Michael Burgess

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, health care reform should not cost patients their health care. Unfortunately, several of the plans that have been passed by this House and are now being written in secret in the Speaker's Office with the White House will do just that. If it is cheaper for employers to drop employees from employer- sponsored insurance and move them into a public option, employers will do just that. One-quarter of America's seniors who enjoy the added benefits of Medicare Advantage will lose their coverage. They get the things we want them to get: care coordination, disease management, medical homes, the things that we have told our seniors we will provide for them. And yet they will lose it under the health care reform. Millions more Americans will be moved into Medicaid. Patients whose doctors can no longer afford their liability insurance will lose their doctor if we don't pass some sort of meaningful liability reform. Not just another study, but meaningful liability reform like we passed in Texas in 2003, and the point has been proven over the years since that has happened. Portability should bring hundreds of more choices. We don't need a public option that will simply deliver a single additional choice. No cuts to Medicare. America's seniors have paid, and they deserve better.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, it's now been over 5 months since the White House announced numerous deals with major stakeholders in the health care debate. Little or no details regarding these negotiations have been released. And last week during the Finance Committee hearings in the other body, a plan for a commission to slow the growth of Medicare spending was revealed. But it was then revealed that the hospitals would be exempt from this commission because, according to Congress Daily, they had already negotiated a cost-cutting agreement with the White House. You know, despite the rhetoric of last fall, then-candidate Obama's promise to make all health care reform negotiation public, we still have very few details on what exactly was agreed to during these highly publicized but very secret meetings last May. How can Congress do its due diligence in creating policy before us without the crucial details? More importantly, how can the American public know what we are doing is indeed in their best interest? In January of this year, we were promised an administration that would bring all parties together; we were promised an administration that would not negotiate behind closed doors and in fact would be broadcasting these negotiations on C-SPAN so that the American people could see for themselves what the choices were. When will these cease to become promises and become reality?

Mr. BURGESS

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

Mr. BURGESS

Mr. BURGESS. I thank the Speaker for the recognition. Mr. Speaker, I come to the House floor tonight to talk a little bit more about health care. It is, it seems, the number one topic of the day here in Washington, D.C. It's interesting because probably 50 percent of Americans care more about what we are doing as far as job creation, and 14 percent are concerned about health care. You would think that we would adopt the Bill Clinton phrase of ``focusing like a laser beam'' on the economy and ``focusing like a laser beam'' on job creation. But health care is important, and it is appropriate that we spend some time discussing it because, likely as not, before the end of this month, certainly before the end of this year, it is possible that some type of bill will pass this House, although it may not be to the liking of a great number of Americans. Mr. Speaker, I know that my comments must be directed to you and not to others, but I would say, Mr. Speaker, that if I were able to talk to people about what they could do, a plan for action, I will be discussing that toward the end of this hour. So I do encourage people to stay tuned to this debate--not necessarily to this discussion this hour--but stay tuned to this debate because it is important. It is going to affect the lives and livelihoods of Americans from this day forward for a long, long time. It is extremely appropriate that we take our time, that we get this right, that we do not hurry through the process, that we do not cut corners. Now, Mr. Speaker, you look at where we are 10 months into this year. Do we have the trust of the American people in this body? The answer to that question is, it doesn't seem so. What people have seen this year-- and even going back into last year in the term of the previous President, President Bush, they saw a couple of bailouts last year, they've seen more of the same this year, they've seen stimulus, they've seen automobile takeovers, financial sector takeovers, cap-and-trade that passed the floor of this House that many Americans felt was inadvisable in a time of economic downturn; and Washington yet still has the nerve to say, Trust us because we can take care of you and we will make your lives better. But the current polling numbers don't really suggest that that is something that's believed by the American people. Now true enough, the President started this year with extremely high approval ratings, somewhere likely in excess of 80 percent approval ratings at the time of the inauguration--an extremely popular individual--and has retained a great deal of that popularity, depending upon the poll that you select. Now it is down to about 50 percent, 49 percent this morning in Rasmussen, 52 percent in the RealClearPolitics daily average poll. But, still, one out of every two Americans still has a favorable impression of the President. What about the United States Congress? Is it one out of two? Is it one out of three? It's one out of every five people holds the United States Congress in high regard. So with our current approval ratings hovering around 20 percent, why do we think the American people would believe that we, in fact, do know best and that they should trust us on an undertaking of this mammoth scale? And you can see how big the undertaking is. We heard previous speakers in the last hour talk about how difficult it is. We have had three health care bills that passed the various committees in the House last summer. You had one health care bill that passed the Senate Health, Education, Labor and Pensions Committee in June of this year; and then most recently you had the talking points memo that passed out of the Senate Finance Committee yesterday with a single Republican vote on that. I do not believe there were any Republican votes on any of the House products in the three committees that considered this bill under their various jurisdictions. The Congress doesn't have a lot of credibility right now on this or, quite frankly, many other issues. It would be a great thing, in my opinion, if Congress spent some time in trying to rebuild that credibility; but unfortunately, it's the old adage: Don't check the weather; we're going to fly anyway. And off we go with a big cap-and-trade bill in June that upset a lot of people; we did the three health care bills on the House side in the various committees in July. We ran into the town hall meetings during the month of August when people told us what they thought of our efforts, and now we're back here in the fall taking up the big bill on health care reform. As we've watched this debate, you think back to a year ago, we were in the middle of a presidential campaign. Both presidential candidates had ideas about what should happen as far as health care and the possibilities for health care reform. Remember now-President Obama's position last fall was significantly tilted towards getting coverage for the uninsured. It was a moral imperative. It was something that we had to do. Then we worked through some of the more difficult parts of the economic downturn, a lot of job losses were incurred during that time; and at the beginning of the year, many more people were concerned about the cost of health care and would they be able to continue to afford their insurance, would they be able to continue to afford health care. So affordability became perhaps a higher priority for Members of Congress who were considering these reforms during the spring. In June when the first congressional committee in the Senate, the Health, Education, Labor, and Pensions Committee passed their bill out of the Senate committee, the focus was all on cost and coverage. The cost numbers turned out to be significantly higher than anyone thought they would be; somewhere in the neighborhood of $1.5 trillion over 10 years' time. The coverage numbers were disappointing at only a third of the uninsured actually being picked up. And there's no question that that delayed the second Senate committee, the Senate Finance Committee, in introducing a bill and marking up a bill which they just completed this week because they were trying to fine-tune those numbers. Now on the House side, we did, in fact, get a Congressional Budget Office score that came in around a trillion dollars for a 10-year bill. A little disingenuous because the Congressional Budget Office--in the hearings we had on Energy and Commerce from the Congressional Budget Office, the score was administered not on legislative language but on conversations, telephone calls, that the members of the Congressional Budget Office had with members of the Democratic majority who were writing the bill. So, yes, it was a cost number but there was some question as to the accuracy of that. And then here was a really big problem and one that really hasn't been addressed yet. These are enormous programs to undertake. They are not going to start overnight. So even if we pass a bill before the end of the year, it is going to be some time before these programs--whether it be a public option, whether it be exchanges within the States--it is going to be some time before the Centers for Medicare and Medicaid Services in the Department of Health and Human Services--which is likely to be charged with writing the rules and regulations under which these new products are formed--it's going to be some time before those things happen. The benefits are actually not scheduled to begin to kick in until the year 2012, 2014. It will be some time before those benefits occur. The taxes, of course, will begin the minute the ink is dry on the President's signature on the bill. So if we have a tax on high-end insurance plans, if we have a tax on medical devices, if we have a tax on any number of things, these taxes will begin to accrue January 1 of that year, but the benefits don't actually begin to kick in for some time. And once again, the United States Congress, when it's questioned by the American people, the United States Congress says, Don't worry. Trust us. We know best how to plan for you. We know best how to take care of you. We know that you don't know how to do this for yourself. And Congress, with its 20 percent approval rating, is just the man for the job to get this done for you. During the presidential campaign last year, President Obama promised to bring all parties together and not negotiate behind closed doors and to be broadcasting those negotiations on C-SPAN. Now we had kind of an unusual situation occur in May and June of this year when stakeholders in the health care community met at the White House and offered up things that they could do, things that they could do to hold down the cost of health care--you had to wonder where were these individuals for the 15 years before--but you had groups. The American Medical Association, of which I am a member, was in those meetings; the American Hospital Association was in those meetings and offered up a number of things that they could do for substantial cost savings. A little bit of controversy then last week as the Senate was working through its product, will those things that the American Hospital Association offered, are those going to be taxed or not? And there was some back-and-forth with the Congressional Budget Office as to what those numbers actually meant. Medical devices. Again, similar situation. PhRMA came to the table with--I forget the number now, but it seems like it was about $80 billion in cuts that they were going to be offering. Well, none of these things that were agreed to behind closed doors last May, none of these deals are available to us as Members of Congress so that we can know what did America's health insurance plan group, when they came to the table and said, We can save you billions of dollars, Mr. President, and he said, What took you so long? But as members of the committee that were charged with working through this bill last July, why did we not have that information available to us? Why was it a surprise at the Senate Finance Committee when, hey, we thought these breaks we were giving the hospitals were going to still be subject to a corporate income tax, not an off-tax item? Why was there even that discrepancy or that discussion? Why not share with us those deals that were struck down at the White House? And indeed, last month I sent a letter to the White House and asked for the release of those discussions, the transcripts of those discussions, the minutes or notes of those discussions, pertinent e-mails that may have occurred during those discussions. Just quoting from my letter to the White House: It has been now over 4 months since the White House announced numerous deals with major stakeholders in the health care debate to save upwards of $2 trillion in the health care system. Little to no details regarding the negotiations have been released. And recent actions and press reports have reminded me of the importance of openness and transparency throughout the legislative process--the very openness and transparency that we were promised by this President during the campaign. So the letter has gone to the White House. I eagerly await a response to that. I am in fact somewhat surprised, my committee, the Committee on Energy and Commerce that has a fairly robust oversight and investigation subcommittee, I am somewhat surprised that they have not been curious about the deals that were made down at the White House early in the spring; why they have not been curious about some of the e-mails that may have occurred during the back-and-forth working through these negotiations. Again, the letter went to the White House on September 30, and I await a reply. I will ask later to include this letter as part of the Congressional Record this evening so that people will have the opportunity to read through that letter themselves. But again, the American people just simply do not trust the American Congress, the United States Congress, to make these kinds of decisions for them. When you look at some recent polling data when the question was asked if Congress works through this process and comes up with a major health care reform piece of legislation, is health care going to get better or is it going to get worse? Well, a quarter of folks think it's going to get better. About 26 percent say, Yeah, we think Congress will make the kinds of improvements that are necessary and health care will, in fact, improve. Fifty percent say it will get worse. Not great numbers with which we're working. You know, it was startling for many of us, the interest that was out there over the summer during the August recess on the health care bill, on cap-and-trade. Town hall activity was widely reported in news media outlets across this country. My district back in Texas was no exception. Town halls where I might typically have 30, 40, 50 people show up on a Saturday morning, 1 or 2,000 people would show up. In fact, one venue we had to change from inside to outside and just held the bulk of the meeting out in the parking lot because of the number of people that showed up. I have to tell you, Mr. Speaker, August in Texas in the parking lot is--you're asking a lot of people to stay with you through an hour or so discussion of a health care bill. But they did, and they asked questions, and they were respectful. I don't think that this August was an anomaly. I don't think that the American people had some sort of fugue state during August where they reacted to the health care legislation and the cap-and-trade legislation and reacted in no uncertain terms as to how angry, how anxious they were about these bills that we were passing. But when we get back to Congress in September, it's like August never happened. It was unimportant. ``Don't pay any attention to those people back home because we're Congress. Trust us. We know best. We know best how to take care of you. We know best how to give you what we think you need.'' We got back in September and I think I thought after seeing the August town halls, I thought this Congress would hit the pause button, hit the reset button, hopefully the rewind button on this health care legislation, but no such luck. We went at it full force. We, in fact, even had a little bit of an extended markup in the Energy and Commerce Committee where it was suggested to the chairman of my committee, you know, that August was a rough month for a lot of people, a lot of people on both sides of the dais--Republicans and Democrats both, even Republicans who voted against the bill--people were angry that the bill was even being considered and would likely pass. On the Democratic side, there were a number of town halls that were quite contentious. We thought, I thought Members would welcome the opportunity to, well, let's sit down and revisit this. Let's reorganize. Maybe there were some good ideas on the other side of the dais. Maybe Republican members should have been brought into this process and take some ownership of this bill, if nothing else. Don't leave us being the only ones out there to defend it; but, no, that wasn't the case. The chairman of the committee said August, in so many words, August didn't matter. The people that spoke up were few and far between, and these large crowds that showed up at the town halls were somehow manufactured and didn't count. Not only did they not count, we were not reconsidering any part of the bill. We had some additional amendments that Members on the Democratic side wanted to offer. I offered a couple on our side as did other Members on the Republican side. But for the most part those amendments were struck down on a party-line vote. Both sides of the aisle genuinely see a problem and genuinely want to work toward improvement of the process. You have heard me say it before. You have heard other Members of Congress say it before. Some people dispute it as a fact, but I will say it: America has the best health care system in the world. There are distributional problems, and there are inequities in the insurance system that need to be fixed, and they are within our purview. They are within our capability of fixing, but we do not need to turn the entire system on its head to effect those ends. How could we best go about improving what we call health care in America? Well, we can ensure that patients continue to have, continue to get, care, have access to care, and continue to get the best care. That would be a good thing for us to work on together. Instead of being an obstacle, instead of threatening cuts every time you turn around, we could help doctors, nurses and hospitals continue to provide that excellent care. We, as Members of Congress, and sometimes it's do as I say, not as I do, but perhaps we could set a better example about living healthy lifestyles, staying within our-- staying within our ideal weight. Maybe that's something we should look at. Again, an amendment to that effect was turned back in my committee on Energy and Commerce. You know, really, one of the keys is going to be, if we are going to hold down medical costs, we really do have to involve the patient in the process. We have to have patient involvement in the doctor's office. We have to have patient involvement in making those healthy lifestyle choices. If we do not have the patient involvement and increase the patient knowledge base, the health literacy, if you will, about things like preventive care, about things like the importance of eating right and staying fit and the importance of regular health checkups and medical screenings, if we don't do that, the cost for health care is going to continue to increase and increase at a rate at which it's go going to be very, very difficult, regardless of the number of new taxes, regardless of the cuts to doctors and hospitals and nurses. Regardless of all of those things it's going to be very, very difficult for Congress to keep up. We do put the system at risk when we do that. There could be a day when the generation or two coming behind us will say we can no longer afford the type of tax rate that you have left for us. We will have to do something drastically different, and we don't want to do that. We don't need to do that. Now, you have heard a lot of discussion about how Republicans have been obstructing the process. Let me clarify that just for a moment. There are 177 or 178 Republicans in this body, 256 Democrats in this body. It takes 218 votes to pass a bill, to send it on to the Senate. The Democrats in this body could pass whatever bill they wanted. They do not need Republican support. They have, in fact, told us that on more than one occasion. The famous phrase that came out in January or February, well, after all, we won. There hasn't been a lot of reaching across the aisle, because it was just simply not necessary. Now, you think back to February. Again, the President had an approval rating of, I don't know, 70, 75, 80 percent. The President could have passed whatever health care bill he wanted in February of this year. There would have been nothing anyone could have done to stop it. In fact, there likely would have been very few people with the courage to try to stop it because the President was seen as so popular and so powerful, evidenced by the fact that the President did get a $787 billion stimulus bill passed through this House, a bill that many thought was ill advised, a bill that many thought was duplicative, unnecessary and wasteful. But they got it passed, no Republican input into that bill as it was being written and no Republican support on the floor; but they didn't need it. It passed overwhelmingly with only Democratic votes, went down to the Senate for a similar fate, went down to the White House and was promptly signed into law by the President. It was followed a week later by an omnibus bill that spent a lot of the same dollars on the same things. Again, not much in the way of Republican support was solicited or required for that. It passed because, after all, 218 votes are all that are required to pass a bill on the floor of this House. The Democrats with their 256 majority have more than enough votes to pass almost anything they want. Now, the Republicans even tried--and I don't know the answer to that for everyone, but I will tell you that I did. I met with the transition team in November of last year. I met with the chairman of my committee in January of this year and said, look, I didn't give up a 25-year medical career to come here to sit on the sidelines. I want to be involved in this debate. I may not be able to be with you on some issues. There are some things that I think are just the wrong approach to reforming health care, but let's sit down and have the discussion and see what can be worked out. I was thanked for my interest and never received a call back. Oh, I did get called down to the White House in March for a photo op, but that was about it. There wasn't much more to it than that. Then as the bill was being written behind closed doors for the various committees where we worked on the bill on the House side, certainly at no point was I ever offered any input. Now, I did, as did many members in my committee, offer a number of amendments, and we did amend the bill in committee. It would be interesting to see now whether or not those amendments stay in the bill. But I don't think anyone is fooling themselves. There was not--there was no way to amend that bill, H.R. 3200. There was literally no amendment you could offer except striking the language in the bill and offering the new bill. There really was not. It was not salvageable, in my opinion. Now it's interesting because all three committees have passed the bill. They all amended it and some of those amendments will be completely--the incentives will be aligned. Some of them actually will be at a 90-degree intersection. Someone is going to have to redo that bill. That is happening now, and you can expect that there is probably a heavy hand from the White House in aligning all three of those House bills into one product. We will likely get to see it a few hours before we vote on it. It may come as early as the end of this month, and we are promised that it will, in any case, be something that we see before Thanksgiving. I expect that that is true. I don't know whether any Members on my side will vote for it. There don't seem to be a large number of Republicans who are supporting H.R. 3200. I don't know if any Democrats will vote against it. We certainly saw that in all three committees that there were some Democrats who simply could not support the things in the bill and did vote against it. The public option continues to be a political football kicked from one side of the rotunda to the other. The House wants a robust public option, the Senate not so much. How will it pass on the Senate side if they have a public option, or will a public option be ignored by the Senate but added back in the middle of the night when the two bills come together in the House Senate conference before we vote on the final product? It's anybody's guess and, Mr. Speaker, again, you know, just speaking to you, I would say if I were able to speak to the American people, I would say stay tuned to this because it is going to be a very important process. You will have a House unified bill coming up the next couple of weeks. How long we have to evaluate that before we vote, I think, is going to be very telling. If it's a very short period of time, there is probably some bad stuff in the bill that they don't want you to know about before we actually vote. Now, we are arguing for 72 hours. I will just tell you, for what's likely to be at least a 1,000-page bill, more likely a 1,500-page bill, 72 hours is a very short interval of time to work on a bill of that magnitude. Bill language is inherently very difficult to read. There is a lot of referral back to the Social Security Act. There is a lot of referral back to the Medicare or the Medicaid provisions in the United States Code. It takes some doing to get through that bill language and really understand what the implications of what you are reading. But it doesn't mean we shouldn't do it. It just means that we need have the time to do it. I certainly encourage the Democratic leadership to give us the time necessary and make the facilities available to us so that we can have the opportunity to read through that bill and read through it with experts and come to understand what's being contained within the bill. You know, the President has said repeatedly that if you have good ideas, I will listen. In fact, here in the House, in the joint session that was held on September 9, the President said, right from the podium behind me, and I am quoting now, ``I will continue to seek common ground in the weeks ahead. If you come to me with a serious set of proposals, I'll be there to listen to you.'' Well, that's kind of interesting, too. During the campaign, the President said that he would sit down with people who might be regarded as folks that don't like us very much, folks like Ahmadinejad and Hugo Chavez. The President said, I will sit down with leaders of other countries and meet with them without preconditions. Well, when it comes to congressional Republicans, he does set some preconditions. We have to come with a serious set of proposals. We can't just show up with ideas. I prepared a serious set of proposals and sent it to the White House on September 16 of this year, about a week after we had the joint session of Congress. I prepared a number of things within the letter. Attached to it were a number of bills that I had introduced that I thought should be parts of whatever type of health care reform is passed. I am still waiting for a response to that. Things like addressing the problems of the physician workforce, things like addressing the liability, the problems that doctors face with the liability insurance, fixing the sustainable growth rate formula, some price transparency, a lot of good ideas contained within here. Again, I will, at the end of this, I will submit this for the Record. But, again, no response from the White House. The list talked in some detail about those things that the Republicans agree should be a part of the meaningful reform. You know, we hear it said all the time that there is agreement on, like, 80 percent of the things contained within health care reform. I think that number is a little bit high. But, nevertheless, we hear it said all the time. But what is the primary thing? What is the number one thing I heard about over and over and over again in the town halls in August? The thing that is really grating on the American people is those individuals who want insurance but can't get it. They can't get it because they have had a tough medical diagnosis. They have a preexisting condition. They had insurance on their job and they lost their job and they couldn't keep up with the COBRA payments, so they lost their insurance. Now they are stuck without insurance, but have a preexisting condition. It wasn't that they wanted to drop their insurance; but the conditions were such, the rules were set, that they didn't have any choice but to let that insurance coverage go, even though they knew it might be difficult to get back into a state of coverage in the future. Another thing that just really bothers people is the fact that Americans can do the right thing and have health insurance and pay that premium religiously, get a tough medical diagnosis, and the insurance company looks back and says, you know what, we really never meant to offer that policy to you in the first place, or we think there was something you obscured in your history. Now, by a process of what are called ``insurance company rescissions,'' they are going to take that insurance policy away. The President even referenced that in his speech on September 29, and that's wrong. People acknowledged that it's wrong, both sides of the aisle. Now, in cases of fraud, correct. The insurance company has to have a right of action. They have to have a way to protect other people that have insurance. You don't want people coming and buying insurance under fraudulent terms. But for people who have an omission from a medical history that makes no difference as to their subsequent care and diagnosis, these are things that are generally recognized by the American people as being egregious overstepping by the insurance companies, and that needs to be fixed. Here is the sad part, Mr. Speaker, that could have been fixed. That could have been fixed before we went home for the August recess. We just simply chose not to do it. So, if we provide a way for someone who has a preexisting condition, perhaps through a reinsurance, perhaps through high-risk pools, perhaps through high-risk pools with additional State and Federal subsidies, there can be ways to bring individuals who have a preexisting condition into a state of coverage. It's a shame. It's a shame we never had a hearing on that in our health subcommittee. We had hearings on almost every other issue under the sun, but we never had a hearing on, is there a way, short of an unconstitutional individual mandate, is there a way to get people insurance coverage who have had a bad medical diagnosis and lost their insurance? We never had a hearing on that. We could. I think we should. I think bright minds on both sides of the aisle could get together and work out ways that this problem could be solved. Rescissions. Again, with a history that's now newly disclosed, has nothing to do with the medical diagnosis, and it was in no way fraudulently withheld from the insurer, rescissions need to stop. States that have high-risk pools, there are 34 of them. States that have the opportunity for reinsurance. These are States that are working, trying to offer their citizens a method of dealing with this problem. We could encourage more States to pick up high-risk pools. We've got some States where they're working well, some States where they're working less well. I always felt that in my home State of Texas, it wasn't working so well. It turns out it's really not a bad program, it's just not funded to the level that it need be. Well, if we could encourage a contribution from the Federal Government, the State government and perhaps even the private sector, the insurance companies themselves, perhaps we could get that figure down to a point where people can actually utilize the program. Because people that then are subsequently covered by those high-risk pools in Texas love the program. I had someone come up to me after a town hall in the district in August that said, Please, whatever you do, don't do anything that's going to mess up my high-risk pool because that's the best insurance I've ever had. The problem is it's limited to the number of people who can access that. We have people losing their jobs. It's an unfortunate, disastrous occurrence that happens in a recession. Some people are laid off. And if you have employer-sponsored insurance, there's trouble brewing. Yes, because of rules and laws that Congress passed many, many years ago, COBRA coverage that is extended for 18 months is available to an individual who loses his job, but that insurance has to be the same insurance that that person had while they were employed. So the individual can pick up the premium for that employer-sponsored insurance, but most of the time the employer is not continuing to pay their part so the individual has to pay the entire freight; in fact, it's actually 102 percent because there's an administrative cost tacked onto that. Well, that is an expensive issue for someone who's just lost their job. Could we offer people another choice? If someone loses their job, they've got good employer-sponsored health insurance, they are protected. As long as they keep their insurance, they're protected against falling into that preexisting condition trap. But right now it's either pay that large premium--and again you just lost your job so it may be hard to do that--or become uninsured. We offer people two choices right now. What if we made something else available to people? What if we allowed people to transition into the individual market and not have to go through the COBRA system to do that, but still protect their ability to have the coverage for a preexisting condition should one have developed or develop during the time that that individual is transitioning to insurance on the individual market. Why does it always have to trigger the COBRA insurance? Why is there not an intermediary step that is less expensive, but still provides the protection? Other things we could do. What if someone has COBRA, has that coverage, but they move to another State and they may not be allowed to take that coverage with them? Why not allow that transition from State to State without rerating that individual, without causing that individual to be rerated by a new insurance company where now their preexisting condition that they've acquired along the way prevents them from getting or obtaining that insurance in the individual market in a new State? I liken that to the National Football League, and you have a player in the National Football League who gets traded from one city to another, their insurance goes with them. No problem. If they had a knee injury in one city, it's going to be taken care of in the new city. But if their fan who wants to follow their favorite football player moves from city A to city B, they've got to start all over again, if they're in the individual market, and during the time that they do that, they may find that they are rerated by their insurance company, reunderwritten by their insurance company, and if they had even a modest diagnosis like high blood pressure, depression or adult onset diabetes, it can be a very expensive adventure for them buying insurance in that new State. So why don't we allow that type of transition so that someone doesn't have to be rerated? We talk a lot about being able to buy insurance across State lines. I think that's important, too. That's a little bit heavier lift. It's a little bit more difficult for Congress to come to that understanding, but this ability to allow someone to buy in the individual market without being rerated when they change States, that's easy and we should be able to do that. Again, I frankly don't understand why we don't take that up. Again, remember if we pass this big, comprehensive, robust public option health care bill, when do you get the benefit? Four years. We're going to have people losing jobs next year. We're going to have people losing jobs the year after that. What are we going to do for those individuals in the short term? And, again, I'll reference back to the President's own speech that he gave here on September 9. When he was at the podium giving the speech, John McCain was in the audience. He acknowledged that John McCain had a good idea for covering people with high-risk pools and that perhaps that would be a way to provide some immediate relief for people who couldn't wait for the 4 years before the Federal Government starts this new robust public option plan. You hear me talk about medical liability. Medical liability is a big deal. The fact that it's been left out of the House and Senate bills, I think, is a big deal. Look, we're asking our doctors to be our partners. Whatever the brave new world of health care reform looks like, whatever we go to, we're going to ask our doctors to be there and be at our sides and help us, or be the ones to take care of the patients and answer those emergency calls in the wee hours of the morning. We're asking our doctors to stand with us on this. And yet we won't do the one thing that would simplify the lives of doctors across the country, keep doctors from dropping out of the practice of medicine, and, that is, bring some sense, some stability, to the medical justice system that we have in this country. Now, Texas has done what I consider to be a very good thing, with putting caps on noneconomic damages. They did that in 2003. They had to do it with a constitutional amendment so that it would become immediately effective and didn't have to go through all sorts of court challenges; and, boy, it was like turning a switch and things have improved in Texas since that bill was passed. But you will also hear people say, Oh, medical liability, it doesn't save that much money. You can do whatever you want, but it's like a 1 percent savings. But that's based on a very old study that really only looked at the cost of the premiums themselves, from back in the early 1990s, the American Medical Association, a very famous study called the Tonn study, frequently still quoted here 15, 20 years later. The Tonn study did say that you weren't going to save much money with medical liability. But, of course, the Tonn study discounted what would happen as far as the practice of defensive medicine. Let me ask you this: medical liability premiums have gone up year over year over year. Medical liability has continued to be a problem year over year over year these last 20 years. Do you think the practice of defensive medicine is more widespread now than it was 20 years ago? Well, you bet it is. You bet it is. Twenty years ago we didn't have PET scans. We barely had MRIs. The more new things, new technology that becomes available, doctors are continually trying to see what is the maximum I can do so that I won't look bad if things go wrong and I'm called into court and have to defend my medical judgments. So it's no small wonder that the cost of defensive medicine has gone up and up and up. Now the Congressional Budget Office has put out a new report. In a letter to Senator Hatch, they talk about their new estimate for what medical liability reform would save the Federal Government. This is just in the Medicare and Medicaid system, and it's estimated to be $54 billion over 10 years. That's getting to be a significant amount of money. But wait a minute. Remember that the Federal Government is now responsible for about 50 cents out of every health care dollar that's spent in this country. Fifty cents out of every health care dollar that's spent in this country actually originates right here on the floor of this House. So that $54 billion over 10 years only represents about half of the medical expenditures in this country. It doesn't count those that are paid for by private insurance, those that are paid for out of just individuals paying their bills or that is gifted to people through charity. So double that number. It's over $100 billion over the 10-year life of the health care bill that is a potential savings with modest medical liability reform. Again, that's not going to pay for the whole health care bill, but it would pay for 10 percent of it. Don't you think if we could pay for 10 percent of what's being proposed that we ought to at least consider it in our committees, that we should at least consider it in the legislative language that's being proposed? I will just tell you what's happened in Texas since 2003 when we did pass a cap on noneconomic damages. Since 2003, Texas has licensed 15,000 new physicians. Over a similar time span preceding that, that number was about a third. We've gained 192 new obstetricians; 26 rural counties have added an obstetrician, including 10 where previously there was no OB doctor. Texas is a big State. We've got 242 counties, so there's a lot of counties in Texas. But, still, 10 counties without an obstetrician before that now have one. That's prenatal care that's available to patients that wasn't available before unless you drove multiple miles to a medical center. That's doctors who are there when patients need them, frequently when time is of the essence, in the process of having a baby. So that is a good thing. Thirty-three rural counties have gained ER doctors, including 26 counties that previously did not have an emergency room doctor now have one since the passage of commonsense medical liability reform in 2003. Doctors have contributed $594 million in charity care since the bill was passed. I introduced similar language at the Federal level, H.R. 1468 for those keeping score at home; and I had offered that as an amendment to our committee bill last July. I was at first struck down on a technicality. Then I was struck down on a party-line vote. It doesn't seem that the Democratic majority has really had any interest in trying to reform the medical justice system in this country. Yet now the Congressional Budget Office in a letter to Senator Hatch, where he requested a new analysis of the cost of defensive medicine, has said that it would be a savings of $54 billion over 10 years, and they do cite several studies in there where they've gained that information. Again, at the end of this hour I will ask to make the Congressional Budget Office report, the letter to Senator Hatch, a part of the Record. Portability, being able to take your insurance with you. There was a time when I was a youngster when you went to high school, perhaps went to college, but whether you graduated from college or just started after high school, you took a job and you probably continued that job until you got your gold watch in retirement. It doesn't work that way anymore. I don't know exactly what the figure is, but the estimate from the Census Bureau is that people will have perhaps 10 or 11 jobs during the course of their productive years. So it only makes sense that if we continue, and we likely will continue, to have employer-sponsored health insurance, that we allow more portability than is within the system now. Some people have talked about things like defined contributions from employers, rather than just the employer providing the insurance, providing a designated sum of money for the purchase of that insurance. There is a lot of discrepancy for what insurance costs. In the State of New Jersey, the average health insurance premium for a family of four recently quoted at $10,000. You go across the State line to Pennsylvania and it drops $4,000, to $6,000. Well, there's not a lot of difference right there on the State line between one segment of the population and those that are north of the line in New Jersey. Why not? Why not allow people to perhaps look into the purchase of insurance in other markets that may fit their needs and may be more affordable? And then, of course, again we get into the issue of someone who moves across the State line, why not allow that portability? Just in the interest of completeness, the State of Texas, a family of four, the average insurance premium is $5,000 a year. The State lines concept is one, and we heard the President talk about it in his speech of September 9. He talked about a part of rural Alabama where if someone was going to the individual market, they only had one insurance company from which to choose. And that's not terribly surprising. Insurance companies tend to be natural monopolies. They tend to want to form monopolies and capture market share. But the President's quite correct; you don't get much competition if you've only got one insurance company. So the President's solution to this problem is, well, let's create a public option and we'll have two insurance companies for that family in Alabama to choose from. But there's over 1,300 insurance companies in the United States of America. Why not open the market up so that more of those 1,300 insurance companies that already exist in the country-- we don't have to create a new one, we don't have to pay all that start- up capital for creating a new program--why not just allow them to compete across state lines? And you know, interestingly enough, Democrats that reflexively opposed this idea year in and year out now seem to be warming to the concept. At the very least, if you have a public option that is available in Alabama, it's going to be the same public option that's available in Tennessee, and the same public option that's available in Texas. Guess what? That public option is going to be sold across state lines because it is a Federal program. So why don't we, before we go to all the trouble and expense and anxiety of creating an entirely new Federal entitlement and type of insurance, why not just simply allow some open competition across state lines? Now, cooperatives are something that we hear, that word gets a lot of traction, co-ops. You know a purchasing co-op that could go across state lines, I could be okay with that. A co-op that was just a dressed-up public option, I'm not so much in favor of that. But certainly, allowing people to band together, people that may belong to the same alumni association, the same church, you name whatever association, realtors, dentists, physicians offices, that want to get the purchasing power of a much larger group in that individual market, we should allow them the freedom, the freedom to be able to make those associations and to purchase. You know, tax credits--and I will admit there are people on my side that get nervous when you talk about tax credits. But tax credits to help with the purchase of insurance I think is certainly something that was talked about during the last presidential campaign. I think it is a way to provide immediate help, not help 4 years from now, but immediate help to people who don't have employer-sponsored insurance, where otherwise the cost of insurance is an obstruction to them getting that coverage. Maybe if we take away some of the issues with preexisting condition rescissions, we take away some of the issues with portability, still it may be an affordability issue, and if we could help that with the tax credit or even a pre-fundable tax credit, I think that is something that is, it's at least worth having the discussion. And again, through all the hearings that we've had on this, we never once visited that issue. We never once invited the Congressional Budget Office in to kind of give us some views and estimates on what this might cost or what this might look like. Instead, we just simply said, we're Congress, we know best, we're going to build an entirely new insurance company that's administered by the Federal Government and that will be your competition. Take it and like it because we, after all, know best. Again, the ability for people to associate, whether it be a church group, an alumni association, maybe it's time that we gave people the option of not having insurance that's tied to a single employer, because, again, many people will change jobs over time. Allow the cross-state purchasing. We've talked about things like association health plans. Various bills have been introduced that would deal with this. H.R. 3218 introduced by Representative Shadegg from Arizona is one such plan. And certainly, that is one that should be included in any compendium of plans that are offered as conservative or Republican alternatives to what is being proposed in health care. Medicare payment reform. We're going to pay for half of this trillion-dollar bill with cuts in Medicare. Well, I've got to tell you, I get more letters, more mail from individuals who are doctors who are concerned about what we, what Congress is doing to them in physician reimbursement. It's easy to say, oh, man, doctors they make so much money, so you cut them a little bit--who cares? December 31st of this year, under the current formula, sustainable growth rate formula, physicians will undergo a 20 percent reduction in reimbursement. Now, true enough, Senator Baucus' bill does delay that by 1 year. That's our typical response. We'll do something to kick the can down the road. If we do that, then next year they face a 25 percent reduction in reimbursement. In some specialties, cardiologists, in particular, where there's been some re-basing of what are called relative value units for the work that they do, are facing cuts in excess of 30 percent at the end of the year. Well, I'm here to tell you that you don't have that much excess capacity in the average doctor's office where you can squeeze 30 cents out of every dollar in savings and expect those offices to stay open. Well, wait a minute. We've got an unemployment rate that's approaching 10 percent. Cardiology offices are small business across the country, and they are facing a 30 percent reduction in Medicare reimbursement, when oftentimes Medicare is 50, 60 or 70 percent of the business that they do. How do we expect them to keep their doors open after January 1st? How do we expect them to make employment decisions for their employees in their offices over these next couple of months while they're living with this kind of limbo? I mean, they're sitting here watching Congress and wondering if we're just going to run out the clock on December 31st. When these huge cuts go into effect, what are they going to tell their employees? If they wanted to hire someone new earlier this year they're certainly not thinking about doing that now. And we've got a 9.6 percent unemployment rate. Cardiology offices are small businesses. Echo techs, phlebotomists that draw blood in the lab, people that put the patient back in the room. All of these jobs are now at risk because of what Congress is doing, or not doing, with fixing the sustainable growth rate formula and the cuts in Medicare. If we pass a bill like the Baucus bill, the cuts only become deeper and more Draconian. Again, you don't save $500 billion out of the Medicare program over 10 years by not making some pretty harsh decisions. And you know, if you think it's bad now with the sustainable growth rate formula, what's it going to look like if we enact some of these things that have been discussed over on the Senate side and indeed on the House side? What if we create this body that's going to come to us every year and say, in order for the books to balance, Mr. or Mrs. Congressman, we are going to have to cut fees that are paid to hospitals, doctors, nurses, nursing homes by whatever percentage amount they say. Congress, if we pass this law, simply votes that up or down. They don't take any responsibility for it. There's no accountability. We just simply pass those cuts on. That's a terrible way to do business. Wouldn't it be better if we found a way to deliver care more economically so we didn't have to come to our provider community, to our doctors, to our hospitals, to our nurses and nursing homes, and say, We're going to have to keep a little bit more of your money this year in order to make our books balance? Now, ensuring the future physician work force, I think, is extremely important. H.R. 914, the Physician Workforce Investment Act that I introduced last Congress and this Congress as well, I've provided that to the White House. You know, here's the deal. We can sit here and talk all night long about health insurance, and that may be an important discussion to have, but I've got to tell you, if you don't have any doctors there at the end of the day, all the insurance in the world isn't going to do you a bit of good. In fact, I'd far rather have a doctor and no insurance than I would have insurance and no doctor, because if I'm in trouble, if I'm needing someone to take care of me, the insurance company typically hasn't been all that great at that endeavor. But physicians always respond. Preventive care and wellness programs. Clearly, these are going to be necessary in the world going forward. The model that was brought to us by Safeway Stores, the model that we were not allowed to consider in our markup in committee, but realistically, we have to do that. H.R. 3148, which is the Burgess-Christian CBO scoring bill, would allow for the Congressional Budget Office to score those savings that could be achieved with healthy lifestyles. Price transparency. We did include some language in the bill that was passed. H.R. 2249 was the Health Care Transparency bill that I introduced two Congresses ago and have continued to introduce every Congress. A lot of that language was inserted into H.R. 3200, for which I was grateful. But at the same time, transparency has got to be there. So if we're going to ask people to make more and more decisions for themselves, we have to give them the information with which to do that. Mandates have no place in a free society. And when I hear the Senate talk, and I hear the House talk about we're going to have an individual mandate and an employer mandate, wait a minute. I'm not even sure that's constitutional. Mandates just create laziness, create laziness on the part of the insurers, create laziness on the part of the insured, and certainly create laziness on the part of your Congressman. Wouldn't it be better if we required people to actually build programs that people wanted, rather than just force people to take what we think they ought to want? Mandates are an anathema to free society. And there are ways to do this. Prescription-drug benefit in part D, for all its faults, Dr. McClellan, when he was constructing that program, had six protected classes of drugs and said there had to be at least two drugs offered within those six protected classes, and people flocked to those programs. It has been a success in the number of seniors that now have credible drug coverage and seniors that are satisfied or very satisfied with the drug coverage that they have. Normally, if you have a mandate you're going to get about 85 or 95 percent compliance. We've got about 85 percent compliance with the voluntary system right now. You're not going to get that much more with the mandate. Even without mandates in the prescription-drug benefit, by creating programs that brought value to people's lives, 93 percent uptake on a credible drug program. So, you know, I've got to tell you. I will never sit down here and advocate for private insurers. But I will tell you that most Americans do have coverage under a private insurance, and they like it. They don't want to lose it. That has been one of the big obstacles to getting sweeping health care reform. The President always says if you like what you have you can keep it. I think that's right. Sixty percent of the American people like what they have, and they don't want it to change, so that makes it difficult to do reform that is on this scale and this sweeping. I'll tell you another little secret. The Federal Government, the public option that we already have, doesn't pay its full share of the freight of the cost of delivering the care. It's subsidized by the private sector. If you shrink the private sector and grow the public sector, how are you going to make that up? Where's that money actually going to come from? And that's something that I never hear discussed. Yeah, insurance companies do bad things. And we'll hear stories, we're going to hear stories in my committee tomorrow about how bad insurance companies are. But if we didn't have that cross-subsidization of the private sector, we could not afford the public sector. Now, people will tell you that it's the cost of the uninsured that we're leaning on the private sector to provide for us. No, that's a small amount. That cross-subsidization that's coming to the public sector is the lion's share of that. That 9 percent figure, about 2 percent is people who have no insurance; 7 percent goes to paying the freight that Medicare and Medicaid are not carrying themselves. We have a good system. Let's build on what we have. Let's not tear it down and then create something out of whole cloth to go in its place. You know, the government can referee some of these things, but the government doesn't need to be the man in charge of all of these things. Again, remember, the United States Congress, we've got about a 20 percent approval rating. I think reforms can and should go forward. I think there are good ideas on both sides of the aisle here. I'll take the President at his word. I'm anxiously awaiting their response to my letters. I look forward to this debate we're going to have over the next several weeks, and I would encourage people that, every morning when they get up, remember, you've got one Member of Congress and two Senators. They need to hear from you on this issue. Whether you agree with me or not, I promise you they need to hear from you on this issue before we have this vote. For more information on H.R. 914, the Physician Workforce Enhancement Act of 2009; H.R. 1468, the Medical Justice Act of 2009; and H.R. 2249, the Health Care Price Transparency Promotion Act of 2009, log on to http://thomas.loc.gov. House of Representatives, Washington, DC, September 16, 2009. President Barack Obama, The White House, Washington, DC. Dear Mr. President, I am once again compelled to write to you to accept your offer to meet with you at the White House to discuss the health care reform proposals currently before us. I listened intently as you addressed the Joint Session of Congress on September 9, 2009, and you once again extended an olive branch to members of the minority. I want to reiterate that I am completely committed to working in a bipartisan fashion to deliver reforms that all Americans can be comfortable with, increase access to care, lower health care costs for America's families and businesses, and deliver changes to the health system that improve quality. I thank you for your public commitment to accept innovative ideas from Republicans and hope that you will follow through with your public pledge by reviewing this letter thoroughly. As you stated last week: ``I will continue to seek common ground in the weeks ahead. If you come to me with a serious set of proposals, I will be there to listen. My door is always open.'' I accept your gracious offer and want you to know that it is not my intention to ``kill'' health reform. In fact, I stand proudly by my bipartisan work in the U.S. House of Representatives on health care issues. Several of my amendments in the Energy & Commerce Committee were accepted unanimously while others are currently under negotiation with Chairman Waxman for inclusion in a final House product. That said, I have read the America's Affordable Health Choices Act (H.R. 3200) and I do concede I have many concerns with the approach the bill takes. Many of the items you outlined in your speech do have wide bipartisan support. While we may have disagreements on the policy approaches to address those problems we will never know if we can find common ground if we do not try. To assist you in identifying measures that could gain wide bipartisan support I am enclosing four pieces of legislation that will make incremental but important reforms to our health system. I believe that, with your leadership, these measures could be passed and signed into law before Thanksgiving. These efforts would show that we can work together to make important reforms that improve access to care and protect the doctor/patient relationship. Physician Workforce: H.R. 914, the Physician Workforce Enhancement Act, would establish an interest-free loan program for eligible hospitals to establish residency training programs in certain high-need specialties. Under the program, eligible hospitals could receive up to $1,000,000 that must be repaid within 3 and a half years. H.R. 914 will provide needed resources to smaller and emerging communities so they can attract and retain the medical professionals their communities will rely on in the future. If we do nothing to assist the training of physicians, waiting lines will grow longer, lapses in treatment will occur, and many of our small and rural communities will be at risk of not having physicians to meet their growing needs. Medical Liability Reform: As you alluded to in your speech, too many doctors are forced to practice defensive medicine and face the constant threat of lawsuits and unsustainable medical liability insurance rates. This results in millions of dollars in unnecessary tests and procedures. Seasoned medical professionals are retiring early because staying in practice is no longer financially feasible, further contributing to our nation's doctor shortage. This is a growing crisis that is pushing affordable health care beyond the grasp of millions of Americans. H.R. 1468, the Medical Justice Act, is based on medical liability reform implemented in Texas. The reforms have created a magnet for doctors and provided the funding mechanism to improve access to care and enhance patient safety. To prove the success of Texas' reforms, I'd like to share a few of the statistics, from the Texas Medical Association: Since the 2003 reforms, Texas has licensed 14,496 new physicians. This is a 36 percent increase from pre-reform. Thirty-three rural counties have seen a net gain in ER doctors, including 26 counties that previously had none. After years of decline, the ranks of medical specialists are growing in Texas. In my field of obstetrics, Texas saw a net loss of 14 obstetricians in the two years preceding reform. Since then the state has experienced a net gain of 192 obstetricians, and 26 rural counties have added an obstetrician, including ten counties that previously had none. Charity care rendered by Texas hospitals has increased by 24 percent, resulting in $594 million in free care to Texas' patients. Texas physicians have saved $574 million in liability insurance premiums, a significant savings that has allowed more doctors to stay in their practice. Medicare Reform: Many new Medicare beneficiaries find it difficult to locate a doctor who will accept Medicare. This is because physicians around the country realize that Medicare is an unstable payer, subject to the whims of political will and influence, and are doing what they must to protect their small businesses. Physicians are scheduled to receive a significant reduction in Medicare payments on January 1, 2010. The Ensuring the Future Physician Workforce Act, a bill I plan on introducing shortly, will give doctors what they really need a stable and reasonable predictor of an inflationary reimbursement under Medicare. This will allow seniors to maintain access to their doctor. The legislation also rewards quality reporting of data, further incentivizes the adoption of Health Information Technology, and brings increased transparency on utilization, billing, and funding to the Medicare program. Health Care Price Transparency: A patient should be able to know what they are paying for and how much they will pay out- of-pocket. H.R. 2249, the Health Care Price Transparency Promotion Act, directs states to establish and maintain laws requiring disclosure of information on hospital charges. The legislation requires hospitals and health plans to make this information available to the public, and to provide individuals with information about estimated out-of-pocket costs for health care services. H.R. 2249 aims to make health care more affordable by promoting greater transparency about the cost of health care services for patients seeking care. The legislation sets a national floor for transparency. As someone who has committed his Administration to transparency, this is an important step in helping make health care, and specifically health care costs, more transparent, which empowers the consumer. As a practicing physician for over 25 years, I believe I bring a unique perspective to the current health care reform debate. I am committed to finding areas of collaboration between the political parties that can deliver meaningful system reforms that will benefit all Americans. I would greatly appreciate the opportunity to review both the efforts outlined above and also my areas of concern with H.R. 3200 so that we may mutually work to bring quality, affordable health care to all Americans. I look forward to the opportunity to meet with you at your earliest convenience. Should your staff have any questions about any of the attached proposals or would like to arrange a meeting, please contact me or my Legislative Director J.P. Paluskiewicz at my Washington, D.C. office. Sincerely, Michael C. Burgess, M.D., Member of Congress.

Mr. BURGESS

Mr. BURGESS. And if I may, the taxes and fees that are added on top of medical devices and insurance policies in order to pay for these programs are going to drift down to the middle class. There is no way to avoid taxing the middle class or putting a fee schedule on the middle class with the structure that has been proposed by the Senate Finance Committee. With the gentleman's indulgence, I would just make a point that if people are interested in this debate, healthcaucus.org has documented the debate that has gone on since January and February of this year. I would just further like to point out, we do hear the complaint that Republicans have not been involved or engaged in this process. I met with the transition team in November and offered my assistance. I was never called back. I met with the chairman of my Committee on Energy and Commerce in January and never received a call back. I submitted 50 amendments to our bill in committee and had several of them accepted toward the end. Republicans do have ideas. They are reasonable ideas. They deserved a fair hearing and a fair airing in committee. Unfortunately we were denied that opportunity, because as the gentleman correctly points out, as the deputy President has said, ``Never let a good crisis go to waste.'' They were determined to use this economic crisis to expand the reach and grasp of the Federal Government in health care. Here is the reality: If the President had really wanted to do this, they could have done it in February when the Presidential approval rating was near 80 percent. No one would have been able to stop him. It could have been signed into law before the month was over.

Mr. BURGESS. But even the President himself said here the other night when he addressed the joint session of Congress, because these programs won't be up and running quickly, maybe we should take the John McCain idea of the high-risk pools, the reinsurance and get people some immediate help now. I would submit to you that if we would work a little harder on that, it may not be necessary to go the full strength of the government program. Why do we have to fix a program that is arguably working well for 60, 70, 80 percent of the population? Why do we have to change it for everyone to capture those 8 to 10 million people who get caught in that cycle of having a preexisting condition? I yield to my friend from Nebraska.

Mr. BURGESS. The real tragedy in this debate is we've never really explored those types of ideas. Maybe it doesn't need to be throughout the entire United States. Maybe there could be regions. Maybe there can be reciprocity between States that make that agreement. But we've never even explored that. One of the things that really concerns a lot of people when they look at this bill is you get 10 years of taxes and 6 years of benefits. Remember, none of these good things that are going to come people's way and lift the burden of health care off their shoulders, none of them happen until after the next Presidential election. Part of that is to keep the score low on the Congressional Budget Office; part of that is because, again, it's going to take a long time to set up those programs. We don't even have an administrator at the Centers for Medicare and Medicaid Services right now. And that's the individual who's going to be charged with setting up many of these programs. So, in the meantime, we do need to do something to cover those individuals with preexisting conditions, those individuals who get a tough medical diagnosis, their insurance is rescinded from them. Nothing is more offensive to Americans than to think that someone has played by the rules, written that check every month, they get a tough diagnosis and the insurance company finds a reason to drop them. If there's been outright fraud in purchasing the policy, maybe so. But in so many of those cases it is really iffy why those policies are dropped. We could fix that.

Mr. BURGESS. It would suggest when the President stands up before us and says there's a place in Alabama where there's only one insurance company--sure, insurance companies tend to form natural monopolies. But if you remove the barriers rather than adding another company for competition, which is a government-run option, why not remove the barriers and open it up to the 1,200 or 1,300 companies that might like to compete for that business in Alabama.

Mr. BURGESS. Further, a multistate corporation actually has the ability to deliver their health care product over State lines. Individuals in the individual market are prohibited from buying insurance across State lines.

Mr. BURGESS. I think on our side of the aisle, no question, you'd get 95 percent. I can't speak for the whole House.

Mr. BURGESS. If the gentleman will further yield, all last month I heard from small business people either at home or who came up to Washington to see me. I heard from a lady who has a saddle manufacturing plant in Fort Worth; I heard from cardiologists; I heard from air-conditioner compressor remanufacturers in my district. I heard from literally butchers, bakers, and candlestick makers, all concerned, yeah, the economy may be doing a little bit better in north Texas. Yeah, maybe those aren't wild leaves; maybe those are in fact green shoots. I said, Well, are you looking to expand business or add any jobs? No, I am not, because I don't know what you're doing to me in health care. I'm scared to death about what you're going to do with this energy bill. I haven't a clue what you might do with this financial service reregulation you're going to do, and it is too uncertain. When I look across the horizon, all I see is the abyss. I cannot possibly add a job in this environment that Congress is doing. Forget the economy; forget the worldwide situation. It is what Congress is doing; the uncertainty that Congress has now injected into the small business climate, small business environment. They are holding back on adding jobs in a climate where, otherwise, maybe if I could find a banker to loan me some money to do something, I might do it, but not if I'm going to face an 8 percent payroll tax, not if I'm going to have to pay more for my energy or, by the way, pay some sort of premium in a carbon offset somewhere at some point in the future. And, oh yeah, who knows what this financial regulation is going to do to me if I'm a financial planner. All kinds of businesses in my district, the multiplier effect of perhaps those one or two jobs in every small business spread out across my district, spread out across my State, spread out across the country; and is it any wonder that our unemployment rate is 9.7 percent?

Mr. BURGESS. I thank the gentleman for yielding, because that's a very good point. I had several roundtables with small business in my district over the summer. An 8 percent payroll tax will be the largest single tax ever levied upon small businesses in this country. Think about that for a minute. We just hit, what, 9.6, 9.7 national unemployment.

Mr. BURGESS. Reclaiming my time, if the gentleman will continue to yield, the fact is the American people do not trust us to do something this big. They look at this 1,000-page bill, they recognize that it will go to a Federal agency, the interpretation of those thousand pages will lead to 10,000 or 20,000 or 30,000 pages in the Federal Register, years of rulemaking, and years of rules that will be rained down upon a free society because of the actions taken on the floor of this House within the next couple of weeks.

Mr. BURGESS. I'll be happy to yield on that point.

Mr. BURGESS. On a hot Saturday morning in Denton, Texas, we had to call an audible and change it from inside to a parking lot location and, with no thought to my personal safety, I took my jacket off and my tie off, grabbed the microphone, stood under the hot sun and answered questions for an hour, 2 hours, about this bill that we had just passed. Now, I will admit that I had a little bit of an advantage being on the committee. I could hold a copy of the bill up, because I had a copy of the bill, and say that I can truthfully say I'm one of the Members of Congress who's voted no on this bill because we had it in committee, and that I will likely vote no every time it comes back again. And that seemed to be a reasonable approach for the people in my district. But I've got to tell you, I was astounded, I was stunned, coming back in September, after all this angst and anxiety we encountered during the month of August, and it was like it never happened. It was like the Democratic leadership assumed that the country was in some sort of fugue state in August and they weren't really serious about the opposition to this bill because we came back to committee in September. We had a few more amendments that they said we could consider after the fact and we did. Many of us brought up the fact that boy, August was a game-changer, and really the American people want us to be more serious about and more thoughtful about our approach to this bill. And the chairman of the committee said, no. We're not paying any attention to August. August didn't happen. It was a mirage, it was a heat-induced hallucination. It wasn't the American people speaking, it was made up.

Mr. BURGESS. I thank the gentleman for yielding. I thank him for putting this hour together this evening. I think it's terribly important. Rumor mill out there is that we will have this bill next week or the week after on the floor of the House. People do need to be paying attention to this. I am on one of the committees of jurisdiction, on the committee of Energy and Commerce. We had this bill in our committee for a couple of weeks in July. I thought that it would pass along party lines and the Democrats would vote this favorably out of committee. I thought we would have it on the House floor in the month of July, and I thought that the Democratic leadership would force this bill through passage again on a party line vote in July. It didn't happen that way. I think it's because they pushed the cap- and-trade bill through at the end of June. Many Members went home and were startled by the reactions of their constituents and said, hey, maybe we'd better study about this a little bit before we just go ahead and pass it. As a consequence, we didn't pass the bill on the floor of the House, passed it out of the three committees, and then we hit August. And what happened in August was, the same sort of anxiety that we encountered in July after cap-and-trade came back big-time in the month of August. And little sleepy town halls that I would normally do in August that might command the attention of a dozen people, maybe 50 people if there's something big going on, 2,000 people would show up. They wanted to look--

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate the Saint Mark Missionary Baptist Church on their 130-year anniversary. The church, located in McKinney, Texas, will be hosting anniversary services on October 9, 2009. Saint Mark Missionary Baptist Church was founded in 1879 by Reverend Jones and Reverend Dick White, who conducted prayer services in the homes of their members, many of whom were freed American slaves. Through a commitment to ministry and mission work, the church serves to enrich the community within its own congregation as well as the surrounding Dallas-Forth Worth areas. The church has undergone numerous expansions, helping them grow to provide more resources for their community. Recently they acquired over 2 acres in north Texas to accommodate a growing membership. Madam Speaker, today it is my honor to recognize the Saint Mark Missionary Baptist Church. They have demonstrated a level of commitment to community that is well appreciated, and serves as an example for us all.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to honor the former City Manager Larry Cunningham for his years of service to the City of North Richland Hills and the North Texas region. After a public service career that spans more than four decades, Larry Cunningham retired this year from his position as City Manager of North Richland Hills, which he has held since 1997. Prior to being appointed City Manager, he served as the North Richland Hills Finance Director, as well as City Manager in Lubbock, Texas. During his tenure, City Manager Cunningham was known for his integrity, dedication, and enthusiasm. Under his leadership, North Richland Hills has remained financially stable and continued to grow, even during changes in the economy. The City's bond rating ranks it among the top 2 percent in the state and top 10 percent nationwide. Larry Cunningham's service to the City includes a number of initiatives that improved the quality of life for the residents of North Richland Hills. Under his leadership, over 30 Parks and Recreation Facilities were constructed in the city. Mr. Cunningham also worked to improve public safety, enacting drainage improvements and flood control, upgrading Fire Department facilities, and supporting increased police patrol and crime prevention programs. He was also instrumental in the creation of the North Richland Hills' Art in Public Spaces Program, helping to create a distinctive community identity. Many of his projects will continue to develop long after Mr. Cunningham's retirement. It is with great honor that I recognize City Manager Larry Cunningham for his years of hard work and dedication given to the citizens of North Richland Hills and North Texas. I am proud to represent him in Washington. His service sets a standard of devotion and true leadership, one that will endure.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate the Community Christian Church on their 100th anniversary. The church, located in Fort Worth, Texas, will be hosting centennial services on October 11, 2009. Community Christian Church was founded in 1909 by the Reverend William M. Alphin, who held services before a 40-person congregation on the rented second floor of the local Masonic Hall. The Christian Church denomination today maintains a membership of nearly 700,000 across North America. Through a commitment to service and fellowship, Community Christian Church continues to enrich the community of Fort Worth as well as the surrounding areas. The church has expanded and grown over time, acquiring their proud home on East Vickery St. in 1971. Under the leadership of current Pastor Rueben Thompson, the church remains committed to serving as a ``bridge'' between Christians of a diverse denominational background. Madam Speaker, today it is my honor to recognize the Community Christian Church. They have demonstrated a level of commitment to community that is well appreciated, and it serves as an example for us all. It is a privilege to represent the congregation of Community Christian Church in the 26th District of Texas. I look forward to observing the positive impact they will continue to have on our communities at home and abroad.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to remember former Forth Worth City Councilman Jim Bradshaw, who helped to positively shape his community by serving its citizens. Mr. Bradshaw graduated from Baylor University and soon after began his career in North Texas. He was elected Mayor Pro Tem by the city council, serving beside Hugh Parmer in 1977. Mr. Bradshaw resigned from the city council to challenge House Majority Leader Jim Wright, who remembered Bradshaw as being tough competition. Bradshaw also ran against Tom Vandergriff for the 26th Distict seat in the House of Representatives. He was not successful in the bid, but it did not deter him from continuing in public service. Mr. Bradshaw's service to his community went far beyond his time spent on the city council. He sat on advisory boards for the Recovery Resource Council and the Betty Ford Center. Bradshaw's own experiences led him to help others battle addiction, and in 2005 President George W. Bush awarded him The President's Call to Service Award. Mr. Bradshaw also served on the board of the United Way, March of Dimes, and was the recipient of Bank of America's Local Hero Award for Neighborhood Excellence in 2006. It is with great honor that I remember Mr. Jim Bradshaw for his tenacity in public service as well as his strong commitment to his community. We will always remember the example he set, and he will be greatly missed.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate North Central Texas College on their 85th year of providing quality education. NCTC will be hosting an anniversary celebration on September 25, 2009. North Central Texas College, originally Gainesville Junior College, was created when Randolph Lee Clark received authorization from the Gainesville City Council to create the college as part of the Gainesville school system on May 20, 1924. By the 1950s the college had out grown its original location in the old Newsome-Daugherty mansion and moved to a new location thanks to the support of citizens like W.T. Bonner, who not only voiced support for funding of the new campus but also donated land. The college eventually changed its name to Cooke County College and then, on June 1, 1994, the Board of Regents voted for the current name, North Central Texas College. NCTC has seen steady enrollment increases over the years. Since 1980, the student population has nearly quadrupled to a current total of more than 6,000 students. With the addition of campuses in Corinth, Bowie and Graham, the institution has positioned itself as a key provider of quality workforce education and training in areas such as nursing, law enforcement, agriculture, and computer sciences. The college also provides a foundation of academics to propel students to higher degrees. The college is home to the Small Business Development Center which offers assistance and training to owners, managers and employees of area businesses. The Bowie campus houses the Oil and Gas Technology Center to help meet the technological demands of the energy industry. And with the new addition of the Career and Technology Center, students will be trained to rapidly adapt to ever changing industry needs. This all gives North Central Texas College a significant role in the economic development of Cooke County and the North Texas region. I am honored to represent North Central Texas College as part of the 26th District and I congratulate Dr. Eddie Hadlock, the faculty and students as they celebrate their 85th anniversary.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today in recognition Reby Cary, a man who has contributed extensively to the Fort Worth community. His life achievements are being celebrated this month by family and friends at New Rising Star Baptist Church. Mr. Cary's life has been one of patriotism, service and achievement. After graduating from I. M. Terrell High School, he earned a B.A. in History and Political Science at Prairie View A&M University. He started the path to a higher degree, but would first answer the call to duty. While forced to endure the numerous social inequalities of the time, Mr. Cary served ably and honorably as one of the first African American Radiomen First Class in the Coast Guard, supporting combat operations in the Pacific Ocean aboard the U.S.S. Cambria during World War II. Mr. Cary returned to complete his Master of Science degree at Prairie View A&M University in 1948. He later participated in graduate studies at Texas Christian University and North Texas State University. He would then go on to educate future generations as an instructor at Dunbar High School and as a professor at numerous institutions. He served as Dean of Personnel at McDonald College of Industrial Arts, and Associate Dean of Student Life and Director of Minority Affairs at the University of Texas in Arlington. He also broke barriers in public service as the first African American on the Fort Worth ISD School Board, as well as serving as the Texas State Representative from District 95. Mr. Cary has also given back to his community through his service with many area organizations, including volunteering with the Boy Scouts, United Way, Rotary Club of Arlington, and President of the Fort Worth Metropolitan Black Chamber of Commerce. And through all of this, he also found time to be an accomplished author. He continues to have an impact on the community through his insight and advice. Mr. Cary has always been available to take my phone calls and he has been a rich source of information and history regarding Tarrant County and the City of Fort Worth. He has a unique ability to bring the correct historical context to some of the more contentious debates today. His commitment to the community has continued through his daughter, Faith Ellis' active political and community advocacy in issues such as infant mortality and support for medical research. It is with great honor that I recognize Reby Cary as a man who has served the Fort Worth community for over a half century as someone dedicated to the education and advancement of all. His is a legacy of service to the City of Fort Worth, the State of Texas and this great Nation, and one that will endure. I am proud to represent him the U.S. House of Representatives.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today in recognition of a brave American; Anne Whiteman. Anne was born September 5, 1956 to parents who met and married in Tubingen, Germany. Her father was born and raised in Germany and fought as a soldier in the German Army during WWII and was later held captive by the American Forces. During Anne's childhood, he recounted many fascinating stories that led to his love for America and his becoming a U.S. citizen. Though Anne was born in Virginia she completed high school in Germany and worked at the American Consulate in Frankfurt. After college and various jobs she applied with the FAA in 1981 and was the first woman certified Air Traffic Controller to work at El Paso. In those days, pilots were not used to speaking with a female controller but she quickly earned their respect. She was selected for a position at DFW in 1984 where she started in the Tower but later moved downstairs to work in the Terminal Radar Approach Control, TRACON, radar room. Anne believes that her move to the TRACON gave her the best gift as it was there that she met her husband. No one thought they could survive working together every day but not only did they survive but they thrived. Anne was certified on all positions in February of 1986 and became the first female controller to certify at DFW TRACON. Anne has worked many aircraft in distress and has assisted pilots as she grew in her knowledge of aircraft and skills. As a result, she was encouraged to bid on a supervisor's position and after much encouragement bid on a temporary supervisor detail and was selected for the 120 days in August 1985 and became hers permanently and the rest is history. While Anne Whiteman received numerous awards throughout her career and became recognized as a valued FAA team member, this all changed when the safety concerns she reported were compromised and covered up which led to her blowing the whistle. As a result, she was ostracized at the job she loved. During Anne's career, she has supervised or trained at least 30 air traffic controllers at the DFW Tower or in TRACON and was recognized by the Department of Transportation Inspector General who found her egregious reports were well-documented. Twice during a three-year period, these reports were submitted to the President. This reporting activity also led to her being awarded the Office of Special Counsel's 2005 Public Service Award and later sharing the Public Servant of the Year in 2008 for her contribution to air safety. She was also nominated for the 2006 Service to America medal while the reprisals continued along with her safety concerns. After some 30 years of service with the FAA, Anne Whiteman is no ordinary hero for she put her job and well-being on the line for what she believed was needed in order to protect the flying public. As a Member of Congress it has been my honor to serve this valiant American who not only helped pave the way for women controllers but also serves as a courageous example in the protection of air travel and she did not flinch at such a great personal loss. This record serves to honor this service as she retires from the job she loves on September 3, 2009.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, regrettably, today we voted on yet another expansion of our federal government at a severe cost to the American taxpayer. $100 billion dollars of stimulus money has already been given to the U.S. Department of Education in the ``American Recovery and Reinvestment Act''--the so-called stimulus bill. With money borrowed from our children's future, the full appropriations of the stimulus bill have yet to be spent--and we have yet to be given an accounting of who exactly is getting and spending the American taxpayer's money. I can not support the duplicative spending in H.R. 3221, the Student Aid and Fiscal Responsibility Act of 2009, until there is full accountability from the U.S. Department of Education of how they are spending this stimulus money. Furthermore, while I cast a no vote on H.R. 3221, I will note there are several good things in this bill. For instance, one of the proposed nine new federal programs at the U.S. Department of Education is one focused on our veterans. Members of our Armed Services should be given loan forgiveness when they valiantly serve to protect our freedoms, and they should be allowed to transfer general education credits from one school to another while they are serving. I wish this portion of this bill was given to Members for individual consideration; however, it wasn't. Instead, this bill primarily sought to get rid of the Federal Family Education Loan Program (FFELP) and replace it with the U.S. Department of Education's Direct Loan Program. FFELP has been around for 40 years and served our constituents in allowing them access to higher education. To replace it in its entirety with the direct Loan program would be fiscal malfeasance. The U.S. Department of Education does not have the funds to give loans to students who are eligible for college loans and, in fact, has lost money in this program. From 1995 to 2003 the Direct Loan program borrowed $137 billion to float this program and has posted a loss in the amount repaid and the amount borrowed. I am also troubled by particular attention in this bill in Title III directed at giving grants to Louisiana, Mississippi and Alabama for losses suffered during their Hurricane Katrina and Hurricane Rita, but no similar funding will be given to Texas for the losses they suffered during Hurricane Ike. Texas students deserve as much sound infrastructure as a result of hurricane destruction as Louisiana, Mississippi and Alabama. Furthermore, we should not have to use an education bill to address the voter fraud and tax evasion activity by the organization known as ACORN. I voted yes on the Motion to Recommit this bill to address the ACORN issues, but considering ACORN could have access to $1 billion--as compared to the $50 billion the American taxpayer could lose as a result of H.R. 3221--I will continue to vote no on H.R. 3221. This bill is just another example of the federal government getting rid of choice and mandating only a public option. Just as I have fought the battle with regards to our healthcare, I am equally concerned that our education program remains vibrant and competitive.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, the President of the United States came to this House last Wednesday night and talked about health care. At the end of his speech, he talked about how perhaps we could consider some, at least a look, at medical liability reform. And I encouraged the President to do that. I encouraged him to look at my home State of Texas. Look what's happened in Texas since 2003. Texas has become a magnet for doctors. Since the reforms passed in the State of Texas in 2003, charity care rendered by Texas hospitals has risen 24 percent. Texas has licensed almost 15,000 new physicians, which is a 36 percent increase from pre- reform. Thirty-three rural counties have seen a net gain in emergency room doctors, including 26 counties which previously had no emergency room doctors. After years of decline, the ranks of medical specialists are growing in Texas. In my field of obstetrics, we had seen a loss of obstetricians in the 2 years prior to reform. Since the reform was passed, we have had a net gain of 192 obstetricians in the State of Texas, and 26 counties have added an obstetrician, including 10 counties where none was present before. We have a great story to tell in Texas. I encourage the President to look at the sensible types of reforms that were enacted in Texas in 2003.