Michael Burgess

Mr. BURGESS

Mr. BURGESS. Madam Speaker, we heard just a few minutes ago from the other side that it is time to show the American people what is in this bill. I couldn't agree more. It is high time. So with an acknowledgement to Dr. John Goodman at the National Center for Policy Analysis, let me just run through a few of the numbers. Nineteen million people are predicted to lose their employer- sponsored insurance. Thirty-three million people, the number of people in traditional Medicare, at risk because of cuts in Medicare spending, according to the Medicare chief actuary. There will be no tax increases for anyone who earns less than $200,000, except the 73 million people who earn less than $200,000 who will see their tax bill rise, according to the Joint Committee on Taxation. A 2.3 percent hidden tax on medical supplies, class II medical supplies, sutures, syringes, needles, some pregnancy tests, a 10 percent tax on tanning salons, according to the reconciliation summary, and a $60 billion hidden tax on health insurance. To quote, ``The average family will save $2,500 in health care costs by the time I complete my first term as President of the United States.'' However, according to the Congressional Budget Office, a $2,100 premium increase for the average family. There is a lot more like this, and I will be exposing this over the coming days.

Mr. BURGESS

Mr. BURGESS. I thank the gentleman for yielding. There's lots of things I could say. Let me say this on the physician fix in Medicare, because that has been something that has been left out of the equation. The Democrats do say that they passed a bill last fall that the Republicans tried to block and the Senate won't take up, but the fact of the matter is they haven't got it done. What does it really cost to repeal the sustainable growth rate formula? I have some familiarity because this is something I have worked on ever since I first got here. Three years ago, the Congressional Budget Office score to repeal the sustainable growth rate formula was in the neighborhood of $290 billion over 10 years. But what happens, as we all know, every year that we don't fix the SGR, that dollar figure that should have been saved gets added on to the cost of the fix. There is no way that the cost of fixing the sustainable growth rate formula is 1 dollar less than $300 billion. It is likely $350 billion or more. What many of us conveniently choose to ignore is that there will have to be something done to protect seniors who are part B participants, because the premium paid by the seniors in part B is, by law, fixed at 25 percent of the cost of the part B program the previous year. Well, if you add that much money to the cost of the part B program, guess what's going to happen to that senior's 25 percent of their premium? It's going to go up significantly. Well, in Congress, sometimes we don't like to do that because it makes people mad at us and they get grouchy around election time and they won't vote for us, so we are likely to do something to hold seniors harmless from that rate increase. And, as a consequence, that makes the cost of repealing the SGR even higher. When you hear people talk about perhaps it can cost as much as $400 billion to repeal the SGR, they are talking about, yes, the true cost of repealing the SGR and a protection for seniors--at least low-income seniors--in the part B program. All of that is going to cost money. That's the reason that that number gets inflated so high. Yes, there were some tricks and gimmicks that were used when the Democrats had their bill here in the fall to hold that cost down to, I think it was, $240 billion or $250 billion. The fact of the matter remains that it is a huge expenditure completely left off the CBO, Congressional Budget Office, tally sheet. As a consequence, you're not being honest with the American people if you said, Well, this is going to be the greatest revenue saver of all time. Nonsense. Start that story with, ``Once upon a time,'' and finish it with, ``And they lived happily ever after,'' because it is truly a fairy tale or a bedtime story, except it's kind of scary when you think of what your children are going to have to face with the amount of debt we are laying at their feet. Again, this has been through both the Republican and Democratic- controlled House of Representatives that we have let this happen. It's not to put all the culpability at the feet of the Democrats on the SGR formula, but they are culpable in this regard: They are not attesting to it. They are not accounting for it in this formula or in this score sheet, this tally sheet they have. And then they're going blithely around the country talking about how this is going to save the greatest amount of revenue that anyone has ever seen in peacetime. The President is going to have a signing ceremony tomorrow for the bill that we passed. He is then embarking upon a tour to sell the American people on the concept of what we passed. That's getting a little backwards, isn't it? Shouldn't we have engaged the American people and gathered the popular support from around the country for this bill before we passed it through the House and the Senate and signed it down at the White House? This has been their problem all along. I have said it before, but it bears repeating. If you do not have popular support for a measure this large, then it's no great surprise that the people push back. And because the people pushed back, yeah, the Republicans didn't want this and they didn't vote for it, but it was the Democrats within their own conference, within their own caucus. This was a fight in the Democratic caucus. Because how can you go home and face your constituents when they have told you over and over and over again in town halls, telephone town halls, emails, cards, faxes, letters, they have told you over and over and over again, We don't want you to do this. We don't trust you. The congressional approval rating right now is 17 percent and dropping. We don't trust you to do this. You won't read the bill. You won't take the insurance yourself. Why should we believe you that you can do something this large? Now had we taken an alternative approach, which was rejected by the President, rejected by the Speaker of the House, but had we taken an alternative approach and said, Let's take three things that are really bugging people and try to fix them, and maybe if they see we can do that, maybe they'll give us the permission to work on a few more things. So instead of a 1,000-page bill that became a 2,000-page bill that became a 3,000-page bill that became a 4,000-page bill--and this was a 4,000-page bill, by the way. There was 2,700 pages in the Senate legislation, and then another 1,300 pages in reconciliation. That's a lot of pages for the American people to have to sort through on a weekend. And many brave souls, I'm sure, tried. Rather than doing a 4,000-page bill, let's do three or five 50-page bills and try to take care of some of the problems. You know, here's the sad part. Because a lot of the benefits are shifted out so far because it's just going to take a long time to build the infrastructure and the bureaucracy to administer these things, they're ironically going to do some of the things that John McCain suggested during the campaign. They're going to create risk pools for people with preexisting conditions, and subsidize these risk pools, and get people some help right away. That's a good thing. I would support that. I would have supported that a year ago, had we said, Look, we know we want to work on a big health care bill, but let's get some help for the people that are really needing it right now. And that poor group of people with preexisting conditions, there is a way we can help them. The Congressional Budget Office scored that at about a $20 billion cost over 10 years' time. I personally think it's going to be a little bit higher. But that's a far sight less than a trillion-dollar bill. So why didn't we do that a year ago? Why didn't we have a hearing on it in my committee? Why didn't we call in some experts and say, How do you get this done? We are still going to pass a big bill at some point, but we just really want to help these poor folks who have preexisting conditions today. Why didn't we have a hearing on, What do we need to do to help people who are perhaps facing early retirement, a way to buy into Medicare? Or is there some other type of insurance product that might be out there? Might we do something in the marketplace that would allow a product to be developed and sold for them? We didn't even try. We didn't have a hearing. We didn't talk about it. We just said, No, we're going to do mandates. We're going to do a public option. We'd love to do a single- payer if we thought we could pull the wool over the American people's eyes for just a few more days, and this is what we want to do. The reality is that people would look back at it and say, No, you can't do that to us. Mandates are unconstitutional. What about equal protection under the law? This deem and pass thing that they flirted with for a few days really got people in a snit until they finally backed off on that. But why be so duplicitous? Why be so fancy about passing these things? Make it a straightforward bill. Make it the number of pages that someone could reasonably read in one sitting, and tell people what you're going to do, tell people what you're going to propose. Even better yet, go out amongst the people and find out what they want. This is what I did with my nine principles that I have developed for health care reform that were up on my Web site--or perhaps are still up on my Web site. I listened to the people in my town halls. I listened to the people who were on my telephone town halls. They said, Help us with preexisting conditions. Sell across State lines, fairness in the Tax Code, liability reform, blah, blah, blah. That's what we want. Why didn't we do it that way? Instead we have this gargantuan bill that we shoved down the throats of the American people. And I don't know, we're stuck up here in Washington. We're insulated inside the cocoon. Our phones have been shut down all weekend. Our faxes have been overloaded. So we don't really know what people are thinking out there. But I've got a hunch they're not happy about what we did last night. I'm sorry to have consumed so much time. I will yield back to the gentleman from Iowa.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I, too, am coming to the floor of the House tonight to try to clarify for the American people some of the things that have happened here over the weekend. As you know, we passed a very big bill last night, hasn't been quite 24 hours, it was about 11 p.m. Eastern time when everyone else in the country was watching basketball tournaments and otherwise engaged with weekend activities, this House was in full session, the place was packed, Democrats and Republicans, and we passed a bill that had been passed by the Senate on Christmas Eve. Now, I remember when I first got here, Republicans were in the majority, and when we would pass major pieces of legislation, if there was an all-day fight, we would be accused of waiting until the dark of night to try to sneak this legislation through. Now, I have never been one who would pass on the chance to attribute to coincidence that that can be adequately explained by conspiracy, but how is it that we passed, in the Senate, this very difficult legislation the day before Christmas when America was engaged in other activities, and then here on the floor of the House last night at 11 o'clock on a Sunday when most every other honest American was doing something other than watching their Congress. I do have to address some of the things that I just heard mentioned from the other side. Remember that there were two pieces of legislation passed here last night. One was the previously passed Senate bill which the House passed. That one is on its way down to the White House. That's going to be signed by the President. That's going to be the law. And then we also passed a sham bill, a bill that might be called a fig leaf because no one really likes the Senate bill. The Speaker of the House said that herself. No one wants to vote for the Senate bill, and I agree with the Speaker. No one wanted to vote for the Senate bill. So how did they get their side to vote for the Senate bill? Well, they said don't worry, we are going to fix the problems that you don't like in the Senate bill, and we will do that under reconciliation so it's only going to require 51 votes over in the other body, don't worry, we will get that taken care of. The only problem is, the Senate bill that we passed here last night had already passed the House before last summer--you might not recognize it because it was a housing bill then, but it passed the House last summer--went to the Senate, got changed into a health care bill and then got brought back to the House. And the question before the House, will the House now accept the amendment, the Senate amendment to H.R. 3590, the answer was affirmative, and the bill is on its way down to the White House for a big signing ceremony, probably tomorrow. Now, what's going to happen to the reconciliation bill? It also passed, and it passed, and went back to the Senate. And is there anything that compels the Senate to take up that bill and work on it? Why, no, there is not. In fact, the Senate might rationally argue, I am sorry, Mr. Speaker, the other body might rationally argue that, hey, we already passed our health care bill, we passed it on Christmas Eve, you guys apparently liked it because you ratified the amendments we had to it, and last we saw, it was on its way down to Pennsylvania Avenue to the White House. So why would we pick up this contentious package of fixes in the bill? You know, quite honestly, the oxygen may have all gone out of the room for health care legislation in this Congress. Fourteen months is a long time to have fought this thing, and the Senators may just not have the stomach to pick this thing up and fight through it again. So some of the things that we need to be careful about when people are talking about the bill--and I will do this too, many of us here in the House are not that familiar with the Senate bill that we just passed because it was the Senate bill. We had a health care bill that was marked up in my committee and passed out of committee over my objection July 31. I didn't like the bill, but I knew it. I submitted amendments and some of those were even accepted. So I had a lot of familiarity with that bill. Now, that bill went to the Speaker's office, sat there for a couple of months, got changed all around. All of my amendments got pulled out, every other Republican's amendments were pulled out of that bill. It became a 2,000-page bill, even with the loss of those amendments, and was brought back to this House in early November, and this House passed the House bill. We knew the House bill. Many of us were--although we didn't like the House bill, we were fairly comfortable with what it contained and what it didn't contain. The Senate bill is completely different. Most of us did not ever see the Senate bill before the Senate brought it up on Thanksgiving and then passed it right before Christmas. Mr. Speaker, quite honestly, many of us felt like we'd already read a lot of health care bills this year; do we really need to read that Senate bill? Maybe not. Because the Senate will pass it and then the normal procedure is we call a conference committee. We go to conference committee and we debate both sides, get to the debate the House bill, the Senate bill, Republicans and Democrats, a true bicameral process. We're finally going to have that open and transparent process that was promised to us and we'll read the conference report. We won't have to worry about the Senate bill because it's all going to be changed anyway. Except that didn't happen because, for whatever reason, the Democrats did not want to do a conference report. They say it's because Republicans were going to block the appointment of conferees. But, Mr. Speaker, I would just point out to you that in December and early January there were 60 Democratic votes in the Senate, 256 Democratic votes here in the House. There wasn't much we could block, even if we wanted to. So how we would have blocked the appointment of conferees is anyone's guess, but I did hear that mentioned several times during the debate. So let me just set that point straight. They thought they could just put things together on their own outside of a conference, and they were doing a darn good job of it. The last week in December, the first week in January on into the second weekend in January, people were meeting in this Capitol, meeting in this building, in the new Capitol Visitors Center, and putting together the pieces, cutting secret deals with unions, cutting secret deals with this group and that group, and we were going to have a bill that would just be blessed by both sides. No conference report. Not necessary because we'll just bring a new bill to the floor that will be the amalgamated bill. The Senate will vote for it. They've got 60 votes. The House will vote for it. They've got 256. And if they don't lose too many, then they can pass pretty much whatever they want. Then we'll have a health care bill. What happened in that scenario was that the second Tuesday in January they had an election in the State of Massachusetts. As a consequence of that election, suddenly the Democrats' 60-vote supermajority in the Senate was no more. Now, the new Senator was not seated for several weeks after that election and there was still time to come together with a hasty conference committee and get that thing done or even push through that amalgamated bill, but, for whatever reason, they didn't do that. It really looked for a while like things might just languish indefinitely. Now we all know the story. In those last 10 days, the President really engaged, the White House engaged, and the Speaker's office engaged. They were just going to get this bill through the House because that was the quickest way--they always say a line is the shortest distance between two points. The shortest distance to getting health care legislation passed in this Congress, in this President's first half of his first term, was to pass the Senate bill through the House. It was something no one wanted to do. No one wanted to vote for that bill. It had awful things. Most of us don't know all of the awful things in that bill because it was the Senate bill. We passed House bills. We knew the House bill, but we heard the minority leader say it last night from this floor, Most of you on the Democratic side do not know what's in that bill. Now, I dare say, today you've learned a lot of what's in that bill because you've got the phone calls from the press the same as I have. Suddenly, the press got real curious about what was in the Senate bill and they're asking all kinds of questions. So tonight perhaps we can deal with some of those. But one of the things I wanted to point out at the very beginning, be careful what you talk about when you hear us talk about what's in the bills, because both sides of the aisle, both Democrats and Republicans, may not be quite sure what's in the bill. We heard testimony, or we heard the speeches on the other side here just a moment ago about how Medicaid rates now were going to be plussed-up for primary care doctors. Medicaid rates will become Medicare rates. Well, that actually, in fact, is only for primary care doctors and it is only for 2 years, but it is also only in the reconciliation bill. Did we pass the reconciliation bill? We did in the House. They haven't in the Senate. What did we pass that has passed the Senate? The Senate bill. And that does not have that plus-up in Medicaid rates. In fact, the expansions of Medicaid that we have now put forward that were in the Senate bill, the expansion of Medicaid, will be reimbursed at standard Medicaid rates, which vary from State to State. But I will tell you, as a medical provider, those put a lot of providers back on their heels, because those rates do not pay the cost of delivering the care, and there is only so much of that kind of business you can do in an average day and still keep your doors open. So there is a problem with expanding Medicaid to larger and larger populations. The provider community is going to find it difficult to be able to absorb that many more Medicaid patients into their practices because the reimbursement rates are going to remain low. In fairness, it was fixed in the reconciliation bill, but if the Senate doesn't take that up, it never happens. It was the skinniest of fig leafs because it's not there when you need it. What is there is the Senate bill, which is on its way down to the White House, and that will be the law of the land, which will expand Medicaid, to be sure, but does it have the enhanced Federal matching in there for Medicaid? In one State it does. In one State it does. The reconciliation bill was going to fix that so all States would have what that one State now has in the Senate bill, but it is the Senate bill, and only one State has that enhanced Federal match for Medicaid: the State of Nebraska. The famous Cornhusker kickback. So what happened here last night, what transpired on the floor of the House last night was really dramatic and, in many ways, a fitting end to the 14 months of chaotic process that had brought us to this point. We've heard over and over and over again--and I don't want to belabor the point, and this may well be the last time that I discuss the process that brought us here. But it is worth mentioning, because over and over and over again last night during the debate we heard, You Republicans obstructed at every step of the way. Remember, there's 177 of us; there's 256 of you. We can't obstruct anything, particularly the House of Representatives, where majority rules on almost everything. And, oh, by the way, the Rules Committee really rules. And the Rules Committee has a nine-to-four advantage for the Speaker. There's not much you can do with 177 Republicans in the House of Representatives if you want to obstruct. Well, you can all hang together and make a principled vote that we're all against this. And that's indeed what has happened. But the real debate was an internal debate within the Democratic caucus, because had they had the votes, they could have done this in February. Had they had the votes, they could have done this in January. They could have done it in December, the day after Christmas, as opposed to the day before Christmas when the Senate bill was passed. If they'd known this was what they were going to end up with, maybe they should have just done that and saved everybody 3 months of additional anxiety. The fact of the matter remains, Republicans did not obstruct this bill. Democrats obstructed this bill. Democrats and, oh, yeah, one other thing. They never had the popular support of the American people. Now think about that for a minute. We passed a bill that's going to affect in a very profound and personal way the next three generations of Americans. That's a pretty big bill. One-sixth or one-seventh of the Nation's economy. That's a pretty big bill. Now, we've heard over and over again, if you're going to do something like that, it needs to be bipartisan. So Republicans should have signed onto the bill. Republicans should have backed the bill. Republicans should have been there. But, wait a minute. The people did not want this bill. Poll after poll after poll has shown, fill in the blanks--52 percent, 55 percent, 60 percent--of the people did not want this House- passed bill, did not want the Senate-passed bill, did not want what the United States Congress was going to do to health care. Now, if you don't have popular support, then even if you've got 256 Democrats and, now, 59 Senators and the White House, it's very difficult to get your Members to--it's a very technical term we use here in the House of Representatives. It's called, ``walking the plank for your leadership.'' It's very difficult to get your Members to walk the plank for leadership when everybody back at home is howling mad because of what you're doing. And I'm sure many people felt--the old saying that Everett Dirksen used to have, ``When I feel the heat, I see the light.'' A lot of people saw the light when they went back home. Now they came back to Washington and got their arms twisted and things promised and things promised to be withheld and goodness knows what and they lined up and walked the plank last night. That's what we saw. People are voting in favor of things they said they would never do. They misled their constituents back home. People turning at 90-degree intersections to principles that they've held for a long time. It was painful to watch. I felt some sorrow for people I saw on the Democratic side having to make these very tough gut-wrenching decisions. These are good people that are well intentioned, but they got pushed into a corner from which there was no escape. And that corner was the Speaker of the House and the President of the United States. And as a consequence, this bill passed, a pretty slim majority. Not a single Republican. In fact, the only thing that was bipartisan about this bill last night was the opposition because you had 30 Democrats standing with 177, or 178 now, Republicans. That was the bipartisan block on this bill, but they were in opposition. This bill presents a real problem for the American people. The American people don't like it. The American people don't want it, but now the American people have it. Now ideally--and people have asked me all day long, Well, what are you, as a Republican, going to do about this now? And the answer is, You fix what you can, and you work toward repeal of the bill. Now working toward repeal of the bill, you've got to ask yourself. There likely will be bills introduced today and bills introduced tomorrow that will call for the repeal of the bill. I may very well sign on to one or more of those bills. But with the same vote total that we had last night, do you think any of those bills are even going to be brought up for debate? Is the Speaker of the House, is the majority leader going to bring up one of those repealed bills and say, Let's go through this argument and see if any of our Members now feel differently? Well, they could. And there is history there. There is precedent there. In the late 1980s, this House passed a seriously flawed catastrophic coverage bill for Medicare. They charged Medicare recipients the premium for that catastrophic insurance; and all across the country, people said, Wait a minute, we didn't want that. We didn't ask for that. You're charging us for something we didn't ask for or want. And the seniors in this country rose up, and the very famous pictures of then-chairman of the Ways and Means Committee, Dan Rostenkowski, being chased out of his own town hall by senior citizens who objected to what they had done. And Congress did come back in short order and repeal that bill. Will that happen now? I don't know. That's a pretty painful thing for people to have to go through. We'll see. We've got an Easter recess coming up. If people do town halls and they get that kind of reaction, maybe we'll be back here talking about one of those repealed bills. But honestly, Mr. Speaker, I think that's a pretty heavy lift to repeal this bill that we passed last night, this bill that's now on its way to the White House to become public law. It's pretty difficult to do that in this Congress because it's not likely that there will be the votes. And then, of course, on the Senate side, it's really not likely that there would be the votes. And if it happened, the President likely would feel differently about it and would exercise his authority to veto that repealed bill, and it is unlikely to get to the threshold of a veto override, two-thirds of the House and two-thirds of the Senate to override a Presidential veto. In fact, if America has the reaction to this bill that I think they're going to have, there may be many more Republicans and many fewer Democrats here in the House of Representatives next year. I don't know if that number will be enough to change the majority control of the House. It sure could be. It certainly looks increasingly likely from the degree of anger and how upset people are that talk about this bill out in the middle part of America. But I don't know if there is the political will to change the majority makeup of the House. Again, even if there is, sure, we'll bring that repealed bill up. We'll bring it up pretty quickly and send it down to the White House, and the White House will veto it. I doubt that there will be a new Congress that's seated that will also have the ability to override a President's veto. Again, that's a tall order, two-thirds of the House, two-thirds of the Senate. So I don't know within the time frame between now and January of 2013, if the numbers work out, for this Congress to have the ability to repeal the bill. It's worth trying. It's worth testing. But I don't know if that's a realistic trajectory. Well, then, what can we do? I think it is extremely important to at least begin to work on some of the more egregious portions of this bill. And I will just tell you, one of the things that really bothers me about this bill that we did is the instituting of an individual mandate to purchase health insurance. Now surely it is the responsible thing for every American, every family to have health insurance against the unlikely but frightening occurrence of some of the diseases that can happen to us as human beings. It's the responsible thing to do. But just because it's the responsible thing to do does not mean that your Federal Government has the responsibility to require you to buy it. We've never done that in this country. Simply as a consequence of being born or living in this country, your Federal Government now says that you're going to buy this product. In fact, when the bill was passed, people said, Well, under the commerce clause, we have the authority to do that. But that kind of turns the commerce clause on its head. The commerce clause is there to protect commerce, but coercing someone to buy a good or service or product and then invoking the commerce clause to protect that transaction really seems to be going at things the wrong way. Now, if an individual State wants to say as a condition of living in our State, there is a mandate that you will buy health insurance--and there are States that have done that, and if their State legislature passes that legislation, and their Governor signs it, and the citizens of that State are okay with that, then good on 'em. That's fine. That is their prerogative. That's one of the things that a State government is there for. If they pass an individual mandate, and the people turn out the State legislature, well, then they learned their lesson. But that's a different set of circumstances than having the Federal Government make that decision that we're going to require everyone to purchase insurance. In my opinion, mandates have no place in a free society; and in my opinion, mandates are not going to get us the kind of coverage numbers that people expect it to. You stop and think for just a minute, for a mandate to work, there has to be general knowledge that this mandate is there; there has to be general knowledge of the penalties that one would possibly incur for not complying with the mandate; and there must be general knowledge that those penalties will be swiftly and surely administered. Now, we do have a model for that in this country, and that is called the Internal Revenue Service. The Internal Revenue Service says that everyone who earns income has to pay a percentage of that income in income tax. In fact, it's withheld from most of us from our paychecks every month. But that income tax must be paid, and we all know that, and we all know that if we don't pay our taxes, we may not know exactly what's around the corner, but most of us know it's something we really don't want to find out about. Now, with such a draconian mandate for Federal income taxes administered by the Internal Revenue Service with such a mandate, you would expect the compliance rate to be pretty high. Well, it is. But it might be lower than what you might think. The compliance rate is around the order of 85, 86 percent. That's with a pretty severe mandate. What about health insurance? Right now it's voluntary. As I said, it's the responsible thing to do. People should have coverage. People want to have coverage. In this country, most people are covered by employer-sponsored insurance. There is another 8 to 15 percent covered in the individual market. But insurance is a responsible thing to do. And in the voluntary program of insurance that we have in this country, what is the problem that we hear about over and over again? We've got 15 percent of our population without health insurance. Well, that does mean conversely you have 85 percent with insurance. And what is the compliance rate with the IRS? It's pretty close to the same number. So are you going to get more of that 15 percent to sign up for health insurance if you put this very draconian, liberty-stealing mandate from the Federal Government out there? I don't think so. I think mandates have no place in a free society; and as a consequence, I don't think they belonged in this bill. Further, what did the stock market do today? It jumped up a bunch, didn't it. You might say, well, see that proves the point, Americans so wanted this health care bill to pass the House of Representatives that they rejoiced by going out and running up the stock market. Or perhaps because insurance companies and pharmaceutical companies are going to profit so much by the fact that you now have to buy health insurance, that their prices went up. Their stock went up because people looked at futures and forecasting and said, wait a minute, insurance might be a good stock to buy because in just a short period of time, everybody in the country is going to have to buy insurance. Wouldn't it be a better approach, instead of mandating people to buy insurance, and again, I don't believe you are going to get a reduction in insurance rates by demanding that everyone buy health insurance, because what incentive is there for the insurance company to hold the price down? There isn't any. If anything, there is an incentive to raise rates because you have to buy it, otherwise the IRS is coming to visit grief upon your household. So the insurance companies may be feeling pretty good about this bill that we just passed last night because they are going to sell a ton of product. You are going to have to buy it, or you get into all kinds of trouble. The IRS is going to come and raise billycane on your head if you don't buy this insurance. So the insurance companies are feeling okay with this. And the pharmaceutical companies, yes, they came to the table with a big bunch of money, and they gave up something to get this health care bill passed. But at the end of the day, the closure of the doughnut hole, yes, but it is for brand name products you get that discount, so they will sell more of that branded product which is the most expensive product, and people are going to blow through that area where they have to match some of the expenses and the catastrophic coverage will kick in pretty darn quick. Pharmaceutical companies may stand to gain a great deal from the passage of this bill. So it is really no surprise that the stock market went up today. Drug companies and insurance companies, they may look to be doing okay in this brave new world order that we gave to the American people last night. A very famous quote from the Speaker earlier in the debate on all of this was: We need to go ahead and pass this bill so people can find out what is in it, and then they will really like it after the fog of the discussion is removed. In fact, I have heard essentially that same statement on the floor here today. One of my friends on the Democrat side said, You know, finally, all of the rhetoric can be put aside and people will see what is in this bill, and they will really like it. So let's talk about what is really in this bill, and I will leave it up to the American people how much they like it. We have already talked about the individual mandate. Absolutely unprecedented. The government has never required people to buy a good or service as a condition of lawful residence in the United States. That is a quote from the Congressional Budget Office. It will be invoked under the commerce clause. The power to regulate commerce among the States is not unlimited. And here is a thought: What if the courts allowed this to stand? What if that power was in fact unlimited? Your imagination almost cannot handle what some of the things that your Federal Government might decide to do if we removed that power, or we removed that condition on exercising that power. Some of the other things that are going to be found in this bill are tax increases. I know I heard it over and over again during the debate that the Republicans shouldn't mislead people about tax increases in the bill, but they are there for all to see. Go to the Web site Thomas, the Library of Congress Web site, and download the CBO letter on S. 3590, the Senate-passed bill, and look at some of the tax increases that are there. Medicare cuts, are they there? Yesterday the Democrats kept saying, There are no cuts to Medicare in this bill. Well, there darn sure are. Again, looking at the tables at the back of the CBO report, some of them look to be pretty darn significant. Reductions in annual updates to Medicare fee-for-service payment rates over the period 2010 to 2019, that is a 10-year budget cycle, that is a cut of $86 billion. Medicare Advantage rates based on plan bids, that is cut $118 billion. Medicare and Medicaid disproportionate share hospital payments, that is cut $43 billion over that 10 years. Community living assistance services and supports, that is cut $70 billion over 10 years. One of the things that is really disingenuous about these cuts, and they have it laid out year over year in the Congressional Budget Office report, and the next 4 or 5 years those cuts are actually pretty modest, and then they really kick in the last 5 or 6 years. And we all know there is a big Presidential election coming up again in 2012, and so perhaps it is no accident that those cuts are diminished in the early years and then expanded in the out-years. Payment adjustments for home health care, that is almost $40 billion in reduction. Again, Medicare disproportionate share hospital payments down significantly. That is one of the significant things. It is hard for people to understand what is a disproportionate share hospital payment. Some hospitals see--and remember I told you that Medicaid doesn't really reimburse providers the cost of providing their care. Now no one cares so much about the doctor because who needs doctors in the health care system anyway, but we do care about hospitals. And hospitals historically have been protected. If they see what is called a disproportionate share of uninsured patients or underinsured patients, Medicaid where the reimbursement rate is low, they get a plus-up from the Federal Government, and it is called a disproportionate share payment. One of the things that they did in the State of Massachusetts, they said we are giving all of this money to hospitals for disproportionate share payments, what if we just took that money and helped people buy insurance? Everybody is insured, and then you don't need to provide the disproportionate share payments any longer. But you take a State like mine, a State like Texas, where a great number of the uninsured happen to be in the country without a valid Social Security number, for whatever reason. Now we heard the President of the United States stand here in this House in September and say very clearly that no one who is in this country illegally will be able to participate in any of these benefits. If that is correct, and Texas has a problem with people who are in the country without the benefit of a Social Security number who also happen to be uninsured, they won't be eligible for any of these benefits. They won't be eligible for any of the subsidies in the exchanges. They won't be able to access the insurance that Congress is passing. That is not necessarily a bad thing. You don't want to provide an incentive for someone to come into the country without going through the proper channels. So what are we going to do in a State like Texas where we have vast numbers of uninsured who are there without benefit of a Social Security number? They are still going to access care through the emergency rooms of our safety net hospitals, but we are also at the same time cutting those disproportionate share payments to those hospitals. So the hospitals are actually catching the grief from both sides. Their uninsured and underinsured populations are going to go up, and their reimbursement rates are likely to stay low, and disproportionate share payments are going to go down. That is a business plan that may make sense to the Federal Government, but I bet it doesn't make sense to most hospital administrators who run our safety net hospitals around the country. So anyway, when people tell you that the Republicans are misleading, we are trying to scare you on the Medicare cuts, they are outlined in the Congressional Budget Office report, and they are as plain as day for everybody to see. The subtotal for Medicare cuts: A negative $430 billion over 10 years. Add the other community-living reductions of $70 billion, and that is $500 billion. That is what you have heard Republicans saying for the last several months. You are going to cut Medicare by $500 billion. At the same time, you have more people coming into the Medicare system, and you are really doing nothing to hold down the cost of delivering medical care. You're creating a situation where you're actually going to increase the stress on the system, not decrease the stress on the system; additionally, $500 billion in new taxes coupled with that $500 billion of Medicare cuts. The President stands in front of us and says, And this bill will be paid for; in fact, this bill will reduce the deficit. Well, you're leaving out a big part of one of the things that didn't get fixed in the Senate bill. You've heard me talk before about what's called the sustainable growth rate formula. This is the formula under which doctors are reimbursed in Medicare. Back in 1988, the institution of the, what's called, relative value payment scale, RBRVS, whatever that acronym stands for, every year we tended to try to ratchet down reimbursements to physicians because we felt, if we didn't, they'd just spend too much money. Well, what has happened over time, of course, as doctors' reimbursement rates have gone down, they've tried to see more and more patients so that their bottom line didn't suffer. And, as a consequence, the spending has gone up and the SGR has had exactly the opposite effect of what was intended. We are in a real problem with this formula right now. This year, there were projected to be cuts of almost 21 percent to doctors who provide services to our Medicare patients. The payment rates for part B in Medicare were going to go down by one-fifth. For some specialties, it was going to go down even more than that. But just in general, it was going to go down about 21 percent. We put a stay on that just about a week ago with a bill that passed by voice vote in this Congress, so it wasn't a recorded vote, and this put a stay on that cut until November. What happens then is anyone's guess because we didn't fix the problem in the House-passed bill. I mean, we didn't fix the problem in the Senate-passed bill. That bill's going down to the President for his signature. What's going who happen to the doctors in Medicare? Well, Congress needs to fix that. Why hasn't Congress fixed that, by the way? It's been going on for years. Started with the Democrats, then it got worse under Republicans, and it's getting a whole lot worse now that the Democrats have retaken the majority. Well, why didn't anybody fix that? The reason they don't fix it is because it scores, by the Congressional Budget Office, as a cost, a cost that is, no one really agrees upon the price, but it's somewhere between $250 billion to $350 billion. It could even be more than that if you tried to protect some part B premium payers from the rapid expansion of Medicare costs, Medicare part B costs caused by the rapid increase in repealing the SGR. Remember that part B premiums are based on a formula: 25 percent of the actual cost of administering the part B program. We add another big cost to the part B program in the repeal of the sustainable growth rate formula, and Medicare recipients, Medicare participants in the part B program may see their premiums go up even faster than they've seen them go up the past several years. So that's a problem. If we are honest about addressing the problem, it is likely to be $350 billion to $400 billion. But it could be scored as low as $250 billion if you use some smoke and mirrors, which we try to do when we do budget things. Nevertheless, it's still a big amount of money that will have to be added to this bill, and we didn't do it. We just simply didn't do it. The congressional Democrats told the Congressional Budget Office, don't score the SGR repeal in this bill. Now, the House will tell you that, Hey, we passed an SGR repeal last November, didn't get any Republican support. Oh, wait, they got one. Okay. It was me. But that bill was going nowhere and everybody in this House knew that was going nowhere. In fact, the Senate had previously rejected the same bill 10 days before. So that was another fig leaf. Oh, we're going to take care of the doctors. Let's pass this SGR repeal. And, Oh, the rascals in the Senate or the rascals on the Republican side wouldn't let this thing stand. But the fact of the matter is it hasn't been fixed. The fact of the matter is the Democrats are in charge. The fact of the matter is they need to tell us how they propose to deal with that. This kicking the can down the road--and we did it, too, when we were in power. But this kicking the can down the road is making the problem a lot worse, and it is really putting our seniors at risk of not being able to access physicians. Just look at the statistics out there. A company called Medicus that is a doctor search firm did a survey in December. And kind of depending upon how you ask the question, they said, If the Democrats' health care bill passes, will that affect your decision to retire or continue practicing medicine? If the public option was contained within the bill, almost 45 percent of physicians said they would consider retirement. That doesn't mean 45 percent of doctors will retire, but it meant nearly half of the doctors in this country would seriously look at it. Doctors who were near retirement age, about a quarter of them, about a quarter said, Seriously consider retiring early. Doctors who were nowhere near retirement age, about a fifth of those said, Yeah, I could see myself having to get out of this. Now, if you remove the public option from the equation, if you remove the public option, the number goes down, and it's about 30, 31, 32 percent of doctors who would consider retiring early. A significant number of those who are already near retirement age, about 20 percent of doctors who were near retirement age would consider retiring early, even with the public option out of the Democrats' health care plan. And about 7 percent, 7 or 8 percent would if they were nowhere near retirement age. But still, that's a lot of doctors who are considering retiring if we pass one or two of these bills. Let's leave the public option question alone for just a minute. We need to come back to that later because that is a significant part of this, but amongst the things that are in the bill that people may want to know about are these tax increases, are the Medicare cuts. Of course, one of the big fights here last night was would the bill contain what's called the Hyde amendment language that would prevent Federal funding for abortion. A lot of controversy ensued. The bottom line is the Senate-passed bill did not contain the Hyde amendment language. The Stupak language that passed in the House bill in November did, but that wasn't the bill we were debating. That wasn't the bill we were passing. Again, another fig leaf was trotted out in the form of an Executive order. But how many Executive orders did President Obama repeal on his first day of office, Executive orders that President Bush had had in place? It was a ton of them. Now, the President, to his credit, did say that he would not tear up the Executive order the first day after the bill is passed, but I don't recall if he made a promise about the second day or the third day or the fourth day. The fact of the matter remains that protection against using Federal funds for abortion, for paying for abortion is pretty tenuous right now, and that thread could be snapped at any time. And the fact is the American people just don't know at this point. And it's a shame, because we could have had that argument. We could have had a more solid amendment. But the fact of the matter is we didn't do that. Other things in the Senate-passed bill: The special deal for Nebraska, the Cornhusker kickback, it is in the Senate bill. It did pass. It's on its way down to the President for signature. Does that violate any constitutional principle like equal protection under the law? It might. It might. If the good, long- suffering, taxpaying citizens of Texas now have to subsidize Medicaid in Nebraska, that might get some suspicion from the Supreme Court of violating the 14th Amendment, but we'll have to see. A special deal for Florida where their Medicare Advantage would not be cut in certain counties in southern Florida. Medicare Advantage cuts, as I pointed out to you, are going to be steep and significant in this bill, but the three counties in Florida will not sustain those cuts. Again, equal protection under the law. That may be a violation of the equal protection clause of the Constitution. In fact, my attorney general back home in Texas said the Federal health care legislation passed tonight violates the United States Constitution and unconstitutionally infringes upon Texans' individual liberties. To protect all Texans' constitutional rights, preserve the constitutional framework intended by our Nation's Founders, defend our State from further infringement by the Federal Government, the State of Texas and other States will legally challenge the Federal health care legislation. So what looked like a Federal health care bill may in fact have represented a bill for full employment for lawyers in this country. There are some other bad provisions. There is a tax on the so-called Cadillac health insurance plans. Remember that was supposed to be fixed in the reconciliation bill, but the reconciliation bill is not the law of the land. The Senate bill is the law of the land and that Cadillac tax is in there. So for individuals with incomes under $250,000, they're going to get a significant tax if they have one of the high-end insurance policies. Clearly, that is a broken promise by the administration. Boy, construction firms. I mean, who did they irritate in the Senate? Construction firms were singled out for higher taxes. In the Senate language, the employer mandate only exists or a fine if you don't provide--if your employees have to access care under the exchanges with subsidies. The fines don't kick in until you have more than 50 employees, but construction firms, there is a much smaller number. Single digits. If they're employed by a construction firm, they will have to pay an employer mandate or an employer fine. Now, here's one of the provisions that is really--I don't think people know about it. I'm not sure if they do know about it and they understand it, but this new board that has been created in the Senate bill. One of the ways that they attempted to deal with Medicare spending was to assemble this board, this board of commissars and commissioners who are going to set Medicare spending targets, and they will do that and they will set those targets. Yes, they have to come back and be voted on by Congress, but we just have to vote them up-or- down. We can't amend them. We can't say, well, we're just going to plus them up a little bit and reduce this one down a bit. We've got to take the whole board of recommendation as a slate. It's an up-or-down vote here on the floor of the House. I will just tell you when Congress has to be the enforcers on these things, look what we've done with doctor payments over the years. We're supposed to reduce them, but we really didn't because we didn't want to face the wrath from doctors for seniors so we took the easy way out and gave them a 1-year stay on that. And the consequence on that is the tab continued to run on those doctor payments. So now it's as high as $20 billion that--I am sorry, a 20-percent cut that will have to come out of doctor payments. We might do the same thing with this independent board, or we would lack the courage to vote on the cuts anyway if we didn't like the way they came down to us. Congress does have a history of doing that. Some other provisions of the bill double-counts some Social Security payroll tax revenues, double-counts the premiums collected for what was called the CLASS Act. That was one of the great bait-and-switch things that was included in this bill. We're going to provide long-term care insurance. You pay for that $50 a month and then you can get a benefit of $50 a day if you need to access long-term care insurance. Well, this actually scores as a savings because for the first several years it is in play, more premiums are collected than money is paid out. But guess what happens in the second half of, or the second 10 years of, these expenditures? Those payouts are going to exceed the premiums paid. And that is going to be an unmitigated disaster. And the real pernicious part of the CLASS Act--look, people my age, if they can afford it, they should buy long-term care insurance. Don't wait on the Federal Government to give it to you. Don't believe you're going to get it from Medicare for you. It's only for a short period of time. Yes, you can get long-term care under Medicaid, but you've got to spend yourself to near bankruptcy before you get any of that benefit. The sensible thing to do if you can afford the premium is to buy a long-term care policy. The CLASS Act is going to tell people, Hey, you don't have to worry about that. Pay your $50 a month for long-term care. You're covered. That's nonsense. The coverage is thin. It will not be there after a period of time because that program is going to pay way too much money after a few years. And the problem with long-term care insurance is the longer you wait to buy it, the higher the premiums are going to be. For people who are in their early fifties, it's something worthwhile to look into. But we're going to send a message to the next 10 years of Americans who are turning--Don't worry about it; We've got you covered with the CLASS Act. There is no coverage at all there. In fact, it is going to be an unmitigated disaster when people start trying to access that. Besides that, anyone who's paid for long-term care, anyone who's had a family member in a long-term care facility, does 50 bucks a day really take care of what you need in a long-term care facility? It's nowhere even close. The bill double-counts some of the Medicare cuts. So we get to count them once, and we get to count them a second time. Texas is really going to suffer under a reduction in disproportionate share funding. Drug makers will face an annual fee of $2.5 billion. But you know what? That $2.5 billion is not doing to come out of the CEO salaries. It's going to come out of product sales. So that will be passed on to the consumer. So although they look like they're being all great and helping out the President and putting out $2.5 billion, this goes back to the Americans who buy their product. In 2011, this bill will limit flexible spending accounts to $2,500 per year. Yeah, you'll still be able to have your FSA, but you will be limited on the amount you can put into it. Here's one that really most people are not aware of. There is a medical device manufacturers' fee which is again going to be passed on to the end user, the consumer, the patient, which is you. Continuing on the time line in 2011, there is a health insurance provider fee--$2 billion in 2011, $4 billion in 2012, and then it goes up from there rather dramatically. Again, a tax on health insurance providers. Who do you think is going to pay that, the CEO of the big insurance company? Probably not. The guy that's buying the insurance? Probably. Again, I talked about this before. In 2013, the excise tax of 40 percent will be imposed on the Cadillac plans. In 2013, new Medicare taxes on individuals earning more than $200,000 a year and couples making more than $250,000 a year, the Medicare tax on your withholding is going to rise to 2.35 percent. There is going to be a new 3.8 percent tax. Starting in 2013, a new 3.8 percent tax on unearned income. Dividends, interest, capital gains. 2013, an excise tax of 2.9 percent imposed on the sale of immediate medical devices. Now, not all medical devices--and we all heard the stories about the Band-Aids when the Senate was talking about this. There will not be a Band-Aid tax. This will be for so-called class 2 and 3 medical devices. Class 2 devices would be syringes, sutures, some testing that a doctor might do in their office. Some of those testing kits will be taxed at that 2.9 percent rate. Let me tell you something here. As a doctor, you don't get to pass that tax on to your patient because most of your patients that come in that are insured, you actually see them at a contractual rate. So whatever the code is, there is a contractual rate for that code and it doesn't include that 2.9 percent tax. And employers with more than 50 employees must pay a fine of up to $3,000 if employees receive tax credits to purchase insurance. So billions of dollars are going to be spent to hire thousands of new IRS employees needed to collect the taxes. Yet three out of 10 doctors says if Congress goes against their will and the will of the American people and passes this bill, they may retire from practicing medicine. So that's what the people are going to get--more IRS agents, less doctors. Simple equation. How does that equal health care reform? Ideally, we would repeal the entire bill and start over with real reforms. It seems unlikely that's going to be able to happen. Really, Members on both sides of the aisle that were concerned about this bill last night need to work together to repeal the more egregious portions of this bill and ultimately work toward the repeal of the entire bill when the make-up of the Congress and the White House has sufficiently changed to allow that to happen. Let me talk a little bit again about the Senate-passed bill. We're not talking about the reconciliation bill. We're not talking about the House-passed bill. Remember the Senate-passed bill in December? There was a Senator from Connecticut who said, I cannot vote for a bill if it's got a public option in it. Maybe it's because there are a lot of insurance companies in Connecticut, I don't know what the reasoning was, but that Senator was very firm that they would not have his vote, and they needed every vote they could to get to 60, so the public option was very reluctantly stripped out of the Senate bill. But is it really going? And the answer is it might not be. Now, you have heard that several States around the country are looking at, I believe it's up to 37, was the last count, are looking at either filing a constitutional challenge or somehow exempting their State from participating in this new Federal legislation, and that also means that they may not set up the State-based exchange that the bill, the Senate bill, calls for. Well, what happens in a State that doesn't set up an exchange? Is there not going to be any exchange, so there won't be any insurance in the exchange available to citizens of those States? You would think so, because States should ultimately have sovereignty, except that there is a little known Federal agency called the Office of Personnel Management that is going to be charged with setting up a State-based exchange or a national exchange that every State that doesn't have a State-based exchange, that their citizens can buy through this national exchange. And the Office of Personnel Management, in the language of the bill, is required to set up one insurance company, one for-profit insurance company, and one not-for-profit. Does this federally administered, national exchange, not-for-profit, insurance company begin to look a lot like the public option that was discussed in the Democrat's bill in the House? The answer is, of course it does. The Office of Personnel Management currently administers the Federal employee health benefits plan here for all Federal employees, not just in Congress, but all employees. So they are a relatively small agency. That's a big insurance plan, but still, as Federal agencies go, that's a relatively small agency. It is going to have to rapidly ramp up with a great number of new employees. Perhaps that's one of the ways we are going to deal with unemployment is to hire more people in the Federal Government. But the Office of Personnel Management will have to get considerably larger, and this Office of Personnel Management will now be the de facto public option as it administers the not-for-profit that's in the national exchange that is available to people who are in States that don't set up a State-based exchange. It is a public option by another name. Unfortunately, the Senator that sought to prevent that from happening did not see the way this was going to work out in their own Senate bill. So when I say the doctors who look at retiring from practice, if there is a public option in the bill, perhaps the more they get to understand that this public option is really in the bill, maybe they will rethink their willingness to continue to work within the system. Are there other ways to change this bill that we passed last night? Certainly, everyone ought to be treated equally under this bill, and they haven't been. Maybe that's one of the technical fixes we could work on so that there is no geographic disparity, there is no racial disparity. People, equals, ought to be treated equally, and that is one of the things that really we should work on. I think we should work on getting rid of the individual mandates and the employer mandates. Certainly we could encourage comprehensive coverage for seniors. Right now, look what we are doing to Medicare Advantage. Look what we are doing to putting the tax on the supplemental insurance. We really should, rather than discouraging seniors from having a Medicare Advantage plan or a supplemental plan, maybe we ought to encourage that. After all, the Medicare Advantage plans are doing what we asked them to do. We asked them for care, coordination, disease management, expanded health IT, expanded use of physician assistants, nurse practitioners, paraprofessionals. Medicare Advantage plans are performing those functions. They are just now getting to the point where they are really starting to see the cost savings that we all said would be there if they would do those things, and now we are going to take them away. Okay, never mind, we shouldn't have done it anyway, so sorry about that. Allow health insurance to be sold across State lines. We have talked about this a lot. If you want competition, don't have the Office of Personnel Management create a nonprofit that everyone is going to compete with. That's only one other bit of competition. Let the 1,300 insurance companies that exist in this country, let them compete. Let them compete up on the Internet, let them compete across State lines. The portability of insurance, Congress attempted to address that back in 1996, arguably made kind of a mess of things. But if we would do things that would establish and create an enhanced portability of insurance, we would go a long way towards establishing a longitudinal relationship, a patient with their insurance company. If you go from job to job, you don't change insurance companies. You have your insurance company, and you can take it with you. Allow private insurance and alternatives to Medicaid and SCHIP, special health savings account for the chronically ill, health insurance plans to specialize in solving problems for the chronically ill. All of these things are out there and within our purview. These are all things we should undertake to fix the egregious problems that are in the Senate bill.

Mr. BURGESS

Mr. BURGESS. I thank the gentleman for yielding. You know, it's really a shame we have this health care bill in front of us. We have provisions now for 17,000 new IRS agents but not one dollar for a new nurse or a new doctor. You know what, you'll have access, all right, but you may be getting your prenatal care from Turbo Tax. announcement by the speaker pro tempore

Mr. BURGESS

Mr. BURGESS. Well, I thank the gentleman for yielding and thank him for the recognition. The gentleman and I spent some time this afternoon up in the Rules Committee, a little hideaway up on the third floor of the Capitol. I don't think the air condition was working today. It is always an interesting time when you get to spend a little time in the Rules Committee. And we heard several people sort of lead off their soliloquies as they were talking and extolling the virtues of this bill and that it is going to try to come through the House tomorrow and they say we are going to go down in history. And I think the gentleman from Georgia said, and it certainly ran through my mind, I don't know if you are going to go down in history, but you are very likely to go down in November. With that, let me just refer--the gentleman talked about the people who have been here all day around the Capitol. And it has been impressive. And I think back to a year ago, my town halls, people were so frustrated with what they saw happening. They didn't know how bad it was going to get, but they were very frustrated with the direction they saw from this Congress and from this administration. And they kept saying, Well, we want to do something. What can we do? We want to stop this. We want you to stop this. And if you can't stop it, we want to stop it. And a year ago it seemed like we were so far away from a fall election; but that unease, that energy kept building and building through the spring and through the summer and through the fall. And we saw it here on July 4, when the people came and camped out on the Washington Mall. We saw it again on September 12 when people flooded to the Capitol to make their voices heard. And we certainly heard it today. And you might ask, does this do any good, this sort of outpouring of angst and emotion and energy to surround the Capitol with living, breathing Americans who want to press the point of, hey, look. It is supposed to be governed with the consent of the governed--government with the consent of the governed--and we didn't give you our consent for this. We don't want it. We want you to take it back. So you do wonder if it does any good to have people around the Capitol all day, all of that energy, all of that enthusiasm, all of that pushback against what they see as a very bad health care bill, and I will tell you that it does. Because as we started the day today--we just refer to my little friend from School House Rock. I brought him out earlier in the week. This is a bill who is on Capitol Hill and one day he wants to become a law. This bill looks mad, and I wonder why this bill is mad. Well, you look at what he is thinking and he says, I don't want to be deemed or Slaughtered. He is referring of course to the Slaughter rule. The chairwoman of the Rules Committee, Ms. Louise Slaughter, had put forward the Slaughter rule that said we wouldn't even have to vote on this Senate bill that no one wants to vote on. We will just deem its passage and then send it on to the President for signature. Well, that is kind of a big deal in this body. It kind of might not really be in accordance with all of the rules laid down by the Founders in the Constitution. So the bill was mad. He didn't want to be ``Deemed or Slaughtered.'' Well, guess what happened. About the middle of the afternoon up in the Rules Committee--and I don't know if it was because of all the people who were here or not. I don't know if it was because their voices were heard and folks on that Rules Committee felt the heat that was being generated around the Capitol outside; but somewhere or another in the middle of the afternoon, they said, You know what? This guy is right. We will just have an up-or-down vote. So tomorrow, although the outcome may not be what I want, we are going to at least have an up-or-down vote on H.R. 3590, the Senate bill. I do want to tell people what is at stake here. This bill, H.R. 3590, is a bill that actually originated in the House of Representatives. It was not a health care bill; it was a housing bill, through the Ways and Means Committee, voted on on the House of Representatives floor, went over to the Senate as a housing bill. It languished over there. When the Senate needed a vehicle for a health reform bill, they took up that bill that had already been passed by the House, stripped all the language out of it, just like coring out the inside of an apple or something, pushed their health care language into this bill, passed that bill in the Senate with 60 votes. And now that they no longer have 60 votes in the Senate and do not want to go--they had the opportunity to go to a conference committee right after Christmas. They still had 60 votes. To heck with the notion that Republicans were blocking a conference committee. That is a fairy tale. They had 60 votes on December 26. They could have named conferees. They could have gone to a conference committee and done it the right way and tried to put those two bills together and bring that product back to the House, but they didn't want to do that. They wanted to do something smoother or something easier. Scott Brown won an election in Massachusetts; they don't have 60 votes anymore. Now they really can't go to a conference committee. Their only way forward is to pass the Senate bill or take the Senate bill that has passed the Senate and bring it back to the House. And then the question will be for the House of Representatives: Will the House now concur with the Senate amendment to H.R. 3590? If the answer to that is ``yes,'' the bill is passed. It does not go to the Senate. There is no further finagling or adjustments on it. It is what the Senate bill is with no changes. That goes down to the White House or the President comes here, it is signed, and within a matter of 20 minutes that bill has become law. Now, all the people in this House who say, yeah, but I want to tweak things a little bit, I want to change some language here, I want to adjust this some over here, maybe there is something we can do for the doctors over here, maybe there is something we can do for seniors over here--and we will do this in a reconciliation bill that only takes 51 votes. Yeah, have fun with that. Because you are going to make all of those adjustments, we are going to pass that bill in the House, however it looks it will go over to the Senate. And there is no guarantee that the majority leader of the Senate will ever pick that bill up and even look at it because they don't have to. This Congress was charged with passing a health care bill, and, hey, that happened March 22 on the floor of this House when we passed H.R. 3490.

Mr. BURGESS. An important point is that is a Senate bill. It never went through any House committee. There was never any House input or imprint upon that bill. All of that language was derived over in the Senate. And the House of Representatives, although will go down in history as having passed sweeping health care reform if that bill passes tomorrow, the reality is that is all a product of the Senate. The House will have no fingerprints on that bill but will--but will-- have that bill hung around their neck. Nobody knows what is in that stupid bill, I beg your pardon. Nobody knows the degree and the depth of the intricacies of the legislative language contained therein within that bill. And we will be learning. The press will then suddenly become very interested in this bill, and we will learn in great detail over the next several months how many bad things were hidden within the dark recesses of that 2,700-page bill. I am going to finish up in just a minute. If I could, I want to just reiterate the letter from Greg Abbott, the attorney general in the State of Texas, in dealing with the issue of constitutionality of this bill. Because if this bill passes tomorrow, then all eyes go to the States, and what are they going to do? Are they simply going to accept this new unfunded mandate from the Federal Government, or will there be some pushback from the States? Greg Abbott has indicated that they have serious concerns with the bill and told me today on a conference call that Texas will be ready to lead when the time comes if this bill is passed. But just his thoughts on the individual mandate. And quoting from Greg Abbott here: ``The individual mandate is constitutionally suspect because it does not fall within any of the normal categories. The mandate provision of H.R. 3590 attempts to regulate a nonactivity. The legislation actually imposes a financial penalty upon Americans who choose not to engage in interstate commerce because they choose not to enter into a contract for health insurance. ``In other words, the proposed mandate''--continuing to quote--``In other words, the proposed mandate would compel nearly every American to engage in commerce by forcing them to purchase insurance and then use that coerced transaction as the basis for claiming authority under the commerce clause. ``If there are ever to be any limitations on the Federal Government, then commerce cannot be construed to cover every possible human activity under the sun, including mere human existence. The act of doing absolutely nothing does not constitute an act of commerce that Congress is authorized to regulate.'' And I thank the gentleman for his indulgence, and I will yield back to the gentleman.

Mr. BURGESS

Mr. BURGESS. I appreciate the gentleman for yielding. Mr. Roskam from Illinois talked about how the American people want us to fix the economy. And one of the ways we can help that is if we will conclude this discussion we've been having about taking over America's health care system, because I firmly believe that is one of the things that is holding back small businesses across the country that have been having to cut back over the last 18 months. They have been doing what every American family has been doing and say, We will have to make do with a little bit less, maybe we won't hire that extra employee. But they also don't know what we're going to do. Are we going to put an 8 percent payroll tax on them? Are we going to put an $1,100-a-year energy tax on them? What are we going to do in financial regulation? They are scared to add employees right now in small businesses across the country. And maybe it's only one or two jobs in a location, but extrapolated across the wider economy, it's thousands and thousands of jobs. That is the problem with us not dealing with the fundamental problem that is concerning the American people, which is jobs and the economy and being distracted by health care. That is the fundamental problem out there right now with the people. That is the basis for the anger that people are feeling when they see what Congress is doing late tonight and what we are fixin' to do tomorrow, as we like to say in Texas. Now one of the things that I have heard over and over again, and I have heard the President say it, it is so aggravating to hear, is that Republicans are obstructing this process, Republicans had no ideas to bring to the table, and Republicans could have fixed everything in the last 12 years but chose not to, so now they need to get out of the way. Let me briefly take each of those points, because it is important for Americans to hear, Mr. Speaker, what has been going on up here this past year. From the standpoint of Republicans obstructing this process, it just isn't so. There are, as the gentleman from Texas said, 178 Republicans. In fact, a few months ago, there were only 177. The arithmetic of the House is if you have 218 votes, you get to do what you say. One hundred seventy-seven Republicans were not enough to stop anything in the House of Representatives unless some Democrats crossed the aisle and voted with us. And do you know what? That's what started happening. And as a consequence, it's not Republicans who are obstructing this process; it's Democrats. It's a problem they have within their own conference. Why is that? Well, they don't have the popular support of the American people. A poll out just today said 40 percent of the people think we are doing too much and we ought to go back to the drawing board and see if we can't do something more manageable, and 20 percent said we shouldn't be working on health care at all. Sixty percent, six out of 10 Americans think this is the wrong thing for us to be doing right here right now. So without the popular support of the American people, the Democratic leadership, the Speaker of the House, the President of the United States, the majority leader over in the other body cannot get done what they want to get done. And oh, my God, what is the reason? Those darn Republicans are obstructing us. Now from the standpoint of Republican ideas, as the gentleman from Texas has said, there have been Republican ideas that have been talked about literally all year long. Now, look, right after the President was sworn in, I was surprised that they didn't come forward with a big health care bill. I was surprised that health care wasn't the number one thing on the agenda because they talked about it. All during the campaign that's all you heard about was health care, health care, health care. I thought they had a bill ready to go. I thought they had a bill in the works. I thought it would come out of the Senate Finance Committee, the House would simply follow suit, and there we would be, we would have a health care bill. The fact is if we voted on this health care bill last year, it probably would have passed. The President was extremely popular at that time. Congressional Democrats were popular at that time. There likely would have been nothing that would have been standing in the way. But since they decided to do some other things first, stimulus, cap-and- trade, taking over school loans, whatever else they had on the agenda, because they chose to do other things first, people had a chance to start looking at this bill. And we have heard this story several times tonight. We heard it in the previous hour. A year ago, I was feeling in my town halls an enormous amount of anxiety, an enormous amount of unease, an enormous amount of energy that was bubbling up to the surface. We want to do something. If you're voting against this stuff, we want to help you. What can we do? What can we do? And people began to figure it out for themselves. They could organize at home and, yes, they can come to Washington, D.C. So they did over Fourth of July this past year, they did September 12, they sure did in November, and they came back again today. And I couldn't help but think every time I talked to just regular people that were out in the great weather today on the lawn on the west side of the Capitol to hear the speeches and listen to the stuff, they were just regular people from back home who had come up because they were concerned about what they saw happening in Washington. But if it had not been for them, Mr. Roskam is right, this bill would have passed in July. I don't know if people recall that. We had a cap-and-trade bill right at the end of June. After that was queued up and put over the finish line, we were then supposed to take up health care. The bill was dumped into our committee about the middle of July. We were supposed to mark it up over 1 day, 1 day, and then turn it back to the House floor, and we would vote on it and then we would go home for the August recess. Just take a step back for a minute. You have heard people talk about this all day long. We've been talking about this for a year. We don't need to talk about health care any more. We've been talking about it for a full year. In 1990 and 1991, when my committee, the Committee on Energy and Commerce, marked up a bill that dealt with clear air, the Clean Air Act, they held that markup for I think it was 8 months. My lands, the people in that committee hated each other at the end of that 8 months. But do you know what? It was the right thing to do, because in the end, it had bipartisan support. In the end, it did get passed. And in the end, it functioned as advertised. But not because they slammed it through, because they did have big majorities back in 1990 and 1991. It worked because they did it the right way, and even though it was a terribly painful process, and although, again, people on the committee hated each other at the end of those 8 months, still, it was a better way to go about doing major legislation that is going to affect the lives of every American not just today but for generations to come, much better way to do that. We chose not to do that this year. We chose to ram it through as fast as we could. My committee, which was supposed to do this in 1 or 2 days' time, ended up stretching it out over 8 days. And the reason it stretched out over 8 days is because seven Democrats on my committee heard from people back home during the month of July and they said, Wait a minute, wait a minute. We're getting nervous here. We're hearing all kinds of stuff from back home that people don't like what we're doing. They don't like what we did with cap-and-trade. Now they are looking at what we are doing with health care, and they are saying, put the brakes on. This is going too fast. Now we didn't end up stopping it in committee. It ended up passing on July 31. But the story is, it passed on July 31. It did not come to the House floor before we went home for the August recess. And then what happened in the August recess? That energy that had been almost palpable in April really, really did bubble to the surface. And we had people in town halls like we have never had before. The little sleepy town of Denton, Texas, early on a hot August Saturday morning I had 2,000 people show up. Later in the day, I went up the road to Gainesville, Texas, up on the Red River, 600 people showed up. I have never had that kind of turnout in town halls. Not everyone agreed with me. Not everyone thought I was doing the right thing. But there was a broad consensus that they did not like what they were seeing with what Congress was doing with their health care. And you saw it play out over and over and over again across the country. It wasn't just north Texas. It was Michigan. It wasn't just north Texas, it was that way out West, it was that way on the east coast, over in Wisconsin, over and over and over again you saw the scenario replay itself. But do you know what? When I would have those town halls, people would say, we don't trust you with a 1,000-page bill. If the gentleman from Texas would indulge me, remember the good old days when it was only a 1,000-page bill, and he has a 2,700-page bill up there with him tonight? We don't trust a 1,000-page bill. We know you didn't read it. You said you wouldn't take this insurance yourself. Why should we be for that? But what we are for is some sensible reform. And I heard that over and over and over again. Yes we would like help with preexisting conditions. In committee, we never had a hearing about is there any way to deal with the problem of existing conditions without resorting to an unconstitutional mandate? I believe that there is. But we never had a hearing on it. We never heard any testimony on that. It was simply, we have to have the mandate because everyone has to have insurance because that is just simply the way it's got to go. But that's not necessarily so. So what we heard: Help us with preexisting conditions, provide us a little flexibility, and maybe we would like to buy across State lines if it brought the cost down. We would like some liability reform if you don't mind. How about some fairness in the Tax Code so we don't punish the person who is in business for himself as opposed to someone who gets their insurance tax free from an employer. And do you know what? COBRA is awfully complicated and awfully expensive. Could you make that a little simpler for us because people are losing jobs right now, and as they lose jobs, they lose employer-sponsored health insurance. Yeah, you have COBRA where we can make that big payment and keep your insurance, but I just lost my job. I can't afford to make the big payment. And they let their insurance expire. And then, unfortunately, some major medical crisis may hit, and then they have got a preexisting condition and the cycle repeats itself and repeats itself and repeats itself. These are the things that people told us they want to see. Now, I do have a Web site, healthcaucus.org. These things that I heard over the summer I have put into legislation, or I have taken legislation that other people have introduced and affixed that to those things that people told me they wanted to see. So at healthcaucus.org, under the issues tab, ``Dr. Burgess' prescriptions for health care reform,'' you can print that out yourself at home on your own computer, and there are nine things there. It is not like there is not already legislative language on most of those things, because there is. In fact, if there is a bill number there, I put the bill number beside it. If there is another Member of Congress who has a bill that has been introduced that will cover that issue, I have got their name there and the bill number beside it. The fact is that there are ideas out there. Some of them are even bipartisan. What a novel concept. But those ideas are out there on paper. We could take them up in an incremental fashion over the next 3 weeks, and we could really be down the road on solving the problems the American people want us to solve. Instead--instead, it says one-size-fits-all. Washington knows best. Forget governing with the consent of the governed; we are going to give you this bill. And when we pass it and you find out what is in it, you are really going to like us after all. I thank the gentleman from Texas for taking this hour. The hours are growing close where this bill will come to the floor for a vote. We are probably getting down to almost the single digit number of hours that remain for America to remain a free country. This has been such an important debate. I hope people will continue to watch. I hope they will continue to interact with their Member of Congress. Remember, your Member of Congress runs for office every other year. We are people's closest contact with the Federal Government. That is what the Founders wanted. So I encourage people, even though it is late and even though it is on Sunday, this interaction that takes place between a Member of Congress and their constituents is a sacred bond, and that needs to be upheld over this next 24 hours. People do need to let their Member of Congress know how they feel about this. I think that is one of the most critical things that we have been missing in this debate. I thank the gentleman for his indulgence, and I will yield back to the gentleman from Tyler, Texas.

Mr. BURGESS

Mr. BURGESS. I came to the floor of the House tonight because I want to share with the House a letter I received from the Texas Medical Association. The letter says, ``On behalf of the nearly 45,000 physician and medical student members of the Texas Medical Association--and on behalf of our 25 million patients--we are writing to express our opposition to the health reform bill (H.R. 3590) that will be before the U.S. House of Representatives this weekend. Please vote `NO.' ``Unlike the American Medical Association, we do not believe that passage of H.R. 3590 and the accompanying reconciliation bill are steps in the right direction. Our position on health reform remains steadfast: Keep what's good in the health care system and fix only what's broken. ``To repeat what we said in December when the U.S. Senate passed this bill, the bill is bad medicine for our patients, and TMA cannot support it. The legislation: ``Does nothing to correct the flawed Medicare payment formula that Congress created in 1997.'' The legislation ``would increase the cost of health insurance for our patients and deliver even less in return.'' It ``would dramatically enhance Federal Government interference.'' It ``would create incentives for patients to pay a fine for not having insurance rather than to pay an unrealistic amount for insurance coverage.'' It ``would not protect Texas' liability reforms and does even less to expand those protections to patients and physicians in other States.'' It ``would impose untested and arbitrary treatment standards that do not improve the quality of patient care. ``In addition, this bill could be a budget buster for Texas. According to the Texas Health and Human Services Commission, the current proposal would cost the State of Texas up to an additional $24 billion in increased Medicaid spending over the first 10 years of its implementation. ``Please note that our position is not based solely on the personal opinions of the TMA leadership. In a recent survey of nearly 3,300 TMA members, almost 70 percent said if a new health care bill becomes law, it will make the U.S. health care system worse than it is now in the long run. Six out of 10 said the quality of patient care will get worse, patients' cost for care will go up, and patients' health care coverage will go down if a new bill becomes law. ``Please work with your Texas colleagues on both sides of the aisle to develop and pass a rational Medicare physician payment system that automatically keeps up with the cost of running a practice and is backed by a fair, stable funding formula. No more Band-Aids. It's time for a permanent Medicare fix. ``Thank you for your consideration of our requests.'' And I will insert the letter from the Texas Medical Association into the Record. Texas Medical Association, March 19, 2010. Dear Member of Texas' Congressional Delegation: On behalf of the nearly 45,000 physician and medical student members of the Texas Medical Association--and on behalf of our 25 million patients--we are writing to express our opposition to the health reform bill (HR 3590) that will be before the U.S. House of Representatives this weekend. Please vote ``NO.'' Unlike the American Medical Association, we do not believe that passage of HR 3590 and the accompanying reconciliation bill are steps in the right direction. Our position on health reform remains steadfast: Keep what's good in the health care system and fix only what's broken. To repeat what we said in December when the U.S. Senate passed HR 3590, this bill is bad medicine for our patients, and TMA cannot support it. The legislation: Does nothing to correct the flawed Medicare payment formula that Congress created in 1997. That formula is directly responsible for the slow erosion of access to care for seniors and the poor. Would increase the cost of health insurance for our patients and deliver even less in return. Would dramatically enhance federal government interference, bureaucracy, and red tape for patients and physicians. Would create incentives for patients to pay a fine for not having insurance rather than pay an unrealistic amount for insurance coverage. Would not protect Texas' liability reforms and does even less to expand those protections to patients and physicians in other states. Would impose untested and arbitrary treatment standards that do not improve the quality of patient care. In addition, this bill could be a budget buster for Texas. According to the Texas Health and Human Services Commission, the current proposal could cost the State of Texas up to an additional $24 billion in increased Medicaid spending over the first 10 years of its implementation. Please note that our position is not based solely on the personal opinions of the TMA leadership. In a recent survey of nearly 3,300 TMA members, almost 70 percent said if a new health care bill becomes law, it will make the U.S. health care system worse than it is now in the long run. Six out of 10 said quality of patient care will get worse, patients' cost for care will go up, and patients' health care coverage will go down if a new health care bill becomes law. Finally, regardless of whether HR 3590 becomes law, we strongly urge you to take swift action to stop the implosion of our Medicare system. Since its inception, the Sustainable Growth Rate Formula (SGR) has not worked. Annually, it has forced physicians to limit access for our patients, pushing patients into higher-cost areas like emergency rooms. Every year for a decade, we have faced steep cuts that jeopardize our ability to care for patients. You and your colleagues have recognized this glaring problem--this gaping wound in our health care system--but have been willing to address it only with Band-Aids. We need more than Band-Aids. We need more than sutures. We need a complete transplant. Congress created this disease, and only you, as a current member of Congress, can cure it. We note that HR 3590 creates a physician payment board-- independent of and not answerable to Congress--with the authority to unilaterally determine physicians' Medicare payments. Even if Congress were to fix the flawed SGR formula, your action could be, and likely would be, ignored by this board. Please work with your Texas colleagues on both sides of the aisle to develop and pass a rational Medicare physician payment system that automatically keeps up with the cost of running a practice and is backed by a fair, stable funding formula. No more Band-Aids. It's time for a permanent Medicare fix. Thank you for your consideration of our requests. Please feel free to contact us at any time if we can be of any assistance in this process. Sincerely, William H. Fleming III, MD, President, Texas Medical Asociation. Susan Rudd Bailey, MD, President-Elect, Texas Medical Association, Chair, Texas Delegation to the AMA. I also want to share a letter I received from the American College of Surgeons. Again, this is similar language. ``On behalf of the more than 75,000 members of the American College of Surgeons, I write to restate that the College shares your commitment to make quality health care more accessible to all Americans. Over the past year and a half, the College has consistently sought to serve as a constructive voice of reform, guided by the College's principles of providing quality and safety, improving patient access to surgical care, while enacting meaningful liability reform, and reducing health care costs.'' ``The College's principles underscore our commitment to health care reform that will extend coverage and improve access to quality health care for more Americans. Without addressing these fundamental concerns, the College believes that H.R. 3590 will undermine quality and threaten patient access to surgical care. Therefore, the College opposes the Patient Protection and Affordable Care Act of 2009.'' But we do ``remain steadfast in our role as champions for meaningful health care reform that is in the best interest of patients.'' I also have a letter from the Texas Association of Home Care & Hospice. They conclude by saying, ``The Texas Association for Home Care & Hospice again respectfully requests that Congress reject the notion that reductions in Medicare home health and hospice reimbursement rates equates to health care reform and long-term cost containment and ask that you vote no on the current health care proposal.'' I also wanted to share some insights from the Texas Attorney General regarding the constitutionality of the individual mandate. According to Greg Abbott, ``The individual mandate is constitutionally suspect because it does not fall within any'' of the normal categories. ``The mandate provision of H.R. 3590 attempts to regulate a nonactivity. The legislation actually imposes a financial penalty upon Americans who choose not to engage in interstate commerce--because they choose not to enter into a contract for health insurance. ``In other words, the proposed mandate would compel nearly every American to engage in commerce by forcing them to purchase insurance, and then use that coerced transaction as the basis for claiming authority under the commerce clause.'' Seems a little tortuous to get to that point. Finally, a letter from the Governor of the State of Texas, Rick Perry, who also delineates concerns about the cost of the program. He ends up, ``While Washington argues, Texans wait for real reform that results in everyone to have the opportunity to live a healthier life without adding trillions of dollars of debt that we and our children will'' end up having to pay. Thank you for the consideration.

Mr. BURGESS

Mr. BURGESS. Thank you, Speaker. Mr. Speaker, I want to take the opportunity--we've had a pretty full day with a lot of debate on the floor regarding the health care legislation that's going to be coming to the floor on Sunday--and I wanted to read into the Record some correspondence that my office has received. First, is a letter from the Governor of Texas, received March 19, 2010. The Governor, says: Texans deserve affordable, high-quality health care, but not higher taxes, increased health insurance premiums and unprecedented mandates. It goes on to say, We recognize the need for true health care reform that controls rising costs and ensures hardworking Texans can afford health care for themselves and for their families. But government programs should not be the first place we look to expand coverage. It goes on to say, In addition to the enormous cost to Texas, we believe the backroom negotiations and special deals that some congressional leaders have cut may well be unconstitutional. Additionally, it appears that congressional leaders might resort to employing an obscure parliamentary procedure to avoid an actual vote on the bill. This is not how the public expects legislation of this magnitude to be debated or enacted. It's signed, Governor Rick Perry, Governor of Texas. A letter from Tommy Williams, who's the chairman of the administration committee of the State senate. He's also on the senate finance committee. He says, Recently, the Texas Health and Human Services Commission provided me with an analysis of the impact of President Obama's proposal on our state budget. It would, in a word, be devastating. The analysis estimates that the President's proposal would cost the State of Texas over $24 billion over the next 10 years. This includes a $6 billion reduction in available disproportionate share of funding for hospitals. Our State simply cannot afford an additional average cost of $4 billion to $5 billion per biennium over the 10 years it would take to implement this plan. Signed, Tommy Williams, State senator from Texas. Attorney General Greg Abbott wrote to Senators Hutchison and Cornyn earlier this year in a very detailed correspondence about the problems he saw with the Senate bill as it was passed on Christmas Eve--and do remember it will be the Senate bill that will be here on the floor on Sunday. There will be a reconciliation bill to fix some of the things in there, but it will be the Senate bill, make no mistake about that. It will be the Senate bill that passes. All of those technical corrections could just as easily pass by the wayside if the administration is not interested in fixing the problems in the Senate bill. Nebraska compromise. We've heard a lot about that. The attorney general was concerned about the equal sovereignty and due process contained within the Cornhusker kickback, the Nebraska compromise. The individual mandate was particularly instructive. The attorney general talked about the commerce clause. And he concludes by saying, The individual mandate is constitutionally suspect because it does not fall within any of the normal categories. The mandate provision in H.R. 3590 attempts to regulate a nonactivity. The legislation actually imposes a financial penalty upon Americans who choose not to engage in interstate commerce because they choose not to enter into a contract for health insurance. In other words, the proposed mandate would compel every American to engage in commerce by forcing them to purchase insurance and then use that coerced transaction as a basis for claiming authority under the commerce clause. That is Attorney General Greg Abbott from the State of Texas. Now I have a list of many physician specialty societies that are opposed to this legislation. This list was current as of today. This list represents nearly 500,000 physicians in the United States of America--parenthetically, more than the American Medical Association. The dermatologists; plastic surgeons; eye doctors; head and neck surgeons; trauma surgeons; neurological surgeons; American College of OB-GYNs; the College of Osteopathic Surgeons; the American College of Surgeons; the American Academy of Orthopedics; the Society of Breast Surgeons; the Society of Anesthesiologists; American Society of Cataract and Refractive Surgery; colon and rectal surgeons; metabolic and bariatric surgeons; the American Urological Association; the American Society of Plastic Surgeons. State medical associations. That is not a complete list, but State medical associations: Alabama; Delaware; District of Columbia; Florida; Georgia; Kansas; Louisiana; Missouri; Medical Society of New Jersey; Ohio; South Carolina; Texas; and Tennessee. I will submit the entire list for the Record. America's Physicians Do Not Support the Current Health Reform Bill

Mr. BURGESS

Mr. BURGESS. I received a letter yesterday from a State senator in my State, Tommy Williams, who's from the Beaumont area, not my immediate area but he serves on their Senate finance committee in the State. He worked on the State budget last year and will work on it again next year. He says: ``I am writing respectfully to ask you to oppose President Obama's proposed health care reform plan as outlined in the President's summary reform.'' He said: ``In a word, it will be devastating.'' The analysis provided to Senator Williams from their Health and Human Services Commission is roughly $4 billion to $5 billion for the 2-year budget if we implemented this plan in a State that is arguably in better shape than other States but still facing a significant budget shortfall for the next budget year, $11 billion to $17 billion. He concludes with: ``I hope you understand as a member of the Senate Finance Committee who has wrestled with these very difficult issues I respectfully ask you to oppose President Obama's plan because of the fiscal havoc it would cause for the State we both love so dearly. ``Respectfully, Tommy Williams, State Senator.'' I will put Tommy Williams' letter into the Record. March 16, 2010. Hon. Michael Burgess, Cannon Office Building, Washington, DC. Dear Representative Burgess: During the last session of the Texas Legislature it was my privilege to negotiate the Article II (Health and Human Services) provisions of the conference committee report on our state budget. In doing to I have become intimately familiar with the effects that state and federal mandates can have on health care-related costs in Texas and to Texans. I am writing to respectfully ask you to oppose President Obama's proposed health care reform plan as outlined in the President's summary reform document released February 22, 2010. Recently, the Texas Health and Human Service Commission (HHSC) provided me with an analysis of the impact of President Obama's proposal on our state budget. In a word, it will be ``devastating.'' As I am sure you are aware, our state is in much better fiscal shape than many of the others; however, we are facing a gap between projected revenues and expenditures of approximately $11-$17 billion for the next biennium. Health and Human Services expenditures already make up roughly 1/3 of General Revenue (GR) expenditures and are a significant cost driver in the state's budget. HHSC's analysis estimates that the President's proposal would cost the State of Texas as much as $24.3 billion dollars over the next 10 years. This includes a $6.0 billion reduction in available DSH funding. Our state can simply not afford an additional average cost of $4.0-$5.0 billion per biennium over the 10 years it would take to implement this plan. I appreciate your hard work toward health care reform we can all support. I hope you understand as a member of the Senate Finance Committee who has wrestled with these very difficult issues I respectfully ask you to oppose President Obama's plan because of the fiscal havoc it would cause for the state we both love so dearly. Respectfully, Tommy Williams, Texas State Senator, District 4.

Mr. BURGESS

Mr. BURGESS. The last hour just ended, and you heard the admonition at the end of the hour that it is extremely important for people to pay attention. And during this hour, I am going to echo that thought. It is important for people to pay attention, Mr. Speaker, and, yes, I will direct my remarks to the Chair. But, Mr. Speaker, if I could talk to the American people, what I would tell them is now is the time, it is late at night, but now is the time for you to be keeping this House under intense scrutiny and watch what happens here over the next 72 hours as we drag this carcass of a health care bill across the finish line. Now, how did we get here? It's probably useful to think about things for just a moment. We had a big election in 2008. People said they voted for change. Right before that election in 2008, in the other body, the chairman of the Senate Finance Committee held a big meeting over in the Library of Congress and had all the big players and the stakeholders in health care in the room, and came up with what was called a white paper on health care reform. For all the world, it looked like a bill. For all the world, it looked like it would be the bill that was brought forth in the Senate should the Democrats take control of the White House, the House and the Senate. Indeed, the election was held, and they did. I will tell you, Mr. Speaker, I was somewhat surprised that there was not a health care bill, no health care bill came forth in those early days after the election. I thought perhaps we would see one in December of 2008 during the holiday season, but no health care bill. No health care bill in the weeks that the Congress was getting organized. We had a big inauguration, no health care bill. We had a designee named to be Secretary of Health and Human Services. Still no health care bill was forthcoming. Well, surely it will come along right after that confirmation for Health and Human Services. But as it turns out, that individual had some tax problems and that nomination was withdrawn before it ever got to the confirmation vote in the full Senate. So we were left without a Secretary of Health and Human Services for several months, no health care bill. Suddenly, it was early summer. There was a letter sent from the other body from the two committees of jurisdiction, the Health, Education, Labor and Pensions Committee over in the other body, and the Senate Finance Committee in the other body, they sent a letter to the President and said, We will be producing a health care bill within the next couple of weeks. In fact, the Health, Education, Labor and Pensions Committee did produce a bill. The coverage and cost numbers were quite startling when they were revealed: A cost of $1 trillion. It left a lot of people uncovered as the original plan was unveiled, and then several weeks were spent in what was called the markup of that bill over in that committee over in the Senate. Then the three committees of jurisdiction in the House had a health care bill that was rapidly brought forward. We didn't really get a lot of time to look at it. There was certainly no subcommittee markup. It came straight to our Committee on Energy and Commerce for a markup. And to give credit to the chairman of the Energy and Commerce Committee, we did get a little more time than the other two committees, the Committee on Education and Labor and the Committee on Ways and Means. They each had a day, a 24-hour period, to mark up this bill. Think of that. This bill, this legislation that's going to affect the lives and livelihood of Americans for the next three generations was allowed 1 day in markup in Ways and Means, 1 day in markup in Education and Labor. We at least had 8 days in Energy and Commerce. Four of those days were spent recessed because we couldn't agree on some things, but we did have more time in the Committee on Energy and Commerce than in any other committee in the House. Think back, Mr. Speaker, to the Clean Air Act in the early 1990s. I'm told it was an 8-month markup for the Clean Air Act, 8-month. Think how the people on those committees must have hated each other at the end of those 8 months. But what did they get? What did they get for that 8 month investment? They got a bill that had support from both Republicans and Democrats, eventually passed the House, eventually passed the Senate, eventually was signed into law by George Herbert Walker Bush, and the Clean Air Act became the law of the land and arguably has been successful since that time. So that's the way the process is supposed to work. Let me take one step back. The House passed a bill, the Senate passed a bill, they went to a conference committee, had a continuation of that long and drawn-out process, but the conference committee produced a conference report that was endorsed by the Senate, endorsed by the House, again bipartisan majorities on either side, the bill then went to the President for his signature, and that's what we now know as the Clean Air Act. But think of the difference between that major piece of legislation that had a great and far and reaching affect on the lives and livelihood of every American, contrasted with what we've done over the past year. And quite honestly, Mr. Speaker, it's not that we didn't have time. It's not that we didn't have time. After all, we have been working on this thing nearly 15 months. We actually had time to do a real markup in each of the three House committees. We had time to do a real markup. We had time to do a real conference committee. Look at the timeline of this bill. We got it in Energy and Commerce in the middle in July. We didn't have a lot of time to deal with it before, but when we got it, we worked on it, we worked hard. I offered a multitude of amendments. I had 50 amendments prepared in committee. Five of those were accepted by the time the bill passed out of committee, all of those on a voice vote, so presumably a unanimous vote, and every one of those amendments was stripped out when the bill went to the Speaker's Office before it came back to the House, to the House floor in late October, and then we had the vote in the House in early November. The Senate had their bill. The Senate Finance Committee completed their work in the fall. They brought their bill to the Senate in the month of December. It was voted upon, famously, on Christmas Eve, and then the normal sequence of events would be for the bill to go to a conference committee. And there in the conference committee, yes, the Democrats have substantial majorities in the House and the Senate. The Democrats would have had a significant advantage in the conference committee. The idea of the conference committee is to meld the differences of those two bills to create a product that can be endorsed by both Houses in the Capitol. But they didn't do that. They thought, well, that was hard to get that one through the Senate. Let's not go through regular order. Let's try something different. And that something different was, maybe we can just get the House to pass the Senate bill because the Senate bill was, in fact, a House bill. It has a House bill number. In fact, it was our appropriations bill, I think, for Treasury Department appropriations last year. It did pass the House as an appropriations bill, went over to the Senate for work on their appropriations bills. That never happened, but the bill was then used as a shell. The legislative language for appropriations was stripped out, the health care language was put in, so the Senate passed a House bill on Christmas Eve, and then that bill can come back through those doors, come into the House, and the Speaker of the House will say, the business of the House is now, will the House concur with the Senate amendment to H.R. whatever it is, the House agrees by a simple majority, at that time 218 votes, and the bill goes to the President's desk. But House Members didn't want to do that. They didn't like the Senate bill. For some it didn't go far enough. For some it went way too far. But the Senate bill was not seen to be an acceptable product. So while all of that discussion was going on, there was a little-noticed, to that point, election that took place in the State of Massachusetts, and the election was to fill the vacancy that was created when Senator Kennedy died. And that election was won by Scott Brown, who is a Republican who said he would be the 41st Republican vote against this health care bill. Whoa. Now, a lot of doors are closed over in the other body. They can no longer go to a conference committee and expect that they will have their 60-vote majority to pass anything they want. In fact, to take any bill back to the Senate now, and under Senate rules where you need to have 60 votes to cut off debate, that is going to be a pretty tall order because they only have 59 votes, 41 votes on the Republican side. So what to do? We do still have the bill that was passed by the Senate. That Senate bill passed with a 60-vote margin, so it is still quite viable. If there is just some way to convince the House to vote for that bill. Now the Republican side, we didn't vote for it in the first place, we are not likely to vote for it in the second place. But on the Democratic side, if they can put together enough coalitions and enough votes, now the number is only 216, with some unfortunate deaths we have had on this side and some people who have left the House of Representatives, so 216 is the simple majority in the House. That is all that is required. So, well, look, maybe if we could do some technical corrections, we can't really do them to the bill because the bill has already passed the Senate, and if we took those corrections back to the Senate, we would have to have 60 votes to cut off debate. But there is a Senate process called reconciliation to deal with budgetary and fiscal matters. And under reconciliation, only a simple majority is required in the Senate. Maybe we could do those technical considerations in the Senate under reconciliation and pass that through the Senate with 51 votes. And if we, the Senate, do that, will the House then agree to pass our bill with the understanding that these technical corrections would quickly be instituted? That is the big question right now. And are there going to be any problems with any of those technical corrections to be done under reconciliation? Well, there might be. There might be. Because, remember, reconciliation is to pass those very tough budget and fiscal bills that are really hard to get the number of votes because sometimes you are actually cutting spending, sometimes you are actually irritating a constituency back home because we are reducing Federal spending in some of those reconciliation bills. If it deals with budgetary issues and spending issues, then it could pass under reconciliation with 51 votes. The Vice President gets to vote in the case of a tie over in the Senate. So 50 Senators plus the Vice President would actually pass any of those reconciliation provisions, unless, unless someone makes a point of order over in the Senate that they don't deal exclusively with budgetary issues, that they are in fact changes in policy that are outside the budgetary process. Then the Senate has rules that say if a point of order is made, that it would require 60 votes to put that provision into the reconciliation bill, the so-called Byrd rule initiated by Robert Byrd, the dean of the Senate many, many years ago, to keep just this type of problem from happening. Didn't want the Republicans if they got in charge to be able to do things like this. So the Byrd rule has been in effect for a number of years; and the Byrd rule would say, well, say you have a contentious issue in the House bill. Say there is some issue with the language regulating the Federal funding of abortion. Say there is some question of what do we do as far as dealing with people whose legal status in this country may be in some question. Well, those issues are beyond budget and may in fact be subject to a point of order and may require 60 votes to then be included in the reconciliation bill. So it is not a given that everything that is wanted by House Democrats in changes in the Senate bill for the House to agree to pass the Senate bill, they may not be there when those technical corrections are finally voted on in the Senate. And that will take some time, because every amendment in the Senate may not necessarily be debated, but every one will be voted on; and all of that is going to take some significant time. So where we are in the House tonight is that my understanding is the Rules Committee is to meet soon, if they are not already meeting, and the Rules Committee will come up with the language for that reconciliation bill. None of us have seen that yet. It hasn't really been scored by the Congressional Budget Office, so no one really knows what this bill will cost yet. So all of that is still hanging out there. Then there is one more wrinkle thrown in. The Speaker of the House said it very well the other day: no one wants to vote for the Senate bill. Well, that is a problem if you are going to need to get 216 votes in the House for the Senate bill to allow the reconciliation bill to then go forward to fix the technical problems in the Senate bill. I know this gets a little confusing, but no one wants to vote for the Senate bill. Is there a way around voting for the Senate bill? Probably not. But, wait. What if we voted on a rule that allowed us to go forward with reconciliation, and within that rule we kind of made it like the Senate bill had already passed without actually having to vote on it? Mr. Speaker, I would just ask the question: Do you really think the American people are not paying attention? The last Democrat who spoke here in the well of the House said it is time for the American people to pay attention to this process. I would submit that is exactly right. Now, many people will recognize this icon, the Capitol Rock figure from when my children were young. This was the individual who was just a bill, and one day he hoped to be a law but today he was just a bill. But you can see today he is mad. He is angry. And why is he angry? He is still a bill. He wants to be a law. But he doesn't want to be deemed, and he doesn't want to be ``slaughtered,'' referring to the Slaughter rule that the House may vote on. By this time on Sunday the House may vote on the Slaughter rule which would deem acceptance of the Senate product. Well, you can see why Mr. Bill is upset. He wants to go through regular order. He wants to go through committee, he wants to be voted on by the House, he wants to be voted on by the Senate. He really would have liked to have gone to a conference committee and have those two products melded together and then come back for an up-or-down vote in the House or the Senate. But as it appears tonight, he may not get his wish. And is there a consequence to doing this? Now, you are going to hear people say that, oh, things have been deemed for a long time. This is nothing new. I will tell you, this is different. This is new. This is not something that, certainly in my short tenure, I have seen. In fact, I recall a reconciliation bill in 2005 when the Republicans were in charge, it was called the Deficit Reduction Act, a very contentious bill, because we were trying to bend the cost curve on Medicaid spending. Does that sound familiar? You have heard the term ``bending the cost curve.'' We were trying to bend the cost curve on Medicaid spending from an increase of 7.7 percent year over year to 7.3 percent growth year over year. Not a heavy lift in anyone's book, but it was a big lift here in the United States House of Representatives. Now, we were coming to the end of the calendar year 2005. In fact, it was coming up on to the Christmas holidays. People were anxious to get home and be with their families. We voted on that bill, as I recall, early on a Monday morning. We had been here through the weekend, up all night, debates, debates, debates. A lot of changes, a lot of moving things around on the chessboard. And then, in the final analysis, the bill passed very early in the morning on a Monday morning. I think it was December 19, so it was getting very close to that cutoff for Christmas. Later in the week, that bill was voted on in the Senate. And this was a conference report. We had voted on the regular bills, it had gone to a conference, so these were the conference reports that we were voting up or down on. The House passed its version. The Senate passed its version on Tuesday or Wednesday, quickly left town, and were gone. The House had already vacated the premises. And it was found that there was a little discrepancy. There were some differences in wording between the two bills. Well, as they should have done, the Democrats that were then in the majority went nuts and they said, You cannot send that bill down to the White House for a signature because the House and the Senate did not pass the same bill, the same identical language. And it was a big deal. The reason I remember this so well is, remember the doctor fix that we talked about a lot? In fact, we did a little doctor fix today. We extended the time before the doctors get their big pay cut; we moved that from April 1 to May 1. Well, there was a doc fix in the Deficit Reduction Act. At that point, I think the doctors were facing a 6 percent reduction in Medicare reimbursement, and that clock ran out at midnight on December 31. We fixed it in the Deficit Reduction Act, but there was a problem. The House bill and the Senate bill were not word for word identical. I don't even remember the number of words that were different. It was not many. It seemed like an awfully picky process. But in order to comport with all of the laws in our Constitution, the House and the Senate had to pass identical bills for the bill to be regarded as passed and be available to go down to the President for his signature. So the clock ran out on Medicare and the doc fix. Now, everything else that was in the bill was not perishable, and it would keep until the House came back in January of 2006 and could fix the damage. In the meantime, there was much wailing and gnashing of teeth here in the House on the then-minority Democratic side: this is unconstitutional. We will go to court. We will take this down. So the bill did not go to the President for his signature. It stayed and languished. And then, when the House came back, they passed identical language to the Senate. The bill was passed and went off to the President for his signature. The doc fix was taken care of a month late. Dr. Mark McClellan, who was then the administrator for the Center for Medicare and Medicaid Services, told the country's doctors that he would make good and retroactively supply that difference in the bills that they had submitted; they would not have to resubmit. He tried to paper over the problem and make it as painless as possible. But it was a big deal. It was a painful deal for the country's doctors. That is why I remember it so well, because so many were calling me in my district office and my staff here in Washington and voicing their displeasure that Congress really couldn't have gotten this right and passed the identical bill through the House and the Senate. But the fact is they didn't. And the fact is that that was a problem as far as passing a bill and getting it signed by the Senate. Well, what are we doing today or this weekend? What are we doing? We are not even going to pass the bill. We just deem it as having passed. Because, you know, a lot of the things that are in the Senate bill are things that we have talked about a lot here in the past 14 or 15 months, and some of them we may have even voted on a time or two. So we can just deem it as having passed. Well, no wonder, no wonder Mr. Bill is so mad. That is not what he signed up to do. He didn't want to be deemed or Slaughtered. Slaughtered refers to the chairwoman of the Rules Committee who has created the so-called Slaughter rule, which means that the rule that allows us to take up the reconciliation bill is a self-executing rule and will deem passage of the Senate product that passed on Christmas Eve. Do you think the American people can't see through that, Mr. Speaker? Do you think there are many phone calls going into Members' offices over the past couple of days about this? I think so, because I have heard from a lot of people. They are not happy about a lot of things right now, but they are really upset about this, and I think rightly so. We are supposed to do things by the book. That book is called the Constitution. And when we stray from that on something like this--and this is no small matter--this is going to affect one-seventh of the Nation's economy. This is going to affect the lives and livelihood of every American not just this month, not next month, not the month after that, but for the next three generations. Think of Medicare, passed in 1965. How has that affected people's lives, for good or for ill? But this is sweeping legislation that has a long half-life and is going to affect the way of life in this country from this day forward, really long past my time on this Earth, and I suspect a long time past the life expectancy of almost everyone who is serving in this body. So it is so important that we get this right. It is our obligation. It is the oath that we swore on this floor the early part of January of 2009 after those very famous elections, those historic elections that created the new Presidency, created a supermajority for Democrats in the House, created almost a filibuster-proof majority in the other body. A historic election. We were signed in, we put our hands on our hearts, we put our hands on the Bible, we swore an oath to protect and defend and uphold the Constitution. What happened to that, men and women who are here with me tonight? What happened to that oath? Did you not believe it then, or has something happened that you don't believe it now? This is critical. I know it looks lighthearted. I know I have copied a figure from a children's musical. But this is critical. This is going to change the way of life for every American, not just now, but for far into the future. Now, we don't even know yet the cost of this bill. There are multiple iterations of the reconciliation package that have been floated around the Congressional Budget Office. You call them up and try to get them to do anything at all and they will not because they are working on health care. Unfortunately, it has been that way now for well over a year. It is almost impossible to get any piece of legislation scored by the Congressional Budget Office, but we don't even know what this thing is going to cost. We talk about bending the cost curve. The Commonwealth Foundation, the good folks at the Commonwealth Foundation, I attend a number of their seminars. I think they do a good job of trying to educate Members of Congress. They will talk in lofty terms about bending the cost curve. Well, we are just bending the cost curve, all right. We are just bending it in the wrong direction. Now, this bill is supposed to cost on the order of $800 billion and change. I think it was $824 billion. But anyone will tell you that is not the real cost. In fact, when this reconciliation stuff gets scored, it is very likely that we are going to see a number in excess of $1 trillion. You know, just a lot of this stuff people look at it and say, What is the plain truth here? You say that you are going to raise taxes by $500 million, you are going to cut expenses in Medicare by $500 billion, and you are going to cover 30 million more people. How is that not going to affect me? You say if I like what I have, I can keep it, but how in the world is it possible to do all of those things and it won't affect me? And the President said this several times during the summer. He said: Many people look at this bill and say, What is in it for me? What do I see differently, either positively or negatively, after this bill has passed? For one thing, we know what they will see is a lot of new Federal regulations. We're going to see new fees on insurance companies, new fees on medical devices, new fees on prescription drugs, new fees on insurance plans. All of those, of course, have to, by definition, drive up health care costs. One of the things that we're not doing--and you've heard me reference the ``doc fix'' in the Deficit Reduction Act. We had a baby ``doc fix,'' if you will, for just the next month. But there is a looming 21 percent reduction in reimbursement for physicians who practice in the Medicare system, doctors who take care of some of our sickest patients, our seniors who might have multiple medical comorbidities. We've asked them to do this, and yet we come at them every year with a formula that says we're going to pay you a little less this year than we paid you last year. Now maybe that's okay if you're fortunate enough to practice medicine in a location where energy prices are falling by 5 percent every year, labor costs are falling by 5 percent each year, cost of capital is no concern because the banks are just giving away plenty of money at a zero percent interest rate. Maybe if you live in that area, this is not a problem. But most of the doctors who live in the real world, the same world as you and I, know that their costs of labor are going up. Their cost of capital is going up. In a doctor's office, you don't make a great many large capital purchases, but you sometimes hire a new doctor; and in order to do that, you sometimes have to go down to your friendly banker and secure either a loan or a line of credit. So the cost of capital goes up for those physicians' offices year after year. Energy costs go up the same as they do for every other American. Even the cost of the doctor buying the health insurance for their employees will go up. Believe it or not, the insurance companies don't come into the doctor's office and say, Doc, you know what? You've done such a good job at taking care of all the people enrolled in our insurance company that we're going to enroll your employees for free or at a very reduced rate. It doesn't happen. In fact, what happens in doctors' offices across the country every year is the insurance underwriter comes in and says, Hey, you've had some claims activity. Your rates are likely to go up in your small business here. And the doctor says, Well, maybe that's okay because maybe my reimbursement rates are going to go up enough to match it. But then most private insurance companies actually peg their reimbursement rates in the private sector to Medicare. So if Medicare is reduced by 5 percent, 8 percent, 21 percent, as we're scheduled to do this year, guess what? Insurance reimbursement rates go down. So the poor doctor is left scratching his or her head, saying, How come it costs me more to insure my employees and my reimbursement rates are going down? How's that going to work out for me? The cost of doing business in a medical office is no different than any other small business in America, and doctors' offices simply cannot continue to survive if we continue to impose this draconian pay formula upon them, and yet nothing in this bill fixes that problem. We had a temporary fix today. We talked in grand terms about this great and wonderful fix that the House passed last fall, but we all knew over here in the House, even those of us who voted for it, we knew that the Senate was never going to take it up and pass it. In fact, they had already rejected it. As a consequence, this provision has been left out of this big, gargantuan health care bill, this 2,700-page bill, and there is no fix for the problems that the doctors face in the Medicare reimbursement system. There is no fix in the bill. It's a simple arithmetic problem. The simple arithmetic problem is that it costs somewhere between $280 billion and $350 billion to fix that problem. Well, clearly, if you're trying to keep the cost of your bill under a trillion dollars, and I'm not sure that they have done that, but if you're trying to do that, a $350 billion addition to the price tag is not likely to make your life any easier. There is a cost for simply repealing the sustainable growth rate formula, as it's called. Medicare part B has an additional problem in that, by law, seniors are charged 25 percent of the actual cost of their premium. The Federal Government picks up the other 75 percent very generously. But if the cost of the Medicare part B program increases, then Medicare part B premiums, by law, have to increase, and they have to increase by a formula which, again, is 25 percent of the actual cost. Now we hear a lot of talk about insurance companies raising the rates. They do. Can they justify it or not? There are supposed to be State insurance commissioners to oversee that process. I know we had a big hearing in my committee on Energy and Commerce a few weeks ago on the Anthem, WellPoint rate increases that occurred out in California, but I honestly don't know where the California insurance commissioner was when all of that was going on. And the people at Anthem did say they submitted their paperwork to the insurance commissioner. I don't know what happened there. I honestly don't know what the disconnect was, but there are rules in place where these types of increases are supposed to be justified. But the fact is that part B recipients will likely get a big increase in their premiums this year because the cost of paying for the part B program goes up every year, and, just interestingly enough, that increase is likely to be somewhere in the order of 12 to 16 percent. The President is very critical of private insurance companies that will do that but, wow, he is the CEO of the biggest insurance company in the world. It's called Medicare. And he's raising his rates by 12 percent this year. In fact, over the last decade, over the last 10 years, those premiums have increased almost 150 percent. Again, it's by law. It's no one doing something that they shouldn't be doing. It is just the cost of delivering that medical care has, in fact, increased over time, more people making claims on the system. And as a consequence, those costs have gone up, and, by law, the seniors who are participants in the part B program are obligated to pay 25 percent of the cost of the program in their premium. So when people tell you that the cost of insurance is going to increase, that's true whether you're talking about a Federal program, such as Medicare, or programs in the private sector. One of the things that concerned a lot of us as the debate was going through the House this summer was the appearance of what was called a public option. At the time, a lot of concern by, actually, Members on both sides of the aisle--probably voiced more consistently by people on the Republican side--about what this public option was going to do to pay for insurance coverage in this country. Many people on the Democratic side said, Oh, it'll be competition for the insurance companies so it'll bring their prices down. Well, here's part of the problem. One of the reasons that the insurance companies are raising their prices is because there is a cross-subsidization, that there is a shifting of cost from the government sector onto the private sector. Medicare reimburses at a rate that's far lower than most of the private insurers for both doctors and hospitals. In order for those doctors and hospitals to keep their doors open, that means they need to charge a little bit more to those patients who come in who have actual insurance coverage. So that cost shifting or cross-subsidization exists because the government isn't actually carrying its share of the load today. So if we expand that part, how are we going to help keep the costs low on the private side? Because, again, it's a cross-subsidization that we're already doing in the existing public plans--Medicare, Medicaid, SCHIP, and the variety of other programs that exist. Those public programs are not filling the holes that are being dug, the overhead holes that are being dug at hospitals and doctors' offices, and those holes have to be filled with dollars from private insurance. So right now it's about a 50-50 mix. Well, that's not fair. Fifty cents out of every health care dollar that's spent in this country today is already spent on one of those public options--Medicare, Medicaid, SCHIP, add the VA, Federal prison system. It's about fifty cents out of every dollar that is spent on health care, and it is going up. The other 50 percent is not all private insurance. Some of it is paid out of cash flow for some families; some of it is paid out of savings for some families, and some doctors and hospitals just simply have to write off some debt because it will never be paid. They certainly do contribute more than their share of charity care. So the government, which has about 50 percent of the health care dollar right now, is not carrying its load, which drives up the cost for people with private insurance. So we're going to expand that part and expect that the cost for private insurance is somehow going to go down. You're talking about magical thinking. That's just never going to work out. There's no way it can work out. And sometimes you step back and you look at this and you think, Wow, the people who want a single-payer, government-run system have really set the wheels in motion to accomplish just that. Let's create another public option, bleed off more dollars from those greedy folks on the private side. Their prices go up. The President, whoever the President is at that point, says, Well, I tried. We tried to keep the private sector involved, but look what they've done to you. There's nothing we can do about it. We will just have to take over everything. At that point, you have a completely nationalized health care system in the United States of America. A lot of people look at that and say, No, that's not what we want. You said, if you like what you have, you can keep it. That's what we want. Sixty-five percent of Americans have insurance either through their employer or in the individual market, and they like what they've got. They're concerned about cost, to be sure. They want costs to be held down, but they like what they have and they want to keep it. So it does concern them when they look out over the horizon and say, What might have happened with this public option? Now, the Senate bill, at least in theory, does not have the public option written into the bill. It does. It's kind of hidden. You kind of have to look for it a little bit. The Senate bill sets up insurance exchanges across the country in order to ensure that everyone has access to at least two products in an insurance exchange. The Senate has said that the Office of Personnel Management, OPM, will ensure that there is at least one for-profit and one not-for-profit insurance company in each of those exchanges. Well, what happens if no one shows up on the day they hold the auction to sell the insurance? Office of Personnel Management will find a for-profit company and a not-for- profit company, and if they can't find one, somehow they will make one. Now, the Office of Personnel Management right now is a relatively small Federal agency. It administers Federal benefits. It administers things like the Federal Employees Health Benefits Plan. It does a good job with that, arguably, but this is a vast expansion of their mission, a vast expansion of scope to then put them in charge of these various exchanges that are in place all around the country. The Office of Personnel Management could become the de facto public option, and in fact, as it was looking like this bill was getting very close to being enacted in the early part of January before that famous election in Massachusetts, the Office of Personnel Management was indeed gearing up to take on that responsibility. So whether you get the House bill or the Senate bill, there's still a possibility that you're going to see a public option. It may not be the so-called robust public option that you heard talked about here on the floor of the House ad infinitum last summer, but it will be a public option nevertheless, and it remains to be seen what happens to that over time. It may always stay a small part of what is available to the insurance market or it may grow significant. What has been mystifying to me about that process, and you heard the President say earlier or last year in the fall, he cited there's a part of Alabama that you go to and you have only got one choice of an insurance company; and if you've only got one choice of an insurance company, there's not a lot of competition, so let us put a federally administered program on the ground to compete with that one insurance company. But there's well over 1,000--in fact, over 1,300 insurance companies--in business right in the United States of America. What if we changed the regulations such that more companies could, in fact, sell in that market in Alabama? It looks to me like a market that companies might be interested in because, after all, there's not much competition there. That's the way to get robust competition in the market, and that is the way to get the types of cost controls that we would all like to see that could be delivered more efficiently by a competitive marketplace than it can be by government regulation and price-fixing. We know what happens when you fix prices. Those of us my age who are old enough to remember gasoline purchases in the 1970s, when you put price controls on gasoline, you end up with gasoline shortages. You remove the price controls, and miraculously there's enough gasoline for everyone to buy. And as more gasoline becomes available, then the price comes down. It was a wonderful study in just how markets were supposed to work. You put the price controls on, it becomes very scarce and very expensive. And I can remember as a young resident at Parkland Hospital waiting for hours in line at a gas station because I did not want my gas tank to be empty and risk running out of gasoline on the way to the hospital in the middle of the night. It's something I couldn't afford to let happen to me. So I missed a lot of family time sitting in those gasoline lines. Fortunately, that didn't last long because the folly of that decision was recognized, the price controls were removed, and the price went up temporarily, and then it came back down as the supply of gasoline increased. We don't know where we're going on the cost of this bill that's before us. The one charge that the American people gave us was, We want you to do something about the cost of health care. The one thing that we're not doing in this legislation is moving in a sane way towards doing anything that would get control of those costs. In fact, some of the things we're doing may, indeed, lead to a reduction of availability, and that means a reduction of access for patients to medical care. An interesting little article that I found online on the way over here tonight was about what will happen to health insurance premiums under the bill that has been proposed. And what got this reporter's attention was a Presidential speech where he said that the cost of insurance if the bill was enacted would drop by 3,000 percent. Later on, the White House clarified and said the President meant to say the premiums would drop by $3,000, and that is money that could be returned to the worker. The next quote in the story is, `` `There's no question premiums are still going to keep going up,' said Larry Levitt of the Kaiser Family Foundation, a research clearinghouse on the health care system. `There are pieces of reform that will hopefully keep them from going up as fast. But it would be miraculous if premiums actually went down relative to where they are today.' '' So next line in the story is, ``It could be a long wait.'' Indeed, it could. I do urge people to pay attention. I do urge people to dig a little deeper in the story--don't necessarily accept what I am saying here tonight. But do look carefully into this story and understand what your Congress is doing because if it doesn't affect you the day after the bill passes, it will affect you at some time. Now convincing reluctant Members to vote on this bill by doing the Slaughter rule and deeming the bill passed may be a way to trick some wavering Members into voting for the bill. But I promise you, it's not tricking anyone out there in America. You hear stories of people going to the supermarket at the checkout line, and the person who's checking their groceries will say, You are not really going to deem that bill as passed, are you? They get it. People understand it. They've been watching this. We've been working on this for 14 or 15 months. Goodness knows we're tired of it. The country is tired of it. People do understand and are watching. Now tomorrow in The New England Journal of Medicine, it's been widely reported that they're going to have an article detailing the attitude of America's physicians towards this legislation that the House of Representatives is likely going to try to pass sometime this weekend. The numbers were somewhat startling, and I don't have the exact numbers in front of me. But if the bill were to pass, around 30 percent of practicing physicians would consider concluding their practice and finding something else to do with their time. And if a public option is included, that number gets significantly higher--45, 46 percent. People who have been working in the trenches, who have been delivering the health care, understand how pernicious it has been with the constant reduction in rates for Medicare, to be sure, Medicaid in some States. In most States, physician reimbursement is just an easy target. When those State budgets start getting stressed, that's one of the first places that the State legislatures will go to try to pull some of those dollars back in. They'll reduce reimbursement rates to physicians. And as a consequence, if it was difficult to keep your doors open and pay your overhead costs with the reductions that we were seeing in Medicare, it becomes an absolute certainty that those doors are not going to stay open if Medicaid rates are vastly curtailed. One of the things we're going to do with this bill is significantly expand Medicaid. The cost to the States right now is somewhat in flux. Nebraska got a pretty good deal on the Senate floor right before Christmas that would kind of protect them against some of the dollars that the State would have to match into the Medicaid program. Now there's talk of extending that to every State and not just making Nebraska a special case but extending that to every State. I promise you, I promise you that is not going to make the cost of this legislation go down. It is going to make the cost of that legislation go up significantly. If we don't do that, right now there is a Federal share and a State share of Medicaid expenses that are paid. It varies from State to State. In some, it's a 50-50 proposition. In some, it's much more generous from the standpoint of what the Federal Government contributes. On average, about 57 percent of the Medicaid cost is contributed by the Federal Government. The State pays 43 percent. In this bill, the language might be more generous than that, but there would still--unless the so-called Cornhusker kickback is applied to every State, then States are going to be hit with additional Medicaid expenditures. I have received communications from senators and legislators back home in my State where that number could approach $20 billion for the 2-year budgetary cycle that we have in Texas. And although many people in Washington would consider that so small as to not even be worthy of consideration, in a State budget, it is significant, and that is why the legislators and senators have written to their Members of Congress to advise them of this that's occurring. That means money that's not going to be available to fund transportation projects in the State. That means money that's not going to be available to pay for educational activities in the State. These will be real dollars that are taken out of circulation in the State to pay for the expansion of Medicaid that the Federal Government is going to require. The whole question of making everyone buy health insurance, the question of an individual mandate that is contained within the Senate policy, is something that this country has not done before. That is a new phenomenon. Now I know you hear people say, Well, look, look Massachusetts has a mandate, and it's working okay up there. Well, maybe. Maybe not. I think the costs went up a little bit because the insurance companies are now under no--there's no reason for them to try to hold costs down to attract customers because, hey, you've got to buy it. It's the law. But still, if a State wants to pass an individual mandate or an employer mandate, for that matter, within their State to cover health care costs, that's their business. They can do that under the 10th Amendment, that those powers not taken by the Federal Government are reserved to the States. That's one of those powers that are reserved to the States. So if a State wishes to do that, and the people who elect the Governor and State legislators and State senators in those States are saying, Well, that's okay with us, then good on 'em. That's what they should do. But what's working in Massachusetts likely wouldn't work in Texas. It's a different demographic, different problems. So we can't apply a one-size-fits-all solution across the country, and the Founding Fathers recognized that. You will hear people say, Well, look, it's a mandate that you've got to have car insurance if you drive your car. But you are driving your car voluntarily on a public road, and that is a State mandate for the purchase of that insurance. Not every State has them. I think there are two States that don't have an insurance mandate. Texas didn't until a few years ago. I don't know if it's actually increased the number of people who carry insurance because you are forever hearing about some poor soul that was hit by someone else who carried no insurance. But that's a State issue. And the States make that requirement. Again, those State governments have to be responsive to their citizens in the State. If the citizens get too upset by the liberties that are being taken from them by a State government, they are free to react against that. And that's what a democratic process is all about. That's what elections are all about. But never in the history of this country has there been required the purchase of a product just as a condition for living in the United States. Now we do have to pay income tax, it's true. You don't have to earn any money. And if you don't, then you don't have to pay taxes. But in order to ensure that this program is administered effectively, we go to the meanest, biggest Federal agency of all, that very same Internal Revenue Service, and say that they're going to collect--they're going to enforce this individual mandate that you buy health insurance. Just a thought on that in some of the moments that are remaining to us this evening. Does putting an individual mandate on people increase the number of people who carry, say, health insurance? Putting an individual mandate on for the requirement that everyone have health insurance, does that increase the number of people who have health insurance? Right now in the country with a robust employer-sponsored insurance program, people who are employed in the individual market, small businesses who provide insurance in the individual market for their employees, the compliance rate or the insured rate is about 85 percent. We hear the figure of the number of people uninsured in this country, and it works out to be about 15 percent. In the Federal tax system, does everyone file and pay taxes who should? The answer is no, they don't. By the IRS' own estimates, by their own estimates, 15 percent of the population decides not to file or not to pay their income taxes. Now that's a pretty stiff mandate that the IRS puts on us. Most people don't know exactly what the penalty is, but they're pretty darn sure that they don't want to find out firsthand because they do know it to be severe. So with this very severe penalty hanging over people's heads, you still have 15 out of 100 who will say, No, thanks, I'll still take my chances. How many more people are going to buy health insurance who don't already have it if we put that on as a requirement? And then one of the other considerations is, if the fine is not as much as the insurance policy itself, then someone who believes themselves truly to be at zero risk for any medical condition says, You know what, I'll just pay the fine if it's less money, and I'll worry about insurance if I get sick. Of course under the plan that's over in the Senate now, they can do that because there will be what's called guaranteed issue. If they get sick, they can literally purchase the insurance policy from the back of the ambulance on the way to the hospital. You know, we heard a lot during the course of this debate on health care over these past 15 months. One of the things that I will never forget is the energy and enthusiasm that I encountered this summer in doing town halls during the month of August. As you will recall, we passed the bill out of the Energy and Commerce Committee sort of at midnight Friday night, July 31. We all went home to our districts. We started seeing the stories on the evening news of vast throngs of people showing up at Representatives' town halls, both Republicans and Democrats. Whether they had come out in favor or in opposition to the bill. We hadn't voted on the bill on the House floor at that point. Because I was sitting in the committee that voted on the bill, I could tell my constituents back home that I voted no in committee, and I would vote ``no'' when it came to the floor, unless there were substantial changes. And people supported that decision overwhelmingly in the town halls that I did this summer. But it doesn't mean that they said, We don't want you to do anything. They had some rather specific things that they would like to see Congress do to help them with the problems that they were having with either insurance companies or with their doctors or with their hospitals. There were some things they thought that Congress could do. Now bear in mind the approval rating for Congress is somewhere south of 20 percent. We do not enjoy a significant amount of political capital. In order to do something this big, you really have to have the American people behind you, but we don't. And therein is the trouble that the Democrats are having passing this bill. Right, they've got no Republicans, but then they really didn't try. They weren't interested in having any Republicans a year ago when this process was beginning. So it's no surprise that at this point, a year later, they don't have any Republican support for their proposals. Their problem is within their own conference. Now, they've got 40 seats on us. It really shouldn't be a problem. I'm sorry, they have 40 more seats than they need to pass this bill, because in the House it's a simple majority. It really should not be a problem. All you've got to do is keep 40 people from leaving you. That shouldn't be that hard. These are people who feel the same as you. They're members of your same party. They believe the same things you do. That shouldn't be a hard lift. Why is it so hard? It's hard because there's not the popular support for this bill that everyone assumed would be there shortly after the 2008 election. We had an election. President Obama won the election. Health care was a big deal during the election, so it was just naturally assumed that the American people would be with the Democrats no matter what they did, with, to or from health care. As a consequence, they didn't need any Republicans. They really couldn't be bothered. We were noisy and inarticulate in meetings, and they just wanted to write the bill they wanted to write, and they'd get it passed without any Republican votes. Now they're up against an impasse with their own side. Very difficult to pass something this large that affects this many people without at least some input from both sides. That's never been done before, to my knowledge, in this country; and that's what we're trying to do tonight. You might be able to do that if you had the popular support of the American people behind you. You could say, well I've got the people with me. I don't need Republicans. And that would be true, but they don't have the people behind them. So the fact that the Republicans are not supporting the Democratic bill is actually of no consequence. Their difficulty is the people don't believe what they're doing. And, quite frankly, I don't see how there is a way to change that equation between now and Sunday, the day we're supposedly going to vote on this monstrosity. I did hear from people in town halls about things they do want done. I maintain a Web site that's devoted to health care policy. It's called healthcaucus.org, @healthcaucus.org. ``Healthcaucus'' is all one word. Healthcaucus.org. Under the issues tab, you see Dr. Burgess' prescription for health care reform. And I've listed there the nine things that people told me most consistently during the summer and fall that they wanted to see us do. Number one thing, people sure do want some help with preexisting conditions. There are things we can do to provide some help, and it doesn't mean an individual mandate. It doesn't mean guaranteed issue. It means helping those people who need help. It does cost some money. The Congressional Budget Office scored an amendment that Ranking Member Joe Barton had on our committee. It scored at $20 billion. Nathan Deal, the ranking Republican on the Health Subcommittee and I have introduced legislation that captures the spirit of that amendment. We erred on the side of being more generous. That's a $25 billion authorization for that program. The Congressional Budget Office said $20 billion over 10 years. We plussed it up by $5 billion. Let's start it and see what happens. After all, that Senate bill comes over here and becomes law, no one gets any help tomorrow. It's 4 years before they get help. Preexisting conditions are a problem today. We heard this over and over again in the summer time. This is something people actually wanted us to work on. We could work on this in a bipartisan fashion. We never even had a hearing on how to approach the problems of preexisting conditions without a mandate. We never even had one word of testimony about that in our committee leading up to this. Does there need to be some fairness in the Tax Code? You bet. Why does someone in the individual market who's paying for their health insurance out of pocket have to pay with after-tax dollars when someone who works for a large multi-state corporation gets their insurance paid for with pre-tax dollars by their employer? That fundamental unfairness is something that has to be fixed. I'm not sure that I know the best way to fix that, but I know we haven't even tried. We haven't even had those discussions. We do need some medical liability reform. It's working in Texas; it could work in other places around the country. It does help keep costs down, in spite of what congressional Democrats and the White House tell you. Portability, the ability to carry insurance with you through life, is extremely important, especially to younger workers. Think of the relationship with your insurance company if you had a longitudinal relationship with that insurance company. There are some things that we could be doing that are not that heavy a lift and don't cost that much money. Most importantly, we can show the American people we can deliver real value and work together while we're doing it. Then we could improve those approval rates, that low esteem that the country holds us in. Dr. Burgess' Prescriptions For Health Care Reform 1. Insurance Reform We should eliminate the bias against patients with pre- existing conditions, outlaw rescissions except in cases of fraud, and ensure states have well-designed high-risk pools. H.R. 4019--Limiting Pre-Existing Condition Exclusions in All Health Insurance Markets (Deal) H.R. 4020--Guaranteed Access to Health Insurance Act (Burgess) 2. Tax Fairness Providing individuals the same tax benefits no matter where they want to get their health insurance, and tax credits to help individuals purchase insurance in the individual market. H.R. 3218--Improving Health Care for All Americans Act (Shadegg) 3. Medical Liability Reform The success of Texas' 2003 reforms: Texas has licensed over 15,000 new physicians and Texas hospitals have delivered more than $594 million in charity care. H.R. 1468--Medical Justice Act (Burgess) 4. Portability Allowing patients to shop for health insurance plans across state lines = more choices at lower costs. Example: Average health insurance premium for a family of four: New Jersey: $10,000, Pennsylvania: $6,000, Texas: $5,000. H.R. 3217--Health Care Choice Act (Shadegg) 5. Medicare Payment Reform The current formula Medicare uses to pay doctors--the SGR-- is unstable, and a permanent fix is needed to ensure seniors continue to have access to their doctors. H.R. 3693--Ensuring the Future Physician Workforce Act (Burgess) 6. Doctors to Care for America's Patients We must ensure that we have enough doctors to care for all of America's patients--now and in the future. H.R. 914-- Physician Workforce Enhancement Act (Burgess) 7. Price Transparency Health care services are the only product that we don't know the actual cost of before utilization, so let's have the prices up-front, just like in a restaurant or clothing store. H.R. 2249--Health Care Price Transparency Promotion Act (Burgess) 8. Preventative Care and Wellness Programs Health care reform must include participation from America's patients, so living healthy lifestyles and making healthy decisions is very important. 9. Create Products People Want Mandates have no place in a free society. Instead, we should challenge insurance companies to create innovative health plans that Americans want. Example: Health Savings Account--offers flexibility and control.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I move that the House do now adjourn.

Mr. BURGESS

Mr. BURGESS. I thank the gentleman for the recognition. One minute is not much time to deal with what is a very complicated process. It is unfortunate we didn't have more time to actually look at this bill before it came to the floor on the concept of expanding the definition of a hospital-based physician for the use and purposes of electronic medical records in the stimulus bill that was passed last year. That's a good provision. That was language that we had asked for in the letter that was signed by 293 Members of this body that went to the acting director for the Center for Medicare and Medicaid Services. I do have to point out, Ranking Member Barton is exactly right. This SGR problem is not an emergency. Everyone in this body knew this was going to happen. What this signals us is perhaps the Democrats don't have the votes to pass their health care bill because, otherwise, the fix would be included in their health care bill. The fact that we are having to provide yet another month signals to me that they don't have the votes to pass their larger underlying bill. There is no other Member in this body that wants this SGR fixed more intensely than I do, but this is not the way to go about it. It is not an emergency. It should not come to us at the 11th hour. That is an insult to the Nation's physicians. They can't run their businesses when we always do it in this fashion.

Mr. BURGESS

Mr. BURGESS. But, and I am sure the gentleman feels the same way, I would not want to stand in front of the 2,000 people on a hot August morning in a town hall in Denton, Texas, and say, you know what, I never voted for that bill. I voted for the rule that deemed the bill.

Mr. BURGESS. Correct.

Mr. BURGESS. And Gator Aid.

Mr. BURGESS. I would just go back, too, to that instance with the Deficit Reduction Act, where a small difference in the House- and Senate-passed bills led to a court challenge, and we came back in January. We left on December 21st or whatever day it was when we passed that bill out of the House, it went over to the Senate, there was a problem, they couldn't fix it under unanimous consent because of an objection, and we had to repass the bill in January. The reason I know this is because there was one of those doc fixes in that bill. And the doc fix did not go into effect December 31 and every doctor who saw Medicare patients across the country took a 6 percent ding in their Medicare reimbursement rates because we had not passed the bill by January 1. Now, Dr. McClellan, Mark McClellan, to his credit, who at the time was Director of the Center for Medicare and Medicaid Services, came back and said, you don't have to refile those claims, we will take care of them if Congress passes the bill within a month or two of coming back, which we did. So they went back and reimbursed. But a terribly, terribly complicated process. All of it was brought up because one or two words different in the bills, because the Constitution says we shall pass the same bill and then it goes down to the President for signature.

Mr. BURGESS. So we have two problems. The Constitution says we have to vote on the bill. We say the mandates may be extraconstitutional in their scope. And then the whole question of equal protection under the law. We have a constitutional scholar with us, so we turn to the gentleman from Texas, the judge from east Texas, for perhaps his rendition of this complicated process that faces us.

Mr. BURGESS. One interesting point. You have these groups that went down to the White House in May and June--and I'm not going to criticize them for going down and advocating on behalf of their industries, on behalf of their groups. But what is so onerous about this is the President has proclaimed this Sunshine Week. Transparency is going to be the watchword of his administration. Remember? We heard it over and over again. Everything will be up on C-SPAN, everybody will be able to see it--except for these deals that were struck down in the White House in May and June. And now they come back and say, Well, there really wasn't anything written down. Two trillion dollars in savings and you didn't write a word of it down? Now, in Texas, as the gentleman knows, we trust each other. A handshake is as good as a signature a lot of times. But when it's $2 trillion, you're probably going to need a little more than a handshake even in Texas, because are people going to perform as they said they were going to perform? When Senator McCain wanted to push an amendment that dealt with reimportation in the markup of the Senate bill, in the debate of the Senate bill at Christmastime--I don't agree with reimportation. I think it's unsafe. I think it's unwise. But Senator McCain was prevented from offering that amendment because, to quote somebody at the time, That wasn't part of the deal that we had. Well, wait a minute. If there is a deal that someone knows about, is it written down somewhere? Could we please see what else is in that deal? We're the legislative body. If there are deals struck at the White House--and it is Sunshine Week--if there are deals struck at the White House, let us see what those deals are. I'm not criticizing the groups that went down there and advocated on behalf of those groups. That is fine. They should have done that. But we, as the legislative body, should have been privy to any of that information as we tried to craft the legislation that would have to either enact or confirm or deal with those deals.

Mr. BURGESS. And I can be as critical of the insurance companies as anyone else, but they take the path of least resistance. Their capital is not necessarily any more courageous than anyone else's. The easiest way to get to what they want is an individual mandate. But I suspect if we set up pretaxed expenses, buying across State lines, if we develop that market for them, I'll bet they'd find a way to compete, I'd bet they'd find a way to work in that market and win in that market.

Mr. BURGESS. Let me point out just one thing. We hear over and over again Republicans have no solutions for health care. HealthCaucus.org is a Web site that deals only with health care policy. On that Web site, Dr. Burgess's prescription for health care reform, the seven or nine things that I heard consistently in my town halls this summer are up there. People can download that and look at that themselves. Suffice it to say that we really have been frozen out of this process from the beginning. They were not interested in our input last year because they had a supermajority in the House of Representatives. You can't pass a bill with 40 extra votes? What's the matter with you? Well, now, the entire argument, the entire argument is within the Democratic Caucus. They don't have the votes on their side because it is a badly flawed product and a badly flawed process that they are trying to push through on the American people. People do need to understand this bill has nothing to do with health care any longer. This bill has, as has been pointed out tonight, if we wanted to fix these things, we would have fixed them. This bill is about higher political power for the party in charge, and they want to obligate the American citizenry to re-up their contract every 2 years in order to not lose the benefits that they are ostensibly going to get with the bill. The bill is a bad deal, Mr. Speaker. I would submit that the American people need to continue to weigh in on this. All is not lost. Time is not up. There is time to make a difference. I'll yield to the gentleman for a final thought.

Mr. BURGESS. I thank the gentlemen for their time this evening.

Mr. BURGESS. There is no question that they are. You are right, the American people can see through that. It's an elaborate charade. It will provide no protection.

Mr. BURGESS. Actually, that is a House bill that the Senate passed. So we would simply have to concur with the Senate amendment, and that would be the identical bill. But in this case the Slaughter rule would say we don't even have to bring that bill to the floor, we just deem it--Deem me up, Scotty--we just deem it as passed and then go on to the reconciliation process to try to fix some of the problems with the bill. No guarantee that they will be fixed.

Mr. BURGESS. The exact same bill. We learned that in December of 2005. The Deficit Reduction Act had one word different between the House and Senate bills, and the whole thing was held up.