Floor Statements

Madam Speaker, as an OB/GYN physician who has delivered close to 5,000 babies, I strongly support the sanctity of life and, therefore, H.R. 7.

Since 1976, Congress has prevented taxpayer funding for abortion. Unfortunately, this door was reopened with the passage of the Affordable Care Act. This misguided law, in addition to causing incredible harm to our health care system, has potentially put taxpayers on the hook for funding the termination of innocent life. That is why H.R. 7 is so important. It explicitly states that taxpayer dollars should not be used to fund abortions.

I am not here today making a point. I am here on this floor as a physician, trying to save lives. Abortion is not a business our government should be involved in. As legislators, we carry the responsibility and privilege to protect those who do not have a voice. We must make our laws consistent with our science and ensure full legal protections to those who are waiting to be born. This starts with legislation like H.R. 7.

One of our government's core functions is to protect the most innocent among us, and I will do my best to ensure that government fulfills its duty. I will always fight for the right to life because it is my belief that we are unique creations of God, who knows us and loves us even before we are born.

I urge my colleagues to support this important rule.

Mr. Speaker, before I begin, I must spend a moment or two talking about Congressman Chris Smith, who has been down here for three decades of his life advocating for life tirelessly.

This Nation and the unborn owe this man right here a gift of thanks and gratitude. And I do, Mr. Smith, thank you very much for your work and leadership in this. It is truly amazing.

Mr. Speaker, it is with a heavy heart that I once again, in my 5 years in Congress, return to the House floor on this date, both as a father of three, a grandfather of two, and professionally an obstetrician and gynecologist. I have delivered close to 5,000 babies, and I strongly support the sanctity of life. Using technology like 3-D ultrasound has given us a window to the unborn as a living, breathing, feeling human being.

I have looked through that window with my own eyes thousands of times. I have seen human development occur at its earliest stages of a baby's life all the way through birth, which strengthens my conviction in the right to life. I have lived in a small rural community in east Tennessee and watched these children I have delivered grow up to be doctors and nurses and professionals and teachers and to have their own children and families.

Life is a precious miracle from God that does begin at conception. It is our responsibility and a privilege as legislators to protect those who don't have a voice. I will always fight for the right to life, because it is my conviction and belief that we are all unique creations of a God who knows us and loves us before we are even conceived. What a loving and caring God that is.

Tonight we mark one of the most tragic, misguided Supreme Court cases in our Nation's history, ROE v. WADE. Since 1973, more than 55 million babies have been denied the right to life. We must make our laws consistent with our science and restore full legal protections to all who are waiting to be born. If government has any legitimate function at all, it is to protect those most innocent among us.

For over 30 years, Congress has prevented taxpayer-funded abortions. Unfortunately, this door has been reopened with the passage of ObamaCare, the largest expansion since the pivotal ROE v. WADE decision. The Members who stand before you today have pledged themselves to protect those without a voice, and I look forward to working with my colleagues on both sides of the aisle to ensure this promise is kept. It is only by making good on this oath that we can expect to restore the trust that the American people have in their own government, and in doing so, ensure that the door to taxpayer-funded abortions remains closed.

I am glad to be here tonight on the House floor with other legislators fighting for the rights of the unborn. Mr. Speaker, I prayerfully ask that hearts and minds are changed.

I thank the gentleman for yielding.

I appreciate the opportunity to be down here on the House floor today to discuss, Mr. Speaker, this extremely important issue of health care. One of the reasons that it is so important is that it affects every single American citizen in a personal way.

As Dr. Gingrey said, I spent 31 years practicing medicine and teaching in medical school in Johnson City, Tennessee. I know the thing that I saw as the biggest issue and problem in health care--and Dr. Gingrey did also--was the cost of care. I saw the cost going up, and I saw more and more people that didn't have access to affordable health insurance coverage.

And I say this as a joke, but it is true. I have never seen a Republican or Democrat heart attack in my life. I have never operated on a Republic or Democrat cancer in my life, and I have operated on many of them. These are people issues. And why in the world we passed a partisan health care bill makes no sense to me whatsoever, Mr. Speaker. I never understood that for now going on 5 years later.

We should have sat down in that bipartisan way and talked about, as Dr. Gingrey so eloquently explained, taking care of those 15 or 20 million people, whatever the number is. We could do that. Let me just give you some data from my own State.

In 2011, we had 2\1/2\ percent of our children in our State who didn't have health insurance coverage. We are not a wealthy State, and about 10 percent of the population--1 in 10 Tennesseans--didn't have access to coverage. Not everybody had a Cadillac plan, but they had basic health coverage. We did this massive, 2,700-page bill, which I have read. I almost hate to admit that I have read it all, but I

have. We did this with now tens of thousands of pages of rules that add absolutely no value for patients whatsoever. It doesn't pay for anybody's prescriptions. It doesn't pay for operations, hospitalizations, immunizations, and so on--none of those things.

So, Mr. Speaker, I certainly see the need for health care reform--I totally agree with that--but on the premise that if we repeal the Affordable Care Act we will go back to where we were is not true at all.

Again, let me say this--and I believe this to the core of what I did for 30-plus years, and I believe it today. It is that health care decisions should be made between a patient, that patient's family, and his doctor. They shouldn't be made by an insurance company. They shouldn't be made by a clerk at the insurance company. They shouldn't be made by the Federal Government.

I think one of the problems with the rollout of the Affordable Care Act--and it was absolutely predictable what would happen when you listed the Essential Health Benefits. Mr. Speaker, if you had read the bill and if you had ever run a business, as I had, you would know that you make some changes in your health insurance. Every year, we did this. It was, maybe, the copay or the out-of-pocket or something that changed in that bill. Maybe it was a new procedure. If you the read the bill, it said, if those things changed in any significant way, you lost your grandfathered status.

I apologize if Dr. Gingrey has already done this, but I want to read the Essential Health Benefits that are required for you to buy and purchase. There are 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn services.

Let me just point out that one of my friends who is a sheriff-- Sheriff Seals in Sevier County, Tennessee--came to me the other day when I was visiting there. He said he had a friend who had just lost her insurance because she is 55 years of age and has had a hysterectomy. Her insurance plan, which met all of her needs, did not include maternity coverage, so she lost her health insurance, as almost 90,000 Tennesseans have done.

Mental health and substance abuse disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services; devices; laboratory services; preventative and wellness services; chronic disease management; pediatric services, including oral and dental and vision care.

Those are things that you have to have in a plan or you lose your coverage.

Remember now that this is only affecting about 18 or 20 million people. Next year, when the employer mandate kicks in--the employer reporting requirement kicks in--many people on ERISA, or if you get health insurance through your job, through your work--if you don't hit these benchmarks, guess what? You're going to lose grandfathered status. That is why these staggering numbers are 50 to 100 million people, because, right now, Mr. Speaker, about 160 million people and their families in our country get insurance through their employment. So that is what we are facing.

Now, we mentioned what the Affordable Care Act promised it would do, and Dr. Gingrey has pointed this out very well. He has pointed out the promises that were made:

Universal coverage, that we are going to cover everybody. It didn't do that;

No new taxes on the middle class. Boy, is that ever something that wasn't true;

An annual savings of $2,500. We have heard the President say that on numerous occasions. That is not true;

No increase in the deficit. We already know that this bill is going to cost some two or three times what it was purported to cost;

Then I think the most famous one we have all heard now enough times is that, if you like your doctor, you can keep him. If you like your health insurance plan, you can keep it. Not true.

We were tasked on the Republican Study Committee, the health committee, to come up with a market-centered approach to health care, which would include no new taxes, no mandates, and would maintain the doctor-patient relationship. It is a very short bill of 180 pages. It had been reviewed, back during the Bush administration, to increase by 9 to 11 million people who would have health insurance and, we think, far more than that. There are six titles to this bill, and they are very simple to understand:

One is to overturn the Affordable Care Act. That is No. 1.

No. 2 is to equalize the tax treatment between an individual and a company. What does that mean? I will use myself as an example. When I worked for my medical group, my health insurance was deductible. I then retired from that group to run for Congress, and when I then had to go buy health insurance, I had to pay first dollar. I couldn't deduct it. This simply says, if you are an individual out there or a farmer or a small business person, you get to deduct your health expenses just exactly like a huge company like Dow Chemical can do. So it treats you the same as an individual. That is a mistake that was made 60 years ago in the tax law that we correct.

We massively expand health savings accounts. I use a health savings account. What is that? It is when you put pretax dollars away in your own account, and if you don't spend them on health care, you get to keep them. I will use myself as an example again. We had a health savings account for 2 years that we started 7 years ago. I still have $6,000 in that account that I can use for preventative services, for buying prescription drugs--for lots of things that my insurance doesn't cover. If it is above a $5,000 deductible, my insurance is 100 percent covered--all the costs.

Guess who would have had that $6,000 if I didn't have it? The insurance company would have had it as a profit. This allows you and your doctor to make those decisions. We expand those to veterans, to seniors.

We also do medical liability reform. Dr. Gingrey has a wonderful bill that we do that for.

We also allow you to buy across State lines. The only insurance you cannot purchase is health insurance across a State line. You can buy life, fire. I, personally, have never seen an insurance agent. I have always used the Web, and have bought my insurance across State lines. You can do that, and you can form association health plans. Let's say large church groups want to get together. Instead of small churches at which there is one pastor or two, you can join with larger churches and groups across, maybe, an entire region of the country and get thousands of people. That helps take care of preexisting conditions, and we also have a high-risk pool for preexisting conditions.

Lastly, there is no funding for abortion services.

So it is a very simple bill. It is patient-centered and market- oriented, and it will work.

Just a couple of points I would like to make, Dr. Gingrey.

This bill is not perfect, and it is open for amendment, as opposed to the Affordable Care Act that was not open for amendment. As I recall-- you and I were both here then; that was my first term--when we had that debate, some 80 amendments were brought to the Rules Committee here and none of them--none, zero--was ruled germane to the bill.

As Dr. Bucshon was speaking, there were nine of us physicians in the Doctors Caucus 5 years ago. Not one of us was consulted about the health care bill. Really rather astonishing, I thought.

And to Congresswoman Ellmers--she made a point a minute ago and wasn't as passionate about it as I am--I think one of the most arrogant things I have heard stated in this town was that what you have bought that you like is no good. I still find that amazing that somebody--a talking head--could be on television and say with a straight face, not knowing what I purchased that I am perfectly happy with, that it is no good. That is beyond arrogance. We have heard people over and over in this town say that very thing.

That is why people are turning against this. When you tell me when I have sat down with my family and worked out what I can buy, and it seems to work for me just fine, that it is no good, that I know what is better because I have got it right here that you have to buy, that is the height of arrogance. I just was a little more passionate about it.

Just one comment. I tried today for the sixth time to get signed up, and I couldn't. So I am going back Thursday for the seventh time.

Mr. Speaker, I thank the chairman, and I rise in support of the Keep Your Health Plan Act.

This bill is important for many people in my district, including Joann. Joann lives in Limestone, Tennessee, and because her policy doesn't meet the minimum requirements set by ObamaCare, she has been forced to buy a more expensive health care plan. Her premiums will rise from about $95 a month to $200 a month. Joann thought $95 was affordable, but $200 not.

Despite promises of more affordable health care, this law is making insurance unattainable for many across my home State.

BlueCross BlueShield of Tennessee, our State's largest insurer, has announced it will be forced to send 66,000 cancelation notices to my fellow Tennesseeans because of ObamaCare; a Medicaid plan called Cover Tennessee, another 16,000 lose their care.

Mr. Speaker, it is well past the time for President Obama to work with Members of Congress to provide relief to families hurting because of this law. I urge my colleagues to support the Keep Your Health Plan Act.

Mr. Speaker, we are here for the next hour to discuss the Affordable Care Act with my colleagues and my cochair of the Doctors Caucus, Dr. Gingrey, a fellow OB/GYN from Georgia. I thank the gentleman for being here today.

We are going to break this hour up into several segments and talk about, number one, how the Affordable Care Act was initiated, how it actually came to be. Two, the promises that were made by the President and the Democratic Party about what the Affordable Care Act would do. The failures, which I think are probably fixable of the Web site--if, in 1969, we put a man on the Moon with a slide rule and a handheld adding machine, surely we can get a Web site to work in the year 2013. If we cannot overcome that, we are in trouble. Number four, I want to discuss something very near and dear to my heart, because I participated in this for years, which is medical education. I will go into this in more detail.

We have a huge doctor shortage in America today, and it is getting worse.

A major university in my State, Vanderbilt University, this past year, that university has lowered their workforce by approximately 1,300 people--it will, by the end of this year. It is very disconcerting for those people who lost good-paying jobs.

We have had hospitals close in our region. We have had layoffs in our area, in the health care industry, for the first time in my medical lifetime, which has been over 40 years as a physician now.

Also very distressing to me as a doctor and as a faculty member of the College of Medicine at East Tennessee State University, the Quillen College of Medicine and Vanderbilt University are reducing their class size by 10 percent.

They are also reducing the number of the M.D./Ph.D.s that they have. These are our future researchers to find the great cures for diseases in the future.

There is a pipeline out there, and we certainly know that a vast number of our senior doctors are considering, or have retired, as my own personal physician has done, due to the effects of the Affordable Care Act. So we will discuss that in more detail.

I think, also, we need to discuss and focus on the new taxes, and also, on the effects on business.

Then lastly, perhaps--hasn't been discussed much recently, the effects on Medicare, quite frankly, with $700 billion being cut from Medicare.

There is one particular part, Mr. Speaker, of this bill that Dr. Gingrey and I have worked on closely together in the Medicare portion of the Affordable Care Act that is called the Independent Payment Advisory Board. It hasn't gotten a lot of press because it hasn't affected any seniors yet.

It's a board, an independent board, independent of Congress, that will determine how Medicare dollars are spent, and we will go into that if we have time in more detail toward the end of the hour.

I think that is one of the most egregious parts of this bill when it comes to our seniors, and we are adding 10,000 new seniors per day, each and every day, over 3 million per year, with a decreasing number of physicians and less money in that very-needed program that needs reform.

Let's go back, Dr. Gingrey, approximately, 4 years when we were here on the House floor debating this bill--and the premise of the Affordable Care Act I completely agree with, which is to lower costs and increase access to care. That is a noble, noble goal to have, and I still share that goal to this day.

There were three committees of jurisdiction in the House of Representatives that looked at the Affordable Care Act: the Ways and Means Committee; Energy and Commerce; and the committee I serve on, Education and the Workforce.

Those committees had a bill brought forth by the House of Representatives. It was voted on, debated in the various committees, brought to the House floor, and was voted on in a straight party-line vote. That particular bill did not include the IPAB and some other things that are in the permanent bill, the so-called ObamaCare, or the Affordable Care Act.

The Senate then voted on Christmas Eve, I believe it was 2009, brought a bill back over here the following month. We debated it again on the House floor for a very short time and, famously, our then- Speaker said we had to read the bill to find out what was in it.

Well, guess what I did?

It is a 2,600, 2,700-page bill, but I felt that a bill that affected ever American citizen in a very personal way deserved my attention, so I read that bill, and the surprises that you are seeing now I have been talking about now for 3\1/2\ years, as have my colleagues on the Doctors Caucus and others on our side of the aisle, and many, quite frankly, recently, in a bipartisan way.

The only thing bipartisan about the Affordable Care Act was its opposition. I think some 32 Democrats voted against that bill.

So it comes as no surprise to me when the President says--and we will go over the broken promises in a minute--it comes as no surprise to me when the President says, if you like your health insurance, you can keep it. That wasn't going to happen.

Why did I know that?

Let's go over the promises that were made. Number one was universal coverage. I quote. This is the President saying this. He wasn't the President then, but this was in June of 2007.

I will sign a universal health care bill into law by the

end of my first term as President that will cover every

American.

Well, that is a promise that hasn't been fulfilled. It does increase access by a massive expansion of Medicaid, and we will go through the Medicaid expansion in just a minute, about why some States chose to do it and why our State of Tennessee has chosen not to. And there are very good reasons why these Governors have chosen not to.

There are a host of unintended consequences of this bill that we are dealing with today. The decreased payments to our hospitals have forced some of our rural hospitals and, certainly, where I live in rural America, has put great strain on these hospitals.

Even in the more major medical center areas, as I pointed out, at Vanderbilt University, and many others, I have talked to colleagues today in Indiana who have experienced the same scenario.

So the promises that were promised, there would be no new taxes on the middle class--here is the President's quote:

I can make a firm pledge under my plan: no family making

less than $250,000 a year will see any form of tax increase;

not your income tax, not your payroll tax, not your capital

gains tax, not any of your taxes.

That was September 12, 2008.

The third promise, and this is one that anybody who has studied health insurance and has dealt with it in private business, as I have, knew was not going to be possible, was the outrageous claim that, by the end of his first term, that premiums would decrease by $2,500 a family. I mean, anybody would know better than that that has ever run a business.

This is the quote:

We will lower premiums up to $2,500 for a typical family

per year. We will do it by the end of my first term as

President of the United States.

That was June 5, 2008.

The next promise was there would be no increase in the deficit. No increase in the deficit. Here is the President's promise:

I will not sign a plan that adds one dime to our deficits.

That was Promise Number Four.

And the last one, Promise Number Five, is, you can keep your plan if you like it, and here is the quote:

``If you like your doctor''--which, by the way, I like my doctor a lot; I went to medical school with him--``you will be able to keep your doctor, period. If you like your health care plan, you will be able to keep your health plan, period.''

Well, let me point out at the end of that period, that people who work for me now in this congressional office have lost their plan, so that is not true:

No one will take it away, no matter what.

Well, I certainly don't see that as being true. The failure of the Web site rollout, we will get into that a little later. I think that, as I said, certainly, if we can't correct a Web site, if we can't build a Web site, I have no faith that this plan will ever be workable.

I would now like to yield some time to my good friend and colleague from Georgia. We have been joined by Dr. Paul Broun, also from Georgia, a family practitioner, but I would like to turn it over now to Dr. Phil Gingrey from Georgia.

I thank the gentleman for yielding.

Let me back up a little bit so that this is a little bit more understandable for people. Typically, in this country--and we had problems. There is no question we needed health care reform. I think everybody in this Chamber--

It is one of the reasons that the doctors that you see here tonight ran for Congress, because we wanted to be part of the health care reform debated here. Unfortunately, we were not.

There were nine of us in our Physicians Caucus on the Republican side during the health care debate. Not one of us, not one, was included in the debate on health care. Not any amendment. We offered 80 amendments, to my recollection, to this health care bill, and not one was allowed to be heard on the House floor and voted on.

This would be a better bill if the other side of the aisle had simply slowed down, taken a breath, and let us help amend this bill.

People say now, well, Phil, can't you just tweak it a little bit and help?

No, you cannot. It is so complicated and so expensive, it is very difficult to do.

Now, this bill does do some things I like. I do like the under 26- year-old being able to stay on their parents' plan. The private market would have offered that.

You also had a problem with preexisting conditions. I want to spend just a minute with that because it is not totally understood, or not understood well by the public.

We worry about us getting a preexisting condition, losing our insurance and not being able to get coverage. In America, about 160 million of us get our insurance through our employer, through ERISA- based plans. Preexisting conditions do not affect those plans. You cannot be denied coverage. My practice had an ERISA-approved plan. You had to take everybody in the plan.

Number two, if you get Medicaid, you cannot be denied coverage, and Number three, if you have Medicare. So it really left the small group market and the individual market and the uninsured.

Now, people are wondering, why did I lose my insurance coverage?

In other words, I had a policy I liked.

I want to tell you today, Mr. Speaker, one of the most arrogant things I think I have ever heard in my life I heard on TV this last week by several pundits, and those comments are this: that your insurance is no good. I heard the President say that.

Well, look, not everybody can eat at Ruth's Chris. Some people have to eat at McDonald's or have to eat at Shoney's. They can't all eat at the most expensive one, but they buy what they can afford and what meets their needs.

The reason that the costs are going up so much are the following: in this bill, there is something called essential health benefits. You don't get to decide what you buy for your family. The government decides what you buy for your family.

And let me read this to you, because I want you to hear this very closely to see if you need all of these services. One is ambulatory patient services; that sounds pretty good. Emergency services. Sure, you want a plan that covers you when you go to the emergency room. Hospitalization, absolutely. I think you will see most plans do that.

Maternity and newborn care. Well, I don't know about that. What does a single 30-year-old male need maternity care for? What do I need maternity care for at my age? I certainly have cold sweats thinking about that right now.

Mental health and substance abuse disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services; chronic disease management; pediatric services, including oral and vision care. Well, if you are a family at an age where you don't need all of those things, probably your plan doesn't hit some of those. If you miss any of them, your plan is not an approved plan.

The second thing that made you lose your plan was--and this is where I challenge the President here tonight--one of two things occurred. I read the plan and I understood by reading that plan that if you changed anything in the bill, if you changed the prescription drugs, if you changed your copay, if you changed anything significantly in that plan, you lost your grandfathered status, or if you didn't meet the essential health benefits. No one said that.

So if the President had read his own bill, he would have known that and would not have come out and said, If you like your plan, you can keep your plan, because that clearly isn't true. Or number two, as Congressman Kurt Schrader said today, that we were misled. I think that is the term he used. So either of those two things occurred. If the President said, You can keep your plan, or he just did it for political purposes, which I hope he didn't do because a lot of people are hurt.

Mr. Speaker, 16,000 low-income small business people in my State had a plan called Cover Tennessee. It wasn't the greatest plan in the world. It covered, I think, 12 doctor visits a year, all preventive services, an operation. It covered up to about $25,000. It didn't have lifetime limits. And 16,000 people had that. They could afford that. And many of them bought a catastrophic policy so that if they had something that cost more than $25,000, it would be covered.

So it was basic health insurance coverage. It did for them and their families what they needed. It gave them some certainty and peace of mind. That is all gone. They have lost that.

As Dr. Gingrey was pointing out just a moment ago, he was mentioning some people in Georgia--and you can find this story from the Atlantic to the Pacific Ocean. One story I heard this weekend, an employer of mine who is a building contractor, he has looked at his business. He has 110 employees. He said, Phil, I think I am just going to have to pay the $200,000 fine. I can't afford what they are going to force me to buy. I can't do it and stay in business.

I have an employee that I know personally because she works in my office whose insurance is going to go from $400 a month for her family of three with the ObamaCare plan--``if you like your plan, you can keep it''--to $800 a month. This is an employee who makes in the mid-$50,000 range. This is not somebody who is rich who can afford this. That is a car payment or a college education payment or whatever she wants to spend her money on. You can hear this story over and over again.

There are 66,000 Tennesseans who got a letter from Blue Cross explaining that their plans didn't meet the essential benefits package in the individual market. That is one insurance company, and this is going on all over.

So this business about the costs going down--I think we will be on the Key Bridge jumping in the Potomac River when we finally get the bill for this. That is how expensive it is going to be.

And, by the way, most people don't understand this. A lot of our Governors have read the fine print; and Governor Bill Haslam of Tennessee, a good friend of mine, wanted to expand coverage. He wants to expand coverage. But he wants it done through market-oriented principles. And one of the things that we have had in Tennessee with our health care coverage expansion is that we went through health care reform 20 years ago.

In 1993-94, we began a program called TennCare. In the TennCare plan, we had a problem with access and not enough people had coverage in our State. So we did this. And within 10 short years, our spending had tripled. And almost half the people--47 percent, I think--of the people who got insurance on TennCare dropped their private health insurance and got it through the TennCare program. What our Democratic Governor Phil Bredesen did in the mid-2000s was--because we have a balanced budget amendment in our State, with the approval of the legislature--he had to cut 200,000 people from the rolls.

And people say to me, Dr. Roe, don't you think this bill will just fall under its own weight? And I say, No, I don't. And the reason is because the Federal Government can deficit-spend. We can print money. If we had to have a balanced budget in this body right here that we are standing in, I can assure you, we would be having a different discussion about this bill.

One other thing I want to read about the Governors that have signed up for this great deal with Medicaid, which is a program for our low- income people--

And by the way, I want to publicly state that the group I am in and the group I was with from the time Medicaid became available until I left practice, we took those Medicaid patients; and for many of them, we didn't get paid a lot of money. But that is what physicians do, we care for people who are uninsured and people who have policies like Medicaid.

But this new policy, the insurance policies must cover these benefits in order to be certified and offered in the health insurance marketplace. States expanding their Medicaid programs must provide these benefits, these essential health benefits to people who are newly eligible for Medicaid. So that means at the end of the 3 short years, the percent that the State has, which is no guarantee, is going to be a large sum of money and much larger than I had thought of after I started seeing these premium increases.

The other thing that has been said out there--and I have heard it for the last 4 years--is that Republicans have no ideas about health care reform. Well, there is a plethora of our ideas from this side of the aisle for health care reform. And one that I happen to have right here in my pocket is a Republican Study Committee called the American Health Care Reform Act, and I chaired the Health Subcommittee which wrote this bill. Dr. Tom Price, Dr. Broun of Georgia have a bill. Louie Gohmert, others. There are many of them. The Republican substitute bill of 4 years ago is an excellent health care bill that is market-centered. And it does something that I think is essential for the American health care system to survive as we know it, and that is, to maintain the physician-patient relationship.

This will tear that down because what does it do? So many people are going to lose access to their doctor. And as there are fewer and fewer doctors out there to see you, the waits are going to get longer and longer and longer. I think that is the very fabric that has made us the system that we are and the envy of the world, where people come from all over the world. And I think that can cease. And when you see great universities, like Vanderbilt University, cutting down on the number of doctors they are educating because of these cost constraints and cutting down on the number of young doctors that are going into the M.D.-Ph.D. programs that go into medical research and into faculties in medical school, boy, 10, 15, 20 years ago, we are going to suffer a great price for the mistake we have made right now.

I would like to take now the opportunity to introduce one of my colleagues from Georgia, a family practice physician, Dr. Paul Broun.

I thank the gentleman.

I would like to spend a few minutes now beginning to talk a little bit about the effects on businesses and how this will affect individuals.

I serve as the chairman of the Health, Employment, Labor, and Pensions Subcommittee on the Committee on Education and the Workforce; and we have held several hearings around the country over the last 2, 3 years outside of Washington, D.C. We have held them in Concord, North Carolina; Evansville, Indiana; Butler, Pennsylvania; Lexington, Kentucky; and others. And we have actually asked small businesses to come in and testify on how this plan will affect their business.

Let me give you just a couple of examples. We were looking at a small textile owner in North Carolina, and I won't mention his name tonight. But, anyway, it is part of the public record. He has a business where he had supplied--his business, he was self-insured as many small municipalities, large municipalities are. Many businesses are self- insured. And it didn't look like their plans were going to be affected too much by the Affordable Care Act, the ObamaCare bill. However, they have to pay a $63 fee per person insured. Most people don't know this because it doesn't personally affect them. It just affects the business owner. Or in the case of my hometown of Johnson City, Tennessee, that little bill is going to come to $177,000 next year. One major corporation, which will remain unnamed, came to my office and shared with me that their bill for that this year would be $25 million.

Let me explain to you about this small businessman in North Carolina. He provided 80 percent of the health insurance. The employee paid 20. He paid all preventive services. If you needed a colonoscopy, if your wife needed a mammogram, he paid 100 percent. He had a nurse onsite and a wellness program that he paid for. It is the Cadillac of all Cadillacs.

So what does he get for that? He gets a $63 fee for every single person he has insured this year. The following year, it decreases a little bit and the following year. Guess what that money is used for. That money is used to indemnify insurance companies so that they will provide insurance on these exchanges, and it will limit as a stop-loss for them. That is how complicated this bill is.

Now, I have had numerous businesses that are in the 50 range that I have talked to. And where we are, small business is the kingpin. The majority of our people are employed by small business. What incentive is there for a business to go above 50 when this arbitrary number was picked? And I have no idea to this day why 50 was picked.

So what is magical about 50? Well, if you go above 50 employees, as my practice is, and you decide not to provide health insurance, and you are now, that costs you $2,000 per employee as a fine, tax, penalty, whatever Judge Roberts wants to call it.

But that is what this is--a tax, I assume, a penalty or a fee on those. Many people are willing to pay that. Businesses are. Or, if they are at 47 or 48, guess what they are doing? They are not going to 50. Or, if they need more employees, what are they doing? They are hiring part-time people.

I can assure you that I have heard this over and over and over again about how businesses are cutting back their employees' hours to under 30 hours a week, because now we define full-time employment as 30 hours per week. I assume the only place 30 hours a week is full-time employment must be France, because there isn't any place I know of on the planet that 30 hours a week is full-time employment. Certainly, in Tennessee, it is not.

I would now yield to Dr. Gingrey, again, my friend from Georgia, if he would like to have a few words to say.

I thank the gentleman.

I will introduce our next speaker tonight, my colleague from Maryland's First District, Dr. Andy Harris, who is on the faculty of Johns Hopkins University and is an anesthesiologist and has been a great member of the Doctors Caucus. I hope that Dr. Harris will address some of my concerns in his remarks about educating future young physicians. That is a great part of my life. Certainly, I want to see that continue.

I think one of the things that also struck me was how it affects our colleges. We didn't think it would affect universities much, but in our community colleges. I have talked to a lot of them. One of them was over in North Carolina. Many of them now are limiting their adjunct faculties. And what an adjunct faculty member is is someone who is not there full time, but they may need a specialty let's say in accounting or physics or math or whatever it may be, and then they teach several classes. They now have limited those hours, those classes, to simply three per semester. The reason is because they will have to provide all these benefits if they go above that. Because our good friend, the IRS, has determined for every hour you spend in class, there are 2 or 3 hours that is counted for preparation for that class. That is counted as work. So now community colleges are cutting back the number of hours students can be taught by this particular faculty member. The reason that is important is because a student may need a certain subject that is out there that this faculty member teaches and can't get it, and it delays their graduation.

I have had community college presidents tell me this can be the case in their community. The State of Virginia has cut back to many part- time

workers. I think Secretary Sebelius was in front of our committee and stated that this is just basically people just talking about it, a supposition. And I said that is not true because people are making those decisions in lieu of what is going to happen. That is what businesses do.

I now, Mr. Speaker, would yield to my good friend, Dr. Andy Harris from Maryland.

Will the gentleman yield?

Then how do you answer to her that the pundits that we heard all last week and some of our colleagues here on the House floor, including the President, who said these were substandard plans that these individuals' plans were? And I have just heard you say, Dr. Harris, three or four times that people were perfectly satisfied; they met their needs.

Mr. Speaker, I would like now to mention a couple of things and to talk about this a little bit. We don't have a lot of time left, but it is extremely important. I know that both of my colleagues on the House floor tonight have taught in medical schools and that we have a huge problem in this country with graduating enough doctors and educating them. Let me give you an example.

When you graduate from medical school, you are not then prepared to go out and practice. You need to go and either do your specialty training or surgery--or whatever it may be--or a family practice residency or a primary care residency. In my small town of Johnson City, Tennessee, we have lost about 50 primary care residency slots. Those are 50 primary care doctors per year who are going to have to look elsewhere for residencies. Last year, for the first time in my lifetime, we had over 1,000 young students graduate from medical school--with huge debt--who could not find residency programs. Those are 1,000 students who are doing something this year before they can get into the residencies they need in order to be able to train to take care of us as patients.

The American Medical Association and others have said, in the next 10 years, we will have 90,000 too few doctors to see us. We all know what that means. That means that we wait longer and longer to see the doctor. I think it is a tragedy that is out there that we have young doctors--and I can't imagine graduating from medical school when I did, Mr. Speaker, and not being able to find a slot.

The reason that has happened is that Medicare pays a certain amount-- a cap that they put on--for residencies to train young doctors. Then hospitals and universities, through their endowments and other income, put more money in to help train these doctors. What has happened is, because of the Affordable Care Act, the hospitals are getting less money, and they are having to look to cut. That is why they are cutting their staffs, and that is why they are cutting residency programs and are delaying training.

Folks, let me tell you that, downstream, Mr. Speaker, this is a very, very bad thing for us and for the health care of this Nation.

I now would like to yield to Dr. Gingrey from Georgia.

I thank the gentleman.

In conclusion, let's go back and look at why we needed health care reform in this country. We needed it because costs were rising and because we had a problem with access for many of our people. That clearly was true. There was no question about it. There were also problems with preexisting conditions. We know that.

The Republican Study Committee has a plan out there called the American Health Care Reform Act. It addresses all of these issues. It truly does lower costs, and it does one important thing that I mentioned earlier in my remarks. I think the patient-doctor relationship--medical decisions--should be made between a patient, a doctor and the family. That is who should be making them, not the insurance company and not the Federal Government. You should be deciding what you purchase.

We have talked about a lot of complicated issues here tonight because this is a very complicated bill, but it is important for everyone to understand it as best one can because it affects every American citizen. That is why we in the Doctors Caucus on the Republican side of the aisle read that bill and tried to understand it, because it was going to affect every citizen in a very personal way.

We want to continue this discussion on the House floor, and I have certainly enjoyed this 1 hour with you this evening.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, I move that the House do now adjourn.

The motion was agreed to; accordingly (at 8 o'clock and 56 minutes p.m.), under its previous order, the House adjourned until tomorrow, Wednesday, November 13, 2013, at 10 a.m. for morning-hour debate.

I thank the chairman.

Mr. Speaker, I rise in support of the Retail Investor Protection Act and preserving access to financial advice to all Americans.

The Department of Labor's efforts to redefine the fiduciary standards is classic Washington. It is a solution in search of a problem. The DOL has yet to present tangible evidence--beyond anecdotes--that workers are being hurt by current law, nor has the Department conducted a sufficient cost-benefit analysis.

This is not to say that the fiduciary standards must never be changed. All of us, Republicans and Democrats, want to strengthen workers' retirement security and perhaps need to modernize the longstanding fiduciary standard; but instead of working with Congress, the Department of Labor has single-mindedly pursued a course that would actually drive up the cost of retirement planning and restrict access to important investment advice. Millions of Americans could potentially be left to prepare for retirement on their own. How on Earth could this be a good thing?

The 2007 recession wreaked havoc on the retirement savings of American workers. We should work together on responsible solutions that will help workers enjoy their retirement years with financial security and peace of mind.

I am privileged to serve as chairman of the Subcommittee on Health, Employment, Labor, and Pensions, and that is precisely what we are trying to do in the area of multiemployer pension reform. The subcommittee has convened numerous bipartisan hearings to closely examine the problems plaguing the multiemployer pension system and potential solutions. In fact, we held such a hearing earlier today. Will we all agree on every point? Of course not. However, we remain committed to working together on real solutions that will promote the best interests of American families.

I hope the Department of Labor will reconsider its ill-conceived approach to revising Federal fiduciary standards and work with Congress, interested stakeholders, and other Federal agencies to strengthen the retirement security of hardworking Americans. Until the Department does what is right and changes course, I urge my colleagues to support the Retail Investor Protection Act.

Mr. Speaker, I was not present for votes on October 22, 2013 because I was undergoing a medical procedure. Had I been present, I would have ``yea'' on rollcall votes Nos. 551, 552, and 553.

I was also not present for the first series of votes on October 23 because I was travelling to Washington from my district. Had I been present, I would have voted ``yea'' on rollcall votes Nos. 554 and 555.

Mr. Speaker, I submit these remarks today to commend Of One Accord Ministry of Hawkins and Hancock Counties for their 25 years of service to East Tennessee.

Of One Accord Ministry began humbly in 1988 in the home of Sheldon Livesay, founder and director of the organization. Livesay's desire to give back to the people of East Tennessee led to the creation of this organization, which began with the aim of meeting the needs of low- income families in the First District of Tennessee and has since expanded to include a free medical clinic, a drug recovery program, and several international humanitarian missions.

This year marks the 25th year of operation for Of One Accord Ministry. In its time, this organization has served over 833,000 East Tennesseans with the distribution of approximately 11 million pounds of food, 21,600 winter coats, and 900 pairs of eyeglasses. In addition, Of One Accord Ministry has served countless others internationally with over 1 million meals around the globe.

Of One Accord Ministry has dedicated itself to improving the lives of low-income families in both Appalachia and around the world and I sincerely thank them for all that they do for the Volunteer State.

Madam Speaker, I rise in strong support of this legislation.

I thank the chairman for yielding.

Madam Speaker, as a former mayor, I associate my remarks with the chairman.

I rise in strong support of the legislation on the floor today. What we have before us today is an opportunity to keep the faith with America's veterans, of which I am one, and ensuring the funding for disability payments, for the GI bill, which I used, education training, and VA home loans.

No matter what your thoughts on the current impasse, we owe our veterans this much. This should not be, must not become a partisan issue. There are real and serious debates to be had about how we're able to deal with ObamaCare and our Nation's debt crisis, but that's not what we're discussing now.

Northeast Tennessee, which I'm honored to represent in this body, has a long history of military service and hosts Mountain Home VA Medical Center, one of the largest and finest such facilities in the country. When I visit them, I don't see Republicans or Democrats; I see patriots who answered the call, did their duty, and then came home to make a life.

Let's make sure they all get the support they need. I urge my colleagues to vote ``yes.''

I thank my friend.

Mr. Speaker, I rise in strong support of the rule and the underlying resolutions.

The situation in which we find ourselves is as unfortunate as it is unnecessary. The House has voted three times to fund the government. It's been rejected three times by the Senate Democrats. With each successive vote, the House compromised on its position that ObamaCare should be defunded.

Our most recent offer would have delayed the individual mandate for 1 year and ended the congressional exemption from ObamaCare. Nine House Democrats supported this proposal, which would give American families the same relief from ObamaCare that President Obama unilaterally gave Big Businesses. But, again, Harry Reid said ``no.''

As we wait for Senate Democrats to come to the table, the House will continue its efforts to restart government operations.

Two areas we seek to fund today--national parks and veterans benefits--hit incredibly close to home. The district I represent in east Tennessee includes parts of the Great Smoky Mountains National Park. The Smokies are more than a natural wonder. They are an important part of the economy in Sevier County, Tennessee.

Dale Ditmanson, the park's superintendent, told me that 1.1 million people typically visit the park in October; but as long as the gates to the park remain closed, hotels, restaurants, and other parts of the service industry in that county will suffer.

Even more important than reopening our national parks is meeting our commitment to America's veterans. I'm privileged to serve on the nonpartisan Veterans' Affairs Committee; and as a veteran myself, I hope we can come together on a bipartisan basis to provide funding for processing disability claims and for benefits like the GI Bill and VA home loans. How could anyone stand in opposition to those who have stood in the line of fire to keep this country free? The answer is President Obama, who has promised to veto such a bill. This is unconscionable.

These funding bills represent a series of commonsense steps to get more of the government back online and to meet our commitments to the American people. After all, I wasn't elected and sent here by my constituents to shut down the government. I was sent here to reform it, to make it smaller, and to make it more accountable.

I urge my colleagues to support the underlying rule and the underlying bills.

I thank Dr. Burgess, and, Mr. Speaker, I rise to urge my colleagues to support the School Access to Emergency Epinephrine Act.

This bill will encourage States and schools to take small but meaningful steps to protect schoolchildren from anaphylaxis, a severe and potentially fatal allergic reaction that can be triggered by a food allergy, or even an insect sting. According to Food Allergy Research and Education, one in 13 children has a food allergy--roughly two in every classroom.

The bipartisan bill I introduced with Congressman Hoyer--and I want to thank Congressman Hoyer profusely today. His staff and my staff worked diligently on this bill to bring it to the floor. This bill provides a preference for asthma-related grants to States that adopt laws to permit properly trained school personnel to administer epinephrine to a student reasonably believed to have an anaphylactic reaction. To obtain preference, schools would have to maintain a supply of epinephrine and ensure trained personnel are present to administer.

This legislation has been scored by the Congressional Budget Office at no cost to the taxpayer. Our bill simply builds on an existing preference system signed into law in 2004 that helped make student self-administration of epinephrine a reality in 49 States.

Anaphylaxis, however, is not always predictable. An individual--adult or child--could have a severe allergic reaction even with no prior history of a food allergy, and I've seen this many times in my practice. Because anaphylaxis can cause deaths in just minutes, it is essential that epinephrine, the best treatment for anaphylaxis, be readily available for treatment. In most States, however, schools are not required to keep epinephrine stocked in case of emergencies. The result is needless tragedies, like that of Amarria Johnson.

Amarria was a 7-year-old girl--the same age of my granddaughter--who lived in Chesterfield County, Virginia. On January 2, 2012, she died from cardiac arrest and anaphylaxis as a result of eating a peanut. I had an opportunity to meet Amarria's mother, Laura Pendleton, at a briefing that Mr. Hoyer and I hosted on our bill. Her story is absolutely heartbreaking.

As a father and a grandfather, I can't begin to imagine what she had to go through. In response to her death, the Virginia Legislature passed what has become known as ``Amarria's law,'' which required public schools in the State to keep epinephrine on hand. But while 28 States have laws allowing schools to stock epinephrine, the States requiring the same remain in the minority.

A set of two epinephrine autoinjectors costs about $150 and are good for a year. With new competition in the marketplace to produce what are commonly known as EpiPens, I'm confident the price will come down even further. The training required to use an EpiPen is minimal. School personnel could be trained by an EMT or a school nurse in a brief session. The autoinjectors themselves are safe and very easy to use. The needle is covered by a protective sheath and only comes out when the EpiPen is pressed against the leg.

To make sure that teachers and other adults working at the school don't have to worry about a lawsuit for doing the right thing, our bill requires, as a condition of receiving preference for asthma-related grants, that the State attorney general reviews existing civil liability protection laws and certifies that they provide adequate protection to the trained school personnel.

I thank the minority whip, Mr. Hoyer, who worked tirelessly on this, for being an outstanding partner in this process. His story with his granddaughter is a compelling one. This has become a bipartisan process every step of the way.

I would also like to thank Chairman Upton and Mr. Waxman and his staff for helping advance this proposal. My hope is that this bill gives the States a little encouragement to ensure that what happened to Amarria doesn't ever happen to another child.

I thank Mr. Butterfield, and I thank Dr. Burgess for allowing me to be here this evening, and I encourage my colleagues to support this bill.

Mr. Speaker, I thank the gentleman for yielding, as I want to talk about what Dr. Harris just spoke about a minute ago. I want to do that before I actually explain how we got where we are to our viewers.

What Dr. Harris didn't say is that in the small group market in New York in 1992, there were 1.2 million people who got their insurance through the small group market. At that point in time, Governor Cuomo initiated no preexisting conditions in the small group market community rating. And ``community rating,'' for those who don't know what that means, it means that your sickest patient or your sickest customer can't be charged more than three times what a well person is. So they're not actually paying the cost of their care; someone else is paying that cost. So that's community rating. And ``guaranteed issue'' means you can't be turned down, exactly what we're doing here.

What happened to that market? Within 10 years, that market all but evaporated in New York. There were 120,000. It dropped by 90 percent. Today, in a State with almost 20 million people, there are 31,000 people--that's .0016 or so percent of the people--who are in that State that get their insurance through that market.

What is it? Not only did they basically ruin that market, it's now one of the most expensive in the United States, and the only way it's going to come down is for those premiums to be subsidized by young, healthy people. As Dr. Harris said, young people like my three children, who just got out of college and are starting their families, cannot afford something that basically they're not paying for. I wanted to point that out. I thought it was very important to understand how we got there and to why we think this won't happen again.

Let's go back, Dr. Gingrey and Mr. Speaker, to how we got here. Basically, the health care debate started because health care needed reform in this country. The reason it needed reform is we had costs going up more than inflation--no question that was occurring--and we had a group of our people in this country who work every day who were uninsured. We needed to do that. We had people with preexisting conditions that couldn't get health insurance. You and I saw them. It was maybe a woman who had developed breast cancer, dropped out of the job market, and on the way back in couldn't find it. So there's no argument from us that we needed to have health care reform.

So what did we have? We had a Doctors Caucus at that time that had nine physicians, and not one of us was asked one thing about this health care bill. I brought 31 years of experience to the House floor and experience with health care reform in Tennessee where we tried to reform our Medicaid program, called TennCare.

How is this supposed to work? The idea was we're going to expand coverage and make it more affordable.

What was the President's promise, Mr. Speaker? The promise was, if you like your doctor, you can keep your doctor. If you like your health insurance coverage, you can keep your health insurance coverage, and we're going to make the costs go down.

What is the reality? People are losing their doctors for a variety of reasons, the cost has gone up dramatically, as Dr. Harris pointed out. Let me also point out about what sectors are involved and who in health insurance. It is complicated.

In ERISA-approved plans, if you work for a company that provides health insurance coverage, that covers about 60 percent of the people in this country. About 160 million people work under that. Let's say in my practice we have 400-plus employees in my medical

practice that get their health insurance through their job. That covers about 60 percent of the people in this country. Sadly, in the last 4 or 5 years, because of the change in the percent of people who are employed in the workforce, that number has actually gone down 2 percent to 58 percent, instead of going up as it usually does in most recoveries. Number two, Medicare, and number three, Medicaid.

So all of this entire debate about--remember, preexisting conditions are not an issue in that group of people, and we're looking at over 80 percent. So this 2,700-page bill really had to do with less than 20 percent of the population. I think we could have done something much simpler, much less expensive, and certainly much easier to explain.

We're going to spend an hour here tonight, Mr. Speaker, in trying to break this down to where the average person can understand it, understand how it affects me and my family. I'm going to hopefully share some of those things with you.

I chair the Subcommittee on Health, Employment, Labor, and Pensions in the Education and the Workforce Committee. I've held three hearings around the country. I held one in Evansville, Indiana, one in Butler, Pennsylvania, and recently in Concord, North Carolina. What happened is we had businesses come in. Remember, the market that wasn't functioning was a small group market and the individual market. And let me explain how the individual market works.

When I left my practice 5 years ago to run for Congress, after 31 years of practice, I left the practice, I had group insurance covered under ERISA, that 160 million people in my family. I left that, and I then am on the individual market. Because I'm treated differently tax- wise, the day before, I had a tax-deductible health plan. The next day, I could buy that plan, but guess what? It was much more expensive because it was not tax deductible. That's how individuals find themselves. So those are the people we were trying to help.

What's happened to them? Well, I'll give you an example. In our State of Tennessee--Dr. Harris spoke about several States. I spoke to our State insurance commissioner just recently, and in the individual market, someone out there who is a young person going out to get insurance, they've just finished college or whatever--we'll talk about the under 26-year-olds in a little bit, about what the bill actually did. Those rates are going up between 45 percent and 75 percent in my State; in the small group market--that's where small businesses go out and select their insurance--50 percent to 55 percent. Does that sound like rates are going down? And this story is all over the country. State after State after State you see this in.

I wanted this plan to work because, as I said, we did need health care reform, but we needed patient-centered, market-driven health care reform that would help hold those costs down and put the decision making not in bureaucrats' hands, not in insurance companies' hands, but in doctors' and patients' and families' hands. That's who it needs to be in.

I think the ObamaCare plan started this way: How do we fund this plan? Well, they knew it was going to be expensive because of all the tax subsidies that were going to go out.

Where did the money come from? The money came from about a $700 billion grab from Medicare, a plan that's already underfunded, Mr. Speaker. Mr. Speaker, we have a plan now in Medicare where for every dollar placed in that plan--and I'm on Medicare, as Dr. Gingrey is. Every dollar we spend, the recipient gets $3 out. We know that's not sustainable. We have as many as 10,000 people a day entering Medicare age, which means that every year we're going to have 3 million people who turn 65 years of age as the baby boomers hit. We have an already underfunded Medicare plan adding in the next 10 years 30 to 36 million people onto a plan that we're taking $700 billion out of.

How do we control that cost, Mr. Speaker? We pass a part of that bill called the Independent Payment Advisory Board. Wow.

What is that? Well, I think that's one of the most egregious parts of this entire health care plan, and it's an interesting little thing.

You have 15 unelected bureaucrats proposed by the President, approved by the Senate, paid $164,000 or $165,000 a year to a 6-year term accountable to no one. The courts can't do anything about it. We have to have 60 votes in the Senate to overturn what they do or agree with what they do, and you couldn't get 60 people in the Senate to agree that the sun was coming up in the east tomorrow. So don't worry about them worrying about your health care.

What can they do? Basically what they can do, they start out--and this board is now supposed to be appointed this year, and they have a budget, which we've tried to cut the funding for because, as I said, I think it's the most egregious part of this plan.

What can they do? Well, they can withhold and cut providers. And when you cut providers enough, and that's doctors and hospitals and medical providers, they will refuse to see those patients. I've had it pointed out a thousand times. Oh, it says in the bill, you cannot ration care.

Well, there is a very good article--and I still read my medical journals--in the New England Journal of the Medicine, one of the most prestigious journals in this country, that reviewed the Independent Payment Advisory Board and looked back over the past 25 years.

Mr. Speaker, 21--and this analysis of the Independent Payment Advisory Board wasn't for it or against it; it was just analyzing the effects of it. And in looking back over the past 25 years, in 21 of those 25 years, cuts would have occurred. We all know, Dr. Gingrey and I know, and we know that our colleagues out there have been prevented from cuts by the action of this body right here and the sustainable growth rate in Medicare.

I thank the gentleman for pointing that out. It will put the power in one person and take the power away from this body right here, which is why we have a bipartisan bill to overturn this and reclaim the power which the people gave us. We are accountable to the people, and right now when you make those cuts, we would have almost no way to fix it.

I think that is a great point, and I appreciate, Mr. Speaker, Dr. Gingrey pointing that out.

So we have that board, the money grabbed from Medicare.

Number two, 21 new taxes to pay for this bill. One of them is a medical device tax. Let me assure, you as a physician, I have been the recipient, as many of my patients have been, from all of the incredible improvements in laparoscopic surgery. I watched it start from its infancy, learned my first laparoscopic procedure when I was a captain at Fort Eustis, Virginia, in 1974 in the military after having returned from Korea. I learned how to use a laparoscope, and I watched all of this wonderful new equipment occur to where we are doing absolutely marvelous things, minimally invasive to patients, and it has improved patient care dramatically.

There will be taxes on that new innovation. What I'm fearful of, in my State, the single biggest export we have is medical devices, that this will be pushed offshore, and the thing we have been the shining star in the world is medical innovation. There's no question about it, and we do not want to lose that.

So we have 21 new taxes. And there are taxes on health care plans; the mandates are taxes. So we have the taxes.

ObamaCare works because of a three-legged stool, Mr. Speaker. This is how it works:

It works because of Medicaid expansion. That is over half of the new people there, a plan that already is under siege in most States in the Union;

Number two, the individual mandate--that's what I'm getting around to--the mandates that occur because we have to have young, healthy people subsidizing others to make the individual market work; and

Number three, the mandate on business.

And last week in a blog from the Treasury, not in an announcement from the White House, just a blog came out and said, hey, we are not going to have the business mandate for a year. And I applaud the President for that. It is not something that I disagree with. The disagreement is it's the law of the land. I don't see how you can unilaterally decide I'm going to enforce this part of the law because I can't make it work right now, or the individual mandate, and we voted last week, as the Speaker knows and I believe the Speaker supported, both of the bills that Mr. Guthrie talked about.

I thank the gentleman for yielding.

You always hear, Mr. Speaker, that Republicans have no ideas for health care. Well, we had plenty of ideas; they just weren't heard. We had 80 amendments to this bill. None--and I want the people who hear this, to show you how frustrating this process has been, now that we're looking at this almost incomprehensible bill, is that we had 80 amendments to the Affordable Care Act taken to the Rules Committee. I think I had 10. Not one--not one--amendment was ruled in order. Not one.

Dr. Harris was here a moment ago and talked about the price of an individual insurance policy in the State of New York, and then he talked about the price of an insurance policy in Delaware and Illinois. Think about if a person in New York, an employer, a person in a small business, an individual there, hey, I'd like to buy my plan in Illinois. If I could buy it across State lines, I could save myself a lot of money, and I can guarantee you the price in New York State would come down or people would buy those plans somewhere else. That's why empowering the free market system will help and work in health care.

Let me go to the real world, Mr. Speaker. Let me go to Concord, North Carolina, and I held a field hearing there. I want to introduce you to a business owner there, Mr. Horne, who has a textile manufacturing business. He has 350 employees. If you are in the textile business, you're a pretty good businessman if you're in business today, as difficult as that is. He provided 80 percent of all the health care costs for his employees. They covered 20. He covers all preventive services, everything. If you need a colonoscopy, if you need a mammogram, he covers all of that. In addition to that, he has a health nurse at his business to help if you have issues there. So he has a prevention and wellness program. He's done everything right.

So what exactly does he get for this? What he gets for this, when the fiscal cliff bill was passed, because of the way his company was set up, he got an increase in his personal tax rate. He got that. Number two, he got a $62 per person, not per policy but per person, which will cost him tens of thousands of dollars. And guess what that money goes to do? It goes to indemnify insurance companies so that they'll be induced to provide this insurance on the exchange and they won't lose money. Mr. Horne gets absolutely nothing.

So what will he have to do? He'll either have to cut his salaries, he'll have to cut the benefits, or he won't hire someone or he won't be able to make needed investments.

Let's go to my hometown of Johnson City, Tennessee, where I was mayor before I came here. My political job there was being mayor of our local community. I just talked to our city manager not long ago, and we're going to get a bill in our community of 60,000 for $177,000, of which we get absolutely nothing because it is on the self-insured market. And anybody who is self-insured, and a lot of major businesses, and I talked to one who's going to get a $25 million--and I won't mention who it is. It's a major company. Everyone in this room will know who it is. They write a $25 million check. That could be to hire new employees. It could be for new plant and equipment. It could be to grow their business. It's a globally competitive company that has to compete around the world.

Let me introduce another person here, Sonny's Real Pit Bar-B-Q. That's a famous restaurant in the Charlotte area. We had the field hearing over there, and we sampled Sonny's barbecue the night before we had the field hearing. It was great. What that company is doing is that they found out that 70 percent--since the recession, 70 percent of people changed their eating-out habits by reducing or even eliminating dining out. And increasing menu prices, which is what they'll tell you to do, people quit coming to your restaurant and you go out of business. What they are finding out is they have had to cut, as Dr. Gingrey clearly pointed out, they're looking at cutting their employees' hours to 29 or under so that many full-time employees will now be part-time employees so they'll go under that threshold of 49.

The community college where we held the hearing made a very eloquent statement that they were going to have to not allow adjunct faculty. What most community colleges do, about 65 percent of their faculty are full-time, but the others are people in the community, Mr. Speaker, maybe like Dr. Gingrey, who would teach a health class or a class on whatever issue would be in his specialty.

Well, now, because of what the IRS has said, you can only teach three classes or you hit the 29-hour threshold. How does that happen? Well, for every hour you're in the classroom, they count 2 hours outside the classroom. I think it's called the Cambridge hour. So you can only teach three classes. It will mean in their community college that they won't be able to offer certain classes on time. It'll delay students getting out. The State of Virginia has 7,000 part-time workers, and

they're going to be sure they stay under those 29 hours. And they make it a little more individual.

Someone that I know in my district works for a chain restaurant, Mr. Speaker, divorced woman who works full-time. She relies on tips and relies on her 40 hours a week. She has a health insurance policy. She's going to lose her health insurance policy, and they are going to cut her hours to 29, which means that for every month, she loses an entire week of wages.

So she now has got to go find a second job to pay her bills, Mr. Speaker. And I can go on and on with examples like this that I've heard in testimony.

Just yesterday, we had testimony on the mandate. Certain of the businesses appreciate the year of reprieve. We voted here on the House floor in a bipartisan manner, Mr. Speaker, I might add, to also take individuals. My goodness, here's a person out here that just graduated from college, got their first job, and we're taxing them if they don't buy this insurance. And let me point out how quickly the young people will figure this out.

I did something rather unique, as Dr. Gingrey did. I heard here on the House floor we should pass the bill and then read it and find out what's in it. Well, guess what? I did just the opposite. I read the bill and found out some things. I went back and checked to be sure I was correct on this.

But here's what happens if you don't pay the penalty. Let's say you're a young individual out there and you say, I just can't afford $400 or $300 a month out of my paycheck. I've got student loans and other things to pay for. I'm trying to get into my first apartment. The penalty is this: it's $95 for the first year.

So what can the IRS do to collect that money? They can't garnish your wages. They can't do that. There's no civil or criminal penalty so there's nothing they have to come after you. The only thing they can do is if you have overpaid your taxes or if you have a refundable credit coming in like an earned income tax credit or child tax credit, they can withhold your refund. That's the only recourse they have.

Young people will figure it out. And why will they figure it out and not buy it? Why is this going to collapse? It's going to collapse because these young people are going to pay the $95, not the $300 a month or $200 a month that they're going to pay. They'll pay the one- time penalty, if the IRS can ever figure out how to collect it. That's what they're going to do. And if you don't have all these young, healthy people paying in, it doesn't work.

Above 30.

People ask me if there are things in the bill I like. Absolutely. You can't write a 2,700-page bill and not put some things in there that are positive. There are positive things in the bill. We should have worked together in a bipartisan way to look at those positive things we agreed to and then things we didn't agree to.

I think the approval rating now for the Affordable Care Act is at 35 percent. Is this objection just Republicans? Are just Republicans out there?

Well, let me read to you just a little bit here. This came up in testimony yesterday in my subcommittee hearing. The letter was from James P. Hoffa, general president of the International Brotherhood of Teamsters; Joseph Hansen, international president of the United Food and Commercial Workers Union; and Donald D. Taylor, president of UNITE- HERE, a union representing hotel, airport, food service, gaming and textile workers. This is to then-Speaker Pelosi, now minority leader:

When you and the President sought our support for the

Affordable Care Act, you pledged that if we liked the health

plans, we could keep them. Sadly, that promise is under

threat. Perverse incentives are causing nightmare scenarios.

First, the law creates an incentive for employers to keep

employees' work hours below 30 hours a week.

Numerous employers have begun to cut workers' hours to avoid

this obligation, and many of them are doing so openly. The

impact is two-fold: fewer hours means less pay while also

losing our current health benefits.

These are the presidents of three major unions.

So it's not just Republicans, Mr. Speaker. It's the public beginning to focus on this now, because this bill is becoming the law of the land January 1. I wish it had worked as smooth as it could. It has not. And it has not because it's not doing what it promised, which was the single most important thing, which is cut the cost of care so more of us out there could afford to have it.

I thank the chairman for yielding.

Mr. Chairman, I rise in strong support today for the Student Success Act, H.R. 5.

The goal of increasing accountability within education under No Child Left Behind was a worthy one, but the reality of the law is that there is too much Federal control and too many mandates put upon our States, our local school administrators, and our teachers. Our bill today makes needed reforms that will move us closer to our shared goal of ensuring every American child receives a quality education.

Under the Student Success Act, we are giving States and school administrators the flexibility to meet the unique local needs they understand far better than Washington bureaucrats.

I have listened carefully to the concerns of teachers in Tennessee's First District; And if there's one thing I've learned, it's that the current accountability mechanisms undermine parents' confidence in their schools without providing any useful information--and by the way, my next-door neighbor is an elementary school principal whom I speak to regularly about these things.

Today, we are eliminating Adequate Yearly Progress, a well- intentioned, but unworkable, accountability metric, and repealing the Highly Qualified Teacher requirement in favor of State and local teacher evaluation systems. The effectiveness of a teacher should be judged by how well students learn, not how many credentials are hanging on a wall.

Right now, there is a confusing web of overlapping programs, and we need to step back and ask a simple question: Are these programs actually meeting the needs of the students? That's why we create a Local Academic Flexibility Grant, which replaces 70 of these overlapping and often ineffective programs with one flexible grant to States. With this grant, States and school districts can help ensure local challenges are met.

Because we have too many kids trapped in failing schools, this bill strengthens charter schools, which have become a viable educational option for thousands of hardworking students without other options.

Finally, in recent years, the administration has been able to coerce States into adopting reforms using what is known as the Common Core Standards Initiative by offering waivers from current law. Many are concerned Common Core could become the foundation for a national curriculum. This bill will prevent States from being required to adopt Common Core and ensures that States will be able to choose which reforms they want to enact.