Floor Statements

Dr. Gingrey, thank you, and it's good to see you moving your arm well and recovering from your surgery so well.

I think the question that comes up, and Dr. Gingrey and other Members and I have discussed this, when I got here--and I've been here 4 years, and Dr. Gingrey came a couple terms before I did--we did this for a reason because we wanted to impact the health care system in our country. The problem with the health care system in our country was that costs were exploding.

If you look, as he pointed out, the Affordable Care Act has been anything but affordable. It's suggested that by 2016 the average family of four, when you have to buy an essential benefits package--which the government will determine what that is--will cost a family of four $20,000. That's unbelievable when you think that the per capita income in my district is $33,000. So I think we're at a point or we're going to be at a point where no one can afford it.

Well, what Dr. Gingrey is mentioning in the SGR, sustainable growth rate, what is that? What does that mean, and why should I care if I'm a senior? And Dr. Gingrey and I both have Medicare as our primary source of insurance. Well, Medicare started back in 1965, a great program for seniors who did not have access to care. It met a great need there and has met a great need since then. It started as a $3 billion program. The estimates were from the government estimators that in 25 years this program would be a $12 billion program--we don't do millions here, billions--and the real number in 1990, Madam Speaker, was $110 billion instead of $12 billion. They missed it almost 10 times.

So there have been various schemes throughout this time in which to control the cost, always by reducing the payments to providers. And who are providers? Well, those are the folks who take care of us when we go to the doctor's office--nurse practitioners, it may be a chiropractor, it could be a podiatrist, and it can be your hospital. So when you say providers, those are the folks and institutions that care for us when we're ill.

So in 1997, the Ways and Means Committee brought together something called the Budget Control Act. This is a very complex formula based on how you're going to pay doctors--their zip code, where they live, the cost of an office, the humidity in the air--I know it's an incredibly complicated scheme to pay doctors. The idea is this: We have this much money to spend in Medicare, and so we've put a formula together to only spend this much money. If we spend less than that money, that will go as a savings. If we spend more than that much money, then we will cut the doctors and the providers that amount of money to make that line balance.

Well, the particular slide that Dr. Gingrey has down there is very telling. Basically what it says is that each year that we've recalculated what our physicians will be paid, we haven't met those metrics, which means that we have to cut.

Well, what has Congress done? Well, Congress has realized that what we're talking about is not payments to doctors; what we're talking about is access to care for patients. What happens is if you go back to 2003--I think it was 2003--when there was a 5 percent cut in Medicare payments, we realized at that point right there that if you continue to do that, that access would be lost.

So let's fast forward to 2013, what we're just facing. Doctors were facing a 26.5 percent cut, the providers were.

That's correct, that number right there. That was avoided by a 1-year so-called ``doc fix.''

What has happened over the last 15 or so, 16 now, years is that the Ways and Means Committee line--now law--says we have to spend this much money, but we've actually spent this much. That is a deficit in spending that we've got to make up somewhere in our budget or add it to the budget deficit.

Now, I go back to when I was in practice just 5 years ago now in Johnson City, Tennessee. Dr. Gingrey, I don't know about you, but I was having a harder and harder time finding primary care access for my patients that I had operated on, or maybe someone who had been my patient for 30 years--if she was 40 years old when I started taking care of her, in 30 years she's 70 years old and needed a primary care doctor. That was getting harder and harder and harder to do.

Now, when you look at today's young medical students, we're having a much harder time convincing these young people to go into primary care. What is primary care? Well, it's pediatrics. If you want someone to take care of your baby, it's family medicine. It's also internal medicine and also OB/GYN. I certainly served as a primary care doctor, as Dr. Gingrey did for his patients, for many, many years. That would be the only doctor that they would see. But that's getting harder for our patients to do. And Dr. Gingrey, that's my primary concern--access for seniors to their doctors.

That is correct. And so much so that in California, what they're recommending, I don't know whether they've carried it out or not, but they've recommended expanding the definition of ``primary care'' to a lower-level provider, that would be a nurse or nurse practitioner or PA or this sort of thing, this sort of designation.

I think the other thing, Dr. Gingrey, that we haven't talked about, and we probably should spend some time on, is the age of our practitioners. In our State of Tennessee--where you see that we're not quite as dire in need as Georgia, our friends to the south--the problem with it is that 45 percent of our practicing physicians in the State of Tennessee are over 50 years of age. I'm concerned that with the advent of the Affordable Care Act, the complexity of that, the frustration that I see when I go out and talk to our providers is that I'm afraid that many of them are going to punch the button for the door.

I know in my own practice, where we have now about 100 primary care providers in my program, in my OB/GYN group, in the last several years we've had over 120 years of experience walk out the door and retire. That's not a good thing for the American health care system that just lost access. Quite frankly, the crux of it all is that access. If you do not have access, you will decrease quality, and you will increase cost. That is our concern. Ultimately, the cost will go up if our patients can't get in to see us.

I thank you.

And thank you, Mr. Bilirakis, for being here. I appreciate your leadership on the committee, too.

Why should I be concerned about this, and what experience do I have to say that if this is not fixed it will affect access and quality? I've had, I guess I could say, the misfortune in Tennessee of going through health care reform 20 years ago.

What happened? What happened was we had a large group of people in our State who didn't have access to quality, affordable health care. We reformed our Medicaid program and opened it up. We had an open enrollment time where we were going to have these various plans compete against each other. It was very much like the public option I heard discussed during the debates 4 years ago.

What happened? What happened to us was that our costs tripled in 10 years in that plan. It went up three times. And you can already see in the Affordable Care Act, even before it's been fully implemented, the estimates of costs have already doubled. The costs to patients are going up and the costs to businesses are going up. It didn't do what it had to do to really help solve the problem, which is lower the cost, bend the cost curve down. It did not do that.

When we saw those costs go up, what did we do? We started cutting our providers, and we cut our providers and we cut our hospitals and our doctors and our nurse anesthetists and our nurse practitioners and PAs and so forth. Guess what happened? Access got cut off. They stopped seeing those patients.

Now, our practice where we were, we, as an obstetrician as you were, we took everyone, because pregnancy is one of those conditions where you either are or you're not. We felt like if those folks needed care, we kept seeing those critical-care patients like that. But many elective-type things--orthopedics and dermatology and those kinds of things--got cut off, and people would have to drive hours to see a specialist.

So I saw access get denied in that system when the cost of the whole system went up to where no longer the State could afford it. I've seen that happen. That's why patients should be worried.

Dr. Gingrey, you and I know these numbers. We have 10,000 people a day hitting Medicare age. That's 3\1/2\ million people this year that are going to be Medicare age. These are new people on the plan with less money. And if we have more people and we're not producing more doctors, do the math. In 10 years, we're going to have 35-plus more people on Medicare, and who is going to care for those people?

Another thing I want to bring up is that we're not just talking about how doctors are paid. We're talking about increasing quality. One of the measures we're going to look at when we look at the new payment formula--right now the way you and I were paid when we were in practice was a patient came in and you got a fee for that visit. That's called fee-for-service medicine. That's going to change. We're going to look at quality outcomes and measures. I'll give you an example about why that's important.

One percent of our Medicare recipients use 20 percent of all Medicare dollars, so we have to look at how we manage the care of those patients better. For instance, with congestive heart failure, when someone leaves the hospital, we know that certain metrics are taking place: weights are taken

every day, blood pressure and so on. If you check in with a provider, you can prevent rehospitalizations and save tremendous morbidity, mortality, and cost. It also increases the quality of life that patient has and the quality of care they receive. So doctors are going to be evaluated on the kind of outcomes we have and the quality of care we provide our patients, which we all agree should be done.

I think coordinating care, hopefully, with better electronic records--and I could spend an hour talking about that. If we have a coordinated electronic system where, when you order a test at your office or the hospital, we have access to it so that test is not repeated and duplicated, that will make a huge difference in cost.

I just had a duplicated test, myself, done. You may have, too, when you had your procedure. I had a surgical procedure done 2 weeks ago this last Monday, and there was some testing on myself that really didn't have to be done. But because of various rules and regulations and the inability to get that information easily, it was easier to repeat it and pay for it than it was to go find it. I think that happens to 300 million people. Actually, it is 47 million of us who get Medicare now. We need to do that, better coordinate that information with sharing and transparency.

I had the misfortune of going from paper to an electronic record. I was in the process, at our practice, of converting. It's a very difficult conversion. I think if you started with just an electronic medical record, it would be much easier than transferring tens of thousands of patient charts to an EMR. But when you start from scratch, it's a little easier.

Certainly I think the electronic ePrescribe, which I like, I didn't have the pharmacist call me and tell--I can't believe he couldn't read my prescription. Anyway, they claimed they couldn't, and this solves that problem.

I think there are some disadvantages to it, but overall, I think it is the wave of the future. I think you are correct.

I'm going to bring up something now about: let's say we go ahead and we do fix the SGR payment that's based on quality and that's based on outcomes and transparency, on hospital re-admissions, and so forth--on all those metrics we've talked about to better serve our patients. There will still be fee-for-service. I'm sure, Dr. Gingrey, you're a rural Georgia Representative as I'm a rural east Tennessee Representative. I have counties that have one doctor, and you can't do an accountable care organization--or all of these things--in a small, rural county. So fee-for-service medicine will still be there for those patients so they can have access in small, rural counties and don't have to drive long distances.

Let's say we do all of this wonderful stuff and that we fix this payment model and that it all looks good. The Affordable Care Act has in it one little thing called the Independent Payment Advisory Board. This Independent Payment Advisory Board trumps what we just did--all of the things that you're going to do in your Energy and Commerce. Also, thank you very much for what you're doing on that. As to all of these cuts that you see right here, let me just give you the data.

I think correctly the Congress, in its constitutional authority, has overridden the SGR 15 times since 2002. I think that's the correct data.

What this IPAB does in the Affordable Care Act--it sets the same metric. It has a very complicated formula, which is the same as SGR, and if you have expenditures above those projections, cuts will be made. There is no judicial review, no administrative review, and it takes a 60-vote margin in the Senate to override this. Let me tell you how important this is, what Dr. Gingrey just pointed out.

Whether you agree with the plan or don't agree with the plan, there was a great article in the New England Journal of Medicine, one of our premier medical journals, that was published in June of 2011. I would recommend this for anyone to read as it will take you 30 minutes or less. They went back with the CMS and looked at the last 25 years and said, What if we had IPAB then? What would it do? In 21 of the 25 years, cuts would have occurred to providers--and I know exactly. Because of what I have seen in Tennessee, I know exactly what would happen. What would happen is you cut those providers right there. As you're seeing up there, Dr. Gingrey, I can tell you that, as to the access to care, that entire map of the United States right there would be a bright red because you would not have the providers to take care of those patients.

That is a tremendous concern for me because it is current law. This year, those 15 bureaucrats are supposed to be nominated by the President. What happens if he doesn't nominate those 15 people? One person--that's the HHS Secretary, Secretary Sebelius--makes those decisions and recommendations. I hear it all the time. I go on the talk shows like you do, and they say, Well, in the bill right here, it says that you cannot ration care. That's true. This board can't ration care. What they can do is just not pay the providers. In 2017, I think, or in 2018, the hospitals are included in this. They're not included first, but they will be in 5 short years.

That is correct, Dr. Gingrey.

Unless you are very deeply buried into this--meaning, if you're a Medicare recipient out there today--you don't see this. I go home, and I see my physician friends and talk to my friends who are on Medicare. They

don't know this has happened or that it could potentially happen to them, but it can and it will, and it is the law right now unless we change the law.

I would strongly encourage my colleagues on both sides of the aisle-- and we have bipartisan support for the appeal of the IPAB--to put that constitutional authority back in the hands of the people who are directly responsible and responsive to the American people--us, the Representatives. Let us make those changes and, the Senate, the same thing.

That's correct.

I had the privilege of being in the chambers when a good part of this health care debate was going on in front of the Supreme Court. It was the first time I'd ever been there. Fascinating. I'd totally misread it.

As you pointed out, it was the first time in American history that the Supreme Court said that you had to purchase a good or service--even if it's good for you, that you had to purchase it. We've never forced anybody into commerce before like this. As an individual, I think you have a right to make good decisions and bad decisions. I agree with you. I think a good decision is, if you can afford health insurance coverage, you should purchase it. I think there is no question. I have for my family my entire life, and I would recommend it strongly and encourage people to protect themselves in that way.

But does the government have the right to do it?

This Court said 5-4 that they did. The Court also said that they did not have the right to force States into expanding their Medicaid if they did not want to, and the IPAB specifically was not brought up.

I believe it will be challenged and should be. No one has standing yet because it hasn't gone into effect. In other words, they haven't issued any rulings--or the Secretary hasn't--to say that I've been harmed by that ruling so that, therefore, now I have standing in the Court and that I can bring a case.

Actually, the IPAB board of 15 bureaucrats will make $165,000 a year with a 6-year term, and they can be appointed twice to that term. And it's something, and what bothers me about it is, no, it says in the bill you can't ration care, but we are the elected representatives. We should be able to go back home, as Congressman Bilirakis said, we should be able to go back home and face our constituents, and they're going to say: Dr. Roe, we have a situation where I can't go see my doctor. I can't go in and see them because they aren't accepting patients, and they aren't accepting patients because of this particular board that's cut their reimbursements enough to where they can't afford to see patients.

Now, another couple of things I want to talk about in the Affordable Care Act, not just SGR formula effects, but there is a tax out there in the Affordable Care Act that hasn't been very well discussed, and that tax is on individual insurance accounts. For instance, there are companies out there that are self-insured, and they're going to get a bill for each person that has insurance. Let's say a family of four or five, they'll get a bill for four or five people, and one company in particular, this will add--and they have no reinsurance. They cover everything. They're totally self-insured, but this basically is a tax that will go into a fund to indemnify insurance companies so that they won't have a loss of more than $60,000 a year, and this is billions of dollars when you stretch it across the country.

And these insurance companies are going to not have the loss to encourage them to accept patients on the exchange. That's as wrong as it gets to take a company that is doing everything right, they're going ahead and providing the health insurance coverage for their employees, and to penalize them for that.

So there are many, many issues in the Affordable Care Act we could talk about, but I want to basically finish my comments on the sustainable growth rate by saying in the past, since 2001, just so that our viewers out there will understand this, since 2001, your Medicare doctor at home has gotten an average increase in his or her payments when you come see them of 0.29 percent per year, 0.29 percent per year. When you look at all that graph that Dr. Gingrey has down there and you do all the math, that's how much of an increase. It's a very minimal increase. It hasn't even come near to covering the cost of inflation.

So again, Dr. Gingrey, I want to conclude by saying that the major concern I have, and I saw it in my practice, is the cost of care, and, number two, access to care. I'm concerned as our patients age and our population ages--and look, a good thing is happening in America: almost every 10 years we live, we're adding 3 years to our life expectancy. In 1908, the life expectancy in America was 48 years old, 47-48. In 1922 when my mother was born--and she's still living, I might add. She's living alone, by herself, doing great. She has Medicare. And I'm going to tell my mother now that later today I'm going

to call her prescription in. She notified me today that she needed some medicine called in, and so I will do that for her today. I look at her and I think about her need for access to care, and if it's cut off, what does she do.

Dr. Gingrey, I think one of the things I know you did and I know one of the things that I did was to come here to this body, this great body, to work on the repair of our health care system and improve on it.

One of the major pieces of our health care system is our Medicare system. I cannot tell you the patients I have seen in my career that have benefited, whose lives have been helped and saved by the Medicare system and by the doctors and nurses and hospitals and other providers who've cared for them. You have, too. I've operated on them, and I've seen them get cardiac care, renal, whatever it may be, that has improved the quality, improved and lengthened the quality of their life, not just to live longer, but to live better.

My goodness, look at the number of patients that we see of our orthopedic friends that we have that are mobile, that are active who've had joint replacements and so forth. Look, if you're 80 years old, 75 or 80 years old, you understand that your life is not going to be that much longer, but you also want the quality of that life to be the absolute best it can be. And it cannot be if you can't get your knee fixed if you're in pain, or your hip fixed if you're in pain. One of the things that I think our side of the aisle is committed to, I believe the other side, we may have differences of opinion, but one of the things I want to do is to be sure that we shore up and save this great system of Medicare.

I had a meeting today just after lunch about the Medicare part D program that was passed by the Republicans at some political risk for them. That's been a plan that has actually come in under-budget. It came in under-budget because seniors are able to go shop and purchase exactly what they want that meets their needs. That is exactly what we want to do in the Medicare system.

And when our budget is published next week, we are going to look at a system where we help fix and save and sustain Medicare, as you pointed out, not only for your mother, who's 95, and my mother who is 90, but for my two grandchildren who are 7 and 9. They also deserve the same great system, and we're going to have to change it; but I think we can make it better. I really believe it can be more responsive. You see what patients do when they get Medicare Advantage. You saw what they did. There was a little confusion, I admit, when Medicare part D first came out. There is no confusion now. People shop for the best value that meets their needs, and that's exactly what we should do.

Let me give you an example, Dr. Gingrey. I turned 65 a very short time ago. What happened to me when I turned 65? Nothing. I got one day older. Except what happened was I had a plan now that had an alphabet soup--A, B, C, D.

The day before I had a health care plan. Why, when you turn 65 years of age, don't you have a health care plan? And in that health care plan I can pick out I don't need fertility coverage at age 65, thank you very much. And I think that's the kind of thing--allow seniors to be able to pick what meets their needs and meets their family's needs at that particular point in their life; not just one-size-fits-all, but what they need.

And seniors have done that. They do it with everything else in their life. There's no reason it should change when you hit 65. You should pick out what plan--just like you and I can do up here with the Federal Employees Health Benefits plan. There's no reason that a senior shouldn't have exactly the same plan. It will be cheaper. It will be a better plan for them, and that's one of the things I think we're going to be discussing in the next several months when the Republican budget is published.

I have just one quick statement, Dr. Gingrey. And when you brought this up in 2003--and I want to thank you, because I can remember sitting at my desk in my office in 2003 working, and I could take this pen right here, and in about a minute or a minute and a half, I could write two or three prescriptions that might take up a patient's entire monthly income. That was the decision patients were having to have.

And Republicans stepped up to the plate, made a very difficult decision. Like you said, maybe we should have some criticism for not having offsets. But seniors out there today don't have to make that decision about whether I break this pill in half or whether I don't take it today or whether I buy food.

And you ran across that in your practice. I mean, I would look in our area, many widows that I would see would have a $600, $700 a month Social Security check and maybe a $100 or $200 a month pension. And you write three prescriptions, and the first thing they say is, Dr. Roe, it's gone. And you could easily do that. So I want to thank you for your vote.

Mr. Speaker, on rollcall No. 46, had I been present, I would have voted ``Yea.''

Mr. Speaker, on rollcall No. 47.

Had I been present, I would have voted ``yea''.

Mr. Speaker, before starting this Special Order, I'd like to yield as much time as he may consume to my friend from Mississippi, Steven Palazzo.

Sequestration Effects

I thank the gentleman.

Mr. Speaker, we're going to take the next hour or so, the Doctors Caucus, Dr. Gingrey, myself, Dr. Harris, and we're going to speak about the Affordable Care Act, how we got where we are, the plan to save Medicare, and other health care issues.

I came to this Congress after a 31-year medical practice in Johnson City, Tennessee, just a doctor out each day in east Tennessee taking care of patients; and I made a decision that I didn't like the direction that the country was headed in health care, and I wanted to run for Congress to be here for that reason.

Well, it turned out that two Congresses ago we did have a debate on the health care issue. We have nine physicians in our health care caucus, and not one of us was consulted about that health care bill. Not one of us was brought in the loop and said, What do you think?

Well, we had an extensive debate, I will admit, in the House. This bill was passed on a pure party-line vote in November of 2009; and on Christmas Eve, the Senate passed a bill that had not been vetted, had not been heard in the House, was not debated in the House, a completely different bill. But because of the rules in the Senate, it never got heard here and was not debated fully in the Senate.

That bill was passed, it will soon be, 4 years ago--3 years ago, I mean. We thought that we'd have an opportunity after the Supreme Court looked at this--those challenges were brought to overturn this bill-- and we're going to spend the next hour explaining why we don't think it was the right prescription for the health care of the citizens of this country.

I bring an extensive knowledge about a health care reform bill we did in our State of Tennessee. The biggest problem with the health care in this country is not the quality of care. Certainly, we can always do better, and physicians want to do better and have new techniques and new innovative medicines that we use. But the biggest problem with health care in America is the cost of that care. I got to see it every day in my practice, where going to the hospital could bankrupt families if they didn't have proper insurance, it was more expensive to come in, and so the number one driver was cost.

Number two, there's no question we had a group of people who worked

every single day of their lives and could not afford health insurance. It was not affordable for them. I would see it in my community where you would have, let's say, a carpenter who would work and during the winter they didn't get to work too much. They would work and maybe make $20,000 or $25,000 a year. Their wife may work at a local diner, maybe, and make $20,000 or $25,000. Together, where we live, they could make $40,000 or $50,000, maybe, in combined income and they could live okay. But they could not afford a thousand dollars a month for health insurance coverage. It was just out of their reach. And thirdly, we had a liability crisis in this country.

So what did the Affordable Care Act actually do? Well, it did increase access. But it increased access mainly, the best I can tell, through a massive expansion of a failed system called Medicaid. The Medicaid system right now in this country is broken and needs to be reformed. We did not reform it with this bill. So that's one thing it did.

Two, it did not touch liability. And we can go into that a little bit later. But the liability crisis still exists. My State of Tennessee has done something, as has the States of Texas and California. Other States have been successful in liability reform. And that has helped. But the President was here Tuesday night. We were all sitting in this Chamber. And amazingly, in the seat right below you here on the dais, the President said with a straight face that his bill, his Affordable Care Act, so-called ObamaCare, had lowered costs. I was astonished by that because it clearly has not done that at all. And let me just go through a few things.

I serve as the chairman of the Health, Employment, Labor and Pension Subcommittee in the Education and Workforce Committee. So if you have a private health insurance plan, that issue, that plan will come through my subcommittee. Let me just go over a couple of things that we found. We've had numerous hearings over the past 3 years about this. And this is recent data right here. President Obama's health care law will push about 7 million people out of their job-based insurance coverage, nearly twice the current estimate. That was just in the last week or two, that estimate, according to guess who? The Congressional Budget Office. Not Phil Roe and not some Congressman. But the CBO believes that. So twice what they thought it would do.

Spending on health care is up. And we estimate it's as much as $4,500 per family since this bill has come into play. That is not pushing the cost of health care down. So we see that. And one of the things that this bill did, I think which was good and bad, Mr. Speaker, is we allowed millions of young people under the age of 26 to be on their parents' health care plan. That sounded like a good idea. And if you have a mom and dad that paid for that, it probably is a good idea if they pay for. I know one of the great points of my life were when my three children got out on their own and paid their own health insurance. That was the biggest raise I probably ever got, them getting out of college and paying their own health insurance.

But what happened was, the way the bill was written, actuaries can no longer charge the actual cost of that care. Let me give you an example. If a person my age is out buying an individual policy, it will cost about six times what a young person under 26 pays because actuarially I'm much more likely to need health insurance or need my health care plan. This bill only allows a 3-to-1. So that means a young person is going to pay two to three times, that person out there paying for that health insurance coverage, than they otherwise would have.

I've had a good friend of mine who's in the health insurance market at home, and for all three of my children I bought them individual plans, and I specifically remember exactly how much I wrote the check for. He said, Dr. Roe, I was having these plans for about $100 a month, just a basic health care plan. Some less than that, depending on risk. Immediately after that bill passed, those rates tripled--they were $280 a month. All of a sudden now, if you're an individual, that isn't affordable. Most people don't have an extra $200 or $300 right now in a tight economy to do that. So we've made it less affordable for a lot of young people. More accessible but less affordable.

I'd like to introduce my colleague and cochair of the Doctors Caucus and fellow OB/GYN physician from Georgia, my good friend, Dr. Phil Gingrey.

I thank the gentleman.

I'd now like to yield time to my good friend, Dr. Andy Harris from Maryland. Andy is an OB anesthesiologist. And I say this to my good friend: I

spent a good bit of my adult life waiting for anesthesia to put my patients to sleep so I could operate. So I now yield to Dr. Harris.

I thank the gentleman for his comments. I felt a little deja vu there, Dr. Harris, after walking out of the delivery room after about 5,000 deliveries for some of the very reasons that Dr. Harris brought up. I'd now like to yield to my friend from Georgia, Dr. Gingrey.

I thank the gentleman for yielding. Just to carry on with what Dr. Gingrey and Dr. Harris have brought up, let me share with you about affordability. When Dr. Harris was talking about young people, it's obvious that the President--I don't know who writes the check for health insurance in his home, but he hasn't looked at the check, whoever is writing it, if he hasn't figured out that costs have gone up.

Dr. Harris, I may be a little more than a generation past where you are, but when I left, when I quit operating and doing obstetrics, I had an 8 percent primary c-section rate. You've seen that. And why did that happen? When I came back from the Army to Memphis, I trained at the University of Tennessee in Memphis. I had 2 years of training, and then I had to go in the military for 2 years and came back and finished my training. All the malpractice carriers left the State of Tennessee. In 1975, they all left. So the doctors and the Tennessee Medical Association set up an organization called the State Volunteer Mutual Insurance Company. This insurance company was a mutual company, so money that we didn't pay in came back to us at the end of a year. It wasn't owned by some stock-traded company. Strictly, it was just to give us malpractice liability insurance coverage, which I've kept until this day.

In the entire time that that company has been in existence, over half the malpractice premium dollars have not gone to injured people. They've gone to lawyers, both plaintiff and defense lawyers. What a terrible system that is; to try to compensate someone who has actually been injured, we have no way to do it. Less than 40 cents on the dollar that we paid in for 35 years has actually gone to people who have been hurt. That's a terrible system. We need a better system.

As Dr. Harris pointed out, when I started my practice, my malpractice premiums were $3,000 a year. Five years ago, when I left, a young physician who replaced me was paying $7,400. And guess what? The patients didn't get better quality and better access. They just got higher costs. So that's why we need to address that issue. I think you're spot on, Dr. Harris. I yield to the gentleman from Maryland.

I think we all could stand here for hours talking about--I certainly could--the innovative new devices that I've used through laparoscopy that have helped patients shorten their length of stay, shorten their pain. I hope we don't go into the Middle Ages of health care in technology because we could spend literally hours talking about what we've seen. We're the place in the world that people come for this.

Before I go back to costs, the estimates are that this device tax will cost 43,000 jobs. The fear is that we'll start producing these offshore and lose jobs in this country. That makes no sense whatsoever. Actually, it was Dr. Milton Friedman who said:

If you want more of something, subsidize it; if you want

less, tax it.

That's a fairly simple concept.

Back to the initial problem we have in health care, which is cost. Let me just go over a couple of things, and not just behavioral things. In a recent Gallup survey, the top concern cited by small business owners was rising health care costs. Remember, the President stood right here--and I listened to the debate and so did Dr. Gingrey--for hours on end about how this was going to lower the average person's health care insurance premium by $2,500 a year. Remember that? You remember that, Dr. Gingrey. I heard it over and over right in this well and right at this dais. Guess what? Exactly the opposite happened, which is exactly what we predicted would happen. It did not bend the cost curve down, and it's making it less successful and affordable for people.

Anyway, on with this Gallup survey. So three-fourths, 74 percent, of respondents reported that rising health care costs were hurting their businesses; and 61 percent of small business owners, who are not hiring, point to worries about potential costs of health care as a reason for why they're not hiring. That ought to be a clear signal to everyone here that we need to deal with costs.

What I should have stated at the outset of this hour is what we do not need to do. Health care decisions should be made between physicians, the family, and that patient. That's who should be making them. It should not be insurance companies and certainly not some bureaucrat here in Washington or some policy wonk up here that thinks they know what's best, as Dr. Harris just pointed out what is best for that patient. He saw and he knows what's best because that's what he's done for the last 30 years.

I think our cost issue is clearly what we're not dealing with with this care. Are there good things in this bill? Sure. There are things in here that I like in the Affordable Health Care Act, and we can talk about that.

Dr. Gingrey, I would like to yield to you at this point.

I thank the gentleman.

I do want to say to the American people that 47 million people, including Dr. Gingrey and I, are on Medicare.

We made a solemn promise to our seniors in 1965. When that program came out, it was a $3 billion program. Why was it put in place? Because many people retired from their business at that point in time, they no longer worked, and they had no access to care. Again, lack of access to affordable health insurance.

It was a $3 billion program. There was no Congressional Budget Office at that time, but the estimators here in Washington said we believe in 25 years

this will be a $12 billion program and maybe even balloon to $15 billion. The actual number in 1990 was $110 billion. Today, in 2013, it's going to be over $550 billion.

Now, we've made a solemn promise to people who paid premiums--2.9 percent of their income, basically. The employer pays 1.45, and they pay 1.45. Of all the income you make, all of your paycheck goes to that.

One of the things that we've discovered and found out is that we pay in, as I have--as the average person does--about $117,000 or $118,000 over a lifetime, a family does, but they get out over $300,000 in services. So we know we can't pay $100,000 in and get three times that much service out. What are the reasons? It's the same issue with Social Security. We have fewer and fewer people paying in and people living longer and longer and longer. By the way, each day in this country, over 10,000 baby boomers hit age 65. That's 3.5 million people a year who are getting to be about 65 years of age.

You have to laugh at the lingo up here, when ``savings'' means that you take money out of something and when an ``investment'' means you spend it into something. So you have to learn the language up here to understand what people are talking about.

About $700 billion was taken out of the Medicare program--savings-- and we've got 3.5 million more people being added every year. Well, you do the math. How they were going to control this cost was with a little plan called the Independent Payment Advisory Board. What that is is a board of 15 unelected bureaucrats who are appointed by the President and confirmed by the Senate. Here is a little tricky part of the legislation. The President is supposed to be appointing these people this year. If they are not appointed to that board, one person--one-- the Director of HHS, Kathleen Sebelius, has the power to enact all this. We have given that bureaucratic power to one person if those members and that board are not confirmed. Most people don't know that.

I've heard all the pros about how wonderful this is. I go back to my scholarly journals, and I want to refer people to the New England Journal of Medicine. An attorney in the New England Journal of Medicine, Timothy Stoltzfus, wrote an article in June of 2011, not pro or con, but just about the Independent Payment Advisory Board.

In addition, my friend Dr. Gingrey just said--and he is absolutely correct--that Congress changed this payment to doctors, the so-called SGR--the sustainable growth rate--so that patients would maintain their access to their doctors. We've had a retrospective look at the last 25 years. Let's say we fix SGR, like we're talking about, so that patients maintain their access. In a retrospective look in his report, the CMS actuary questioned--this is not me saying this--whether this goal is achievable to maintain these cuts, noting that the IPAB-targeted growth rates would have been met in only 4 of the last 25 years and would have approximated the sustainable growth rate, meaning that a cut would happen. We have almost no power to change this.

Now, here is what I found interesting. In the bill, it's absolutely correct that you can't ration care, that you can't do any of those things. That's maybe true, but if patients don't have access to their doctors, you, in effect, have rationed care. It's that simple.

This is what Peter Orszag said, the former Office of Management and Budget Director here in the Obama White House:

The IPAB is the single biggest yielding of power to an

independent entity since the creation of the Federal Reserve.

That is an astonishing statement when you hear it. That's one of the reasons I'm so passionate about maintaining the decision-making power with patients and with their families and their doctors and not with some bureaucratic board up here and also, certainly, not with the insurance companies. I agree with that.

Another comment that I've seen made:

The Independent Payment Advisory Board puts important

health care payment and policy decisions in the hands of an

independent body that has far too little accountability.

That's one of the things. You may like it or not, but we in Congress have been able to change these things, and it would require 60 votes in the Senate to do it. Quite frankly, with my good friends on the other side of the building here, you couldn't get 60 Senators hardly to agree whether the Sun came up in the east, so the benchmark is very, very high.

Mr. Speaker, how much time do I have remaining?

I want to finish by spending the last little bit of time on Medicare. It is such an important part of our health care system. I want to strengthen this program--and I certainly know the folks on my side of the aisle and, I think, on the other side of the aisle want to--for future generations. We've made a promise to our citizens in this country that when they are at retirement age they'll have at least an affordable health insurance product available to them.

Let me tell you, the funny thing I found out about myself when I turned 65 was, the day before, I had a health insurance plan. It had a prescription drug benefit plan; it had a hospitalization part; it had a part that paid for my physician services. The day I turned 65, I got a part A, a part B, a part C, and a part D I could have. Well, nothing happened except I got 1 day older. Why, when a person turns 65, wouldn't you just have a health insurance plan that offered you those various options in your plan? You should be allowed to pick what's in your best interest and need.

Remember, in the Affordable Care Act, the Federal Government now decides what's an essential benefits package. You don't make that decision with your family and your doctor. A Federal bureaucrat makes that decision--what you must buy, a good or a service that you must purchase.

Some of the facts I've mentioned already about Medicare, and one of the things that we have to do, I think, in Medicare--and I know my colleagues will confirm this--is that, currently, one in 10 physicians is not accepting new Medicare patients. In some areas, it may be as many as three in 10 primary care or as many as half won't. We have a huge shortage of primary care physicians in this country. We know that the hospital insurance trust fund is insolvent. It may run out of money as soon as 2016.

I yield to my colleague, Dr. Harris.

I thank the gentleman. He is absolutely spot on. One of the reasons that he ran for Congress and I ran for Congress is to preserve this great program for our seniors out there, and I am absolutely committed to do it.

Let me give a couple of facts before we end up. The actuary of the Medicare program--this is not me, this is the Medicare actuary--said that congressional action will be required to ensure that our seniors have continued access to care. In May 2012, he said it is reasonable to expect that Congress would find it necessary to legislatively override or otherwise modify the reductions in the future to ensure that Medicare beneficiaries continue to have access to Medicare services.

This is not some right-wing Republican, this is the Medicare actuary, and we're not even talking about it. We have heard nothing from the President about how we preserve this great program other than we just keep doing what we're doing. That's not an honest, fair assessment of where we stand today. The sooner we deal with it, the more likely we are to come to a less painful solution to this.

I do want to finish by saying that I appreciate the hour you've shown us, Mr. Speaker. We will continue this very, very important discussion on Medicare in the future, and I yield back the balance of my time.

Mr. Speaker, today I would like to recognize Mr. Daniel C. Reese of Tennessee's First District, who has been appointed Chairman of the Tennessee Department of Environment and Conservation Commissioner's Council on Greenways and Trails. This council is an organization that encourages our communities to utilize green spaces, promotes volunteerism in the community, and works hard to preserve our natural and cultural resources. Through his efforts on the council, Dan has set a great example for East Tennessee.

A graduate of East Tennessee State University, Dan has dedicated his career to working for the people of the Great State of Tennessee. He is a member of the Tennessee Department of Transportation Depot Restoration Demonstration Project, and continues to volunteer his time and expertise to develop additional green spaces within our community.

Mr. Speaker, I commend Daniel for his selfless contributions to our state and wish him the best as he continues to exemplify the Volunteer spirit.

Mr. Speaker, today I recognize the centennial anniversary of the Johnson City County Club in Johnson City, Tennessee. Since 1913, the club has been a driving force for social, recreational, and cultural development in Johnson City. Having grown from the vision of a few local leaders into an establishment that has touched many thousands of lives, the club has carried its traditions into the modern era.

The Johnson City Country Club's centennial program began in June 2009 when a group of members envisioned the club to be more than simply a social and recreational entity. These members recognized that the club was sitting on a historic property that had influenced the growth of the city. As of November 15, 2011 the Johnson City Country Club was placed on the National Register of Historic Places in recognition of its rich history and contributions to society.

The club serves as a home to numerous non-profit organizations and has collected funds for both World Wars and other conflicts. Its facilities have helped Johnson City youth develop in golf, swimming, and tennis. As a result, the golfing program at East Tennessee State University is considered one of the top programs in the Nation.

Mr. Speaker, I commend the Johnson City Country Club for their significant impact on both Johnson City and Tennessee's First District. I wish them the very best in their centennial anniversary celebrations and hope to see continued growth in the club's role in the community.

I thank the gentleman for yielding.

First, Mr. Speaker, I want to thank Chris Smith for not just this year, but for over 30 years of advocating for life and making that one of his missions in life. Chris, thank you for what you have done not only for this Congress, but for our country, to make awareness. I really appreciate it. I can't

thank you enough for what you have personally done and sacrificed.

Exactly 40 years ago next month, I was a young doctor in training in Memphis, Tennessee, and I was drafted in the U.S. military and left the country to go to Southeast Asia for a tour of duty there. And something happened when I was gone. Roe v. Wade passed. It really passed, and I wasn't even aware of it because I was out of the country. I came back to my training, which had been interrupted by my military service, and realized something very fundamentally different had happened to America.

As an obstetrician, I personally have delivered around 5,000 babies. In the 31 years I was in medical practice in Johnson City, Tennessee, a small town in northeast Tennessee, our group had delivered over 25,000 babies--25,000 children. I see these children now as doctors, lawyers, teachers, Sunday school teachers, soccer coaches, housewives, and farmers, you name it, bettering our community. I cannot imagine my community without these young people there. They are the future of this great Nation.

As Dr. Harris mentioned, I saw when ultrasound went from when it was just a blob that you saw to being able to visualize the heartbeat 28 days or less post-conception. It's unbelievable to be able to see that. And to see this child develop is something that I can't explain to you how fulfilling that is to be able to see that happen. And to have a ``choice'' snuff that out is a law that we have to get right in this country. Thank goodness minds are changing.

I look around this great room here, this great Chamber, and wonder what it would be like if different choices were made, the great people that I've met here in Congress that might not be here had a different choice been made. In this Chamber, we have a clear responsibility and duty for those that do not have a voice. The fourth President of our country, and the architect of the Constitution, James Madison, warned that the rights of the minority must be protected. The unborn children of America represent the greatest silent minority that there is. They are the most innocent among us and deserve the protection we afford all people in this great country.

Life is a precious miracle from God that begins at conception. As a physician, I can personally attest after visualizing literally thousands of ultrasounds. We have to make our laws consistent with science of today.

It's been mentioned before that one of our government's most important duties is to protect the most vulnerable among us, and I pledge to continue to remember and strive toward this as long as I breathe. I'm heartened that so many others today have chosen to do the same thing. And may God very much bless the 4 million women last year in this country who chose life, not a choice to terminate life.

Mr. Speaker, I move to suspend the rules and pass the bill (S. 3472) to amend the Family Educational Rights and Privacy Act of 1974 to provide improvements to such Act.

Mr. Speaker, I ask unanimous consent that all Members have 5 legislative days in which to revise and extend their remarks on S. 3472.

Mr. Speaker, I yield myself such time as I may consume.

I rise today in support of S. 3472, the Uninterrupted Scholars Act. The bill amends the Family Educational Rights and Privacy Act of 1974, better known as FERPA, to give child welfare agency caseworkers access to the educational records of foster children. This is an important bill that will help improve the quality of education for children in foster care.

In 2008, Congress passed the Fostering Connections to Success and Increasing Adoptions Act, which tasked

child welfare agencies with ensuring that children in foster care are enrolled in school. In carrying out this important mission, agencies are required to consider educational stability when identifying foster care placements and coordinate with local school districts to ensure that young people stay in their current school when placed in foster care or are immediately enrolled in a new school if that is in their best interest.

Over the last 4 years, student privacy law has made it difficult to properly implement the educational stability provisions of the Fostering Connections law. For example, child welfare agents are unable to access student education records in a timely manner, if at all, to properly monitor student progress and coursework, or to get students enrolled in the proper courses if a transfer of schools is necessary.

The Uninterrupted Scholars Act will correct these challenges. By allowing direct--and limited--access to the education records of foster kids, caseworkers can follow the students' education in a timely manner and help ensure greater success in school.

The Committee on Education and the Workforce--and this Congress-- understands the importance of maintaining strong student privacy protections and supports the provisions included in FERPA. It is our responsibility to ensure a student's personal information, such as academic progress, placement or disciplinary records, is not shared with anyone other than officials directly involved in the student's education.

For children in foster care, child welfare agents have a responsibility to look out for the education of their students and have a direct need to have access to these important records. The bill before us today narrowly grants caseworkers access to these important records.

Mr. Speaker, S. 3472 is a narrow, but critical, step in helping children in foster care receive a better education. I urge my colleagues to support this bill and reserve the balance of my time.

I have no speakers at this time. I continue to reserve the balance of my time.

I continue to reserve the balance of my time.

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

I wish to conclude by saying, Ruth, congratulations, and thank you for all the hard work that you have done for both sides of the aisle and for the work you've done for the children of this Nation.

I also want to thank Senator Landrieu and Congresswoman Bass, who is my next-door neighbor in the Cannon Office Building, and Ranking Member Miller for the work you've done for many decades for the children of this country, and Chairman Kline.

I will conclude by just saying I'm proud to sponsor the Uninterrupted Scholars Act, and I urge my colleagues a ``yes'' vote.

With that, I yield back the balance of my time.

Mr. Speaker, I object to the vote on the ground that a quorum is not present and make the point of order that a quorum is not present.

I thank the chairman for yielding.

Mr. Speaker, I rise today in support of H.R. 6582. This legislation would establish a uniform energy-efficiency descriptor for all water heaters, walk-in freezers, and walk-in coolers. The legislation also improves the testing methods that determine whether or not these products are energy efficient, which will provide certainty for the manufacturers of these products.

The importance in my district, in my hometown, is one of our largest manufacturers there is A.O. Smith, which makes up to 8,000 water heaters a day. This is a real jobs issue in my hometown. These jobs have good retirement plans and health insurance. Their competitors are both in Canada and Mexico. And certainly we need to do anything we can to help support these local manufacturers.

This bill will make it easier for consumers to compare the energy efficiency of products and eliminate confusion that stems from having more than one type of label. The decision to invest in a large-scale appliance of this nature is a big one, and during these tough economic times, consumers deserve information that's easily understood so that they can make well-informed decisions. It's also helpful for manufacturers to have clear guidelines for how products will be judged for energy efficiency. And this is why--just to simplify what's going on to make it easier for our manufacturers.

And let me tell you, I've walked through A.O. Smith's plant. I've been through it. It's absolutely incredible to see a piece of sheet metal, to see our manufacturers take a piece of metal and produce 8,000 water heaters in a single day for consumption in the United States. I have one in my home. That's what I use. And I proudly have one in my apartment here in Washington, D.C.

I would encourage support of this measure.

Mr. Speaker, I submit these remarks to recognize the 40th anniversary of the International Storytelling Center in Jonesborough, Tennessee.

On a warm October day in 1973, Jonesborough--a tiny Tennessee town in the heart of the Southern Appalachian Mountains--played host to the first National Storytelling Festival.

A Jonesborough journalism teacher and his neighbors rolled an old farm wagon into Courthouse Square and, around that wagon, told stories. The Festival was modest, but something happened that sunny October day that has forever changed our culture, the tradition of storytelling, and this Tennessee town.

Recognized as the world's first public event devoted exclusively to storytelling, the Festival ignited a renaissance of storytelling that has spread throughout America and the world and transformed Jonesborough into the Storytelling Capital of the World. In 1975, two years after the first Festival, the institution that would one day become the International Storytelling Center was founded--propelling this growing cultural movement for almost 40 years.

During the past four decades, the International Storytelling Center has advanced the power and possibilities of storytelling--in performance, preservation, and professional practice.

Storytelling can't directly feed the hungry, house the homeless, or cure the sick. But within each of us is the capacity to tap into our stories, our narrative assets, to communicate more effectively--to share knowledge, persuade, entertain, advance a cause, teach, lead change, and visualize the future.

Indeed, a well-told story can communicate truth, concept, or idea with immeasurable power. So, based on this belief, ISC is dedicated to connecting the powerful tool of storytelling with the voices of individuals, organizations, and communities across the world to help them achieve their goals.

The vision of the ISC is a better life, a better world, through the power of storytelling. To achieve this worthy vision, the ISC is advocating for the power and possibilities of storytelling and providing people across the world with the knowledge, experiences, and tools to effectively tap into the contemporary applications of this longstanding tradition. The ISC is

inspiring and empowering people across the world to discover, craft, and share their stories to: enliven and enrich performance--as teller and listener; celebrate our personal, community, and cultural heritage through the preservation of our stories and story traditions; and enhance health and wellness, education, and community services through the professional practice of storytelling.

On October 5-7 of 2012, the ISC and the Jonesborough community are celebrating their 40th anniversary of the National Storytelling Festival--the acclaimed event that launched the storytelling renaissance and transformed Jonesborough, the oldest town in Tennessee, into the Storytelling Capital of the World.

Mr. Speaker, I submit these remarks to recognize Mr. Arthur Byron ``Deacon'' Bowers of Carter County, Tennessee, for receiving the James H. Collier Service Award. The James H. Collier Service Award is given to veterans who continue to serve their country and fellow veterans through their retirement and into their civilian lives. Deacon Bowers is a veteran of the Korean War and has provided a perfect example of how one man can better the lives of veterans in his community.

For 36 years, Deacon dedicated his efforts to the Tennessee Department of Labor and Workforce Development. From 1974-2004, he served as Regional Veterans Employment Representative. By the time of his retirement, Deacon had assisted thousands of military veterans. In retirement, he continues to build on his volunteer legacy by visiting veterans and their families in the hospital. Deacon also helped create both the Veterans War Memorial and the Walk of Honor in Elizabethton, Tennessee.

Mr. Speaker, I commend Deacon for his selfless contributions to Cocke County's veterans and wish him the best as he continues to exemplify the Volunteer spirit.

I thank the chairman for yielding.

Mr. Speaker, I rise today in support of H.J. Res. 118. This resolution will express Congress's disapproval of the Obama administration's attempt at weakening bipartisan welfare reform and prevent the administration from implementing their plan to waive the work requirements of the current law.

Sixteen years ago, a Republican-led Congress worked with President Clinton to fix a broken welfare system, a bipartisan law that resulted in the Temporary Assistance for Needy Families block grant. Our ranking member said there is about a 20 percent requirement to increase work, and I think that's a great idea. But how do you define work?

Well, the GAO in 2005 issued a report that said some States counted work as such activities as bed rest, personal care, massage, exercise, journaling, motivational reading, smoking cessation, weight-loss promotion, helping a friend with a household task or running errands.

That makes a mockery of work, and that doesn't pass the laugh test. Independents, Democrats, and Republicans in our area of the country know what work is, and that isn't it.

Since then, since the passage of the law, a number of individuals have dropped off the welfare, a 57 percent decrease. The poverty level among single women dropped by 30 percent while their income and earnings increased. More than 80 percent of the people in this country support work requirements in the welfare reform bill, and this legislation ensures that the hard work of the 104th Congress and President Clinton isn't weakened by the Obama administration.

Let me speak to my friend, Mr. Andrews, for just a moment. It's a great idea to hire teachers and firefighters. I've done that as a mayor of a city of 60,000 people. Democrats have it just backwards. What you do is you create a work environment with decreased regulations and decreased government interference where the private sector can go out and create the jobs that create the taxes that pay for all of these services that we want.

That's what we did. It works, and that's a very basic difference in philosophy.

Mr. Speaker, I submit these remarks today to recognize Mr. Roy T. Campbell, Jr. of Tennessee's First District, who has been named 2012 Citizen of the Year by Senior Citizen Home Assistance for his longstanding dedication and service to Cocke County. For those unfamiliar with Senior Citizen Home Assistance, this is an organization that provides services to seniors and enables them to live at home. Once a year they recognize an exemplary individual and honor their achievements. Through his work as a lawyer and volunteer, Roy has made many selfless contributions to his community.

A graduate of the University of Tennessee School of Law, Roy has endeavored to help the citizens of Cocke County throughout his career. In addition to more than 61 years of practicing law, he has been involved in many civic, church, and community groups. He is a founding member of the Industrial Development Board of Cocke County, which has attracted businesses and jobs to the region. He has also been an enthusiastic supporter of higher education in East Tennessee with generous gifts to the University of Tennessee, UT School of Law, and East Tennessee State University.

Mr. Speaker, I commend Roy for his selfless contributions to Cocke County and wish him the best as he continues to exemplify the Volunteer spirit.

Mr. Speaker, during the week of October 21-27, the American Chemical Society, ACS, will be celebrating the 25th anniversary of National Chemistry Week. National Chemistry Week is an annual community outreach program hosted by the ACS and its volunteers across the country to highlight the importance of chemistry in our lives. This year's theme is Nanotechnology: The Smallest Big Idea in Science.

I applaud the ACS for its efforts to showcase the importance of science to all Americans--especially our students. The study of chemistry and nanotechnology has made tremendous advances possible in areas ranging from energy and the environment to health. And with so many American servicemen and women still in the field, it is worth noting that nanotechnology has been used to create a special coating of Teflon to Kevlar, which offers added protection to those in uniform. And in chemistry--as with all of science--we are just scratching the surface of what is possible.

I commend the American Chemical Society--and its Northeast Tennessee Section--for hosting its annual celebration of National Chemistry Week.

Mr. Speaker, I rise today to commend the Kings Mountain Chapter of the Sons of the Revolution for observing the 225th anniversary of the signing of the United States Constitution on September 17. I am proud of these men for remembering Tennessee's part in obtaining our independence.

The limited, constitutional government that we enjoy was made possible by the sacrifice of American patriots. At the Battle of Kings Mountain, the Overmountain Men from Sycamore Shoals, Tennessee defeated British forces, creating a turning point in the Revolutionary War. By taking up arms to free a nation from tyranny, these men exemplified Tennessee's volunteer spirit.

I sincerely thank the Kings Mountain Chapter of the Sons of the Revolution for observing this important day.