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Public Statements

Affordable Health Care For America Act

Floor Speech

Location: Washington, DC


Mr. DICKS. Mr. Speaker, we have reached a pivotal moment in the House of Representatives today as we are about to approve the most significant expansion of access to health care in America in at least a generation. And the bill we are about to approve also represents the most substantial improvement of the quality of health care in our country that has been passed in the entire time I have been in Congress. I am proud to support this long-overdue and aptly-named legislation, the Affordable Health Care for America Act.

I am particularly pleased that we have come to an agreement within this bill on a provision that I believe will lead to a dramatic improvement in the way we pay for health care for America's seniors under Medicare. Under the current Medicare payment system, providers are reimbursed on a ``fee-for-service'' system that encourages more procedures and office visits. One of the most encouraging aspects of H.R. 3962 is language that will help shift Medicare to a system that is more efficient and that encourages better coordination of health care for seniors.

Medicare's complex reimbursement formula has long punished doctors for providing more cost effective, quality health care. It is truly unfair under our current system that Medicare spends $7,363 per enrollee in a city in my district--Tacoma, Washington--while it spends twice that amount, $14,946, in the small Texas town of McAllen. These differences are largely due to discretionary decisions by physicians that are influenced by the local availability of hospital beds, imaging centers and other resources--and a payment system that rewards growth and more intense use of medical facilities and testing. But this focus on utilization is not only inherently more costly, it tends to ignore the health care outcomes, which should really be the goal of any system of care. And it exacerbates the problem we are already facing with Medicare: out-of-control growth rates. At current trajectory, Medicare will be $660 billion in the red by 2023, highlighting the urgent need to find ways to trim this growth rate. If we could reduce the annual growth in per capita Medicare spending from the national average--3.5 percent--to 2.4 percent, the rate in San Francisco, Medicare could save $1.42 trillion over that period and turn the deficit into a healthy surplus.

So in order to help move us toward this goal and produce a more equitable system of reimbursement, I was pleased to work with a number of concerned Members here in Congress on language in this bill that will enlist the resources of the independent, non-profit Institute of Medicine to examine the existing Medicare geographic payment inequities for both physician and hospital payments and to address the inequities that are clearly contained in our current system. We are also investing $4 billion per year in 2012 and 2013 to make payment rate adjustments so that no geographic area will be disadvantaged during 2012 and 2013.

I am also pleased that a related provision of this bill calls for an additional study by the Institute of Medicine to conceptualize a system of Medicare payments based on quality outcomes versus the current system of ``fee-for-service.'' This ``High-Value Study'' will be completed by April 15, 2011 and the Institute's recommendations will be submitted to the Secretary of Health and Human Services, who will then have 240 days to submit a final implementation plan to Congress. This plan will take effect unless Congress passes a resolution of disapproval by the end of May 2012.

These are very important reforms that I believe will help ensure the solvency of Medicare and promote a more equitable system of health care for seniors that stresses results over process. They are among the many aspects of this overall health care reform package that deserve our support, and I am proud to be speaking today to recognize these provisions and to urge all my colleagues to pass the Affordable Health Care for America Act.


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