill and say, What is in it for me? What do I see differently, either positively or negatively, after this bill has passed?

For one thing, we know what they will see is a lot of new Federal regulations. We're going to see new fees on insurance companies, new fees on medical devices, new fees on prescription drugs, new fees on insurance plans. All of those, of course, have to, by definition, drive up health care costs.

One of the things that we're not doing--and you've heard me reference the ``doc fix'' in the Deficit Reduction Act. We had a baby ``doc fix,'' if you will, for just the next month. But there is a looming 21 percent reduction in reimbursement for physicians who practice in the Medicare system, doctors

who take care of some of our sickest patients, our seniors who might have multiple medical comorbidities. We've asked them to do this, and yet we come at them every year with a formula that says we're going to pay you a little less this year than we paid you last year.

Now maybe that's okay if you're fortunate enough to practice medicine in a location where energy prices are falling by 5 percent every year, labor costs are falling by 5 percent each year, cost of capital is no concern because the banks are just giving away plenty of money at a zero percent interest rate. Maybe if you live in that area, this is not a problem.

But most of the doctors who live in the real world, the same world as you and I, know that their costs of labor are going up. Their cost of capital is going up. In a doctor's office, you don't make a great many large capital purchases, but you sometimes hire a new doctor; and in order to do that, you sometimes have to go down to your friendly banker and secure either a loan or a line of credit. So the cost of capital goes up for those physicians' offices year after year.

Energy costs go up the same as they do for every other American. Even the cost of the doctor buying the health insurance for their employees will go up. Believe it or not, the insurance companies don't come into the doctor's office and say, Doc, you know what? You've done such a good job at taking care of all the people enrolled in our insurance company that we're going to enroll your employees for free or at a very reduced rate. It doesn't happen.

In fact, what happens in doctors' offices across the country every year is the insurance underwriter comes in and says, Hey, you've had some claims activity. Your rates are likely to go up in your small business here. And the doctor says, Well, maybe that's okay because maybe my reimbursement rates are going to go up enough to match it. But then most private insurance companies actually peg their reimbursement rates in the private sector to Medicare. So if Medicare is reduced by 5 percent, 8 percent, 21 percent, as we're scheduled to do this year, guess what? Insurance reimbursement rates go down. So the poor doctor is left scratching his or her head, saying, How come it costs me more to insure my employees and my reimbursement rates are going down? How's that going to work out for me?

The cost of doing business in a medical office is no different than any other small business in America, and doctors' offices simply cannot continue to survive if we continue to impose this draconian pay formula upon them, and yet nothing in this bill fixes that problem. We had a temporary fix today. We talked in grand terms about this great and wonderful fix that the House passed last fall, but we all knew over here in the House, even those of us who voted for it, we knew that the Senate was never going to take it up and pass it. In fact, they had already rejected it. As a consequence, this provision has been left out of this big, gargantuan health care bill, this 2,700-page bill, and there is no fix for the problems that the doctors face in the Medicare reimbursement system. There is no fix in the bill.

It's a simple arithmetic problem. The simple arithmetic problem is that it costs somewhere between $280 billion and $350 billion to fix that problem. Well, clearly, if you're trying to keep the cost of your bill under a trillion dollars, and I'm not sure that they have done that, but if you're trying to do that, a $350 billion addition to the price tag is not likely to make your life any easier.

There is a cost for simply repealing the sustainable growth rate formula, as it's called. Medicare part B has an additional problem in that, by law, seniors are charged 25 percent of the actual cost of their premium. The Federal Government picks up the other 75 percent very generously. But if the cost of the Medicare part B program increases, then Medicare part B premiums, by law, have to increase, and they have to increase by a formula which, again, is 25 percent of the actual cost.

Now we hear a lot of talk about insurance companies raising the rates. They do. Can they justify it or not? There are supposed to be State insurance commissioners to oversee that process. I know we had a big hearing in my committee on Energy and Commerce a few weeks ago on the Anthem, WellPoint rate increases that occurred out in California, but I honestly don't know where the California insurance commissioner was when all of that was going on. And the people at Anthem did say they submitted their paperwork to the insurance commissioner. I don't know what happened there. I honestly don't know what the disconnect was, but there are rules in place where these types of increases are supposed to be justified.

But the fact is that part B recipients will likely get a big increase in their premiums this year because the cost of paying for the part B program goes up every year, and, just interestingly enough, that increase is likely to be somewhere in the order of 12 to 16 percent. The President is very critical of private insurance companies that will do that but, wow, he is the CEO of the biggest insurance company in the world. It's called Medicare. And he's raising his rates by 12 percent this year. In fact, over the last decade, over the last 10 years, those premiums have increased almost 150 percent. Again, it's by law. It's no one doing something that they shouldn't be doing. It is just the cost of delivering that medical care has, in fact, increased over time, more people making claims on the system. And as a consequence, those costs have gone up, and, by law, the seniors who are participants in the part B program are obligated to pay 25 percent of the cost of the program in their premium.

So when people tell you that the cost of insurance is going to increase, that's true whether you're talking about a Federal program, such as Medicare, or programs in the private sector.

One of the things that concerned a lot of us as the debate was going through the House this summer was the appearance of what was called a public option. At the time, a lot of concern by, actually, Members on both sides of the aisle--probably voiced more consistently by people on the Republican side--about what this public option was going to do to pay for insurance coverage in this country. Many people on the Democratic side said, Oh, it'll be competition for the insurance companies so it'll bring their prices down.

Well, here's part of the problem. One of the reasons that the insurance companies are raising their prices is because there is a cross-subsidization, that there is a shifting of cost from the government sector onto the private sector. Medicare reimburses at a rate that's far lower than most of the private insurers for both doctors and hospitals. In order for those doctors and hospitals to keep their doors open, that means they need to charge a little bit more to those patients who come in who have actual insurance coverage. So that cost shifting or cross-subsidization exists because the government isn't actually carrying its share of the load today. So if we expand that part, how are we going to help keep the costs low on the private side? Because, again, it's a cross-subsidization that we're already doing in the existing public plans--Medicare, Medicaid, SCHIP, and the variety of other programs that exist. Those public programs are not filling the holes that are being dug, the overhead holes that are being dug at hospitals and doctors' offices, and those holes have to be filled with dollars from private insurance.

So right now it's about a 50-50 mix. Well, that's not fair. Fifty cents out of every health care dollar that's spent in this country today is already spent on one of those public options--Medicare, Medicaid, SCHIP, add the VA, Federal prison system. It's about fifty cents out of every dollar that is spent on health care, and it is going up. The other 50 percent is not all private insurance. Some of it is paid out of cash flow for some families; some of it is paid out of savings for some families, and some doctors and hospitals just simply have to write off some debt because it will never be paid. They certainly do contribute more than their share of charity care.

So the government, which has about 50 percent of the health care dollar right now, is not carrying its load, which drives up the cost for people with private insurance. So we're going to expand that part and expect that the cost for private insurance is somehow going to go down. You're talking about magical thinking. That's just never going to work out. There's no way it can work out.

And sometimes you step back and you look at this and you think, Wow, the people who want a single-payer, government-run system have really set the wheels in motion to accomplish just that. Let's create another public option, bleed off more dollars from those greedy folks on the private side. Their prices go up. The President, whoever the President is at that point, says, Well, I tried. We tried to keep the private sector involved, but look what they've done to you. There's nothing we can do about it. We will just have to take over everything. At that point, you have a completely nationalized health care system in the United States of America.

A lot of people look at that and say, No, that's not what we want. You said, if you like what you have, you can keep it. That's what we want.

Sixty-five percent of Americans have insurance either through their employer or in the individual market, and they like what they've got. They're concerned about cost, to be sure. They want costs to be held down, but they like what they have and they want to keep it. So it does concern them when they look out over the horizon and say, What might have happened with this public option?

Now, the Senate bill, at least in theory, does not have the public option written into the bill. It does. It's kind of hidden. You kind of have to look for it a little bit. The Senate bill sets up insurance exchanges across the country in order to ensure that everyone has access to at least two products in an insurance exchange. The Senate has said that the Office of Personnel Management, OPM, will ensure that there is at least one for-profit and one not-for-profit insurance company in each of those exchanges. Well, what happens if no one shows up on the day they hold the auction to sell the insurance? Office of Personnel Management will find a for-profit company and a not-for- profit company, and if they can't find one, somehow they will make one.

Now, the Office of Personnel Management right now is a relatively small Federal agency. It administers Federal benefits. It administers things like the Federal Employees Health Benefits Plan. It does a good job with that, arguably, but this is a vast expansion of their mission, a vast expansion of scope to then put them in charge of these various exchanges that are in place all around the country. The Office of Personnel Management could become the de facto public option, and in fact, as it was looking like this bill was getting very close to being enacted in the early part of January before that famous election in Massachusetts, the Office of Personnel Management was indeed gearing up to take on that responsibility.

So whether you get the House bill or the Senate bill, there's still a possibility that you're going to see a public option. It may not be the so-called robust public option that you heard talked about here on the floor of the House ad infinitum last summer, but it will be a public option nevertheless, and it remains to be seen what happens to that over time. It may always stay a small part of what is available to the insurance market or it may grow significant.

What has been mystifying to me about that process, and you heard the President say earlier or last year in the fall, he cited there's a part of Alabama that you go to and you have only got one choice of an insurance company; and if you've only got one choice of an insurance company, there's not a lot of competition, so let us put a federally administered program on the ground to compete with that one insurance company.

But there's well over 1,000--in fact, over 1,300 insurance companies--in business right in the United States of America. What if we changed the regulations such that more companies could, in fact, sell in that market in Alabama? It looks to me like a market that companies might be interested in because, after all, there's not much competition there. That's the way to get robust competition in the market, and that is the way to get the types of cost controls that we would all like to see that could be delivered more efficiently by a competitive marketplace than it can be by government regulation and price-fixing.

We know what happens when you fix prices. Those of us my age who are old enough to remember gasoline purchases in the 1970s, when you put price controls on gasoline, you end up with gasoline shortages. You remove the price controls, and miraculously there's enough gasoline for everyone to buy. And as more gasoline becomes available, then the price comes down. It was a wonderful study in just how markets were supposed to work. You put the price controls on, it becomes very scarce and very expensive. And I can remember as a young resident at Parkland Hospital waiting for hours in line at a gas station because I did not want my gas tank to be empty and risk running out of gasoline on the way to the hospital in the middle of the night. It's something I couldn't afford to let happen to me. So I missed a lot of family time sitting in those gasoline lines. Fortunately, that didn't last long because the folly of that decision was recognized, the price controls were removed, and the price went up temporarily, and then it came back down as the supply of gasoline increased.

We don't know where we're going on the cost of this bill that's before us. The one charge that the American people gave us was, We want you to do something about the cost of health care. The one thing that we're not doing in this legislation is moving in a sane way towards doing anything that would get control of those costs. In fact, some of the things we're doing may, indeed, lead to a reduction of availability, and that means a reduction of access for patients to medical care.

An interesting little article that I found online on the way over here tonight was about what will happen to health insurance premiums under the bill that has been proposed. And what got this reporter's attention was a Presidential speech where he said that the cost of insurance if the bill was enacted would drop by 3,000 percent. Later on, the White House clarified and said the President meant to say the premiums would drop by $3,000, and that is money that could be returned to the worker.

The next quote in the story is, `` `There's no question premiums are still going to keep going up,' said Larry Levitt of the Kaiser Family Foundation, a research clearinghouse on the health care system. `There are pieces of reform that will hopefully keep them from going up as fast. But it would be miraculous if premiums actually went down relative to where they are today.' '' So next line in the story is, ``It could be a long wait.'' Indeed, it could.

I do urge people to pay attention. I do urge people to dig a little deeper in the story--don't necessarily accept what I am saying here tonight. But do look carefully into this story and understand what your Congress is doing because if it doesn't affect you the day after the bill passes, it will affect you at some time.

Now convincing reluctant Members to vote on this bill by doing the Slaughter rule and deeming the bill passed may be a way to trick some wavering Members into voting for the bill. But I promise you, it's not tricking anyone out there in America. You hear stories of people going to the supermarket at the checkout line, and the person who's checking their groceries will say, You are not really going to deem that bill as passed, are you? They get it. People understand it. They've been watching this. We've been working on this for 14 or 15 months. Goodness knows we're tired of it. The country is tired of it. People do understand and are watching.

Now tomorrow in The New England Journal of Medicine, it's been widely reported that they're going to have an article detailing the attitude of America's physicians towards this legislation that the House of Representatives is likely going to try to pass sometime this weekend. The numbers were somewhat startling, and I don't have the exact numbers in front of me. But if the bill were to pass, around 30 percent of practicing physicians would consider concluding their practice and finding something else to do with their time. And if a public option is included, that number gets significantly higher--45, 46 percent.

People who have been working in the trenches, who have been delivering the health care, understand how pernicious

it has been with the constant reduction in rates for Medicare, to be sure, Medicaid in some States. In most States, physician reimbursement is just an easy target. When those State budgets start getting stressed, that's one of the first places that the State legislatures will go to try to pull some of those dollars back in. They'll reduce reimbursement rates to physicians. And as a consequence, if it was difficult to keep your doors open and pay your overhead costs with the reductions that we were seeing in Medicare, it becomes an absolute certainty that those doors are not going to stay open if Medicaid rates are vastly curtailed.

One of the things we're going to do with this bill is significantly expand Medicaid. The cost to the States right now is somewhat in flux. Nebraska got a pretty good deal on the Senate floor right before Christmas that would kind of protect them against some of the dollars that the State would have to match into the Medicaid program. Now there's talk of extending that to every State and not just making Nebraska a special case but extending that to every State. I promise you, I promise you that is not going to make the cost of this legislation go down. It is going to make the cost of that legislation go up significantly.

If we don't do that, right now there is a Federal share and a State share of Medicaid expenses that are paid. It varies from State to State. In some, it's a 50-50 proposition. In some, it's much more generous from the standpoint of what the Federal Government contributes. On average, about 57 percent of the Medicaid cost is contributed by the Federal Government. The State pays 43 percent. In this bill, the language might be more generous than that, but there would still--unless the so-called Cornhusker kickback is applied to every State, then States are going to be hit with additional Medicaid expenditures.

I have received communications from senators and legislators back home in my State where that number could approach $20 billion for the 2-year budgetary cycle that we have in Texas. And although many people in Washington would consider that so small as to not even be worthy of consideration, in a State budget, it is significant, and that is why the legislators and senators have written to their Members of Congress to advise them of this that's occurring. That means money that's not going to be available to fund transportation projects in the State. That means money that's not going to be available to pay for educational activities in the State. These will be real dollars that are taken out of circulation in the State to pay for the expansion of Medicaid that the Federal Government is going to require.

The whole question of making everyone buy health insurance, the question of an individual mandate that is contained within the Senate policy, is something that this country has not done before. That is a new phenomenon. Now I know you hear people say, Well, look, look Massachusetts has a mandate, and it's working okay up there. Well, maybe. Maybe not. I think the costs went up a little bit because the insurance companies are now under no--there's no reason for them to try to hold costs down to attract customers because, hey, you've got to buy it. It's the law. But still, if a State wants to pass an individual mandate or an employer mandate, for that matter, within their State to cover health care costs, that's their business. They can do that under the 10th Amendment, that those powers not taken by the Federal Government are reserved to the States. That's one of those powers that are reserved to the States. So if a State wishes to do that, and the people who elect the Governor and State legislators and State senators in those States are saying, Well, that's okay with us, then good on 'em. That's what they should do.

But what's working in Massachusetts likely wouldn't work in Texas. It's a different demographic, different problems. So we can't apply a one-size-fits-all solution across the country, and the Founding Fathers recognized that. You will hear people say, Well, look, it's a mandate that you've got to have car insurance if you drive your car. But you are driving your car voluntarily on a public road, and that is a State mandate for the purchase of that insurance. Not every State has them. I think there are two States that don't have an insurance mandate. Texas didn't until a few years ago. I don't know if it's actually increased the number of people who carry insurance because you are forever hearing about some poor soul that was hit by someone else who carried no insurance. But that's a State issue. And the States make that requirement.

Again, those State governments have to be responsive to their citizens in the State. If the citizens get too upset by the liberties that are being taken from them by a State government, they are free to react against that. And that's what a democratic process is all about. That's what elections are all about. But never in the history of this country has there been required the purchase of a product just as a condition for living in the United States.

Now we do have to pay income tax, it's true. You don't have to earn any money. And if you don't, then you don't have to pay taxes. But in order to ensure that this program is administered effectively, we go to the meanest, biggest Federal agency of all, that very same Internal Revenue Service, and say that they're going to collect--they're going to enforce this individual mandate that you buy health insurance.

Just a thought on that in some of the moments that are remaining to us this evening. Does putting an individual mandate on people increase the number of people who carry, say, health insurance? Putting an individual mandate on for the requirement that everyone have health insurance, does that increase the number of people who have health insurance? Right now in the country with a robust employer-sponsored insurance program, people who are employed in the individual market, small businesses who provide insurance in the individual market for their employees, the compliance rate or the insured rate is about 85 percent. We hear the figure of the number of people uninsured in this country, and it works out to be about 15 percent.

In the Federal tax system, does everyone file and pay taxes who should? The answer is no, they don't. By the IRS' own estimates, by their own estimates, 15 percent of the population decides not to file or not to pay their income taxes. Now that's a pretty stiff mandate that the IRS puts on us. Most people don't know exactly what the penalty is, but they're pretty darn sure that they don't want to find out firsthand because they do know it to be severe. So with this very severe penalty hanging over people's heads, you still have 15 out of 100 who will say, No, thanks, I'll still take my chances. How many more people are going to buy health insurance who don't already have it if we put that on as a requirement?

And then one of the other considerations is, if the fine is not as much as the insurance policy itself, then someone who believes themselves truly to be at zero risk for any medical condition says, You know what, I'll just pay the fine if it's less money, and I'll worry about insurance if I get sick. Of course under the plan that's over in the Senate now, they can do that because there will be what's called guaranteed issue. If they get sick, they can literally purchase the insurance policy from the back of the ambulance on the way to the hospital.

You know, we heard a lot during the course of this debate on health care over these past 15 months. One of the things that I will never forget is the energy and enthusiasm that I encountered this summer in doing town halls during the month of August. As you will recall, we passed the bill out of the Energy and Commerce Committee sort of at midnight Friday night, July 31. We all went home to our districts. We started seeing the stories on the evening news of vast throngs of people showing up at Representatives' town halls, both Republicans and Democrats. Whether they had come out in favor or in opposition to the bill. We hadn't voted on the bill on the House floor at that point. Because I was sitting in the committee that voted on the bill, I could tell my constituents back home that I voted no in committee, and I would vote ``no'' when it came to the floor, unless there were substantial changes. And people supported that decision overwhelmingly in the town halls that I did this summer.

But it doesn't mean that they said, We don't want you to do anything.

They had some rather specific things that they would like to see Congress do to help them with the problems that they were having with either insurance companies or with their doctors or with their hospitals. There were some things they thought that Congress could do. Now bear in mind the approval rating for Congress is somewhere south of 20 percent. We do not enjoy a significant amount of political capital. In order to do something this big, you really have to have the American people behind you, but we don't. And therein is the trouble that the Democrats are having passing this bill. Right, they've got no Republicans, but then they really didn't try. They weren't interested in having any Republicans a year ago when this process was beginning.

So it's no surprise that at this point, a year later, they don't have any Republican support for their proposals. Their problem is within their own conference.

Now, they've got 40 seats on us. It really shouldn't be a problem. I'm sorry, they have 40 more seats than they need to pass this bill, because in the House it's a simple majority. It really should not be a problem. All you've got to do is keep 40 people from leaving you. That shouldn't be that hard. These are people who feel the same as you. They're members of your same party. They believe the same things you do. That shouldn't be a hard lift.

Why is it so hard?

It's hard because there's not the popular support for this bill that everyone assumed would be there shortly after the 2008 election. We had an election. President Obama won the election. Health care was a big deal during the election, so it was just naturally assumed that the American people would be with the Democrats no matter what they did, with, to or from health care. As a consequence, they didn't need any Republicans. They really couldn't be bothered. We were noisy and inarticulate in meetings, and they just wanted to write the bill they wanted to write, and they'd get it passed without any Republican votes.

Now they're up against an impasse with their own side. Very difficult to pass something this large that affects this many people without at least some input from both sides. That's never been done before, to my knowledge, in this country; and that's what we're trying to do tonight. You might be able to do that if you had the popular support of the American people behind you. You could say, well I've got the people with me. I don't need Republicans. And that would be true, but they don't have the people behind them.

So the fact that the Republicans are not supporting the Democratic bill is actually of no consequence. Their difficulty is the people don't believe what they're doing. And, quite frankly, I don't see how there is a way to change that equation between now and Sunday, the day we're supposedly going to vote on this monstrosity.

I did hear from people in town halls about things they do want done. I maintain a Web site that's devoted to health care policy. It's called healthcaucus.org, @healthcaucus.org. ``Healthcaucus'' is all one word. Healthcaucus.org. Under the issues tab, you see Dr. Burgess' prescription for health care reform. And I've listed there the nine things that people told me most consistently during the summer and fall that they wanted to see us do.

Number one thing, people sure do want some help with preexisting conditions. There are things we can do to provide some help, and it doesn't mean an individual mandate. It doesn't mean guaranteed issue. It means helping those people who need help. It does cost some money. The Congressional Budget Office scored an amendment that Ranking Member Joe Barton had on our committee. It scored at $20 billion. Nathan Deal, the ranking Republican on the Health Subcommittee and I have introduced legislation that captures the spirit of that amendment. We erred on the side of being more generous. That's a $25 billion authorization for that program. The Congressional Budget Office said $20 billion over 10 years. We plussed it up by $5 billion. Let's start it and see what happens.

After all, that Senate bill comes over here and becomes law, no one gets any help tomorrow. It's 4 years before they get help. Preexisting conditions are a problem today. We heard this over and over again in the summer time. This is something people actually wanted us to work on. We could work on this in a bipartisan fashion. We never even had a hearing on how to approach the problems of preexisting conditions without a mandate. We never even had one word of testimony about that in our committee leading up to this.

Does there need to be some fairness in the Tax Code? You bet. Why does someone in the individual market who's paying for their health insurance out of pocket have to pay with after-tax dollars when someone who works for a large multi-state corporation gets their insurance paid for with pre-tax dollars by their employer? That fundamental unfairness is something that has to be fixed. I'm not sure that I know the best way to fix that, but I know we haven't even tried. We haven't even had those discussions.

We do need some medical liability reform. It's working in Texas; it could work in other places around the country. It does help keep costs down, in spite of what congressional Democrats and the White House tell you.

Portability, the ability to carry insurance with you through life, is extremely important, especially to younger workers. Think of the relationship with your insurance company if you had a longitudinal relationship with that insurance company.

There are some things that we could be doing that are not that heavy a lift and don't cost that much money. Most importantly, we can show the American people we can deliver real value and work together while we're doing it. Then we could improve those approval rates, that low esteem that the country holds us in.

Dr. Burgess' Prescriptions For Health Care Reform

1. Insurance Reform

We should eliminate the bias against patients with pre-

existing conditions, outlaw rescissions except in cases of

fraud, and ensure states have well-designed high-risk pools.

H.R. 4019--Limiting Pre-Existing Condition Exclusions in

All Health Insurance Markets (Deal)

H.R. 4020--Guaranteed Access to Health Insurance Act

(Burgess)

2. Tax Fairness

Providing individuals the same tax benefits no matter where

they want to get their health insurance, and tax credits to

help individuals purchase insurance in the individual market.

H.R. 3218--Improving Health Care for All Americans Act

(Shadegg)

3. Medical Liability Reform

The success of Texas' 2003 reforms: Texas has licensed over

15,000 new physicians and Texas hospitals have delivered more

than $594 million in charity care.

H.R. 1468--Medical Justice Act (Burgess)

4. Portability

Allowing patients to shop for health insurance plans across

Madam Speaker, I come to the floor tonight to talk about health care on this, the 6-month anniversary of the signing of the Patient Protection and Affordable Care Act in the East Wing of the White House, March 23 of this year. It's interesting because since the passage and signing of that bill into law, support has actually decreased rather than increased.

This bill came to the House in the most unusual fashion. And in fact, our Speaker, Speaker Pelosi, was quoted as saying, ``We have to pass this bill so that you can find out what's in it.'' Well, that sounds pretty odd, doesn't it? It turns out the last 6 months have been just that, pretty odd.

On August 31 of this year, Secretary Sebelius, Secretary of Health and Human Services, said, quoting, ``Unfortunately, there is still a great deal of confusion about what the reform law is and what it isn't. We have a lot of reeducation to do.''

I don't know if that means they will be setting up reeducation camps for some of us, but nevertheless you have to wonder about the implications of that statement.

Now, it's interesting, I sit on a small little subcommittee on the Committee on Energy and Commerce. The committee is called Oversight and Investigations. Part of our jurisdiction is the Department of Health and Human Services, the Center for Medicare and Medicaid Services. You would think that our little subcommittee would perhaps have had some curiosity to have a hearing or two to talk about the implementation of this bill, to ask about how things are going, what's the future look like. It's been 6 months, maybe we could sit down and have a little talk. But we haven't done so.

I have sent letters to the chairman asking him to call the Secretary in. I have sent letters directly to the Secretary. I even gave an assistant Secretary a letter one day at one of our hearings and asked to please deliver it to the Secretary. We need to have some interaction with the Department of Health and Human Services in our little committee because the bill is complicated. The bill is complex. The bill is going to intimately touch the lives of every man, woman, and child amongst us for the next three generations.

And yet complete silence from the side of the administration, complete silence from the Democratic leadership of my committee, indeed the Democratic leadership of this House as to where is our oversight function in regards to the implementation of this bill.

This bill came about in the worst of any possible way. I don't know if people recall last summer our committee did work on a House product, a bill, a health care bill. It wasn't very good. I voted against it in committee. I voted against it again here on the floor in November when the Speaker of the House brought it up. But, nevertheless, we did at least go through some semblance of regular order here on the House side. Three committees of jurisdiction marked up the bill.

Amendments were to some degree allowed. The bill came then from the Speaker's office having doubled in size and came to the House floor, was debated all day one Saturday and then at the end of that Saturday evening passed by only one or two votes. But it's interesting. That was the end of the story for that health care bill, all 2,200 pages of it. It died that night shortly after it was passed.

What happened next between Thanksgiving and Christmas. The story shifted over to the Senate. The Senate took up a bill, H.R. 3590. This was a bill that had previously been passed by the House of Representatives in the summer of 2009. It was not a health care bill at the time. It was a housing bill. For the record, I voted against it; but it did pass the House and was sent over to the Senate to await action on a housing issue. This bill was picked up by the majority leader in the other body, dusted off and then said, ``This will be our health care bill.''

Now think for a minute. Why in the world would the other body decide to rework a housing bill that had been passed by the House and turn it into a health care bill? Well, I may have maintained from the beginning that this bill that the President signed, this law that the President signed in March of this year, was not anything to do with health care. This was a tax bill. And the majority leader in the other body recognizes full well that tax bills must originate in the House of Representatives, so he took a House bill. It didn't have anything to do with health care. It didn't have anything to do with health care taxes. It had to do with housing.

So the bill was amended, stripping out the existing language and then beginning to add in the health care language that they so dearly sought. But part of this process between Thanksgiving and Christmas was the cumbersome process of getting to 60 votes to cut off debate. Now it shouldn't really be too much of a challenge because the ratio in the other body at that time was 60 Democrats to 40 Republicans. Well, technically 58 Democrats and two independents who vote with the Democrats, so they had a pretty solid lock on that 60-vote majority to pretty much do whatever they want. But, still, it was tough. And the leader in the other body had some difficulty in getting his Members to sign on and agree to vote ``yes'' on this now health care bill, and we all remember the stories and they were uncomfortable. They were uncomfortable for me to listen to these stories as they came up.

You remember at Christmastime we heard about the Cornhusker Kickback; you remember the Louisiana Purchase; you remember Gator Aid down in Florida. And these were all payoffs, if you will, to certain Members of the other body to get them to agree to vote in favor of the health care bill. And when they got to 60 votes, they brought the bill up and they passed it in the Senate. This was accomplished on Christmas Eve and it was done in a great hurry to get the Senators out of town because a very large snowstorm was bearing down on Washington, D.C. and they all wanted to get home for the holidays and not be trapped here in the city over Christmas and New Year's. And they accomplished that goal. Now it was a bad process and it was hard to watch and in many respects it was very ugly in the process and many people across the country watched that and said, This is not what we elected our legislative branch to do. This is not the kind of work product we want to see them engaged in.

And as a consequence in those days after the start of the new year, people, the backlash, the pushback against what had happened in the Senate was beginning to be felt across the country, and it was felt in some unusual ways. It was felt in a special election in a small little State up in the Northeast, Massachusetts, where they were replacing Senator Kennedy; and, as a consequence, a Republican won a seat that had not been in Republican hands since anyone could remember. This so severe was the angst and anger of the American people when they saw what had happened in the Senate to the process.

So now the Democrats in the other body have a real problem. Now they only have 59 votes. How in the world are they going to get to 60 votes? They decide they just simply cannot do it and the House will have to pick up and pass the Senate bill, and since it originated in the House of Representatives and the House had already passed it, albeit it was a housing bill, not a health care bill but the House had already passed this legislation, it's a tax bill that originated in the House, went over to the Senate, it's being sent back to the House with the question, will the House now agree to the Senate amendments in H.R. 3590?

I didn't think there was any way. In fact the Speaker of this House said she didn't have a hundred votes for the Senate bill when it came back over. I thought she was right. I took her at her word. But then over the next 2 months they found a way to pass that bill. And late on a Sunday night, the third week in March, by one or two votes this bill was passed and immediately went down to the White House for a signature and a signing ceremony and thus you have the health care bill, the health care law, the worst of all possible worlds.

And is it any wonder with the way this legislation was drafted over in the other body that it is full of drafting errors. There are omissions of things, like a severability clause. At least in the House- passed bill as bad as it was--and again I voted against it--but in the House-passed bill we recognized that some of the things we were doing in that bill, some of the things that Congress was doing in that bill really skirted pretty close to being unconstitutional and if the Supreme Court actually found that to be the case and struck down a provision of the bill because we had a severability clause, only that section would be struck down by the Supreme Court ruling and the rest would be allowed to stand. The Senate bill lacks a severability clause. We hear a lot of stories about what are happening with 20 or 21 attorneys general across the country pressing a lawsuit because of the question of the constitutionality under the commerce clause of the individual mandate. Well, what if this were struck down by the Supreme Court? It is possible that the entire bill would fall because it lacked a severability clause. Simply an oversight, simply a drafting oversight, but at the same time a fairly significant one.

There was another oversight where physician-owned hospitals across the country that were under construction could not expand. They were allowed to continue construction but they could not expand beyond the number of beds that they had in operation as of the bill's signing. I had a hospital in my district that fell into this category, it's under construction, it's being built, the day of the bill signing it's not quite finished so zero beds are occupied. That hospital under a strict interpretation of the rules would not be allowed to expand the number of beds beyond zero. Well, that clearly was not the intent of the people who drafted the bill, but that's the way that the legislative language could be interpreted, and it took

several months working with CMS to try to get clarification. I'm not sure that we have the final report on that even to this day, but the hospital has been allowed to open and it has been allowed to open at least the initial 100 beds. But this is in a very vibrant and growing community in north Texas, and do you think the population in that area is going to increase, such that a 100-bed hospital will be sufficient from now and forevermore, or will perhaps someday they have to add some additional beds to that hospital? It's surely a possibility. And under the way the bill is drafted and drawn, the expansion of those hospital beds will not be permitted. But at least we were able to get clarification on the rule to allow that hospital to open.

Many people as the whole health care debate was going forward were insistent that Members of Congress take whatever health insurance we were forcing upon the rest of the country. Certainly a valid and legitimate request that the American people made of their Congress. So final passage of the Senate bill as it came over here did include the fact that all Members of Congress and their personal staff would be covered under the exchanges. They would have to purchase their insurance in the exchanges after they are set up in the year 2014. It is a little unclear what happens between now and 2014 since those exchanges do not exist, but nevertheless the language was written so that Members of Congress have to purchase their insurance in the exchanges. Staff has to purchase their insurance in the exchanges.

Oh, except for a couple of exceptions. We excepted leadership staff, so the staff of the Speaker of the House is not bound by this requirement. The staff of the committee that drafted the bill over in the Senate, not bound by this commitment. Staff in the White House, not bound by this commitment. Political appointees at the Federal agencies, not bound by this commitment. It seems like this must have been an oversight. Well, I'm not so cynical as to believe this would have been done on purpose. Surely this was just an oversight and surely that's one of those things that should be corrected.

Well, here we are 6 months later, the half-year anniversary of ObamaCare, if you will. The bill was signed, and what do you know? What Americans were promised didn't happen. And it's important that people understand what has happened and what didn't happen.

We were told by the President early in his administration that if you like what you have, you can keep it. How many times did you hear that repeated? But the reality is nothing could be further from the truth. And we actually got a glimpse of this almost on the day the bill was signed.

There were several companies that restated or had to restate their earnings because of some of the immediate effects of this bill as it was signed. Now, that was a point of some contention. Now, let me just quote a couple of paragraphs from a CNN story that was up on the Internet. The story is from CNN Money. The title of the story is ``Documents Reveal AT&T, Verizon, Others Thought About Dropping Employer-Sponsored Benefits.'' Digging into the story, ``In the days after President Obama signed the bill on March 24, a number of companies announced big write-downs due to some fiscal changes it had ushered in.''

``The announcements greatly annoyed Representative Henry Waxman, who accused the companies of using the big numbers to exaggerate health care reform's burden on employers. Mr. Waxman, chairman of the House Energy and Commerce Committee, demanded that they turn over their confidential memos, and summoned their top executives in for hearings.

``But Chairman Waxman didn't simply request documents related to the write-down issue. He wanted every document the companies created that discussed what the bill would do to their'' expenses and to their health care costs.

The result was 1,100 pages of documents from four major companies and the realization by the chairman's staff that the write-downs were--I am quoting here--`` `proper and in accordance with SEC rules.' The committee also stated that the memos took a generally sunny view of the new legislation. The documents'' . . . ``show that `the overall impact of the health care reform on large employers could be beneficial.' ''

But nowhere--I am continuing to quote from the CNN Money article here. ``Nowhere in the 5-page report did the majority staff mention that not one, but all four companies, were weighing the costs and benefits of dropping their coverage.''

I am continuing to quote from the CNN Money article from March of this year. ``Indeed, companies are far more likely to cease providing coverage if they predict the bill will lift rather than flatten the cost curve.'' One company said, ``We do expect double-digit health care increases as most Americans will now have insurance and providers try to absorb the 15 percent uninsured into a practice.''

Well, we can begin to see, internally at least, in some of these organizations that they were having some serious discussions. From the final paragraphs of the article, ``if 50 percent of people covered by company plans get dumped, the Federal health care costs will rise by $160 billion dollars a year''--a year; not a 10-year window, but a year--in 2016, in addition to the $93 billion in yearly subsidies already forecast by the Congressional Budget Office.

Finally, I'm continuing to quote, ``Of course, as we've seen throughout the health care reform process, it's impossible to know for certain what the unintended consequences of these actions will be.''

So here we see a fairly significant disruption on what many Americans, probably 60 to 68 percent, rely upon for their health insurance, and that is employer-sponsored insurance. Could it go away as a result of this bill? It doesn't have to. But to answer the question honestly ``could it go away?'' the answer is companies will look at that from a cost benefit analysis. And when you consider for one of those companies the $1.8 billion a year that they would save by letting their employees buy insurance from the government exchanges and simply paying the fine, certainly those companies may have to make a choice that is uncomfortable for them. But certainly if you like what you have, it's going to be difficult to keep it.

Now, some additional things have come up since the signing of the bill into law in regards to what is called grandfathering. And it turns out, if a copayment increases by more than just a small amount or a deductible increases by more than just a small amount, the grandfathering clause will not be allowed, and those companies will not be allowed to keep their insurance. Once again, ``if you like what you have, you can keep it'' may become extremely problematic.

What about patients on Medicare? Over the next year, nearly 1.5 million seniors on Medicare Advantage could lose their benefits, if not lose their plan altogether, because of changes that came about as a result of passing this legislation. President Obama said, ``If you like your doctor, you can keep your doctor.'' But what does that really mean? A Houston Chronicle article, May 17, 2010, says, ``Texas Doctors Are Opting Out of Medicare at Alarming Rate.''

`` `This new data shows that the Medicare system is beginning to implode,' said Dr. Susan Bailey, president of the Texas Medical Association. `If Congress doesn't fix Medicare soon, there'll be more and more doctors dropping out and Congress' promise to provide medical care to seniors will be broken.' ''

Just for a moment let me display an ad that was run in some of the local papers up here on Capitol Hill. This was an ad produced by the AMA that does a good job of showing how expensive it becomes to fix the reductions in reimbursement to physicians under the Medicare system. Cost to fix today, $210 billion; in 3 years, it will cost $396 billion; in 5 years, $513 billion. These are indeed staggering sums.

There was an opportunity to fix this when the health care bill was done. We'll talk about that more in just a moment. But this is an important point that people need to bear in mind. There's a lot of anxiety right now. People are calling their doctor's offices and finding that if they are a new Medicare patient, their doctor may not be able to see them because the doctor simply cannot afford to allow any more Medicare patients into their practice,

and that is indeed a very uncomfortable position to place upon both patients and doctors.

One of the most startling things we heard about this legislation as it went through and this new law after it was signed that health care reform will create 4 million jobs, 400,000 jobs almost immediately, well, this really was one of the most hollow promises made during the run-up to the passage of this legislation. Health care law has not created a single job, much less 400,000; and, in fact, the growing costs on businesses associated with the law may cause many businesses to lay off workers.

Now, we talked just a little bit about large businesses, multi-State corporations that provide employer-sponsored insurance. What about the smaller business? What about franchise businesses in your community that may have several locations and employ 100, 150, 200 people? I am hearing from those individuals literally every day. They do not know what to do. They do not know where to turn. They provide jobs that might be thought of as entry-level jobs. Yes, they pay the minimum wage. Yes, their benefits are not generous and some of them do not have benefits. So, great. These workers now will have the ability to buy insurance in the exchange. But if a worker purchases insurance in the exchange, whether the employer provided the option for insurance or not, that employer is now fined $2,000. Extrapolate that to a 100- person workforce and a 150-person workforce, and it's not long before you have eliminated any possibility of profitability for those businesses.

So I have people in my office all the time talking to me, asking me about this, talking to me about the problems that they are seeing on the horizon, the immediate horizon. And over and over again, I hear the same thing: I will tell you what I'm not doing right now; I'm not expanding. Any position that comes open, I'm thinking long and hard before I fill it. In fact, I think I will reduce my workforce significantly.

No H.R. director in the country right now wants to be responsible for hiring that 51st employee in a business because that triggers a whole host of new requirements as brought about by the law.

From the White House, the health care czar, Nancy-Ann DeParle, said the law will make health care more affordable for Americans. Is that a fact? What's really happening? This law is causing health care insurance prices to increase. The Wall Street Journal reported the reform is causing rates to increase up to 20 percent, 20 percent for some buyers. In Connecticut, rates are increasing at 18 percent for small businesses and 14 percent for the self-employed. Early retirees and others who buy their own coverage also see that same 14, 14\1/2\ percent increase, who are buying their own coverage as of the beginning next month, October 1, 2010.

Further, Secretary Sebelius of the Department of Health and Human Services actually sent out a letter detailing the fact that insurance companies were misleading people and that they were to remain silent on these issues of increased prices.

Now, I don't know about you, but that is disturbing. We've had the Secretary talk about reeducation, and then we've had the Secretary talk about you are not allowed to exercise your free speech rights when it comes to talking about the cause for price increases in your insurance product.

The fact is nobody knows right now; and again, I would stress, we have not had oversight hearings. Our chairman has not called oversight hearings in our committee. I am troubled by the increases I hear people talking about in their insurance. When I talk to groups of doctors back home, it is no longer discussion about how am I going to be able to do the medical treatment of my patient. Most of the questions I get even from doctor groups now are: How am I going to keep up with the new taxes? How am I going to provide health insurance for my employees because of all of these new regulations, and because of the fact that the cost is going up so fast that no company can even give me a quote on what my insurance costs will be next year?

Now, if insurance companies are simply pricing in what they see as a premium because they are worried about the effect of this bill in the future, maybe we should talk about that in committee. Maybe we should have some actual information about that. If insurance companies are indeed increasing prices because they are having to price in some of these new benefits that were mandated and come into effect essentially today at the 6 month anniversary of the signing of this bill, maybe we should have that discussion. The fact is, we don't know. No one knows. Insurance costs are going up. There is some suspicion that they may be inappropriate rises, but there is some suspicion that these may be elevations in costs that are occurring because of the unintended consequences of the new mandates that are put upon insurance companies.

Surely this is important enough for us to ask these questions on behalf of our constituents and our families back home. And surely this is important enough that the Secretary can spare a few moments from her photo-op tour on the 6-month signing of this bill to come into our committee and discuss this with us.

We had numerous hearings on how insurance companies were overcharging for their product leading up to the run-up of the passage of this bill. Maybe we ought to have a few of those companies in and say, well, Congress passed a bill that was going to hold the costs down and now the costs are going up, and we want to know why. It is a fairly simple question to ask, and I don't understand why we have yet to ask it.

What about this one: When the President ran, when the President talked about health care, all during last summer he said: These negotiations will be open. They will be transparent. I will have everyone around a big table, and we will have it on C-SPAN. You will be able to watch it until you are sick of watching it.

What about the promise of being the most transparent administration ever? The President said negotiations would not be performed behind closed doors, but on camera in front of the American people on C-SPAN for all to see. And what really happened? This law was written behind closed doors by committee staff. Those very same committee staff who, by the way, are exempt from the changes that were brought about in this bill.

On May 9, 2009, there was a big, secret meeting in the White House, a big meeting. Who was there? Well, the AMA was there. American Health Insurance Plans, AHIP, was there. PhRMA, the big Pharmaceutical and Research Manufacturers Association was there. The Service Employees International Union was there. Why they were there I don't know, but they were represented. AdvaMed, the medical device manufacturer, was there. The American Hospital Association was there. The President emerged from that meeting that morning, that bright May morning, and said, All of the stakeholders have come in and around the table we have all agreed to savings of $2 trillion in our health care system. Wow, $2 trillion, that is pretty significant.

It did raise some questions in my mind, but I am okay with that if they can extract those kinds of savings from those various interest groups. That is great. Let's see the data. No luck on that. I wrote to the White House repeatedly. I wrote during the summer, and I wrote during the fall. I asked for the information. I got nothing.

In December of 2009, I filed what is called a resolution of inquiry in the House of Representatives asking the White House to produce documents, emails, written notes of meetings. A resolution of inquiry has to be heard within 15 legislative days in the committee otherwise it proceeds directly to the floor as a privileged resolution. Obviously, the chairman does not want that to happen, so my bill was brought up, interestingly enough, on the same day as the President delivered the State of the Union message this year, so that day late in January. The resolution of inquiry was brought up, and I was informed that my resolution was overly broad, and I really could not have those things.

Just for a moment indulge me. I want to go back to that CNN Money article from last spring. I want to remind this body of Chairman Waxman's words when he thought the private companies were simply raising their prices because they didn't like the President's health care bill. Again, quoting from

the article, Chairman Waxman, chairman of the House Energy and Commerce Committee, demanded that they turn over their confidential memos and summon their top executives. But Chairman Waxman didn't simply request documents related to the write-down issue; he wanted every document the companies created that discussed what the bill would do to their most uncontrollable expense, health care costs.

Well, our request was not even as broad as Chairman Waxman's request was to legitimate American businesses. Yes, we asked for emails, communications, memos, minutes of the meetings. We got nothing. At the end of the day, Chairman Waxman, to his credit, did say of the 11 things I requested, I should receive some information on 6 of those 11. And Chairman Waxman and Ranking Member Barton did write a letter to the White House asking for the same. We got a couple of press releases and we got some reprints of White House Web sites, but really no significant documents. And I was told that there really wasn't anything written down. There really weren't notes made of these meetings.

Well, wait a minute. You have six major stakeholders of cost drivers in health care down at the White House, you come out and announce $2 trillion in savings, and nobody wrote anything down? Two trillion dollars in savings, and no one scratched that number in the margin of a big yellow legal pad and made a note of it? No one emailed a colleague and said, We just saved $2 trillion, yea for us! I am asked to believe nothing was written down at these meetings and that all of the documents that I have received are all that I can expect to receive.

Well, okay, then we passed the bill, and remember, we were told that it would save $142 billion over 10 years. President Obama himself came to the floor of this House and said he had a plan that would result in a net savings to the American people. And what really happened? We passed the bill. The House passed the bill. Again, I must stress that I voted against it, but the House passed the bill in March. And a month later we get an amended report from the chief actuary's office at the Center for Medicare and Medicaid Services which said, Oh, by the way, the cost of this bill is $318 billion more than what you were told it was going to be.

Well, that concerned me. Getting this actuarial report from the Center for Medicare and Medicaid Services raised a question in my mind: Did the Department of Health and Human Services know their report would reveal higher costs? Was this information that was in fact available when the House voted on this bill? Or were we so misled, was this House so misled by its leadership, that it voted on a bill knowing full well that we did not have adequate cost data in order to make this type of determination.

Remember, we are talking about restructuring almost one-fifth of the American economy in this legislation. Is it possible that the leadership of this House--the Speaker and the majority leader--would have brought to the floor, in front of Members of their side and our side, a bill for consideration when they didn't even know the cost this was going to place on the American people?

So I asked for information. I asked for information from the Secretary of Health and Human Services. I asked for information from the chief actuary. I did not get a response. So, in July of this year, I filed another resolution of inquiry, this time dealing with the actuarial report from the Centers for Medicare and Medicaid Services. After filing the resolution of inquiry, I finally got a response. On August 3, Secretary Sebelius wrote to me.

It reads: ``Thank you for your letter regarding recent reports by the Centers for Medicare and Medicaid Services' chief actuary. For your review, I have enclosed an August 2 memorandum from CMS Chief Actuary Richard Foster to CMS Administrator Donald Berwick about the timing and process for the Office of the Actuary's preparation of financial coverage and national health expenditure estimates for the Affordable Care Act. I wanted to send it to you immediately as it addresses many of the questions and concerns raised in your letter.''

Well, again, I did not get this response until after I had filed the resolution of inquiry. Dr. Foster's memorandum, indeed, says that he received the reconciliation bill for the health reform legislation when it was publicly issued on March 18, which was 3 days before the House vote took place on March 21. Because of the complexity of the legislation, it was not possible to estimate the bill's financial and other impacts before the House or the Senate voted. We began to work on the estimates right away, but were not able to finalize them until the afternoon of April 22.

Well, obviously, it would have been helpful to have received this information when I had first requested it. It would have been helpful to have received this information before filing the resolution of inquiry, but it doesn't answer the broader question. Okay. I accept the chief actuary's version of the events. He has got no reason to tell me anything other than what is factual and truthful; but if what he says is factual and truthful, the legislation was publicly issued on March 18. Three days later, the House took a vote on March 21, and he didn't know what the cost was until April 18.

Did the Speaker of the House know that it was going to be another month before she would actually have the cost data? Is it okay for this body to vote on a piece of legislation that, again, is one-fifth of the American economy and that is going to affect every man, woman and child amongst us for the next three generations? Is it okay to do that with a price tag that is simply a question mark? It's unknown. It's coming next month. What's the rush? Why don't we have that information before we vote?

I still have not received the information that I've requested. Again, the documentation, the emails, the meeting notes, they do raise questions because it was so hard to get this information. I'm not a suspicious person by nature; but when no information is forthcoming, it raises questions in my mind.

Is there something here that someone is trying to hide? What did they know, and when did they know it? You know the scenarios. You've heard them before. Why was it so difficult to get this information from Secretary Sebelius and the Department of Health and Human Services? Why did it take an act of Congress--literally, an act of Congress--to get a simple response to a fairly straightforward request?

Then most disturbing and most importantly, why would the House leadership, why would the Democratic leadership of this House, bring before this body late on a Sunday night a bill, again, that is going to affect every man, woman and child amongst us for the next three generations, without knowing what the cost of that legislation would be? It's shocking when you stop and think about it.

Again, I reference Chairman Waxman. He asked for every jot and tittle of information from legitimate private companies in this country that were doing their required SEC filings. He wanted to know everything about how they came to their decisions, and I can't have the simplest of documents from the Department of Health and Human Services and from the Centers for Medicare and Medicaid Services? What is wrong with my having that information?

Now, the resolution of inquiry came up for a vote today in my committee. It was reported without recommendation on, basically, a party-line vote. There were a couple of Democrats who voted with me on that. Reporting a resolution of inquiry out without recommendation means that it's essentially killed. That's the end of it. It's not coming to the floor for a privileged resolution. There is no action that must be taken by the Department of Health and Human Services or by the Centers for Medicare and Medicaid Services.

At some point in the future, I hope the committee will have the wherewithal to ask the Secretary and to ask the actuary, Donald Berwick, in to talk about the troubling time around the passage of this bill when this House voted on altering one-fifth of the economy of this country with incomplete data, with insufficient data, to actually make a determination.

Again, remember, one of the selling points of the Patient Protection and

Affordable Care Act that was brought to us time and again was: we save money; over the next 10 years, we're going to save $142 billion. False. Wrong. Not true. In fact, over the next 10 years, not only is there not a savings, but there is a net deficit; there is a net addition to the deficit of $318 billion.

Would anybody have voted differently? I don't know the answer to that. I was a ``no'' when it started. I was a ``no'' when it ended. If it had cost another $318 billion, I would have been a ``no'' because there wasn't a stronger negative vote for me to cast.

How about someone who was wavering--someone who voted ``yes'' and who thought, I'm really not sure if I should vote ``yes,'' but everyone tells me it's going to save money, and I want to save money, so I'll vote ``yes''? Would that person have voted differently? I don't know. I don't know, Mr. Speaker.

It would be interesting, as people go home during the month of October to petition their constituents for reelection, if perhaps that question might be asked: Would you have voted the way that you did if you knew that this bill, in fact, cost an additional $318 billion?

This health reform legislation remains secretive, hidden, behind closed doors. It is probably one of the most secretive things that this Congress has ever done in its history.

We were told that this reform would make it easier for small businesses to provide health insurance for their workers. One thing I heard over and over again all summer long from small businesses across my district is that complying with the new 1099 provision will be time- consuming and costly. It's expected to cost an additional $74 an hour to complete. And if not done correctly, guess what? That's a monetary fine. Due to the strict compliance, only a small fraction of businesses will be able to apply for any tax credits that are contained within the bill. Yes, there is an expiration date on those tax credits.

The 1099s have been particularly onerous. In fact, there have been bills introduced by both sides. Both sides have said maybe we ought to do away with the 1099. Republicans had a motion to recommit that contained a repeal of the 1099. Some Democrats have offered similar legislation. I say that's fine. I'd like to see the entire bill repealed, but you know what? If it has to be piece by piece, that would be a good piece to start with, wouldn't it? Let's repeal that. Let's stop putting that additional burden on our small businesses.

Today is the sixth-month anniversary. There are some new changes that are coming about as a result of the health care law. Today, young adults can remain on family health plans until they turn 26. No one disputes that that's a good thing. In fact, that was taken from a piece of Republican legislation, from a bill that was offered by the gentleman from Missouri, from a Republican Member of Congress, to allow youngsters to stay on their parents' plans until--I think his level was age 25. We could have argued. We could have debated about: Is 25 or 26 the right number there?

The fact of the matter is that could have happened a year and a half ago. It is happening today. Arguably, it's a good thing, but at the same time, was it necessary to turn the entire health care system in this country on its head in order to accomplish that goal?

Immunizations for kids: it's not the first time that has been brought up, and it's not the last time. Arguably, it's a good position, but let's face it: we could have done that without disrupting the whole health care system in this country. We probably could have done that without it costing $1 trillion. Why didn't we do that a year ago? Why didn't we do that a year and a half ago?

Some other things, preventive care, cholesterol screenings. But I would stress, as great as these benefits are and as important as it is for kids to have coverage until age 26, nothing happens in a vacuum. This doesn't happen for free somewhere. Someone somewhere is going to have to pay for it. Will that pay-for be some of the dollars that we saw in the higher premiums that insurance companies are charging now? Again, we don't know. It would be a great question to ask. It would be a great question to ask; bring your books in, let's talk about this. You raised your rates; was part of it because you have to cover kids up until age 26?

Some companies that I've talked to have explained to me that that is an additional cost that they are now taking on. Some others have told me that perhaps we will just stop covering children altogether so we don't get faced with that. But nevertheless, we ought to have those oversight hearings. We ought to have people who deal with this every day in to talk to us about how this is going. Maybe there are some ways we can improve it. Maybe there are some ways we can keep it from costing so much. We don't know because we don't ask.

All of the things that kick in today that are arguably good things, any one of those could have been done without disrupting the entire health care system and without costing $1 trillion. Many were ideas that were introduced by Republicans over the last several years. Existing legislation was out there, could have been picked up and passed at any time, but the fact of the matter is it was not. The bottom line is the bill does disrupt the health care system for everyone in this country, and it does cost, as we know now, well north of $1 trillion. That is going to be problematic for some time to come.

One of the other things about the implementation of this law is the deadlines that were missed, and it is important to pay attention to those deadlines. These were bits and pieces of legislative language that were included in the bill, presumably for a reason, presumably for a good reason, and for whatever reason the Department of Health and Human Services has decided that they don't matter, so we're not going to do them right now.

Required by April 22, shortly after the bill was signed: requiring the Department of Health and Human Services to publish a list of its new authorities, an action described as complying with an important transparency-in-government provision. Well, what actually happened on that date was the Department of Health and Human Services just simply reproduced the table of contents from the bill; hardly, hardly complying with the spirit or the intent of that language in the bill.

The law required, by May 7, 2010, proposing methodology and criteria for designating what qualifies as ``medically underserved populations'' and ``health profession shortage areas.'' Again, maybe the determination was made by Health and Human Services that this was not important. Someone thought it was important enough to include it in the bill. We should at least be given an explanation as to why that deadline was allowed to expire without action.

Required by May 7, 2010: establishing a government task force to develop a strategy to improve government health care programs in Alaska. Again, this was important to someone and included in the bill for some reason. Perhaps we are owed an explanation as to why that deadline has lapsed and when we might expect to see compliance with that.

Here is an ironic one. Required by May 22, 2010, to comply with what's called the Early Act: establishing an advisory committee to assist in creating and conducting an advertising campaign to educate young women about breast cancer and breast health, including early detection. Again, this language was important to a Member of this body, important enough to have it added to the bill. I believe this language was, in fact, important to a Democratic Member of this body. Why was it not thought important enough to meet that deadline? And if the Secretary is going to have difficulty meeting that deadline, perhaps she owed an explanation to Congress about why that deadline was allowed to lapse and when we might be expecting to see compliance with that deadline.

Required by June 1, 2010: that the National Association of Insurance Commissioners was supposed to provide technical guidance to the Secretary to what is known as the Medical Loss Ratio, the MLR. That didn't happen. The deadline was much too tight.

Now, this was interesting because lots of places in the bill it says ``the Secretary shall,'' which means there's going to be rulemaking over at the Department of Health and Human Services and a new rule is going to be introduced by the Department of Health and

Human Services. But this one, the rulemaking was kind of outsourced, if you will, to the National Association of Insurance Commissioners, certainly a fine group who have a lot of expertise and a lot of knowledge in this area. It turned out that they said they were unable to comply with this deadline and, as a consequence, were given an extension on that until the end of July. I don't think we're quite there yet, though we are getting close. And the Secretary is reviewing the documents that were provided to her by the National Association of Insurance Commissioners, but if she is having difficulty deciding on the validity of the documents that they provided her, whether or not what has been recommended is the correct course, perhaps we could have a hearing in committee and have that evidence presented, have those documents presented to the committee so we might understand something about it.

I do want to just briefly mention that there will be, Madam Speaker, a hearing--not in the hearing room. This will be a forum on the Medical Loss Ratio conducted by the Congressional Health Care Caucus, healthcaucus.org. This will be Tuesday of next week at 1 p.m. eastern time. At healthcaucus.org, you will have the ability to watch a Webcast or a simulcast of this forum. And the forum will be preserved in the archive section of the Web site, so people who are interested in learning about the Medical Loss Ratio, here will be an opportunity to do so. Unfortunately, we're not going to have that in our committee, but I thought this was important enough to bring to people's attention, and so we will be having that discussion next Tuesday on the Health Caucus Web site.

There certainly was some imprecision about how this bill was crafted, some imprecision coming out of the Department of Health and Human Services. According to The New York Times, the new high-risk pool program is so underfunded that it will cover fewer than 10 percent of those who are denied health insurance because of preexisting medical conditions. Remember, that was just one of the selling points of this legislation. The President stood right here in the well of this House in September of last year and said never again will you be denied insurance because of a preexisting condition. It turns out that's not exactly true. This law provided $5 billion to help people with coverage for preexisting conditions. It turns out, when the money is spent, the money is spent, and until the exchanges are set up in 2014, no additional help will be forthcoming. A good idea, an idea that was actually talked about by Senator John McCain during his Presidential campaign in 2008. The fact of the matter is the Congressional Budget Office estimated that it would cost $20 billion to do that.

Former Member Nathan Deal and I introduced legislation to cover just this situation, H.R. 4019 and H.R. 4020, that would provide for preexisting coverage. Those bills are still available. They could have been passed instead of turning the entire health care system on its head, instead of spending north of $1 trillion. For $25 billion-- because we added an additional $5 billion because we weren't sure that $20 billion would cover the number of people who needed to be covered. For $25 billion, we could have had one of the main features that has been promoted as to why this health care bill, why this health care law was necessary.

Deadline after deadline has been missed, but in spite of that, the administration has found time and the resources to send brochures to seniors on Medicare highlighting the benefits that they will receive and, in fact, even hiring a spokesperson in the form of Sheriff Andy Griffith to talk about the new health care bill, the new health care law.

Just going back for a moment to the chart that was produced by the American Medical Association about what's called the sustainable growth rate formula, the health care reform debate and time was the perfect opportunity to address this. Let's be honest; there were significant cuts in Medicare to pay for these new entitlements. The American Medical Association was supportive of this legislation as it came through. I would just simply offer the observation, since this sustainable growth rate formula is so onerous and preventing patients from having access to doctors, wouldn't it have been nice to at least have a down payment on solving this problem with the sustainable growth rate formula when this bill was discussed, when this bill was passed?

December 1 of this year physicians across the country face a 23 percent reduction in Medicare reimbursement. An additional 6.1 percent has been proposed by the Centers for Medicare and Medicaid Services. Doctors face an almost 30 percent reduction in Medicare reimbursements starting January 1 of next year.

It's even worse than it sounds. Many private insurance companies in this country peg their reimbursement rates to Medicare. So if Medicare is reducing 30 percent, guess what happens to some of the private insurance companies? They reduce 30 percent their reimbursement rates also. This is an extremely onerous burden that we've placed on our country's physicians, physicians that we've asked to take care of some of our most sickest and most vulnerable patients, those with multiple medical conditions, those covered under Medicare.

Medical liability reform. We had the opportunity to do it. We didn't do it. It needs to happen. We're asking doctors to be our partners in this brave new world of health care. The least we could have done was provided them a little bit of respite from some of the burdens they face with medical liability and oh, by the way, we might be able to reduce the cost of defensive medicine, which is one of the cost drivers that's driving up the cost of health care.

From an oversight perspective I've called for hearings to examine the implementation of this massive bill. My subcommittee has the jurisdiction to call in the secretary of HHS, the administrator at the Centers for Medicare and Medicaid Services. Chairman Waxman has refused to do so. I don't know what will happen next year. Perhaps we will have an opportunity to actually question some of those individuals.

In fact, the stimulus bill that this body passed in February of 2009 contains some money for helping physicians in hospitals purchase information technology that everyone recognizes as important for going forward in implementing any type of health care change in this country. But the reality is that the rule that was produced in January of this year regarding meaningful use was so difficult that most hospitals and most doctors will not be able to live with that.

We tried to alter that. We tried to get CMS to understand some of the difficulties that people would have in the real world dealing with this. Some relief has been achieved, but we're still a long way from an actual solution there.

This law, this bill, when it was passed on the floor of this House late on a Sunday night in March of this year, 55 percent of the public opposed this bill. Fifty-five percent of the public supported repealing the bill on March 25, 2 days after its enactment. Six months later, what has happened to that figure? It has increased. Over 60 percent of the American people believe that this bill ought to be repealed.

The Department of Health and Human Services has spent millions on television commercials featuring people like Andy Griffith and brochures sent to Medicare beneficiaries.

The audacity of the administration to disregard the opinion of the majority of Americans is unacceptable. Remember, we are government by the consent of the governed. The governed did not consent to this. The governed did not want this. The governed are now rejecting this legislation.

There was a better way. There are dozens of bills that would lower costs and increase access. Many of them have been covered on the health caucus Web site that I referenced a moment ago.

The fact of the matter is, this Congress, whether we like it or not, is faced with this massive health care law. In my opinion it should be repealed. The law is so massive, the structure, the reordering of structure is so onerous on our medical system that it's almost as if it were designed to fail. It's like building a bridge to the

Moon. You will collapse of your own weight before you get only a fraction of the way there.

It's hard to know whether the difficulties encountered in this bill, this law, are the result of incompetence or malevolence, but it doesn't matter which.

The time to repeal this bill is now. I urge the leadership of this House to recognize the mistake. Don't wait for another Congress. Let's do this today.

Thank you, Mr. Speaker.

Well, we have had quite a day here in Washington, D.C., in your Nation's capital. The 6\1/2\ hour health care summit that was held down at the Blair House right adjacent to the White House has mercifully concluded. And as the saying goes up in Washington, everything's been said, everyone has said it, so it was time to go home. But for those who haven't had quite enough discussion about health care today, maybe we can spend just a little while longer talking about some of the things that we heard today and some of the things that we maybe perhaps didn't hear today.

One of the things that I do want to stress, we heard several times in the past several weeks that the Republicans don't have ideas. In fact, that was one of the admonitions of the President on starting this summit was that the Republicans didn't have ideas, and he wanted to in fact show the country that the Republicans were devoid of ideas. But nothing could be further from the truth. If anything, we saw today abundant Republican ideas. Some may say there are too many Republican ideas, too many to fit in one room.

I wanted to spend a few minutes tonight talking about some of those ideas on our side. I have a Web site, Mr. Speaker, that is devoted entirely to health care policy. It is from the Congressional Health Care Caucus. The Web address is www.healthcaucus.org. And under the Health Caucus Web site, under the Issues tab, I think it is the second heading, is a Prescription for Health Care Reform. Anyone is free to go to that site and click on the Prescription for Health Care Reform, follow the links, and they will be taken to a one-page description of nine different bullet points on health care reform.

In fact, there is even a little segment to record comments if someone would like to leave their ideas or their thoughts on the paper. Or if someone thinks of other things that might in fact be included, we welcome those comments on the Web site.

I am just going to briefly go through this list, and then I have got some other observations that I want to make on the summit that occurred today. And we will be joined from time to time by other Members of Congress, and I want to give them an opportunity to speak. But under the Prescription for Health Care Reform, certainly everything I heard this summer was, we don't want a 1,000-page bill. People really didn't want a 2,000-page bill after we came back and revamped it after the summertime. But what did people want Congress to do on health care?

There are people who have legitimate concerns that the system is not functioning in an optimum fashion. We do have great health care here in America, but there are distributional issues. The employer-sponsored insurance system does work well for the 60 to 70 percent of the population that is therein covered, but in fact there are problems for people who are outside the employer-sponsored insurance system, and there are certainly problems that all of us face with the advancing cost and complexity of health care.

So just running down the list, insurance reform that would include limitations on insurance companies excluding people for preexisting conditions, and guaranteeing access to insurance. Now, one of the fundamental differences on the Republican and Democratic approach to this is that the Democrats want to have, and the President wants to have, a mandate. That is, you are required to buy a product, an insurance product.

It is interesting because during the campaign in 2008, President Obama, when he was a presidential candidate, actually moved away from mandates. Candidate Hillary Clinton during her candidacy was in favor of mandates. Barack Obama was less enthusiastic about mandates. He did feel that there should be a mandate for children. We don't hear much discussion about that anymore. In fact, I don't think I heard that during the 6\1/2\ hours of debate today.

But mandates really have no place in a free society. There's some argument as to whether or not it would even be constitutional for the Federal Government to require someone to purchase an insurance product that they might

not want. So there are legislative products out there. And this is the point I want to make. When people say, oh, we can't start all over, this would be too taxing. There are a couple of bills out there that I would encourage, Mr. Speaker, people to look at. H.R. 4019, a bill introduced by Nathan Deal of Georgia; H.R. 4020, a bill introduced by myself. Those two bills, taken in conjunction, would go a long way towards eliminating the problems with preexisting conditions.

Another bill to address the tax fairness or the tax inequity that exist in the health insurance market today introduced by John Shadegg, H.R. 3218, the Improving Health Care for All Americans Act, that would allow the same benefits, no matter where you get your insurance, whether it's through employer-sponsored insurance or in the individual market, the same benefits should accrue to an individual as accrue to a business.

Medical liability reform. Texas and California have taken big strides in medical liability reform. So why do I care? If Texas has fixed their problem with medical liability, why would I care about that? Well, I care because the cost of defensive medicine is significant. And since the Federal Government is the purchaser of about 50 percent of all the health care in this country, the costs of defensive medicine that drive up the price of Medicare and Medicaid, those costs need to be brought back under control, and medical liability reform is a way to do that.

Portability. Allowing patients to shop for health insurance across State lines, again, a bill introduced by Mr. Shadegg is H.R. 3217, the Health Choice Act.

To back up for just a moment to medical liability reform, H.R. 1468, the Medical Justice Act.

We're about to bump up against an important deadline on Sunday night, and that is the expiration of the prevention of a reduction in payment to doctors who take care of Medicare patients. We go through this time and time again. It is time for Congress to fix the physician payment reform, and H.R. 3693 would do just that.

Do we need to be worried about if there are going to be doctors there to see us when we get sick in the future? I think that is a concern, and I think that is something where Congress might play a role. Doctors to care for America's patients, the Physician Work Force Enhancement Act, H.R. 914. People ought to be able to know what the cost is when they go to the doctor or the hospital.

How about a bill for ensuring price transparency? H.R. 2249, the Health Care Price Transparency Promotion Act. Prevention and wellness programs, we all agree, during the hearings this summer, the individuals that come in who worked at Safeway and talked about how health promotion and wellness was saving them money, firms like Allegiant in Omaha, Nebraska, brought in great stories about how they had involved their employees in living healthier lifestyles and reaped the benefits from lowered insurance costs.

An odd thing about the way we do things at the Federal Government, we're actually going to have to change the HIPAA laws, the privacy laws, a little bit in order to have this type of legislation be passed. But that's certainly within the purview of Congress and within the ability of Congress to do that.

But prevention and wellness programs, although I do not have the bill number attached to this, we had several amendments in committee and in the Rules Committee leading up to the passage of the Democrats' bill this fall that dealt with prevention and wellness. The legislative language is written. It is not in bill form right now because it would require a simultaneous modification of the HIPAA laws in order to allow that to happen.

And finally, I mentioned before, mandates. No place in a free society. And this is one of the fundamental differences between the President and myself. He wants to force everyone to buy an insurance policy. He said that's the only way to bring costs down. I would submit that if the insurance companies know you have to buy their product, their prices are not likely to go down. In fact, if you're required to buy their product under the penalty of law, with the IRS as the enforcer, it is very likely that the cost will go up because no one wants to run afoul of the Internal Revenue Service.

And then we make insurance companies lazy. Why bother to compete with a better product? Why try to create a program that people actually want? You've got to buy it anyway. The government's going to force you, you're going to buy my product, I don't even have to make it something that you want, and I can charge you more for it. Mandates make insurance companies lazy.

We actually have a model for what works in this endeavor, and that is when the Medicare part D program rolled out, then Administrator of the Center for Medicare and Medicaid Services, Dr. Mark McClellan, required, out of six classes of pharmaceuticals, there were six protected classes of drugs. Within each class, an insurance company had to offer two choices, and using that as the parameter, the companies did produce the plans that people wanted. The product, part D, has been very popular. Ninety-two percent of seniors now have credible drug coverage under Medicare because of the flexibility and the desirability of these programs. The cost came in way under budget, and 92 to 94 percent of seniors are satisfied or very satisfied with their prescription drug coverage, so a program that indeed worked. And the whole emphasis was to make this look more like insurance and less like an entitlement.

Creating products people want is a better way to go about getting meaningful change in the insurance market than giving the insurance companies a license to steal, which is what a mandate would be, in my opinion.

I have some other observations on the day's activities, but I wanted to yield such time as he may consume to my good friend from Pennsylvania, Mr. G.T. Thompson, who in a former life was a health care administrator. I know it's odd that a doctor and a health care administrator would get along, but the two of us do get along very well.

G.T., I will yield to you such time as you may consume.

I thank the gentleman for his work on these issues. I thank him for always being willing to be involved in these. These are tough problems. These are complex problems.

You know, the activity today, I referred to it earlier today on a radio show as the Blair House project, not to be confused with the Blair Witch project. There were times when it did seem to be that there probably were some spells being cast.

The other thing that really had to strike you in watching the discussion today is that there are fundamental differences as to the role in government, fundamental differences as to the involvement in government.

You know you can't help but be struck. Here we've worked on this concept now for 13 months. The President was sworn in the 20th of January of last year. Here we are at the end of February, and still no bill is across the finish line. Boy, I thought it would have happened much, much more quickly. In fact, had the energy that was put into the stimulus bill been put into a health care bill, in all likelihood they could have passed whatever they wanted in February of last year. Instead, they chose to work on the stimulus first and then cap-and- trade and then gradually, gradually, gradually, their capital bled away to where they did not have the votes necessary on their side to pass one of these bills.

And this is the fundamental problem that is happening with the President's plans and the Democrats' bills in the House and the Senate right now is they do not enjoy popular support. Pick your number: 56, 58, 75 percent of the American people who do not support this 2,000- page monstrosity that literally required bribes to bring Senators down to the well to pass this bill Christmas Eve. The American people saw that and they rejected it.

They might trust us--I am not sure that they will--but they might trust us to work on some of these individual concepts one at a time. But at the very end of the summit today, the President decried incrementalism and said we have to be bold and we have to move forward with a large bill.

Why? Why do we have to do that? The programs to deal with preexisting conditions would involve risk pools to be sure. Reinsurance options for States, yes, it's going to require some Federal subsidy. The Congressional Budget Office has estimated $25 billion over 10 years. They may be a little bit light on that, but still we're nowhere near a number like a trillion dollars, which is scaring Americans to death.

We could provide some help in that market. The States could provide some help in that market. We could ask our partners in the insurance industry to voluntarily or by law cap their premiums at some level so that the person who was in this market did not find the costs so daunting that they simply gave up and did not get insurance.

Now, all of these great programs that the President and the Speaker talk about that they're going to give to the American people at no charge, none of these programs start for at least 4 years.

Now look, here we are 13 months into a new administration and the administrator at the Center for Medicare and Medicaid Services is not there. He hasn't even been appointed, much less confirmed by the Senate. That is the individual who is going to be responsible for taking this 2,700 pages of legislation that we give them and turning the legislation into rules and the Federal rulemaking process. That is going to be an enormously difficult task. It is going to take 4 years to work through all of that and impugn all of the legislative intent and make those Federal rules and leave the rulemaking period open long enough so that people can comment on it. That is an enormous task. It's not going to happen overnight.

So the people that come to us and say, My premium's going up too much, I want you to take it over, they're not getting anything for at least 4 years.

Now, in the meantime, what if we took an approach--and, in fact, it was an approach that was talked about by

Senator McCain in the fall campaign of 2008. What if we took the approach of we're going to take existing risk pools of the States--34 States have already created. We're going to emulate the best practices of the best States. We're going to allow for some reinsurance options if companies are willing to take on higher-risk individuals so that no individual insurance company is tasked with too much in the way of financial loss, and we're going to cover this group of individuals.

I heard it over and over and over and over again this summer at town halls, Stop what you're doing. We don't want you to destroy the system that is working well for 65 or 75 percent of the country. We want you to concentrate on those individuals who, through no fault of their own, have suffered a tough medical diagnosis, have lost their job and employer-sponsored insurance, couldn't keep up with the COBRA payments and now find themselves having fallen into that dreaded category of uninsured with a preexisting condition.

While we're at it, we might look at the COBRA system. COBRA was placed as a protection to help people who had employer-sponsored insurance but they lose their job. So employer-sponsored insurance means the employer generally pays about two-thirds of the premium; the employee pays about one-third of the premium. When you lose your job, you can't continue that insurance. But in all likelihood, your employer is not going to pay their two-thirds any longer because you're no longer their employee. But for 18 months, you can pick up the whole premium and pay that with a small administrative charge--I think it's 102 percent of the premium--and you can continue your insurance for 18 months and not fall into the category of uninsured. And if you have a preexisting condition, you continue to be covered at that cost.

But that's a tall order for someone who just lost their job to continue to carry that degree of premium. What if we allowed people-- instead of you had to keep that same insurance your employer provided you, what if we allowed them into a lower-cost, high-deductible plan for those 18 months and still preserved their insurability during that time, so that when they found employment, they would not fall into that same category again. Or they might even decide to continue that high- deductible policy with a lower premium and continue to have the protection of health insurance without falling into a preexisting category.

But we never really worked on those issues. We just decided we were going to do this big bill, and it was going to have mandates, and it was going to have a public option, and this is the way it was going to be. But to tell you the truth, for 4 years there is no help. There is taxes. For 4 years there is the immediate Medicare cuts, but the benefits don't start until year 4 or 5 or possibly even 6. We don't even know how long it's going to take to set up those programs. And again, we don't even have the administrator at the Center for Medicare and Medicaid Services. The President needs to nominate one. The Senate will then have to confirm them. We may still be months away from filling that very important bureaucratic job over at the Department of Health and Human Services.

I'll yield back to my friend from Pennsylvania

I was criticized on a news show earlier today referring to this exercise as a 6-hour photo op. Probably I would fall into the category as a ``plummet.''

Isn't it interesting that, yes, premiums for the average family may increase for 10 to 12 percent, but that's okay. Instead of an apple, you get an orange, so you're coming out better in the deal.

Now, yesterday, in our Committee on Oversight and Investigations, we hauled in Anthem Insurance Company in California. And Anthem, to their great discredit, chose right now as a time to increase their premiums, and they have become the whipping boy and the poster child. And I will concede, I think they raised their premiums too fast. They were tone deaf. Their highest premium increase was 39 percent. Their average was 25 percent. Twenty-five percent. Okay, that seems high, but the President's already said 12 percent. Yeah, that's okay because you get an orange instead of an apple, so after all, you're good in that transaction.

So I guess if Anthem wanted to raise their rates, they probably should have stayed at that 12 percent rate. They would have been right in line with the President of the United States. They could have raised their rates and all been happy about the transaction. Instead, they overshot. They hit an average rate of 25 percent and, as a consequence, found themselves sworn in under oath in our committee having to absorb the ordeal that we put people through when they come before our committee.

It's interesting, perhaps the one thing that would provide the right impetus in the competition to hold down those costs we are not going to do, and that's the ability to buy across State lines.

In the individual market, buying a policy for a family of four in New Jersey is $10,000 a year. Your State of Pennsylvania, $6,000 a year, my State of Texas, $5,000 a year. As long as people know what they are purchasing, I don't see why it is reasonable to restrict someone from having a policy that may be more affordable.

My insurance premiums have decreased by about 50 percent over the last 2 years. Not because I am a Member of Congress and I get a special deal, but I said, you know what, I can no longer afford this high option PPO insurance that is available to us in Congress, so I have elected to go into what's called a high deductible health plan with a health savings account. I actually had one several years ago when I was in private practice. I liked it.

I liked the fact that I was the one who got to choose which doctors and facilities I got to use. I didn't have to call 1-800-California to get an X-ray preapproved. I wrote the check and I controlled the money, and I made the decision about who I saw and when. So I have gone back to that type of policy, and I will tell you I am very satisfied.

We have improved from the old medical savings account in 1986 to the Health Savings Account improvements that started in 2003 and continue to this day. Preventive care is now included as part of the benefit in a high deductible health plan because the insurance company has an interest in making sure if you have a problem that it is diagnosed early, while it is less expensive to treat, and I think ultimately that's a good thing.

I have chosen a plan that does not have prescription drug coverage because after we passed the prescription drug benefit in Medicare in 2003, one of the unintended consequences was we changed the market so that now many generic medicines are available at Wal-Mart for $4 a month. I try to find those bargains for those medicines if I should need one. I try to find those bargains at Wal-Mart or go to an over- the-counter variety, which is much cheaper than the name brand that is bought at the pharmacy, and you can actually achieve significant savings.

I am motivated to do that because it's my money that I am spending for those compounds. Yes, I could have paid more for PPO insurance and then, yes, I could have had a nice mail order, even gone down to my pharmacy and gotten brand names, but I have found that, hey Prevacid is over the counter now. It costs a fraction of what it used to cost a few years ago. Even before that, Prilosec was a similar medicine, not quite the same thing, but that was available in a generic form over the counter at that time at a fraction of the cost of the 30-pill bottle of Prevacid that I was taking before.

So it makes the consumer more informed and motivated. Here is how you hold down health care costs: Let me be the decisionmaker about that. Don't tell me from a comparative effectiveness board that, hey, this medicine is just as good as this medicine, and so this is all you get because this is what we are buying for you this month.

Let me have some of that money back to spend myself, the premium that I pay every month, a portion of that goes into the medical savings account. Every year that it accrues and grows larger it's tax deferred until--if I don't spend it on health expenses I would obviously have to pay taxes on it when I took it out. As long as I spend it for legitimate medical purposes, hey, that's pretax dollars. That's probably the best deal you could do in the individual market. So these are changes that we actually ought to encourage.

I was stunned today to hear the Democrats admit, you know, we agree on a lot of this stuff that we have got here on these sheets, but, well, we don't do the health savings account thing. My goodness, that is the one way to really start to bring--you talk about bending the cost curve, that's one way. Get a motivated patient, educate them about some of the options that they have, and, oftentimes, not oftentimes, almost always they will make the right decision. I cannot tell you how many times in my medical practice if I recommend a test, a CT or MRI scan, a CAT scan or an MRI scan, and the next question from the patient back to me was not, Doctor, is it really necessary, or, Doctor, is this safe to do this, the next question was, well, does insurance cover it? If it did, there were no more questions. Go ahead and have the test.

I, on the other hand, with the type of policy that I have, yes, I may have hurt my knee or shoulder bad enough to go get a CAT scan, or I may make the decision that, Doctor, with a little ice and tincture of time would this not perhaps resolve on its own? Yes, it could, and if it doesn't get better in a week we could still do the CAT scan and we won't have delayed beyond the therapeutic interval, so it is okay to do that.

I am happy to take that advice and not have the test. If I don't feel better in a week or 10 days or whatever the prescribed time limit is, fine. Go get the test, and I will still be able to write the check and have that done. Here is how you bend the cost curve down. You get the patient involved, put the power back in the hands of the patient. Let the patient and the doctor make those decisions.

Don't make them buy the insurance at 1-800-California, but don't make them buy across the street at Health and Human Services. Let the patient and the doctor make those decisions. Every doctor has had the unpleasant experience of having called a preapproval number and have their patient denied a test or a procedure or a surgery, and then you have got to go to bat for them and prove all of these things. It is an enormous nuisance, and I hated it every time it happened.

On the other hand, in the Medicare and Medicaid system, they go ahead and cover that, but maybe 3 or months from now, maybe a year from now, they call you back and say, you know, we don't think that hospitalization was actually necessary, and we are going to deduct what we pay to you from the next round of payments that we give you for your next round of Medicare and Medicaid patients.

That is beyond frustrating because at that point you may not have at your immediate disposal the documentation that you at least would have had with a preapproval process. Neither is a good occurrence in a doctor's office. We need to come to some sort of consensus. But, as much as I hated the preapproval process, I see now, dealing with these large, large Medicare and Medicaid outlays, why it is necessary sometimes to assess medical necessity and why it is necessary sometimes to seek that preapproval, perhaps in our Medicare system.

If we really were serious about bending the cost curve, instead of just cutting doctors' payments--and that's what we do, we say, well, we will pay 20 percent less this year than we did last year--what's the practical effect of that? Well, the doctors' costs are fixed. He is not paying less for electricity to light his office this year than he was last year. His office help certainly didn't come in this year and say, hey, you know what, we can all take a pay cut because we love working for you.

That doesn't happen. His costs go up every year. The reimbursement rate goes down because Congress says, hey, we are spending too much money. What is the practical effect of that? The practical effect of that is, you know, I was able to pay my bills and take something home last year seeing 18 patients a day. But you know what, this year I have got to see 25 patients a day. And maybe if I can squeeze an extra procedure or two out, maybe I should do that because I have got to make up that difference somewhere.

So we have gone about this the wrong way. We are ratcheting down costs at the provider, and yet the doctor, he or she is the one who picks up the pen and writes the prescription, orders the hospitalization. The most expensive item in the doctor's office is their ballpoint pen most of the times because the doctor is the one making the decisions about that medical care.

Wouldn't a different way to look at this might be to say, Doctor, we are not going to cut your pay this year. We are, in fact, going to pay you a little bit more. We hope you will see fewer patients and maybe take a little bit more care and a little bit more preventive medicine and education with those patients along the way. It would be a phenomenal thing to look at but we never tried. We just cut the doctor's pay and said, whew, we got through it this year, the doctors are all mad but maybe they won't remember come November, and we will cut them again at the end of the year.

We are probably going to bump up against the clock. I do want to make this point from what we talked about the cost of insurance at the hearing we had yesterday.

It is important to understand, I think, that Speaker Pelosi, Harry Reid, President Obama, their health proposals would not make health insurance significantly cheaper for America's families. Under the bill passed by the House in November, H.R. 3962, a family of three making just under $55,000 a year and buying now a plan in this new exchange that's going to be set up and created by the bill, they would have to personally contribute after a tax credit about $5,500 a year in premiums. Additionally, this family would also pay $4,000 of out-of- pocket costs exclusive of the premium--copays and drugs that weren't covered--so this family would pay about $9,500 for a family of three that earns $55,000 a year in the Health Insurance Exchange.

I think it's important for people to understand that when we pass these bills and it's all settled and done, it doesn't mean free insurance. It doesn't mean free health care. It means, yes, you have got a government option here for buying insurance, but it's still going to cost something. It is still going to be an expensive item in that family's budget every year, and we are misleading people by telling them that, hey, we need to pass this bill because too many people don't have health care.

True enough, the person who has no income and no job will now have access to Medicaid, which they may not have had before, but the average person earning a reasonable salary is still going to find that the cost, the expense they paid for health insurance, is going to be significant. Here is the rub: If we pass this bill, this won't be an optional expense in their budget. They will be required to buy this, and the enforcer is going to be the Internal Revenue Service.

Now, Mr. Thompson, you brought up the online purchase of insurance for automobiles that has the cute little lizards and cave men on the logos. People will sometimes bring up to me, well, why, why not have a mandate. After all, there is a mandate to buy car insurance in your State, so, what would be the matter with having a health insurance mandate?

Here is the key. In my State, this is a State decision that in the State of Texas, people have to carry insurance if they are going to exercise the privilege of driving on the roads of the State of Texas. Health insurance is a different animal, and for the Federal Government to require, not a State government, but the Federal Government to require the purchase of health insurance is taking us in the direction of loss of liberty that none of us have really ever encountered before. It is a new concept.

So if a State wishes to exercise a mandate, which they have done in Massachusetts, then that's a State decision and that decision will either be supported or rejected by the voters in that State, but for the Federal Government to create for the first time a mandate, a requirement that a person purchase a product just for the privilege of living in this country, again, we are going down the road of loss of freedom that, again, I don't think people really want to go there.

Now, you will also hear, and it's so strange to hear the comparison of we have got to have a mandate as you do with automobile insurance, and you know what, you can buy that consumable insurance online. What if, instead of, if we had our thinking right, we would let the health insurance be available online, let the plan finders be available online and, if people think it's necessary to have a mandate, let that be a State decision. Let that be a State decision if the exchange is--right now you have, and I don't know the precise number, 30 or 34 States whose attorney generals are drawing up legislation to prevent their States from or prevent their citizens and their States from being required to follow an illegal Federal mandate.

It just shows you the type of tension that we are going to set up between the State and Federal Governments if we were to pick up and pass either the House or the Senate bill and send it down to the President for his signature.

Thank you, Dr. Burgess. I really appreciate what my good friend from Texas is doing in terms of his leadership with the Congressional Health Care Caucus. It's refreshing in this Chamber to deal with folks who have the facts and have the experience to make informed decisions when it comes to such important topics like health care. I think of all the issues that come before this Chamber, there are probably few things as intimate to our individual lives as health care. And to observe this process over this past 14 months, where bills are written as I look at these bills, 1,000, 2,000, 3,000 pages, which has been special agendas for, you know, just misled government-run health care, it's apparent to me that those who are writing those bills have very little experience, if any experience in health care. And so it's been a real privilege to be able to work with you and under your leadership to really look at the solutions that we need to have.

Now, as I travel around, and I did, my background was 28 years nonprofit community health care where I, in the hospitals, the health systems I come out of, we work very hard to be partners with our physicians.

And so what am I hearing? As I travel in my congressional district and I listen to folks throughout the country, I haven't met anyone that says, just don't do anything. The commitment is that, as I talk with folks, that they feel that they like the health system we have. Can we improve it? I think there's an acknowledgment that we can do that. And I've certainly spent my professional career serving my patients first as a therapist and a rehabilitation services manager and ultimately as a nursing home administrator. And looking at four dimensions of health care that we should always continue to strive to improve. Number one is cutting cost. And that's just not cost for a certain segment or a certain group, but cutting cost of health care for all Americans, which we're committed to that with the solutions you've talked about. It's about improving access, increasing access and improving quality and strengthening that decisionmaking relationship between

the patient and the physician, not allowing government or a bureaucrat to be that wedge in between.

As I talk with people about health care, and I've been doing that since I came to Congress, that's what they're asking for. The people I talk to, they like the solutions. They like the bills that we've introduced as far back as last July that dealt with medical malpractice reform, tort reform that drives the cost of the health care up for all Americans through both the premiums for medical liability insurance that has to get absorbed into the cost of doing business, those premium costs get passed along as a part of the fees, and not just the premium fees, but then there's the cost of defensive medicine that occurs, with extra tests that are ordered, not so much maybe to serve our needs and whatever particular illness or disability we come to the doctor for, but to provide a record that shows that the physician has exhausted every possibility.

It's things like many of the solutions you talked about, allowing to purchase across State lines. It fascinates me that you can go to the Internet and you can go on a Web site, some of them got little critters like lizards on them, and you can purchase car insurance and get the best value, the best product for the best cost. You make that decision as an individual. And yet we are barred from purchasing health insurance across State lines.

In States like Pennsylvania, especially rural Pennsylvania where I'm from, if you have choices, you have just a couple of choices. Maybe if you're lucky, you have three choices to pick from. And a lot of people say, well, I want the insurance that you have as a Member of Congress. Well, I'm quick to tell people, I worked nonprofit community health care for hospitals for 30 years. I'm paying more today as a Member of Congress than what I ever paid for health care. But what I would like every American to have, certainly every constituent in my district that I have today are just lots of choices. And we do that by allowing purchasing across State lines, more competition. That's a good thing. Competition brings the cost down and raises quality. I don't care what you're purchasing, that's a principle that lasts.

Certainly, a formation of association health plans, and preexisting conditions, as you've talked about. I mean, those are all just a few of the different parts of the proposals that Republican Members have introduced and are pending bills that are right here that the Speaker could elevate to the floor at any moment so that we could actually take an up-or-down vote on these. I think the American people would vote yes. I see a thumbs-up from the American people as we talk about these different proposals.

Preexisting conditions, that's a tough issue, but we're addressing that within the proposals we have. Just because you're born with a preexisting condition or you happen to have the misfortune to develop a disease such as breast cancer or prostate cancer in the course of your life doesn't mean that you shouldn't be able to afford to be able to purchase affordable health insurance. We address that in the solutions that we put forward. I'm so very proud of all of the representatives from the Republican Caucus who were at the Blair House today. I thought they did an outstanding job of representing the American people and ideas that the American people are looking for.

You mentioned about workforce issues, and to me that was something that I came to Congress just looking as a crisis. Starting with rural America and underserved urban areas first, the baby boomer generation, my generation, we're beginning to retire in tremendous numbers. And in those areas where our physicians, our nurses, therapists, technicians are retiring, this payment system will get changed if we don't proactively address those workforce issues. If you don't have a physician in your community to provide services, you do not have access to quality care. And so because we've been misled with these 1,000, 2,000, 3,000 pages, all the attention's been drained in the wrong direction, we're missing the bigger issues that, frankly, we've been talking about. We've got bills that address some of the workforce issues, and so it's time to get beyond the misinformation and the misdirection that my Democratic colleagues have been putting together in these 1,000, 2,000-page bills, and get to the business of really addressing the real health care issues.

Some of the observations of just watching the summit, as I guess it was called--I have a question for you. I will come back to you for that.

Some observations of the proceedings that I watched today when I had an opportunity to tune in in my office--I wasn't on the invitation list to be there. It was pretty limited invitations. But I heard--and I don't know which leader it was, whether it was the President or the Speaker or whom, made comments there were absolutely no Medicare cuts that are involved in this. And yet the fact is the Congressional Budget Office Director, Doug Elmendorf, back on December 19, just a month ago or 2 months ago, noted that there were Medicare cuts, and those Medicare cuts built into this impact all areas of health care from hospitals to skilled nursing to home health to hospice. Hospice, which is a wonderful service for people who are in the final stage of dying, where they have the support of compassionate health care professionals surrounded by family to be able to die with dignity, and yet that is an area, one of many areas of Medicare cuts that are slated for under these proposals.

In my responsibilities across many different settings of health care, I have to say that there is a lot of reasons why commercial health insurance is expensive. Tort reform I would put right on top of the list.

But maybe even higher on the list, I would say, is the Federal Government. The Federal Government pays--underfunds and has systematically underfunded the costs of health care--the physician, the hospital for Medicare payment. For every dollar of cost of providing care, the Federal Government pays 80 to 90 cents. For medical assistance, it's maybe, if you're lucky, 40 to 60 cents. It depends on the State. The commercial health insurance pays, on the average across the Nation, 135 percent of costs. And the primary reason for that is the hospitals' physicians have to negotiate at that rate. If they don't, they can't make up for what the government does not pay.

So what are some of the other costs that I heard today that really intrigued me?

I heard the Democratic leadership claim that it was going to bend the cost curve, meaning it's going to bring the cost down for everyone. Yet, what we saw was the administration's actuarial--the professionals that work for the White House, that look at those numbers and do those cost projections--have found the Senate bill, in fact, will not decrease health care costs. The Center for Medicare and Medicaid Services, who you just talked about, the Medicare professionals, their finding was that those were going to increase expenditures by $222 billion, with a ``b,'' billion; not hold costs, not cut costs, but will expand the costs of health care.

And the President today was very up front in his comments where he said that, yes, this proposal will increase premiums for the average American and American family by 10 to 13 percent. Well, I thought the number one thing we were looking at here is decreasing the cost of health care, making it more affordable. How do you truly get access to greater health care? Well, you bring the costs down so people can afford it.

So I was curious to get my good friend's opinion. This morning when I woke up and I knew this was going to occur, it struck me as I was walking to the Capitol, was this going to be a health care summit today or a health care plummet? And to me, the indicator was whether the President showed up with either a white board, a large white board that was blank that we could start over and do what the American people want, and that would be what today's events would be--it really would be problem solving, because that is what Americans are looking for, problem solvers--or would he show up with a rather large hammer and really try to hammer through, push through Big Government, bad ideas that the American people, in a large majority, have rejected.

So I yield back to my good friend just to get your impressions of do you think it was a health care summit today or a health care plummet.

I have to wonder with that because I see premiums like announcements, and they are going up. And this is why we're committed to doing the right type of smart government solutions to bring the costs of health care down, the premiums down. Giving a license to 12 to 13 percent additional increases, that's unacceptable to me for the American people.

I have to wonder how much of what's going on in Washington and these health insurance companies as America is watching the debate here, that--you know, giving this approach that the Democratic leadership, my good friends and colleagues on the other side of the aisle are taking, how much is that driving up premiums right now because they don't know what's coming. They don't know the premiums. There is a lot of uncertainty.

I mean we, not too long ago, passed a credit card bill under similar circumstances. It was going to provide all kinds of limitations and impose new conditions on really what has been kind of a free market type of process, and what I have seen, actually, as a result one of the unintended consequences, is some of those interest rates--before the new regulations kicked in, some of those interest rates went way up as an unintended consequence of government overreaching, government-run approach.

I have to wonder if what we are seeing with some of these more recent--like the situation you just talked about, may be an unintended consequence of just the wrong-minded direction that our Democratic colleagues are taking this health care debate in, as a reaction by the health insurance industry.

Pennsylvania being one of those, absolutely.

Well, you have touched on so many very important issues during that time, during the course of this hour. I certainly want to come back to--you know, when I started in health care, I mean, the patients were not a part of the treatment team, they were, you know, everyone kind of focused their energies on the patient, the individual, the consumer, but they weren't included in health care decisions. So much has changed in at least three decades.

Today, I don't know of any health care professionals that don't consider the patient themselves a very important part of the treatment team, and it's so important that individuals take that, exercise that self-responsibility to be informed and to make decisions and to take control of their health care, extremely important.

You also talked about, you were talking about the stress on physicians, and it's significant. In Pennsylvania, the average age of physicians in Pennsylvania is 50. Many that I talk with, they look at the challenges of practicing medicine today. In Pennsylvania, we have terrible medical malpractice costs. We export our physicians. We train a lot of them, but we export them to States like Texas. You know, we don't keep them. And many of the physicians I talk with that are 50 and older, they look at what they have accumulated in their lives, and they look at how much they are spending each year, whether it's medical malpractice, these additional costs or regulations that are coming, the extra costs they had to put into practice to comply with Federal mandates like the HIPAA law from the 1990s.

And they are saying, you know what? Why don't I retire now while I

can at least retain a little bit of what I've earned so I can have some type of future enjoyable retirement? That would contribute so much to our access issue in States like Pennsylvania where citizens are not going to have access to quality care. I see that as a significant unintended consequence as a part of what my friends across the aisle are proposing and pushing at us.