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Public Statements


Floor Speech

Location: Washington, DC

Mr. BURGESS. I thank you for yielding. I really thank you for bringing this important topic to the floor tonight.

Look, we are 6 months and 6 days away from the full-on implementation of the Affordable Care Act. We are 3 months and 6 days away from the open enrollment period of October 1. I just can't help but feel it's like a fast-moving train that's charging down the tracks, moving toward a head-on collision with the American economy, and it's going to be the small business that suffers the devastating effects of that head-on collision.

We've had opportunities to talk to the people from the agencies to the extent that they will. I'm worried. I don't see how they can have that Federal hub up and running by October 1 and have it work the way it's intended the very first time, especially if they don't have time to test it before they turn it loose on the American people. I am very worried about what the world is going to look like after January 1.

I've got to tell you, from the standpoint of a practicing physician of a small practice--we had five doctors in my practice--well, look. Remember when part D came? Maybe you don't. I was here on January 1 of 2006. It was rough for the first several weeks, but there we were talking about the prescription drug benefit for seniors on Medicare, for maybe 42 million, 45 million people out of 310 million people. We were just talking about the prescription drug benefit, and that was difficult to implement.

There were pharmacists all over the country who basically did not get paid for the prescriptions that they filled for 1 month to 6 weeks, but they were able to keep going because they had other prescriptions, they had other business going on in their pharmacies. But this is going to be everything from tonsillectomies, to childhood vaccinations, to ER visits. If the cash flow is disrupted for even just a few weeks, the small businesses, which are medical practices in this country, will have a very difficult time enduring.

More importantly--and you all have correctly addressed it--is the 29ers and 49ers in this country, the people who are scared to add one more than 49 people to their employment rolls or the people who've had their hours now cut to 29 hours a week so that they will not require a health care benefit.

That wasn't the way it was supposed to work. The gentleman from Kentucky nailed it right off. The people of America in 2009 were saying to us, Whatever you do, don't mess up the system that's working for 65 percent or 70 percent of us. The other thing they said was, If you're going to do anything at all, please help us with costs. And what have we done? Exactly the opposite. We've messed up the entire system, and it's becoming more and more apparent every day. If you don't believe me, wait until a year from now or 16 months from now, and just see how bad it is.

The other thing is we didn't do anything to help with cost. If anything, we've made it worse. By ratcheting up the demand side, not increasing the number of providers, we've guaranteed that prices are going to go up not just next year and not just the year after that, but for every foreseeable year in the future. And I know that's hard for people to estimate. I know the Congressional Budget Office can't give us a figure on that. Just do the arithmetic yourself in your head, on the back of an envelope and you'll be able to see that we are headed for a significant disaster.

It's all well and good for me to criticize the administration and the way they've implemented this, but I've got to ask: Where are our Democratic colleagues? Where are the solutions that they're offering? Clearly we should do something to help the small business owner who is having to restrict employment hours to 29 hours a week. Surely we should do something to help that. Where are the solutions from the other side? They're nonexistent.

We should do something to help that small employer who wants to grow beyond 49 employees, but is now frightened to do so. Where are our Democratic counterparts? Where are the people from the agencies coming to our committee and talking to us about how this might be managed or maintained? Why aren't they talking to us about their contingency plans? You know they've got them. You know they're over there at the Department of Health and Human Services right now talking about what if the Federal hub doesn't work, what if it doesn't work the way it was intended. We'll have to have a way of narrowing the scope, of confining the number of people we bring into this new ObamaCare environment. But they won't talk to us about that. The Democrats won't come forward with a solution.

We're doing what we can to bring people's attention to this very important topic. To some it may be complaining; but if you don't think about it, you can't prepare. And If you're not prepared, it is the unprepared person who is really going to suffer in this new environment that, again, is created in 6 months and 6 days.

I do thank the gentlelady for bringing this topic to the floor tonight. I think it is important that we continue to talk about it and we continue to talk about our ideas and our solutions. There are many out there. And people need to assess for themselves how they will be best served in this new environment that's brought by the administration, or perhaps it's not too late or perhaps there are some things we can do to alter that course, to move it off that center of destruction where it's aimed right now.

I thank the gentlelady for having this tonight.

Mrs. ELLMERS. Thank you to my colleague from Texas. His insight on this very important issue is vital to coming up with the solutions that we need.

I do want to touch on one of the points that you were making, Dr. Burgess. Basically, I saw a report this morning put out by the Republican Study Committee that basically said that there was a study that is showing that we will have a shortage of 30,000 doctors within this country in 2 years. That is devastating.

Mr. BURGESS. You know, you're in a medical family. I know because I hear it everywhere I go. Physicians all across the country are concerned. They don't know what they're getting into, and they don't know what the world will look like.

As a consequence, like anyone else, they are reluctant to make those big decisions, they're reluctant to hire a partner, buy a new piece of equipment, open a branch office. They are like everyone else: they are in that hunker-down mode where so many small businesses have been for the last 4 1/2 years.

But without expanding the provider core, without expanding the health care manpower, you can pretty much predict that there is going to be a price spike because you know you're ratcheting up demand by increasing coverage, and at the same time you're not providing for areas where those people can be seen.

What's really unfortunate, by some of the means with which coverage has been expanded, we already know that there are places in this country where it is hard to get a new patient appointment if you're a Medicaid patient. The reimbursement rate is so abysmally low that a provider can't possibly keep their doors open if they accept those levels of payment. As a consequence, they don't. What are those patients going to do? They do what they've always done and go to the emergency room, which is the highest cost point of contact care that you can have.

So instead of solving a problem that every Democrat here talked about 4 1/2 years ago, we've doubled down and

made it worse. Again, as a consequence, the cost of care is going to go up and providers are going to drop out just because the frustration is going to get so high that it will simply not be worthwhile to continue in practice, or you'll go work in a practice environment where you simply don't have to put in the number of hours that you would in a solo or small-group practice.

But we've really selected against those practitioners, those men and women who go to work every day early before the sun comes up and they work until after the sun goes down taking care of their patients. We're actually self-selecting against that very type of individual that we all knew, we all grew up with, we all look to as our leaders in the medical profession. It will be very difficult for those people to endure.

We'll look to academic medical centers, perhaps to hospitals, perhaps to the government itself for that leadership, but it's not going to be the same thing.

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