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GOP Doctors Caucus: The Anniversary of ObamaCare

Floor Speech

Location: Washington, DC


Mr. ROE of Tennessee. I thank the gentleman for yielding. I appreciate the opportunity to speak again here on the House floor about health care, something that I've dedicated my life to, as many of us have here on the House floor--Dr. Burgess, Dr. Harris, and others.

I think the thing that has bothered me so much about this, and the reason I've made a choice to come to Congress, is to work on health care. There are many other things I wanted to work on, but this was primary. And I've brought a wealth of experience from our State that tried health care, a program called TennCare, where we reformed our Medicaid program in the '90s and then re-reformed it in the mid-2000s when we realized it didn't work.

What happened? What was the argument? Well, the argument and the promise. What was the promise that the President and the opposing party made during the health care debate? We want to include--which is a good thing--more people in health care, provide coverage for more people.

As Dr. Burgess just pointed out, we had 160 million people in the private insurance market that needed a little tweaking, but didn't need to be blown up, as we are seeing has happened right here. We have our Medicare patients, 47 million of them, already covered.

Medicaid, which we tried to reform in Tennessee, is an entirely different issue because Medicaid doesn't provide, in my opinion, the best quality of care for lower-income people.

There are studies out there. I read one this morning: 900-and-something-thousand patients who were uninsured actually got better health care outcomes than those patients covered by Medicaid. There is something wrong with a plan that you're expanding that doesn't work now. So I think that was one of the things.

What did we find out in Tennessee? What did we discover? Well, we found out we were spending $2.5 billion a year on TennCare in our State; 10 years later we were spending $8.5 billion, over three times what we started out. Half the people that got on TennCare had health insurance and dropped it. This is exactly what you are going to see in the market.

And quality of care went down. Why did it go down? Because when Medicaid paid less, doctors saw less, patients lost access. That is one of the great concerns I have here now, is that right now we don't have enough primary care people, and you are going to see access lost in this State.

I certainly think we have a plethora of ideas about how to improve the health care system. Three years ago, I stood out with Michele Bachmann at midnight outside this Capitol with thousands of people who passionately did not want the Federal Government making their health care decisions. They're still out there. When you go home, you will find out that 55 percent of the folks do not want this and they want it reformed. They want health care reform; they do not want this plan.

I appreciate the opportunity to be down here and speak on this extremely important issue on the third anniversary of ObamaCare.

Mr. BURGESS. I'm so glad that you came to the floor because you bring up an important point. I actually want to ask you a question on one of the things that you brought up.

Many people forget that access to an insurance policy, access to a Federal program, is not the same as access to a physician or access to care. In other words, you can show up with a card, and if there's no office open that takes that card, you're about in the same shape you were before the card was produced. Is that not correct?

Mr. ROE of Tennessee. There's no question, Dr. Burgess. What we saw happen in our State was--the way governments always fix their problem when they overpromise--is they put a plan out there, more people sign up than they thought, as will happen in the exchanges and the subsidies and so forth; and when that happens, the way they balance the budget is they cut the providers--the doctors, the nurse practitioners, the hospitals, the home health care. The people that actually give the care get cut.

They finally cut it enough that it doesn't cover the cost of the care. And when that happens, the providers can no longer afford to see you, which means if you lose access, even if you've got the prettiest looking card in the world but you can't get a doctor to see you, the quality of your health care goes down, and ultimately it increases the cost because the severity of your problem which goes undiagnosed, untreated, is more severe to take care of. And then you show up in the emergency room, which is exactly the wrong place. We saw this over and over in our State.

For instance, in New Jersey right now, I think 60 percent of the primary care providers don't take Medicaid. What good does it do to expand Medicaid in a State when you don't have providers that will see those patients.

Mr. BURGESS. If the gentleman would yield for a further question.

Then where do those patients go for their care? You just said it, but I would love for you to repeat it.

Mr. ROE. If you look at Massachusetts, we were told that the number of ER visits were going to go down. They didn't. They went up. That's exactly where they end up. They end up in the emergency room for primary care, which is where they should not be.

Mr. BURGESS. Well, if the gentleman will yield, Doctor, if I recall correctly, on the floor of this House we heard over and over again the problem with the cost of health care in this country is those people who are uninsured. Those free riders who won't bother to buy insurance, they show up at the emergency room. It is the highest delivery point cost. They're the ones that are driving up the cost of care. I heard this in the Supreme Court the second morning in the oral arguments. The Solicitor General made this very point. It's the free riders that are driving the cost up.

Listening to you, it almost sounds as if patients for whom Medicaid is provided as the point of coverage, if there are no providers to provide that coverage, they do what they've always done. They go to the emergency room, the highest cost point for the access for care. How are we solving that problem by increasing that population?

Mr. ROE of Tennessee. Dr. Burgess, one of the great frustrations I've had in my short 4-year political career here--this is my third term--was there were nine of us in the Physicians Caucus when I showed up here. Not one of us was asked about this bill. I spent my life out there in the private world, 31 years, practicing medicine, providing care for patients, not bureaucracies and this, but actually seeing one patient right after another, delivering their babies, operating on them.

And what happens is, when you have a public program that promises more than it can produce, guess what? You get that patient in the hospital, and because it doesn't pay for the cost of the care, what happens? You shift that cost to the private sector, not only taking in inflation, but that cost shifting, to force it up. And you were led to believe it was the ``free riders.'' It's the public programs that are the biggest problem there, that are forcing those shifts in costs, and hospitals are caught in a dreadful situation.

They agreed to take the cuts in Medicare because they thought they were going to get an increase in insured people. It turns out what Congresswoman Bachmann brought up about how can you lose your private insurance, there may be as many people that lose their private insurance as we increase in Medicaid, which is a failed program now.

How bad is that when you take people who had insurance they liked, and they lost it, and now they are forced to no program or a Medicaid program that is fading?

Mr. BURGESS. As the gentleman also points out, no, members of the Physicians Caucus, the Doctors Caucus, were not frequently or ever consulted on this issue. But I know people--and I know, Mr. Speaker, I must refer my comments to you--who might just be casual observers of the conversation this morning and would say, Well, the two doctors are self-serving. Of course you want to be in charge, because that's the way you are.

But the Governors have a big footprint in the delivery of health care in this country. Where were the Governors? Why were the Governors not down in the East Room of the White House? Why weren't the special interests, why wasn't Pharma, why weren't the insurance companies, why wasn't the Service Employees Industrial Union down at the White House making these decisions and not the Nation's Governors? That's one of the great mysteries that may never be answered, but it's a question the American people should ask themselves. Because in all 50 States in this country, the Governors have an enormous health care footprint. They're the ones that administer the State Medicaid programs. They administer the programs for their employees' health insurance. They have their State prison programs. They have an enormous interest in the cost of health care. The Governors should have been invited from the get-go. It is a travesty that they never were. It's political malpractice that the Governors were not involved in the development of this policy.

Mr. ROE of Tennessee. Will the gentleman yield?


Mr. ROE of Tennessee. One of the things I noticed with our Democratic Governor, Phil Bredesen, who is a health care specialist and was the Governor of our State of Tennessee 8 years during the 2000s, the Obama administration would have been well-served to pay attention to Governor Bredesen, because Governor Bredesen was forced with a situation where he had to balance a budget. The health care costs were eating up this budget, and he had to cut the rolls. That's how the Governor elected to take care of this. After they cut the providers until there weren't any providing, he then had to cut the rolls from the TennCare program. That was very painful and hard to do.

And I would certainly warn Governors out there, when you massively expand these rolls, let me tell you, politically that was very difficult for the legislature and for our Democratic Governor. My hats are off to him for the decisions he had to make. Those were not easy for him to make. And you're absolutely right, the Governors are really the thought processes and the experiments in the local governments and State governments that you can actually do something and see whether it works instead of this massive mess that we have.

I just got a schematic of this yesterday. It's a 21-page--and I should have brought it down here on the House floor--schematic about trying to figure out whether you qualify for health insurance.

Let me tell you how it was when I hired somebody in my office. When I hired a new employee, guess what I did? They came in said, Dr. Roe, do you have health insurance? I said, Yes, we provide health insurance; go sign up on the way out. It took 5 minutes.

This thing is going to take you a week to go through to figure out whether you belong in the Medicaid box, whether you belong in the private insurance box, whether you're going to get it at all, whether you get the subsidy or you don't. It's maddening. And it provides nothing to increase the quality of the care that we are required to do to give to our patients.

Mr. BURGESS. I thank the gentleman for his participation.


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