Michael Burgess

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I object to the vote on the ground that a quorum is not present and make the point of order that a quorum is not present.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, on that I demand the yeas and nays.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I have the honor of welcoming and recognizing Rev. Charles E. Smith, who just gave the opening prayer before Congress this 13th day of May of 2009. Rev. Smith is the pastor at Berea Baptist Church in Forest Hill, Texas. He is joined today by his wife, Gloria; his children; and many, many members of his church family and church congregation. Rev. Smith is a native of Texas and a longtime resident of Fort Worth, where he and his wife live with their six children. A graduate of the Southern Bible Institute and of the University of Texas at Arlington, with a degree in architecture, Rev. Smith has served as a spiritual foundation in his community for over 25 years. Mr. Speaker, I commend Rev. Smith for his longstanding service to his parishioners and congregants in Forest Hill, Texas, in the Forth Worth area, and to members of his congregation whom he has so capably served. It is my pleasure to have Rev. Smith here with us today and an honor to represent him and his parishioners in the 26th District of the State of Texas.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I have the honor of welcoming and recognizing Reverend Charles E. Smith, who just gave the opening prayer before Congress this 13th day of May, 2009. Reverend Smith is the Pastor at Berea Baptist Church in Forest Hill, Texas. He is joined today by his wife Gloria, his children, and several members of his family and church congregation. Reverend Smith is a native of Texas and a longtime resident of Fort Worth, where he and his wife live with their six children. A graduate of the Southern Bible Institute and of the University of Texas at Arlington, Reverend Smith has served as a spiritual foundation in his community for over 25 years. Madam Speaker, I commend Reverend Smith for his long-standing service to Fort Worth and to the members of his congregation whom he has so capably served. It is my pleasure to have Reverend Smith here today, and an honor to represent him in the 26th Congressional District of Texas.

Mr. BURGESS

Mr. BURGESS. I thank the gentleman for yielding. Mr. Speaker, I am generally not in favor of commissions. I think Congress gives up too much of its power to commissions in my brief experience here. But this is one point that I think does call out for a commission. Certainly just as egregious as what happened to this country on 9/11 was what happened to this country in September 2008 when we experienced a financial meltdown. And to date, we have not looked back into the causes of the crisis and held anyone accountable. In fact, Congressman Brady from Texas and myself introduced a bill earlier this year for just such a commission, H.R. 2111, that differs substantially from the bill under consideration today. The bill that we are considering today creates a 10-member commission with subpoena power. It is going to be composed of six Democrats and four Republicans. When we did the 9/11 Commission, was that not a 50/50 split with some members being named by agreement amongst the commissioners who were already selected? Why would we unbalance this commission when, quite frankly, Mr. Speaker, there is just as much guilt on one side of the aisle as there is on the other. Senate 386 allows the chairman of the Senate Banking Committee to select a commissioner. The chairman of the Senate Banking Committee may have been part of the problem. The bill allows the chairman of the House Financial Services Committee to appoint a representative to the commission. Mr. Speaker, the chairman of the House Financial Services Committee may have been part of the problem. Senate 386 creates an accountability commission focused on protecting the government. H.R. 2111 creates an accountability commission focused on protecting taxpayers and restoring public confidence, something that is critical at this juncture. Importantly, Mr. Speaker, we do things like this all the time. We bring up an important concept and we pass it under suspension of the rules. This is an important commission that should be created with all due care and caution by this Congress, and then empowered to go out and do the work that we want it to do, not slipped in in the middle of a very quiet legislative day when Members don't even have any idea what they're coming to the floor to vote on. I just want to end by quoting from the Investors Business Daily, an article entitled, Probe Yourselves, from April 16, 2009. The article says, `` `Regulators also deserve blame for lowering lending standards that then contributed to riskier home ownership and the housing bubble.' Exactly correct.'' Continuing to quote, ``As such, Pelosi's proposed commission will be little more than a fig leaf to cover Congress' own multitude of sins-- letting its Members, the true creators of this financial mess, bash business leaders as they pose as populist saviors of Main Street from Wall Street.'' Continuing to quote, ``On NPR Thursday, a reporter confronted Representative Frank, chairman of the Financial Services Committee, with the fact that his $300 billion `Hope for Homeowners' program''----

Mr. BURGESS. ``Chairman Frank was asked about his $300 billion `Hope for Homeowners' program, passed with much fanfare a year ago that had so far helped one homeowner. One. Frank's response: `It was the fault of the right.' '' Continuing to quote, ``The truth is, Mr. Frank's party has been in charge since 2006. And during that time, Democrats have presided over one of the most disgraceful and least accomplished Congresses in history. This financial mess began on their watch, yet they pretend otherwise.'' Further quoting from the Investors Business Daily, the commission that is outlined ``won't get to the bottom of our financial crisis; it will carefully select scapegoats to be ritually shamed by the liberal media, stripped of their wealth, and exiled. The new rules will be imposed that will no doubt make things worse. And the cycle will begin again. ``Wall Street didn't create this subprime mess, Congress, through repeated interventions, did. When the whole thing failed, it was Congress' fault.'' They conclude by saying, ``We'd be happy to support a 9/11-style commission to look into the causes of the financial meltdown. But only if Congress agrees to put itself under the microscope. Anything less would be a sham.'' [From Investor's Business Daily, Apr. 16, 2009] Probe Yourselves Named for its chief counsel, Ferdinand Pecora, the 1932 congressional commission dragged influential bankers and stockbrokers before its members for rough questioning--both of their business practices and private lives. The Pecora Commission led directly to the Securities Act of 1933, the Securities Exchange Act of 1934 and the creation of the Securities Exchange Commission in 1935 to oversee Wall Street. Now Pelosi's calling for an encore. ``People are very unhappy with these bailouts,'' she noted, especially the bonuses that went to executives. ``Seventy five percent of the American people, at least, want an investigation of what happened on Wall Street.'' No doubt, that's true. The problem is, what ``happened on Wall Street'' was a direct result of what happened on Capitol Hill. And we're not the only ones who believe that, by the way. ``Government policies, especially the Community Reinvestment Act, and the affordable housing mission that Fannie Mae and Freddie Mac were charged with fulfilling, are to blame for the financial crisis,'' wrote economist Peter Wallison, a fellow at the American Enterprise Institute, recently. ``Regulators also deserve blame for lowering lending standards that then contributed to riskier homeownership and the housing bubble.'' Exactly correct. As such, Pelosi's proposed commission will be little more than a fig leaf to cover Congress' own multitude of sins-- letting its members, the true creators of this financial mess, bash business leaders as they pose as populist saviors of Main Street from Wall Street predators. Why do this now? Pelosi and her Democrat colleagues are feeling the heat from Tea Party demonstrations and growing voter anger over the massive waste entailed in the $4 trillion (and rising) stimulus-bailout bonanza. Again, the Democrats created all this spending. Now, as it proves unpopular, they just walk away from it. On NPR Thursday, a reporter confronted Rep. Barney Frank, chairman of the Financial Services Committee, with the fact that his $300 billion ``Hope for Homeowners'' program, passed with much fanfare last fall, had so far helped just one homeowner. One. Frank's response: It was the fault of the ``right.'' And Bush. Truth is, Frank's party has been in charge since 2006. And during that time, Democrats have presided over one of the most disgraceful and least accomplished Congresses in history. This financial mess began on their watch, yet they pretend otherwise. What better way to take the heat off yourself than by pointing accusing fingers at those most unlikable of people-- Wall Street bankers? That's what the Pelosi-Pecora Commission will do. It won't get to the bottom of our financial crisis; it will carefully select scapegoats to be ritually shamed by the liberal media, stripped of their wealth, and exiled. Then new rules will be imposed that will no doubt make things worse. And the cycle will begin again. We're not saying Wall Street has no blame for the financial meltdown. But Wall Street didn't create the subprime mess. Congress, through repeated interventions in healthy markets, did. And when the whole thing failed, it was Congress' fault. We'd be happy to support a 9/11-style commission to look into the causes of the financial meltdown. But only if Congress agrees to put itself in the dock. Anything less would be a sham.

Mr. BURGESS

Mr. BURGESS. I thank the Speaker for the recognition. Mr. Speaker, I thought I would come to the House floor this evening and talk for just a little while about health care, because there is a lot of talk going on about health care in this Congress, a lot of talk about the bills that we will see, we haven't seen, and bills that we may not see. I wanted to point out to the Members that yesterday I introduced a bill, H.R. 2249, which is a bill I had actually introduced in the previous Congress. It is the Health Care Price Transparency Promotion Act of 2009, updated from the last Congress and reintroduced this year. I urge Members on both sides to take a look at this because, after all, we hear a lot about the concept of transparency these days, and it is important for our constituents, for our consumers, for our patients in our districts to be able to access clear and timely information about physicians, hospitals, health care facilities in their areas, and understand and do some research on their own to find out which are the best facilities for them to use when they have occasion to need a doctor or a hospital. So as we talk about health care--and it was, of course, all of the discussion during the Presidential campaign last year--I would just point out that there are good ideas that are coming from both sides of this House of Representatives. Certainly, Democrats are not the only ones with ideas on health care. There are Republican ideas. There are Republican ideas that really should shape the debate of health care reform or the natural evolution of health care that we see going on in our country at the present time. There are plenty of people working on health care reform. You know, when I take a step back and look at what should we be doing when we try to frame the debate, when we have our hearings in committee, when we mark up our bills in committee--really, when you look at the vast American medical machine, the widget that it produces, what we do on a daily basis in doctors' offices and hospitals across the country, it is that fundamental interaction that takes place between the doctor and the patient in the treatment room. That is the fundamental unit of production in American medicine. And when we look at it in that context, whether it be the treatment room, the emergency room, the operating room, that fundamental unit of interaction, are the things that we are doing here bringing value to that interaction or are they subtracting value from that interaction? And to the extent that, whether it is a Republican or Democratic idea, if it brings value to that interaction, that is something that I am going to have to look at quite critically and quite favorably. If it is something that subtracts value from that interaction, that is something that is going to be very difficult for me to be for. So I try to always look at it through that lens of, ultimately, it is about doctors taking care of patients, it is about hospitals helping people get well. And to the extent that we can encourage and enhance that process, where there are places where we can help, certainly we should. If there are places where we don't belong--that is, between the doctor and the patient--maybe we ought not to do that. Now, it comes to me frequently, not infrequently, when I'm sitting in committee--and I am fortunate enough to sit on a subcommittee that deals with health care, on the Committee on Energy and Commerce. In fact, in the last Congress I was the only physician to sit on that committee. And when we would deal with problems, when we would deal with issues that had to do with health care or the regulation of the Food and Drug Administration, I was always mindful, when I looked around the room, there is only one person in this room that has ever sat across from a patient, looked him in the eye, picked up a pen and written a prescription, counseled as to risks and benefits, torn off that prescription, and sent the patient on the way. There is only one person in the room that has ever done that, and that was me. And yet here we were with a hearing or a bill that might have profound impact on how that doctor/patient interaction was going to be carried out from that day forward for the next generation or two, and there is only one person in the room who has ever actually been there and done that. So I feel a tremendous amount of responsibility as we go through this health care debate. Yes, I have been joined by some other physicians on the committee. There are physicians on the Subcommittee on Health on Ways and Means. We all bear that special burden to ensure that the decisions that we make today do not negatively impact the next generation and the generation after that. Think back just 44 short years ago when Medicare was enacted in this body. The men and women who sat in this body at the time were the ones who crafted that legislation. And we are dealing with the good aspects and the bad aspects that have been dealt to us because of decisions that were made in our committees, in Congress, and in this body in the House of Representatives. So it is in that sort of context that we need to look at what we are doing. It is not about, and let me emphasize, it is not about the next election. It is not about who wins or loses seats in the great economy that goes on here in the House of Representatives or over in the other body on the other side of the Capitol. It is not about the next election; it is about the next generation. And that is why it is so important for us to get it right. That is why the American people get so frustrated with us as a group here when they see us fight about things and never work together. It is difficult, I know. It was difficult when we were in charge. When the Democrats were in the minority, it was difficult for them to understand how to work with us in the majority, and it is difficult for us to understand in the minority how to work with the Democrats, but it our obligation. That is why we were sent here. That is why we were elected, to do that hard work, and to work with each other where we can, to oppose each other where we must, but to always have focused not on November of 2010, but what is life going to be like when our children are the age we are now, when our children's children are the age we are now? What is it going to look like to them? What is health care going to look like in this country? Are they going to continue to be blessed with the stunning rate of advances that we have seen since the Second World War in the practice of medicine? And it has been stunning. The last 50 to 60 years has seen untold events. Think of the physician in practice right at the dawn of the antibiotic age, when a patient comes into the hospital, significant infection, and there is just not much they can do but keep them comfortable, perhaps drain an abscess if one is available. But the medications that they had were--at best you hoped they didn't do any harm to the patient. Now we have a vast array, a huge armamentarium of medicines to fight infections, bacterial infections to be sure, but also fungal infections and some viral infections. It is an incredible armamentarium that today's physician has. When you think of the young physician sitting in a medical school or attending to a patient in a clinic at a residency program today, think of the things that they are going to have, the tools that they are going to have at their disposal if only we don't screw it up for them today. So we always have to keep foremost in our minds and our imagination what that world is going to look like for the patients of tomorrow, for the young physicians and nurses, folks that work in the hospital that come after us. We have to keep them foremost in our minds. And how great it would be if we didn't even need a health care system, if we had a way to keep people healthy throughout their lives. We're not there yet. But we always need to stay focused on that goal because, after all, I would much rather have my health than my health care. If I have my health, I don't have to worry about my health care. But we know it doesn't always work out. We know that people do have problems, we know that illnesses do strike, we know that problems and complications do occur. So when health care is necessary, to the extent we can make it more affordable and more accessible, sure, we need to do the things we can to make that happen. Now, a lot of people are working on health care reform. A lot of people have been talking about it certainly throughout the last year or two on the floor of this House. I know I have come down several times a month to have this very discussion. Throughout the Presidential campaign last year I worked for the nominee of our party as a surrogate on the health care debates. I got to meet a great many of the surrogates on President Obama's team and heard their discussions for health care. And everyone talks about, well, where is the Republican plan? In fact, for that matter, where is the Democratic plan? I have to say that as I watched the health care debates really from the inside last fall as a surrogate working for Senator McCain, I thought that when this Congress convened with a referendum that was likely to be on health care in November, that they would be much further along as far as the development of a bill--maybe not from the Republican side, but certainly from the Democratic side. The Democratic chairman of the Senate Finance Committee last October convened a big group over at the Library of Congress one day, developed a white paper that really had all the look to it of a roadmap for legislation. I was fully prepared, after the election, for the chairman of the Finance Committee in the Senate to have a bill that would be sort of the model bill, if you will, that everyone in the Senate would support and then, likewise, everyone in the House. In fact, I counseled my colleagues to think in terms of having something, if there are things that concern you about that white paper, be certain you have your arguments all spiffed up and all toned up, because I thought we were going so see that perhaps even in the lame duck session last December. So I was very surprised that we didn't see anything in November or December. Well, surely we are going to see a bill before the inauguration; but in fact we didn't. And then of course the story continued to unfold. The nominee for the Secretary of Health and Human Services ended up withdrawing his name and there was a several-month gap until Secretary Sebelius was confirmed last week. So now we are near Mother's Day of 2009 and still no health care bill--from the Republicans, to be sure, but still no health care bill from the Democrats, either the Democrats in the House or the Democrats in the Senate. Now, I know that there was a letter sent to the President from the Democratic leadership in the other body last week or the week before that said we will have a bill that will be marked up in the Senate the first week in June. But that is a pretty long timeline from a white paper in October to having a bill on the floor of the Senate perhaps in a month that is going to be debated. I think what that shows us, it underscores how difficult this process is. There are many people in this body on both sides who have worked on this issue for years. There are many people in this body who have very set ideas of whatever this bill is when it comes forward--from whatever side that it comes from--they have very definite ideas of what it should look like. In fact, you stop and think; if you were to pick out six of us from either side of the aisle in this body, put us in a room by ourselves and say write the health care legislation that you would like to see, I have no question that there are six of us who could just sit down and do that really without any other help or any other input from anyone else. The problem is when you put all six of us in the room together and say now write a health care bill on which you all agree, that becomes much more difficult. And that is sort of the position that I know I see occur on my side of the aisle. I rather suspect that's the position we see on the other side of the aisle. And then you add into the mix all of the other things that go on here in the course of a normal week or a normal month, notwithstanding the scare we had with the flu last week, the cap-and-trade bill that is out there that at some point is going to come through, it is going to come through my committee. So that is going to take resources and time that the majority, the leadership of the committee, the majority leadership of the committee has to devote their time and resources to that as well. So really working on two tracks in tandem, two parallel tracks, one on energy and one on health care. And it's a tall order. Either one of those bills by themselves is a tall order, but put both of them together. And then you heard the discussion that just concluded from the last hour, what is going to happen as far as regulatory reform in the financial industry, in the banking industry? In fact, when President Obama gave his speech at Georgetown 2 or 3 weeks ago, he talked about how before the end of this year he will have a health care bill, he will have a climate change bill, and he will have a banking regulatory bill all signed before the end of December this year. That is an extremely tall order. And of course many of these things, as their work is in process, one affects the other. Certainly, when you look at the way the budget was constructed, the health care part of the budget is likely to depend upon the energy part of the budget, as some of the costs for health care are going to be offset by some of the revenue that is raised on the energy side. One can't proceed without the other. And it becomes very, very difficult then to marshal these things through and keep everyone on track and everyone on task. And then when you add to it the fact that, yes, by definition, the House of Representatives is a house that is divided between the two major political parties and we don't always work together, that just increases the amount of difficulty. It underscores to me why it is important for us to work together and why it is disappointing that sometimes we don't take those opportunities to work together. But a tall, tall order. And then add to all of that, when you think of the timeline that stretches out ahead of us on health care, remember there was, in this body--I think it was September 23, 1993, when then-President Bill Clinton stood at this very podium and gave a beautiful, eloquent speech that had people weeping for joy about how the President was going to change the delivery of health care in this country. I was just a regular guy sitting in labor and delivery back in Louisville, Texas, monitoring a labor and watching the speech on television, but a beautiful speech delivered. And everyone left this House thinking, oh, now we are well on the way to getting this done. But the reality hit that by the end of September of a nonelection year, you are very close to everyone getting ready for the next election. Because in the House of Representatives, we have 2-year terms. We really don't have an off year. Many of us are already thinking about the next election. So that is another consideration and another thing that makes it more difficult to get big things done because the time frame for getting those big things done between elections is relatively small. The off year, if you will, is condensed down to perhaps 6 months. Certainly by the end of July, when we leave for the August recess from this House, my impression is that the health care bill, whatever it is, likely will have to pass the House before then or it may become very problematic to get something done before the end of the year. And then of course you know what happens next year, it is all election all the time. So even as late as the end of September of 1993, it turned out to be too late for then-President Clinton to get his vision of health care reform through the House of Representatives and the Senate because at the end of September, we were already into the electoral process, and by the time things were finally prepared and ready for a vote, it actually came too late. Look at the difference between 2009 and 1993, 15 to 16 years' difference. But you didn't have all the cable news shows back in 1993. You didn't have the instant analysis, the 24 hours of instant analysis, that we have today. So if anything, the time frame for development of a complex legislative issue like health care or energy or banking regulation, the time frame likely is even more condensed now than it was back in 1993. But I think back to 1993 and 1994. Again, I was just a regular guy working as a physician in a small town in north Texas. It wasn't like nothing got done during that interval. True enough, it wasn't the vision that was articulated by the President that night. But we do have now an entirely different type of insurance product called a health savings account that was actually a byproduct of having an alternative solution to offer to what the then-Democratic majority was offering in health care reform. So there are things that happen during the course of the normal evolution of things, and sometimes they work out to be good things. I would argue that the institution of a health savings account, the ability to buy a high-deductible insurance policy on the Internet, at least provides an option for insurance particularly for younger individuals just getting out of college but also people more in the middle of life, like in their 50s, who may find themselves between jobs. There are options out there for purchasing insurance. It actually didn't exist in 1994. And I know that because I tried to buy an insurance policy for a member of my family in 1994 and you couldn't do it at any price. Now you can go onto the Internet. You type ``health savings account'' into the search engine of choice, and you can get a variety of choices. The cost for a high-deductible health plan for someone in their mid-20s who's just getting out of college is very reasonable. It runs somewhere between $75 and $100 a month depending upon the policy that you select. These are reputable companies that are well recognized. Many of them are PPO plans with, again, a high deductible, but they are affordable and they are available. And it is not always necessary to go without insurance simply because we don't happen to be working for a company that provides insurance as one of its benefits. You know, you want to see a plan. You want to see a plan come from the Democratic side. You want to see a plan come from the Republican side. You want to see the merits of each argued and debated here on the floor of the House. You want to see the strongest points articulated well and perhaps incorporated into whatever the final product is. And then, of course, the other body that has its opportunity to work on the legislation comes together in a conference. And in an ideal world, going through that regular order, in an ideal world, you would get the best possible legislative product. And I do worry that we will adhere to regular order throughout that process, but at the same time, as we sit here today, I'm going to profess to some optimism that we will adhere to regular order, mark the bills up in the appropriate subcommittees, have the full committee markup, as we are supposed to, bring the bill through the Rules Committee to the House floor, have ample opportunity for debate and amendment. Then it goes over to the other body. After passage of the bill, it goes to the other body, a similar process, and we have a real conference committee, not a made-up conference committee but a real conference committee of appointed conferees that get together and work out the differences between the House and Senate version and ultimately then get a product that will serve the American people well. We really do our best work when we go about it that way. If we short-circuit the process, which we do--unfortunately, we do. We did it when we were in charge. And certainly the Democrats have done it in the last 2\1/2\ years since they have taken back the majority. When we short-circuit the process, that's when we get our less than perfect legislative products that are shoved out the door. Now, if I were one of those people that sat in a room by myself, what would I envision as a plan? How would I make things better? And bear in mind that for 63, 65 percent of the country who has primarily employer- sponsored insurance, many people don't want to change from where they are now. So although people are concerned about where we are with what's happening in the health care system in America, those individuals who have employer-sponsored coverage or those individuals who have purchased their own coverage on their own may be quite satisfied with where they are today. So really it must be approached from building upon what is currently in place and working, building upon that platform, and making certain the problems that occur in the existing system today are mitigated or eliminated for the individuals who are feeling the effects of those problems. Well, what are some of those problems? Well, I mentioned someone who perhaps owns their own insurance policy. And there are, depending upon what you read, for round numbers, 10 million people in this country who own their own insurance policy. They are discriminated against in the Tax Code, and that's unfortunate. That has the effect of actually raising their cost for insurance, and there are things we could do to correct that. I'm not sure I have all the answers there. I'm not sure that Republicans have all the answers there or Democrats, but we could fix that. We could fix that. That would be one of the relatively easy fixes we could do. And certainly that's something that I think has to be one of the pieces. That's one of the things that needs to be debated in subcommittee, full committee, here on the House floor, and in conference committee, but we could fix that problem. It is within our power to do that. Now, one of the great fears that people have is that, yes, I've got health insurance now through my job, but I worry that if I get sick, I might lose it, or if I lose my job, I might lose my insurance and then I get sick, and then it will be difficult when I have a claims history, when I have got a preexisting condition. It will be difficult for me to get insurance after that. Again, we can fix that. There are things that could be done to address that segment of the population. We may not even necessarily need to change the whole structure to help that segment of the population that has a condition of medical fragility or a preexisting condition. Many of the States, 32 or 33 out of the 50 States, already have some system in place for helping an individual with preexisting conditions. Certainly we as a body can look at the best practices from those States. Look at the States that are doing things well. North Carolina, Idaho come to mind. Look at the States that are doing things well. Take from those best practices. Is it going to be necessary to ask there to be some contribution from the private sector? There may be. So there may be a level at which the premiums cannot increase above. There may need to be some help as far as a voucher or subsidization of the premium from the Federal Government, from the State government. But this can be fixed. This can be addressed. And it doesn't mean that we don't act upon it just because it's not everything we want. We can help those individuals who find themselves between jobs, between insurance companies, then with a significant diagnosis who then fear that they're not going to be able to get insurance past that point. That can be dealt with. That can be fixed. Insurance reform, there's no question. Even the American Health Insurance Plan Organization admits that there is a need for insurance reform in this country. One of the things that has concerned me is that if an individual works for a large corporation in this country, if that corporation does business in multiple States, that individual can move from location to location throughout the several States and their insurance never changes. It never varies. It's the same insurance policy in one State as it is in the other. And think of the analogy of the National Football League. If there is a player that is traded from one city to another, their insurance goes with them. If they have a knee injury in one location, that knee injury is covered in their secondary location. But the fan, just the regular guy or woman who follows their favorite player from one city to the next, they've got to start all over again with their insurance policy. And that's one of the fundamental inequities. That inflexibility that we built into the system, that's one of the things people want to see us fix. So why not give the regular individual, why not give the little guy the same breaks we give the larger multi-State corporations? We can do that. That's within our power to do that. One of the biggest issues that we hear about all the time is affordability. Well, there are things we can do as far as providing benefits packages that are affordable, and it is within our power to do that. And, quite frankly, I don't understand why we haven't done that. We have at different times agreed on what basic benefit packages are. We did that 35 years ago when we created the Federally Qualified Health Centers across the country. Anyone who goes into a Federally Qualified Health Center knows exactly the benefits that are going to be available to them in that facility. But why don't we get together and do the same thing for now, not necessarily a bricks-and-mortar facility, but do the same thing for a policy that could follow a person from place to place, job to job, State to State, a policy that would be affordable that perhaps could build some longitudinal stability because it would be a policy that someone could keep throughout various phases of their life? We can do all of that. We don't need to endanger the current system that's in existence. We can build upon what is good in our system and add more choices and more options and more flexibility and ultimately more security for people within their health care. After all, that's what people are concerned about. They're concerned about if I lose my job, am I going to lose my health care? If I lose my job and lose my health care, there is no way I could afford a product out there. We can help with that. There are things that we can do. There are regulations that we can look at, that we can suspend, that we can pull back. There is flexibility we can build into the system if we only have the courage to do it. And there's the problem. We won't have the courage or we won't have the opportunity if one side won't talk to the other on this, if we craft our bills out of the public view, behind closed doors, committee staff rooms, Speaker's Office, wherever they are done, and don't do it in the light of day. Politics is a full-contact sport. I understand that. I didn't begin my life to live it in public service, but in the last 6\1/2\ years I have, and I understand the nature of the beast. I understand that there are going to be people who take issue with what I say who want to attack me personally because of it. That's okay, as long as we do that debate here in the public arena, as long we do it in the light of day and that we don't do it behind closed doors and then roll out something at the last minute that the American people had just better like because that's what they are going to get. It's wrong if we do it when we're in charge. It's wrong if they do it when they're in charge. That's not the type of legislative activity that the American people want to see. They want to see legislative activity that brings them peace of mind. They want to see legislative activity that saves them time and saves them money. And why wouldn't they? If we can deliver more care to more people at less cost with better quality, why wouldn't we do it? Why wouldn't we take that choice? In short, as I look at this and I look at how to craft particular legislation, there's also room for common ground, I think, on both sides. On both sides. People talk about how we want to see an expanded role for information technology in health care. Some of the easy discussions that we can have. We may disagree on how it's to be apportioned or how it's to be structured. I don't think we should be writing the codes. I don't think we should be telling doctors and hospitals what type of platform they need to buy. But certainly we ought to be encouraging people to evolve into that next arena, which would include electronic medical records and electronic prescribing. What about things like medical homes? I don't think you would find a lot of disagreement throughout the body on whether or not this is a good thing. Care coordination, we talked about it when we were talking about the Medicare bill back in 2003 and 2004. Disease management care coordination, accountable care organizations, these are things that bring value to that doctor-patient interaction that I referenced at the beginning of this talk. So it's easy to be for that stuff, and I think you would find a good deal of common ground on both sides on that. Where the arguments occur is who is to be the owner and are we going to micro-manipulate these aspects of health care from here or from the committee room or are we, in fact, going to let the people know what they are doing, the doctors, the nurses, the hospitals, are we going to let them be in charge of the system? In short, the American people want everything but a Washington takeover. And that, I think, is the one place where the American people really draw the line, and they are concerned that Washington will overreach, that we will put that congressional committee between the doctor and the patient. We have no place between the doctor and the patient, that interaction in the treatment room. The doctor and the patient activity should be completely free from any congressional interference, and too often, too often, it is otherwise the case. We hear about expanding a public program. We hear about perhaps expanding Medicaid, maybe expanding Medicare. Some of the more serious problems that we deal with in this body are problems that are brought to us because those two programs, for all the good that they do, they do have some problems. Medicare and Medicaid are programs where, unfortunately, the inefficiency, the duplication of services and sometimes just the actual theft of services occurs, and we don't do a good enough job to keep that under control. No one wants us to be spending money inappropriately in any of those programs. The problem is, with both of those programs, they do consume a lot of time, they do consume a lot of activity, and they consume a big portion of the budget every year, the so-called entitlement budget. And when Congress looks to control costs on those programs, the only lever we can pull is to restrain payments to doctors. The other lever we can pull is to restrain payments to hospitals. And the only problem there is you are going to be getting less, then, of the doctor's attention and less of the hospital's attention when you restrain those provider payments. And, unfortunately, we do that all the time. Medicare is notorious for every year coming up and having to face a reduction in the reimbursement rate to physicians across the country. Medicaid reimbursements vary from State to State, but in many States the reimbursement for Medicaid is a fraction of what it is for Medicare. And here is the hard truth of this. You can't run a medical practice off of what Medicare and Medicaid reimburse, at the levels where they reimburse. And you are sure not able to run a practice if we, in fact, restrain provider payments like we are scheduled to do later this year and like we are scheduled to do every year for the next several years. We had a pediatrician come and testify in my committee last year in Energy and Commerce, and she testified and really got my attention because she started practice the same year I did, 1981. Her practice was 70 percent Medicaid in rural Alabama. She was having to borrow money from her retirement fund to keep her practice open. That's a bad situation. If you are losing money on each patient, it's hard to make that up in volume, and that was the situation that she faced. You know, a physician in that kind of crisis, they are not going to be able to keep their doors open. And if they can't keep their doors open, that entire patient population in rural Alabama, that pediatric population is going to be put at risk. Because she didn't talk about how many other providers are in the area, but you can only imagine, if it's that hard to make a practice go in that environment, there may not be many pediatrician practices. If you don't have the private sector to cross-subsidize the public programs, the Medicare and Medicaid, a lot of practices just simply can't make it. Here was an individual who had cut expenses everywhere she could. She had let people go. She had reduced hours. She had reduced some of the services she provided, all in an effort to try to keep the doors open, but she was still unable do that. Therein is a problem. If we expand the public sector, and we depend upon cross-subsidization from the private sector to keep the public going, what's going to happen if you reduce the private sector? How are you going to get that money to cross-subsidize the public part of that? And the amount of subsidization varies from study to study on what you read, but it's about 9 or 10 percent that it costs the private sector to support the public sector to keep it going. So, on a 50/50 mix, Medicare, Medicaid, private pay, you will likely be able to make the cash flow, but when you get to 70/30, it just doesn't work any longer, and that's a physician who is at risk of not being in practice this time next year. So those are some of the problems that we need to fix. We are obligated to fix those problems within our publicly administered health care plans before we expand them. And that is my concern when I hear us talk in this body about how we want to have an expanded public option that competes with the private sector. Right now it doesn't really compete with the private sector. It depends on the private sector in order to keep those practices open. So I think we are obligated to look at the job we are doing now before we reward ourselves with an ever-increasing or an ever-larger segment of that. You know, currently, we are close to about a 50/50 split in this country. About 50 cents out of every health care dollar that's spent comes from here, originates here in the House of Representatives. The other 50 cents of every dollar that's spent is self-pay private insurance or charitable gifting of a doctor who just doesn't expect to get reimbursed for what they do. Fifty percent comes from the Federal and State governments, 50 percent comes from the private. If we shift that balance, we are apt to find that we are no longer supporting the infrastructure we had hoped we would be able to continue to support. So adding to the public sector may, in fact, be detrimental. For people who want to keep what they have now, we say you can, right up until the time we make it unprofitable for that to continue. One of the things that concerns me greatly is, again, what we do with our provider payments. December 31 of this year, physicians across this country will face a reduction in reimbursement for Medicare patients of 20 percent, a little over 20 percent. That's a significant and stark reality that's facing every doctor that sees Medicare patients throughout the country. And doctors are concerned about it, patients are concerned about it. Many patients will find they move locations, and finding a new doctor on Medicare becomes extremely difficult. There are stories in The Washington Post. I have seen stories in my hometown newspaper in Dallas and Fort Worth, extremely difficult to find a physician to take a new Medicare patient in many locations in the country. And the reason for that is what Congress has done the last several years where we say we are spending so much money on Medicare, we would like to hold the costs back a little bit, we will just hold the cost down or we will hold the price down by cutting payments to doctors a little bit each year. And that, over time, has become a very pernicious effect on people going into medicine, quite frankly. There are concerns that the physician workforce will continue to erode over time, such that just the sheer numbers of doctors available may not be enough to treat the patient load as us baby boomers get older, may not be enough to treat the patient load that emerges on the other side. So it's a problem that this Congress, this Congress, the one that's seated here, really has to face up to, because by the end of December, there will be a 20 percent pay cut across the board. We did a big Medicare bill July of 2008, big, big hoopla here on the day we did it. Yeah, we solved the problem for a little while. Every time we do that temporary fix, every single time we do that temporary fix, we make it harder, we dig the hole deeper and we make it harder to get out of that problem on the other end. Now, every Congress that I have been here, I have introduced legislation to deal with what's called the sustainable growth rate formula that creates that 5 percent, 10 percent or now 20 percent reduction in rates to physicians. I will be reintroducing a bill next week that will deal with this problem. I had a similar bill last year. There have been some changes made because of some of the changes in legislation that have happened over the past 24 months, but ultimately we are going to have to deal with this problem. We need to move physicians into the same type of payment formulas that we do for hospitals, that we do for insurance companies, that we do for drug companies, that we do for HMOs, and that's essentially a cost-of-living adjustment that occurs every year. There is no magic to it. I didn't invent it. It's called the Medicare Economic Index. It's about a 1 or 1.5 percent update that occurs every year to account for the increased cost of delivering that care. We haven't kept up with the cost of delivering that care. There are some years we have provided a zero percent update. There are some years we have allowed the cuts to go into effect. There are some years we have provided a 1 percent update, but it hasn't been enough. And as a consequence, it now costs doctors more to actually do the work of seeing the patient. It costs them more. It costs them money to see every patient on Medicare. We are not carrying our load. We are not paying our freight from Congress, and that has an extremely detrimental effect on the physician workforce, the morale of the physician workforce, and certainly the continued--it will lead to continued problems with physician--spot physician workforce shortages, some patients not being able to get in to see a Medicare provider. And it's up to us, up to us to address it. Doctors are seeing the patients we asked them to see, our Medicare patients. Congress in 1965 said we are going to take over the care of individuals over the age of 65 in this country, and we asked the doctors to see those patients. They are arguably sometimes the most complex and complicated patients that will be in a physician's practice. They are complicated because they have multiple medical problems. They may be on multiple medications. They are not necessarily the easiest patients to take care of, but they are important, because they are our parents, they are our colleagues. In fact, many of us, in a few short years, will be in that Medicare age group. It is critical that we provide the physicians the support they need to take care of those Medicare patients. And it's something I just frankly do not understand why this Congress is always so reluctant to deal with this problem and always pushes it off to the last minute. We push physicians in this country up to the brink every year, every 6 months, every 12 months, every 18 months, whatever it is we decided to fix it for the last time. We don't even deal with it until we are right up against that problem again. Well, this time let's be different about it. We have 8 months till the end of the year, 7 months till the end of the year. Let's take that time to fix it and get it right and make certain that this time we don't leave our doctors waiting at the last minute to wonder if they are going to be able to keep their doors open January 1 or not. One of the last things I want to touch on, a few weeks ago in March, I was invited down to the White House to participate in the White House forum. And, again, as alluded to earlier, I have been concerned that there is a bill that's already been done and the rest of this is just for show. At the appropriate time, the Speaker's door will fly open, the health care bill will come out. It will roll down here to the floor of the House. We will have a brief time to debate it, no time to read it, and off we will send it to the Senate. I have been concerned about that. As I said, I am the eternal optimist, and I am going to be optimistic that we are going to go through regular order, but I also fear at some point there will be a bill that just comes crashing through with no time to read, evaluate or debate, and off it will go to the Senate and that will be that. Now, the President, to his credit, said that that was not the case, that we would go through regular order. In fact, as we wrapped up after the breakout sessions that afternoon in the White House, the President stood in the East Room and said that it will up to the congressional committees and congressional leadership to get this bill done through the regular order, that he would be glad to offer guideposts and guidelines, perhaps some budgetary boundaries, but he wanted that work done in the Congress, where it was supposed to be done. Again, I will take him at his word. In fact, I applaud his courage for saying so. He said at one point, I just want to find out what works. Well, I want to help the President find out what works, and to that end, I will continue to be involved in this debate. Now, let me just spend a few minutes talking about a caucus that is currently working in Congress to try to help inform on the health care debate. It's not a legislative caucus. It's not a legislative committee. It won't write legislation, but we do have forums. We do have hearings. We do have Member educational events. We do have educational events for staff, congressional staff, particularly on the communication side. On occasion, we go outside of the confines of Washington and talk to groups of doctors, nurses, hospital administrators, again, the people who are involved in taking care of our patients on a day-to-day basis. We like to solicit their input, to receive their advice and criticism on things they see happening from Congress. And the caucus is the congressional health care caucus, and it does have a Web site, www.healthcaucus.org, healthcaucus being all one word with no space or bar in between. I encourage people, Mr. Speaker, to look into this. It is a way for people to have their voices heard on this debate. We have had several good forums. I try not to make them one-sided. We try to have people who represent, perhaps, a left-of-center view and a right-of-center view. We had one forum on the options for reform that was attended by people from the Commonwealth Fund, by people from the Galen Institute and the Council for Affordable Health Insurance. It was a very instructive forum. The Webcast for that is, in fact, archived on the Web site if anyone is interested in that. We had another forum on improving affordability, listening to some of the people who have actually done the work of making health care affordable in their communities and for their groups of patients. We heard that time from Rick Scott, who runs a number of outpatient clinics in Florida. We heard from Greg Scandlen from the Consumers for Health Care Choices, and we heard from Dr. Nick Gettas, who is a chief medical officer at CIGNA. Again, on the Web site, the Webcast of that is archived and people are welcome to look at that and review that. When we do these forums, we do Webcast them from the Web site, and they are available live and broadcast live on the Web site when they are done, and through the magic of Twitter, we are able to take questions from people who are not actually in the physical audience. We do take questions from the physical audience. We take questions from the virtual audience. This can, again, sometimes lead to some quite lively debate. Upcoming within the balance of the month of May and into the month of June, we are going to be doing another forum, one dealing with the question of mandates and one dealing with the concept of health reform from the journalists' perspective. We have many good writers up here who write about this on a regular basis, and we want to bring them in, perhaps turn the tables and interview the interviewers for part of the morning on some of the aspects of the health care debate. And then finally, in the month of June, we are going to have another forum on promoting quality. And we have got a number of good people lined up for that. Again, some left of center, some right of center, but designed to give a balance of opinion as we have these forums. And again, as I mentioned, Mr. Speaker, if anyone were interested, they are available live on the Web site when we hold those. In short, Mr. Speaker, I did not leave a viable and active 25-year practice of medicine to come here and sit on the sidelines. I came here to be part of the debate as the debate was going on, and I intend to be fully engaged. I hope that both sides will stay lively and will stay engaged on this debate. I hope we can have this debate in the light of day and not in the dark of night. I hope we can have input from both sides when this bill ultimately comes forward from this and leaves the floor of this House and goes over to the Senate. Certainly I know the American people are depending upon Republicans and Democrats to work together. And it is my hope, my fervent hope and my prayer that that is indeed what happens. Mr. Speaker, you have been very generous, and I'm going to yield back the balance of my time.

Mr. BURGESS

Mr. BURGESS. I thank the gentleman for yielding. Madam Speaker, I should start by offering special thanks to the Motorcycle Industry Council and the American Motorcyclist Association who have really helped shepherd this bill through the various congressional committees and through Congress. Madam Speaker, $300, that is what I paid for my first motorcycle. Throw in another $20 for the helmet, the freedom, the fresh air, the open road in Texas, the exhilaration was priceless. There are a lot of bikers out there who know exactly what I feel about riding along on the open road, especially in a beautiful State like Texas. Gas prices last year were on the rise. The gentleman from Tennessee mentioned better weather heading our way. More people across America are going to start using their motorcycles, using them to go to work, travel, or just go for a ride and enjoy the freedom that is uniquely American. Yet as ridership increases, so does the risk for everyone on the road. Last year in the Lone Star State alone, preliminary numbers revealed that more than 9,100 motorcycle crashes accounted for more than 400 deaths. As a doctor, I have been in plenty of emergency rooms and trauma centers. Take it from someone with nearly 25 years of experience in medicine, you don't want to be involved in a crash of any kind, but most particularly in a motorcycle accident. As the old saying goes, an ounce of prevention is worth a pound of cure. For bikers, prevention is riding the right way, and that is responsibly. That means getting trained. That means you don't do motocross on suburban streets. That means you wear protective gear. That means you are aware of the cars and trucks around you. For other drivers, drivers in the larger vehicles, prevention means keeping your eyes open and staying alert. Something as simple as conversing on the cell phone or comforting a crying child is a dangerous distraction that can lead to a crash as well. Abundant caution for all drivers is essential and encouraged. But accidents do happen, and when they do, people need to receive proper medical care to treat their injuries. That is why for the past several years I have introduced legislation to close a loophole on the HIPAA health care law that allows insurers to deny payment for injuries sustained while engaged in certain recreational activities, including riding a motorcycle. The original point of this law was to make health plans more accountable to the people they cover, but these very same provisions are hurting the people they intend to help. Congress is charged with making laws to protect people. When these laws have the opposite effect, we also have the responsibility to fix them and fix them immediately. This loophole has been a problem for almost 12 years. The time has come to fix it. I am grateful to say H.R. 1086 passed out of our committee earlier this year. It allows for increased transparency so that people are at least entitled to know the information of what their policy does or doesn't cover, and it must be spelled out up front in a language that everyone can understand. The time has certainly come for riders and those who desire to ride in the future to listen to the wise advice of people, like our former Transportation Secretary, Secretary Mary Peters, who happened to ride a Harley herself, who was steadfast in her support for this legislation in many Congresses past, and I am sure would join with me today in supporting this legislation. As I stand here in support of Motorcycle Safety Awareness Month, I am extremely cognizant of the current problems that the motorcycle industry has been having with the Consumer Product Safety Commission, specifically the bill H.R. 4040 that became the Consumer Product Safety Improvement Act that we passed in the last Congress. Motorcycle dealers are small businesses, and we have put a burden on them that is, in fact, putting their business in danger of survival. And at a time when our economy is losing jobs, we can scarcely afford to continue that. It is reported today that the President intends to provide the Consumer Product Safety Commission with a 71 percent increase in resources than what they had before to enforce the sweeping laws that were passed in the last Congress. No law has been more sweeping than the Consumer Product Safety Improvement Act. Unfortunately, it has swept up businesses Congress did not intend to be swept away. So yesterday, the Consumer Product Safety Commission issued a Federal Register notice providing a stay of enforcement for the motorcycle industry, but a stay is not enough. These businesses need the assurance that they will not be again required to close down. So I introduced a bill earlier this year, H.R. 1587, to permanently exclude the ATV, motorcycle and snowmobile industries from the application of the Consumer Product Safety Improvement Act because what child under the age of 12 is going to get lead poisoning from consuming the battery in their ATV? In fact, there is the potential for more harm to a child by having them ride an adult-sized ATV or motorcycle than there is the risk of the child consuming the battery that is contained within their motorcycle. The Consumer Product Safety Commission cannot do the job that it needs to do without an administrator. It requires the leadership of the administrator of the Consumer Product Safety Commission to winnow out the intent of Congress and to put this law on the track on which it was intended. So while I enthusiastically support President Obama for trying to give the Consumer Product Safety Commission more resources, what the Consumer Product Safety Commission really needs is leadership. I ask the President to nominate an administrator for the Consumer Product Safety Commission so they can provide the leadership to truly impute congressional intent. If there ever was a bipartisan issue on which both Democrats and Republicans can agree to, it is the fact that the CPSC needs a new administrator, and some common sense needs to be applied to the act that we passed in the last Congress called the Consumer Product Safety Improvement Act.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, on Wednesday, April 29, 2009, on rollcall number 216 I am not recorded. This rollcall vote on S. Con. Res. 13, the Conference Report to a Concurrent Resolution setting forth the Congressional Budget for the United States Government for fiscal year 2010 and budgetary levels for fiscal years 2009 and 2011 through 2014, occurred while I was absent from the floor of the U.S. House of Representatives. Had I been present, I would have voted ``nay.'' I would have voted ``nay'' on S. Con. Res. 13 because the budget significantly increases the Federal deficit and passes the burden of payment on to future generations of Americans. The reserve funds singled out for healthcare reform, climate change, affordable housing, and Medicare alone represent a dramatic expansion of the powers of the Federal government. I am committed to voting to improve fiscal responsibility and to reduce the size and power of the federal government. As a result of that commitment, I would not support this resolution. On April 2, 2009 the House of Representatives voted in favor of the House Budget Resolution (233-196), on that vote, I am recorded as voting ``nay.''

Mr. BURGESS

Mr. BURGESS. Madam Speaker, on Wednesday, April 29, 2009, on rollcall number 223 I am not recorded. This rollcall vote on H.R. 1913, the Local Law Enforcement Hate Crimes Prevention Act of 2009, to provide Federal assistance to States, local jurisdictions, and Indian tribes to prosecute hate crimes, and for other purposes, occurred while I was absent from the floor of the U.S. House of Representatives. Had I been present, I would have voted ``nay.'' Violence, whether it's based on a perceived or actual threat, is of enormous concern when it is combined with constitutionally protected rights. Race. Color. National Origin. Religion. Gender. Disability. All of these fundamental rights are protected by our Constitution and hate crimes themselves have additional protection in Section 280003(a) of the Violent Crime Control and Law Enforcement Act of 1994. Any hate crimes perpetrated in violation of either law should be fully prosecuted by the U.S. Department of Justice and we, as the DOJ's appropriators, should give them all the resources they need to prevent any hate crimes from occurring. I believe existing federal law is more than adequate to prosecute hate crimes and, as such, should I have been present I would have voted ``nay.''

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to celebrate the contributions of Judge Ron Hurst and his 30 years of distinguished service. As a Member of the State Bar of Texas, Judge Hurst has served his community of Highland Village with acute clarity of the law and a stringent application of justice. His reputation is one of impartiality and fairness. Judge Ron Hurst is an alumnus of Loyola University School of Law. In 1977, he moved to Texas from Louisiana and found his home within the Highland Village community. He accepted the position of Corporate Attorney with the Placid Oil Company of Dallas, Texas and joined the Texas Bar. Judge Hurst claims the distinct honor of being the first judge of the Highland Village Municipal Court. Having served as the presiding judge for the past 30 years, he is the city's longest tenured employee. Judge Hurst moved to the Highland Village area when it was home to 800 families. As the city grew, Hurst continued to dedicate his time to the development of the community. Aside from being a loving husband and father, he served on the Highland Village Planning and Zoning Commission, the Board of Ethics and his work as a Court Appointed Special Advocate volunteer. Hurst is also involved in his church where he has served as a teacher, youth group facilitator and Financial Committee member. Madam Speaker, I am proud to recognize Judge Ron Hurst for his 30 years of legal service and contributions to the Highland Village community. His devotion serves as an example to others and it is an honor to represent him in the 26th Congressional district of Texas.

Mr. BURGESS

Mr. BURGESS. I thank the gentleman for yielding. You know, home on the 2-week recess that we just had, you are so busy--recess is a misnomer, you are so busy going from one place to another that oftentimes you don't even have an opportunity to keep up with the current events of the day. And I did what I was doing so often as I drive through my rather long and narrow district, I was listening to talk radio, a subversive station there in the Dallas/Fort Worth market, and they started talking about this report that had just come out from the Secretary. Well, I was so upset about what I was hearing on the radio that I got on my phone and I called the staff up here in the Washington office and I said, we need to get a letter to the Department of Homeland Security, to the Secretary right away. So I am going to read to you a few excerpts from the letter that I wrote last week to the Secretary of the Department of Homeland Security. And Judge, it actually goes back to something that you were saying. Within the letter, the report states that ``the economic downturn and the election of the first African American President present unique drivers for right-wing radicalization and recruitment.'' The report goes on to connect associations with right-leaning ideology with the Oklahoma City bombing, the murder of law enforcement officials, bank robbery, attacks on infrastructure, racism, and bigotry in general. This report claims that, ``high unemployment leads to alienation, increasing an individual's susceptibility to extremist ideas.'' This report appears to claim that high unemployment amongst Caucasians, Christians, second amendment supporters and Armed Forces veterans has a causal relationship with radicalism and violence against the State. I call into question this underlying assumption and baseless claim. The implication that veterans returning home from serving our country are at risk of becoming domestic terrorists or assassins is sensational at best, but dishonorable and disrespectful of their service. Profiling based on race, ethnicity, religious beliefs, or life experiences is always wrong. I believe the Department of Homeland Security owes an apology to the Americans that are offended by this report, especially to the men and women of our Armed Forces. Furthermore, the Department should rescind this report so that those local, State and Federal law enforcement officials who received it are not compelled to profile individuals as terrorists simply because they associate themselves with conservative organizations. I ask that you enact these recommendations on behalf of the constituents of the 26th District of Texas. And just briefly, I want to read some lines from a stack of mail that I got from my constituents back home. Some of them are pretty outspoken. A resident from Flower Mound, Texas put it pretty simply; ``Fire Napolitano immediately. The United States is not a police state.'' Another resident wrote, ``The only acceptable response is to fire Secretary Napolitano immediately. No apology should be accepted. Even her resignation should not be allowed. All Americans should demand that the Secretary be fired without delay.'' Another resident from Mound, ``Dear Congressman Burgess: Americans are repulsed by the leaked DHS Anti-Terrorism Security Assessment Summary that clearly targets mainstream Americans as dangerous extremists.'' A resident from Keller, Texas, ``The report issued yesterday by the Department of Homeland Security was reprehensible and insulting to tens and millions of Americans. The statement issued today by Secretary Napolitano standing behind the report is absolutely inexcusable. Secretary Napolitano should resign.'' A resident from Hurst, quoting from the body of the letter, ``I ask you to speak out against this kind of rhetoric, Congressman, and to call for the immediate resignation of the Secretary of the Department of Homeland Security, Janet Napolitano.'' Another resident writing from Hurst said, ``In fact, I am considering calling the Department of Homeland Security and giving them my name and address so they can keep an eye on me and my radical ideas, like a smaller Federal Government, more control back to the States. Maybe we should start a list for them.'' A resident from Corinth, Texas stated, quite simply, ``Fire Janet Napolitano immediately. I viewed her so-called apology on Fox and Friends in the morning on Thursday; that was no apology as she stands by the report.'' Another one writing in said, ``I have spent over 20 years of my life serving my country as an officer in the United States Navy fighting to protect the Constitution and America from the very likes of this. I joined during the Cold War, and I know firsthand how Communists act and what they do to political dissenters. Now to have this said of me and my family, my children, my friends, my neighbors, my church, and everyone else I know by my own government makes me''--I'll use a colloquial term here, I'll just say ``sick to my stomach.'' I demand Janet Napolitano's immediate firing. She has demonstrated she is unfit for service in any capacity in the U.S. governments. Another resident of Flower Mound. ``This is disgusting. Of all the departments and agencies in our government which should be apolitical, Homeland Security is one of the most, if not the most critical, to remain apolitical. They are tasked with defending all Americans. I implore you to call for a congressional investigation immediately. I urge you to call immediately for the resignation of Secretary Napolitano. If she is so concerned with advancing a political agenda, let her go work for ACORN, whoever they are.'' A resident from Pilot Point, ``Warmest regards from Pilot Point. We are former U.S. Army officers. One of us is a West Point graduate. We are both veterans of Desert Storm. Both of our fathers and my grandfather are veterans. My father was a career Army officer and my uncle a Navy fighter pilot. My little brother, a U.S. Army officer, has served tours in Afghanistan and just returned from a tour in Iraq last month. ``Forgive my tedious intro, but in the spirit of full disclosure, I thought you should know that we are biased. We bleed red, white and blue. I cannot find the words to share with you, how repugnant we find the justification of discriminatory governmental directives and a complete lack of rational government demonstrated by the DHS Secretary. ``Someone can be given knowledge, but unless they truly accept and internalize the error of their actions they cannot be taught good judgment. She must be held accountable with a full investigation. Short of that, please demand her resignation. ``There is no apology that will change the discriminatory character that she demonstrates and apparently supports. Please make an outspoken stand on principle. I feel we cannot change her character.'' Well, to the two Army officers from Pilot Point, consider it done. Resident from Lantana, ``Why have Republicans not been screaming for Janet Napolitano's firing? My employees would be fired in this situation.'' It goes on to say ``I love you, and I went to the Denton TEA party.'' A resident from North Richland Hills, ``Returning veterans are being subjected to unjust scrutiny by the DHS Secretary.'' A resident from Denton, ``Her pronouncements are an insult to every American and probably 95 percent of hardworking citizens. To hear such word from a high-ranking Federal employee, language that denigrates those who defend our country and every patriotic American makes me one that Napolitano, I suppose, would consider a threat even though I have always thought that nothing in my personal life and belief system would so delegate me.'' Well, I have a few more, but in the interest of time, I am going to stop there. Those are some of the most poignant that were submitted to the office. Certainly this is something that has gotten people's attention and appropriately so. I think, Judge, you are doing the correct thing by having this special hour tonight, giving many of us a chance to come down to the floor and talk about this. I can't say it any better than my constituents have said it, an investigation, to be sure, a replacement of the Secretary, I think, is certainly in order, and I do have to question the sincerity of an administration that would not undertake these measures after the types of very, very painful words that have been included in that report, and how it has affected those that we have depended upon to fight for us and maintain our freedom. April 16, 2009. Hon. Janet Napolitano, Secretary, U.S. Department of Homeland Security, Federal Office Building, Washington, DC. Dear Secretary Napolitano: I am writing to express my concerns regarding a recent Department of Homeland Security (DHS) report entitled, ``Rightwing Extremism: Current Economic and Political Climate Fueling Resurgence in Radicalization and Recruitment.'' This report claims to provide law enforcement officials with the tools to help them deter, prevent, preempt, correspond to terrorist attacks against the United States. I understand the purpose of shared intelligence, however, I am concerned that by broadly characterizing those who support a conservative ideology with terrorism the DHS may have mischaracterized and offended several million Americans and placed them at risk of profiling bylaw enforcement officials. This report states, ``The Economic downturn and the election of the first African American president present unique drivers for rightwing radicalization and recruitment.'' The report goes on to connect associations with right-leaning ideology with the Oklahoma City bombing, the murder of law enforcement officials, bank robbery, attacks on infrastructure, and racism and bigotry in general. This report claims that ``high unemployment leads to alienation, increasing an individual's susceptibility to extremist ideas.'' This report appears to claim that high unemployment among Caucasians, Christians, Second Amendment supporters, and Armed Forces Veterans has a causal relationship with radicalism and violence against the state. I call into question this underlying assumption and baseless claim. The implication that veterans returning home from serving our country are at risk of becoming domestic terrorists or assassins is sensational at best and is dishonorable and disrespectful to their service. Profiling based on race, ethnicity, religious beliefs, or life experiences is always wrong. I believe the Department of Homeland Security owes an apology to the Americans that are offended by this report, especially the men and women of our Armed Forces. Furthermore, the Department should rescind this report so those local, state, and federal law enforcement officials who received it are not compelled to profile individuals as terrorists simply because they associate themselves with conservative organizations. I urge you to enact these recommendations on behalf of the constituents of the 26th District of Texas. Sincerely, Michael C. Burgess, M.D.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I have come to the floor tonight to talk about health care, but some of the comments that we have just heard in the last hour, I just feel obligated to respond. I cannot let the fantasies that are put forward on this floor stand unchallenged. We heard the statement made that no investment in renewable energy occurred in the last 8 years. That is absolutely preposterous. The State of Texas has one of the most aggressive renewable portfolio standards in the country. In fact, the State of Texas is the leader in the generation of wind. And this did not spring from the Earth fully formed on January 21 of this year. This has been the product of well over a decade of hard work back in the State, our renewable portfolio standard that, I might add, was signed into law by Governor George W. Bush back in the 1990s in the State of the Texas. Please, let's have the debate, but let's argue from the standpoint of facts. Let's not continue to engage in this fantasy that nothing has occurred over the last 8 years. Nothing makes the American people more angry than to hear this type of falsehood repeated over and over again. Texas is the leader in the production of wind energy. We have an aggressive renewable portfolio standard, and all of that was initiated under the governorship of George W. Bush. It has been continued under the Republican governorship of Rick Perry and, yes, during the 8-year Presidency of George W. Bush. Thank you for letting me get that off my chest. Now on to health care. Mr. Speaker, the Health Caucus Web site went live this week, www.healthcaucus.org. I formed the Health Caucus earlier this year because I felt it was important to have a forum to talk about some of the changes, some of the things that we are seeing in this health care debate. The Health Caucus is not a legislative caucus. We're not going to write the law. That never was the intention of the Health Caucus. But the intention of the Health Caucus was to provide a forum where ideas can be exchanged, and, indeed, that's exactly what has happened. And I want to talk about a couple of those that we have had recently. It was to provide a vehicle for Member education so Members who perhaps weren't as familiar with issues surrounding health care would have an opportunity to avail themselves of recent information and prepare themselves for the debates, prepare themselves for the legislative process that's going to be ahead of us. Certainly a great deal of effort in the Health Caucus is spent towards staff training, to prepare the communications staff for Member offices on how to communicate with constituents about health care, how to communicate effectively in the health care debate that is going to be ahead of us. And probably most important or one of the most important functions of the Health Caucus that was recently formed is outreach. We spend a lot of time here in Washington, we spend a lot of time in windowless rooms in the basement of the Capitol of the new Capitol Visitor Center. And as beguiling as those accommodations are, it always seems that we have the same discussion with the same people rehashing the same ideas over and over and over again. And yet out across the country, there are men and women who are engaged and involved in this debate. They are engaged and involved in the actual delivery of health care, taking care of actual real patients on a day-in and day-out basis. They kind of know what works; they kind of know what doesn't. And it is so important for us to go out and solicit those stories, take the advice of the men and women who are working in the health care industry, and bring that information back to Washington, learn from what works, learn from what doesn't work. There is no reason that we should continue policies or try to develop policies that have been proven not to work, say, in a State jurisdiction or a State venue, but it is very important that we learn from those things that do work because we are going to be called upon at some point this year to do something, and it remains to be seen what, but to do something with health care in this Congress. Now, the Web site, www.healthcaucus.org, that Web site is available. There are links on that Web site to the various forums that have been held where ideas about health care are exchanged. And they're not all Republican ideas or Democratic ideas. We seek to have a balance of opinion. In fact, the very first forum that I held earlier this year had Karen Davis from the Commonwealth Foundation, Grace-Marie Turner from the Galen Institute, ostensibly one speaker from a little bit left of center, one speaker from a little bit right of center. We have had other speakers from the Commonwealth Foundation come and participate in some of our member organizations as well as other members from the Galen Institute. It's important to expose Members to ideas from both sides of the political stripe. Today's forum was no exception. We had a lively discussion, in fact, in the Capitol Visitor Center. I will talk a little about the panelists and their presentations later. But, again, a Webcast of today's forum is available for anyone who wants to go to www.healthcaucus.org and view that. When we do these events, they are Webcast live. It's not always possible to compete for C-SPAN coverage, but we do generally Webcast these events live. And the audience that is seated at the forum is certainly free to ask questions. These events are open to the press, and questions can be submitted over the device called ``Twitter'' that many people use for instant message communications. So today's audience, for example, we had probably between 50 and 70 people in the audience, and we had a similar number who were watching live on the Webcast. And, indeed, we did pose a couple of questions from folks who sent in questions via e-mail and Twitter. We did pose some of those questions to the panelists in the course of that forum. Also up on the Web site are brief, minute interviews primarily with the panelists who have come and talked, but we have had some other individuals that have just been part of the discussion and part of the debate as we go along. Dr. Mark McClellan, the former head of the Food and Drug Administration under the Bush administration, former head of the Centers for Medicare and Medicaid Services, graciously provided me a brief video which is up on that Web site and also available on Youtube. Today the policy forum was titled ``Making Health Care Affordable Without the Government.'' You know, it was interesting, yesterday one of the papers that is published up here in Washington called Politico had an article, and, in fact, it was a front-page article yesterday, talking about the health care reform debate as it's unfolding; in fact, talking about how it appeared that the Democrats are ahead of the Republicans in the health care debate. Some statements were made that were perhaps a little bit hyperbolic, a little bit overblown. It's not that there is no Republican health care plan right now. There are many Republican health care plans. The challenge is to get us all to agree on a set of facts, a set of principles, and a health care bill going forward. But I would point out that that is no different from the difficulties that are being encountered on the other side of the aisle. In fact, last fall during the Presidential campaigns, the presidential debates, Senator Baucus, the chairman of the Senate Finance Committee, produced a white paper. He had a forum over in the Library of Congress and invited many of the stakeholders, many of the players who are involved in the issues around health care reform, and produced a white paper. Many of us thought that this white paper was, in fact, a prelude to legislation and, in fact, that this legislation would likely appear just shortly before the November elections. It's perhaps somewhat of a surprise that that legislation has not come forward yet. In fact, there was a recently released letter to President Obama from the Democratic leadership in the other body stating that indeed there would be a bill to mark up by early June. So you can see it is difficult not just for Republicans, but it is, indeed, difficult for Democrats. You've got lots of different and differing constituencies to be represented, and it is a challenge to bring everybody together, get everyone reading from the same page, and then going forward with a unified plan. My suspicion last fall was that that would be very quick to materialize from the other body, from the Democratic leadership in the other body, and perhaps not too surprising that the Republicans are where they are, but very surprising that we had not yet seen more as far as a fully formed plan from the other side. A question came up during the forum today: What do you think of President Obama's health care plan? And that's a tough one because I don't know if anyone can honestly tell you right now today what the President's health care plan is. In fact, during the Health Care Forum that he put on at the White House a few weeks ago, he was very careful to say that this is legislation that will be developed by the United States Congress. It will come through the appropriate committees on both the House and the Senate, that he would provide guideposts and guidelines and boundaries going along, but the legislation would be developed from the congressional committees. And that's a reasonable thing for the President to say because 15 years prior, another President who was new in town and was trying to also effect some major changes in the way health care is delivered in this country went entirely the other way. He said, we are going to sit down within the confines of the White House--again, one of those small windowless rooms that we have so many of up here in Washington, D.C.--500 lawyers behind closed doors, and we are going to generate a health care plan, and, by golly, the Congress will like it. But it turns out they didn't. And, as a consequence, no health care reform was done in 1993 and 1994 and the argument languished for many years, 15 years after that. It's not that nothing happened, I do want to stress. We keep hearing that the status quo is not acceptable. I will submit to my colleagues on both sides of the aisle here in the House, men and women, American medicine has not sat still during the last 15 years. In fact, there have been dramatic changes in health care in the last 15 years, dramatic changes in the science of health care, dramatic changes in the delivery of health care. One of the changes that came about as a result of the Republicans having a plan back in 1993 and 1994 to offer, as a counter to the Clintons' plan, was the concept of the health savings account. At the time they were called medical savings accounts. They came along after the Republicans took control of Congress in 1995. I think it was 1996 or 1997 that the first health savings accounts became available. They have matured over the last 10 or 15 years. In 2003 we expanded, and now they are called health savings accounts. But that program was expanded and some of the more onerous red tape was removed. And now you do have a system that provides health insurance, on the individual market the high deductible health plans for probably anywhere between 7 and 14 million people. And these are individuals that at least almost half would not have insurance were it not for the availability of this product. I know that because back in 1994, I attempted to buy an individual policy for a family member and could not find one at any price. I was prepared to write a large check in order to get that insurance coverage, and it just simply was not available. Fast forward to the present time, you can go on to the Internet, to the search engine of choice and type in ``health savings account'' and find that there are a variety of programs, a variety of products that are out there and available and priced at a reasonable amount. A 25- year-old, such as I was trying to purchase insurance for back in 1994, a 25-year-old now for a high deductible policy, a good product, a PPO product from a well-recognized company that would be listed on the stock exchange, so you would know they were a reliable company, those policies are available for between $75 and $100 a month. To be sure, there is a high deductible. But, of course, under the HSA laws there is the ability to put a medical IRA, a tax-deferred account away to help defer those high deductible expenditures. And, over time, this can be a very satisfactory type of insurance to have. In fact, it's the type of insurance that I carry. We have a health savings account option through the Federal Employee Health Benefits Program. It costs about half of what the high-option PPO costs. So I am saving the government money. I am putting money away in a medical IRA. And, in fact, the HSA that is available is very conscious about making sure you have your routine studies done, your routine medical care done. I get e-mail alerts all the time reminding me I need to take care of this or that, and it's a good program. It's one that I think shows a lot of promise for into the future. But I do digress. Right now, currently, President Obama does not have an official White House health care plan that's out there, so it was very difficult to provide a precise answer to the gentleman's question today in the forum. During the fall, we heard some campaign rhetoric on what some of the--perhaps the proposals that President Obama would put forward. We heard discussion of a mandate for covering children. I don't hear much talk of that currently. You hear some talk currently of there being some sort of government- run public plan, either a Medicare, Medicaid or some other type of plan to compete with the private sector. There is some unease on both sides of the aisle about this type of program, but, nevertheless, these are the relatively broad areas that are being talked about under the Obama plan. There is no specific Obama plan. So it's a little bit, again, a little bit overly critical for the newspaper article yesterday to say there is no Republican plan. Well, there is no Republican House plan, but there is no Democratic House plan. In fact, there is no White House plan that is being talked about. The other thing the article said, there is no Republicans leading the charge. I would submit to you that I have been on the floor of this House an hour, at least 1 hour out of every month for the last 2\1/2\ years. As many people who suffer from insomnia who from time to time turn on C-SPAN, Mr. Speaker, will recall that I have talked on this subject, sometimes at painstaking length. And I would just say that there are a number of leaders on the Republican side in the arena of health care. It perhaps does not get the billing that the energy debate does, perhaps does not get the billing as the security debate, but, nevertheless, suffice it to say that there are good and engaged and energetic people on the Republican side who are working this area. One of the things that did concern me about the article is it points to findings from a Kaiser health tracking poll that said 58 percent of Americans lack confidence in the Republican Party to do the quote, unquote, right thing for health care. And that does concern me and that is why, when I put together the Health Caucus, I wanted to be sure that we included the communications arm of Members' offices because people do want to hear Republicans talk about health care. In fact, that's one of the things that comes out consistently in the polling. They do want us to talk more about health care. They want to hear our ideas. In fact, during the months of the Presidential campaign, from time to time I would be tasked to participate in a debate. Well, after the debate was over and both candidates' points were discussed, as things were winding down and the podiums were being taken away, invariably, invariably I would have a throng of people around me wanting to hear more. Is there really a way to do this without the government taking everything over? And I would submit to you that there is, and I would submit to you that we are closer now to achieving that state than we really ever have been at any time, certainly in my professional time, having practiced medicine for 25 years before I came to Congress some 6 or 7 years ago. Isn't it ironic that we are perched on the threshold of being able to provide more care at lower cost and better quality to more people under the existing system, and we are talking about doing things that might fundamentally disrupt the system. And I will tell you that's one of the very difficult things both sides have to wrestle with. You heard it repeatedly during the Presidential campaign. Both sides said if you like what you have got you can keep it. Of course they said that. Polling shows 65 to 68 percent of Americans are satisfied or very satisfied with their health care and do not want it to change. Yes, they are concerned about the number of people who are uninsured or underinsured. They want to see that segment of the population get some help, but they are also terribly concerned that, in the process of doing so, will undo what they have. And that is a great concern. Again, it's something that has to be borne in mind by both sides when they talk about doing anything to the health insurance market. When Republicans talk about we would like to see more people own their own insurance policies, some people are concerned because that might undo the employer-sponsored insurance that so many people like. When the Democrats talk about we want a robust option to compete with the private sector, people are legitimately concerned that there will be a crowd-out and drive-out of the private sector, and they, indeed, will lose what they have. The old adage is, if you like what you have got you can keep it right up until the time we take it away from you. Both sides have to be mindful of that concern. You know, in any case, we have got to continue to move forward in this debate, and it's important that we Republicans, my side of the aisle, continuously challenge and continuously try to penetrate the echo chamber that surrounds Capitol Hill and hear from Americans that are on the front lines of delivery of health care all over the country. At some point, both sides are going to unite behind a plan. Both sides maintain they want to unite behind a plan that actually will work, and both sides will be required to take their ideas to the American public. Now, certainly Democrats have an advantage. They have a huge size advantage here in the House of Representatives. My committee, the Committee on Energy and Commerce is no contest. The Democrats can pass anything they want with no Republican input. It is not necessary for us to even show up and vote most days because they are going to overwhelm us with their numbers in committee and subcommittee. The Rules Committee upstairs, a 9-4 ratio, Democrats to Republicans. We are not going to win any of the arguments in the Rules Committee. It is very possible that we will win no arguments here on the floor of the House. It's possible the Democrats can pass whatever they want. Where it is possible for Republicans to make a difference, and this is why it's so important that we be able to communicate these issues, is we can win this in a court of public opinion. And that is really where this battle is going to be fought, probably late this summer, but certainly into the fall. Now, a lot of people have asked me about the time line, what I see ahead as far as the time line for health care reform. We've heard 2 hours tonight on energy tax, cap-and-trade. We're going to do that in our committee before we do health care. Sometime before the end of next month, before the end of May, we will have that work done in our committee, or at least that is what the chairman has told us, and we'll clear the decks for health care in committee starting in June or July. I would submit to you, having watched then-President Clinton 15 years ago deliver his speech here on the floor of the House to a joint session of the House and Senate, and I think it was about the third week in September of 1993, and he gave a wonderful speech, had everyone in the room mesmerized. Go back and get the video of it and watch it. It was a wonderful speech. But it was about 3 months too late because they were already into an election time and, as a consequence, the ability to get a big concept like that through the Congress was severely compromised. By the end of September, first of October, a lot of Members here are thinking about their re-election. The House of Representatives has 2- year terms, remember. And we are about to finish our so-called off year. Our off-year lasts about 6 months, and it will be done by the middle of the summer. So the time window is real very, very narrow for getting a big concept like this through. Add to that the fact that we are going to do some major piece of legislation on climate change, energy, energy tax, whatever you want to call it. That will be a big push to get that done. And the President said in his speech last week that he is going to sign a major banking regulatory bill before the end of the year. Those are three very big things to get done. And that's a lot on the to-do list, and we're already halfway through April of this year. And we really haven't gotten the guts of any one of those bills to get to the House floor. So the window of opportunity may be closing faster than some people realize. Just briefly, today's forum, we had three great folks come and talk to us. We heard from Rick Scott, we heard from Greg Scandlen, we heard from Dr. Nicholas Gettas who is the chief medical officer at CIGNA, a family physician who gave a wonderful talk about how important it is to have things like care coordination; how important it is to have things like disease management to be able to manage the exponential increase in the rising cost of care. Rick Scott talked about a number of outpatient clinics that he runs in Florida and how he manages these clinics by absolute transparency. Everyone who comes in knows exactly what it's going to cost for any procedure that's done, and there is a cap. There is a limit on the amount that can be charged on any patient visit. And how about this: if you come in to see a doctor in the clinic, say, you've got a viral syndrome, a little cough, a little runny nose, scratchy throat; 3 days later you've taken the medicines they're giving you; not only are you not better, you're worse, you can come back in for a reevaluation, and according to Rick Scott, the patient would not be charged for that revisit within 3 days' time, if, indeed the patient felt that the treatment was--or they were not responding to the treatment that was recommended on the previous visit. So a very forward way of looking at things, both in the outpatient clinic sitting, by being very transparent about price, and with Dr. Gettas within CIGNA Health Care, found that by anticipating problems, covering problems early, taking care of problems early, they could significantly hold costs down. And both of these are different sides of the same coin. They both are what are called consumer-directed health care, where you engage and involve the consumer. You engage and involve the individual in the control of, as an active participant in their health care, and you tend to get the ability to lower cost without resulting in denying care and without pulling that ratchet that we love to pull, that reduces reimbursement to the physician and creates so much anxiety in our physician community across the country. So these were two very forward looking statements that we, three very forward looking bits of testimony that we heard today. And I would just encourage people who are interested in learning more about this, it's www.healthcaucus.org. Now, tomorrow morning, for the Member briefing, we're going to have Ramesh Ponnuru, who is the senior editor of the National Review, came to my attention because he wrote an article that appeared in the Dallas Morning News over the break, and he was also talking about ways we can increase affordability; very, very important concepts. He talked about, you know, some people are concerned about universal coverage. Other people are concerned with the desire to reduce costs. Turns out when you poll this, the people who have the desire to reduce costs are much more than those that desire universal coverage. People are concerned about flexibility and policy design and benefit design, and there ought to be ways that we can get around some of the State regulatory problems, the State regulatory burdens that cause insurance in some locations in the country to be priced so high that literally prices some people out of the market. Another concept that Mr. Ponnuru brought up was the ability to bring more people into, if you hold down costs, the ability to bring more people into a state of insurance coverage. In fact, Steve Parenti out of the University of Minneapolis did an economic study, which indicated that in excess of 20 million people could be brought into coverage simply by doing things that will hold the price of care down. What about individuals with pre-existing conditions? And this can be a terribly difficult, difficult problem to deal with. But, you know, we've got 34 States right now that are doing what are called assigned- risk or high-risk pools. Some are working better than others. We ought to look at those States, take the best practices from States that are working well and create at least a floor below which no State would go on learning from these best practices. To be sure, it is going to take some shared support from the insurance company that is providing the insurance, probably will have to be a cap on insurance premiums so that they will stay affordable. The State and the Federal Government are likely going to have to participate, depending upon income levels, but likely have to participate in that shared support. But it just goes to underscore that doing these three things, where we no longer discriminate against someone in the Tax Code, where we provide someone the ability to buy an affordable insurance policy in a reasonable fashion, and we take care of, or provide for contingencies for people that have pre-existing conditions, we've gone a long way towards solving a lot of these problems. And then, just like Dr. Gettas relayed this morning, add to that the care coordination, disease management, the electronic medical records, infection control, the kinds of things that you want to do because they're the right things to do and they provide better care at a lower price. Accountable care organizations are one of the things that I talked to Dr. Mark McClellan about. These are all ways of holding costs down. And you've actually got the nidus of an almost pretty workable health care plan just right there in the last 30 or 40 words that I spoke. So it's not terribly difficult to construct something. What's difficult is to construct something that more of us can agree on than disagree on, and that's certainly the challenge that is ahead of us. Certainly, the work done through the Health Caucus is going to continue. I did have an opportunity to go to Omaha last Friday and speak with doctors at Alegent Medical Center in Omaha, heard from them about a number of their concerns. You know, I'm from Texas and we passed a bill in 2003 dealing with medical liability, a bill that put caps on noneconomic damages. Other parts of the country, issues of medical liability are still front and center as far as doctors are concerned, and I did hear a little bit about that in Omaha, a lot of concern that if we really push things in the government-plan realm, that public option, if that's really what catches on, and that's what's going to be the model for reform, that the concern there is that in those settings there's very little incentive to hold down costs, and what we end up doing in these government plans, and we certainly do it in Medicaid and we certainly do it in Medicare. In fact, if we don't do something by the end of this year, doctors across the country are facing a 20 percent cut in Medicare reimbursements. We go through this type of machination all the time because one of the only leverages we have to pull to hold down costs is to decrease reimbursements to providers. I did hear from one gentleman in Omaha who felt that the way forward was going to be an individual mandate that required everyone to purchase health insurance. We need to be careful. Certainly, there are some States that have done that on an individual basis, and certainly we need to look at and learn from those States that have explored with mandates. We do get some information back that, yes, more people are covered but that, yes, costs have gone up. Insurance companies are only human. You tell them that, yes, now everybody is going to have to buy your product and, doggone it, wouldn't you know that the price just crept up a little bit. You do have to be careful about pricing products out of the range where people can afford them because, if you put an individual mandate out there and say you have to buy insurance or you're going to get a fine, some people will look at the cost differential and will say, ``You know what? The fine is cheaper than the insurance,'' and it never crosses their minds that actually the insurance is something of value that they need. They will just simply pay the fine, will pocket the extra cash and then will hope that they'll be able to get care if they do, indeed, ultimately get sick and need that care. So mandates, in my opinion, are something that we need to be extremely judicious of in our approach there. We just finished tax time. The IRS. There is no bigger and harsher mandate out there than what the Internal Revenue Service places on each and every American. We know that, if we earn above a certain level every year, we've got to file a tax return. We know, if we don't and if we don't pay our taxes, the retribution will be swift and it will be certain. Well, almost. I mean there are a few exceptions. Members of Congress and some members of the administration, perhaps, don't have to pay taxes, but for most Americans, we know that this mandate out there from the Internal Revenue Service exists and that the consequences are extremely unpleasant if we do not comply. What is the compliance rate with the IRS? What is the voluntary compliance rate with people who pay their income taxes? Well, it's about 85 percent. Right now, we have a voluntary system of insurance in this country. We don't have a mandate. What is our compliance rate? It's about 85 percent. So, before we go down the road of mandates and of putting yet more governmental control into people's lives, I think we ought to look at what the other options are. Well, the other options are keeping the product at an affordable price and to actually create programs that people want. When part D in Medicare was constructed a few years ago, it was done very, very carefully so that there were six protected classes of drugs that had to be covered, that had to be provided for anyone who wanted to provide a prescription drug benefit. Okay. There are six classes of drugs where you have to at least offer two choices in each of those six classes of drugs. Now, the original cost for the prescription drug benefit--I forget the number--is reported to be at $35 or $37 a month under the plan that was constructed by the Centers for Medicare and Medicaid Services; but with the competition by allowing many people to participate, in fact, we were criticized because there are too many plans out there, and it's hard to choose. There are some plans out there, but the price for that prescription drug coverage was down at about $24 or $25, easily $10 per month under what it would have been under the program designed by the Centers for Medicare and Medicaid Services, and those prices have held now over the past 3 years. It's not that there weren't some problems with the initial rollout, but by and large, 9 out of 10 seniors are satisfied with their prescription drug coverage, and over 9 out of 10 seniors have some type of credible drug coverage. So we have exceeded what we would have expected with voluntary coverage. We have exceeded those numbers, and the satisfaction rates are high. Well, maybe that's a model that we ought to look at. How was that so successful? It was so successful because we offered a lot of choice. It was so successful because there was competition between the companies that were involved. Yes, there were some significant parameters laid down. Dr. McClellan would not budge on the concept of the six protected classes of drugs. Now I don't remember all of them, but they dealt with anti-inflammatories and anticancer drugs. There were six classes that he said you had to offer, and each of those classes had to have at least two different offerings. You didn't need to offer everything within that class, but you had to have at least two choices for patients in that. Again, the result is a program that has gained wide acceptance and that has enjoyed significant popularity. So I would submit that that would be a better model to follow than the IRS model where we put a big, bad penalty out there if you don't comply, and we still see that 15 percent of the people are still willing to take their chances and stay away from the mandate. The city of Dallas, Texas, close to my home, has an individual mandate for car insurance, and they were having difficulty with compliance. People would just not purchase the car insurance. So now my understanding is, if you get a traffic ticket in the city of Dallas and you cannot provide proof of insurance, they'll tow your automobile. Well, you can't really do that in health care. It just leads to all kinds of bad news stories when you go and repossess people and lock them up for not having health care insurance. How are you going to enforce that individual mandate? We're going to have to ask ourselves: To what limits are we going to go? Is it going to be purely a monetary penalty? What are going to be the consequences of not providing that mandate? Remember back during the campaign, then candidate Obama talked about, if he became President, he would have a mandate to cover children--a noble concept to be sure, but nobody could really ever define what was a child as far as: Is that age 18, 19, 25, 30? I heard every one of those numbers during the course of the Presidential debate depending upon the audience that was hearing the information. Who is going to be responsible for a 23-year-old who had moved out of the home? Obviously, the parents are going to be looked to for the responsibility of a mandate for children if we're going to mandate children's insurance, but what about a 23-year-old who is on his own, perhaps off and not living with his parents any longer? Who is responsible for paying that insurance premium? Is it still the parents? Is it the parent's employer? Is it the child, himself, or the child's employer? No one could define it. It becomes very, very difficult, and there are lots of areas where corners can be cut. Unfortunately, it's in just the areas where those corners are cut where you typically get into the bad problems where someone finds himself without the coverage that he so desperately needs. When we look going forward at the very programs and plans that might be available, one of the things that concerns me greatly about the so- called ``public option plan''--and during the campaign this was always talked about--is that we will have insurance coverage for everyone who is uninsured today. Insurance coverage will be available that's just as good as a Member of Congress'. That's the Federal Employees Health Benefits Plan. Now, remember. There are a variety of products available under the Federal Employees Health Benefits Plan. I chose a Health Savings Account, which again saves the government money, but who's going to get to pick and choose which of those plans it is? Even with more on the low options side, we're still talking about a tremendous amount of money. How much money were we talking about putting into this? Well, in the President's own budget that he submitted to Congress, he said $650 billion is the down payment on health care. That's over a 10- year budgetary window, so that's about $65 billion a year. Is $65 billion a year going to pay for insurance in the Federal Employees Health Benefits Plan for 40 or 45 million uninsured individuals? I don't think so. It's not even going to be close. Steve Parente, the economist from the University of Minneapolis, estimated that cost to be somewhere north of $700 billion a year. The $60 billion a year actually buys you a slimmed-down Medicaid product. Now, many people have difficulty--different States do things differently, but Medicaid has--without the cross-subsidization from the private sector, Medicaid would have a very difficult time providing the coverage that we're required to provide. So I feel I'm at the end of my time. Obviously, it's not the end of this discussion. We'll be back to do this again many more times before the time is through. I yield back my time.

Mr. BURGESS

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

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to recognize Paul K. Harral for his service to the Fort Worth community throughout his career with the Fort Worth Star Telegram. After providing his expertise for nearly a quarter-century in almost every news department of the Star Telegram, Harral will retire at the end of April. Media is Harral's passion. Before joining the Star-Telegram family in 1986, Harral served the United Press International, Baptist Medical Center and Florida City Magazines Inc. In the Star-Telegram, his goal has always been to present the issues that are important to his community and keep citizens informed. Over the years, Harral served as Senior Editor of Metro news, Ombudsman, Editor of the editorial pages, Editor of zoning operations, and supervised the online department. Under his tenure in 1995, the Texas Associated Press Managing Editors (APME) recognized the weekend and daily commentary sections as best in the state. Madam Speaker, I am proud to recognize Paul K. Harral for his years of service to Fort Worth. His devotion serves as an example to those who had the privilege of working with him. Even though he is retiring, his contribution will be forever appreciated by the Fort Worth community. It is an honor to represent him as a member of the 26th district of Texas.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate Galilee Missionary Baptist Church on its 100th anniversary. Galilee Missionary Baptist Church was originally founded in 1909 near Sanger, Texas. In 1910, Church officials established a church for the community to worship in and a school where they could educate their children. Construction of a new church building began in the 1950s after the first building was not big enough to accommodate the growing number of members. Galilee Church takes pride in its service as an educational facility and a place for worship for its community. Many members have served in the United States armed forces. Others happily serve their communities through various leadership and service activities, participating as Sanger Sellabration Singers, Nursing Home Carolers, community Thanksgiving program volunteers, and more. Their Women's Mission Group frequently supports the community by opening their hands and hearts to the Denton State School, Annual School supply drive, African Orphans, Operation smile, Food Pantry and Chamber of Commerce Angel Tree Program. I am proud to recognize Galilee Missionary Baptist Church for their accomplishment of a century of service to their community. It is my privilege to represent the members of Galilee Missionary Baptist Church in the 26th district of Texas.

Mr. BURGESS

Mr. BURGESS. I can't help but notice this seems to be an all-Texas Joint Economic Committee on our side tonight. Ranking Member Brady is very good to allow me the time to speak in opposition to the budget resolution that's on the floor this evening. You know, I think back to the late 1980s in Texas and it was a tough, tough time. We had the savings and loan collapse, we were in the middle of our own recession, energy prices collapsed literally overnight, real estate that collateralized loans was suddenly worth near zero. Loans were being called. It was a true mark-to-market phenomenon. And what happened during that time? Well, you saw families tighten their belts. You saw businesses not expand, not borrow money, and they were dark days and they were tough times. And we lost some businesses, and people had to leave the area. But I don't recall at any point during that time anyone from the Federal Government coming down with a big bag of money and saying, gee, can we help you out of these tough times; can we perhaps buy you out of this recession in which you find yourself. No, what I recall the Federal Government sending me was the Resolution Trust Corporation that absorbed a bunch of assets and sold them off to foreign holdings, and it really wasn't all that helpful. In fact, if the Federal Government had shown up, I don't know that I would have welcomed their presence, but we got through that. Those dark days quickly gave way to sunshine and light and 25 years of expansion and growth in the North Texas area. In fact, it is only very recently where my part of North Texas has begun to feel the effects of the recession that has gripped the country for the last five quarters. Now, Ranking Member Brady talked about the fact that the budget deficit is going to grow by $8 trillion to $10 trillion over the next 3 years, and I would just simply ask rhetorically--and I will not yield time but I'm going to ask rhetorically--at what point over the next 3 years during the expansion of the deficit by $8 to $10 trillion do we begin to accept some responsibility on the other side and from the new administration? Surely, at some point over the next 3 years, this ceases to be a George Bush problem and becomes a Barack Obama problem. Surely, sometime over the next 3 years, this ceases to become a George Bush problem and becomes a Nancy Pelosi problem. But, Madam Chair, the American people don't want us to point fingers at each other, but they do appreciate facts, and let me share a few facts. Here is a graphic representation of the budget deficits for the last several years prior and on into 10 years into the future. The last year over which we had control over the appropriations process, the budget deficit was $160 billion. It was outlandish. In fact, we lost the majority because we were spending too much, and the budget deficit was $160 billion. And where do we find ourselves a little over 2 years later? As Ranking Member Brady pointed out, it's now 10 times that much. It is no accident that we're having this debate at midnight on April 2, so that the American people maybe won't notice what has happened because surely when they wake up in the morning and find out that this budget deficit has now increased 10 times since the beginning of fiscal year 2007, that they're going to have some serious questions. And, Madam Chair, I would also point out, that at this point when the budget deficit was so high under Republicans at $160 billion, we put $100 billion right before the end of that fiscal year into the gulf coast of Louisiana and Mississippi because of Katrina and Rita. We had to help a recovering Indonesia from the tsunami, and oh, yeah, we were still fighting two wars as Dr. Paul pointed out, and we had supplemental appropriations of $60 billion and $80 billion during that cycle as well. And that's why our budget deficit was so high at $160 billion. Well, we had a big hurricane last September, and we've given $12 billion to the good people of Galveston. That's a scandal in and of itself. Well, spending money to get out of a recession did not work in the 1930s. It certainly didn't work for Japan in the 1990s. And I certainly don't intend to be part of that today. We've heard some talk this evening about jobs and job creation. Well, what better way to continue a recession than to kill job creation, and that's exactly what this budget proposes to do by instituting what's going to be known as a cap-and-trade, or really, what we should honestly call a carbon tax. And what is that carbon tax going to do? It is going to be used to offset the expansion in health care in this country.

Mr. BURGESS. I thank the gentleman. Madam Chair, it is no accident that the cost of expansion of health care in this country at $1.2 trillion estimated by the Congressional Budget Office is almost exactly the amount of money that will be raised with this egregious carbon tax of $1.5 trillion. If you want to kill jobs, if you want to drive jobs overseas, tax energy. That's a proven way to do it, but I don't recommend it. I hope when the American people wake up tomorrow they can turn on a light without the feeling that when they turned that light on they just paid for their neighbor's health care.

Mr. BURGESS

Mr. BURGESS. I thank the gentleman for yielding. This bill is certainly a misplaced priority. Mr. Speaker, I lost both parents to tobacco-related illness. I know of the seriousness of this illness. I saw it virtually every day in the 25 years I practiced medicine. Tobacco is a scourge upon our society. It is for Congress to meet then. In the bill in front of us this evening, the Food and Drug Administration, a Federal agency that right now is essentially a beleaguered agency that cannot do what we require it to do with regulating food and drugs, is now going to be given a completely new mission. The mission of the Food and Drug Administration is to ensure that we have drugs that are safe and effective. Tobacco, when used as directed, kills 400,000 people a year. Tobacco certainly could be regarded as effective when used as directed, but it could never be regarded as safe. Last night, in the Rules Committee, I attempted to offer an amendment which would have allowed the Food and Drug Administration to at least require that a cigarette be manufactured that contains zero milligrams of nicotine. In fact, there is explicit language in the bill that prohibits the Food and Drug Administration from requiring a zero- milligram nicotine cigarette. Why is this important? Well, I told the Rules Committee last night that this was essentially the anti-hypocrisy amendment. If we were serious about what we were trying to do for public health, we would allow the Food and Drug Administration to eliminate nicotine in the cigarette because, after all, a tobacco cigarette is a drug-delivery device. Its sole purpose is to deliver nicotine to the user. In fact, if you do not have nicotine with its addictive powers, cigarette smoking is, itself, so unpleasant that no one would willingly smoke a cigarette. They do so to satisfy the addiction to nicotine. In some of Chairman Waxman's hearings that he did in the last decade, he had tobacco executives admit that they manipulated levels of nicotine. Why? Because the nicotine is required to addict a smoker so he will continue to smoke. Eliminate the nicotine, and you have eliminated the smoking as a habit. As a consequence, the enormous public health debt that we're piling up in treating smoking-related illnesses suddenly becomes a much more realistic figure. I, frankly, do not understand why we would have a bill on the floor to allow the Food and Drug Administration to regulate tobacco usage when we will not allow them to have the one tool that would actually do some good in this legislation, which is to allow the Food and Drug Administration to require a zero-milligram nicotine cigarette. In other words, we're going to allow nicotine to continue to be in cigarettes, allow the level to continue to be manipulated and continue to allow the youth of this country to be addicted to this pernicious habit. If we were really serious, if it weren't just the fact that we're addicted to tobacco money, we would allow the FDA the ability to exclude nicotine from cigarette products.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I am coming to the floor of the House tonight to talk about health care. We had the occasion this morning over in the Library of Congress to have the first forum from the Republican Health Policy Caucus. This will be the first of several that we will do over the coming months. Obviously, health care is going to be a subject that receives a lot of discussion and a lot of debate, as it should. It's an important topic, and it is going to occupy a great deal of Congressional attention. Let me just speak a little bit about the Caucus, and then I want to talk about the event that occurred this morning. The Congressional Health Caucus was founded at the beginning of this Congress, the 111th Congress, and it was formed with several purposes in mind. It is a caucus on the Republican side, it is to educate members and their staff on the issues surrounding health care policy, and certainly, Mr. Speaker, the purpose of the caucus is to equip those same members with the resources for fostering debate and, of course, ultimately serving the American people with the most effective policy. It is designed to help members and their staffs communicate effectively, and we do welcome debate. It is not a closed-end caucus. Certainly we welcome a variety of members. And perhaps one of the most important things that this caucus can do, this is an inclusive caucus. It does include members, is open to any member on the Republican side--I actually thought about the possibility of a bipartisan caucus but there wasn't much interest in that. But nevertheless, from our side of the aisle--and certainly we've had discussions with members of the other body as to whether they might be interested--but the idea is to have an inclusive discussion on the things surrounding health care reform. But perhaps one of the most important things that I envision--one of the most important roles that I envision for this caucus is to take the discussion beyond the Capitol, beyond Washington, beyond the Beltway, the Potomac and all of the accoutrements and all things that are Washingtonian and speak to those patients, those doctors, those nurses, those hospital administrators who are actually doing the work in the trenches day in and day out and are actually looking toward Washington and wondering just what it is that we're up to now because, of course, some of them have seen this before. And it caused a great deal of disruption within the medical community some 15 years ago. They didn't see much that changed that was positive. Perhaps we allowed HMOs to get a more greater foothold in many markets across the country after the failure of the plans of health care reform 15 years ago. So there is a great deal of interest but also a great deal of skepticism as people who work in the field--again, the doctors, the nurses, certainly the patients and their families, certainly the hospital administrators, people who work day in and day out delivering health care to our patients, our seniors, our youth, our families-- there is a great deal of skepticism about what they see going on in Washington right now. Well, in pursuit of those goals that I outlined, the events and resources provided by the caucus will be designed to prepare members to engage intelligently and effectively during this debate that we're going to see over the next several months and then beyond that. Whatever policies are arrived at or not arrived at, it will be the implementation of those policies, it will be the forward activity that occurs as a result of enactment of sweeping health care reform or the failure thereof. Remember back in 1993 and 1994 when the bills did not get out of the--the bills did not become law, what was the focus then of the United States Congress on health care going forward? What type of attention was paid? It will be the purpose of this caucus that regardless of what happens, whether reform is enacted or not, that we will not take our eyes off the ball, and we will continue to be vigilant for the sake of the American people. Now, Mr. Speaker, for reasons that I don't quite understand, I was invited down to the White House a couple of weeks ago to participate in the White House forum on health care reform, the White House Health Care Summit, and the President, in his remarks to us as the afternoon was concluding, was that it was his job to offer guideposts and guidelines, but principally he was there that day to try to find out what works. And to that end, I applaud the President for having an open mind and having a willingness to listen to a variety of points of view. And I intend to be a resource. I intend to help him find out what works. Yes, I have some ideas. They may not be mainstream Democratic ideas, but nevertheless, certainly they deserve some consideration. And many Members on both sides of the aisle have ideas, and we saw this very much in evidence in the break-out session that I attended. One of the concerns I had with going down to the White House that day--was I just another pretty face to be down at the White House? Had this reform bill, in fact, already been written, was it just basking up in the Speaker's office awaiting for the correct time to be visited here upon the House floor and then we would all vote on it--much as the children's health insurance program bill, the reauthorization for that bill, came forward in August of 2007? Well, is this bill already done? The President assured us it was not, that this would go through regular order, that he would look to the congressional committees and subcommittees to hold hearings to do the work to draft the legislation, to mark up the bills and do so under so- called regular order. So I take the President at his word that--in fact, we're having a number of hearings in my subcommittee on health in the Energy and Commerce Committee, and I welcome that because I think these are important discussions for us to have. But the American people also feel that Congress should do its work in the appropriate way and not just simply allow a bill to be crafted out of the public domain and arrive fully formed from the Speaker's office and come to the House floor. But the public expects us to have the debate, to have the discussion, to work on this bill in a bipartisan fashion. Congress, in undertaking this project, must focus on solutions and not politics, and that's going to be very difficult for some of us to do. And, in fact, the later it gets in the 2-year cycle that the House lives with, the more difficult it is to separate politics from solutions. But still, we need to rise above that and work on those solutions, long overdue solutions, and focus on what is good for the American people. We need to keep the idea of patients and not payments uppermost in our mind. Now, the membership in the Republican Health Care Caucus is open to all members of the House Republican conference and their staff. We will host regular briefings and forums for members and staff as well as providing timely resources. This was the first today, the first policy forum that the caucus will host, and we were very fortunate. We were joined by three wonderful panelists whose ideas were not necessarily in concert with mine. Some I agreed with, some I disagreed with, but it was food for thought and very thought provoking; and I certainly learned some things as a result of the conference that we held today. There will be a follow-up document that will be posted on the caucus Web site. It's actually a tab that can be accessed through my official congressional House Web site that's Burgess.House.Gov, and there is a health care caucus tab that's pretty easy to see when you first go to the page and, in fact, by clicking on that page, there is the opportunity to visit a--we simulcast this on the Web and the archive of that simulcast is now available on the Web site. In fact, we did--to show that we were well into the 21st century, we took some questions from the audience and we took some that were sent to us over the new media phenomenon known as Twitter. So people outside the Beltway were able to send in questions which could then be posted to the panel. And I think that made for, again, a pretty lively question-and-answer period after the presenters did their formal preparation. We left about half the time for question and answer and again, not all of it came from the audience--or the physical audience-- some came from the virtual audience that was watching on the web and sent their comments or questions in through the phenomenon known as Twitter. So we came together actually in response to President Obama's desire to learn about what works. And with our assurances from the majority party that they are willing to work with Republicans as long as we negotiate in good faith, okay, great, and we wanted to get some ideas on the table, and I think we accomplished that this morning. We had several questions that we put forth as we started the forum. We wanted to hear about what is being talked about as a so-called public health insurance option, the so-called government-run option, what the President's proposal for a government-run option could mean for health care in the future, what effect would this have on patients, what effect would this have on doctors, what effect would this have on the private market; and indeed, what effect would this have on those already-existing public programs such as Medicare, Medicaid, and SCHIP. We heard testimony relating to what is called a National Insurance Exchange, a so-called insurance connector that can bring people and insurance policies together, and what are the good things about an insurance connector and perhaps what are some of the drawbacks of an insurance connector. And we did hear discussion about what has been proposed as a national health board, a Federal-type of Federal Reserve board that would apply to health care and would this board have--how much power would it have, how much ability would it have to direct medical spending and medical decisions. All very important concepts that are all outlined or have been part of the discussion as far as what might be contained within the President's plan. Just off the subject for a moment. During the fall, I had an opportunity to hear about the President's plan in a variety of cities across the country in a series of debates that were held during the presidential election, and I got fairly familiar with what was being talked about on the other side as far as the concepts embraced by then- presidential candidate Barack Obama as far as what his ideas were for health care reform. It is interesting, now that we're out of the campaign and into the legislation part, some of the things that we heard a great deal about during the fall, we don't hear about so much any more. And in fact, some of the things that were vilified on the other side are now perhaps being embraced as ideas that are worthy of study and worthy of merit. Specifically, during the fall we heard a great deal about a mandate for children, all children should be covered. I never could get a definition of what is a child. Is that a person who is under the age of 18, 19, 25, or 30? And I heard all four ages mentioned at some point during the debates. Well, the mandate for children seems to have gotten lost in the translation. We expanded the State Children's Health Insurance Program in January. So I guess the assumption is that that box is checked and we have moved on to other things. The National Health Board received a lot of attention during the fall. It remains to be seen how big a role that will play in whatever legislation is going to be written, and certainly the concept of a public option was one that was out there and discussed at great length during the presidential debates of last fall. The public option plan, I can recall several statements that this would be a plan for people who right now lack health insurance, the so- called 40 or 45 million of individuals in this country who lack the benefit of health insurance, and that everyone should be given a plan just as good as a Member of Congress. So that would be the Federal employee health benefit plan option, which is a fairly expensive way to approach that. Now, faced with the reality of what are some very significant budget deficits stretching ahead of us before we even get to anything beyond the preliminary discussions of health care reform, perhaps that is going to be, of necessity, be scaled back just a little bit and perhaps that public option, that government option, is going to look more like Medicare or perhaps even more like Medicaid going further into the discussion. But it remains to be seen because that part of the story has not been written, but I bring it up because it's significant and it behooves people to pay attention to what those discussions are because it makes some difference. We have had multiple hearings, as I mentioned, in our Subcommittee on Health in the Committee on Energy and Commerce. We have multiple panels who will come and discuss various aspects of health care reform. We have Democratic witnesses. We have Republican witnesses. And out of perhaps somewhere between 10 and 15 witnesses that we have had come before our committee, I've only found one witness who would be willing to exchange their health insurance that they have today for a program such as Medicaid if that were to be the government-run option. Almost every other panelist who's come before us, whether it be Republican or Democrat who's presenting to the panel, has no interest in substituting their health insurance for a Medicaid-type program. Mr. Speaker, in fact, during the debate on the rule in Rules Committee leading up to the State Children's Health Insurance Program expansion, I offered an amendment in Rules Committee to allow Members of Congress the option for signing up for Medicaid as opposed to some of the other insurance products on the Federal Employee Health Benefits plan. Needless to say, that amendment was not adopted and received very little interest when I brought that up to the Rules Committee. But it brings up the point, if we're not willing as Members of Congress or the people who testify before our committees are not willing to take on a public option program, a government-run program like Medicaid for their health insurance, well, what does that say about what we are making available then to people who currently are covered under Medicaid and people who are currently uninsured who may be offered a government-run program if it is made to look very much like Medicaid looks today? I think we have a long way to go to fix some of those programs. Certainly, both Medicare and Medicaid have some significant problems. There are significant problems with finding providers. There's a significant problem that the funding for those programs falls far short of what it needs to be, and as a consequence, the private insurance in this country subsidizes or cross-subsidizes the Medicare and Medicaid programs to a significant degree, such that if you lost the option for private health insurance in this country it might be very very difficult indeed to pay for those public, government-run programs that are in place today. But I have gotten a little far afield. Let me bring it back to the things that we had before us in the forum this morning. We heard testimony on ways that our current system, public-private hybrid system, of insurance can be improved, and we heard about lessons from the States, lessons that we might look at very closely when we're formulating public policy. After all, in medicine we're always told you need to practice evidence-based medicine. You need to look at randomized clinical controlled, clinical trials before you make a decision about what to do. Well, if that's good for America's physicians and America's patients, might that not also be good for America's policy-makers? Should we not also ask ourselves what is the evidence for the best policy? In other words, can we practice evidence-based policy here in the House of Representatives, the same as we ask our physicians to practice evidence-based medicine? So, we are fortunate the States function as laboratories, as the Founding Fathers envisioned, and we did hear some testimony on lessons from the States. And then finally we heard about proposals for a consumer-driven, market-based approach to reform that really may hold out a great deal of promise as being the most affordable of all of the options that were out there. Our first presenter this morning was Dr. Karen Davis from the Commonwealth Fund, which is a private foundation that aims to promote a high-performing health care system that achieves better access, improves quality and greater efficiency. Dr. Davis has a Ph.D. from Rice University, the recipient of many accolades, the author of many books, and we were very, very fortunate that she was willing to come down from New York and participate in the forum this morning. Dr. Davis talked a good deal about some of the problems that we have in our current system, and she spent a good deal of time discussing payment reform as a component of health care reform. Payment reform might reflect a new concept. The Medical Payment Advisory Commission, MedPAC, has talked about a concept called bundling, where we don't actually pay for individual treatments but that we bundle these services, doctor, hospital, laboratory, and there is a payment for an episode of care rather than a doctor billing for the doctor services, the hospital billing for the hospital services, the laboratory billing for the laboratory services. So there's more of a global fee, if you will, but bundling is even perhaps one step more than a global fee. And one of the concepts embodied therein is that perhaps there would be a payment for an episode of care that would comprise a period for as long as a month, because some of the really difficult payment difficulties we get into, in Medicare in particular, result from patients who have to come back into the hospital after being released, and those rehospitalizations tend to be very expensive. And so this was a way to bring that type of expenditure under control. Another concept that was discussed was a concept called gain-sharing; that is, if a medical group, hospital and doctor group could devise a method of delivering care in a more economic way, that part of the savings that that doctor group and hospital was able to demonstrate, part of that savings then could be shared with the medical group, the hospital that was involved in that episode of care. These are concepts that are--they have been tried in some demonstration projects. To be sure, there's some difficulties. Emotionally, I have some difficulties when we talk about bundling a doctor's payment with a hospital payment. Quite honestly, doctors don't trust hospitals and hospitals don't trust doctors, so there are some barriers to overcome there. The concept of gain-sharing, certainly if we're going to ask physician friends to do things smarter, cheaper, faster, perhaps we can include them in whatever benefit accrues to the government, i.e., the Medicare system. Perhaps we can include them in the distributional aspects of that. Dr. Davis did talk some about the concept of a health care connector or an insurance exchange, the advantages there that you bring together the patient and the insurance policy. Particularly for someone who doesn't have employer-sponsored insurance, it can be a confusing array of products that are out there, particularly now if we're going to have a government-run option out there. A public plan, a public government- run plan out there, perhaps an insurance exchange may be a way to bring together the patient and the insurance company. So, to be sure, there's some people are skeptical of exchanges. The current experiment going on in the State of Massachusetts points out some of the benefits but also some of the pitfalls for insurance connectors and insurance exchanges. Part of the difficulty that has been discussed about is, is there an inherent conflict of interest having an umpire also play for the home team, and therein is the problem with the combination of a public, government-run plan and an insurance connector. The insurance exchange is going to set the rules by which coverage must be sold. It's going to set the rules as far as pricing is concerned, and oh, yes, it's also a competitor because the government-run option is going to also be part of that exchange. But nevertheless, all of these are ideas that are worthy of discussion because the concepts going forward, we need to have the discussion on these. We can't just accept them as good ideas because someone else thought of them, and it's a way out of our conundrum with the uninsured and it's a way perhaps to control costs, but certainly, these philosophies need to be fully vetted. We were then very fortunate to be joined by Dr. Merrill Matthews, who's the director for the Council of Affordable Health Insurance, and this is a Washington, DC-based research and advocacy organization promoting free market health insurance reform. Dr. Matthews earned his Ph.D. in philosophy and humanities from the University of Texas at Dallas. Now, Dr. Matthews had a very interesting discussion for us. He focused more on what was happening with the role of the States and brought to us current examples of six States that are doing things. Some are working well, some not so much, but nevertheless, the President did, in his charge to us as he finished up that day at the White House, he said, I want to learn from what works. And Dr. Matthews brought to our policy discussion this morning six examples of things that are going on in States around the country and how those might deliver to us ideas that may be worthy of study or ideas that perhaps deserve a great deal of scrutiny because they've already been tried somewhere and they're not working so well. The first State that Dr. Matthews mentioned was the State of Georgia. Georgia, of course, has a State income tax, and he highlighted the role of the tax system in providing for health care for the citizens of Georgia. A State tax credit for qualifying employers that offered health savings accounts and high deductible health plans was available. So an employer could get a tax credit off of their State income tax for offering a high deductible health plan or a health savings account, and for individuals, also, there was a State tax deductible for individuals purchasing health insurance, which begins to remove a little bit of the discrimination against an individual holding an insurance policy. But apparently, the preliminary results of Georgia are encouraging, and certainly that points the way to some discussion of some changes within our Federal tax code that may be more applicable to the national stage. The State of North Carolina really highlights the need and the benefits of having a robust safety net for patients who have a preexisting medical condition. This is always a great fear that people have, what if I lose my employer-sponsored health insurance, I can't keep up with the COBRA payments, I'm diagnosed with some serious illness in the meantime, and then I am thereafter uninsurable and will remain uninsured until I can get taken on a Federal program such as Medicaid or Medicare. North Carolina has now a program to deal with those individuals who, because of the condition of medical fragility, are uninsurable by really fine-tuning the State high-risk pools. This requires an assessment from the health plans that sell in the State. So each of the private entities are asked to contribute to the overall maintenance of this high-risk pool. To be sure, there is a sliding scale, Federal subsidy, State subsidy that can be made available, but it certainly shows with a little bit of planning and a little bit of willingness to work between the public and private sector that individuals with preexisting conditions do not need to be shut out of the health insurance system. There is a way, indeed, to provide insurance and bring people back into the fold. Dr. Matthews talked about the State of New Jersey and how New Jersey has some of the highest health insurance premiums because of various requirements on policies in New Jersey and how just across the State line in Pennsylvania the health insurance premiums are significantly lower. So, within the State of New Jersey, legislation has been introduced to allow individuals to purchase insurance in adjoining States, insurance that is under the control of the insurance commissioner in those States, that has been fully evaluated and vetted, but at the same time has relief from some of the mandates that drive the cost up so very high within that individual's home State. Certainly, this is a concept that is worth exploring. And it will be interesting to see if this legislation is indeed enacted in New Jersey and, if it is, how does it fare for allowing more people to use their own money to purchase insurance when the cost is not set arbitrarily so high that it is beyond their ability to pay. Dr. Matthews also talked a little bit about what's going on in the State of Florida. Florida also highlights the issue of cost. They have required from the insurance companies within the States to sell insurance to anyone--the so-called guarantee issue--but it does focus on catastrophic coverage that is the high-deductible, low-premium type of insurance. Again, it will be interesting to see if this does indeed bring more people into a condition of coverage and remove those individuals from the ranks of the uninsured. Tennessee had an example with TennCare where virtually everything was offered to everybody for almost nothing. It really put severe financial constraint upon the State. So the Governor has now outlined a new plan--it's called Cover Tenn, which is a much more limited benefits plan. The premium is $150, which is split three ways--the individual, the employer, and the State all paying a share. There is a significant focus on preventive care and routine screenings. Somewhat controversial, there is a benefit cap. Benefits are capped at $25,000 dollars, which may seem like this is not providing enough care but, in actuality, only four out of several thousand people covered under this program have actually hit that ceiling. Clearly, this is a work in progress and this will have to be monitored. But it certainly shows we always talk about we need more preventive care, we need more disease management, we need medical homes so those so-called low dollar-expenditures you can make in health care perhaps, perhaps can deliver a significant benefit and prevent some of the high expenditure situations that people encounter. Finally, Dr. Matthews talked about what's going on in the State of Arizona where a State initiative has been in place that sort of deals with the issue of personal freedom. You can choose to have insurance or you can choose not to. It is important. It is not forcing someone to pay something that they don't want or feel they don't need. Now that initiative was put forward in the Arizona legislature. The initiative failed. But it's likely to see some additional activity in the coming legislative session. So those were the ideas brought to us by Dr. Merrill Matthews, who is, again, from the Council for Affordable Health Insurance, and certainly showed how the States can function as laboratories in the concept of creating new ideas in the arena of health reform. Finally, we heard from Dr. Grace-Marie Turner, the president of the Galen Institute, a public policy organization that promotes an informed debate over free-market ideas for health reform. Perhaps one of the most impressive statistics that Grace-Marie Turner has brought to the discussion is the percentage increase--the cost increase for regular indemnity insurance, the cost increase for PPOs, the cost increase for Medicare and Medicaid has all been 6 to 7 percent a year, well ahead of inflation, and it is that cost driver that is pushing the affordability of insurance past the reach of many patients. With so-called consumer-directed health plans or consumer-directed options, high-deductible health plans, the actual rate of increase is 2\1/4\ percent. So about one-third of what it is for the public plans and the indemnity plans and the PPO plans. If indeed we want to find out what works and if indeed affordability is an issue, and I believe that it is because affordability is what is preventing many people from actually being able to afford or buy insurance, then why wouldn't we look at this type of data and why wouldn't we look at expanding, as Florida has done, as Arizona discussed doing, why wouldn't we look at expanding these so-called consumer-directed options that clearly the price goes up at a level much more in line with inflation and the consumer price index and not two to three times that level. So certainly Grace-Marie Turner brought some good ideas to the forefront. She did talk about there being a climate for innovation that is pervasive and the fact that everyone is talking about health care, everyone is talking about how do we reform and improve the system. So that climate for innovation is one that we should embrace and capture and utilize, not for political advantage, but for the advantage of, after all, the person who should be at the center of all of this is not an insurance executive, it's not the Secretary of Health and Human Services. The person at the center of all of this, ultimately, is the patient and their family. Now, Mr. Speaker, just to depart for a moment, I've spent a lifetime in health care and I know very well that you look at this vast machine that we call the American health care system and what is it that we produce, what is the widget that the American health care machine churns out at the other end? Well, the widget is the interaction that takes place between the doctor and the patient in the treatment room. It may very well be the operating room or the emergency room or the delivery room. But it is that fundamental action that occurs between doctor and patient. So when I think of things that deal with changing health care and how it's delivered in this country and how doctors are paid and how patients are cared for and how insurance companies are structured, you have to look at that fundamental interaction between the doctor and patient in the treatment room and does this change that we're talking about, does it bring value to that interaction or is it perhaps somehow injurious to that interaction. If it brings value then it really doesn't matter to me which side of the aisle the idea came from; it is one that is worthy of merit, it's worthy of study, it's one that perhaps is worthy of inclusion in whatever we eventually do in health care reform. On the contrary, if what we are proposing to do detracts from the level of value of that fundamental interaction between doctor and patient in the treatment room, then we have got to be very, very critical, very, very serious about how we look at that because, after all, if we devalue the interaction between the doctor and patient in the treatment room, ultimately we devalue the experience for the patient and ultimately we are causing more stress and more harm to the system. As we've talked about a number of things this evening and when Dr. Matthews was talking about his experience with the several States, I couldn't help but think of what has gone on in my own home State of Texas in the past 5 years since September of 2003, when the State passed what was then a very innovative, very forward leaning, extensive medical liability reform that really has been a game changer back home in Texas. When I ran for Congress in 2002, Texas was in the middle of a very serious medical liability crisis. We were losing medical liability insurers. They were leaving the State because the State's environment was so hostile. They were losing money so they left the State. We went from 17 insurers down to two in a very short period of time. I promise you--you don't get many competitive influences when you have only got two insurers out there writing medical liability insurance. Medical liability insurance was going up and up and up. Even for physicians who didn't have a claims history, just because you were practicing medicine in Texas, you were a significant risk to that insurance company. As a consequence, doctors all across the State saw their premiums go up, and some doctors simply could not find insurance at all, at any price. I talked to a number of doctors that year I was running in 2002 who had just simply left practice or never were able to start their practice and were just out of school and unable to set up their practice in their home State of Texas because the medical liability climate was so severe that insurers were not willing to write them insurance policies at any price. The whole trauma network in the Dallas-Fort Worth area was brought down by the fact that one of the neurosurgeons got his premium bill to re-up his medical liability premium, looked at the six-digit figure and said, That's it. I can't do it any more. I can't earn enough money to pay this bill, and I will have to leave the State. When that happened, about 50 percent of the neurosurgeons then were gone from the trauma system, the trauma network in north Texas, putting that trauma network in serious jeopardy. How were they going to provide neurosurgical services 7 days a week, 24 hours a day, when they had but one physician remaining to provide those services? So we were under extreme stress in the State of Texas in the fall of 2003. Then the State legislature passed a very forward leaning medical liability reform. It was a cap on noneconomic damages. It was a cap similar to the Medical Injury Compensation Reform Act of 1974, which has done such a good job in California, but perhaps modernized a little bit for the 21st century. The cap was trifurcated; that is, there was a $250,000 cap on the physician, a $250,000 cap on the hospital; and a second $250,000 cap on a secondary hospital or nursing home if one was involved. So an aggregate cap of $750,000 for pain and suffering. Actual damages, medical damages were not capped in any way. In fact, punitive damages, if gross negligence could be demonstrated, punitive damages were not capped. What this has done in the State of Texas has been nothing short of phenomenal. We have doctors coming to the State, a State that was losing doctors in 2002, is now seeing more and more doctors coming to the State. In fact, one of the bigger problems we have today is not the inability to find medical liability insurance; one of the bigger problems today is the State Board of Medical Examiners finds itself short-staffed and is having difficulty keeping up with the volume of applications for State licenses that are coming in from other States. As a consequence, Texas has gone from a situation where we were in fact getting into difficulty. We were in quite a fragile condition from the standpoint of providers. And now we find that that situation has been reversed. This is such a commonsense application of previous legislation, again, that was enacted out in California over 25 to 30 years ago, that now is working today in its modern iteration in the State of Texas. I've introduced a similar bill in Congress because I feel this is so important to be able to offer this same type of protection to other doctors in the country. There's no question that the concept of defensive medicine is a real one. When people look at the cost, escalating cost of medical care, one of the problems is that as a doctor you feel like you have got to do every test and every study so that if something goes wrong and you're called into court and that chart is put on the stand with you, that chart is going to be an A-plus and you've done every possible test right down the line and there can be no second-guessing. That's the onus, that's the burden that doctors practice with today in this medical liability climate. So the idea of being able to relieve some of that pressure from defensive medicine, it won't happen overnight. This will take a significant amount of time to reverse some of these work patterns and thought processes. But, as they say, the journey of a thousand miles starts with the first step. And this Texas legislation is a very, very good place to start. The legislation in fact saves money. As estimated by the Congressional Budget Office, it saves $3.8 billion, almost $4 billion over 5 years. I know that's not an enormous sum of money when you've got Congress writing a blank check for $787 billion in one weekend. I know a paltry little $5 billion doesn't look like much. But we are up in budget time and every little billion dollars adds up. So I have, with no thought to any personal aggrandizement, I have offered this concept to both sides in their budgetary process. I'm willing to give up my $5 billion to the cause. And I would like to see us seriously take on some type of meaningful medical liability reform. That brings up another issue. We've got 47 million people who are uninsured and we have got various proposals to bring more and more of those individuals into the ranks of the insured. You look at some of the graphs and people will talk about, ``well, we've got this plan, we've got that plan.'' And look how the number of the uninsured just drops precipitously. But, unfortunately, the other line on that graph that no one ever pays any attention to is the number of doctors out there who are capable and willing and able to see patients. That's a relatively stable number. So what is the essential effect of bringing many, many more people into the ranks of the insured if we haven't impacted the physician workforce at the same time. No question we are going to put additional stress on the system. Now I do work on issues dealing with the physician workforce because I think that is so important. In the Health Care Caucus that will be the subject of one of our future forums because I do feel this is so important. Certainly, at the end of the scale that deals with the young person getting out of college and contemplating a career in health care, cost--the barrier to entry right now--is a huge barrier to entry. No one wants to end up with 8 or 12 years of professional education with a loan repayment plan that is structured such that it's almost impossible to repay. We have got to pay attention to that. We have got to make more help available to those, the best and brightest of our young people who may be contemplating a career in health care. We passed a bill on the floor of this House just a couple of weeks ago that came through our Energy and Commerce Subcommittee on Health that dealt with the number of residencies out there for primary care physicians, pediatricians, OB/GYNs, family practice, internal medicine, general surgeons, the type of doctors that are going to be needed on the front lines of delivering care for generations to come. We are not making enough of them, and many communities just simply cannot attract a doctor. One of the things that we found in Texas, a study done by the Texas Medical Association, is that a lot of doctors, maybe it is because they don't have much imagination, but they tend to practice close to where they train. I am a very good example of that; I trained in Dallas and I practiced in Louisville, Texas, about 15 miles away. We tend not to go very far away from where it was that we took our training. As a consequence, if you can develop residencies in more communities where the actual need is high, those medically underserved areas, and you can develop residencies in those programs, pediatrics, general surgery, OB/GYN, family practice, internal medicine, if you can develop those residencies in hospitals or in those communities, you might be able to keep some of those physicians in the area, and that would be an innovative or a different way of trying to bring doctors or keep doctors in those communities. Now, there was a bill very similar to that that passed out of Energy and Commerce. It passed on the floor of the House here a couple of weeks ago. It is now over in the other body. We in fact passed it last year as well, and it made it over to the other body, but it didn't quite make it out of the other body. And it was late in the year and I understand that. It is certainly no criticism to our good friends in the other body. But this year we passed it relatively early in the 111th Congress. We want to give them plenty of time to scrutinize it, plenty of time for the guys down at Office of Management and Budget and the White House to scrutinize it. But ultimately I think they will see that this is a good program, and it is not an enormous program. The money that is going to be used for this will be a self- replenishing loan program, so that as the program matures the money will constantly be repaid. But it removes some of the barriers to entry for a hospital that right now is not offering a residency program in a medium-sized community, in a smaller community, perhaps a rural community that has got a hospital with sufficient clinical material that can be accredited by the American Council of Graduate Medical Education but at the same time right now does not have a residency. This can help eliminate one of the barriers to entry for that hospital being able to set up a residency program and, ultimately, can bring more physicians to those communities that right now are medically underserved, particularly in the primary care specialties. Then, finally, and I talk about this frequently, we are going to talk about it I suspect many times this week because of the ongoing budget debate. But a formula that is used to calculate physician reimbursement for patient services in the Medicare program, the so-called sustainable growth rate formula which has programmed into it payment cuts for physicians, reimbursement reductions for physicians for years to come is a significant onerous burden on our physician community, and we do need to correct that problem. We did a temporary fix in July of last year, about 9 months ago; it was an 18-month fix. It expires December 31 of this year. And Members of Congress who are not paying attention to this may find themselves very unpleasantly surprised when they go home sometime after the August recess and their physician community is up in arms because Congress hasn't done anything about this 20 percent reimbursement reduction that they are facing New Year's eve of this year. This is a problem that is barreling down the pike at us, and so far this year we haven't spent a great deal of time or energy dealing with that. Now, to the President's credit he talked about dealing with that in some way in the budget, and indeed there was a line item in the budget that the President put forward, but it didn't really solve the problem. It extended this cliff that we fall off of every 6 months, 12 months, or 18 months. It extended it out for 10 years, but the cliff will be every bit very in evidence and in fact all that steeper because it is a 10-year cliff as opposed to a 2-year cliff. We really need to fundamentally change that formula, pay doctors under what the Medicare Payment Advisory Commission has called the Medicare Economic Index. That is a cost of living adjustment for paying Medicare physicians that basically says if the cost of doing business increases, we are going to increase the amount of reimbursement. It is the same thing we do for hospitals, it is the same thing we do for drug companies, it is the same thing we do for HMOs. We ought to do the same thing for America's physicians; because if we don't, we are going to wake up some morning and find ourselves with an absolute lack of physicians that is going to be almost impossible to overcome, and then Congress will be left scrambling on how to fill that gap. Do we just simply ordain people as doctors and tell them to go to work? Do we open the borders and bring people and steal doctors from some other country? Who knows what the position of a future Congress might be. It is incumbent upon us to face that problem this year. It is important enough that we take care of it, that we not leave it for a future Congress, that we not postpone it 10 years, as was outlined in the President's budget. We just simply need to change this formula, and do it now. This is something that doctors are looking at the Congress and saying, well, you are talking about a public option government-run plan, you are talking about expanding Medicare, you are talking about all these things that you are going to do. But, Mister Member of Congress, when the only lever you have to pull to reduce cost is to restrain provider payments, that is going to make it pretty painful for those of us out here who are trying to earn a living taking care of your patients, the patients you asked us to take care of, the country's Medicare patients, arguably some of the most fragile and difficult patients to manage, and you are telling us you are going to cut our pay every year as far as the eye can see by 4 percent, 5 percent, 6 percent per year. This year, in fact, the aggregate will be a 20 percent reduction if we don't do something. Well, we have got to maintain our physician workforce, and those three areas, paying attention to the health profession scholarships, loans, and bringing that up into the 21st century, perhaps we can talk about additional tax benefits for people who are willing to go into the health professions, certainly looking at residency programs in areas that are currently in medically underserved areas with high-need specialties; and then finally fix, once and for all, this cockamamy idea of a sustainable growth rate formula which pays physicians under a formula that is clearly, clear unsustainable and it is unjust. Here is the secret about the sustainable growth rate formula. We talk about the fact, oh, it is so difficult to repeal because it costs so much. Guess what. That money that it supposedly costs is money that we have already spent. That is not money that is sitting in an earning account in some Federal T-bond somewhere. It is money we have already spent. It went out the door in 2001. We paid it out in 2005. Doctors were reimbursed that money in 2007. We just never accounted for it on the books. We sound like AIG. This is nuts. We have got to stop this. End the SGR formula. Be up front about it. If the Congressional Budget Office needs to be instructed through legislation to do directed scoring to wipe that debt off the books, and then going forward we play this game straight with our country's physicians, then that is what we have to do. I intend to be introducing a bill; I have done so every Congress that I have been here, and I intend to introduce a bill that will do just that, and I will be back on the floor to talk more about that when that time comes. We will hear some talk about mandates. When you hear the talk about the public option and mandates, you have got to ask yourself, what are we trying to do here? Now, with mandates you tell everyone that you have got to buy insurance. We either do it as an individual mandate or an employer mandate. Well, employers look at that as a tax that you are going to put on jobs for health insurance. And if we put a tax on jobs while we are trying to recover from a recession and we want jobs to be created and we are going to tax them, so the small business community will come to us and tell us: Don't put a tax on jobs with an employer mandate in health insurance. Now, an individual mandate says that everyone out there has the responsibility to have an insurance policy. The trouble with individual mandates is people don't always take them seriously. Look at the IRS, a pretty serious mandate, a pretty serious penalty if you don't comply. And what is our compliance rate with the IRS? About 85 percent. What is our compliance rate with voluntary health insurance right now? It is about 85 percent. So you don't get a lot of bang for your buck by putting in mandates. Now, mandates are great for insurance companies, because everyone has to have insurance so they like that. Everyone is going to buy their product. Yea, we all make money. Put a public option plan on the table, and then the insurance companies are not so happy because now that mandate may be satisfied by a public option. But now we are forcing our insurance companies to compete with insurance that we are putting on the table at the Federal Government. It is hard to compete with the Federal Government. We can write a check for any amount of money. We never go broke, we never run out of money, we just simply print more money when we need it. Well, the large health insurers in this country don't have that option. It is very, very difficult for them to compete with a government option or a government-run plan because they don't have the option of just simply printing more money when the time requires it. So we do have to be careful with how we institute, if that is the direction we are going to go. And certainly all through the campaign I heard President Candidate Obama say that, surely if you like what you have got, you are going to be able to keep it. Well, that is true, unless we run them all out of business, in which case it will be hard for you to keep what you have got in your employer-sponsored insurance, and the only option will be a public. Now, there are lots of moving parts to this debate. We are going to be back here frequently over the next several months. We are in the budgetary cycle now. As I understand, late in the night in the Budget Committee, the House Budget Committee, the House-passed budget did contain so-called language for reconciliation, which means that over on the Senate side they will only need 50 votes to pass whatever they want to pass. The way forward is set for almost any change the Democratic majority and the Democratic President want to make in health insurance. I hope they are going to make the right decisions. I take the President at his word that he wants to learn from what works. I think we have talked about some of those things this evening, what we have seen working as far as State plans are concerned, what we have seen working as far as the affordability concept in the consumer directed plans. Certainly we need to learn from what works as far as connectors, because we have a State, Massachusetts, that is currently using a connector, and we need to see what the effect has been on the cost and availability of insurance; and, are people in fact conforming with the individual mandate that the State of Massachusetts has imposed? If we look at all of these things in aggregate, we may not always make the right decision, but we will come closer to making that right decision than if we all just sit in a windowless room, as we all want to do here in the United States Congress. We love to do that down. We sit in a little windowless room down in the basement of the Capitol, we all talk about the things that matter to us. We never listen to anyone else's ideas. And is it any wonder that everything always looks the same when it comes out of the United States Congress? Let's do things differently this time. Let's listen to each other. Let's take the President at his word. Let's practice evidence-based policy, let's figure out what works, and then let's get on with it. Mr. Speaker, I yield back the balance of my time.

Mr. BURGESS

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

Mr. BURGESS

Mr. BURGESS. I thank the gentleman for yielding. Mr. Speaker, in January 2001, the Department of Labor, the Internal Revenue Service, and the Health Care Finance Administration issued a rule in accordance with the Health Insurance Portability and Accountability Act, better known as HIPAA, of 1996 that was designed to guard against discrimination in coverage in the group health market. While addressing the issue of discrimination based upon participation in certain activities, these rules allowed continued discrimination in the form of nonpayment based upon the source of the injury. So, in other words, you could have an employer-sponsored health insurance, which many of us do, have your premiums deducted from your paycheck, and yet be responsible for paying your own medical treatment if you were harmed. Trip and fall at home, no problem. Trip and fall while skiing on vacation with the family, and you get the bill. This is simply unfair. People are led to believe that care for a broken arm, for example, is the same regardless of how the injury happened, but in fact that is not the case. The lack of clarity underlying these exclusions has created a confusing situation for individuals that may ride motorcycles, horses, snowmobiles, or participate in other activities that could result in an injury. Millions of American enjoy these activities safely every year within the framework of State laws and utilizing proper safety precautions. The bill we are voting on today will take away the ambiguity and make certain that people are aware of any such restrictions in their coverage. Again, this is not a bill that would require anything new to be done other than people be told up front and in plain language if there are limitations on their health care policy. We are going to stand up and shine the light on these exclusions so that Americans will not be caught off guard by exclusions buried deep within an insurance plan. H.R. 1253, the Health Insurance Source of Injury Clarification Act, is identical to legislation passed by the House last session and will, first, require any limitations and restrictions on health plan benefits be explicit and clear; second, require that they be disclosed to the sponsor of the group health plan in advance of the sale; and, thirdly, require that the issuer in an easy-to-understand way provide participants and beneficiaries a description of the limitations and restrictions as soon as they enroll. For those who are concerned about the potential cost of the bill, I do have a score from the Congressional Budget Office. Their cost estimate is that H.R. 1253 would have no significant impact upon the Federal budget. Further, they go on to say that making the information more easily understood would generate only negligible cost. H.R. 1253 contains no intergovernmental mandates as defined. Mr. Speaker, I again want to thank Representative Bart Stupak from Michigan for his steadfast help in this bill. It has been a long process to get this passed. I certainly want to thank Chairman Waxman for his participation, and a special recognition to former Chairman John Dingell who helped us get this bill passed in the last Congress. We passed it late in the last Congress; the Senate did not get the work finished. We are passing it early in this Congress to allow the other body ample time to see this bill become law.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, pursuant to the U.S. House of Representatives Republican Leadership standards on earmarks, I am submitting the following information for publication in the Congressional Record regarding earmarks I received as part of H.R. 1105, the Omnibus Appropriations Act, 2009: (1.) Denton Regional Public Safety Training Facility, Denton, TX-- $500,000--Byrne Discretionary/COPS Technology--Congressman Michael C. Burgess The purpose of this project is to provide the new Denton Public Safety Training Facility with equipment and technology. The requested funding will help equip the facility, including fire simulation equipment, computerized firearm targeting systems, classroom-based virtual reality simulation equipment and administrative/classroom multimedia equipment. The total project cost is $19,260,000-$4,452,000 federal and $14,808,000 City of Denton. The City of Denton has paid $2.03 million for the 88-acre site of the facility, $205,000 on the master plan for the facility and the City Council has approved $12,600,000 to construct the facility. City of Denton is located at 215 East McKinney, Denton, TX 76201 (2.) Central City, Trinity River Water District--$6 million--MRT Construction--Congressman Michael C. Burgess The United States Army Corps of Engineers (USACE) is currently sponsoring a flood control project in the Central City area of Fort Worth, TX. The aging levee system in the Central City area is no longer adequate to provide protection to an 800 acre area adjacent to downtown Fort Worth. The infrastructure required for the flood control project is a 1.5 mile bypass channel (used to divert waters during a flood event) and related roads and bridges to span the channel. By providing flood control via a bypass channel, the aging industrial area adjacent to downtown can be revitalized into a vibrant waterfront community. The USACE recommended course of action, as set forth in the Final Environmental Impact Statement, combines solutions to flood control, transportation, environmental restoration and community redevelopment in an integrated, comprehensive plan with multiple partners (state, local and federal) collaborating on implementation and funding. Army Corps of Engineers, Fort Worth District, located at 819 Taylor Street Fort Worth, Texas 76102 (3.) Upper Trinity River Basin, (USACE)--$382,000--Investigations-- Congressman Michael C. Burgess The FY 2009 request would be used to complete the Big Fossil Creek Watershed Interim Feasibility Study and Regional Resource Inventory and initiate two new interim feasibility studies on the Irving Northwest Levee and Elm Fork of the Trinity River by developing existing conditions for ecologic, engineering, real estate, cultural, and hydrologic and hydraulic modeling. Army Corps of Engineers, Fort Worth District, located at 819 Taylor Street Fort Worth, Texas 76102 (4.) Grapevine Lake, USACE, Fort Worth District--$2.692 million-- O&M--Congressman Michael C. Burgess Grapevine Lake is located in Denton and Tarrant Counties, at river mile 11.7 on Denton Creek, Trinity River Basin, near the city of Grapevine. The funds in this project request would be used for scheduled operations and maintenance, including Murrell Park and Rockledge modernization, habitat restoration, repair erosion in downstream outlet channel and removal of vegetation. Army Corps of Engineers, Fort Worth District, located at 819 Taylor Street Fort Worth, Texas 76102 (5.) Lewisville Dam, USACE, Fort Worth District--$3.81 million--O&M-- Congressman Michael C. Burgess This project request and Congressional add is for infrastructure repairs. Non-routine maintenance includes repair and expand seepage collector system and repair gates, frames and liners. This project would also fund scheduled operations and maintenance activities. Army Corps of Engineers, Fort Worth District, located at 819 Taylor Street Fort Worth, Texas 76102 (6.) Ray Roberts Lake, USACE, Fort Worth District--$1.35 million-- O&M--Congressman Michael C. Burgess Ray Roberts is located in Denton, Cook and Grayson Counties, near the city of Denton, Texas. The project consists of an earth fill dam, a 100 foot uncontrolled spillway, and a 13 foot diameter gated conduit through the dam with two sluice gates. The proposed use of this funding would be for schedule operations and maintenance activities including repair service on gate, frames, and liners, repair and expand seepage collector system and maintenance of shoreline erosion control. Army Corps of Engineers, Fort Worth District, located at 819 Taylor Street Fort Worth, Texas 76102 (7.) Center for Advanced Science and Computer Assisted Modeling (CASCAM), University of North Texas--$700,304--Science--Congressman Michael C. Burgess CASCAM uses computing and modeling to conduct and predict advanced scientific laboratory outcomes at reduced cost (chemicals, time) and increased safety (reduces need to expose workers to toxic chemicals, radioactive materials). Scientific computing allows determination of the probability of whether or not two chemicals will explode, become a viable pharmaceutical, the next new nanomaterial, or tomorrow's new alternate fuel source. University of North Texas, located at 1500 Chestnut Street, Denton, TX 76203 (8.) Lewisville Lake, Frisco, Texas, USACE, Fort Worth District-- Section 1135--Congressman Michael C. Burgess FY 2009 funds would be used to execute the Project Cooperation Agreement and fully fund project design and implementation. The recommended plan consists of the reforestation of approximately 57 acres providing linkage among existing riparian and bottomland hardwood habitat and the construction of a series of wetland cells comprising a total of approximately 39 acres. The total project cost would be shared between the Federal Government and the city of Frisco. Army Corps of Engineers, Fort Worth District, located at 819 Taylor Street Fort Worth, Texas 76102 (9.) Alliance Airport Runway Extension--$1.75 million--Airport Improvement Program--Congressman Michael C. Burgess The Runway Extension Project at Alliance Airport in Denton County will lengthen the runways to 11,000 feet and will allow for greater utilization of the airfield and provide greater capacity as a reliever for DFW International Airport. It will also allow for the cargo carriers to safely maximize their loads and not have to compromise fuel, cargo or both. The increased growth of the airfield will provide many jobs and economic activity. The runway extension project has local, regional and national significance and impacts the infrastructure around the airport. In addition to the runway extension the project will open up the west side of the airport for more airside development and improve access to the Alliance Intermodal facility, which has already proven economic growth benefits to the entire North Texas area. With the advantages of a longer runway at Alliance the nation benefits from this premier intermodal industrial facility that can serve the world. Total Estimated Project Cost (2007 dollars) $216,161,603. Funding for the project has come from a variety of sources, primarily from FAA, AIP discretionary grants. City of Fort Worth matching funds have come from land credits valued at over $15 million. Other funding has been obtained for FM 156, specifically, a $6.5 million priority project in the 2005 Transportation Authorization (TEA-LU) bill and $5.1 in the 2006 Tarrant County Bond Fund. Alliance Airport, 2221 Alliance Boulevard, Suite 100, Fort Worth, TX 76177-4300 (10.) City of Denton, Denton Municipal Airport Improvements-- $570,000--Airport Improvement Program--Congressman Michael C. Burgess The Denton Municipal Airport plays an important role in the regional economy, serving as a general aviation hub for North Texas. The City of Denton and the Texas Department of Transportation, Aviation, have made substantial capital improvements in the Denton Airport in the past five years and as a result considerable private development is being realized at this field. The City is requesting discretionary funding for security enhancements at the Denton Airport. These improvements include security fencing and controlled access points to increase airport security and wildlife control. This project is recognized in the current Airport Master Plan. FAA personnel have identified the lack of security fencing as a weakness that needs to be addressed. The installation of the security fencing will further facilitate the current growth trend on the facility as more and more corporate aircraft operators will only utilize secured facilities. The total project cost is $1.1 million; the City of Denton will provide a local match of $110,000. City of Denton is located at 215 East McKinney, Denton, TX 76201 (11.) Denton County Transportation Authority (DCTA)--$475,000--Buses and Bus Facilities--Congressman Michael C. Burgess The DCTA is a county transportation authority, and their mission is to provide safe, customer-focused, and efficient mobility solutions for Denton County, which is a rapidly growing metropolitan area of North Texas. The funds will be used to purchase 16 low-emission replacement buses, as well as to purchase transit system security and resource protection technology and operations and maintenance facility equipment. All of these improvements are needed to enhance DCTA's bus transit service to meet current and future demands. This project is vitally important to meeting their goals to improve mobility and air quality, reduce congestion and enhance the safety, security, reliability and cost-effectiveness of public transportation in Denton County. The finance plan is to match all federal dollars with DCTA local funds on an 80-20 basis and to complete all purchases in FY 2009. Denton County Transportation Authority is located at 1660 S. Stemmons, Suite 250, Lewisville, TX 75067 (12.) Fort Worth Transportation Authority, Fleet Replacement and Expansions--$1.425 million--Buses and Bus Facilities--Congressman Michael C. Burgess The Fort Worth Transportation Authority (``The T'') is seeking federal funding to purchase 20 Compressed Natural Gas (CNG) coaches to replace the oldest vehicles in The T's fleet. Approximately 20,000 passengers travel on The T's bus system each weekday and they ride a fleet of vehicles that accumulate over 1 million revenue miles per year. Wear and tear on each bus is substantial which leads to the need for timely replacement to avoid service interruptions and increasing maintenance and repair costs. This bus replacement purchase is consistent with The T's plan for fleet upgrades. The buses purchased will be wheel chair accessible and fueled with clean-burning CNG. The buses will also be installed with cameras for improved passenger and driver security. The Fort Worth Transportation Authority is located at 1600 E Lancaster Ave., Fort Worth, TX 76102 (13.) City of Fort Worth, Interstate 35 Improvement Act--$1.8 million--Interstate Maintenance Discretionary--Congressman Michael C. Burgess This funding will provide for the design and environmental work of the initial phase of the improvement of this section of I-35W to provide congestion and air quality relief. I-35 impacts the transportation needs, both personal and commercial, of the entire central United States. The improvement and expansion of I-35W from downtown Fort Worth to its intersection with I-35E in Denton will serve to significantly enhance private and commercial access to the important central city renewal work of the Trinity River Vision project. The City of Fort Worth is located at 1000 Throckmorton Street, Fort Worth, TX 76102 (14.) Texas Wesleyan University, Fort Worth, TX--$142,000--Economic Development Initiatives--Congressman Michael C. Burgess This request is the second phase of the Rosedale Plan which calls for renovation and reconstruction of the historic Dillow House, long a part of Texas Wesleyan life through its history as classrooms, housing, offices, and an alumni center. The University will use this facility as the permanent house for its Business Incubation Center sponsored and supported by its School of Business, and also as a meeting place for alumni and community. Additional funding will be used for student housing to be built along Rosedale, which will provide much needed housing for students and their families. Funding will also be used to create green spaces that will provide parks for the community and the University. The University will create attractive fencing to help define the neighborhood borders and will provide security for this designated area through its on-campus security force. Texas Wesleyan University Rosedale Avenue Redevelopment Initiative 2009-2010

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I proudly rise today in memory of one of our nation's bravest and finest men who gave his life protecting our nation and its citizens. Corporal Peter J. Courcy, who served in Afghanistan as a part of the 4th Platoon, Company D, 2nd Battalion, 506th Infantry Regiment of the 101st Airborne Division, who made the ultimate sacrifice for his country on February 10th of 2009. Courcy, a graduate of Frisco High School, was known by others for his positive outlook on life. Serving his country in the military was a lifelong dream of his, which he fulfilled when he joined the Army in 2006. He had ambitions to become part of Army Special Forces. His commitment to his country was so strong that he was willing to endure the pain of being away from his family--including his wife and newborn son, who live in The Colony, Texas. Corporal Courcy was preparing to end his tour in Afghanistan and return home to see his family when he was killed. Corporal Courcy will forever remain in the hearts of his family, friends, and fellow soldiers. It is my honor to have represented Corporal Peter J. Courcy in the 26th District of Texas, and I extend my sincerest condolences to his family and friends. He will be deeply missed and the nation will be forever grateful for his honorable service.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to recognize Jeff Parks on the day of his graduation from the U.S. Marine Corps Officer Candidate School (OCS). Parks embodies the core values of Honor, Courage and Commitment that define a Marine. Jeff Parks is an officer who truly exemplifies his school motto, ``Ductus Exemplo'' (Leadership by Example). Parks served for nine years as an enlisted officer in the Marines--two tours in Iraq and two in Africa on humanitarian missions--and I would like to congratulate him on earning the privilege to lead Marines. I had the honor of having him work on my campaign, and I was impressed by his bold and noble goals and ambitions. He is a determined, hard-working individual, illustrated by the fact that he finished 2nd in his OCS class. Parks will continue with his training at The Basic School (TBS) at Quantico. Madam Speaker, I am proud to recognize Jeff Parks for his outstanding accomplishment. His determination is a source of motivation to others. It is my honor to represent him in the 26th district of Texas.