Health Care

Floor Speech

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Mr. TONKO. Absolutely.

Thank you, Representative Pingree, for leading us in this hour of discussion because there have been many elements of fear that have been introduced into the dialogue, into the discussion--into the debate, if you will--that have been intending to, perhaps, mislead and misinform, and that is not what America needs right now.

America needs a thoughtful, very meaningful discussion on health care--how to provide for certainty for our business community with predictability in their insurance costs--because I do believe most employers want to cover their employees with a sound, basic health care plan. So we also need stability and security.

I think I would share with you the sentiments that we need insurance reform to address the concerns of America--and not just for the uninsured and underinsured. This discussion is as much about those of us who have insurance in hand. The stability and the security of that plan is at risk, so we need to go forward so there is no discrimination for preexisting conditions.

I have heard, and I am certain you have and our colleagues have heard in the freshman class and beyond in the greater audience of this Chamber. We have heard from constituents about the horror stories of premium increases over a short span of 2 years. I'm thinking of a story where there was a 37 percent increase over 2 years, which was the situation for a couple, a married couple, where the wife of that couple had been impacted by a catastrophic illness. They were left then, Representative Pingree, with $18,000 worth of medical bills. It is a growing dynamic of bankruptcy for our American families. Health care costs are driving families to the edge with bankruptcy.

We are also in need of reform that will make certain that there is no dropping your coverage simply because you become ill. That has been a game that has been played on our health care consumers in this country. It needs to stop. Our conference, our House, wants to make certain that those are some of the conditions that are brought about in the insurance reform.

The refusal to renew coverage if you become ill is another obstacle in the way of providing universal health care coverage.

Obviously, a big dynamic is changing jobs, perhaps

starting up a small business on one's own. Oftentimes, they are not allowed to happen out there simply because of the concern for the portability of insurance coverage. Many are losing their jobs, and so 14,000 per day, if not more, are losing health care insurance because of the loss of a job. The list goes on and on. Making certain that there are no co-pays for prevention and wellness programs, these are concepts that are sound insurance reforms that can strengthen the system.

Those who want to provide this message of doom and gloom and who want to use fear tactics are only taking us off track of what ought to be a very focused discussion on what needs to happen, because most world-leading nations offer a tremendous health care policy, and this country is in need of that reform. We have been talking about it for decades. Now is the time for action.

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Mr. TONKO. Absolutely, there is a confusion that exists out there, even with a lack of standardized forms, which is another tool that's used. So there is this confusion.

There is this, I believe, deliberate attempt to make certain that there is a winner in this equation, and it certainly isn't the health care consumer. So many have been concerned about government standing between the patient and the doctor when, in fact, what we have today is the insurance company standing between patient and doctor, where they are limiting. That's why we're asking for reforms here which do not allow for cost caps on what insurance companies are required to cover. We don't want them to be stingy when it comes to providing the health care, especially in prevention and wellness modes, which are so very absolutely essential.

There are out-of-pocket expenses. You talked, Representative Pingree, about the deductibles that this family in Maine had to absorb. We don't want that unlimited in nature. We want caps on what is required of our families out there--our working families across America--and we certainly want to make certain that the co-pays, especially in catastrophic situations, are capped for individuals and families. This is a great bit of service that we can provide.

These whole trite sayings that we're bringing in a Halloween response and all of these individual statements that don't really get to the heart of the matter are disheartening. It's discouraging that there isn't that academic exchange here.

Where is the counteroffer in this House? We have had plans out there for months. We've been talking about things, bringing them to hearing, having forums across the country. There is no alternative that's being offered. Maybe we heard things about status quo and leaving it as it is. Well, we even offer a capitalist model. We offer competition in an exchange that's developed in our bill to make certain that there is the hardiness of a robust, competitive model that is, I think, ``all American'' in its keeping.

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Mr. TONKO. Representative Pingree, I can't help but wonder if that isn't the most classic and bold example of cherry picking. When I listened to Representative Kagen list that number of conditions, preexisting conditions, it excludes a great part of the populace out there. The time for these games is over.

We talk about so many of the people that might be impacted by these preexisting conditions, from toddlers, over to middle age, and yes, even to our seniors.

When I was in the State assembly in New York State for 25 years, for the longest time I represented the largest per capita senior population of any assembly district of the 150 in New York State, so I would hear routinely from seniors. I hear from those same seniors now in this congressional district, and there is concern. There is concern about where their future is going with health care reform.

Well, let me remind all of our seniors out there, this whole process here in the House is about providing stability to Medicare. That is an audience that is critically valuable to this country, people who worked through their lifetimes and now deserve--I think it is an American right--quality health care.

When people talk about fear tactics, telling people that your Medicare coverage is going to be weakened, let me remind everybody that the cuts in Medicare were up to 21 percent for next year for our medical community. This bill stops that. Our bill, our final package, will stop that sort of cut. Those payments to physicians would have put the doctor-patient relationship at risk. It would have reduced accessibility for our Nation's seniors. We will avoid that cut. We will provide stability by addressing the solvency of the trust fund for Medicare.

We will go forward and close that doughnut hole. No one, these critics about this process, about the proposals that we have put forth to the American public, the critics that are there now, especially in the political arena, where were they when we played games with the pharmaceutical industry and created a doughnut hole where coverage stopped automatically and then resumed later after we have again impacted financially our senior population?

You talk to seniors, many of them naturally are in need of medications, of pharmaceutical requirements. Why we would exhaust them financially for that basic core need of health care is beyond me. No one talked about that pricetag. No one talked about the billions of dollars we were going to cost the public and what we paid to the industries to do that.

So there is a chance here to turn that around and close that doughnut hole. I don't know what we are going to call it. A jelly donut? We fill it with good, you know, so that people can then have the kind of health care and the pharmaceutical needs will be addressed. That is a basic stability enhancement that is provided with this measure.

Avoiding the 21 percent cuts to physicians is an enhancement. Making certain that we provide these new models for efficiency; effective use of dollars; making certain that home models, medical home models, can be utilized, these are good concepts. And we want to go forward with the sounder Medicare situation, especially with the coming of the baby boomer generation. Everyone has talked about that. We need to make that part of our plan. It is part of our plan, where we provide stability and solvency for Medicare.

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Mr. TONKO. Representative Pingree, I think that obviously there is a lot of discussion and a lot of focus on the cost. I think across the country, 15 years ago 61 percent of our small businesses provided employer-based health care. That's somewhere below 38 percent now. We hear the average cost of a family plan might be 12,000, 13,000, sometimes rising to 14,000, and people have seen record profits in the industry.

We've seen and heard about the insensitivities here this evening anecdotally from various Members. You know, Representative Dahlkemper, Representative Kilroy, and yourself have all talked about these information tidbits that come our way. But I think what really struck me this weekend was the report that was released by America's health insurance plans, where they actually worked out a study, a report, commissioned a report, and they overstated the impact of the Senate finance bill that was voted upon today to overstate the impact on America's families of that plan. That's one solution that's out there. And I found it interesting that the firm that they hired to do the study actually backed away from the report because they said they fragmented it so. They asked them to do just tidbits, portions of that whole bill and then use that to calculate the impact.

So it shows us, it tells us something that we're on to wringing the cost, the excess cost and the inefficiencies out of the system to the point where it's driving corporate greed to now respond in a way that's manufacturing these price tags that are, again, scare tactics to get us off of just and honest debate. And I think that that needs to be shared with the American public. The tax foundation came out with a plan, a review that said that our health care bill will save families, average working middle class families, $1,900 per year.

Now, when they came up with this other study, when they fragmented it out, they didn't allow for the calculation of savings, corresponding savings that are part of the overall huge package of reform. And so it was, again, disingenuous. It was unfair to put something like that out there. But it does tell me, in very bold and noble terms, that there's fear out there that finally there may be a balancing of the scales, where the public will get their shot at good health care insurance reform and not at the expense of greed that has been allowed to run rampant, I think, for a long time.

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Mr. TONKO. And I think, Representative Pingree, I think when we heard Representative Kagen, Dr. KAGEN speaking about a standard, basic package that would be required if you want to participate in the exchange, how about, you know, the medical loss ratio that has dwindled over 15 years from 95 percent return of all premiums collected going back for health care purposes to now something below 85 percent, below 80 percent, perhaps. That is unacceptable.

So the standards that we establish, you know, having this medical loss ratio defined, if you want to participate, basic core package, if you want to participate, hey, this is open to any and all. Government sets up the exchange. It stays out of that. The public option will have to sustain its own entity by its premiums. It will have to maintain a reserve. That is not what I would call unfair competition. They're all going to be operating under the same guidelines. And when we sharpen that pencil by requiring a robust public option, it drives the bottom line benefit for the consumer.

We talk about small business and impacts and the future forecast and projections on insurance, today I think of some 430 billion that is the price tag paid by small business for health care provided by the employer. In 9 short years, absent nothing, that is supposed to go

to $880 billion. This is a train wreck waiting to happen. And when you hear the options, when you hear status quo is the option that we should exercise, when you hear let's keep the system but provide more tax benefits so that employers can afford this, how much more is government going to write in terms of checks to keep this system going that is sweeping upward in a curve? We're not containing the costs at all.

So this measure, to Representative Kilroy's comment, is an important way to contain costs, to Representative Dahlkemper's statement of wellness and prevention, by not allowing for copayments on those elements of the plan, that's an important bit of progress. And so I challenge anyone, come in here, talk facts not fiction. Come in here with sensitivity, not insensitivity, and let's really put this package together. It's a work in progress. It's been tremendous.

I'm seeing the benefits that the freshmen class has brought to this discussion. I think it's uncluttered thinking. We've brought the debate into, I think, a really good setting so that we can move forward by adding our voices to this effort, and it's really a pleasure to work with my freshmen class.

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