Health Care

Floor Speech

BREAK IN TRANSCRIPT

Mr. FORTENBERRY. Well, first of all, thank you for your comments, and it's a pleasure to join you this evening. I didn't have the benefit of the conversation in its fullness before joining you just a moment ago, but I would like to try to make a contribution to what you're saying, if you can yield a few minutes to me.

Mr. AKIN. I yield. We're basically enjoying having a conversation here. A little bit like going to dinner with your Congressman, except the food, you have to provide that for yourself.

Proceed, please

Mr. FORTENBERRY. Thank you. I think, if I could reframe this for just a moment, I think there's a central question we should all be asking ourselves on both sides of the aisle, and including the administration: How do we actually strengthen health care in America? How do we answer a fundamental question as to reducing cost, improving health care for all Americans, and protecting vulnerable people?

If you start to frame how we move forward on appropriate public policies that improve health care, reduce cost, and protect our vulnerable people, you begin to get actually underneath the reasons that we're in a circumstance now where you have a large section of America that is pretty happy with its health care, but generally unhappy with the rising cost. You have another section of America that has real problems with gaps of insurance coverage either because of preexisting conditions or loss of job and an inability to afford a product individually. That's a real problem.

Then you have certain vulnerable populations who, frankly, end up in the emergency room a lot of times; whereas, if there were alternative methods of care, primarily for primary care, that would reduce that cost as well. So how do you begin to answer those questions, I think.

One is--and I think there has been a certain bipartisan focus on this--and that's this positive in this overall debate--but it's the whole issue of health and wellness.

Our total health care bill in this country is about $2.2 trillion. About 75 percent of that is actually due to the onset of chronic disease. A major portion of that could actually be prevented or better managed with significant cost reductions.

For instance, some estimates suggest that 80 percent of cardiovascular disease could actually be prevented or better managed. Can you imagine the hundreds of billions of dollars that we could be saving if we had a cultural shift in the paradigm of health that looked at incentivizing both prevention and wellness? I will give you a few examples.

In Nebraska, we have a rehabilitation hospital called Madonna Rehab Hospital, and we actually held a committee hearing, a public hearing in the field back home on putting the health back in health care. It was a subcommittee of the Agriculture Committee, which we held back in August.

Madonna Rehabilitation Hospital's principal testified they have a 1.7 percent increase in their annual health care bill over the last 5 years. Incredibly low.

Mr. AKIN. Only 1.7, gentleman? That's not very much increase. Most people's insurance jumps 20 percent a year.

Mr. FORTENBERRY. Exactly right. They have a very aggressive, progressive health and wellness program where you're actually incentivized to watch your health, to take measures to actually engage in preventative care. The largest employer in Nebraska actually has a 50 percent lower increase--it's still increasing--in their own health care cost because they aggressively incentivize prevention as well.

A manufacturing entity in my hometown of Lincoln has a $5,000 per employee cost for their health insurance versus $8,000 dollars in the industry average because, again, a strong focus on health and wellness.

Right now--and, Doc, you might want to add something--we tend to pay the medical establishment, the systems, to fix or cut or prescribe. And if we incentivize wellness for persons who are in insurance plans to actually have incentives to watch their own cost, perhaps through expansion of health savings accounts and other entities that allow for the creative opportunity for families and individuals to better control their own health care as well as companies paying directly for prevention, and then incentivizing the medical establishment to be paid or to be reimbursed basically for that type of care, you'll begin to get to one of the major cost drivers that has left us in this situation. Hundreds of billions of dollars could potentially be saved.

Mr. AKIN. Gentleman, I really appreciate your approach of trying to solve problems. We have focused for some of our discussion this evening on the things that are wrong with basically having the government take the whole thing over and socialize it. But we have also been criticized by the President and others that the Republicans don't have any kind of solutions to health care, which you just showed was a tremendous amount of innovative and very kind of strategic thinking in terms of how do you approach this. I think maybe it would be worthwhile. Doctor, I ask you to join us, please.

Let's just kind of tick off some things that--just think about our Republican colleagues and friends. I'm going to just toss out a few things that I would figure get at least 90 percent, probably 95 percent from our colleagues.

One of them is that the big companies and employees of big companies get to pay for health care with pretax dollars, but the small business guy and the individual has to pay with after-tax dollars. I think most of us would say justice means that people are treated equally before the law, and that if we're going to allow people to buy their medical insurance with pretax dollars, that should be made available to everybody.

Don't you think that we'd get a 95 percent on that, probably?

Mr. FORTENBERRY. If I could speak, Doctor, real quick.

Mr. BURGESS. I think on our side of the aisle, no question, you'd get 95 percent. I can't speak for the whole House.

Mr. AKIN. I'm not speaking for the whole House because they want the government to take things over, apparently. That's just one idea. I toss out another one.

Mr. FORTENBERRY. You've made a very good point that there is an unequal tax treatment based upon your defined status in the Tax Code. And if you're an individual left out there on your own versus a multistate corporation, you have a different incentive, basically, based on the Tax Code structure. I agree with you, it's unfair.

Mr. BURGESS. Further, a multistate corporation actually has the ability to deliver their health care product over State lines. Individuals in the individual market are prohibited from buying insurance across State lines.

Mr. AKIN. Which therefore, Doctor, suggests?

Mr. BURGESS. It would suggest when the President stands up before us and says there's a place in Alabama where there's only one insurance company--sure, insurance companies tend to form natural monopolies. But if you remove the barriers rather than adding another company for competition, which is a government-run option, why not remove the barriers and open it up to the 1,200 or 1,300 companies that might like to compete for that business in Alabama.

Mr. AKIN. Fleshing that idea out a little bit, in the case of Missouri, where I'm from, you've got Kansas City; half of it's in Missouri and half of it's in Kansas. So if somebody in Missouri kind of goes over the line into Kansas and finds out, Hey, I can get a couple hundred bucks less a month on the same health policy, why can't I buy that policy from an insurance company in Kansas?

So what you're saying is, Yeah, that's okay. Allow people to shop for insurance across lines, which then reduces the monopoly problem in the insurance industry. That's something that don't you think most Republicans would support that idea?

Mr. BURGESS. The real tragedy in this debate is we've never really explored those types of ideas. Maybe it doesn't need to be throughout the entire United States. Maybe there could be regions. Maybe there can be reciprocity between States that make that agreement. But we've never even explored that.

One of the things that really concerns a lot of people when they look at this bill is you get 10 years of taxes and 6 years of benefits. Remember, none of these good things that are going to come people's way and lift the burden of health care off their shoulders, none of them happen until after the next Presidential election.

Part of that is to keep the score low on the Congressional Budget Office; part of that is because, again, it's going to take a long time to set up those programs. We don't even have an administrator at the Centers for Medicare and Medicaid Services right now. And that's the individual who's going to be charged with setting up many of these programs.

So, in the meantime, we do need to do something to cover those individuals with preexisting conditions, those individuals who get a tough medical diagnosis, their insurance is rescinded from them. Nothing is more offensive to Americans than to think that someone has played by the rules, written that check every month, they get a tough diagnosis and the insurance company finds a reason to drop them.

If there's been outright fraud in purchasing the policy, maybe so. But in so many of those cases it is really iffy why those policies are dropped. We could fix that.

Mr. AKIN. Which, again, gets to another Republican proposal for portability. I mean, you know something isn't right with the way insurance is written when somebody does all the right things. They run for a number of years, they buy insurance, and all of a sudden their kid gets sick with juvenile diabetes or something very expensive. Then they changes jobs or something and now they're uninsurable. They fall through the cracks.

That's not the way the system should work. That would be a very admirable thing if the House were to just focus on fixing that problem. That would be very good work. No, we have to scrap everything. We've got a hundred million Americans with insurance policies and doctors and doctor-patient relationships, a hundred million of them, and we're going to scrap the whole thing and have the government take it over. That's irrational.

Mr. BURGESS. But even the President himself said here the other night when he addressed the joint session of Congress, because these programs won't be up and running quickly, maybe we should take the JOHN MCCAIN idea of the high-risk pools, the reinsurance and get people some immediate help now.

I would submit to you that if we would work a little harder on that, it may not be necessary to go the full strength of the government program. Why do we have to fix a program that is arguably working well for 60, 70, 80 percent of the population? Why do we have to change it for everyone to capture those 8 to 10 million people who get caught in that cycle of having a preexisting condition?

I yield to my friend from Nebraska.

Mr. FORTENBERRY. This is well stated, doctor, that the injustice of a person who has wrongly had their insurance rescinded has to be addressed by this body, another clear point of bipartisan agreement. Persons who have preexisting conditions through no fault of their own and are caught in a cycle of not being able to find insurance for the type of problem that they're dealing with is another point of real unfairness that I think you could find appropriate solutions for in a bipartisan way and fix.

It leads to my second point that we really ought to focus on creative new risk pools for insurance affordability and innovation as well as increased access for people out there.

I got a letter from Affiliated Foods in Norfolk, Nebraska, the other day. They are a cooperative. Now in Texas, Missouri and Nebraska we are used to the concept of cooperatives. That's where we leverage our buying power to get agriculture inputs a lot less expensively and sell our grain a lot of times. This is a cooperative grocer who basically uses their group buying power to provide the products for mom-and-pop grocery stores throughout rural Nebraska and other States. They used to be able to buy their insurance through that cooperative, but because of the change of the law a few years ago, they can no longer do so. So it leaves the small business entrepreneur out in the rural community who is struggling to make it, to have to go out on the very expensive individual or small business market instead of using the group buying power.

Now this is a legitimate business. It is a group of people who have bought into a business plan and have ownership in it. They are stakeholders. They're going to be appropriately capitalized. There's no reason that they shouldn't be allowed to use that entity as a creative form of association to leverage group buying power to provide more affordable insurance for themselves.

Mr. AKIN. So what you're talking about now, just to kind of summarize what we have talked about, what you're talking about is what people call in this business associated health plans, the idea that people can create these pools and buy, on a discount rate, their health care. That's a pretty straightforward idea. That's something that Republicans have voted for dozens of times. So we have got associated health plans. We're saying people should have their tax treatment and when they buy health insurance should be the same. We're going to deal with the issue of portability so that when you own a policy you get to keep it and the insurance company can't just dump you.

The other thing we haven't, of course, talked about is tort reform which we have good support for that. That drives health care costs tremendously. And yet we are unwilling to really be serious about it. All of these ideas Republicans are supportive of. So the charge that we're not willing to deal with this debate is not true.

Go ahead, my friend.

Mr. FORTENBERRY. There's another option out there that we should actually have a creative policy discussion about in a bipartisan way which the good doctor just mentioned as well, high-risk pools is another option you have to insure or have the government basically subsidizing a market that does not exist for people who are priced out of because of preexisting conditions or other affordability problems, normal market rates through their business, through their individual policy. You could look at the expansion of those opportunities. We have a fairly good one in Nebraska. It's argued that it's a bit expensive for folks, but that's another way that the government, again, could use public dollars to ensure that people are adequately covered and pay normal rates or provide a reinsurance mechanism, and then as the doctor was saying, you will have gone a long way toward resolving the real difficult problems that exist for about 10 million Americans in providing affordable, good coverage. You'd probably have a bipartisan winner on your hands.

If I could add one more point, there are certain other options, maybe this is a little more controversial, but I think it's worth exploring, in terms of basic public health expansions like community health centers, where you actually help persons who are in more vulnerable situations avoid ending up in the emergency room for primary care treatment.

A combination of this, a focus on health and wellness incentives, new insurance risk pools for affordable innovative options and protecting those who are, because of preexisting conditions or other problems, priced out of those markets with perhaps other types of high-risk pool entities combined with other public health initiatives like that, you would have answered the question I posed initially: How do we improve the health of all America, reduce costs, particularly for families and small businesses, and protect vulnerable persons? We could all applaud and have a big bipartisan agreement and have accomplished, I think, what the people have sent us here to do.

Mr. AKIN. Except instead what we've had is apparently our Speaker has pulled together various people, ignored the recommendations that we had and decided, well, we just know what's best, that is the government is going to run it all, we want this public option, and we're charging down this aisle.

Basically people are wondering, well, why is this health care thing stalled? Well, the reason it's stalled is you don't just take over 18 percent of the economy, take $500 billion out of Medicare, basically allow a program which is going to allow public funding for abortion and illegal immigrants getting access to this money and all that stuff without people having something to say about it.

Mr. BURGESS. And if I may, the taxes and fees that are added on top of medical devices and insurance policies in order to pay for these programs are going to drift down to the middle class. There is no way to avoid taxing the middle class or putting a fee schedule on the middle class with the structure that has been proposed by the Senate Finance Committee.

With the gentleman's indulgence, I would just make a point that if people are interested in this debate, healthcaucus.org has documented the debate that has gone on since January and February of this year. I would just further like to point out, we do hear the complaint that Republicans have not been involved or engaged in this process. I met with the transition team in November and offered my assistance. I was never called back. I met with the chairman of my Committee on Energy and Commerce

in January and never received a call back. I submitted 50 amendments to our bill in committee and had several of them accepted toward the end.

Republicans do have ideas. They are reasonable ideas. They deserved a fair hearing and a fair airing in committee. Unfortunately we were denied that opportunity, because as the gentleman correctly points out, as the deputy President has said, ``Never let a good crisis go to waste.'' They were determined to use this economic crisis to expand the reach and grasp of the Federal Government in health care.

Here is the reality: If the President had really wanted to do this, they could have done it in February when the Presidential approval rating was near 80 percent. No one would have been able to stop him. It could have been signed into law before the month was over.

Mr. AKIN. I would like to thank my good friend, Congressman Burgess and also Congressman Fortenberry. Thank you very much.

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