Floor Statements

Mr. Speaker, although this hall is empty, there are a lot of people watching it, and I wonder how many of them have ever actually gone hungry. How many of the people watching this have had to go without a meal so their kids could eat? How many have had to wonder how they'll get through a summer without subsidized school lunches? It's easy to talk about pulling yourself up by your bootstraps when you've had designer shoes on your whole life.

Tomorrow, we will be voting on whether or not to cut $40 billion from SNAP. That's a nutrition program for people who do not have access to adequate nutrition. It's a program that helps one out of seven Americans to put food on the table. If this seems familiar, it's because it is familiar. Republicans tried just exactly this before the August recess, a couple of months ago, and not surprisingly, for the most unproductive Congress in decades, this bill had to be pulled at the last minute because of a lack of support. Even some of the Republicans saw it was too much.

Anyone who has been paying attention knows that symbolic votes to nowhere are the bread and butter for this Congress, but the Republicans couldn't even get their own support on the bill--$20 billion of cuts that primarily help children and the elderly wasn't enough for them. They had to hurt people more, so here we are again with a new, improved plan that doubles the cuts to $40 billion. On top of making 2 million people ineligible for benefits, they are also going to take away our States' ability to provide temporary benefits in times of high unemployment. As a result, the CBO predicts that this will add an additional 1.8 million hungry Americans to the ``ineligible'' list.

Why are we attempting to inflict another needless wound on the working poor?

Republicans will tell you that the program has grown too much over the last few years, as though the need for food stamps were unrelated to a dragging economy. They see no connection between the economy and the fact that people don't have food. That's exactly what the program was designed to do--quickly help people who are in need. When unemployment is high and people can't pay their bills, that's exactly the time they need the SNAP program. Caseloads rose dramatically when the recession hit. We laid off 700,000 people a month in 2007, but that growth has also slowed as the economy has recovered slowly. The CBO projects that, in just a few years, SNAP spending will be back down to 1995 levels as a share of the GDP, and since it's shrinking on its own, it isn't adding to the long-term deficit problems.

The rhetoric is simply empty and stupid. Conservatives can try and push this tired welfare abuse narrative. It's a talking point. Every time they come out here, ``Welfare abuse. Welfare abuse. People are getting money for food. That's welfare abuse,'' but as usual, the reality is not in their corner. Studies show that food assistance has some of the lowest rates of fraud of any benefit program. If you go to one of those food banks and talk to the people who are there, you'll find some surprising people there, people who thought they would never have to go there, but they are short on money and can't feed their kids, so they're getting some money.

So I ask you again: Why are we doing this--wasting time to satisfy the furthest right-wing of the Republican Party?

We are again catering to a fringe agenda thought up by partisans who are obsessed with the deficit bogeyman. That bogeyman has been roaming around here for 4 years. ``We're going to have a terrible collapse. We're going to have inflation. We're going to have terrible things.'' It has never happened. The President has done a miraculous job in keeping us on an upward track in spite of the resistance of the other side. What it does is it makes it harder for 4 million people to put food on the table.

So be it. That's their attitude. I'm in. At least they won't risk facing a primary in the next election. They are all worried about somebody further on the right. We've already got one Member over here, Mr. Speaker, who is worried about somebody coming from the right, and he's about the furthest right I can imagine on the floor.

Senate Democrats and Republicans appointed conferees to negotiate a farm bill back at the beginning of August. Quit worrying about scoring points with the Heritage Foundation, and let's focus on the American family and vote this bill down.

Mr. Speaker, I will enter into the Record four documents. One is a letter from the President, in his opposition to the bill. The second is technical assistance from the Inspector General, saying they have no ability to do this. The third is a cost estimate from CBO, and the fourth is a letter from HHS detailing their verification plans.

Executive Office of the President, Office of Management

and Budget,

Washington, DC, September 10, 2013.

Statement of Administration Policy

H.R. 2775--No Subsidies Without Verification Act

(Rep. Black, R-TN, and 103 cosponsors)

The Administration strongly opposes House passage of H.R.

2775 because the goal of the bill is already being

accomplished while the text of the bill would create delays

that could cost millions of hard-working middle-class

families the security of affordable health coverage and care

they deserve. It is time for the Congress to stop fighting

old political battles and join the President in an agenda

focused on providing greater economic opportunity and

security for middle class families and all those working to

get into the middle-class.

The Affordable Care Act gives people greater control over

their own health care and has already improved many aspects

of the Nation's health care system. Beginning in October

2013, millions of low- and middle-income Americans will be

eligible to receive tax credits to help them purchase

insurance and cost-sharing reductions to help with out-of-

pocket expenses for coverage effective January 1, 2014. Tens

of millions of Americans who have previously been denied

coverage due to a pre-existing medical condition will now be

covered. The nearly one in two Americans under the age of 65

with pre-existing medical conditions will have the peace of

mind that comes from knowing that they cannot be dropped from

their health plan or denied coverage because of those

conditions. House passage of H.R. 2775 would undermine this

security by delaying tax credits and cost-sharing reductions

that will otherwise be provided to millions of Americans.

H.R. 2775 is unnecessary because the Secretary of Health

and Human Services has already put in place an effective and

efficient system for verification of eligibility for premium

tax credits and cost sharing reductions. Moreover, it would

create vague standards for the Inspector General, whose

office has never performed this type of prospective review,

to ``successfully and consistently'' verify eligibility. As a

result, this legislation's unnecessary pre-certification

requirement would impede opening the Marketplaces on October

1, 2013, driving up out-of-pocket health care costs for

millions of Americans and reducing timely access to much-

needed and long-denied affordable coverage.

If the President were presented with H.R. 2775, his senior

advisers would recommend that he veto the bill.

Mr. Speaker, I yield 2 minutes to the gentleman from Texas (Mr. Doggett).

Mr. Speaker, I yield 2 minutes to the gentleman from New Jersey (Mr. Pascrell).

Mr. Speaker, I yield 1 minute to the gentleman from Oregon (Mr. Blumenauer) to close our arguments.

Mr. Speaker, on that I demand the yeas and nays.

Mr. Speaker, I rise today to honor the 40th anniversary of Humanities Washington and the 15th anniversary of its Bedtime Stories literary gala in Seattle.

Since its founding in 1973, Humanities Washington has served the state with humanities programming, sparking conversation and critical thinking using story as a catalyst, nurturing thoughtful and engaged communities across Washington State. As Washington State's flagship non-profit for the humanities, it plays a critical role in addressing an immediate and growing crisis concerning community identity and understanding, respect for other perspectives, and the ability of communities to work together to shape a better future.

Humanities Washington's work in cultural education--ranging from Speakers Bureau to Traveling Exhibits to Family Reading--promotes awareness of the history of local communities and its residents, provides opportunities for people to gather and learn more about their unique past and shared present, and nurtures relationships that enable us to move forward towards a more prosperous future.

The humanities--including history, literature, philosophy, ethics, law, and other fields of inquiry--encourage us to investigate, speak, listen, read, reflect, question, think, grow, and act. Using the disciplines of the humanities, Humanities Washington provides programs and experiences of lasting value, creating insight, understanding, wisdom, and a deeper

appreciation for a variety of perspectives and all that we share as Washingtonians and Americans.

This year also marks the 15th anniversary of one of Humanities Washington's signature events: Bedtime Stories. Bedtime Stories is an annual literary celebration featuring critically acclaimed Northwest writers unveiling new short stories created specifically for dinner galas in Spokane and Seattle. National Book Award Winner Charles Johnson has called it ``the region's premier literary event.'' Johnson is one of the founders of the gala, and will receive the 2013 Humanities Washington Award at Bedtime Stories in Seattle on October 4.

Mr. Speaker, I would like to convey my congratulations to Humanities Washington for 40 years of excellent, necessary work sharing the humanities with Washingtonians. I salute Humanities Washington as it works to ensure that the humanities are key to civic life for generations to come.

Mr. Speaker, taxes are a civic duty essential to governance, yet very little information about how that tax money is spent is ever sent back to the American people. The awareness gap results in significant misinformation and disengagement. For example, a 2005 Washington Post/Kaiser Foundation poll found that by a margin of two to one, Americans believe that the federal government spent more on foreign aid than on either Social Security or Medicare.

For that reason, I am introducing the Taxpayer Receipt Act of 2013 to help clarify misconceptions. The Taxpayer Receipt Act requires the Treasury Secretary to provide each taxpayer with an annual itemized ``receipt'' explaining how his or her tax liability was spent and include: tables reflecting the taxpayer's income tax liability, the amount of the liability spent on each category, and the actual federal outlays for each category; a table containing the 10 costliest tax expenditures; and, an annual budget review using CBO budget projections.

For an example of what a Taxpayer Receipt would look like, go to: http://mcdermott.house.gov/images/pdtitaxpayerreceiptmockupv3.pdf

Nina Olson, the Taxpayer Advocate who is an independent advocate for taxpayers within the IRS, supports this reform and the Washington Post and the New York Times have both featured articles that support the taxpayer receipt. In 2010, Third Way released an idea brief explaining the benefits of such a taxpayer receipt. You can find the entire Third Way idea brief here: http://content.thirdway.org/publications/335/ Third_Way_Idea_Brief_-_A_Taxpayer_Receipt.pdf.

Providing a receipt to taxpayers would be inexpensive and simple to implement and similar to the existing Social Security Administration statement provided each year. Most importantly, this information provides the clarity and transparency that the American people want and deserve.

Mr. Speaker, I would remind my distinguished colleague from Georgia of a story in the Bible about a king who was very famous and one day noticed on the wall some writing. He had someone come in and interpret for him, and the writing said: ``Your days are numbered upon the Earth.''

Your days are numbered on this issue. You have 59 more days. I'm sure you can bring up a bill every single day to try and repeal it. The Speaker has announced there will be two more, but it will not work. This is going to be the law on 1 October, and it's going to go into effect. The Supreme Court has spoken. The Speaker has actually said, ``It's the law of the land.'' Yet we see this hopeless strategy--it's worse than hopeless. It's weak and it's mean. What you're saying is you want to take away

from people what they already have, guaranteed issue, coverage for their kids to age 26, and lifetime limits will be gone. All of that you want to take away.

Have a great break, because you're going to go back to your districts and explain for 38 days why you will not provide health care coverage for the people of America. I hear there's a mythical bill with 141 signatures. The Republicans have been running the Ways and Means Committee for 16 out of the last 18 years, and we have never had a bill put in front of us for a vote. It's never been through the Rules Committee. It's never been out to the floor.

You have no plan. You have a piece of paper that you wave around, but you won't go out and defend it. The President came and put a bill out here, and we passed it, and we're defending it, and it's going to go into effect and provide what all Americans want: security if they get sick; they want to know they'll be covered; they want to know they won't be bankrupted.

Vote ``no'' again today, and we'll be back after the break for a few more ``no'' votes.

Mr. Speaker, as I listened to Mr. Waxman, it's clear he was talking about obsession. And you might ask, Well, why is this happening here and what's going on?

This has happened before. This is the worst nightmare for the Republican Party. In 1964, the American Medical Association was flat out against the institution of Medicare. When I was in medical school, the president said, Boys, there isn't going to be any medicine in this country. We're having that socialized medicine come in. It's a terrible thing.

And you know what happened? They made the people so afraid that when they went out to enroll people in Medicare, people said, Well, I don't want any of that government medicine in my house. Look at Medicare today. Nobody on that side would dare take out Medicare because the American people found out that what they were told in the advertising campaign leading up to it was not true. And that's what you are getting here today--untruths.

Vote ``no'' on this.

Mr. Speaker, I am standing here asking: What's the rush? The Iranian President is being sworn in in 4 days. For the first time in years, there is a moderate who's been elected as head of Iran, who promises us progress on the issues that are of most concern to us.

I'm not a blind optimist, and I have no illusions about the nature of Iran's Government. I understand that one election won't ensure us peace, but it could mean change, and we need to see what it looks like. Experts and former military officers, including the Commander in Chief of Central Command, warn that more sanctions right now will ``undercut the new President and his pledged plan of moderation.'' It gives ammunition to the hardliners who will operate against him. So the timing of this bill could not be worse from a foreign policy perspective.

In addition, Members have not had a chance to fully review the bill, which is significantly different than when it was marked up coming out of the Foreign Affairs Committee. The marked-up version became public only a few days ago, and I know that many Members who cosponsored the original bill are not aware of the changes made in it. For these reasons, we sent a letter to our leadership asking, along with 15 other Members, urging them to delay consideration until after September. We could come back after our vacation and deal with this if it's really needed. It doesn't have to happen now, except because we're going out on Friday.

Passing this legislation would support the hardliners' claims that we have no intention of negotiating; we hit the President before he even sits down in the chair. It's a dangerous sign to send and it limits our ability to find a diplomatic solution on nuclear arms in Iran.

There is no public support in this country for another war. We've seen this movie before. We put sanctions on Iraq. I was here when they put them on. I saw us squeeze them for 10 years. The World Health Organization said 500,000 Iraqi kids died because we cut off medicine and food and other essentials to the Iraq community. Did it end in a change? No. We went to war with them. And if you think that this is going to squeeze and bring us to war, and you think that what happened in Iraq is going to happen here, remember we're 11 years in Iraq. And we do not have a stable democracy today. We have a government that's about to collapse.

What we think we can do by squeezing people--and you're squeezing Iranian children today. Iranians cannot buy medicine on the world market and pay because we have cut off all of the banking connections everywhere so that there's no way for them to slip money through the banking system to pay for medicine for kids.

We should delay this vote. Vote ``no.''

Mr. Speaker, I yield 2 minutes to the gentleman from New York (Mr. Rangel).

(Mr. RANGEL asked and was given permission to revise and extend his remarks.)

Madam Speaker, I yield myself 2 minutes.

We are back in the theater of the absurd. What we are hearing right now is the sound of Republican heart rates going up: ``ObamaCare is coming.'' These last benefits are going to happen, like it or not. And worse, they are going to work. We are seeing the time-honored political tactic of confusion. The sleight of hand. Direct people's attention over here so they won't see what you are doing over there. Shout about delaying the employer mandate and confuse the people when the more corrosive bill comes next, the tool that makes reform possible: the individual mandate.

Maybe they're so scared because it's already working. Washington, Oregon, and California are already reporting lower rates in 2014. Today, New York premiums were cut by 50 percent. Sick children are getting covered. Consumers are getting reimbursements from their insurers. There is no evidence of the sticker shock you will hear about. The promise we made Americans is being fulfilled and Republicans see a giant election map slowly losing red blocks.

This bill isn't about employers. It's a frenetic expression of their anxiety over the President's signature legislation working. I thought 38 times trying to repeal it would be enough, but apparently not. We have got to try one more time. You haven't learned it isn't going to work.

Do you know why there's no fuss in this town about these bills? Because the insurance industry knows it's all nonsense. They know it won't work without an individual mandate, and you will not get it repealed. We ought to just get on with it and vote ``no'' on this bill.

I reserve the balance of my time.

Madam Speaker, I submit for the Record two records which show that hundreds of thousands of constituents in the First District of Wisconsin and the Eighth District of Texas would benefit from the Affordable Care Act.

Benefits of the Health Care Reform Law in the 1st Congressional

District of Wisconsin

Committees on Energy and Commerce, Ways and Means, and Education and

the Workforce Democratic Staff Report, July 2013

The landmark Affordable Care Act (ACA) began delivering

important new benefits and protections to tens of millions of

American families almost immediately after it was signed into

law by President Obama. But the largest benefits of the law

will become available to consumers on October 1, 2013, when

health insurance marketplaces open in all 50 states. These

marketplaces will offer individuals, families, and small

businesses an efficient, transparent one-stop shop to compare

health insurance policies, receive financial assistance, and

sign up for high-quality, affordable, and secure insurance

coverage.

This fact sheet summarizes new data on the significant

benefits of the health care reform law in Rep. Ryan's

district. It also provides the first picture of the impacts

of the law in districts redrawn or newly created following

the 2010 Census. As a result of the law:

4,500 young adults in the district now have health

insurance through their parents' plan.

More than 9,800 seniors in the district received

prescription drug discounts worth $14 million, an average

discount of $650 per person in 2011, $730 in 2012, and $780

thus far in 2013.

123,000 seniors in the district are now eligible for

Medicare preventive services without paying any co-pays,

coinsurance, or deductible.

213,000 individuals in the district--including 50,000

children and 84,000 women--now have health insurance that

covers preventive services without any co-pays, coinsurance,

or deductible.

165,000 individuals in the district are saving money due to

ACA provisions that prevent insurance companies from spending

more than 20% of their premiums on profits and administrative

overhead. Because of these protections, over 36,300 consumers

in the district received approximately $1.8 million in

insurance company rebates in 2012 and 2011.

Up to 42,000 children in the district with preexisting

health conditions can no longer be denied coverage by health

insurers.

259,000 individuals in the district now have insurance that

cannot place lifetime limits on their coverage and will not

face annual limits on coverage starting in 2014.

Up to 61,000 individuals in the district who lack health

insurance will have access to quality, affordable coverage

without fear of discrimination or higher rates because of a

preexisting health condition. In addition, the 34,000

individuals who currently purchase private health insurance

on the individual or small group market will have access to

more secure, higher quality coverage and many will be

eligible for financial assistance.

Madam Speaker, I yield back to the gentleman from Michigan (Mr. Levin).

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

Mr. Speaker, now we get to the real bill. If the Republicans can't repeal the Affordable Care Act, they're going to try and rot it from the inside.

For the last few days, my Republican colleagues have been spinning this vote as a great populist effort to help the middle class. They explain that, even with these repeals, we can keep all the things we like, covering our kids till age 26, prescription drug help, banning the denial of coverage for those with preexisting conditions.

And legally, they aren't wrong. They're not lying. They're just confusing the people. These laws will still be in place; but realistically, in the real world in which we live, it will be hard to cover your kids and subsidize drugs if the insurance industry no longer exists in this country.

Without the healthy consumers the mandate guarantees, only the sickest and the costliest will be left, and prices will skyrocket.

We have a letter from the Congressional Budget Office that says that if we delay this, you can expect that the prices of insurance will go up and fewer people will be covered.

The reason you don't see any fur flying is because the insurance industry knows this isn't going anywhere. This is just a lot of political theater.

In Washington, we tried this. In 1993, the Democrats put in universal coverage and guaranteed issue. Everybody had a mandate, and you were going to get it. The insurance companies couldn't do otherwise. Two years later, the Republicans repealed the guaranteed mandate, leaving the insurance industry covering the sickest in the State of Washington. Within 3 years, there were no individual policies sold in the State of Washington.

We have run this game once in Washington State, and you are coming out here today and running it again. It's been tried in other States. You cannot have universal coverage without a mandate. You cannot have insurance reform that guarantees everybody insurance.

Now, this isn't prophecy on my part. This has happened. A lot of what you hear about around here is that people

are talking, well, gee, we got these terrible insurance rates going up.

They're not going up in Washington in our exchange. They're not going up in Oregon in the exchange. They're not going up in California in the exchange. Today, New York reports they're not going up in New York.

Anybody who stands out here and says insurance rates are out of sight simply is misleading the people.

We ought to vote ``no'' on this bill.

I reserve the balance of my time.

U.S. Congress,

Congressional Budget Office,

Washington, DC, July 16, 2013.

Hon. Dave Camp,

Chairman, Committee on Ways and Means,

House of Representatives, Washington, DC.

Dear Mr. Chairman: CBO and the staff of the Joint Committee

on Taxation (JCT) have begun a review of H.R. 2668, the

Fairness for American Families Act, but we have not yet

completed a cost estimate for the bill. On a preliminary

basis, however, we expect that enacting H.R. 2668 would have

the effect of reducing the deficit in 2014 and over the 2014-

2023 period. That initial conclusion is based on our prior

work on proposals to repeal the individual mandate

established in the Affordable Care Act.

The legislation would delay for one year the requirement

that nearly every resident of the United States have health

insurance coverage by January 1, 2014. The bill also would

shift by one year the schedule of penalties for people who do

not comply with the mandate.

CBO and JCT expect that, during the period of delayed

phase-in of the penalty for failing to comply with the

mandate, health insurance premiums for individually purchased

coverage would be higher under H.R. 2668 than they are

projected to be under current law. In addition, the number of

people with health insurance coverage would be reduced

relative to current law.

I hope you find this preliminary information useful; if you

wish further details, we will be pleased to provide them.

Sincerely,

Douglas W. Elmendorf.

Enclosure.

Mr. Speaker, I will insert for the Record the report on the Ninth Indiana District and the people who will benefit from that bill when it goes into effect on the first of October.

Benefits of the Health Care Reform Law in the 9th Congressional

District of Indiana

Committees on Energy and Commerce, Ways and Means, and Education and

the Workforce, Democratic Staff Report, July 2013

The landmark Affordable Care Act (ACA) began delivering

important new benefits and protections to tens of millions of

American families almost immediately after it was signed into

law by President Obama. But the largest benefits of the law

will become available to consumers on October 1, 2013, when

health insurance marketplaces open in all 50 states. These

marketplaces will offer individuals, families, and small

businesses an efficient, transparent, one-stop shop to

compare health insurance policies, receive financial

assistance, and sign up for high-quality, affordable, and

secure insurance coverage.

This fact sheet summarizes new data on the significant

benefits of the health care reform law in Rep. Young's

district. It also provides the first picture of the impacts

of the law in districts redrawn or newly created following

the 2010 Census. As a result of the law:

8,300 young adults in the district now have health

insurance through their parents' plan.

More than 9,300 seniors in the district received

prescription drug discounts worth $13.7 million, an average

discount of $680 per person in 2011, $720 in 2012, and $700

thus far in 2013.

110,000 seniors in the district are now eligible for

Medicare preventive services without paying any co-pays,

coinsurance, or deductible.

213,000 individuals in the district--including 45,000

children and 86,000 women--now have health insurance that

covers preventive services without any co-pays, coinsurance,

or deductible.

135,000 individuals in the district are saving money due to

ACA provisions that prevent insurance companies from spending

more than 20% of their premiums on profits and administrative

overhead. Because of these protections, over 33,800 consumers

in the district received approximately $4.4 million in

insurance company rebates in 2012 and 2011--an average rebate

of $157 per family in 2012 and $99 per family in 2011.

Up to 40,000 children in the district with preexisting

health conditions can no longer be denied coverage by health

insurers.

255,000 individuals in the district now have insurance that

cannot place lifetime limits on their coverage and will not

face annual limits on coverage starting in 2014.

Up to 91,000 individuals in the district who lack health

insurance will have access to quality, affordable coverage

without fear of discrimination or higher rates because of a

preexisting health condition. In addition, the 35,000

individuals who currently purchase private health insurance

on the individual or small group market will have access to

more secure, higher quality coverage and many will be

eligible for financial assistance.

I yield 2 minutes to the gentleman from North Carolina (Mr. Butterfield).

Mr. Speaker, I submit for the Record the report on the Third Congressional District of Minnesota and the people who will benefit from this act.

Benefits of the Health Care Reform Law in the 3rd Congressional

District of Minnesota

Committees on Energy and Commerce, Ways and Means, and Education and

the Workforce, Democratic Staff Report, July 2013

The landmark Affordable Care Act (ACA) began delivering

important new benefits and protections to tens of millions of

American families almost immediately after it was signed into

law by President Obama. But the largest benefits of the law

will become available to consumers on October 1, 2013, when

health insurance marketplaces open in all 50 states. These

marketplaces will offer individuals, families, and small

businesses an efficient, transparent, one-stop-shop to

compare health insurance policies, receive financial

assistance, and sign up for high-quality, affordable, and

secure insurance coverage.

This fact sheet summarizes new data on the significant

benefits of the health care reform law in Rep. Paulsen's

district. It also provides the first picture of the impacts

of the law in districts redrawn or newly created following

the 2010 Census. As a result of the law:

3,300 young adults in the district now have health

insurance through their parents' plan.

More than 8,800 seniors in the district received

prescription drug discounts worth $12.2 million, an average

discount of $620 per person in 2011, $680 in 2012, and $1,070

thus far in 2013.

108,000 seniors in the district are now eligible for

Medicare preventive services without paying any co-pays,

coinsurance, or deductible.

220,000 individuals in the district--including 54,000

children and 87,000 women--now have health insurance that

covers preventive services without any co-pays, coinsurance,

or deductible.

150,000 individuals in the district are saving money due to

ACA provisions that prevent insurance companies from spending

more than 20% of their premiums on profits and administrative

overhead. Because of these protections, over 16,600 consumers

in the district received approximately $1.4 million in

insurance company rebates in 2012 and 2011--an average rebate

of $303 per family in 2012 and $160 per family in 2011.

Up to 40,000 children in the district with preexisting

health conditions can no longer be denied coverage by health

insurers.

282,000 individuals in the district now have insurance that

cannot place lifetime limits on their coverage and will not

face annual limits on coverage starting in 2014.

53,000 individuals in the district who lack health

insurance will have access to quality, affordable coverage

without fear of discrimination or higher rates because of a

preexisting health condition. In addition, the 42,000

individuals who currently purchase private health insurance

on the individual or small group market will have access to

more secure, higher quality coverage and many will be

eligible for financial assistance.

I now yield 3 minutes to the gentleman from Michigan (Mr. Dingell). He's been here for a number of years, always fighting for health care, and he is living proof that the price of liberty is eternal vigilance. He's here today fighting for health care, just like he did the first day he got here.

(Mr. DINGELL asked and was given permission to revise and extend his remarks.)

Mr. Speaker, according to a report on the First Congressional District of Tennessee, 5,800 young adults have insurance on their parents' plan, 13,000 seniors receive prescription drug benefit reductions, and 168,000 seniors are now eligible for preventive care that's free. And on and on it goes.

Benefits of the Health Care Reform Law in the 1st Congressional

District of Tennessee

committees on energy and commerce, ways and means, and education and

the workforce, democratic staff report, july 2013

The landmark Affordable Care Act (ACA) began delivering

important new benefits and

protections to tens of millions of American families almost

immediately after it was signed into law by President Obama.

But the largest benefits of the law will become available to

consumers on October 1, 2013, when health insurance

marketplaces open in all 50 states. These marketplaces will

offer individuals, families, and small businesses an

efficient, transparent one-stop shop to compare health

insurance policies, receive financial assistance, and sign up

for high-quality, affordable, and secure insurance coverage.

This fact sheet summarizes new data on the significant

benefits of the health care reform law in Rep. Roe's

district. It also provides the first picture of the impacts

of the law in districts redrawn or newly created following

the 2010 Census. As a result of the law:

5,800 young adults in the district now have health

insurance through their parents' plan.

More than 13,100 seniors in the district received

prescription drug discounts worth $16.9 million, an average

discount of $580 per person in 2011, $630 in 2012, and $680

thus far in 2013.

168,000 seniors in the district are now eligible for

Medicare preventive services without paying any co-pays,

coinsurance, or deductible.

177,000 individuals in the district--including 34,000

children and 75,000 women--now have health insurance that

covers preventive services without any co-pays, coinsurance,

or deductible.

168,000 individuals in the district are saving money due to

ACA provisions that prevent insurance companies from spending

more than 20% of their premiums on profits and administrative

overhead. Because of these protections, over 26,000 consumers

in the district received approximately $3.7 million in

insurance company rebates in 2012 and 2011--an average rebate

of $69 per family in 2012 and $201 per family in 2011.

Up to 36,000 children in the district with preexisting

health conditions can no longer be denied coverage by health

insurers.

190,000 individuals in the district now have insurance that

cannot place lifetime limits on their coverage and will not

face annual limits on coverage starting in 2014.

Up to 103,000 individuals in the district who lack health

insurance will have access to quality, affordable coverage

without fear of discrimination or higher rates because of a

preexisting health condition. In addition, the 28,000

individuals who currently purchase private health insurance

on the individual or small group market will have access to

more secure, higher quality coverage and many will be

eligible for financial assistance.

I yield 1 minute to the leader of the Democratic Party, the gentlewoman from California (Ms. Pelosi).

Mr. Speaker, I would like to insert letters from consumer groups opposing the bill--Easter Seals, American Diabetes Association, American Heart Association, and others.

I also would like to enter into the Record the report on the Fifth Congressional District of Virginia and those who will benefit from the Affordable Care Act.

Benefits of the Health Care Reform Law in the 5th Congressional

District of Virginia

committees on energy and commerce, ways and means, and education and

the workforce, democratic staff Report, july 2013

The landmark Affordable Care Act (ACA) began delivering

important new benefits and protections to tens of millions of

American families almost immediately after it was signed into

law by President Obama. But the largest benefits of the law

will become available to consumers on October 1, 2013, when

health insurance marketplaces open in all 50 states. These

marketplaces will offer individuals, families, and small

businesses an efficient, transparent one-stop shop to compare

health insurance policies, receive financial assistance, and

sign up for high-quality, affordable, and secure insurance

coverage.

This fact sheet summarizes new data on the significant

benefits of the health care reform law in Rep. Hurt's

district. It also provides the first picture of the impacts

of the law in districts redrawn or newly created following

the 2010 Census. As a result of the law:

5,900 young adults in the district now have health

insurance through their parents' plan.

More than 11,400 seniors in the district received

prescription drug discounts worth $15.6 million, an average

discount of $590 per person in 2011, $720 in 2012, and $800

thus far in 2013.

165,000 seniors in the district are now eligible for

Medicare preventive services without paying any co-pays,

coinsurance, or deductible.

201,000 individuals in the district--including 37,000

children and 87,000 women--now have health insurance that

covers preventive services without any co-pays, coinsurance,

or deductible.

188,000 individuals in the district are saving money due to

ACA provisions that prevent insurance companies from spending

more than 20% of their premiums on profits and administrative

overhead. Because of these protections, over 57,300 consumers

in the district received approximately $4.6 million in

insurance company rebates in 2011 and 2012--an average rebate

of $115 per family in 2011 and $88 per family in 2012.

Up to 37,000 children in the district with preexisting

health conditions can no longer be denied coverage by health

insurers.

235,000 individuals in the district now have insurance that

cannot place lifetime limits on their coverage and will not

face annual limits on coverage starting in 2014.

Up to 91,000 individuals in the district who lack health

insurance will have access to quality, affordable coverage

without fear of discrimination or higher rates because of a

preexisting health condition. In addition, the 51,000

individuals who currently purchase private health insurance

on the individual or small group market will have access to

more secure, higher quality coverage and many will be

eligible for financial assistance.

I now yield 5 minutes to the minority whip, the gentleman from Maryland (Mr. Hoyer).

I yield the gentleman an additional 30 seconds.

Mr. Speaker, I yield myself 30 seconds to report on the Seventh Congressional District of Virginia, where the promises have been kept:

4,500 young adults have health insurance on their parents' plan;

10,000 seniors have received help with their drug costs;

112,000 seniors are now eligible for preventive care at no cost;

288,000 people in the Seventh District now have insurance that does not have lifetime limits.

The promises have been kept in the Seventh District.

Benefits of the Health Care Reform Law in the 7th Congressional

District of Virginia

committees on energy and commerce, ways and means, and education and

the workforce, democratic staff report, july 2013

The landmark Affordable Care Act (ACA) began delivering

important new benefits and protections to tens of millions of

American families almost immediately after it was signed into

law by President Obama. But the largest benefits of the law

will become available to consumers on October 1, 2013, when

health insurance marketplaces open in all 50 states. These

marketplaces will offer individuals, families, and small

businesses an efficient, transparent one-stop shop to compare

health insurance policies, receive financial assistance, and

sign up for high-quality, affordable, and secure insurance

coverage.

This fact sheet summarizes new data on the significant

benefits of the health care reform law in Rep. Cantor's

district. It also provides the first picture of the impacts

of the law in districts redrawn or newly created following

the 2010 Census. As a result of the law:

4,500 young adults in the district now have health

insurance through their parents' plan.

More than 10,000 seniors in the district received

prescription drug discounts worth $13.6 million, an average

discount of $580 per person in 2011, $730 in 2012, and $800

thus far in 2013.

112,000 seniors in the district are now eligible for

Medicare preventive services without paying any co-pays,

coinsurance, or deductible.

236,000 individuals in the district--including 56,000

children and 95,000 women--now have health insurance that

covers preventive services without any co-pays, coinsurance,

or deductible.

222,000 individuals in the district are saving money due to

ACA provisions that prevent insurance companies from spending

more than 20% of their premiums on profits and administrative

overhead. Because of these protections, over 67,300 consumers

in the district received approximately $5.4 million in

insurance company rebates in 2011 and 2012--an average rebate

of $115 per family in 2011 and $88 per family in 2012.

Up to 43,000 children in the district with preexisting

health conditions can no longer be denied coverage by health

insurers.

288,000 individuals in the district now have insurance that

cannot place lifetime limits on their coverage and will not

face annual limits on coverage starting in 2014.

Up to 74,000 individuals in the district who lack health

insurance will have access to quality, affordable coverage

without fear of discrimination or higher rates because of a

preexisting health condition. In addition, the 42,000

individuals who currently purchase private health insurance

on the individual or small group market will have access to

more secure, higher quality coverage and many will be

eligible for financial assistance.

Mr. Speaker, I now yield 3 minutes to the gentleman from California (Mr. Becerra).

Mr. Speaker, I yield myself 30 seconds so that I can inform the body of the effect on the Fifth Congressional District of the State of Washington:

7,000 adults, young adults, are on their parents' plan;

5,600 seniors have had benefits around their drug costs;

89,000 who have lacked health insurance now have it.

All of this is because of the Affordable Care Act.

Benefits of the Health Care Reform Law in the 5th Congressional

District of Washington

Committees on Energy and Commerce, Ways and Means, and Education and

the Workforce, Democratic Staff Report, July 2013

The landmark Affordable Care Act (ACA) began delivering

important new benefits and protections to tens of millions of

American families almost immediately after it was signed into

law by President Obama. But the largest benefits of the law

will become available to consumers on October 1, 2013, when

health insurance marketplaces open in all 50 states. These

marketplaces will offer individuals, families, and small

businesses an efficient, transparent one-stop shop to compare

health insurance policies, receive financial assistance, and

sign up for high-quality, affordable, and secure insurance

coverage.

This fact sheet summarizes new data on the significant

benefits of the health care reform law in Rep. McMorris

Rodgers's district. It also provides the first picture of the

impacts of the law in districts redrawn or newly created

following the 2010 Census. As a result of the law:

7,900 young adults in the district now have health

insurance through their parents' plan.

More than 5,600 seniors in the district received

prescription drug discounts worth $7.5 million, an average

discount of $620 per person in 2011, $660 in 2012, and $1,070

thus far in 2013.

113,000 seniors in the district are now eligible for

Medicare preventive services without paying any co-pays,

coinsurance, or deductible.

180,000 individuals in the district--including 36,000

children and 75,000 women--now have health insurance that

covers preventive services without any co-pays, coinsurance,

or deductible.

167,000 individuals in the district are saving money due to

ACA provisions that prevent insurance companies from spending

more than 20% of their premiums on profits and administrative

overhead. Because of these protections, over 700 consumers in

the district received approximately $100,000 in insurance

company rebates in 2012 and 2011--an average rebate of $512

per family in 2012 and $185 per family in 2011.

Up to 36,000 children in the district with preexisting

health conditions can no longer be denied coverage by health

insurers.

203,000 individuals in the district now have insurance that

cannot place lifetime limits on their coverage and will not

face annual limits on coverage starting in 2014.

89,000 individuals in the district who lack health

insurance will have access to quality, affordable coverage

without fear of discrimination or higher rates because of a

preexisting health condition. In addition, the 45,000

individuals who currently purchase private health insurance

on the individual or small group market will have access to

more

secure, higher quality coverage and many will be eligible for

financial assistance.

Mr. Speaker, I now yield 2 minutes to the gentleman from Texas (Mr. Gene Green).

Mr. Speaker, I would like to enter into the Record a report on the effects of the Affordable Care Act on the Tenth District of Michigan.

Benefits of the Health Care Reform Law in the 10th Congressional

District of Michigan

Committees on Energy and Commerce, Ways and Means, and Education and

the Workforce, Democratic Staff Report, July 2013

The landmark Affordable Care Act (ACA) began delivering

important new benefits and protections to tens of millions of

American families almost immediately after it was signed into

law by President Obama. But the largest benefits of the law

will become available to consumers on October 1, 2013, when

health insurance marketplaces open in all 50 states. These

marketplaces will offer individuals, families, and small

businesses an efficient, transparent, one-stop shop to

compare health insurance policies, receive financial

assistance, and sign up for high-quality, affordable, and

secure insurance coverage.

This fact sheet summarizes new data on the significant

benefits of the health care reform law in Rep. Miller's

district. It also provides the first picture of the impacts

of the law in districts redrawn or newly created following

the 2010 Census. As a result of the law:

4,900 young adults in the district now have health

insurance through their parents' plan.

More than 8,900 seniors in the district received

prescription drug discounts worth $11.8 million, an average

discount of $610 per person in 2011, $780 in 2012, and $630

thus far in 2013.

130,000 seniors in the district are now eligible for

Medicare preventive services without paying any co-pays,

coinsurance, or deductible.

210,000 individuals in the district--including 47,000

children and 86,000 women--now have health insurance that

covers preventive services without any co-pays, coinsurance,

or deductible.

177,000 individuals in the district are saving money due to

ACA provisions that prevent insurance companies from spending

more than 20% of their premiums on profits and administrative

overhead. Because of these protections, over 17,100 consumers

in the district received approximately $2.5 million in

insurance company rebates in 2012 and 2011--an average rebate

of $138 per family in 2012 and $214 per family in 2011.

Up to 41,000 children in the district with preexisting

health conditions can no longer be denied coverage by health

insurers.

243,000 individuals in the district now have insurance that

cannot place lifetime limits on their overage and will not

face annual limits on coverage starting in 2014.

Up to 73,000 individuals in the district who lack health

insurance will have access to quality, affordable coverage

without fear of discrimination or higher rates because of a

preexisting health condition: In addition, the 39,000

individuals who currently purchase private health insurance

on the individual or small group market will have access to

more secure, higher quality coverage and many will be

eligible for financial assistance.

Mr. Speaker, I now yield 2 minutes to the gentlewoman from Illinois (Ms. Schakowsky).

Mr. Speaker, I yield 3 minutes to the gentleman who helped write this bill 4 years ago and is here today to defend it, the gentleman from California (Mr. Miller).

(Mr. GEORGE MILLER of California asked and was given permission to revise and extend his remarks.)

I reserve the balance of my time.

I yield myself 30 seconds.

There are 8,300 young adults who are still getting insurance on their parents' plans; more than 8,500 seniors are receiving prescription drug discounts; 86,000 seniors are now receiving preventative care without having to pay for it under the Medicare program; 195,000 now have health insurance that covers preventative care with no co-pays and insurance; and on and on and on it goes.

I enter into the Record the health care reform law as it affects the 11th Congressional District of Georgia.

Benefits of the Health Care Reform Law in the 11th Congressional

District of Georgia

committees on energy and commerce, ways and means, and education and

the workforce, democratic staff report, july 2013

The landmark Affordable Care Act (ACA) began delivering

important new benefits and protections to tens of millions of

American families almost immediately after it was signed into

law by President Obama. But the largest benefits of the law

will become available to consumers on October 1, 2013, when

health insurance marketplaces open in all 50 states. These

marketplaces will offer individuals, families, and small

businesses an efficient, transparent one-stop shop to compare

health insurance policies, receive financial assistance, and

sign up for high-quality, affordable, and secure insurance

coverage.

This fact sheet summarizes new data on the significant

benefits of the health care reform law in Rep. Gingrey's

district. It also provides the first picture of the impacts

of the law in districts redrawn or newly created following

the 2010 Census. As a result of the law:

8,300 young adults in the district now have health

insurance through their parents' plan.

More than 8,800 seniors in the district received

prescription drug discounts worth $12.6 million, an average

discount of $620 per person in 2011, $760 in 2012, and $900

thus far in 2013.

86,000 seniors in the district are now eligible for

Medicare preventive services without paying any co-pays,

coinsurance, or deductible.

195,000 individuals in the district--including 47,000

children and 78,000 women--now have health insurance that

covers preventive services without any co-pays, coinsurance,

or deductible.

169,000 individuals in the district are saving money due to

ACA provisions that prevent insurance companies from spending

more than 20% of their premiums on profits and administrative

overhead. Because of these protections, over 19,900 consumers

in the district received approximately $2.8 million in

insurance company rebates in 2012 and 2011--an average rebate

of $82 per family in 2012 and $134 per family in 2011.

Up to 43,000 children in the district with preexisting

health conditions can no longer be denied coverage by health

insurers.

248,000 individuals in the district now have insurance that

cannot place lifetime limits on their coverage and will not

face annual limits on coverage starting in 2014.

Up to 129,000 individuals in the district who lack health

insurance will have access to quality, affordable coverage

without fear of discrimination or higher rates because of a

preexisting health condition. In addition, the 45,000

individuals who currently purchase private health insurance

on the individual or small group market will have access to

more secure, higher quality coverage and many will be

eligible for financial assistance.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I enter into the Record the effect of the Affordable Care Act on the Sixth Congressional District of Tennessee.

Benefits of the Health Care Reform Law in the 6th Congressional

District of Tennessee

committees on energy and commerce, ways and means, and education and

the workforce, democratic staff report, July 2013

The landmark Affordable Care Act (ACA) began delivering

important new benefits and protections to tens of millions of

American families almost immediately after it was signed into

law by President Obama. But the largest benefits of the law

will become available to consumers on October 1, 2013, when

health insurance marketplaces open in all 50 states. These

marketplaces will offer individuals, families, and small

businesses an efficient, transparent one-stop shop to compare

health insurance policies, receive financial assistance, and

sign up for high-quality, affordable, and secure insurance

coverage.

This fact sheet summarizes new data on the significant

benefits of the health care reform law in Rep. Black's

district. It also provides the first picture of the impacts

of the law in districts redrawn or newly created following

the 2010 Census. As a result of the law:

5,600 young adults in the district now have health

insurance through their parents' plan.

More than 9,800 seniors in the district received

prescription drug discounts worth $12.7 million, an average

discount of $590 per person in 2011, $640 in 2012, and $690

thus far in 2013.

134,000 seniors in the district are now eligible for

Medicare preventive services without paying any co-pays,

coinsurance, or deductible.

184,000 individuals in the district--including 40,000

children and 74,000 women--now have health insurance that

covers preventive services without any co-pays, coinsurance,

or deductible.

188,000 individuals in the district are saving money due to

ACA provisions that prevent insurance companies from spending

more than 20% of their premiums on profits and administrative

overhead. Because of these protections, over 26,900 consumers

in the district received approximately $3.9 million in

insurance company rebates in 2012 and 2011--an average rebate

of $69 per family in 2012 and $201 per family in 2011.

Up to 40,000 children in the district with preexisting

health conditions can no longer be denied coverage by health

insurers.

217,000 individuals in the district now have insurance that

cannot place lifetime limits on their coverage and will not

face annual limits on coverage starting in 2014.

Up to 101,000 individuals in the district who lack health

insurance will have access to quality, affordable coverage

without fear of discrimination or higher rates because of a

preexisting health condition. In addition, the 37,000

individuals who currently purchase private health insurance

on the individual or small group market will have access to

more secure, higher quality coverage and many will be

eligible for financial assistance.

I now yield 1\1/2\ minutes to the gentlelady from Texas (Ms. Jackson Lee).

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I inquire as to whether the gentleman from Georgia is prepared to close.

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

I have in my hand here a letter signed by 30 economists from Harvard, Yale, MIT, Stanford, Rice, the University of Chicago, and everybody else, all of whom say we need a mandate. If this mandate were taken out of the law, the Affordable Care Act would be dead. What they say is that the individual mandate does not specify what care people receive; it simply requires people to pay a reasonable amount for any care that they may ultimately receive.

No less a conservative than Mitt Romney, the Republican nominee for President, noted when signing the Massachusetts equivalent of the individual mandate:

Some of my Libertarian friends balk at what looks like an

individual mandate. But remember, someone has to pay for the

health care that must, by law, be provided: either the

individual pays or the taxpayers pay.

Everyone in this body spends $1,000 a year beyond their own health care costs paying for the uninsured in this country. People walk into the emergency room and they get taken care of because the hospital cannot refuse them and the doctor cannot refuse them, and so they're taken care of and then it's passed on to you and me.

The individual mandate says everybody should pay according to their ability.

Going on, Mr. Romney said:

A free ride on the government is not libertarianism.

Everywhere they've tried this without subsidies and mandates, it has failed. They say in the five States that have tried comprehensive insurance market reform without an individual mandate, healthy people choose to stay out of insurance, sick people took it up, and the premiums go up. That's exactly what the CBO says.

So what you are saying, by repealing the individual mandate, is you want to drive up the costs on the people who now have insurance. That's a very strange political position to be taking.

I must say, I listened to all these people who don't like the individual mandate and all this stuff. If you spend 2 years ranting about the Affordable Care Act and you run a campaign and spend hundreds of millions of dollars and rant against the Affordable Care Act, it's not surprising that people may be a little confused.

When I was in medical school in 1963, the American Medical Association spent 3 or 4 years ranting against Medicare; and when the people went out to enroll people for Medicare, they got the door slammed in their face. Old people said, I'm not going to have that kind of government health care in my house. Well, let me tell you something. If you tried to take Medicare out now, you would find you have taken on a really ugly junkyard dog. You're not going to take out Medicare in this country now.

You can confuse people for a while, but as they see and as I reported on everybody's district, it is already affecting kids who didn't have insurance because of a preexisting condition; it's affecting kids who didn't have insurance from their job and are now on their parents' insurance; it took away lifetime limits on care; it took away all the things that people worry about when they want health care security. They now have it, and you're saying let's take the individual mandate out and have the whole house come down, because that's what these economists have said.

I enter this letter into the Record, and I yield back the balance of my time.

Why We Need the Individual Mandate

The Patient Protection and Affordable Care Act (ACA)

requires people to buy health insurance when they can afford

to do so. This ``individual mandate'' is essential to address

two features of current health insurance markets: the fact

that millions of people cannot afford health insurance

coverage, and the fact that insurance companies frequently

charge high or unaffordable premiums to people who need

insurance most--those suffering from costly illness or

injury.

This mandate is one of three pillars that together support

ACA's private market approach. The first pillar is insurance

market reform--ending the ability of insurance companies to

discriminate against sick or injured people with high medical

costs. Subsidies to help Americans of modest means gain

access to affordable health coverage provide the second

pillar. The individual mandate provides the third pillar. It

requires people to obtain insurance so long as that coverage

is affordable. The mandate expresses a basic obligation of

citizenship as well as an economic reality. Without the

mandate, some people will choose to gamble or to free-ride,

undermining the fairness and financial stability of the

health insurance system.

Few of the uninsured could personally finance medical

treatment for a serious illness or injury. Moreover, this

country embraces the fundamental principal that everyone

should have to minimally decent medical treatment when

needed, without regard to ability to pay. Federal legislation

and the custom and practice of health care providers embody

this principle. A healthy individual's decision to forego

affordable insurance coverage thus imposes real costs on

others, while raising premiums on many people with serious

medical needs who require the most help.

The individual mandate does not specify what care people

receive. It simply requires people to pay a reasonable amount

for any care they may ultimately receive. No less a

conservative than Mitt Romney noted, when signing

Massachusetts' equivalent of the individual mandate: ``Some

of my libertarian friends balk at what looks like an

individual mandate. But remember, someone has to pay for the

health care that must, by law, be provided: Either the

individual pays or the taxpayers pay. A free ride on the

government is not libertarian.''

The ACA's individual mandate is based on Massachusetts's

successful 2006 reforms. That landmark effort covered about

two-thirds of the formerly uninsured, while reducing premiums

for individual purchasers by about 50% relative to national

trends--with strong public support.

In contrast, insurance reform without subsidies and

mandates has consistently failed. In the five states that

have tried comprehensive insurance market reform without an

individual mandate, healthy people chose to stay out of

insurance, sick people took it up, and premiums increased.

Only broad participation in insurance markets can end the

cycle of insecure coverage and high costs.

The Obama Administration's recent decision to delay ACA's

requirement that large- and medium-sized employers sponsor

coverage for their employees or pay a penalty is independent

of the individual mandate. The employer assessment is

designed to bolster the ACA's financing and to ensure equity

between large firms who do and do not provide insurance. This

assessment will have only a very small impact on employers,

since 97% of firms with more than 50 employees already offer

insurance. The individual mandate stands in stark contrast,

as nearly one in five non-elderly Americans is currently

uninsured.

Delaying the employer assessment has almost no effect on

the implementation of the ACA. The only important effect will

be to raise one fewer year of revenue from this

component of the law. In contrast, delaying the individual

mandate would cut at the core of the vision of private-market

based insurance market reform.

Requests to delay the individual mandate are really

requests to gut the Affordable Care Act. Millions of

Americans face immediate health care needs and financial

challenges addressed by health reform. They cannot wait.

Signers

Henry Aaron, Senior Fellow and Bruce and Virginia

MacLaury Chair in Economic Studies, Brookings

Institution; Kenneth J. Arrow, Professor Emeritus,

Stanford University; Susan Athey, Professor of

Economics, Stanford Graduate School of Business; Linda

J. Blumberg, Senior Fellow, Health Policy Center, The

Urban Institute; Len Burman, Director, Tax Policy

Center, Urban Institute; Amitabh Chandra, Professor of

Public Policy, Harvard University; Philip J. Cook, ITT/

Terry Sanford Professor of Public Policy, Duke

University; David Cutler, Otto Eckstein Professor of

Applied Economics, Harvard University; Claudia Goldin,

Henry Lee Professor of Economics, Harvard University;

Jonathan Gruber, Professor of Economics, Massachusetts

Institute of Technology; Vivian Ho, Baker Institute

Chair in Health Economics, Rice University; John

Holahan, Institute Fellow, Urban Institute; Jill

Horwitz, Professor of Law, University of California at

Los Angeles; Genevieve M. Kenney Co-Director and Senior

Fellow Health Policy Center, Urban Institute, Frank

Levy, Lecturer, Department of Health Care Policy,

Harvard Medical School; Peter H. Lindert, Distinguished

Research Professor of Economics, University of

California at Davis; Eric S. Maskin, Adams University

Professor, Harvard University; Alan C. Monheit, Ph.D.,

Professor of Health Economics, Rutgers University

School of Public Health; Richard Murname, Juliana W.

and William Foss Thompson Professor of Education and

Society, Harvard Graduate School of Education; Joseph

Newhouse, John D. MacArthur Professor of Health Policy

and Management, Harvard Medical School; Harold Pollack,

Helen Ross Professor of Social Service Administration,

University of Chicago; Matthew Rabin, Edward G. and

Nancy S. Jordan Professor of Economics, University of

California at Berkeley; James B. Rebitzer, Professor of

Management, Economics, and Public Policy and Everett V.

Lord Distinguished Faculty Scholar, Boston University

School of Management; Meredith Rosenthal, Professor of

Health Economics and Policy, Harvard School of Public

Health; Christopher Ruhm, Professor of Public Policy

and Economics, University of Virginia; Jonathan

Skinner, James O. Freedman Presidential Professor of

Economics, Professor of Community and Family Medicine,

Dartmouth College; Katherine Swartz, Professor, Harvard

School of Public Health; Paul N. Van de Water, Senior

Fellow, Center on Budget and Policy Priorities; Kenneth

E. Warner, Avedis Donabedian Distinguished University

Professor of Public Health, Dept. of Health Management

& Policy, University of Michigan School of Public

Health; Stephen Zuckerman, Co-Director and Senior

Fellow, Heath Policy Center, The Urban Instituted;

Mr. Speaker, on that I demand the yeas and nays.

Mr. Speaker, I rise today to introduce the Accuracy in Medicare Physician Payment Act of 2013. This bill will give the Centers for Medicare and Medicaid Services (CMS) important tools and resources to continue alleviating our dire shortage of primary care physicians. As Congress tries to come together around the challenges of how to repeal and replace the broken Sustainable Growth Rate formula, I want to make sure that we do not neglect the Medicare physician fee schedule and the impact it has on our physician workforce.

It is no mystery that relatively depressed salaries are driving new doctors away from primary-care fields like family medicine and pediatrics and into more lucrative specialties and subspecialties like radiology and orthopedic surgery. I don't begrudge anyone for making that choice; when I graduated from medical school 50 years ago I could not have fathomed being loaded down with six figures of medical school debt. And to be sure, we need talented specialists. But we have a stubbornly small proportion of primary care doctors--just over 30 percent, when most experts agree that 50 percent is the ``sweet spot'' in terms of maximizing quality and minimizing cost.

I am proud that Congress gave primary care a shot in the arm in the Affordable Care Act, under which Medicaid pays higher Medicare rates for primary care through 2015, and Medicare makes quarterly incentive payments to primary care physicians through 2017. The ACA also expanded the National Health Service Corps, which eases the steep cost of medical education for doctors and allied health practitioners willing to practice in an underserved area after graduation. These are meaningful steps, but to make more enduring progress in this area, I believe that Medicare must repair structural inaccuracies in the Medicare physician fee schedule that have eroded the value of primary care. Simply put, Medicare contributes to this imbalance by underpaying for the critical yet undervalued job of managing complex patients with multiple chronic conditions and keeping them out of the emergency room and hospital.

A major obstacle to reform is Medicare's continued reliance on a committee of mostly specialist physicians to help set payment rates for the 7,400 services on the Medicare physician fee schedule. Since 1991, Medicare has outsourced its work of appraising the value of these services to the AMA's Relative Value Scale Update Committee (RUC)--a 31-member panel of physicians who decide how services should be valued and updated. Only a handful of the 31 committee members perform primary care. The RUC meets in private and provides limited release of the minutes of its proceedings. In formulating its recommendations, the RUC also relies heavily on anecdotal and self-serving surveys, rather than forensic evidence.

CMS has begun to update misvalued codes in the fee schedule, but it needs more muscle and resources to do the job. This bill would establish a panel of independent experts within CMS that would identify the distortions in the fee schedule and develop evidence to justify more accurate updates. Medicare could continue to request work from the RUC, but the expert panel would both initiate such requests and review RUC's work product. The panel members would not have a direct interest in the fee schedule, and would include beneficiary representatives. It would be subject to the Federal Advisory Committee Act, which requires advisory bodies to hold open meetings and publish the minutes of such meetings.

In addition to payment accuracy and fairness, this is also about reining in a conflict of interest. After looking at this for several years I believe that we give the physician specialty societies, through the RUC, an undue influence on their own payments. In no other area-- whether it be hospitals, skilled nursing facilities, or any other setting--does Medicare ask the providers to play such an active role in setting their own reimbursement amounts. Medicare certainly needs clinical expertise to evaluate the resources necessary to perform physician services but should not look to an outside organization whose members directly benefit from the fee schedule to apportion some $70 billion in annual public spending, without some checks and balances. No matter how well-intentioned, such a system contains structural biases that need safeguards to prevent abuse.

Medicare is not only one of America's most important social insurance programs and a bulwark of the middle class, it also establishes economic incentives that ripple through all of health care and contribute to our shortage of primary care physicians. As we continue to pursue a permanent doc fix, let's also talk about how we will use Medicare to incentivize the appropriate mix of physicians in the workforce to serve beneficiaries and the public health.

Madam Chair, I am sad to see that, after failing to get the votes to pass a farm bill last year, Republicans are back at it again, this time with even bigger cuts to SNAP. In this year's House farm bill, H.R. 1947, the Republicans are proposing a cut of $20.5 billion dollars to the program, five times more than what the Senate approved last week.

The proposed cuts to SNAP in H.R. 1947 mean nearly 2 million low- income people will lose eligibility for food assistance and 200,000 children will lose access to the free or reduce school lunch program. Of those who still receive benefits, 1.7 million will see a reduction of an average of $90 per month. Additionally, 280,000 people will directly or indirectly lose their jobs.

The Republicans are, once again, using a manufactured fiscal crisis to cut aid for the most vulnerable Americans. But let's be honest, the true purpose of cutting food aid to those in need is not to ``balance our budget,'' especially because the evidence shows that these cuts will actually hurt our economy. Implementing short-term cuts that create long-term problems will only slow job growth and increase our deficit.

Fiscal responsibility is about meeting our obligations. It is about investing in the American people. It is about growing our opportunities and supporting our economy when the free market won't.

What we are deciding right now is whether we ought to eliminate jobs and assistance for people in need over the next 10 years or help them increase their productivity until they no longer need us. We are deciding if we are a nation that takes care of its people or leaves them to fend for themselves when times are tough. It shouldn't be a hard decision to make. Vote against the proposed cuts to SNAP in the House Farm bill.

Mr. Speaker, I rise today to reintroduce the Duwamish Tribal Recognition Act affecting the indigenous people of metropolitan Seattle. Nearly 150 years after the Duwamish Tribe signed the Point Elliott Treaty in 1855, they are still seeking federal recognition, which was granted to them in 2001 but denied under dubious circumstances eight months later.

On March 22, 2013, U.S. District Judge John Coughenour vacated the September 2001 denial of the Duwamish Tribe's recognition by George W. Bush administration officials in the Interior Department. As Judge Coughenour stated, ``plaintiffs should not be left to wonder why one administration thought their petition should be considered under both sets of rules, but a second did not.'' I agree.

This issue of Duwamish recognition has been pending for so long that the Interior Department's rules for federal recognition of tribes have changed from the original regulations set in 1978 to those that were revised in 1994. There is significant evidence to support Duwamish recognition that is not in current record, which was filed 20 years ago.

I have asked the new Secretary of the Interior Sally Jewell to look into this matter. Meanwhile, this bill would provide federal recognition to the Duwamish Tribe.

I urge my colleagues to support this measure. Thank you.

Mr. Speaker, I rise today to re-introduce the True Cost of Coal Act, a bill that would address the negative impacts of coal transportation on both the local communities and American taxpayers.

Currently, plans are underway to develop coal export facilities in the Pacific Northwest that would exponentially increase the volume of coal being exported out of the region. The three proposed terminals-- Gateway Pacific and Millennium Bulk Terminals in Washington and Morrow Pacific Project in Oregon--would export over 100 million tons of additional coal per year. For a sense of scale, the U.S. coal exports in their entirety totaled 125 million tons in 2012. The new terminals would nearly double that total.

With these new plans come considerable burdens on the rail communities through which the coal would be transported, including environmental and public health considerations, worsening traffic congestion, and noise pollution, among others. However, without legislation like this, the taxpayers will be largely responsible for these costs. After all, coal and train companies are currently under no obligation to pay for mitigating the effects of transporting coal. That's why I am once again introducing legislation to hold them accountable for the costs that their activities incur.

According to the U.S. Energy Information Agency (EIA), the average price per ton of coal exports in 2012 was $118 per ton; the EIA also estimates that in 2012 the cost to ship coal from the Powder River Basin to the Pacific Northwest was only about $20 per ton.

The True Cost of Coal Act of 2013 will impose a 10 dollar per ton excise tax on all extracted coal. This money will be used to mitigate the negative impacts of coal transportation and ensure the true cost of coal is paid for by the responsible parties--not the local communities and American taxpayers. The money is allocated to the affected States, who are in the best position to determine how best to use their funds. The Act also requires that trains transporting coal be covered or treated to ensure that no coal dust is released during transportation.

I have long been a champion of preserving the clean air and water that Washingtonians cherish. I am pleased to be continuing that work and hope my colleagues will join me in supporting this legislation.

Mr. Speaker, right now, all across this country, American families are looking at an average of $15,000 of credit card debt. The average student loan debt is double that. I'm sure each and every one of those families would like the option of saying, ``no thanks, I'm not interested in paying those bills.'' But they can't.

Americans don't get to skip out on repaying their debt without drastic consequences. Why should Congress get to play by separate rules?

When we talk about the debt ceiling, we're not talking about our spending habits or curbing our expenses; we're talking about fulfilling the promises we've already made. We can't debate our budget after we've received what we bought.

The last time we played chicken with the debt ceiling, we deeply hurt our credit standing in the world. And we don't have to guess why we were downgraded: Standard and Poors directly told us that is was on account of the political circus the debate had become.

Luckily for us, America still enjoys one of the highest credit ratings in the world, but with continued turmoil and unnecessary, partisan wars over this, how long do we expect our lenders to hang on?

And why are we having this same, foolish fight? In the name of a so- called ``debt crisis'' that even Speaker Boehner and Budget Chair Ryan admitted isn't a crisis.

We're threatening vital services and sacrificing the security of our good national credit for a bogus threat, and all the while the real threat to our economy, anemic growth and persistent unemployment, still looms.

Americans are tired of phony disasters. They want real solutions. They are tired of political theatre. They want jobs. They are tired of a Congress that can't do anything but bicker and point fingers. They want their representatives to get to work.

To default on our debts would be more than irresponsible, it would send us down a path to

becoming a banana republic. We are not a nation of deadbeats and delinquents. We pay our bills or we suffer dire consequences.

If we in Congress won't do our job, we shouldn't get paid.

Mr. Speaker, I submit an important op-ed concerning our nation in war. Sebastian Junger is an author and documentarian whose work includes the book War and the film Restrepo, which tells the story of a platon of U.S. soldiers in the Korengal Valley in Afghanistan.

For the past year, I have been working with Mr. Junger and Karl Marlantes, a decorated Marine veteran and accomplished author, to start a national conversation about what it means for our country to go to war. Mr. Junger's op-ed perfectly encapsulates the reason that Congressman Walter Jones and I introduced the bipartisan bill, H.R. 1492, ``To establish the Commission on America and its Veterans.''

Forty-three years ago, I left the military with a heart and head full of other people's stories from the Vietnam War. As a psychiatrist, I felt the anguish and confusion that my patients experienced as they came home to a country that did not understand, or take responsibility for America's battles abroad. As Mr. Junger points out, ``The country approved, financed and justified war--and sent the soldiers to fight it.''

This is a nation in a perpetual state of war. Vaguely defined missions under banner of combating extremism have desensitized the American people. News comes as someone else's problem in someone else's country. Few understand how it can corrode our nation's fabric. Yet war is not something we can afford to forget.

Consider the 1991 Gulf War, a conflict that lasted for less than two months. Today, we continue to spend billions per year paying compensation, pension, and disability benefits to more than 200,000 veterans. 40,000 of those veterans struggle from long-term disabilities, some of which we are still only beginning to understand as part of ``Gulf War syndrome.''

Mr. Junger's reflections on war extend beyond the economic or political dimensions, though both are important for our national security. It's about our moral duty to own the wars our soldiers fight.S0634

Veterans Need To Share the Moral Burden of War

(By Sebastian Junger)

[From the Washington Post, May 24, 2013]

Recently I was a guest on a national television show, and

the host expressed some indignation when I said that soldiers

in Afghanistan don't much discuss the war

they're fighting. The soldiers are mostly in their teens, I

pointed out. Why would we expect them to evaluate U.S.

foreign policy?

The host had made the classic error of thinking that war

belongs to the soldiers who fight it. That is a standard of

accountability not applied to, say, oil-rig workers or

police. The environment is collapsing and anti-crime measures

can be deeply flawed, but we don't expect people in those

fields to discuss national policy on their lunch breaks.

Soldiers, though, are a special case. Perhaps war is so

obscene that even the people who supported it don't want to

hear the details or acknowledge their role. Soldiers face

myriad challenges when they return home, but one of the most

destructive is the sense that their country doesn't quite

realize that it--and not just the soldiers--went to war. The

country approved, financed and justified war--and sent the

soldiers to fight it. This is important because it returns

the moral burden of war to its rightful place: with the

entire nation. If a soldier inadvertently kills a civilian in

Baghdad, we all helped kill that civilian. If a soldier loses

his arm in Afghanistan, we all lost something.

The growing cultural gap between American society and our

military is dangerous and unhealthy. The sense that war

belongs exclusively to the soldiers and generals may be one

of the most destructive expressions of this gap. Both sides

are to blame. I know many soldiers who don't want to be

called heroes--a grotesquely misused word--or told that they

did their duty; some don't want to be thanked. Soldiers know

all too well how much killing--mostly of civilians--goes on

in war. Congratulations make them feel that people back home

have no idea what happens when a human body encounters the

machinery of war.

I am no pacifist. I'm glad the police in my home town of

New York carry guns, and every war I have ever covered as a

journalist has been ended by armed Western intervention. I

approved of all of it, including our entry into Afghanistan.

(In 2001, U.S. forces effectively ended a civil war that had

killed as many as 400,000 Afghans during the previous decade

and forced the exodus of millions more. The situation there

today is the lowest level of civilian suffering in

Afghanistan in 30 years.) But the obscenity of war is not

diminished when that conflict is righteous or necessary or

noble. And when soldiers come home spiritually polluted by

the killing that they committed, or even just witnessed, many

hope that their country will share the moral responsibility

of such a grave event.

Their country doesn't. Liberals often say that it's not

their problem because they opposed the war. Conservatives

tend to call soldiers ``heroes'' and pat them on the back.

Neither response is honest or helpful. Neither addresses the

epidemic of post-traumatic stress disorder afflicting our

veterans. Rates of suicide, alcoholism, fatal car accidents

and incarceration are far higher for veterans than for most

of the civilian population. One study predicted that in the

next decade 400,000 to 500,000 veterans will have criminal

cases in the courts. Our collective avoidance of this problem

is unjust and hypocritical. It is also going to be very

costly.

Civilians tend to do things that make them, not the

veterans, feel better. Yellow ribbons and parades do little

to help with the emotional aftermath of combat. War has been

part of human culture for tens of thousands of years, and

most tribal societies were engaged in some form of warfare

when encountered by Western explorers. It might be productive

to study how some societies reintegrated their young fighters

after the intimate carnage of Stone Age combat. It is

striking, in fact, how rarely combat trauma is mentioned in

ethnographic studies of cultures.

Typically, warriors were welcomed home by their entire

community and underwent rituals to spiritually cleanse them

of the effect of killing. Otherwise, they were considered too

polluted to be around women and children. Often there was a

celebration in which the fighters described the battle in

great, bloody detail. Every man knew he was fighting for his

community, and every person in the community knew that their

lives depended on these young men. These gatherings must have

been enormously cathartic for both the fighters and the

people they were defending. A question like the one recently

posed to me wouldn't begin to make sense in a culture such as

the Yanomami of Brazil and Venezuela or the Comanche.

Our enormously complex society can't just start performing

tribal rituals designed to diminish combat trauma, but there

may be things we can do. The therapeutic power of

storytelling, for example, could give combat veterans an

emotional outlet and allow civilians to demonstrate their

personal involvement. On Memorial Day or Veterans Day, in

addition to traditional parades, communities could make their

city or town hall available for vets to tell their stories.

Each could get, say, 10 minutes to tell his or her experience

at war.

Attendance could not be mandatory, but on that day ``I

support the troops'' would mean spending hours listening to

our vets. We would hear a lot of anger and pain. We would

also hear a lot of pride. Some of what would be said would

make you uncomfortable, whether you are liberal or

conservative, military or nonmilitary, young or old. But

there is no point in having a conversation about war that is

not completely honest.

Let them speak. They deserve it. In addition to getting our

veterans back, we might get our nation back as well.