Health Care

Floor Speech

Health Care

Mr. PALLONE. Mr. Speaker, this evening I am joined by some of my colleagues who are new Members, and we are going to talk about the President's health care proposals and also what he articulated both in his State of the Union Address, and more recently last Monday when he gave us his budget message.

And my concern, as always, is that President Bush has prioritized, or says he wants to prioritize, health care as an issue and particularly deal with the problem of the uninsured. And we certainly recognize that under his watch as President for the last 6 or 7 years that the problem of the uninsured has grown greater in this country. There are more uninsured than ever. But at the same time the proposals that the President puts forward, in particular the amount of money that has been allocated in his budget for some of these health care needs, does not go along, essentially, with the rhetoric that he has been using, saying that he wants to cover the uninsured and prioritize the concerns of the uninsured.

And, again, I always say my effort is not to chastise the President. I appreciate the fact that President Bush is prioritizing health care and talking about it, because he has the bully pulpit, and to the extent that he is out there talking about health care, it gives us an opportunity in the Congress to address the issue.

But it is unfortunate that the proposals in the budget that he proposes do not really go along with any kind of concerted effort that would be meaningful to address those health care concerns, and particularly the problems of the uninsured.

Before I begin, I wanted to yield to my colleague from Colorado. I know he and I were both watching the debate by our Republican colleagues in the last hour. I know he would like to address some of those concerns.

I yield to the gentleman from Colorado.

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Mr. PALLONE. Mr. Speaker, I appreciate the gentleman's comments. This does directly relate to the health care debate, because if you are in a State where your deficit continues to climb, as we face now under the years of the Republican majority, it is very difficult to address any unmet needs, whether it be health care or whatever, because of the deficit and the constant having to pay back on the debt.

I wanted to say something about what you mentioned in response to our Republican colleagues. I have been here a long time, almost 20 years now, I am in my 19th year. When I first started in 1988, the Democrats were in the majority.

There were a group of Republicans who used to come down every night doing special orders, just like we are, and they would have the pages bring this huge digital clock that literally was the whole length of the well, from this chart over to where my colleague from Colorado is, and there would be two or three pages that would bring this big digital clock down. They would go on and rail about the deficit and the deficit was going up so much a day. This literally went on for like 6 years while I was down here, from when I first started in 1988 until 1994.

In 1994, the Republicans took the majority under Newt Gingrich. The digital clock disappeared, and all we heard were constant spending and going deeper into debt, and nobody in the Republican Party ever mentioned the deficit again as it continued to climb in those years, and particularly now under President Bush. For the life of me, I don't understand where this whole traditional Republican philosophy, which was to care how you spent the money and you didn't want to go into debt, just disappeared from their ideology.

In fact, I have to say, in the last campaign, because you mentioned it, President Clinton was actually at an event that I attended in New Jersey, and I am not sure I can repeat exactly what he said. But essentially he said that he watched the Republican party under their congressional majority in the 12 years or so that they were in the majority go from this party of principles that was worried about not getting involved in wars that were not in the interest of the United States, worrying about the debt and spending money, to a party that just abandoned all these ideals.

He actually said, right now, the Democrats cover both the left and right ideologically, because we are still concerned about the problems of the average person in that we want to cover people who don't have health insurance. We want to make sure people can afford to send their kids to college. But at the same time, we have covered the area where we don't want to get involved in foreign wars or foreign entanglements that are not in our interest. And, most importantly, we are the ones most worried about the debt and trying to make sure we are not spending a lot of money.

Now, all of a sudden, we are in the majority, and they are starting to talk about the deficit that they have grown so much in the last 12 years. It is unbelievable.

When you talk about the health care debate, this goes to the heart of it, because the bottom line is, if you want to expand and deal with the problem of the uninsured, some of them are people that are not going to be able to afford to buy their own health insurance. If you don't have any money because you just keep racking up this huge debt, you are not going to be able to cover the people. So it directly relates.

I just wanted to give these statistics about where we have been in the last few years. If you look at this, the point I have been trying to make is under the President's watch for the last 6 or 7 years, not only have the number of uninsured gone up, but the cost of health care and health insurance keeps rising. Therefore, it has just become unaffordable for a lot of Americans.

This chart says that workers are now paying an average of $1,094 more in annual health care premiums for their families than they did in the year 2000. You can see the problem with the affordability of health care.

Then the next chart has the number of uninsured in 2001, 41.2 million, and the number of uninsured in 2006, 47 million. One million more Americans become uninsured each year under the President's watch.

The chart over there, I will leave to the gentleman to explain.

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Mr. PALLONE. Just briefly, I want to yield to the gentlewoman, and I have my colleague from the Virgin Islands here, too. The problem with what the President has proposed, both in the State of the Union and the budget message on Monday, there are really two major ways to cover more of these uninsured. One is, you do something with the employer-based system, which is traditionally the way most people get their insurance, on the job, so it is easier for employers to provide health insurance and for their employees to contribute to it.

The other, of course, is to build on existing Federal programs, whether it be Medicaid or Medicare or SCHIP, the program for kids, to expand eligibility and make it so more people can sign up for them.

The problem that I wanted to point out tonight, and we will get into it more, is that between the State of the Union address and the budget message, what the President has proposed totally really does nothing to affect either of those areas. He is basically talking about taxing employer-sponsored benefits, group plans, if they are a good plan, and sending people into the individual market with some kind of a tax break. Generally speaking, that is not very helpful because it is going to penalize the people who have a good employer-sponsored plan and at the same time push people into the individual market where they probably cannot afford to buy a good policy. Then with the budget message on Monday, we got all these cuts in Medicaid, SCHIP, the government programs that we would like to see expanded to cover more of the uninsured.

So, between the two, he is addressing the problem but coming with proposals that, in my opinion, actually make it worse.

I yield now to the gentlewoman from Florida. I am glad she is with us tonight.

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Mr. PALLONE. Mr. Speaker, I appreciate the gentlewoman's remarks. You brought it home. It is hard sometimes to talk about the budget. The budget at the Federal level is a very complex thing. But we have to give an explanation, I think, about what the President's proposal is doing, which is really the opposite. It is not going to make it easier to cover the uninsured, it is going to make it more difficult.

I now yield to the gentlewoman from the Virgin Islands, who is a physician and who has been very active in the whole health care issue for a number of years here in the Congress, particularly on the whole health care disparities issue, which is another thing that we haven't really talked about so much in this Congress, but has to be addressed.

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Mr. PALLONE. I appreciate the gentlewoman's comments, and I know how much you have worked on this issue and, in particular, the disparities issues. I could go on, too, with some of these things. We have worked a lot on health care for American Indians and the Indian Health Service. Now, there is a slight increase for the Indian Health Service, but he took out the whole urban Indian issue. And we find a lot of American Indians now gravitating toward urban areas, and he just cut out the whole program for them.

I want to yield to some of the other Members. But if we could just, because it is hard to explain this whole thing with the President's tax initiatives, but I think we should spend a little time on it. In his State of the Union Address, what he basically said is that, for the people who are in employer-sponsored health insurance, which still most Americans get their health insurance that way, a lot of them either through their union or individually with their employers have bargained, if you will, to have a very good health care package that is comprehensive; and what basically he is saying is, if it is too good, I will call it the Cadillac proposal, then we are going to tax you because you don't need such great health coverage. And then, at the same time, whatever money we are going to save on that, we are going to use by giving a tax break for those who go and try to buy insurance through the individual market. But the problem with that is, you know, the individual market is very volatile, very insecure, no guarantee that you can even buy a policy. So most of these people that are uninsured are not in a position to buy a policy in the individual market. So even if they get a break, it is probably not going to mean that much to them that they would actually be able to buy a good policy. So why would you sacrifice people who have a good policy and tax them to pay for people to go into the individual market, which is one that you may not be able to even get into anyway because it is expensive or there are all kinds of problems with eligibility. So that is the biggest concern. I don't know if anybody wants to talk about that, but that is why I think his proposal for employer sponsored care just makes no sense. If anybody wants to address that, otherwise, I will yield to you, and you talk about whatever you would like. The gentleman from Wisconsin.

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Mr. PALLONE. If you could just yield to me for a second. I really appreciate you bringing this up because I think it is so much on point. And I know there is a lot of confusion.

We have a fiscal year that goes from October to October. Last year, when the Republicans were in the majority, they didn't deal with the budget at all. They literally left at the end of the session in their lame duck in December and said, we can't pass the budget, we can't deal with the appropriations, so we are going to go home, and we will leave it to the next Congress. So literally last week, we had to adopt the budget of the appropriations of the previous year that had already began October 1st, and it was level funding. In other words, it was basically a continuing resolution that didn't add any money and used the previous year's budget as a baseline. And even with that, we were able to increase money for veterans' health, for Ryan White, which deals with HIV, for global AIDS, for the National Institutes of Health. The emphasis and the priority was on trying to provide more money for health care even as we were cutting other things, and we did that.

The reality is that President Bush's budget that we got this week, which is for next year, because the last year's budget has not been passed in the Senate and gone to his desk yet, didn't even take into consideration, and in many of the cases, those health care items that he put in this budget are less than what we adopted in that continuing resolution.

So here we are trying to make everything right, and we are not getting any help either from the Republicans last year when they were in the majority or now from the President and the Republicans on the other side. And for them to even come down here tonight and talk about the budget or the deficit is absurd given their record.

I yield back.

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Mr. PALLONE. I appreciate your comments. And I really think it is important that we keep stressing how we want to prioritize these health care needs, and there are so many, whether it is veterans or children or whatever it is.

I just want to give you a couple statistics. And I know it gets so bureaucratic to say, what is he doing up here with these statistics?

When we talk about the uninsured, the biggest groups still are the kids, and the gentlewoman from the Virgin Islands knows how much over the years what this SCHIP or kid care program, that we have tried to prioritize that, send the money back to the States, use their help to try to insure a lot of these kids.

I just use my State, but you could use any State. In my State right now for this SCHIP or kid care program, we have more kids that are eligible, meaning that they could theoretically sign up, or their parents could sign up, for this program than are currently enrolled, even though the program has been around for a while, and that is true in almost every State.

What we were hoping was that the President, in saying he wanted to deal with the uninsured, and knowing that the biggest group of uninsured is children, believe it or not, that he would simply provide funding to at least enroll those kids that are not enrolled who are currently eligible for the program. I am not even talking about expanding eligibility to kids who would not be eligible right now.

We got some statistics because we had a hearing with the Secretary of Health and Human Services earlier this week, and the number of children, if you want to just enroll those who are currently eligible, we figure it would take about $12- to $14 billion over 5 years to keep up with medical inflation to prevent current enrolled children from losing their coverage. I am talking about the ones that are now in the SCHIP program, $12- to $14 billion over 5 years just to make sure that they are still funded, those that are in it, and then at least another $35- to $45 billion over 5 years to reach eligible but uninsured children. These are the ones that could enroll, but they just have not for some reason. Their parents do not know about the program, the application is difficult, who knows.

So you are talking about what, maybe $60 billion over the next 5 years if you want to keep, to keep those that are in the program and expand it to those who are eligible, and we are not even talking about expanding eligibility.

He comes in, the President, in his budget with $5 billion. That would not even allow us to keep up with the kids that are currently in the program. These are not kids that are really poor and the parents are not working. These are working parents. I think the eligibility is up to like $38,000 for a family of four. They are working, but they cannot get health insurance on the job. We went into that before, and so they try to tap into this Federal program.

Well, the Secretary said, well, we think $5 billion is enough, and if it is not, well, then the States will have to take care of it. You know, the States are not in a position, I mean, they already have a hard enough time coming up with the money under the current match without having to go beyond that. So I just use that as an example.

The SCHIP, the kids health care program, is for those kids whose parents are working and who are making a little more money and are not eligible for Medicaid, which is for kids that are actually at the poverty level, like less than $20,000 for a family of four.

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Mr. PALLONE. I appreciate the gentlewoman's comments.

I just wanted to mention one more thing. The President in his budget message highlighted this SCHIP program, this kid care program, saying they are going to get another $5 billion, which, as I said, is not enough to keep up with the kids currently in the program.

But at the same time the Medicaid program, which deals with those who really are in poverty and whose parents probably are not working because they are disabled or whatever their situation is, covers even more kids than the SCHIP, because SCHIP was put in place to try to supplement Medicaid.

So I asked this question of the Secretary. I did not even get a response, because in the President's budget Medicaid, which covers 23 million children, SCHIP only covers 6.6-. So Medicaid covers 23-, SCHIP covers 6.6-. They herald the fact that they are giving $5 billion in extra dollars to SCHIP which does not even keep up with inflation, but in the same time over the 5 years, they cut Federal funding for Medicaid by $25.7 billion, and Medicaid covers, what did we say, five times as many kids and five times the cut. So we are not even talking about the poor kids here. He is just saying, well, forget them. I mean, I am not even addressing the problem of the poor kids and what happens to them.

I yield to the gentleman.

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Mr. PALLONE. Can I just ask you, because I know you are a physician, when we talk about some of these programs like Medicaid, SCHIP, Medicare, and I know the gentlewoman from Florida brought it up. I know it is hard a lot of times when you are on the floor and you talk about doctors and they are not getting enough money for Medicare. They will say the doctors are all making a lot of money; why are you bringing that up?

The reality is we are getting to a crisis now where many physicians simply will not accept payment from some of these programs because the reimbursement rate has gotten so low.

Now, you mentioned Medicare, because that is the big one for seniors and the disabled, and how a lot of doctors now are not even looking to take Medicare, but when you talk about Medicaid, which I mentioned before, that has gotten to the point of no return.

Could I yield to you? Do doctors even take Medicaid in Wisconsin anymore?

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Mr. PALLONE. Well, the one thing that I keep hearing, of course, with the hospitals is their ability to care for what they call uncompensated care. One of the things that the President proposed both in the State of the Union and his budget was to take money from the hospitals that get what they call disproportionate share, DSH. I hate to use these acronyms because it gets so bureaucratic, but your hospitals that have a disproportionate share of people that do not have health insurance, the uncompensated care.

Over the years, we have provided more funding for those hospitals through Medicare and other Federal programs so that they can cover the uninsured. Again, the President says we will give the States more money by cutting the payments to these disproportionate share hospitals.

In my home State of New Jersey, I mean, that is absurd. We have State legislators and the Governor now that are talking about trying to provide some kind of comprehensive health insurance so nobody in New Jersey goes without health insurance. The only way to do that is if the Federal Government provides some additional help in some of the ways we discussed tonight, but if you start cutting back on the funding that is going to these hospitals that cover all these uninsured people, it is like robbing Peter to pay Paul, I guess is the expression. It just does not work.

So I yield to the gentleman.

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Mr. PALLONE. I appreciate your comments, because I know, as a physician and someone so caring, that you really understand how these problems relate to individuals.

I also appreciate the fact that you brought up the issue of priorities, because when we spend so much on the war in Iraq, as you say, we don't have the money, and the gentleman from Colorado talked about the deficit. The fact of the matter is that the President and the Republicans built up this deficit for so long, and now it makes it more difficult for us to find the funds to pay to cover the uninsured in the same way that we are spending all this
money in Iraq, and it means that we don't have the money left.

If I could just conclude, because I know we are running out of time, I do appreciate the fact that, in his State of the Union Address and also in the budget message, that the President was prioritizing health care and pointing out that we have a big problem with the uninsured.

But unless the solutions and the money are there to lead us down the path of covering the uninsured or lowering health care costs, then it is not going to be good enough to just say that is a problem.

I think, as you say, when we talk about going in a new direction, it means that the Democrats and the Democratic majority are determined to not only highlight that these problems exist and that we need to cover the uninsured to reduce cost, but to come up with solutions that practically are going to make a difference. That is why I am so happy that not only are you both here tonight speaking, but just that you are here, because all the new Members and particularly the new Democratic Members, I think, are going to make it possible to address these problems in a practical way.

I would conclude, again, by thanking both of you and everyone who joined us tonight, because we are moving in a new direction, and it is going to make a difference. Thank you.
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