Floor Statements

Madam Speaker, I wanted to take this opportunity to honor the great work of Barry Luboviski. After serving for fifteen years as Secretary-Treasurer of the Building and Construction Trades Council of Alameda Council, Barry is stepping down for some much deserved rest and relaxation.

Barry's commitment to the working men and women of this country began when he joined the Iron Workers Union, Local 378 as an Apprentice in 1965. He became an active participant in union activities, and in 1981, he started teaching evening classes for the Iron Workers Apprenticeship Program.

In 1979, Barry was elected as a Delegate to the Building and Construction Trades Council of Alameda County, AFL-CIO, and he was later appointed to Chair the Political Action Committee of the Building Trades Council. There, he helped organize voter registration drives and membership education.

Soon he was elected to serve as an Executive Boardmember of the Iron Workers Union, Local 378 and continued to help lead his local union until being hired in 1991 by the California State Building and Construction Trades Council, AFL-CIO as an Organizer. After four years of effective service, he was elected in 1995 to the position of Secretary-Treasurer of the Building and Construction Trades Council of Alameda County, AFL-CIO.

It has been an honor to work with Barry these many decades, strengthening worker protections and forging a more just and equitable California. Let the record show that the working people of California are better off because of Barry's leadership.

Mr. Speaker, I rise today in recognition of the St. Mary's basketball team of Moraga and their trailblazing NCAA tournament run. They have inspired basketball fans across this country with their teamwork and determination.

The St. Mary Gaels earned a berth in the tournament with a remarkable season capped with a west coast championship and their victory in the first round NCAA tournament. They tossed aside a half century of tournament setbacks and showed that they are a force to be reckoned with. In the second round, St. Mary's went head to head with the number two seed, Villanova, a perennial basketball powerhouse, and with a gutsy performance they prevailed.

And I will add that many of these young men that are on these teams will be able to stay on their parents' health insurance as a result of the action and the President's signature on the health care bill, up to the age of 26.

In the meantime, we look forward to Saturday's game and another victory by these outstanding players.

I doubt that we will be here for a full 60 minutes, but there are some things that we really do need to discuss, particularly following the previous speaker as he talked about the American Recovery Act and the things that have actually been done to really move the American economy forward.

One of those things was the stimulus bill, the American Recovery Act, that is now just about 13 months old. In that American Recovery Act, there was a major element dealing with green technology, green jobs, which I think most Americans and most economists feel is where the future lies. We know we have an energy security issue. We know we import far more than we could possibly afford in foreign oil. We have to become energy independent. And in the American Recovery Act, there was an enormous advancement in research and in subsidies to encourage green technologies.

I would like now, with the permission of the Speaker, to enter into a colloquy with my colleague, and I would like to yield to our colleague from Maryland, (Mr. Sarbanes).

If I might just interrupt you for a moment, Mr. Sarbanes, this is actually happening, and your piece of legislation will expand what is taking place. I know that in California, the City of Berkeley put this program into effect about 2 years ago, but it was a real struggle for them to find a way in which they could sell the bonds. Now, your proposal would, as I understand it, provide a tax exempt municipal bond opportunity so investors would be willing to do this.

This is a very, very powerful thing in Berkeley, and a couple of other cities in California that have initiated this, they are putting solar panels on the roof that are good for 20, 30 years, and, as you say, you sell the home, the payment mechanism, the repayment mechanism then goes to the next buyer. This is really an excellent concept, and you are moving this thing one step forward.

Where is your bill right now? What is happening with it?

Well, let me give you an example that I know in my own district, the East Bay, Contra Costa County and Alameda County. The community colleges are putting together educational programs for the men and women that will start their own businesses to do that retrofitting, to do the insulation, the caulking of the doors and windows. We need a million caulkers out there in order for our homes to be energy efficient, but they have to be trained. The installation of the solar panels, that's a kind of employment opportunity for small businesses to get up and get going, often in conjunction with the manufacturers.

So what you are doing with your legislation is to provide a foundation, a financial foundation, that the small businesses or that the homeowner would then take advantage of the loan and the small businesses would then have the opportunity to engage with the homeowner to do the work.

This is the kind of thinking that we are finding on the Democratic side of the aisle, how to leverage. And your piece of legislation, together with the educational programs that have also passed this House in the last several months, all come together to create jobs.

Your comment about Chesapeake Bay brought back memories. In the mid-1990s, I was Deputy Secretary at the Department of the Interior during the Clinton period, and during that time there was a major effort under way, What are we going to do about Chesapeake Bay? How do we save the bay because of the enormous decline in crab fishing and the shellfish and other very, very important environment, but also economic assets that were in Chesapeake Bay.

Now, you and your colleagues are carrying this thing a step forward using the programs to generate new ways of keeping water that flows in the bay, or cleaning water that flows into the bay. I want one of those centers of excellence in my district.

I represent the delta of California, the Sacramento-San Joaquin Delta, and this is an enormous environmental problem. The fish are declining, fisheries, invasive species. We know clearly that the contamination from various sources is a problem. So maybe we can get one of those centers of excellence in California also.

But what's at stake here is the knowledge necessary to solve our environmental problems and, simultaneously, from that knowledge will come the new technologies and the new jobs which will be useful, not only in Chesapeake Bay or the Sacramento-San Joaquin Delta, but we can then export that.

Thank you. I was just thinking about the legislation that passed before I arrived here, the effort, it was called climate change legislation, but it was far more than that. It really dealt with national security. And that legislation is now over in the Senate and perhaps will become--will pass the Senate or we will have a conference committee to put it together.

But from that climate change legislation, it's really national security. And the discussion we were just having here on the national security side and about climate and about jobs, all of those things come together. If we are able to reduce our reliance on foreign oil, if we are able to transition to low-carbon fuel sources, whether they are solar or wind or wave or whatever, we will also enhance our national security.

I would like to take just a few seconds, actually a few minutes, talking about some of the other things that were in the American Recovery Act of last year.

There was a $400 per person tax credit for men and women that were working so that they would have more purchasing power. That's $800 for a family of two. There was the tax credit for colleges. And in the legislation that we just passed 2 days ago, along with the health care reform, there was an enormous expansion of the Pell Grants so that kids can go to college, so that they could get the education that they needed; for community colleges, an expansion for community college Pell Grants.

Again, changing the way in which we look at employment, employment is more than just a job. It's preparing for the next job. And in that corrections bill, sometimes called a reconciliation bill, that was accompanied with the health reform, we had the program to expand the support for men and women that wanted to go back to school and men and women that were in school. We also expanded, over time, the ability for those men and women to pay those loans back. Presently, it's 15 percent maximum for each year of employment when they are employed. We are going to reduce that to 10 percent so that they can spend their time acquiring a home, a wife, kids, a husband, and be able to continue to pay back the loans over a longer period of time. Very, very important, but unnoticed in the health care reform. But much noticed in the health care reform was the employment for the employers, the small business tax credit for those employers that continue to provide insurance for their employees.

I remember a phone call that I got from a radio station. A fellow phoned up and said, Well, how does this piece of legislation, the health care reform, help me? My wife and I are a small business. We have two employees: my wife, myself. What's it do for me?

And I was able to respond that when this bill becomes law--and it is now the law of the land. The President signed it yesterday. When it becomes law, it will do this for you. Thirty-five percent of the money you spent purchasing that insurance for you and your wife will be a tax credit. You will be able to deduct that from your taxes, literally reducing the cost of the health insurance by 35 percent. As you grow up to 100 employees in your business, you will continue to receive that tax credit for every insurance policy you buy for your employees.

In 2014, that tax credit goes to 50 percent, an incredible reduction in the cost of health insurance for small businesses all across America. And it goes into effect now, January 1, 2010, now that that bill has been signed. It is a very, very significant reduction in the cost of health insurance, allowing men, women who are in business, who have a small business, maybe it's a gardening business or a home care health business, to be able to continue to provide that insurance.

On another scale, I received a press release today from a group in the San Francisco Bay Area that points out that they are in strong support of what the President does.

This is 1,500 biotechnology businesses in the Bay Area that have banded together in an organization called Bay Bio. They said, this is a tremendous assistance to us.

Small businesses, which I just talked about the tax credit available to them, but also there are billions of dollars in this bill for research on pharmaceuticals, biological pharmaceuticals, enormous impetus for those businesses to produce the biological pharmaceuticals, the next generation of pharmaceuticals, drugs to help us in our health care when we become sick, all kinds of things, from diabetes to cancer treatment and everything in between.

The pharmaceutical industry in the biological area has an enormous push. They have 12 years to recoup their investment. It's given to them in the health care reform.

So when our colleagues over here on the Republican side say there's nothing in this, well, wait a minute. I've got 1,200 businesses in the biological communities in the Bay Area alone saying, this is a great inducement for us to produce new biologicals that will help people with their health care.

Also, in the fuel business, the same thing applies in the enormous effort that's under way to do biofuels. The incentives are built into, not just the health care bill, but also into the previous American Recovery Act to push along a whole new industry that will create an enormous number of jobs throughout the Nation.

So the health care bill is far more than just health insurance. It's also an inducement for businesses to invest and to create new businesses and new pharmaceuticals to keep us healthy and to repair our bodies when we become ill.

I want to talk just now a few moments about another aspect of the health care reform. We heard, before I took the microphone here, about the health care reform bill not being paid for. That's simply not true. The health reform is actually funded; it's funded in a variety of ways. But one of the most important ways is the considerable reduction in the cost of health care.

I had a gentleman come into my office earlier yesterday talking about, oh, my, in the health care reform bill there's an opportunity for us to engage in keeping people healthy. A major part of that health care reform is about keeping people healthy. It's wellness. It's prevention of medical illnesses. And he was looking at this and he said, here's an opportunity for me and my colleagues to expand our business. And he talked about a company that's coming to California that will take an idea about wellness. And this is specifically for the senior citizens, and it is specifically in the legislation. Wellness for Medicare.

He said, the bill allows us to change the way in which the Medicare services are provided. Instead of just fee-for-service, we can do capitation, and there's an incentive in there for us to keep people healthy.

The company operates out of Florida. They're now going to come to California. They're doing 50,000 seniors in Florida, proving that they can reduce the cost by 20 percent by keeping people healthy, keeping seniors from having to go to the hospital, having to go to the emergency room. They want to import it to California.

They're going to move it and ramp it up to 500,000 seniors in a wellness program, you know, everything, I suppose, from the food that's being served and the meals that the seniors prepare to, I suppose, exercise and yoga and other kinds of activities, again, emphasizing wellness rather than sickness.

Nobody talks about that from our Republican colleagues, but that's in the bill. And if that 20 percent reduction is available, we're talking about hundreds of billions of dollars over the years ahead. So there are many, many parts to the program.

I want to just conclude with discussing another part of the health care reform, and this is good for businesses, it's good for parents, it's good for children, and this is the insurance reform.

I was the insurance commissioner in California for 8 years, 1991-1995 and 2003-2007. And during my tenure, I

know the terrible things that the insurance companies were doing to their customers.

First of all, a person would buy a health insurance policy, they'd pay into it year after year after year, then they would get sick, probably a significant issue. Maybe they get diabetes or cancer, some other, maybe a heart illness; and it would get expensive and the insurance companies would go back, they would actually pay a bonus to their people to review those claims, go back to the original application that may have been made years before, and find an error, perhaps it was something as simple as having acne when they were teenagers, or an asthma attack at the age of three. They would then use that to cancel the policy, leaving the person high and dry, in deep financial trouble.

The health care reform law signed by the President yesterday says, no more, no more rescissions. Those days are over. The health insurance industry in this year will be prohibited from rescinding policies and dumping people after they become sick.

Now, for those that are already sick and don't have a health insurance policy, the legislation provides for people that are 50 to 65, who have a preexisting condition, and this is the population that is literally unemployable because they're sick. They have some preexisting illness. And nobody, no employer up there would want to pick them up because they know that if they were to hire that person, the cost of health care for all of their employees would go up. So those people are left out.

But under the new law, there is a solution for them. It's a high-risk pool that starts immediately. It goes into place in the next 90 days. And those people, and there are millions that fall into this category, they will be able to get insurance. They will not have to face bankruptcy. They will be able to be employable.

This is an enormously important thing, and I've seen this in my days as insurance commissioner. We didn't have the ability to deal with this except in a very narrow way in California, with what we call the high- risk medical insurance program. But now, with the Federal Government assistance, people will be able to get insurance.

The same thing for young children. Infants, the day they're born, they come up with some serious illness. Let's say it's a heart issue. That child cannot be insured under the old program. But now that the President has used his left hand to sign the legislation, we now know that those children, from the day they are born until they are 26, will be able to get insurance and their parents will be able to insure not only themselves, but also their child.

The day I was sworn in, 2 days after I was sworn in, I stood here on the floor and I spoke about the health care reform that I voted on on November 6. And I spoke about a dear friend of mine whose child was born with a kidney ailment. He and his wife struggled for years to find the money to pay for the insurance. Their insurance was canceled. They had it when the child was born, but their insurance was canceled by the insurance company because the kid had a very serious kidney problem.

With the new law in place, the hardship that that family has gone through for now 20 years is over. The insurance policy that they had the day the child was born cannot be canceled. And so for that family and millions of families like that, the insurance reform provides an immediate benefit.

And for all of the men and women out there and the mothers and fathers that have a kid that is approaching the age of 23, and about to be thrown off the families insurance policy, know this: with the bill that was signed yesterday, and in 6 months, that child, young adult will be able to stay on the family's health insurance policy until the age of 26.

And I cannot even begin to count the number of calls that I've had, and emails I've had saying, oh, thank God. I know, as a parent, that my child will continue to have health insurance at least until they're 26. And then at that time, 2014, the rest of the program kicks into place.

Final point is this, and that is, preexisting conditions for all of us. At the end of this year, those preexisting conditions will no longer be the case.

Final point, and then I'm going to close, long before my hour is over. And my final point is this: this legislation is fully paid for. Part of the pay, part of the money to pay for this is an obscene bonus that the insurance companies were granted 6 years ago, and that is known as the Medicare Advantage bonus. The average cost of providing Medicare insurance was calculated, and the insurance companies were given a 15 percent bonus to do what they should have been able to do without any additional money. We're going to end that bonus. We're going to take that money and plow it back into the Medicare program.

And the Medicare program, by law, no benefit reductions. That's what the law says. I hear a lot of other talk out there and a lot of scare tactics, but the fact is that the Medicare Advantage program will continue, but the bonus that was given to the insurance companies, an unnecessary multi-billion dollar bonus, is going to end and the money will be put back into the basic Medicare program so that the financial solvency of the Medicare program will be extended 9 years.

Now, that's important to everybody that is approaching Medicare and is in Medicare today. So people are going to continue to want to live to get into Medicare. That's what's out ahead for the Medicare recipients.

And I talked about the wellness program earlier.

Final point is this: on the financial side of the health care reform, the deficit of the United States Government in the years 2010 to 2020 will be reduced by $132 billion. That's in the first 10 years. So that is a reduction in the deficit. It comes about by reducing the amount of money that will have to be spent by the government on health care as a result of all of these reforms that are in the bill, some of which I've talked about tonight.

In the next 10 years, 2020 until 2030, the deficit will be reduced by $1.3 trillion, an enormous amount of money. So whatever the discussion you've heard out there in public, and all of the mischaracterizations of this bill that have been going on for months and, indeed, almost a year now, the facts are the deficit will be reduced, the program is fully funded, and it provides very, very necessary benefits immediately to small businesses with a tax credit to help pay for their insurance; for individuals, ending the insurance discrimination; and for seniors, a major new effort to keep you healthy so that you can enjoy life more, and the cost of the Medicare programs will be reduced.

With that, Madam Speaker, I yield back and thank people for the opportunity to explain a very, very important part of the new America that we will have in the years ahead.

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

The motion was agreed to; accordingly (at 6 o'clock and 14 minutes p.m.), the House adjourned until tomorrow, Thursday, March 25, 2010, at 10 a.m.

Mr. Speaker, today, Democrats in the House of Representatives voted to form a more perfect union. By expanding health care coverage to 32 million Americans, we are continuing the proud American tradition of promoting justice, ensuring the general welfare, and broadening access to life, liberty, and the pursuit of happiness.

Republican leaders in the 1930s said Social Security would lead to ``the lash of the dictator'' and in the 1960s said Medicare would lead to grandparents telling stories of ``what it once was like in America when men were free.'' Yet with time, Social Security and Medicare became incredibly popular services cherished by most Americans. A broader consensus emerged, and a more perfect union was formed. I am confident that the same will soon be said about today's health care reform bill.

When the people get past the slogans, the fear tactics, and the gross distortions, what they find in this legislation is a series of ideas widely popular and aligned with the best of American values. This is the second largest deficit reduction bill in 20 years. In my district, 9,000 people with preexisting conditions will finally be able to have access to insurance. 96,000 seniors will see their Medicare improved with significant prescription drug discounts and free preventative screenings. 106,000 families will receive tax credits to make their coverage more affordable. 52,000 young adults will be able to attain coverage through their parents' insurance. 13,100 small business owners will receive significant tax rebates. 1,400 families will avoid bankruptcy. A similar story exists in every corner of this great country.

In the fight to extend health coverage to every man, woman, and child, this bill is an incredibly important beginning. But it's still just a beginning. ``A more perfect union'' implies that the progress of the American experience is never complete. Each subsequent generation is expected to pick up the torch and continue on our long road toward positive change. Today the House of Representatives bestowed upon this great nation the most historic health reform since Medicare. I am proud to have voted ``yes'' for health care reform. I won't live to see a perfect union, but it is a tremendous honor to see a more perfect union formed before my eyes.

I grew up in the forties and fifties, and I remember the men and women that came back from the war, some gravely wounded, carrying those wounds the rest of their lives, and some having survived but survived behind enemy lines. This resolution honors those that fought in so many different ways, and particularly those behind enemy lines and were unable to really be recognized for the extraordinary contributions they made to the war effort. And it's perfectly appropriate.

What is not appropriate is what our colleagues on the Republican side have done with this debate and with the previous debate. We're honoring our soldiers. We're honoring our men and women that have fought. We will soon be debating the health care issue, and in the appropriate time, we should be taking that up. But to somehow demean, to somehow demean the courage, the resolution, and the extraordinary sacrifice made by these people is just plain wrong.

I would ask our colleagues to set it aside. In a few moments we will pick up the health care debate, and then I would be delighted to join you in that debate. But now let's focus on those who have served this country in time of war.

A moment ago, I asked, Madam Speaker, if we could focus on the issue before us, which is certainly a meritorious issue. But apparently our colleagues from the Republican Party want to debate health care so, okay, guys, let's debate health care. A moment ago, the speaker from wherever you were from spoke about somehow limiting the MRIs. You are absolutely right. The legislation does limit MRIs that are ordered by a doctor that owns the MRI machine. There is blatant fraud going on, and there's blatant overuse and payments by the taxpayers to the Medicare and Medicaid program as a result of physician-owned practices, pharmaceuticals, pharmacies, as well as the MRIs and hospitals, and this legislation does limit it. You're quite right. We must limit that kind of overuse.

I've been at this a long time. I was the chairman of the health committee in California in the 1980s when we limited it. I was the insurance commissioner. I've seen these pernicious practices over and over.

Announcement by the Speaker Pro Tempore

I have the great privilege and honor of representing Travis Air Force Base and the more than 20,000 active service men and women on that base. Their mission is one of supplying the necessary equipment and armaments and food and other materials to men and women that are in the front zone of fighting. They also provide extraordinary support for humanitarian efforts, most recently those in Guam. And they may very well be heading to Chile on missions there. So I honor them and call our attention to their work.

Again, I remain really saddened that my colleagues on the Republican side have used this time, and instead of honoring the work of our active duty men and women in the Armed Forces, they are using it to debate a bill of which there is plenty of time.

Most recently the discussion about the availability. The Senate bill has been available to all of us since Christmas Eve. Three months to read the Senate bill. And that is a large portion of those documents that you have there on your table. The House bill has been available since November 6. So those two bills have been available to

be read all that time. There are about 156 or 160 pages of corrections to the Senate bill that are before us. There are explanations, to be sure. And I suppose all of us would like to see the explanations from the committee. That has been available to us also.

This was not done in the dark of night. This has been done over a long period of time. And that big stack of material before you has been available. And perhaps you have not had or taken the time to read it, but if you had, much of the misinformation that has been presented this evening you surely would not have put before this House because it simply is not reflected in the bill. Specifically, the issue of the veterans. The veterans are fully protected in the legislation. TRICARE is fully protected.

By the way, there are about a million and a half veterans out there that will be able to get medical insurance through the various programs that are created by this legislation. They presently are not in the Veterans Administration process for many, many reasons. They will have access to it.

So on the whole, A, we have had time to read these bills; B, the corrections that are in the reconciliation process, which will be voted on along with the Senate bill, have been around for some time, for 72 hours minimum, and in many cases over 3 and 4 months. So read the bill.

Mr. Speaker, I request that we enter into a colloquy with our colleagues from the Democratic side.

Earlier today, I had the opportunity to exit the Chamber and go out to the veranda overlooking the east lawn of the Capitol, and there were a couple thousand folks out there protesting this legislation. And in their chanting they were saying: Kill Obama bill. I suspect they're referring to the health care bill, not to the President. And I was thinking about what does it mean to kill the bill. What is the effect of killing this legislation and letting time go on with the current situation in the United States?

Next to me here is what is happening in the United States today. Forty-five thousand Americans die each year because they are uninsured. They lack health insurance. Forty-five thousand. That's about twice the number that are found in any of the arenas today as March Madness continues. Forty-five thousand. But that's not the end of it.

So we start with 45,000 Americans. What about the rest of the Americans? We rank 19th among the industrialized nations of the world in the health of our citizenry. Our children die earlier. All Americans die earlier than the other 18 industrialized countries. The rate of increase in the health care market for the individual market in California and in many other States was nearly a hundred percent within a 1-year period. Some 50 percent last year and a similar amount this year, an unaffordable rate increase.

In California, the average number of claims denied by the insurance companies was 21 percent, and the range was from 39 to 17 percent. You talk about a death panel. Here's where the real death panel is. It is in the insurance companies themselves, denying benefits, denying claims, denying treatment for illnesses and for afflictions that cause death. This has to end. On Sunday, we will bring this kind of unacceptable situation to an end, because on Sunday we will pass affordable, available health care for America.

I'd like now to call upon my colleague from New York (Mr. Tonko).

Mr. Tonko, thank you very much. You raised the issue of the insurance companies and how they act in the marketplace. I was insurance commissioner in California 1991 to 1995 and again 2003 to 2007, and I can tell you horror stories about what the insurance companies do, and I will tell this to the insurance companies.

When the President signs the bills tomorrow, the era of the insurance companies discriminating against Americans because they have a preexisting condition, it's over, folks. It's over. No longer will the insurance companies be able to say to you, No, I will not give you insurance because you had acne when you were a child or because you may have taken some asthma medicine early in your life or you have any of the four pages of preexisting conditions. The insurance companies will end their discrimination because the law will make it illegal for them to do so.

And the issue of bankruptcy. The policies that will be available through the networks will provide, by law, that there is no longer lifetime maximum payments so that the bankruptcies that you specifically spoke to will no longer be existing.

The maximum lifetime limitations that the insurance companies have used for years will be over, and shortly the annual limitations will also be over, and the benefit packages will be full because there will be national standards for benefits. The kind of cheap, useless policies that plague Americans when they can't afford a standard policy, they seek something that ultimately will not provide them with the care they need. So that is one of the major reforms in this. This is an insurance reform of extraordinary importance.

Let me now yield to our colleague, the gentlewoman from Texas.

It's interesting to observe the effect of that. This is Blue Cross of California. Two years ago, their profit was almost $300 million. The effect of those rate increases--the first rate increase, not the second one, but the first one which was around 50 percent--was to increase their profits to $2.3 billion, and now they want to add another about 30 percent average on top of that. So what will their profits be after all of that? It's shameful.

What the legislation does is to reign in the excessive increases in the insurance companies' premiums. It does that by requiring that a higher percentage of their total premiums go to medical services. Now if you want, go check Wall Street, go on Charles Schwab, check the Wall Street thing. If you want to make an investment, they will say, Invest in the companies whose medical loss ratio is low and trending downward. That simply means that they're paying less for medical care and more for profit. We're going to turn that on its head. We're going to force the insurance companies to pay for medical services and less for profits.

And we should also remember in that competition model, we will be creating exchanges in which insurance companies will be there, they'll have to compete, and they'll compete on a standard policy.

Let me now call on our colleague from Ohio (Mr. Ryan).

Thank you. We've discussed here the issue of bankruptcy, and I got a call from my daughter this afternoon. She said, Dad, thank God I'm a nurse and I have insurance. Matteo's arm, which was badly broken and required surgery, will probably be a $70,000 event. She said, If I didn't have insurance, we would have lost our house. That's the situation that's faced by every family. Thankfully this was not the situation that my daughter and grandson faced, but it is faced by tens of thousands, if not hundreds of thousands of Americans. And it's right here. The insurance companies dominate these markets. Lifetime benefits. She probably has already run through her lifetime benefit. That child is probably going to be uninsurable because he has a preexisting condition, a badly broken arm. Those days are over.

I would like now to yield to my colleague from California, a magnificent Representative with whom I have worked with for more than 34 years. She was a California State senator and took over my position when I left the chairmanship at the California State Senate Health and Welfare Committee, Representative Watson.

Representative Watson, thank you so very much. I am appalled and personally offended and I think all owe an apology to those Representatives who were demeaned, who were spat upon, who were cursed, and who were called the ugliest of names. It is totally unacceptable.

I yield to Mr. Tonko.

Representative Tonko and Representative Ryan, both of you have spoken to the American economy in Youngstown and the effect that 30 years of recession has had on that town. One of the fundamental problems in the American economy is the extraordinary growth in the health care sector.

This little chart here really explains why many parts of the American economy are not competitive. This little red line here is the growth in the percentage of the wealth of this Nation, the GDP, that is now in health care. We heard earlier one-sixth. Well, it is 16, almost 17, percent of the total wealth of the Nation that is tied up in health care. We are growing faster in this sector than any other sector of the American economy.

Our competitors around the world are down in the 10-11 percent range. President Clinton, explaining this in a speech in California that I had the pleasure of attending, indicated that this gap here between the 16- 17 percent of the American economy that goes into health care versus the 10-11 percent that our competitors are spending is like giving a $80 billion a year gift to our competitors around the world.

And so when the industries in the manufacturing of America go out, the car industry, other heavy industries go out to compete, they are saddled with this extraordinary additional cost because of the growth in the health care sector.

The fact is the more inflation in the health care sector, the fewer people are insured. This is why we are seeing small businesses shedding health care, and why we see the extraordinary run up of the uninsured as the economy goes down. It is not just losing your job; it is the small businesses being unable to continue to purchase health care.

One of the most important things that is going to happen in this legislation for small businesses is a specific tax reduction, a credit, of up to 35 percent in year one and then rising to 50 percent for every employee that they provide health care for. So it is an enormous benefit and incentive to provide the insurance, to maintain the insurance, and that is what is going to go on in the years ahead. So all of the talk about this bill being bad for business, it is simply not true. This is what is bad for business. There is serious cost containment in this legislation through a variety of ways.

I yield to Mr. Ryan.

Thank you, Mr. Ryan.

One of the things that we have heard all day is about Medicare cuts, somehow the Medicare system is going to be cut. I would like to get into that a little bit because this bill specifically helps Medicare. We have talked about the doughnut hole. This is the prescription drug benefit which, by the way, my Republican colleagues, which I guess are not here at the moment, when the prescription drug benefit part D was put in place, the Republicans controlled this House with the President and they never bothered to pay, never bothered to pay for that benefit. And so you want to know where the deficit came from? It came from there and it came from the two wars that the Bush administration started and didn't bother to pay for either, so we ran up the deficit.

But here is the thing for seniors, to go back on my point here, is that the program provides very specific benefits to seniors. It provides $250 this year, a $250 additional benefit for seniors to pay for drugs. Those that fall into the doughnut hole, that doughnut hole begins to close this year, and in 5 years it is totally gone.

In addition to that, it is explicit in this legislation that the Medicare benefits will not be reduced.

I yield to Mr. Tonko.

I might add that between now and 2018, some of us are going to be around here, and we are going to give the Federal Government the power to negotiate drug prices. We are not there today. It is one of the things that is missing in this legislation that I wish was in it. But it will happen. No longer will they be free from competition.

I yield to the gentlewoman from California.

Thank you, Representative Watson, for making it so personal to your district. The same savings are to be found in every one of our districts. We have different percentages of seniors in our districts, but the fact is that there are very, very significant savings in this.

I want to take up one other issue that has been raised over and over again by the Republicans in the most disingenuous and I think rather dishonest way. And that is the reduction of some $500 billion over the 10 years in Medicare expenses. Now, where do those reductions come from? They would let us believe that those savings are from the reduction of benefits. That is not true. There is explicit language here that benefits will not be reduced. I will tell you where the money is going to come from. It is going to come out of the pockets of the insurance companies that have ripped the Federal Government off to a fare-thee-well for the last 6 years, ever since the George W. Bush administration created the Medicare Advantage program, which they did, incidentally, in reconciliation.

It is abominable that this government has had to pay a bonus to the insurance companies to provide Medicare Advantage programs when in fact they said they could do it cheaper than the fee-for-service Medicare program. Sixteen percent bonus over and above the

average cost of Medicare for seniors is given to the insurance company for no good reason. Those days, that bonus, that unintended and unnecessary profit is going to be over.

Secondly, there is fraud and abuse in the Medicare system not from the seniors who are striving to get their benefits, but rather from purveyors, doctors, medical device people, and out and out fraudsters. We are going to be hiring. Some of those people that were talked about earlier from the IRS and the CMS, the Medicare office, those folks are going to be out there chasing after criminals that are ripping the Medicare system off to a fare-thee-well. That is where the reductions are coming from, from those two places.

I yield to the gentleman from New York.

I really want to home in on what you are saying, but let me wrap up the senior part here if I might. Let's be very, very clear about the Medicare program. First of all, the AARP, American Association of Retired Persons, say that this legislation is going to lower costs and improve care for seniors.

Secondly, it is in the bill, no benefit cuts. It is in the bill. Two hundred fifty dollars in the pocket of seniors who have got their medical prescriptions in the doughnut hole to help pay for that. And that is this year. Not 10 years from now, this year. Medicare part D doughnut hole is beginning to close. It is going to take time because it is expensive and it does take a lot of money, but it is going to close by 2018. And there will be significant drug discounts for seniors who use generic drugs this year, saving seniors, just as you said, millions of dollars out of their pocket. And that is not in the CBO score.

I yield to the gentleman from New York.

It's not on my list. Do you want to add to my list another benefit?

So we add to the bill that the Medicare trust fund is made solvent for something either 7 to 9 years.

Nine years. Okay. We added that one here. Medicare Advantage, we talked about that. The bonus to the insurance companies is gone. And that money is not sent off to some other program, that savings stays in the Medicare program. Reduce senior premiums, improve access, expanded benefits, extend Medicare's fiscal--I did have it here. I just didn't read it. Here is the Medicare fiscal health. And finally, the issues you were talking about, prevention, organizing the care so we have continuity of care.

I yield to the gentleman from Ohio.

We've got about 6 minutes left, so let's each take about 2 minutes.

Mr. Tonko.

I appreciate your passion on this no less than Mr. Ryan's.

Thank you very much, Representative Watson. It has been a joy to work with you these 35 years and work with you this evening.

This is a historic moment. This is something you and I and many others have worked to try to provide health insurance for all Americans. Some 32 million Americans will receive health insurance as a result of this. There will be the incredible tax cuts for working men and women. For small businesses, they, too, will receive significant tax credits so that they can provide insurance for their employees. And there will be programs to promote wellness. There will be programs to create better information technology so that we don't have to waste money every time you present yourself with a different doctor. And you have the freedom to choose your own health insurance company, and your health insurance company no longer has their freedom to deny you benefits and coverage. There are serious insurance reforms in this.

Finally, I just want to add, I have seen this sign so many times around the Capitol, so many times, and it says, ``We the people.'' Those are the first three words of the preamble of the United States Constitution. And it goes on to say, ``We the people of the United States, in order to form a more perfect union.'' That is what we're doing here. A more perfect union within our families so that we don't have to fear bankruptcy and the loss of health because we have no health insurance; a more perfect union in our communities so that everyone in our communities has health care and access to health insurance.

It establishes justice.

Thank you so very much.

Thank you very much, Mr. Speaker.

I would like to enter into a colloquy with my colleague from New Jersey who earlier spoke of the truth, what is actually in the bill. One of the things that is not in the bill but is actually a fact is that in America about 45,000 people a year die because they lack health insurance. They don't have the opportunity to see a doctor on a regular basis, and they wind up in the emergency room very, very sick.

The truth is that under this legislation, 32 million Americans will be able to get health insurance, and poor people will see an expansion of the Medicaid program so that they get in under that program. That is in the legislation, is it not?

Mr. Andrews, I believe that every one of the 433 Members, or 432 who are still here in the House, know the exact same experience. All of us, and virtually every family in America has that experience where they have found one of their friends or one of their family without health insurance and facing the reality of bankruptcy, the reality of losing their life because they were unable to get the care that they need.

I will never forget a visit that I made to a carpenter who had worked his entire life and had come down with lung cancer. He was about 63 at the time. I visited him in his home, a trailer home out in the back part of the district. His wife was there. She had emphysema. And she was about 62. He told me, ``I have to hang on. I have to hang on. I cannot die because she will be left without insurance. And then she too will die.'' That doesn't have to happen in America.

What we are doing today, as we prepare for this historic vote on Sunday, is to lay out before the American people why this is so important. It is important to the individual, it is important to that family, that person lying in their sick bed trying to hang on for another year-and-a-half so that the wife would qualify for Medicare.

Now, that's the reality of life. But the reality of this bill is it deals with that problem. Because if that gentleman lived next week, after the President signs this bill, he would have the confidence of knowing that there is a special program created specifically for he and his wife. The gentlemen and the women between the age of 55 and 65 who have lost their job, who are unemployed without insurance, there is a special high risk program specifically for them so that if he is to die, he can die with the confidence of knowing that his wife will have health insurance.

Now, that is really important because so many Americans and so many in my district have lost their job, they fall into that age group. That is a tough place to get a job because of the discrimination that the insurance industry now puts upon people in that age group.

As you said at the outset, I was the insurance commissioner in California for 8 years, '91 to '95 and 2003 to 2007. I saw this problem over and over again, where corporations push aside, literally discriminate against people because they may be more expensive. A particular problem in the smaller companies, where the risk cannot be spread out. This piece of legislation provides an opportunity for those risks to be adjusted, to be smoothed out among all of the people that are insured, all of the companies, thereby reducing the incentive for companies to discriminate in their hiring, discriminate against people that have a sickness or who may become sick because they happen to be 50, 55 years of age.

There is another thing in this legislation that is extremely important to every single qualified, to use your term earlier, qualified American, or qualified person in this country.

Let's talk about that.

Let me get that straight. Qualified means that you are a citizen or you are legally in the country with the appropriate immigration papers.

Green card or H-1B visa, et cetera. So if you are illegal, you don't qualify.

Now, back to the point I was making is that insurance companies discriminate against individuals. We all, if we think about it, know the examples here. I am going to give one. Twenty-three-year- old girl had been insured by the same insurance company for 23 years, from her conception, birth, all the way through teenage years, all the way to 23. She becomes 23. She is no longer on her parents' insurance. She goes back to the very same company and says, I'd like to carry on insurance.

No. Not available to you.

Why?

Well, you had acne when you were 16.

The fact of the matter is she also happens to be a woman and in those child-bearing years. So the company says, well, you know, you might get pregnant, might get married; might get pregnant and not be married. In any case, you're going to cost us a lot of money, and, therefore, no insurance.

That kind of discrimination is over when the President signs this bill, be it discrimination against people who have a preexisting condition--and who doesn't? Who didn't have acne when they were a kid? Who didn't have asthma? Who didn't have a broken arm? Who in our society does not have a preexisting condition? Very few of us. Under the current situation, the insurance companies are able to pick and choose. Only the healthy or likely to be healthy do they want. Those who might be expensive they push aside.

The message to the insurance industry is this: The President signs this bill, your discrimination is over. No longer will you discriminate against women, young or old, whether they are in their fifties or sixties. You will not discriminate against a person who has a preexisting condition. And you will not be able any longer to cancel a policy when somebody becomes sick.

Now, I have got to tell you, I went after Blue Cross of California and a couple other companies out there with a vengeance because what they did, people had been buying insurance from them for years and years, they get an illness, maybe they have a cancer, and suddenly the company goes back and says, oh, you didn't tell us when you were 3 years old that you had a tonsillectomy and had to take antibiotics. Therefore, we're going to cancel your policy because you didn't tell us. That is finished the day the President signs this bill. So in the insurance field, the era of discrimination on all of these methods is over and the insurance companies will take all comers.

The gentleman could not be more correct. And those are very, very common. Along the same lines, we often consider America to be the country of entrepreneurs. We know the statistics are clear, the evidence is there, the polling has indicated that tens of thousands, perhaps even hundreds of thousands of Americans do not begin their own small businesses because they fear that they will be unable to get insurance. They don't want to leave the big corporate family. I know a specific fact of a fellow that worked at the university and wanted to start his own business. He and his wife wanted to start their own business for 10 years, and yet with small children and she with a preexisting condition, they did not do so. And so that entrepreneurial spirit was stifled by the insurance system we have in America.

Under this legislation they will be able to get insurance, either directly with an insurance company or as soon as in this case the State of California develops its exchange, which is a pooling. You talked about this when you spoke earlier. And we really ought to have a better discussion and a more thorough discussion about the exchanges, which is a method of setting up a mechanism in which standard benefit insurance policies will be available from different companies, the information will be readily available, and the insurance companies will be forced to compete with each other on quality and price and availability. Those exchanges are an extremely important way to create competition and availability of insurance.

I'm relatively new here, and I don't know everything about the health systems here. But when I signed up, I was given an array of options. I could go to Blue Cross-Blue Shield, or I can get Aetna, or Kaiser. It turns out that Federal Government employees, including every Member of Congress, have access to an exchange. And if you happen to be in California and you're a public employee at the State or county, many of the counties and cities, you are already in an exchange called CalPers, California Public Employees Retirement System. Those are exchanges. This is nothing new. What we're doing is making that exchange available to everybody.

Mr. Andrews, you have been here some time, and I know you're very familiar and indeed an expert on the American economy. Let us talk a little bit about the American economy and why this legislation is extremely important to the American economy.

Right now we rank 19th in our health, in how healthy we are. And we're actually ranking below Colombia. The fact of the matter is we also spend nearly 17 percent of our total wealth, our GDP, on health care. Our competitors in Europe, Japan, Korea, spend no more than 11 percent--most of them are 10 percent and below. So you know in your economy, we have an enormous disadvantage.

I remember actually it was President Clinton talking about this, and it's as though we took a check every year for about $800 billion and gave it to our competitors. We're giving that advantage to our competitors because our health care system is so expensive and consumes so much of our economy and leaves us not at the top of the heap, but at the bottom.

What happened, if I recall in the 1990s after he said that, the Balanced Budget Act did pass. You were here. I think you were here at the time.

That is one of the wonderful things about life. You can come back and do it a second time.

In this case we're looking at a situation where in the Clinton balanced budget plan, it led to the longest sustained economic growth in America's history. And we created--I forget the number of jobs----

Twenty-three million jobs were created during that period of time.

Excuse me. Do you remember the statistics for the Bush, George W. Bush years?

I want to take up another subject that you broached earlier in the conversation, and that is of seniors.

The senior population spent the good part of the summer being totally scared, frightened, purposely so, with a pack of incorrect, or shall I just call them lies. Death panels, Medicare is going to be cut, other things were put out there to scare seniors into opposing this. When in fact--and you went through some of this; I want you to drive this home--when in fact, this piece of legislation that we will vote on Sunday strengthens the Medicare program and provides significant benefits and increases.

So, please.

And you cited the specific code sections, and you also cited the fact that this will reduce the deficit of America over the next 10 years by some $300 billion.

And that was the Medicare Part D.

Thank you very much, Mr. Andrews.

Madam Speaker, I'm going to fly home hopefully later this weekend, and it is surely important to me that the FAA continues to do what it must do to keep the air safe. And I want to commend the minority as well as the Chair for this extension.

But beyond the extension, there is another extremely important element in this bill, and that is straightening out the funding for transportation. Mr. Oberstar worked a miracle and actually managed to give California less of more, which took a while for me to understand. But the reality is that by being able to work out a compromise with the Senate, we are going to be able to move the transportation programs forward. It's a great example of what can be done with some good leadership working both sides of the aisle.

I want to commend the bill to all of us and move this thing along so that we can fly home safely when we get the health care bill done and go home and tell our constituents about a good highway transportation program that's been put together.

I thank you very much, Congresswoman Schakowsky, and thank you for that terrific description of the history of Medicare. This has been a Democratic program for more than 43 years now. As Representative Schakowsky just said, I get the same thing: if I can just live long enough to get the Medicare.

And I remember as you were saying that an experience I had. I had visited

a carpenter who had become ill with cancer and he wanted me to stop by and see him. This was maybe 10 years ago. He was bedridden, very, very sick. He was about 60, no longer able to work, and his wife was about the same age. And he said, I have just got to hang on long enough so that my wife can get to Medicare. Otherwise, she will have nothing, and she is a diabetic.

We have got about 45,000 Americans that are dying every year because they don't have health care and because they haven't been able to live long enough to get to Medicare.

Medicare is a program that the Democrats have fought for, have fought very vigorous battles in this Chamber against the Republican Party. You mentioned Newt Gingrich, who was right out front about the Republican goals in the 1990s to destroy Medicare.

Well, we are here to protect Medicare. And in this legislation that will be before us for a vote very, very shortly, there is an explicit understanding written into it that Medicare will be protected, that benefits will not be cut, and that cost savings, wherever they may be found in all of the Medicare system, that those cost savings will be plowed back into the Medicare program.

So where are the cost savings going to come from? How correct you are with your chart when you talked about where the cost savings are: well- care, preventing illnesses, taking care of people in the continuity of care rather than episodic care.

There is also a lot of fraud in Medicare. We know that. We also know that it was the Bush-Cheney budget that reduced the appropriations to fight fraud in Medicare. They basically wiped out the Department of Health Services and the Medicare program's ability to fight fraud, and it blossomed. But in the budget that you passed this last year, now that we have a Democratic President and a Democratic budget, he put money back in to fight Medicare fraud. That will save money. We have seen ``60 Minutes''; we have seen the kind of fraud that is out there.

But what really, really makes me upset is the misinformation that is out there, in many cases the downright lies that you see on television, most of them paid for by the insurance industry that doesn't want to lose their 16 percent additional payment over and above the average cost of Medicare that is given to the insurance companies so that they can have this Advantage program. What do the seniors get for it? Not much.

The insurance companies? You bet they do.

The key point here is that in this legislation there is a specific effort to eliminate the fraud that goes on in the system. The unnecessary payments, the stealing of the Social Security cards, all those kinds of things that are out there, we know we need to deal with that. And we are dealing with it. Even before this piece of legislation, we put money into the budget to deal with that; and then this legislation strengthens that.

And, in addition to that, we now will have better medical record technology which will also assist us in keeping track of what is going on. It is a small piece of a much, much larger piece of legislation that does help seniors in very, very specific ways.

Why should the insurance companies get an unnecessary boost in their profits at the expense of the Medicare program? No reason that I know of. They should be competing and they should be helping seniors, but not get that additional bump. Those savings are also plowed back into the benefits for seniors so that they can have those programs that you talked about, those programs of prevention, of wellness, of being able to stay in their home. All of those things are important.

If I could just take a personal moment for a moment. My mother phoned me; she is 87. She is going to have her 88th birthday. If it is 89, I am in deep trouble back home. But she is going to have her birthday soon.

She phoned about 3 weeks ago and she said, John, why are you cutting the Medicare programs? What are you talking about, Mom? Well, the TV advertisement just said you guys are going to cut the Medicare program. And I am going, No, we are not. But tell me about the ad.

It was an advertisement run by the U.S. Chamber of Commerce in the Sacramento region of California. She saw it and became concerned.

So why are these ads out there that are on their face not truthful? One reason: and that is to upset the seniors and to somehow give the seniors false information about what this legislation does.

I got her straightened away. She is okay. Although when she sees this red tie, the good Mary Jane McSorley is not going to be happy. But, Mom, I have got a green carnation here.

Oh, yes. I have been a truthful son.

Let me just talk to that for a moment. This is astounding.

Well, I was the insurance commissioner in California from 1991 to 1995, and then 2003 to 2007, so I've got 8 years as the insurance commissioner in the biggest State in this Nation, with a lot of seniors. Our seniors haven't grown quite as fast as our friend talked about from Nevada, but in total numbers we are so much bigger. Major, major problem for seniors.

You're looking at the most expensive part of the population, the senior population, and it is absolutely true that the insurance companies do not want to ensure people that are going to get sick. Who's going to get sick? It's the seniors. And that's why Medicare came into place, as was described earlier, because that population has the most difficult time of obtaining insurance, and it happens to be the most expensive part.

We figured out here how to provide it. The Republicans are going to do what? They're going to give you a voucher. So if I'm 54 years old now--let me see if this is correct. I'm 54, and if the Republicans had their way, when I become 65 in 11 years, I don't get Medicare, which provides me with a comprehensive policy that I can take anywhere in this Nation. I can go to Maine and get the policy. I can go to California and get the policy. I don't get that. I get a voucher, and I'm going to go to an insurance company that I know does not want me because they know that at 65 I'm going to be expensive.

This is the Republican program? Thank you, no.

You're suggesting you go back and take your privatized Social Security savings? They're going to do away with Social Security, too.

So they're going to do away with Medicare and Social Security, the two programs that provide security for seniors. The Republican Party has said clearly they want to do away with those. That's not where we are as Democrats. This program, as Representative Schakowsky has said very clearly, strengthens Medicare, extends its life for at least 5 years, some would say 10 years.

We'll just take 5, 9, whatever. It strengthens it and pushes it out so it has the financial strength, reduces the doughnut hole by $500 immediately, and you get----

And if you're a senior of low income and moderate income, some of your prescription drugs are reduced by 50 percent.

This is a good deal, and yet we see the TV ads out there scaring seniors that somehow this is a bad deal for seniors. This program is a very good deal for seniors, wherever they happen to be, and for every other American. We're talking about seniors here, but for every other American they will get access to affordable, good quality health insurance because of this legislation. Those are the facts.

These are the worthless insurance policies that are sold across State lines today. They have a very low lifetime cap. You get a serious illness and you blow through that and you have no more health insurance from that company. Not only that, but now you've got a preexisting condition and you can't get insurance from any company. The legislation changes that.

Thank you for pointing that out.

That, too.

Oh, that's so unfair to the insurance companies, that you would take away their bonus for doing nothing more than you can do in another system.

That current unnecessary bonus that's given to the insurance companies will be brought back and reinvested in the Medicare program so that the Medicare program's solvency will be extended into the future. So we're not taking that money away from the Medicare program; we're taking it away from the insurance companies and bringing it back to the Medicare program.

The senior Advantage program is not a free program for seniors. They're paying for it. They're paying a premium themselves, and the Federal Government is paying an unnecessary premium to the insurance companies to do what doesn't cost any more in the regular system. So it's a great savings. It's something that should be done. And oh, the tears. The wailing and crying by the insurance companies.

Yes, exactly.

It's about 2 percent.

A big piece of what is going to happen in this reform is that there will be a continuing study going on through the Medicare offices and the Department of Health Services to find better ways of treating seniors. You've talked about the home care, which we know is a better way of doing it, the continuity of care. We know that over time, new medical devices are found. New medical services are brought online, and other services that have become obsolete are taken off the benefit list, and new ones are brought on over time. That's the way it is because medical services are constantly evolving and changing--drugs, the kinds of services, the hospital services.

All of those things are evolving over time. So change is constant in this program. And specifically in the legislation is an effort to bring online those

new techniques and technologies that enhance the care of seniors. And, I will also say, for other Americans. So all of us, as a major part of the program, but specifically for seniors. And it would roll on. Proven, clinically proven services, evidence-based services. And these kinds of things save costs. Again, the insurance companies are going to cry. The U.S. Chamber of Commerce is spending over $100 million in this last month or two with advertising designed to kill the reform effort.

Because they are greedy, profit-driven, profit-before- people-oriented companies.

Exactly.

She must have been a teenager at that time.

Madam Speaker, we have several of my colleagues here to join us. We will just continue the discussion that we had before. I think I'll move to the other side so I will have the easel available to me. If Ms. Jan Schakowsky will come join us. Mr. Ellison can carry on. I see Mr. Tonko is now in the Chair.

We've got things we want to talk about here. Let's just continue this discussion that we had a few moments ago. Our friend on the Republican side is either late or has decided it wasn't worth continuing to discuss their position. We were covering the Medicare issues here in some detail over the last hour, and some of that we want to continue and make sure that people understand what's happened in Medicare. We want to also talk about the rest of America, those that are not yet 65 or will not soon be 65. We'll go through those issues.

I want to just start off by laying out what's happening here in Congress. I'm a newbie. I haven't been around all that long, and I'm going, Wow, how's this all work? And as I've watched it, I've listened to what our Republican colleagues talk about, ramming through this legislation. And I'm going, gee, I was the Lieutenant Governor in California until November 5 when I was sworn in here. And as near as I can recall, this debate started 14 months ago.

It was the President standing right there in the Well here giving his State of the Union--it wasn't the State of the Union at the time. It was his first speech to the House. He said, We have got to reform the health care system. And immediately, this House and the Senate took up the issue, debated it. We all listened to that debate. All year long it went on and on and on and on and on and on. And it was my good fortune, following my November 3 election, to come back here, and on November 6, be one of the people that were able to put before Americans from this House, the Democratic version of health care reform. It was Christmas Eve that the Senate finished their work and put that out on a 60 vote-- not a simple majority, but on a 60-vote bill.

So now you've got both Houses having completed their work and doing what has been the tradition of Congress since the very inception of our government--more than 200 years--doing the conference work, putting together the House and the Senate versions and finding the compromise between the two of them. And the mechanism that's going to be used is a majority vote of both Houses--51 in the Senate and 216 I think it is now because some of our Members have retired--to pass an extraordinarily important piece of legislation. So the process is not jammed down anybody's throat. This has been debated more than most bills will ever be debated, and the debate actually goes back to the turn of the 20th century. It's been here for a long time. So we're moving, as we should, in a way of openness.

It was the President who had his health care summit for 7 hours on television. That has never happened before. Discussing all the issues. Republican ideas, many of which are going to be in the final rescission vote that we'll take up this week. So this is not ramming anything through. This is a very deliberative process. It's gone on for a long time.

So I want the public to understand that. I want them to understand that as somebody that watched it from the outside and now somebody that's watching it from the inside, this is an extraordinarily open public debate that's gone on for 14 months this session, and this issue has been around for a long, long time--decades. So here we are. Let me call upon my colleagues. What's that sign behind you, Mr. Ellison?

I'm joined with three individuals that have done that throughout their entire career here. Mr. Holt, I know you're going to have to go off to another meeting shortly, so you wanted to fill us in and carry on part of the conversation we were having early about the Medicare program.

Mr. Holt, you raised a very, very important point, and I want to just follow up. And Ms. Schakowsky also raised this point, and it's the rescission issue.

Now, I was the insurance commissioner in California 2003 to 2007. And during that period of time, we received complaints about rescission, about people that had health insurance, had an illness and suddenly the insurance company canceled them.

And I'll tell you that we took action against the largest insurance companies, Wellpoint Anthem, that Blue Cross program in California, and others on this specific issue. And it is a very, very, real issue. I am so happy to be here in Congress and to vote on a bill that says no more, no how, will you be able, Mr. Insurance, to continue that very pernicious, very, very damaging and grossly unfair practice. Lawsuits have gone on. This bill will put a stop to that practice.

Let me just take one other thing. Mr. Ellison had a chart: 45,000 die for lack of insurance. Yes, but there are other things here. America, because of the way in which we've structured our health insurance programs, we rank 19th among the industrialized nations of the world in preventing illnesses. And in the general health care statistics, we ranked below the country of Colombia on how healthy our population is.

We also know--and this is one that has really upset us as it came to all of our attention--I knew this in California, but now America knows, that over the last 2 years, in California alone, and in most other States, and I think in your State, 94 percent rate increase for individual policies. Ninety-four percent. How in the world can they do that when health care inflation has been less than 10 percent? Well, they do it because they're more interested in their bottom line profits. And I think Mr. Ellison's going to come to that in the next few moments.

In California, a study done by the State government, the six largest health insurance companies in California have denied 21 percent, this is the average, 21 percent of all claims. The range goes from 39 percent down to about 20 percent. So if you take the six largest companies, the number of times that they denied claims--you want to talk about a death panel, then you talk about the insurance companies that deny necessary treatment to keep people alive. That's what they're doing in California. One-fifth.

And, finally, the number of Californians, 24 percent of Californians, without insurance.

Ms. Schakowsky.

Mr. Ellison, what's that thing behind you?

Well, we all know the stories of the insured. We all know the stories in our own districts and our own States about those people that have health insurance, but they blow through the deductible and then they blow through the annual, or they hit the maximum benefit package of that insurance, and then they're on their own. At that point they sell their house, and they often wind up in bankruptcy.

The other part of what's happening is the downturn of the economy. Millions of Americans have lost their jobs. You lose your job, you lose your health care, you have no way of paying for COBRA. Even though this bill and the previous bills that this House has passed and the Senate has passed and become law do provide a subsidy to help people stay on COBRA, if you're unemployed, you have a heck of a time trying to make that payment.

So people lose their jobs. They lose their insurance. They lose their health. They go bankrupt. And 45,000 Americans die because they've lost their insurance, or they never had it to begin with. So this is the story of America.

The legislation that will be before Congress in the days ahead specifically deal with that problem. They deal with it, as Ms. Schakowsky has said, by saying that no longer will you lose your policy when you get sick with medical underwriting or post-event underwriting. That's one thing.

Secondly, you will not be denied insurance because you have a preexisting condition. And who doesn't have a preexisting condition?

It was at the summit that Representative Miller held up three pages, and he read. Each of these pages, in small type, was from an insurance company that listed the preexisting conditions that they would use to deny coverage. Everything from acne, the story that you told earlier, to kidney illnesses or colds or whatever.

I know a young lady, 23 today, that came off her family insurance, tried to go back to the insurance company that she had been with for her whole life, from the day she was born. They had all of her medical records, denied her coverage because she had acne. I think the real reason was that she was a female in that child-bearing age. She wasn't pregnant, wasn't married, wasn't likely to have a child anytime soon. But she was in that child-bearing age.

I said, This is not right. What's going on? She said, Well, I tried to go online to get a policy. I said, That couldn't be. I said, Give it a shot. So we went online, put down her name, female, the health statistics: denied, no coverage available.

I said, let's try something. Let's just change one thing here. Let's say instead of a female, you're a male. Bingo, she got coverage.

The present system discriminates in the most pernicious ways. If you're a young female, you're likely to be expensive, medical care of different kinds; you're going to give birth to a child. You talk about family-friendly policies? Not from them. So these are things that are corrected in this legislation.

Exactly.

Before you go there, let me just make this point. This is the point to the insurance companies. The day the President signs this bill, your discriminatory practices are over. You will not be able to discriminate against Americans because of their health status, their marital status, whether they are male or female. Those days are over.

Listen carefully, health insurance companies. I know why you are spending that hundred million dollars trying to oppose this bill, because you know that the day we pass this legislation, the day this is signed by the President, your discrimination is over and every American is protected.

Please go ahead.

Speak the truth, man. The Republicans did nothing.

Let me introduce to all of us a young woman from California who preceded me by about 9 months in a special election last spring, Congresswoman Judy Chu.

Thank you for joining us.

Thank you so very, very much for a very good and thorough description of the problem that women face in this issue and why this reform is so important to them.

I see our colleague from Illinois was getting kind of excited and wanted to get into this and add to this, so please do.

Let's take this just for a little more, and then I really want to come back to something that you talked about, and that is the bill that you introduced having to do with the rate regulation process.

But before we go there, the statistics just came out from the Labor Department that the majority of workers in America are now women. If we keep women healthy, then the productivity of America is substantially increased. And in order to stay healthy, women or men, you really need that health insurance that provides for the preventative care.

And that is in this legislation that there is an expansion of the preventative care services. For seniors, they will be free. For the rest of the public, the insurance policies will have to offer that preventative care. So if we keep women healthy, the productivity of the Nation is going to increase.

So for many, many reasons. We'll come back and deal with the issue of the overall economy in a few moments, but I really would like you to pick up the issue that you raised about rate regulation as a result of the extraordinary announcements that the insurance companies made about their rate increases.

Tell us about what you have introduced.

That's California.

I think in the testimony that you talked about here in Congress--and I know in California that when Blue Cross Anthem raised their rates about 39 percent on the average, or 39 percent maximum, about 25 percent on the average, and then had done that previously just in the previous year, so it's actually--the 2-year period is actually 12 months over 2 years, 2 calendar years.

What happened, the profits of the company went from about $300 million to over $2.2 billion profit. And that's probably why this CEO came before--and correctly, because I suspect she was under oath; you don't lie to Congress--told that she now has a $2 million salary plus an $8 million bonus because she was able, by raising the rates, to obtain a higher bonus for herself and obviously an extraordinary increase in the profitability of the company.

Now, if this bill passes, there will be a national standard for rate increases. It also says that if the State governments--and many State governments already do this--that they will be able to continue their rate regulation process.

Now, in California, as insurance commissioner in 1991, there was a proposition passed that set up a rate regulation system for the property, casualty. This is auto and homeowner and business insurance. It didn't cover health insurance. But the effect of that rate regulation over a 20-year period as described by the Consumers Union is over a $30 billion savings to consumers.

Now, I was able to do that because I became insurance regulator. I set up the rate regulator system. The insurance companies are allowed a profit. They have a steady 10 percent profit. The extraordinary swings in the system, eliminated. The extraordinary increases and then some decreases were eliminated. A steady state was put in place so that the market actually became more competitive. There were more insurers. The policy costs were held down for consumers. We were unable to get that for the health insurance industry. We were unable to overcome the political strength, the contributions, the advertising of the health insurance industry. California remains today a State where consumers in the private individual market in California faced this rate increase because there was no rate regulation.

I am so thankful that you have introduced the legislation. This has been the heart and soul of my work for more than 8 years over a 20-year span of time, and if this comes into place, I know from my experience as insurance commissioner, it will be a substantial improvement to the cost of insurance. It will bring rates down, not just over time, but immediately, because the insurance companies no way, no how can they justify the kind of increases that they're imposing upon the public. And that's now in this legislation.

Which side are you on?

Okay. I prepared a chart. I have got my donkey up here. This is the Democratic proposal, and, yes, this is a very partisan thing. There is not one Republican vote for our reform, but here's what our proposal will do: 31 million Americans will have access to insurance, and if you already have an insurance policy that you like, keep it. Nobody is going to take it away from you. Keep your insurance policy.

If you happen to be of low or moderate income, there will be a substantial--the single largest personal tax cut ever is in this legislation. You mentioned it earlier. It is the tax credit. We're not talking about a deduction for medical care. We're talking about a tax credit. It is taken right off your bottom line taxes, and its up to $53,000--or excuse me, $5,300 for a family of four with a $50,000 income. This is a substantial tax cut going right to the middle class, middle America.

Secondly, denial of coverage. We have talked about this over and over again. Those days are over. Hey, insurance industry, it's done. The day the President signs this bill, you will end your discrimination. It's over. Millions of seniors will see the prescription drug--we've talked about that--and millions of Americans will have access to coverage.

We haven't talked about the insurance exchange. But before we go there, you mentioned the Republicans. Okay. Here we are.

Let's talk about the Republican program. What's the Republican program? And this is in the next 10 years.

If the Republicans have their way, 67 million Americans will remain uninsured. That's an increase. Some 40 million, in that range, today are uninsured. But if Republicans have their way, we're talking 67 million Americans.

Single and family health care policies will double over that period of time. We're already paying more than can be afforded today, and if they have their way, the Republicans have their way, you will see a doubling.

Employer premiums, the cost to employers will double.

And you want to talk about the American economy being uncompetitive; this is where you will find it, right here, out-of-pocket expenses. We'll go from $315 billion today to over $564 billion in the year 2020. And insurance availability from small businesses' employers will be cut in half.

That's the Republican program.

I hope to be 65. Well, I actually am 65.

Yes.

Thank you.

So what you're saying is this is the do nothing, the best case Republican scenario. But if they actually were able to pass a bill, they're going to take men and women that are 54 now, that in 10 years will be 65 going for Medicare, they're going to take those men and women and toss them into the shark pool with the insurance companies?

So for my Republican friends, this is the best deal they have to offer, the do nothing deal?

Let's take a moment, and we can go back and forth with the dialogue here for a moment about the American economy.

This debate has been focused principally on individuals and families and the effect of this, of our program, and how it will help families. Prior to, oh, the last month or so, there was a debate in America, at least there was a discussion in America about the effect of health care and the cost of health care on the American economy.

I don't have a diagram here. I thought I would bring it, but it didn't get over here. And it's the fact that the American economy, we're now spending somewhere close to 17 percent of all of our wealth, our GDP, on health care. It's an extraordinary number, particularly when you consider what other economies are doing around the world.

Our competitors, Japan, Korea, the European countries, all of the European Union countries, have universal health care. All of the people in their societies, including visitors, have access to health care. Their health statistics are better. They live longer. They don't have as many diseases. Their children don't die as often as our children die. So yet the most any of those countries spend is 11 percent. Most of them are 10 percent or 9 percent of their total wealth. So we are at an extraordinary disadvantage.

One of the numbers I heard is like it's writing a check to our competitors for about $800 billion a year, an advantage that we're giving them in our economy because we're spending so much more on a health care system that is so grossly inefficient in so many, many ways.

Part of what is taking place with the reforms we are putting forth here is an effort to hold down the costs in many, many ways, including making sure that people have access to health care in the most efficient, effective way; not waiting until they are very, very sick, uninsured, very sick, going to the emergency room, which is the most expensive place, and being extraordinarily sick when they arrive but, rather, getting preventative care, getting the early care.

I will never forget a young man about 35. We were doing this debate about 4 years ago in California and he was a speaker at this thing, and he said, I want you to know that I am a glazer. I put glass up in buildings. That's my business. I put glass up in buildings, and I worked for a company for 12 years. We had good health insurance. And the company hit upon a hard time and so they cut the health insurance, and they then decided that they would reduce our health program. I said, I'm a healthy young guy and I've got good health, but I will get my children covered.

So he covered his children, and he eliminated his own coverage. He came down with a cold, simple cold. The cold got worse. He didn't have coverage so he didn't go to get care. He wound up with pneumonia, and he wound up then with a collapsed lung; wound up in the hospital for 3 or 4 weeks, became bankrupt. It could have been taken care of with a very simple antibiotic that would have cost $50. It became a $50,000 event.

This is happening across America. Those 45,000 people that die every year, this is the young man that didn't get care.

This is the extraordinary cost in our system because we don't cover everybody. We intend to deal with that and over time bring down the percentage of our economy that we are spending on health care as we make it more rational, more universal and more efficient.

Let me give a personal example. My son is married with two children. He worked for the University of California for almost 19 years. In the last 5 years, he wanted to start his own business. He and his wife wanted to start their own business--actually it has been about 10 years. They hesitated, hesitated year after year and didn't start their own business until finally he just said, I'm going to do it. I'm going to run the risk. Why did he wait all that time? One very important factor: Two young children. Obviously there were some pregnancies and deliveries involved in that, during that period of time. He could not afford, and he could not get, his personal health insurance, so he stayed with the university for an extra 5, 7 years. And the entrepreneurial spirit, his entrepreneurial spirit, was dampened because of his inability to get health insurance in the private individual market because of a preexisting condition that his wife had. He knew that if he left the university, they would be uninsurable.

That is repeated a million times across America, the great entrepreneurial society stifled by this health insurance industry that we have. We are going to change that. And if the Republicans want to join us in changing and freeing the American entrepreneurial spirit, then come and join us. Join us on this bill. Join us on a bill that eliminates the discrimination against women, join us on a bill that eliminates the ability of the insurance companies to discriminate against individuals of all kinds. Free the American entrepreneurial spirit. Give people health care. Make it affordable. We haven't talked about the subsidies that are in this. There are extraordinary subsidies for individuals, for small businesses, so that it becomes affordable, available, and honest insurance.

That's our promise. That's in this bill. And we are going to pass it, because it is the right thing for America. Thank you for joining us. Thank you so very, very much for the leadership and all you have brought to us.

And to the American people, pay attention. This is important. America for more than a century has tried to get to the point that we are going to be voting on in the days ahead.

I often wonder what part of the world our colleagues are living in on the other side of the aisle. I arrived here on November 5. On November 6 there was an up-or-down vote on a major health reform bill in this House. The Senate did it just before Christmas. I think it was Christmas Eve. There has been an up-or-down vote, and now this week we will have an opportunity to take up this bill, pass it on to the President, get it signed, and simultaneously make corrections in the Senate. It sounds to me like that's an open process, and we've been at this now for more than a year here and this Nation for more than a century, trying to provide health care for all.

And let's keep in mind that our economy absolutely demands that we take action now. Seventeen percent of our economy is being used. The more we spend, the more uninsured we have. We solve those problems with this bill. It's

time for action. It's time to stop saying ``no'' and get on with solving a major fundamental problem here in America.

Mr. Speaker, a few moments ago, we heard one of the most outrageous charges I've seen in many, many days and heard in many days around here concerning the health care bill. The notion that somehow the health care bill overrides the HIPAA law that's more than a decade over is foolish nonsense.

The privacy remains for every individual in America under the HIPAA law, and in no way does the health reform bill invade or change in any way the HIPAA law, which provides privacy on all medical records, whether they are with your local doctor, the clinic, the hospital, the Federal Government. Whether you are on Medicare, Medicaid, or whatever program you are in, your privacy is assured by a decade-old law. And what will be before us in the days ahead is a change not in the HIPAA law, but in other sections of the laws pertaining to health care in America.

There is absolutely no truth whatsoever that the privacy of individuals are in any way changed by the bills that we will be taking up in the days ahead.

Thank you. I want to thank the gentlelady from Pennsylvania and the gentleman from New York for the opportunity to discuss this critical issue of small business and jobs.

We know the statistics are very bad. But the discussion you two were having a moment ago used the word ``investment.'' And we talked about the American Reinvestment Act. It's now 13 months old. And it's absolutely critical that we always ponder investment because the investments that we can make at the government level will lead to short-term job growth as well as to long-term job growth and stability.

Years ago, we looked in California about how do you grow the California economy. I did a report on it. This was more than 25 years ago. And we noted that the history of California's great economic growth was centered on five things. The first and foremost of them was the enormous investment that was made in education, both in K-12 and community colleges and in the research institutions. It was that investment that gave the foundation. And here we are today with enormous disinvestment, backing away from that critical investment in education.

Now, the legislation that we talked about, the American Reinvestment Act, moved billions of dollars into the education sector so that we can continue to educate our kids at the universities and K-12 and the community colleges so that people who had lost their jobs could come back and learn the new skills, as you were saying, Mr. Tonko, the new skills in the green technology. Extraordinarily important investment in knowledge, investment in the ability of people to compete internationally.

Our friends on the Republican side say, No, we shouldn't have done that. So what are these people to do? They have lost their job. They don't have the opportunity to get new knowledge and new skills.

The second thing that we learned that was one that you also just talked about, the two of you a moment ago, about the necessity for research. It is in the research that the new jobs are created. Why? Because those are new products. Those are things that people demand and want and need for the growing economy. And in that is the high profit margin. And, again, for the first time, the Democratic Congress and the President--without the help of the Republicans--passed the greatest increase in research money in the last 20 years, putting money into research that will again lead to jobs sooner and later as the economy grows.

There are many other pieces of this. One that's before us is the health care legislation. I know a young couple in their mid-thirties that want to start their own business but they cannot leave the job that they have today because they know that as small business people, they will not be able to get health care insurance. They have two kids.

So these are things that we're bringing to the American public--last year, with the American Recovery Act and now this year, as we look at how we're going to deal with health care. These are the critical investments that we need to make. And I thank you so very much for bringing this to our attention, to the attention of the American public.

Mr. Tonko, thank you so very much for weaving together all the pieces of the puzzle that the Democratic Party and this Congress are putting together. It is the education piece, the health care piece, and also there is another piece, and I'm going to use an example here of what is taking place in one of the counties I represent. It's Contra Costa County and the Contra Costa Council, which is made up of businesspeople who have said, let's use the purchasing power of government to incentivize and to help the small businesses.

Now, it happens that in this particular area, there are major research institutions. The University of California, the Lawrence Berkeley Lab, Lawrence Livermore Lab and the Sandia Lab are all in the area. And out of that comes enormous numbers of new ideas. But those ideas are often left without a real market because they are new and they haven't been able to grow and to develop their market. So the local government said, why don't we get together and become the purchaser and jump-start, use the purchasing power of government, particularly in the area of energy conservation.

For example, street lights, there is a new company that is in the LED lighting system, and it's possible for that company, in their own neighborhood, to create a huge market, replacing the existing street lights. They use an enormous amount of energy with the new LED lights. But one example, in order to do that, that is the wise use of government. At the Federal level, billions upon billions of dollars are spent every year, often going to the large companies to what are known as the ``Beltway Bandits,'' the companies that hover around Washington. We in the Democratic Party are doing this today, the Democratic Congress is pushing the President, pushing the administration to push those jobs back to the local community by contracting with small businesses.

The small business community needs access to the Federal contracts just as they would like to have access to the local government. That has been the policy of the Democratic Congress and is the policy of the Democratic President to make sure that small businesses have access to the Federal contracts. It doesn't come easy. I was the Deputy Secretary of the Department of the Interior in the 1990s, and we had to literally force the bureaucracies to contract with small business. It is like putting in reporting requirements. We are continuing that today.

So once again, there is a web of opportunities, education, health care, the tax laws, all of these things, including contracting and access to the Federal and local government purchasing power that creates opportunities for small businesses. That is our agenda, and it's a good agenda for America. It's a good agenda for business.

Let me give you a very brief example of that connection.

The community colleges across this Nation are one of the very best places for people to get specific job training. When the community college is connected to the business communities, the business community can directly affect the educational program that that community college is providing, making the education pertinent to the employer so that when that employee finishes or when that worker finishes the community college program, they are specifically ready.

I was listening this last weekend when I was back in California to a local radio station talking about the way in which the community college and the employers are working together to educate unemployed construction workers, preparing them for the solar industry so that they knew how to install solar photovoltaic, so that they could be the salespersons, so that they can do the audits that are necessary, and those people would be immediately prepared. Now, the problem is the community colleges across this Nation are running out of money.

Now, Mr. Miller, the chairman of the Education and Labor Committee, has proposed a new piece of legislation called the Local Government Jobs Act, and it has $23 billion to directly go to the educational system so that they can hire the teachers, so that they can do the training in the community colleges to prepare workers for the new economy that is coming our direction. This is the kind of really important and useful legislation that is needed. Some 250,000 teachers would continue to be employed.

And I was noticing in the Washington Post today, the headlines, the right-hand column, ``Thousands face furloughs; schools may lose millions.'' That is repeated. That same headline was found in the Sacramento Bee and the Los Angeles Times in the last week.

So we need to support the educational system so that unemployed workers have the opportunity to become better prepared to take the jobs that will be there as these tax incentives, the new economy kicks in, as we move to the green technologies and the green energy systems. There is a totality here. There is a holistic approach.

That is what the Democratic agenda provides: tax incentives, health care, education, purchasing power of the government made available to small businesses, bringing the new businesses on line. All of these things create a totality that will restart our economy and keep us moving and take these workers that are now tax-takers on unemployment insurance, some on welfare, using the COBRA money that we provided through the American Recovery Act, and let them become taxpayers, building our economy once again. That is our agenda.

Thank you so very, very much for bringing this small business agenda to the American public so that they understand that this party, the Democratic Party, is the party that is concerned and is willing to use the power of government to restart our economy and to give small businesses an opportunity to prosper and grow.