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GOP Doctors Caucus

Floor Speech

Location: Washington, DC


Mr. BURGESS. I thank the gentleman for yielding.

Of course the doctor from Maryland makes an excellent point about having an insurance card--in this case, a Medicare card--that it does not necessarily guarantee access to care. I would see it literally every month in my practice. Being an obstetrician, if I'm called by the emergency room doctor to attend to a patient who is pregnant, under EMTALA laws I have got 30 minutes to show up or I get fined $50,000, so I would always show up.

The difficulty is that, although she was pregnant, sometimes the problem that brought her to the emergency room was something unrelated to pregnancy, such as a heart murmur, tonsillitis, you name it. I may not be the best person to take care of that particular condition, but, just as the doctor from Tennessee pointed out, it was almost impossible to find someone in a specialty practice who would agree to see that patient. Oftentimes, you would find yourself admitting a patient who might otherwise not require admission but simply so that you could get them the specialist care that they needed. It's a very inefficient and very expensive way to go about getting that care.

Mr. HARRIS. If the gentleman would just yield for a very brief question.

Do you think that's the kind of health care that the women of America deserve?

Mr. BURGESS. Look, it doesn't have to be this way. That's what's so disappointing about every aspect of the Affordable Care Act.

I don't want to get too far into it, but we know now that this law was written by special interest groups, secret deals down closeted in the White House, Senate-constructed deals on Christmas Eve before a snowstorm to get out of town. This was constructed under the worst of possible circumstances. Should it be any surprise to us that the darn thing, regardless of how you feel about everything else, it's just not going to work? And yes, as the gentleman pointed out, the difficulties in obstetric care is just one aspect of that.

If I could, I would like to bring up the point that I was in the Supreme Court the day the oral argument was heard on the individual mandate. I heard the Solicitor General make his argument that the cost of health care is going up because we have people showing up in the emergency room without insurance and everybody needs to be compelled to buy insurance and, by golly, that will fix our problem.

Wait a minute. That ain't going to fix your problem because we know, in the State of Texas, only 31 percent of doctors will see a Medicaid patient. As a consequence, if you expand your numbers of Medicaid patients and you don't have the doctors there to see them, what are they to do? They've got this card in their hand, and they go to the emergency room to get the most expensive care.

I wanted to bring this up because in the Austin American-Statesman this weekend, Dr. Tom Suehs, the executive director of the State Department of Health--or the Executive Commissioner of the Texas Health and Human Services had an op-ed in the Austin American-Statesman. I just want to read the first two paragraphs of his piece:

Do you know how much a Medicaid client pays for an emergency room visit? How about if the visit isn't an emergency? The answer to both questions is the same: nothing. Not one dime.

The Texas Medicaid program paid $467 million for almost 2.5 million emergency visits in 2009, and half of those visits weren't even for emergencies. Yet Federal law makes it virtually impossible for States to charge even small copays to discourage unnecessary emergency room utilization by Medicaid clients.

I think Dr. Suehs has hit the nail on the head here. We have to provide the flexibility back to our States.

But it also belies the question: Who thought of taking a safety net program for blind and disabled nursing home residents, pregnant women, and children and then expanding that to cover 15 million more Americans? That wasn't the way to go about this. There were better ideas out there. For whatever reason, the Obama administration chose not to listen, not to solicit those ideas, and now we have the situation as it exists today.

With that, I thank the gentleman for yielding. I thank him for allowing me to participate in this hour. This is an important subject, one that is not going to go away, and we're going to be talking about it a lot for the next several months and the next several years.


Mr. BURGESS. I thank the gentleman for yielding.

I wanted to make one point on this new Congressional Budget Office score that was provided today. And I know some people are looking at that and saying the cost for the program, for the Affordable Care Act over the next 10 years, was only scored I think at $1.16 trillion--if I can use the words ``only'' and ``trillion'' together in a sentence.

But what many people overlook is that the Congressional Budget Office must score under existing law. And one of the things that existing law does is it cuts physician reimbursement in Medicare by 35 percent on December 31 of this year. So add another $300 billion to $400 billion to that cost just for the so-called sustainable growth rate formula, which has not yet been repealed.

Now we will fix that before the end of the year for at least 1 more year. But the Congressional Budget Office has no way of scoring that. They must go with existing law.

And, of course, with the Independent Payment Advisory Board, the same thing applies. They have to think that those cuts that the Independent Payment Advisory Board is programmed to produce, that they are going to continue occur.

The other thing the Congressional Budget Office cannot easily estimate is the number of people who will be moved off employer-sponsored insurance onto the State exchanges or the Federal exchange. And that is a difficult number to know. The MacKenzie Corporation said it was going to be 30 percent. The Deloitte corporation has said 10 percent. We don't know what that number is. CBO is scoring that at a very low 1 to 2 percent because historically, that is the average of the erosion of employer-sponsored insurance.

Those points are important to remember in looking at these figures.


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