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Health Care

Floor Speech

Location: Washington, DC

HEALTH CARE -- (House of Representatives - January 30, 2007)

Mr. PALLONE. Mr. Speaker, I am here tonight to talk about the President's health plan that he discussed or brought forth in the State of the Union address last week, but I couldn't help after listening to some of my colleagues on the other side of the aisle talk about the continuing resolution that is going to come to the floor tomorrow to just spend one minute before I get into my health care Special Order just mentioning why I think what they said is so wrong.

I of course have been in Congress for a number of years now, and last year which was the last Republican majority Congress that we have had, I guess, or that we are going to have, the Republican leadership passed a budget that was so unrealistic that they were unable to complete work on nine of the 11 annual appropriation bills. So I think everyone needs to understand, Mr. Speaker, that whatever the Democrats do tomorrow is simply cleaning up the mess that the Republican leadership left us. They didn't do their job; they didn't do their work.

Most people would say that the main purpose of the Congress is to pass a budget and pass the appropriations bills so that the government can continue to operate, and they simply did not do that. They left here in December with only two of the 11 appropriations bills. Those dealing with defense and the military were passed. The other nine were just left, and they passed their own CR, or continuing resolution, to take us through I guess February 15, and basically said, okay, we are getting out of town and we leave this mess to the Democrats. So back in December, Senator Byrd and Congressman Obey announced a plan to wrap up the bills in a joint funding resolution, and that CR is coming to the floor tomorrow.

But I will stress, and I don't know how many times I can keep saying the same thing: there are no earmarks in that continuing resolution. None whatsoever. In fact, there is even language in the continuing resolution, and I will reference in title I, section 12 that says: ``Any language specifying an earmark in the committee report or statement of managers accompanying the appropriations act for this fiscal year or for the last fiscal year shall have no legal effect with respect to funds appropriated by this division.''

So essentially what that says is: we are not allowing any earmarks. But even if one of the bills in the committee report or in the statement of managers, which are not binding under the law, even if one of those suggests an earmark, that the Federal agency responsible for administering that program has no obligation under the law to implement it.

I don't know how more emphatic we could be in saying no earmarks, no suggestions of earmarks. Don't pay any attention to anybody who tries to suggest an earmark. That is essentially what this language says.

So this whole effort to say that somehow there are earmarks in this is just fabrication. And beyond that, the fact of the matter is that we have no choice but to adopt this continuing resolution because they left us this mess and we have to move on to the next budget year. So I just wanted to point that out, and then I would like to move on to the real issue that I came here tonight to discuss, which is the President's health insurance proposal.

I was glad to see that in his State of the Union address that the President prioritized health care, and he said that he wanted to solve the problems of the current system both in dealing with the large number of uninsured and also with the fact that costs, the costs of the health care system continue to rise. So I will give him credit for prioritizing this issue, because he has not done so in the past.

But I have to be critical and say for the last 6 years President Bush and the Republican Congresses have ignored our Nation's health care problems. Because of that neglect, we have seen health care premiums skyrocket over the last 6 years since he has been President and the number of uninsured increase after we witnessed reductions in the number of uninsured in the late 1990s. When President Clinton was in office in the last couple years of his Presidency, for the first time in a generation the number of uninsured actually went down because of his policies. But ever since President Bush took office, the number of uninsured has gone up. And I just want to give some statistics on the President's record.

Here is the information on the uninsured: when he took office in 2001, there were 41.2 million Americans who were uninsured. Five years later, in 2006, the number had grown to 47 million. That is an increase, Mr. Speaker, of 1 million Americans every year on the President's watch. That is the first and I think most significant statistic.

And then the next poster I wanted to show has a map of the United States. And I think a lot of times when you give numbers, people don't necessarily respond to them or they just sound like a lot of bureaucracy. But forgetting the numbers for the moment, what this map shows is that the number of uninsured now exceeds the cumulative population of 24 States and the District of Columbia that we have outlined in the shade of red or orange here. So that is a lot of uninsured. That is the number of people that live in those 24 States and in the District of Columbia that are now uninsured.

And then the third thing is in terms of the premiums, because again the
President has said that he wants to address not only the problem of the uninsured but also the problem of costs for health care. So if you look at this chart, you can see that workers are now paying an average of 1,094 more in annual health care premiums for their families than they did in 2000.

So that is essentially what has happened while the President was in office. And this is based on information from the National Coalition of Health Care: workers are now paying on the average $1,094 more in annual health premiums for their families than they did in 2000.

Now, again, I appreciate the fact that President Bush highlighted this issue and suggested it needs to be prioritized, and hopefully his statement during the State of the Union address would suggest that he wants to work with the Democratic Congress to try to address these two problems, but his proposals have essentially been a nonstarter because they don't address the actual problems that he is seeking to highlight.

Essentially what he has done, and this is the one thing that I think is the most incredulous, is he is talking about a tax increase, and many of you know that President Bush repeatedly said he would never support a tax increase. It has been sort of the hallmark of his 6 or 7 years in office now, that he didn't want tax increases. But he actually said that he would effectuate a tax increase on a lot of people through his health insurance plan, because what he does is basically take those people who have a very good comprehensive policy, what you might call a Cadillac or a gold-plated insurance policy, well, they are going to be taxed. And the way that he is going to pay for the program is essentially to say, I will tax the people who have very good insurance coverage in order to give a break, a tax break, if you

will, to those people who don't, and I'll encourage people to go into the individual market because we will give them the tax break paid for by a tax increase for the first time on people that have a very good policy. Now, I know it gets a little complicated there, but I think it is very important for everyone to understand that he is actually proposing a tax increase on those people that have very good insurance coverage right now.

Now, I could talk for a lot longer on this, but I see that I have been joined by some of my colleagues. So rather just talking myself for the next 5 or 10 minutes, I would like to hear from some of them. I will start by yielding to the gentleman from Pennsylvania.

If I could just mention that both of my colleagues that are here tonight, one from Pennsylvania, one from Tennessee are new Members, and I particularly appreciate your coming down to discuss this.

The gentleman from Pennsylvania.


Mr. PALLONE. If I could just ask the gentleman to yield back. I just want to give an example of exactly what you were talking about.

Under the President's tax plan, a low-income person who was previously uninsured would receive about a $1,200 tax break. That is assuming that they are paying taxes. At a time when the average cost of coverage for a family is around $11,000 a year, a $1,200 tax break is not going to be enough to get that person insured. In contrast, the higher-income person who was previously uninsured would receive nearly $6,000. So the problem is, the person who is more likely to benefit from this is the higher-income person who doesn't have a very good plan. If their plan is good, then they are even going to get taxed on it.

So your point I think is very well taken, how is that little bit of a tax break going to get that person to be able to go out into the individual market and buy a health insurance policy? It is simply not the case.

I yield back to you.


Mr. PALLONE. I would just ask the gentleman, my question, isn't it also possible under the scenario you laid out that under the President's plan that the employer has an incentive to essentially drop insurance coverage all together and say, Okay, well, now that you have this tax deduction, why don't you just go out and buy insurance on your own. And doesn't even offer the health insurance anymore. It actually could even make the situation worse in terms of the uninsured, because he says, Okay, you go out now and buy the insurance on your own.


Mr. PALLONE. The other thing that bothers me is that a lot of people will either individually negotiate with their employer, or if they are part of a union, negotiate through their union, a better health package, and call it a Cadillac or gold-plated package. They trade that for not having a salary increase or some other benefit because they want that health care benefit for themselves or their family.

So why should they be penalized by having to pay an extra tax because they have made that decision? These are the kinds of life decisions that people make depending on their circumstances.

I yield to the gentleman from Tennessee.


Mr. PALLONE. If I may interrupt, this continuing resolution is essentially continuing the same level of funding; and yet it is making these advances, including a number in the health care area. Veterans' health care goes up, as does funding for the National Institutes of Health and funding for Ryan White and community health centers.

There is a lot of additional money to address the health care crisis in the country that we are focusing on tonight.


Mr. PALLONE. Because they were the do-nothing Congress, essentially. That was their hallmark.

Today is January 30. We have met the majority of the business days this month. We have been in session. We passed bills during the 100 hours that affect so many things: negotiated prices for prescription drugs, cutting the interest rate for student loans in half, and the list goes on.

They met once in the previous session in January. The way the process works, and I know you are familiar with it, is that your appropriations bills are supposed to be passed in both the House and Senate by, say, June or July at the latest, and then you have conferences. And before October 1, which is the beginning of the fiscal year, you come back with the conference reports in September and you pass them before October 1, which is the end of the fiscal year.

They did none of that. They only passed those bills and sent them to the President in two cases: defense and military construction bills, both defense-oriented. Everything else was neglected. I don't believe the Senate passed a single bill. In the House we passed some, didn't pass others.

And when they had the lame duck session after the election, they simply went out of business. They passed a CR which just continues current levels of funding until February 15 and said, Okay, you guys won the election, you deal with it.

Normally, in January, we start the next fiscal year, having hearings and putting together the budget, and the President delivers it by the end of the month or the beginning of February. If we didn't pass the continuing resolution to get this year done quickly in the fashion we are going to tomorrow, or in the next couple of days or weeks, we would be having to deal with last year's budget left to us by them, this mess, and we wouldn't even have time to move on to the next fiscal year.

They just left this mess. The amazing thing is it has no earmarks, which is a reform, and yet they keep talking about it as if it does.


Mr. PALLONE. I don't know the specifics in terms of each line item. It is a 400-page bill. But I would point out, we have that language in the bill that I read before that specifically says that any suggestion that there be an earmark, even if it is just in a committee report or even suggested by the managers, should be simply ignored by the agencies that are involved.

Imagine that, as Democrats in the majority, we are telling the agencies that are controlled by the Republican President, pay no attention to any suggestion of an earmark, do what you think is best. What can be more bipartisan than that? And yet they are saying it is filled with all of these earmarks.


Mr. PALLONE. I am glad you mentioned that. I think that is a very important point.

The President is very much aware of the fact that many States, and there are getting to be more and more--in my State in April there is going to be a proposal to have universal coverage in New Jersey. Many States are trying to cover everyone and get rid of all of the uninsured.

What the President said in the State of the Union address was, we will take money from disproportionate-share hospitals, and these are hospitals that are getting Federal dollars because they have a high number of charity care cases, people who have no insurance; he is saying we will cut back and we will give that to States, to the governors, so they can help deal with the problem of the uninsured.

Well, in many States, including my own, that will only aggravate the problem. They are getting that money to cover people who have no insurance. So it is like, what is the expression, robbing Peter to pay Paul. That is essentially what it is. We will take the money that is now being used to cover people, and we will cut that and give it back to you so you can cover them. It makes no sense.


Mr. PALLONE. I appreciate the gentleman's comments. Now that Dr. Kagen has been mentioned, I will yield to you.

I want to say one thing, and that is, many times in the Energy and Commerce Committee the Republican side of the aisle would point out how they had a number of doctors and would suggest that they had a sort of exclusivity to their knowledge of medical and health care issues because they had these doctors. I am glad to see that there were doctors on the Republican side, but I am also glad to see we are getting more doctors on the Democratic side.

I yield to the gentleman from Wisconsin.


Mr. PALLONE. The President talks about health care costs, but in my opinion the biggest thing that could be done or one of the major accomplishments would be if he would simply go along with what we passed in the first 100 hours, which is negotiated prices for prescription drugs. Imagine the amount of money we could save with that.

It passed the House and it is over in the Senate, but he has said he is opposed to it. I am hoping that we can pass something in the Senate and we can get something to his desk that he will sign.

It is sort of hypocrisy on the one hand to talk about increasing costs, and this would be one of the easiest ways to save money, and we did it as Democrats, with all the new Members' help in the first 100 hours, and I hope that he would reconsider his opposition to it.


Mr. PALLONE. I would just say, you know, a lot of people will say, well, why would the President want to do this? Why does he privatize? Why does he give money to the HMOs? What is the reason? Because you would like to think he would make the right decisions and do the right things.

There are two things I have to point out: one is that he is often driven by ideology, and I think it is a mistake. You have to be practical. You have to look at what actually works and not just look and say, well, government is not good and privatizing is better. Sometimes government is better. Sometimes privatizing is better. But just do not be stuck in this ideology that it is always better to privatize.

The other thing, unfortunately, is the special interests. I mean, the bottom line is that the drug companies traditionally gave a lot of money to the Republican candidates and his own campaign, and the same with the HMOs. The HMOs were always the darling of the Republicans and the President, and they contributed a lot to their campaigns. So there is a special interest reason here, as well as an ideological reason unfortunately.

I yield to the gentleman.


Mr. PALLONE. I want to yield to the gentleman from Pennsylvania, but I would say if you were going to use the tax policy or the tax system as a way of addressing this in some meaningful way, it would be a lot more meaningful to a low-income person if it was a refundable tax credit than as a tax deduction, simply because they really cannot take advantage of the tax deduction.

At some point, I think we should also talk in the next 20 minutes or so about some of the alternatives that we would like to see instead of the President's plan, but I did not give the gentleman from Pennsylvania an opportunity. So I go back to him at this point.


Mr. PALLONE. I appreciate your comments because I think it is very important and I know it is a little detailed, but the fact of the matter is these points need to be made.

I just wanted to lead us, if I could, we have about 15, 20 minutes left, maybe not quite 20, into what we would do as an alternative. As I said, if you wanted to use tax policy as a way of trying to address the problems here, and I am not saying that that is the most effective way to do it, but if you did, certainly a refundable tax credit would be more useful to that lower-income person than this deduction that may not even be able to take advantage of.

But I just wanted to also point out that if you look at the problem with the uninsured right now, first is the employer-sponsored insurance which increasingly fewer and fewer people are able to take advantage of, even though they are working, because the employer simply does not provide either any coverage or a meaningful coverage that they can afford with their copayment.

What employers tell me is that we have to provide some sort of incentive for them if they are going to cover those people that work for them that they do not cover now, and that either means, again, if you are going to use tax policy, some kind of tax benefit to them or, alternatively, getting rid of some of the cost of the coverage.

For example, when Senator Kerry was running for President, he had proposed taking catastrophic insurance off the table. In other words, having the government in some way provide for catastrophic coverage because that is a big part of the cost and so the employers, if they did not have to pay for catastrophic coverage because the government was subsidizing that in some way, they would be a lot more likely to offer a health insurance plan with a relatively low copayment.

This is something the President hasn't mentioned.

The other thing, I think, and even more important, is that you have to realize there are a lot of people that are just never going to get employer-sponsored coverage, either because of the situation with their employment, whether it is full-time or part-time, or because they are not working and they are not, for some reason, eligible for existing government programs.

We also need to look at the government programs which the President completely ignores, whether it be, you know, Medicaid or Medicare or the SCHIP, you know, program for kids, and look at ways to expand eligibility and provide funding for those programs to sort of take up the gap.

I just want to throw those out as the types of things that the Democrats will be looking at in addition to the tax policy.

I yield to the gentlewoman from Florida.


Mr. PALLONE. I appreciate your comments. I think they are right on point. We, in our Health Subcommittee, the Energy and Commerce Committee, in about 2 weeks, are going to have hearings on the SCHIP, the kid care program. One of the things we will be looking at is how we can get kids, now eligible, enrolled, because there are too many barriers.

I mean, in my home State of New Jersey, I really believe in our State we have been doing everything we can to try to get kids enrolled who are eligible. But we still have the majority, we have more kids that are eligible for SCHIP that are not enrolled than we had kids that are actually enrolled.

So something has to be done, whether it is outreach, whether it is getting rid of the bureaucracy, streamlining the application process. These are some of the things that we as Democrats are going to take up here, because this is a major way of covering the uninsured.

The biggest group of uninsured continues to be children, so I appreciate the gentleman's comment.

I see the good doctor from Wisconsin.

I yield to the gentleman from Wisconsin.


Mr. PALLONE. I wanted to yield to the gentleman from Pennsylvania. I think we have about 7 minutes left, but I did want to mention one other thing. I know the gentleman from Florida brought up community health centers and that type of thing. That has got to be an important part of this as well.

It is unfortunate, because a few years ago in his budget message or State of the Union, the President actually said he wanted to prioritize community health centers and create a lot more, but he never provided the funding to do that, which is often the case. We get the rhetoric, but we don't get the funding.

To the extent that you can, take a lot of the people who are uninsured and who will go to an emergency room, and become part of that uncompensated care that is a big burden on the hospital, and you can, instead, set up community health centers, whether in a fixed place or in a mobile van or whatever, and have people go there as they would go to a doctor, as you said, and get the preventive care they would get from a doctor, as opposed to an emergency room later. That is a big factor in this, as well, that we have to look at. I wanted to commend the gentlewoman for what she said in that regard.

I yield to the gentleman from Pennsylvania again.


Mr. PALLONE. I appreciate what the gentlewoman is saying. You can look at every government program, whether it is Medicare, Medicaid, NIH, whatever it is, and you can try to look at those or reinvent them so that there is more of an emphasis on prevention and wellness. This is a theme that we can look at and try to make some changes, and I think it really would make a difference.

I appreciate your comments.

I yield to the gentleman from Wisconsin.


Mr. PALLONE. I know that we only have a couple of minutes left, if that, and I just wanted to thank all of you for joining with me tonight. Other than me, it was all new Members, and I think that gives us new, fresh insights into what we need to do that is really so crucial. Thank you.

If I could just say, Madam Speaker, in summing up, that, number one, we do commend the President for prioritizing health care in his State of the Union address, but essentially what he has suggested as a way of dealing with the problems is not a good start. In fact, it is very much the privatization and ideological answers that I don't think are going to work.

Democrats do have alternatives. We certainly intend, now that we are part of this majority, to move forward on those alternatives. But I know that with the input from the new Members we are going to make a difference.

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