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Affordable Health Care For America Act

Floor Speech

Location: Washington, DC


Ms. JACKSON-LEE of Texas. Mr. Speaker, today I am holding up a concise, efficient, and effective health care plan for America, H.R. 3962, and I plan to stand with America and those who don't have health insurance today as we cast our vote for affordable health care for America.

Eighteen thousand people die every year because they do not have health insurance. The State of Texas has 6 million people who don't have health insurance. Several Republican Members from Texas, have in their districts, some 29 percent, and 18 percent of individuals who don't have health insurance.

So today I rise to say that the plan we have will immediately close the doughnut hole for Seniors. It will provide the uninsured with a bridge to the exchange program. It will extend the coverage for our young people until the age of 27, and, yes, I'm proud of the language on pages 22 and 23 that will begin to help save hospital beds in physician-owned hospitals in the State of Texas and around the Nation. This language is in the bill and we now can continue to work competent quality hospitals in rural and urban areas.

We are ready to fight. We are ready to make sure that those who need health insurance will have us on their side. I am standing with America and voting for America for the first time in which a health care reform bill passes the House with a Public Option to give more access to Americans and lowers the costs of health care insurance. Vote for the health care bill now.

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I rise before you today in support of H.R. 3962, the Affordable Health Care for America Act. On July 5, 1965, President Lyndon Johnson said the following about the passage of Medicare, ``This bill is sweeping in its intent and impact. It will help pay for care in hospitals. If hospitalization is unnecessary, it will help pay for care in nursing homes or in the home. And wherever illness is treated--in home or hospital--it will also help all Americans.'' My friends we can all say that about this sweeping legislation. Madame Speaker, while some say that patients and physicians oppose this bill I know otherwise. Today, I met with dozens including physicians, medical students, patients, and advocates. This group included representatives from Doctors for America, National Physicians Alliance, American Medical Student Association, US PIRG, Disciples of Christ, Episcopal Church, NETWORK--A Catholic Social Justice Lobby, United Church of Christ, and United Methodist Church along with a nationally renowned cardiac surgeon Dr. Salim Aziz of the George Washington University Medical Center.

The health providers with whom I met are on the front lines of the health care debate every day. As such, it is no surprise that they enthusiastically endorse this bill, while holding out hope for progressive changes to health reform legislation before it becomes law. These health professionals see the pain and frustration of hardworking Americans who face financial collapse, physical suffering, and sometimes the loss of their life simply because they do not have decent health care coverage.

Allow me to share with you some of the stories that I've heard from these care givers. One story was that of Dr. ``Alex'', a Pediatrician and Health and Evidence Policy Fellow at Mt. Sinai School of Medicine. Dr. Alex told me of an illness he suffered himself while still a medical student at Howard University College of Medicine here in Washington, DC. One summer, during an internship at the Centers for Disease Control in Atlanta, Dr. Alex became very sick, and was examined at an emergency room. The examination revealed that Dr. Alex's ailment arose from acute kidney failure.

Dr. Alex thankfully had health coverage through Howard University's student health insurance plan. Yet he was faced a conundrum since the university's plan only covered health services required by their students in Washington, DC. It didn't cover him in Atlanta, thus Dr. Alex qualified as under-insured. Aware that he

could not afford out-of-pocket payment for a renal dialysis unit as was being recommended, by his physician, his father drove him through the night from Atlanta, waking him every few minutes to make sure he was responsive, until they finally reached Washington, DC, the next morning, where he could get the treatment needed. This story is proof of the fact that even those who chose to enter the profession of caring for others are not immune to the dysfunction of our health care system. Dr. Alex also related another interesting paradox that I'll share with you. He trained in pediatric medicine at a county hospital outside of Los Angeles. At this county hospital I cared for uninsured children, and those enrolled in SCHIP and Medicaid. What he most enjoyed about working within that system was that they provided high quality care to those who needed it the most. His patients on Medicaid and SCHIP were able to easily see sub specialists: Dermatologist, Ophthalmologist, and Gastro-intestinal physicians. His patients who had private insurance often faced health care barriers which his patients on SCHIP and Medicaid never had to navigate. When children who had private medical insurance visited his county hospital pediatric clinic, staff there had to seek preapproval from the private insurance company so that patients' parents were not billed and required to pay the cost of care out-of-pocket. In this county pediatric clinic he once cared for a 9-month-old boy who had a swollen face covered in a rash on his forehead and cheeks, and raw in his neck folds. He sat before him and scratched his arms, trunk, and face uncontrollably to the point of bleeding. Because of his constant scratching his skin had started to harden. He had uncontrolled eczema and his mother told him in tears how she had not been able to obtain a referral to a dermatologist. The county pediatric dermatologist's one afternoon a month clinic time was that same day. To prevent the patient's mother from receiving a large medical bill, Dr. Alex did what he normally did; he got on the phone to her private insurance company and asked the insurance bureaucrat to agree to pay for the visit. As his other patients had to wait for him, he wasted time on the phone trying to solicit preapproval from her insurance company. But he could not sway the insurance gatekeeper. He tried his hardest to make this bureaucrat understand the child's bloody scabs, the mother's tears. But to no avail. The dermatologist took pity on the child and did what we physicians often do, he saw the patient for free.

Why have we allowed insurance bureaucrats to come between Dr. Alex and his patients? We can do better than allow profit driven bureaucrats decide what medicines my patients receive. He wants a health care system where when he writes a prescription his patient does not have to worry whether their insurance company will pay for it. An insurance bureaucrat sitting in their cubicle should play no part in the relationship between me and my patient. We need to reform our system.

Today is a historic day not only for the 39 million uninsured Americans, but also for our great Nation. As Speaker Pelosi remarked earlier today, we, Members of Congress, are ``humbled to stand here at a time when we can associate ourselves with the work of those who passed Social Security, those who passed Medicare, and now we will pass health care reform.'' Many parallels exist between that history and today. Today, we listened to a parade of Republicans warn that this bill will bring the downfall of American society, of the American way of life. This is not the first time that the Republicans have been on the wrong side of history. In an interview in 1975, David L. Kopelman, who played a prominent role in the early administration of the Medicare Program, remarked that his colleagues were often criticized by Republicans. ``Communist,'' he recalled, ``was the designation all too liberally applied to anyone with a progressive idea. Well, after all, when we went around making contact with employers in those early years that was the designation not delicately applied by many, if not most of them, to the social security program. It must be some communist scheme foisted on the American people.'' Alf Landon, the Republican candidate for President in 1936, even campaigned on the fact that not a dollar in social security benefits would ever be paid.

Mr. Speaker, unfortunately, such ad hominem attacks are as prevalent as ever. The Republicans want you to believe that our country is descending into an abyss of socialism, but nothing could be further from the truth. Today, I am proud to support a bill that is distinctly American. We the people, Thomas Jefferson wrote in the Declaration of Independence are endowed ``with certain unalienable Rights that among these are Life, Liberty and the pursuit of Happiness.--That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed .....'' I believe that it is no coincidence that life is listed first--for without it, the Founders realized, no other rights can be realized. Over years, the millions of Americans who could not access medical services were denied their most basic right. The value of life is echoed in the Universal Declaration of Human Rights as well as in the Hippocratic Oath taken by every physician.

True, health insurance is not a human right by itself, but consider the following: according to the National Academy of Sciences, Institute of Medicine, there is a ``consistent and statistically significant relationship between health insurance coverage and health outcomes for adults. These factors, in turn, improve the likelihood of disease screening and early detection, the management of chronic illness, and the treatment of acute conditions .....'' This year, a study published in the American Journal of Public Health by researchers at Harvard University Medical School concluded that nearly 45,000 excess deaths of Americans can be linked each year to lack of health insurance. Forty-five thousand is fifteen times the death toll at the World Trade Center; 45,000 people are approximately equal to the population of Texas A&M University; 45,000 is almost thirty times the number of American soldiers killed in Iraq since 2001. The lives lost at the World Trade Center and in Iraq will never be forgotten. Why then, do we pretend that a far greater loss of life every year does not exist? Make no mistake about it, health insurance can be a direct determinant of whether somebody lives or dies.

According to the U.S. Census Bureau, 27 million American live without health insurance, and an additional 1.1 million part-time workers lost their health insurance in 2008. Implementing this legislation will instantly improve the life expectancy of millions of Americans of all ages. It is impossible to put a price on that. When we talk about the right to healthcare, we are actually talking about the right to access healthcare. In our current system people do not choose to be uninsured but, instead, are priced out of insurance. These people cannot, as free market proponents often argue, ``Pull themselves up by their bootstraps.'' Instead, they and their families are too often cyclically and systemically trapped in their economic situation. Texas, in particular, with 6 million uninsured persons and 26 percent in the 18th Congressional--H.R. 3962 must pass.

I am committed to working with the Speaker's office and Senatorial leadership now that we are taking the first step in stemming the rising tide of the many uninsured. The protection of physician-owned hospitals is an issue of national interest. We have a lot of work to do as we move toward the Senate and to the conference. I was gratified to meet with the Speaker today to discuss the continued protection of the very viable physician-owned hospitals.

I will continue to work to save physician-owned hospitals that are currently treating patients or under significant development, to ensure that Americans can continue to receive healthcare at the local hospitals they have come to depend upon. Physician-owned hospitals take care of patients covered by Medicare and Medicaid, as well as patients who are uninsured or cannot pay for their care. They also provide emergency departments access for their communities. At a time when we are concerned about the shortage of hospital beds in the face of epidemics like the swine flu, my amendment to this landmark bill will make sure no hospital is forced to shut its doors or turn away Medicare or Medicaid patients. The benefits that will come from our efforts to protect physician owned hospitals are far reaching and will prevent any further losses to local economies. Not only do physician hospitals deliver high quality medical care to the patients they serve, they also provide much needed jobs, pay taxes, and generate significant economic activity for local businesses and communities. Existing physician-owned hospitals employ approximately 51,700 individuals, have over 27,000 physicians on staff, pay approximately $2,421,579,312 in payroll taxes and $512,889,516 in other federal taxes, and have approximately $1.9 billion in trade payables. Hospitals currently under development would employ approximately 21,700 more individuals. With approximately 50 physician-owned hospitals, Texas leads the nation in the number of physician-owned hospitals. The Texas economy could lose more than $2.3 billion and more than 22,000 jobs.

In my district, the 18th Congressional District of Houston, Texas, St. Joseph Medical Center is a general acute care hospital that treats all patients. In fact, its 40 percent Medicaid patient population is double the average hospital's patient population in the entire State of Texas and is one of the highest in the country. St. Joseph's was operated by the Sisters of Charity for many years until it was scheduled to be closed because the order could no longer support it. The hospital was offered to for-profit and not-for-profit hospital systems but no one would accept responsibility for operating St. Joseph's. A plan was developed to convert the hospital into condominiums. I refused to allow that to happen. It was only at that point that the physicians who had practiced there for many years came together to buy the hospital to save it from closing.

St. Joseph's takes care of patients covered by Medicare and Medicaid, as well as patients who are uninsured or cannot pay for their care. The emergency departments of many physician-owned ``specialty hospitals'' have been criticized for not having a true emergency department. St. Joseph's has a department which is open 24 hours per day, 7 days per week, providing an access point for patients in need of emergency services. In fact, St. Joseph's admissions through the emergency department are double the State average;

St. Luke's hospital in Houston, which is church-owned, has three new facilities under development; the nonprofit religious mission has the controlling interest. One full-service hospital has one phase already operating, but would be under the growth restrictions; the hospital cannot be completed if the new restrictions apply. The hospital brought approximately 300 new jobs to the community; and Baylor Health Care System, based in Dallas, has found that their partnership with physicians has increased measurable quality, increased patient satisfaction, and decreased the cost in the delivery of their excellent care. This joint venture model has produced a heart hospital that has the lowest readmission rate in the entire United States. And yet this bill would deny Baylor Health Care System the right to add a single operating room or procedure room to meet its community's need. During the moratorium on physician-owned hospitals some years ago, Baylor wanted to add a badly needed OB/GYN service at its Frisco, Texas, hospital. This service is a money losing service, but there was no such service within many miles for those people--Baylor fulfilled the need. It was prohibited from adding this service simply because the hospital had physicians holding a minority of the ownership of the hospital. After the moratorium was lifted, the service was added and is currently working at its capacity.

Mr. Speaker, can we imagine witnessing an impact, of no patient beds, 6- to 8-hour waiting times, to extend even to 10-hour waiting times, turning emergency patients away at the door? Can we imagine the dramatic case, when patients are not able to have access to quality care? This is true of the most serious trauma, of the most serious medical cases. Physician owned hospitals serve in many cases at least 40 percent of the city's population. I don't just mean the city's population. We are discussing a population that is between 500,000, which is the indigenous population, and the population of 1.5 million that's in the city every day.

When a hospital downsizes in a particular city, it extends beyond the boundaries of that city, and in doing so, with this hospital being downsized, it's impacting all of the hospitals, not only in the city, but those hospitals in nearby jurisdictions. We're seeing

the epicenter of a catastrophic event, and unless we realize the importance of this one medical facility, but look at it not from the perspective that it serves this city, but we have to realize that it serves the world. It serves the Nation. At the very least, it serves the Nation; at the very most, it most serves the world. So when you start looking at it from those perspectives, then it becomes more than just a problem of Houston, Texas, but a problem of this Nation. And it should be addressed in that manner.

If we do not work closely together to look deeper at this issue, we will face a number of medical facility closures that is a disservice to the American people. So, we see that there seems to be a phasing-back or cutback in all of the major services, but the most important of those services, which directly affect the health and well-being of the citizens, or again, those 1.5 million people who visit and work in the city every day. So, we hear the same thing time and time again, even though individuals are saying that the patient caseload can be handled by the surrounding hospitals. You need but step into any emergency room on any day, at any time, and just see the impact of this one hospital being downsized. The impact will reach out throughout the city of Houston.

Again, a true indication of the success of any city government, or any country, is its ability to care for its weak, its injured, its sick, its young, and its old. The ability to care--compassion. Let us be honest--we see the faces of those individuals who we cannot help, because the system has failed them, and they ask us for help. What do we tell them? You never want to lie to a patient. You want to be honest and up-front with this patient. But you reach a point where, in some cases, it's best that you say nothing.

How can we tell a family member sitting across from me, in the back of my ambulance, with their loved one lying on the cot as we do CPR, cardiopulmonary resuscitation, on them, ``Ma'am, I'm sorry, we're going to have to go on the other side of the city because St. Joseph's Hospital is closed''? Then, when we get there, the doctors come to the family member and say, ``I'm sorry, your husband, your son, your daughter, your child, has died.''

How do we explain that to them: We passed the hospital that may have made the difference in this case. The ability to care, to show compassion: It's just apparent to me that that just doesn't exist now. To sign off on anything less is to simply say, we turn our back on the community; we turn our back on the Nation. To do that, is to give away what makes us human. I think now is the time that we make that decision: Whether we are unwilling to turn away from what makes us human, or give in to those individuals who seek to benefit from others' miseries. Those individuals know who they are. I think now is the calling time. Now the horn is being blown, and we've got to answer. But first, the failure of every part of civilization is first, the inability to care for its population. From there, it tends to go downhill.

This is a national problem, but we should be setting the trend, we should set the example for the entire Nation that hospitals like St. Joseph's Hospital do more than just care for our sick and injured. They represent our capacity to care. There is a duty to act and a passion to care.

H.R. 3962 is a bill that will change the health dynamics positively for all Americans--but it is a work in progress. In the manager's amendment after weeks of meeting with the leadership our efforts to seek some relief for physician-owned hospitals was achieved. It is not a winning formula, however on pages 22-23 of the manager's amendment we secured language that says that all physician-owned hospitals should not be treated alike. I have introduced two amendments to cover extending the grandfathering in of physician-owned hospitals and on criteria for other physician-owned hospitals. However, our work is not finished--we must work with the Senate and in conference to keep quality health care.

For the RECORD, I have attached a chart on Texas uninsured, benefits for the 18th Congressional District, and physician-owned hospitals.

This is a vital issue which must be corrected or the bill moves through Congress and for physician-owned hospitals to survive and grow. Martin Luther King, Jr. often told the story of the priest, the Levite and the good Samaritan. ``The first question that the priest and Levite asked was ``If I stop to help this man, what will happen to me?'' But, the Good Samaritan reversed the question ``If I do not stop to help this man, what will happen to him?'' Today, we can be the Good Samaritan--to help all Americans access good health care. Finally a special thanks to Chairmen RANGEL, WAXMAN, and MILLER and a very, very thank you to Congressman JOHN DINGELL and the late Senator Edward M. Kennedy.

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No insurance. Texas has the highest rate of uninsured with about 6 million uninsured.


Benefits of the Affordable Health Care for America Act in the 18th Congressional district of Texas

The Affordable Health Care for America Act will make health care affordable for the middle class, provide security for seniors, and guarantee access to health insurance coverage for the uninsured--while responsibly reducing the federal deficit over the next decade and beyond. This analysis examines the benefits of the legislation in the 18th Congressional District of Texas. Congresswoman Sheila Jackson-Lee represents the district.

In Congresswoman Jackson-Lee's district, the Affordable Health Care for America Act will:

Improve employer-based coverage for 279,000 residents.

Provide credits to help pay for coverage for up to 186,000 households.

Improve Medicare for 70,000 beneficiaries, including closing the prescription drug donut hole for 5,300 seniors.

Allow 16,600 small businesses to obtain affordable health care coverage and provide tax credits to help reduce health insurance costs for up to 14,600 small businesses.

Provide coverage for 187,000 uninsured residents.

Protect up to 500 families from bankruptcy due to unaffordable health care costs.

Reduce the cost of uncompensated care for hospitals and health care providers by $49 million.


Better health care coverage for the insured. Approximately 41% of the district's population, 279,000 residents, receive health care coverage from their employer. Under the legislation, individuals and families with employer-based coverage can keep the health insurance coverage they have now, and it will get better. As a result of the insurance reforms in the bill, there will be no co-pays or deductibles for preventive care; no more rate increases or coverage denials for pre-existing conditions, gender, or occupation; and guaranteed oral, vision, and hearing benefits for children.

Affordable health care for the uninsured. Those who do not receive health care coverage through their employer will be able to purchase coverage at group rates through a health insurance exchange. Individuals and families with an income of up to four times the federal poverty level--an income of up to $88,000 for a family of four--will receive affordability credits to help cover the cost of coverage. There are 186,000 households in the district that could qualify for these affordability credits if they need to purchase their own coverage.

Coverage for individuals with pre-existing conditions. There are 27,600 individuals in the district who have pre-existing medical conditions that could prevent them from buying insurance. Under the bill's insurance reforms, they will now be able to purchase affordable coverage.


Ms. JACKSON-LEE of Texas. Mr. Speaker, I rise in strong opposition to this amendment.

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This amendment critically threatens women throughout America, and is unquestionably a ban on abortion coverage. H.R. 3962 already provided for no federal dollars to be used for abortion--now this bill denies women the reimbursement for insurance to provide them good health care.

This amendment acutely threatens the personal liberties of our country's most vulnerable women. It negatively affects these women's health, wellbeing, and financial security. This amendment will disproportionally affect women of color. According to the Center for Disease Control, ``the abortion ratio for black women (467 per 1,000 live births) was 2.9 times the ratio for white women (158 per 1,000), and the ratio for women of the heterogeneous ``other'' race category (319 per 1,000) was 2.0 times the ratio for white women. The abortion rate for black women (28 per 1,000 women) was 3.1 times the rate for white women (nine per 1,000), whereas the abortion rate for women of other races (18 per 1,000 women) was 2.0 times the rate for white women.'' We should not be so nai 4ve to believe that these statistics represent anything less than the reality that minority women have less financial and personal autonomy. Women who decide to abort a pregnancy are not acting on whim or caprice. Rather, the decision to abort is a painful decision process borne out of necessity. I do not support these higher statistics among minority women, however their lives should not be jeopardized because of botched abortions.

As a woman of faith myself, the issue of abortion is very dear to me. I must begin by saying that I am not pro-abortion, I am pro-choice. The early termination of a fetus is a terribly sad and unfortunate event, and the decision to abort is a long and difficult one. Situations arise in which a woman is forced to make the very tough decision about something very private and personal. In situations like this I believe strongly in a woman's right to choose. It is her body and any law prohibiting woman from having total control over their bodies is in violation of our constitutional rights.

I have always supported a woman's right to choose. The decision to have a baby is something between a woman, her family, her faith and her doctor. This is an instance where the federal government does not need to be involved. It is my hope that society will continue to be progressive in their decisions, and if a woman decides to terminate her pregnancy, there are places that she can go to have the procedure done safely.

The Supreme Court in 1973, in the landmark case of Roe v. Wade, ruled that a woman's right to have an abortion is a constitutionally protected right. Judge Blackmon wrote that ``a statute that criminalizes abortion is violative of the Due Process Clause of the Fourteenth Amendment and the abortion decision and its effectuation must be left to the medical judgment of the pregnant woman's attending physician.''

The Stupak-Pitts amendment effectively reverses a women's control over her body. According to a 2002 study by the Guttmacher Institute, 90 percent of private policies currently cover abortion services. If this amendment is adopted, it will instantly modify the insurance coverage for the millions of women whose current insurance plans include coverage for abortion care. These women entered into their insurance contracts with the guarantee that potential abortions would be covered. Yet, if this amendment is passed, every women covered under the new health care system would have to purchase supplemental insurance or pay out of pocket for abortions. It is estimated that one third of Americans will have an abortion in their lifetime. If this amendment is adopted, thousands of women will be unable to afford a procedure for unpredictable and unwanted pregnancies. This would essentially be a ban on abortions for these women.

This is an unacceptable violation of a woman's personal sovereignty. I strongly oppose this amendment.

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