GOP Doctors Caucus

Floor Speech

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

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

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

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

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

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

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

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

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

In ERISA-approved plans, if you work for a company that provides health insurance coverage, that covers about 60 percent of the people in this country. About 160 million people work under that. Let's say in my practice we have 400-plus employees in my medical practice that get their health insurance through their job. That covers about 60 percent of the people in this country. Sadly, in the last 4 or 5 years, because of the change in the percent of people who are employed in the workforce, that number has actually gone down 2 percent to 58 percent, instead of going up as it usually does in most recoveries. Number two, Medicare, and number three, Medicaid.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So we have 21 new taxes. And there are taxes on health care plans; the mandates are taxes. So we have the taxes. ObamaCare works because of a three-legged stool, Mr. Speaker. This is how it works:

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

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

Number three, the mandate on business.

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

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Mr. ROE of Tennessee. I thank the gentleman for yielding.

You always hear, Mr. Speaker, that Republicans have no ideas for health care. Well, we had plenty of ideas;

they just weren't heard. We had 80 amendments to this bill. None--and I want the people who hear this, to show you how frustrating this process has been, now that we're looking at this almost incomprehensible bill, is that we had 80 amendments to the Affordable Care Act taken to the Rules Committee. I think I had 10. Not one--not one--amendment was ruled in order. Not one.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

When you and the President sought our support for the Affordable Care Act, you pledged that if we liked the health plans, we could keep them. Sadly, that promise is under threat. Perverse incentives are causing nightmare scenarios. First, the law creates an incentive for employers to keep employees' work hours below 30 hours a week.

Numerous employers have begun to cut workers' hours to avoid this obligation, and many of them are doing so openly. The impact is two-fold: fewer hours means less pay while also losing our current health benefits.

These are the presidents of three major unions.

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

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