Michael Burgess

Mr. BURGESS

Mr. BURGESS. I yield myself the balance of my time. Madam Speaker, as the gentlelady mentioned, we've heard a lot today. I think I've said over and over again how I, unequivocally, oppose the Affordable Care Act and would like to see it forever dismantled and thrown on the dustbin of history. Guilty as charged. That is what I would like to see, but that's actually not what we're talking about today. We're here today to talk about the President's promise to help people with preexisting conditions obtain health insurance, and it has been one of the few areas of agreement between Republicans and Democrats over the last several years. House Republicans have urged the President to work with us on a solution to this issue, but all we've heard from the White House has been silence. So, today, we are offering a solution: The bill transfers funds from an unnecessary slush fund and, instead, prioritizes the Nation's most sick and vulnerable who have been denied coverage and who have been the victims of the Affordable Care Act's broken promises. This bill does not provide more money to government health care programs, but instead it helps those who are in desperate need have access to privately run health insurance. Instead of continuing to use the Prevention and Public Health Fund to prop up the Affordable Care Act's flailing exchanges, we would use the money allocated for public health to actually help sick Americans. If we do not act, the administration will continue to spend this money on heaven knows what: neutering programs, pickle ball--whatever the heck that is--and programs that are rife with potential for fraud and abuse to support their own failing implementation plans. Instead of further increasing this Nation's $17 trillion deficit, we can pass this bill that will provide health care to the sick and will reduce the deficit at the same time. In the end, it's not about the money. It's about America's patients. The President should be embarrassed. His political bait-and-switch is not working. Instead of putting the care of the sick first, you tell them, Sorry, Sister, we're closed. Come back in 10 months. Ten months, a week, a day may be the amount of time some of these patients have to get treatment or else face the consequences of the progression of their illnesses. America's doctors and hospitals will be there, and they'll always be there. But why deny them the means to get their services paid for with insurance coverage? Mr. President, your health bill fails this country, and, most importantly, you have failed the thousands of sick Americans who can't get health coverage because you think implementing the health care law is more important than taking care of the people who you promised to take care of. So today we can end the use of the slush fund and use it to actually help people. A vote for this bill is a vote to help sick Americans now. Madam Speaker, I urge my colleagues to support the rule and support the passage of H.R. 1549.

Mr. BURGESS. With that, Madam Speaker, I yield back the balance of my time, and I move the previous question on the resolution.

Mr. BURGESS. I yield myself 1 minute. Since the gentleman wasn't here in the spring of 2010 when the Affordable Care Act passed, he probably didn't hear the utterance of the then-Speaker of the House, Nancy Pelosi, who famously, from that chair, stood up and said, ``We've got to pass this law to find out what's in it.'' Here we are a little over 3 years later, and we're still finding out what's in it. Yes, the law is the law--the law has passed; the law is signed--but what has happened since that time is this torrent of regulations that has come out of the Department of Health and Human Services, the Department of the Treasury, the Office of Personnel Management--all of those Federal agencies charged with implementing this failed product. Now, we can argue all we want about settled law being settled law, but rulemaking is going on even as we speak. New rules are coming out. New rules are being promulgated. Look at the Essential Health Benefit Rule. Why did the administration hide the ball on that one until 2 days after election day? Because they were afraid of what the public's response would be when they saw what that rule actually said. It turns out that most of the Nation's Governors said, We don't want any part of this. I reserve the balance of my time.

Mr. BURGESS. Madam Speaker, I yield myself 1 minute. There's nothing that has been more damaging to job creation in this country than the first 2 years of the first Obama term. During that time, with vast majorities in both the House and the Senate, the anti- employment, the outright hostility to the productive sector of American society, was palpable. People responded to that in very predictable ways, so they hunkered down. And then you come throw the wet blanket of the Affordable Care Act. What did that do to job creation? It killed it in this country, and it is killing it today. If you want job creation in this country, you will provide some stability, some sanity, to allow those people who are still in that hunkered-down modality that they've been in since the first Obama administration was sworn in, allow them a chance for real economic recovery. That's why it's important to divert those funds from the Prevention and Public Health Fund, help those people with preexisting conditions, and, yes, we may get some sanity out of the administration on the implementation of the health care law if we do that. I reserve the balance of my time.

Mr. BURGESS. Madam Speaker, I yield myself 1 minute. It takes me back to when the Affordable Care Act passed this House and the tumultuous time in March of 2010. I had 18 amendments in the Rules Committee the night before that. The ranking member may remember that. None of those amendments were made in order. Look, if that's the yardstick by which we're going to measure, we've got a long way to go. But I need to respond to something that was said by the minority whip. He referenced the Appalachian train wreck. These are not my words. These are words that were used by a senior Democratic committee chairman about this bill. And then just today, breaking news, I'm handed an article from Politico, another senior Democrat, chairman of the Health Committee over on the Senate side, is putting a hold on the administrator for the Centers for Medicare & Medicaid Services nomination. And why is that hold being placed? An aide said that the Senator objected because CMS was using Prevention and Public Health Funds to pay for the health law implementation; the very reason we're here today. I reserve the balance of my time.

Mr. BURGESS. I yield myself 1 minute. I think it's important for Members of this body to understand one of the things we're talking about today. It's section 4002 of the Patient Protection and Affordable Care Act. In my copy, it's found on page 466. This delineates the outline of the Prevention and Public Health Fund. Section A: The purpose is to establish a Prevention and Public Health Fund. That all sounds good. It's to be administered through the Office of the Secretary to provide for the expanded and sustained national investment in the maintaining of public health. All good as it sounds. Then the funding section. The funding section is important because it's unlike other sections of law. Yes, it started small with literally a half billion dollars in fiscal year 2010. It escalated from there, and by next year, this fund will be up to $2 billion a year. That's self-replenishing in perpetuity. That's until the Earth cools another time or the Second Coming. It's $2 billion a year forever. Now, the use of the fund is the next section. That is telling because there is broad authority for the Secretary of Health and Human Services to transfer these dollars to other areas she wants. That is what leads to the problem. That is what leads to the difficulty with this section. I reserve the balance of my time.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, tomorrow on the floor of this House, we will consider H.R. 1549, the Helping Sick Americans Now Act. This bill is a win-win for our constituents. It's compassionate towards the most vulnerable. Unlike other parts of the Affordable Care Act, which only expand broken government-run programs, this program will provide private health insurance to sick Americans. The bill is fiscally responsible. It reduces the country's deficit while redirecting funds from a slush fund while the administration uses the Prevention and Public Health Fund money to prop up their train wreck of implementation for the Affordable Care Act. Conservatives actually want to use it to help sick Americans. This bill helps those with preexisting conditions that have no other options and provides a fiscally conservative policy that reduces the deficit. I urge Members of the House to support and pass H.R. 1549 when it's on the floor tomorrow.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I rise today to honor the life of Dr. George ``Doc'' Holladay. He was a dear friend of mine who will greatly be missed. He passed away earlier this month at the age of 78. Doc practiced medicine as an ophthalmologist for 26 years in Denton before retiring in 1993. After attending the Columbia Military Academy in Tennessee, Doc continued his education at the University of Tennessee and University of Texas Southwestern Medical School in Dallas. He then served in the U.S. Air Force during the Vietnam conflict as flight surgeon before opening his own practice. In 1964, Doc married his wife Shirley Lynn Brink. The two generously founded scholarships at four different universities, including The University of North Texas music program and the Southwestern Medical School Department of Ophthalmology. As a Sigma Chi, Doc also helped start the fraternity at UNT. Along with Doc's charitable contributions, he served on the Board of Directors for the Cumberland Children's Home, was a member of the Texas Medical Association, and became the president of the Denton School Board. He was a great contributor to the Republican Party of Denton County, and I am forever grateful for his unwavering support. Doc's continual commitment to Denton County and the state of Texas have successfully strengthened many communities, and I know he surely will be missed. I would like to extend my sincerest condolences to Doc's family and friends.

Mr. BURGESS

Mr. BURGESS. First, I do want to take a moment and join with so many of my colleagues who have just spoken on the floor in acknowledging the sacrifices that were made by first responders, people who ran toward the sound of the destruction this afternoon in Boston; and I certainly would recognize that even now, at this late hour, doctors and nurses are working in the emergency rooms in Boston to try to provide comfort to the afflicted and save life and limb for those who were damaged this afternoon, an act so astonishing in its cruelty, it is difficult to comprehend. Mr. Speaker, in 5\1/2\ short months from right now, October 1, 2013, the full effects of the Patient Protection and Affordable Care Act are going to start to be felt around the country. It's important that we take a few moments this evening and think about the road ahead, think about the things that are supposed to come online on October 1, and think about the contingencies if those things are not able to be accomplished. It was just a few weeks ago in this town when speaking to the American Health Insurance group, one of the information technologists from Health and Human Services talked about this informational hub that is supposed to be developed by the Department of Health and Human Services, this informational hub that will allow people to go online to sign up for their benefits under the Affordable Care Act. The comments of this individual were quite revealing. Speaking to an AHIP group earlier this year, he said: The time for debating about the size of the text on the screen or the color or whether it's a world-class user experience, that's what we used to talk about 2 years ago. Now let's just make sure it's not a Third World experience. That's a pretty sobering admission from someone who is charged with providing the information hub, the information technology, the computer architecture that is supposed to be the underpinnings of the Affordable Care Act. Bear in mind, it was 3 years ago, March of 2010, that the Affordable Care Act was signed into law. So 3 years later, billions of dollars spent in the implementation phase, and they're not sure if they can get this computer system up and running by October 1, which, by law, is when it is supposed to kick in. That is a pretty significant admission from the information architect at the Department of Health and Human Services. Now, when Barry Cohen, who is the head of the Center for Consumer Information and Insurance Oversight in the Department of Health and Human Services, was addressing the same group in response to a question, he was a little bit unclear as to whether or not they would be, in fact, ready on that October 1 deadline. He said: We'll have to wait. Then we'll be in a position to know which contingency plans we actually have to implement. In other words, we can't plan for the contingency until we get there and see that a contingency plan is necessary. But, after all, what are contingency plans but those plans that are put in place because something unexpected may happen? Last week, on the other side of the Capitol, in the other body, the Senator from West Virginia said: ObamaCare is so complicated, and if it isn't done right the first time, it will just simply get worse. That's a pretty startling pronouncement from someone who was, in fact, a pretty big cheerleader for the Affordable Care Act when it went through the Senate. He went on to say: I believe that the Affordable Care Act is probably the most complex piece of legislation ever passed by the United States Congress. Tax reform has obviously been huge, too, but up to this point, this--the Affordable Care Act--is just beyond comprehension. Now, what does the Secretary of the Department of Health and Human Services have to say about all of this? She maintains that the Affordable Care Act will lower the cost of premiums for everyone; but in fact, in the past couple of weeks, she has admitted: These folks will be moving into a really fully insured product for the first time, and so there may be a higher cost associated with getting into that market. Translation: you're going to be paying more. She goes on to say: Some men and some younger customers could see their rates increase. Women and older customers could see their rates drop. So, Mr. Speaker, I would submit that the coming rate shock is something for which people are actually unprepared. They have been told for 3 years that, after all, this is the Affordable Care Act, and it's going to make health care more affordable for all Americans; but the reality is somewhat different from the truth that is espoused by the Department of Health and Human Services. Let's think about some of these things for just a minute, because they are important. Remember when the Affordable Care Act was debated? Remember the President's discussing the Affordable Care Act? Everyone wanted to talk about patients with preexisting conditions: patients with preexisting conditions are frozen out of the system; patients with preexisting conditions can't get care. Well, they meant couldn't get insurance, because people can get care. Nevertheless, this was proposed as an enormous problem. The Affordable Care Act was going to fix it. How did the Affordable Care Act fix it? Next year, when the exchanges are up and running or when Medicaid is expanded, people, indeed, may be incorporated into that system. Until that day arrives, they were to be taken care of through what is known as the Preexisting Condition Insurance Program, or PCIP, which is the Federal preexisting risk pool that was set up for the first time under the Affordable Care Act. Five billion dollars was put forward to help people with preexisting conditions with their premiums. Now, there was a little bit of a barrier to entry. You had to be uninsured for 6 months' time before you would be eligible for coverage under the preexisting condition program. I've got to tell you, Mr. Speaker, I thought the Supreme Court was going to knock this thing out of the water. I thought there was no way in the world the highest court of the land could look at this thing and agree that it is constitutional under the Commerce Clause; that is, you can compel commerce in order to regulate it. I just knew that that day when the Supreme Court ruled that they would agree with me. In fact, they did; but then they went on to say that, in fact, since it's all a tax, Congress has the power to tax, and for that reason, it's not unconstitutional, and the law was allowed to stand. Leading up to that day that the Supreme Court made that pronouncement, I was so convinced that we as Members of Congress had an obligation to our constituents--to people who were, in fact, thinking that they were covered under the Affordable Care Act--to provide a contingency plan, particularly for those people who were covered under this new Federal preexisting condition insurance plan. Well, it turns out I wasn't right, and the law was constitutional. But what would have happened last June 30 if the Supreme Court had said that it was unconstitutional, and the whole thing was struck down? As a consequence, people who were in the preexisting condition program would have found themselves without insurance, and that would have been a pretty significant event to have occurred. I felt that we needed to have a contingency plan to cover those individuals. Now here we are some 6, 8 months later; and what happened in January of this year? The PCIP program ran out of money. It ran out of money at the end of January, and they said, We're not taking any more people into this program. We had a hearing a couple of weeks ago in the Committee on Energy and Commerce and heard from a patient who had thought she was in the queue, in that waiting period, to get into the Federal preexisting condition program except that they suspended enrollment at the end of January. You've got to believe that there were a lot of people who were in that 6-month waiting period who were waiting for their time to come up so that they could, in fact, enroll in this preexisting condition program; but as of the end of January, they were shut out. So the committee wrote a letter to the President that said, We'd like to help you here. There are probably other moneys in the Affordable Care Act that can be moved around and can continue to cover these individuals until January 1 of 2014 when the exchanges and the Medicaid expansion and all of the goodies prescribed in the Affordable Care Act can come on line. One of the things that we were told in leading up to the passage of the Affordable Care Act is that there were millions of people who fell into this preexisting condition trap. In fact, on the floor of the House, you heard people quote figures of 8 to 12 million people. The Speaker of the House at that time, Speaker Pelosi, said 125 million people had preexisting conditions. In fact, that was a little bit of a misnomer because, when you look at the people who are covered by insurance in this country, the vast majority is covered under what's called a ``large group plan,'' or what we know as ``employer-sponsored insurance.'' A preexisting condition exclusion can occur in that environment, but it's much, much rarer, and there are typically open enrollment periods in which a person can get taken on to his employer's insurance. Now, for 65 percent of the population, that's not the issue. Certainly, for people in the small group market and in the individual market, in the small group market and in the individual market, there was a problem. On the numbers that people quoted prior to the passage of the Affordable Care Act--8 million, 10 million, 12 million people--how many people were in the Federal preexisting condition program at the end of June when I worried that the Supreme Court was going to strike the whole thing down? There were 65,000 people and certainly every one of those individuals with a compelling story--and not a small population but a manageable population. If we are just talking about trying to correct a problem for 65,000 people in a country of 310 million, I would submit that we can do that without destroying the existing program, the employer- sponsored insurance, that people said they liked and wanted to keep. Remember, if you like what you have, you can keep it? Instead of taking care of a problem for a relatively finite but compelling population, the administration and, at the time, the congressional Democrats pushed through a bill of ``we just want to control everything about your health care.'' They got their wish, but now we had probably 100,000 people in January who were in the Federal preexisting condition program, and now no new people can sign up for it because it is going to run out of money. Mr. Speaker, I would submit that there is other money available in things like, we call them, ``slush funds'' that were built into the Affordable Care Act; things like the Medicare Modernization Act; things like the fund that is to allow for other activities in the Centers for Medicare & Medicaid Services. So, by just shifting some money around, these people who have preexisting conditions, in fact, could be taken care of, and we have the ability to do that. Really, it would be a relatively easy lift at this point, and perhaps next week we'll see legislation on the floor. Can you imagine if this had been a Republican President who had taken people off the Federal preexisting condition program? You would have heard about it from every newspaper in the country, and every television outlet in the country would have talked about it. How much did you hear? Well, you're probably hearing about it tonight for the first time. You'll hear about it a little bit more next week. People don't want to talk about the failures embedded in the Affordable Care Act, but it is important that we do so. Now, when this bill was passed into law, March of 2010, the then- Speaker of the House, Speaker Pelosi, claimed that the Affordable Care Act would create 4 million jobs, 400,000 jobs almost immediately. Well, that hasn't turned out to be exactly true, either. The Federal Reserve reported that employers are citing the uncertainty embedded in the Affordable Care Act as reasons for layoffs in companies and the reluctance to hire new employees. The application that was proposed by the Department of Health and Human Services for people to fill out to get coverage in the exchanges next year actually asks an applicant if their job is no longer offering health coverage in the next year. Clearly embedded in the Affordable Care Act was a risk to job creation in this country, and we're now seeing that actually come into being. The law does not treat everyone the same. It creates essentially a new underclass. It promises universal coverage, but it leaves some workers' families without coverage. Now, one of the most significant embedded problems in the Affordable Care Act is if an individual is working and their employer is providing them employer-sponsored insurance, that employer is required to do that; or if that employee looks for coverage in the exchange, that employer may be fined. But if the employer provides that employer-sponsored insurance, great. But he doesn't have to apply it, he doesn't have to provide that insurance to their family. This is a significant problem because that family, which right now may be covered, next year may not. But here's the other part of that. That family would not be eligible for a subsidy in the insurance exchange because the employer is providing the benefit to the employee, but there was nothing in the law that said they had to continue family coverage. So who is going to be affected, primarily women and children. A headline in the Fort Worth Star Telegram a few weeks ago, and the Fort Worth Star Telegram is generally supportive of the administration and generally supportive of the Affordable Care Act, but under their headline was, ``500,000 Children to Lose Health Benefits Under the Affordable Care Act.'' This was actually not through something that was revealed in the Department of Health and Human Services, but rather a rule that was proposed by the Department of the Treasury and the Internal Revenue Service. It turns out that children who lose insurance because the primary employee will be covered but the family will not, those children who lose insurance will not be fined by the IRS for not complying with the insurance mandate; but that is scant consolation for the fact that now they have no insurance and they have no reasonable way of achieving that because, after all, the cost for insurance is going to significantly increase under the Affordable Care Act. There is a 21-page application for Americans who feel that they should be covered under the Medicaid expansion. A 21-page application is pretty significant. It does ask some questions that you have to ask yourself, are they germane to someone who is applying for health insurance. But nevertheless, the application is out there. It's in the public domain, albeit it's a draft at this point. My hope is that the Department of Health and Human Services will refine that, but most of the 27- to 35-year-olds that I know are not going to spend a lot of time filling out a 21-page application. We were told in the run-up to the passage of this law that it would, in fact, pay down the deficit. It was $142 billion over 10 years, but it was supposed to reduce the deficit. Does anybody really believe that anymore? Of course not. And now the further evaluation of the costs and the expansive costs that are going to occur under the Affordable Care Act, probably an additional $1.5 trillion, at a conservative estimate, as to what this will add to the deficit over the next 10 years, and this is just for the subsidies and the exchanges and for the Medicaid expansion alone. Now, why does that matter? Mr. Speaker, it matters because in just a few short weeks, the statutory borrowing authority of the United States will be met or exceeded. And this Congress, this House, will once again be involved in another discussion about raising the debt limit. In July of 2011, we had this discussion. It was pretty acrimonious and attracted a lot of attention and a lot of publicity, none of it good. We're going to have that same fight occur again. A lot of people are concerned about the sequester. They say, we wish the sequester had never happened. But remember, the sequester was what the President proposed in order to get the expansion of the debt limit to a point where he would not have to deal with it again until after election day 2012. So the President got his wish. He said the sequester was good; it will allow us to get past this point and to move on. But now people are dealing with the aftermath. I would just ask you, what is the sequester going to look like in the summer of 2013, because the debt limit will not be just expanded to cover the obligations. There is going to have to be some spending discipline that goes along with that. I don't know what that will be. I'm not privy to those discussions, but will all the money that is promised to be there for the Medicaid expansion, for the subsidies in the exchange, will it in fact be there, or will that be exposed to some type of sequester-type device? I don't know the answer to that question, but those are questions in which this House will have to deal in literally a few short weeks' time. There has been significant tax policy that has gone into effect since the Affordable Care Act was passed. Just this year, five new taxes-- significant taxes--have occurred, as a result of the Affordable Care Act. There's a payroll tax that has increased almost 1 percent, 0.9 percent. A payroll tax for people who earn over $200,000 a year, joint filers of $250,000 a year, some people look at that and say we knew that Medicare was getting into trouble. Maybe that is a good thing that that payroll tax for Medicare has gone up. Well, it might be except the money doesn't stay in the Medicare trust fund. It's collected, and then it immediately goes into the general revenue in order to pay for or offset the cost of the subsidies that are going to exist in the insurance exchange. One of the more onerous taxes that was begun on January 1 was a 2.4 percent gross receipts tax on medical devices. Class II and class III medical devices as defined by the Food and Drug Administration are now subject to a 2.4 percent gross receipts tax. That's not a tax on profits; that's a tax on gross sales. It is significant. Sure, there are some big companies that will make due; but really it's the small entrepreneur who is developing medical devices, and this is happening all the time. Those individuals are the ones who are going to be particularly hard hit. And, as you can imagine, it may reduce some of that entrepreneurial activity or send it overseas. We already have a Food and Drug Administration that's sometimes difficult to deal with as far as getting things approved. Europe and Central Asia are not so difficult to deal with. And, hey, by the way, there's not that gross receipts tax. Perhaps we ought to move our manufacturing somewhere else. And, of course, the jobs go with the manufacturing. There's been a change in what are called flexible spending accounts. Flexible spending accounts are that money which you are able to designate at the beginning of every calendar year, and you can have pretax dollars that can be spent for recurrent medical expenses. This now has been capped at $2,500 a year. The amount was much higher previously; but under the Affordable Care Act, in order to offset some of the additional costs of the Affordable Care Act, they said we're going to cap those flexible spending account contributions to $2,500. That started this year. So if you've got a recurring medical expense that occurs every year, and think about someone with a family member who has a chronic medical condition or a family with a special needs child where they wanted to be able to set some dollars aside at the beginning of the year, not have them taxed so that they could pay for whatever it was that was going to be required, they are now capped at $2,500. People are going to very quickly find that amount is exceeded, and that they have been caught in this so-called FSA trap, or flexible spending account trap. For people who deduct medical expenses from their income tax, and as you know, currently for the last tax year for which we all just prepared our taxes and filed them this evening, there was a 7.5 percent exclusion from your adjusted gross income, that is, until your medical expenses equaled 7.5 percent of your adjusted gross income, you didn't get to deduct medical expenses from your tax. That amount has actually increased to 10 percent for next year. So people who were accustomed, people with a lot of medical expenses who were accustomed to keeping up with those receipts and then being able to deduct those medical expenses as they exceeded 7.5 percent of their adjusted gross income, they're now not going to be able to deduct those expenses until after 10 percent of their adjusted gross income. So who have we punished here? We have punished the families with special needs children. We have punished people with chronic medical conditions. We've basically gone after the sickest Americans to say you're going to pay a little bit more for what everyone else is going to receive in the Affordable Care Act. There is going to be a tax on insurance companies--I'm sorry--a tax on insurance policies that people will have to pay. This will go into a couple of different accounts, a couple of different funds, but the bottom line is it costs more every year to buy your insurance. And then, beginning in 2018, the so-called tax on Cadillac insurance plans kicks in. And who's this going to affect? Well, yes, it will affect higher-income earners who get a generous insurance policy. But it also affects union members whose insurance policies were part of their collective bargaining agreements over time, and those policies which now are going to be judged to be Cadillac plans will actually be taxed at a much higher rate starting in 2018. There was supposed to be an exchange set up for small business. It was called the SHOP Exchange, small business health policies. Twenty- nine times there were deadlines that were missed in setting up the SHOP exchanges. And now, just in the past couple of weeks, the Department of Health and Human Services said, it's pretty tough, pretty complicated. We don't know if we can do it or not, but we're giving ourselves another year. This won't happen until 2015. I think this is one of the things that really caused some of the consternation over in the Senate because in the other body this was one of the deals that they made in order to get the Affordable Care Act passed, in order to get it to the floor of the Senate in the fall of 2009. It is instructive for people to remember how this thing came to be in the first place. Now, in the summer of 2009, the committees of jurisdiction here in the House--Ways and Means, Energy and Commerce, Education and Labor--all debated a version of the House health care reform bill. Now, make no mistake about it. I think it was a crummy bill. H.R. 3200 was the number. It did go through the committee process. It was amended several times in the various House committees. From there it went to the Speaker's desk, where it was all kind of consolidated; all three committee products were kind of melded into one, and then it came to the floor of the House, doubled in size, during that 2- or 3-month hiatus, and was passed by the House of Representatives in the fall, in November of 2009. Not a single--well, one Republican vote, and the rest carried by Democrats. Thirty-five Democrats voted against it because of some of the problems contained within that legislation. But the important thing is, as bad as I think it is, it did go through the regular House process. We may have been curtailed in the number of amendments we could offer in committee. Our time for debate in committee may have been limited but, nevertheless, it did come through the committee process. Not so in the Senate. H.R. 3200 has never been seen or heard from again. It passed the House, went over to the Senate to await activity, and there it went, up into the ether somewhere. No one really knows what happened to it. But, wait a minute. There's a health care law that was signed by the President in March of 2010. How did the health care law come into being? Well, the House had passed another bill in July of 2009. It was H.R. 3590, dealt with housing. I think it passed the House with very few negative votes. But it was a housing bill. It went over to the Senate to await further activity, and that's the bill that was picked up by Senate leadership that was brought to the floor of the Senate and amended. The amendment read ``strike all after the enacting clause and insert,'' striking, of course, the language for the housing bill, which was the base bill, and inserting health care language, and that was the bill that the Senate passed late on Christmas Eve in 2009, right ahead of a big snowstorm that was coming to town. All the Senators wanted to get out so they passed this bill. Sixty votes. Not a single Republican vote. Passed with entirely Democratic votes. Now, under normal circumstances, H.R. 3590, which was now the Senate health care bill, and H.R. 3200, which was the House bill, would have gone to a conference committee. They would have worked rough edges out. They would have worked the differences out between the two bills, and a conference report would have come back to both Houses of Congress, the House and the Senate, and that would have been voted on, up or down. The problem was that, remember, it took 60 votes to pass it on the Senate side. Shortly after H.R. 3590 passed on the Senate side, a Democratic seat was lost. Scott Brown was elected from Massachusetts and, as a consequence, that 60th vote was no longer available to the Democratic leadership in the Senate. So what are they going to do? Well, they said that the House will just simply have to pass H.R. 3590. After all, it was a House bill that was passed already by the House in July of 2009, amended by the Senate, to become a health care bill. All that is required for it to become law is for the House to take a vote; will the House now concur with the Senate amendment to H.R. 3590. So many as in favor, say aye. If that is a simple majority, 218 votes here in the House of Representatives, if that is a simple majority, then that's the end of the discussion. The bill goes down the street to the White House for a signing ceremony, and that's exactly what happened. Now, it took 3 months to accomplish that, because no one here in the House thought H.R. 3590 was a very good legislative product. In fact, let's be honest, Mr. Speaker. It was a rough draft that had been produced by the Senate Finance Committee, the staff of the Senate Finance Committee, as a vehicle to get the Senate to conference with the House. They never expected for this thing to be signed into law. It was a vehicle to get to a conference to then sit down with the House, and let's work out these differences between the two of us, and then we'll get a conference committee product to come to the floor. But it didn't work out. As a consequence, the bill that was signed into law was one that was never intended to become law. It was a product produced by the staff of the Senate Finance Committee as a vehicle to get them out of town before Christmas Eve so that they could then get to the conference committee where the real work, the real work of writing this health care law would occur. The American people were cheated by this process, Mr. Speaker. And now, we're left to deal with the consequences. And what are the consequences? 500,000 children, according to the Fort Worth Star-Telegram, being taken off their parents' employer-sponsored insurance. People in the preexisting program who had been waiting patiently for their turn are now told, we're sorry, it's full up. No more space. You can't come in. It didn't have to be this way. There were good ideas on both sides that could have been taken into account. One of the fundamental questions I think we have to ask ourselves over and over again is where were the country's Governors when this bill was actually written. Well, of course it was written by the Senate Finance Committee staff, so the Governors were nowhere in the room. A lot of deals that were struck between some of the special interest groups and the White House were all done down at the White House in July of 2009. The Nation's governors weren't involved in that. Why were the Nation's governors so reluctant to accept the exchanges, the Medicaid expansion? Well, the answer, Mr. Speaker, is because they were dealt out of the process. And then, the rulemaking that started happening after the law was signed began to scare them, but a lot of the rules were held until after Election Day. The rule governing essential health benefits--what Governor in their right mind is going to sign on to an exchange program where they don't even know what they're going to be required to cover? They don't know how much money it is going to cost them? Well, it's no surprise that 26 States said no dice to the exchange. An additional six States said maybe we'll do a partnership, but you go ahead and set the program up through the Federal level first. And as consequence, the Office of Personnel Management is now required to set up exchanges for 26 States, plus six that might want partnership, and that's a tall order, which is why Gary Cohen said, I'm not sure we're going to need a contingency plan, but we can't know what contingency we have until we actually get there. I will submit there is going to be a need for a contingency plan. The sooner that the agencies admit that to the appropriate committees in the House and Senate, the sooner they can begin to work on a solution for a problem. Because, Mr. Speaker, let's face it. January 1 of 2014, there's going to be an emergency room, there's going to be an operating room, there's going to be a delivery room where a patient and doctor are going to come in contact with each other, and they don't need the uncertainty of what this legislation has dealt them. I thank the Speaker for the time this evening, and I yield back the balance of my time.

Mr. BURGESS. Mr. Speaker, I thank the House leadership for allowing me to utilize this hour to talk about some of the coming effects of the Affordable Care Act. The Boston Tragedy

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, today I rise to congratulate the city of Irving on the receipt of the 2012 Malcolm Baldrige National Quality Award. This award is the Nation's highest Presidential honor for performance excellence through innovation, improvement, and visionary leadership. Irving, Texas, is not just about lower tax rates and efficient government; the city of Irving prioritizes feedback from its citizens, achieving high levels of citizen satisfaction and producing almost $45 million in cost savings over the past 5 years. Through the implementation of the Lean Six Sigma program, the city of Irving, Texas, has lowered tax rates for its citizens, improved the quality of services, and maintained an efficient workforce. I congratulate the city of Irving on its receipt of this award, and I hope that the Federal Government in Washington, D.C., can learn from their example.

Mr. BURGESS

Mr. BURGESS. I thank the gentleman for his participation. Being as he's from Texas, I also feel compelled to add that that 0.1 percent growth, you subtract out the jobs created in Texas this year--somewhere between 200,000 and 300,000--we're in a recession without the State of Texas as a part of the Union. I know the gentleman is grateful for the service of the Governor and State legislature, as am I. They've done a great job in the State. I'd like to recognize another fellow physician, Dr. Gingrey, a member of the committee, outspoken leader on this issue, and one who never ceases to have great ideas on the right ways to do things if we are going to talk about health care and health care delivery in this country.

Mr. BURGESS. Well, if the gentleman will yield, Doctor, if I recall correctly, on the floor of this House we heard over and over again the problem with the cost of health care in this country is those people who are uninsured. Those free riders who won't bother to buy insurance, they show up at the emergency room. It is the highest delivery point cost. They're the ones that are driving up the cost of care. I heard this in the Supreme Court the second morning in the oral arguments. The Solicitor General made this very point. It's the free riders that are driving the cost up. Listening to you, it almost sounds as if patients for whom Medicaid is provided as the point of coverage, if there are no providers to provide that coverage, they do what they've always done. They go to the emergency room, the highest cost point for the access for care. How are we solving that problem by increasing that population?

Mr. BURGESS. If the gentleman would yield for a further question. Then where do those patients go for their care? You just said it, but I would love for you to repeat it.

Mr. BURGESS. If the gentleman actually will yield for a technical correction, I don't think it's necessary any longer for the Fed to print money. They created an electronic transaction. So no trees are harmed; no ink is wasted in the process of this activity.

Mr. BURGESS. I'm so glad that you came to the floor because you bring up an important point. I actually want to ask you a question on one of the things that you brought up. Many people forget that access to an insurance policy, access to a Federal program, is not the same as access to a physician or access to care. In other words, you can show up with a card, and if there's no office open that takes that card, you're about in the same shape you were before the card was produced. Is that not correct?

Mr. BURGESS. Well, I tried to get the word out there. The fact of the matter is, those of us who were here remember the summer of 2009. For most of us, it is indelibly etched on our memories because we went home that summer to our August town halls, and they were unlike anything anyone had ever seen. I went to Denton, Texas, the town where I grew up. Normally if I can get three dozen people there, the staff is high-fiving all around because we got the word out and we got a good turnout for the town hall. I had 2,000 people show up that morning. We weren't ready for 2,000 people. I had to move the entire event outside and stand under the August sun in Texas on a platform, on a riser with a handheld microphone and a little portable speaker because people wanted to be heard. They didn't want to hear from me. They didn't care what my ideas were. They wanted me to know what they thought. And they thought: do not do this, do not take a system that is arguably working for 60 to 70 percent of the country and destroy it, because then we will have nothing. So keep the system as it is working and don't trouble those waters because it's not necessary. But if you really have to do something, if you just have to do something, would you help us with cost, because we're concerned about cost. We see cost going up every year. We do wonder at some point if we will be priced out of the system. So they sent us back here at the end of the August recess with a very clear message: don't mess up the system that's working and help us with cost. So the President comes to the House of Representatives that September--many of you will remember that--and he was going to lecture us on why we needed to do his plan and his bill. I honestly thought when the President asked for time to come and address a joint session of the House and Senate here in the well of the House, I thought maybe he was going to say: Okay, I heard the American people, let's hit the pause button, let's hit the reset button, let's do something differently from what I've been talking about. But, no, we doubled down on it. He said: Let's go faster, we've got to get this done. And, again, it was because we have to have control over you, Mr. and Mrs. America, because otherwise we're afraid we'll never get it. Because, do not forget, at the time the President's chief of staff said: Do not let a good crisis go to waste. The country was in economic turmoil. We got a great crisis out there. Let's just take everyone's health care while we're at it, and then we will have that control established, and the people will never get it back once we've taken it. But the people told us: Don't mess up the system that works. And when you stop and look at it and you take a step back, you actually had a system of employer-sponsored insurance, whether you liked it or not, that was working arguably well. Polls showed that 65 to 67 percent of people said: Okay, this is what we've got, I like this, I can deal with it, I understand it, it's what I've always had. You also had people who did not have those large-group employer policies. They were the small-group market, the individual market. That's where we should have focused our energy. Those were the individuals who actually needed the most help. Those were the people who needed the protections in the marketplace that, perhaps, they lacked. The President made a big deal of 12 million to 18 million people in this country with preexisting conditions. How many people signed up to the Federal preexisting program right before the Supreme Court ruled on the Affordable Care Act? 65,000. That, as the gentlelady from Minnesota points out, was a manageable problem. That could have been dealt with in an afternoon. The best way to deal with it was to help those States that already had a preexisting program or reinsurance, help them fund those programs that they historically have had trouble funding. Those States that just cannot or will not do one, provide them an alternative stream to bring those patients into their Medicaid system, or even the system that's provided for State employees. But it was doable. Instead, we have a new Federal program that, guess what, today if you try to sign up because you've got a preexisting condition, you're turned away. They ran out of money. They didn't plan enough. So before the exchanges kick in January 1 for the next 8, 9, 10 months, those people are out in the cold, the very people that the President said he was setting out to protect. The population was small; it was manageable. It could have been handled without the Federal takeover of health care from everything in your pill box to your Band- Aid box. I see we've been joined by one of the outspoken leaders on this issue, the doctor from Tennessee, Dr. Roe. Dr. Roe, I appreciate your service in the Congress, and we're anxious to hear your thoughts on the third anniversary of, If You Like What You Have, You Can Keep It.

Mr. BURGESS. I thank the gentlelady from Minnesota for coming and participating. You have a way of saying these things that none of the rest of us are capable of, and your voice is an important one in this debate. Thank you for recognizing that there were alternatives and there were suggestions. There were ideas that were emanating from the Republican side of the aisle during this entire what passed for debate on the Affordable Care Act.

Mr. BURGESS. I thank the gentleman, the doctor from Maryland, for participating with us today. He used an interesting phrase. Now, instead of the trickle-down economics that Republicans have been criticized for for so many years, it looks like we've got bubble-up poverty that is coming from the Affordable Care Act, and its devastating effect on employers and employees across this country is certainly something I hear about every time I go home to the 26th District in north Texas. In fact, 2 weeks ago, I was on a panel in Irving, Texas, with a variety of business owners, hospitals, insurance interests. They were talking about the coming implementation of parts of the Affordable Care Act. We've heard all along from the people who run the small shops--the restaurants, the franchises--of the difficulty that this onerous bill is going to place upon their shoulders, but I was hearing from people that I had not heard from before--car painters, metal shop fabricators, those people who have those shops at between 40 and 60 employees, those who are above 50 employees who are looking for ways to reduce their workforces, and those below 50 employees who understand that they must never do so. The gentleman also brought up the ``49ers,'' the businesses that will not go above 49 employees. There are also the ``29ers,'' the employers who will not keep somebody on the payroll for longer than 29 hours lest it trigger all of the other requirements of them under the Affordable Care Act. Then you've got the employers on the other side of the question, the large employers, who are looking at a cost of providing health insurance for their employees, which is steadily going up in spite of the assurances of the President and of the Secretary of Health and Human Services. Those costs are going up every year. They're looking at those costs that are rising. They're looking at the fine under the employer mandate. Some are doing some simple math and are saying, I could save a lot of money--I mean a lot of money--by simply moving my employees off employer-sponsored insurance and into the health exchanges; and that, as a consequence, would balloon the cost for the Federal Government for delivering on this legislation. We do hear a lot about the effect on the economy. The doctor was right to touch on the effects on the health profession, itself; but there is virtually no aspect of American life that will be untouched by this legislation. Every man, woman, and child amongst us for the next three generations is going to be affected by, again, a law which became law as a result of the worst type of process. We are very fortunate now to be joined by another person who, for the time that she has been in Congress, since 2006, has been a leader on the dangers and the perils of letting your government control your health care; otherwise they can control every aspect of your life. I am happy to yield to the gentlelady from Minnesota (Mrs. Bachmann).

Mr. BURGESS. I thank the majority leader for allowing me to participate in this hour this afternoon. I may well be joined on the floor by some people who wish to speak on the very important occasion of the 3-year anniversary of the signing into law of the President's takeover of American health care, the so-called, inappropriately titled, Patient Protection and Affordable Care Act. I'd just point out that I did attempt to have the word ``affordable'' stricken from the title 3 years ago, but I was overruled in that endeavor. It was indeed 3 years ago, March 21, the first day of spring of 2010. The first 3 months of 2010 had seen some pretty unusual activity here in Washington as this bill ground to its eventual rendezvous with destiny in the east room of the White House on the 21st of that month. Many may recall that during the year of 2009, there was, in fact, at least what gave the semblance of some debate over here in the people's House, over here in the committees of the House of Representatives. But when this bill got over to the Senate, it was drastically changed, all debate was concluded, and then it was simply a matter of convincing enough Democrats to vote for the Senate bill, and it was eventually signed into law. I do want to spend some time going through the history of how we got here because I do feel that that is important and people need to understand how a very bad process, a very flawed process gave rise to a very flawed law, which now, 3 years later, we see right on the cusp of the full implementation of this thing, is really going to have a profound and detrimental effect on our country from the standpoint of our economy, our workforce and our job-creation situation with small businesses. Certainly the practice of medicine itself is going to be negatively impacted by the many pages of regulation that are now proceeding in a torrent from the Federal agencies since the President's reelection. First, I want to take a moment and recognize someone who has been a leader on trying to bring to the surface some of the problems contained within the President's Affordable Care Act, a fellow physician, an anesthesiologist from Maryland. I want to recognize the gentleman from Maryland for as much time as he may consume.

Mr. BURGESS. Yes.

Mr. BURGESS. As the gentleman also points out, no, members of the Physicians Caucus, the Doctors Caucus, were not frequently or ever consulted on this issue. But I know people--and I know, Mr. Speaker, I must refer my comments to you--who might just be casual observers of the conversation this morning and would say, Well, the two doctors are self-serving. Of course you want to be in charge, because that's the way you are. But the Governors have a big footprint in the delivery of health care in this country. Where were the Governors? Why were the Governors not down in the East Room of the White House? Why weren't the special interests, why wasn't Pharma, why weren't the insurance companies, why wasn't the Service Employees Industrial Union down at the White House making these decisions and not the Nation's Governors? That's one of the great mysteries that may never be answered, but it's a question the American people should ask themselves. Because in all 50 States in this country, the Governors have an enormous health care footprint. They're the ones that administer the State Medicaid programs. They administer the programs for their employees' health insurance. They have their State prison programs. They have an enormous interest in the cost of health care. The Governors should have been invited from the get-go. It is a travesty that they never were. It's political malpractice that the Governors were not involved in the development of this policy.

Mr. BURGESS. I thank the gentlelady for her comments. Where has the press been on this? Can you imagine if 500,000 children lost their health insurance under a Republican President? That would be the headline. We wouldn't hear anything else out of the press for a week. If people still showed up for the Federal preexisting program and the President said, ``No, no more, we're out of money,'' if it were a Republican President, that's all we'd hear about: the Republican President has prevented people from signing up to his own preexisting program that he started. People need to be aware of what is happening. These things have been insidious. It's been 3 years. There's been a lot of information. It's complicated. I don't understand it anyway. Why do I have to be involved? You have to be involved. As the gentlelady just said, it is going to affect you and your family. Every man, woman, and child in this country for the next three generations is going to be affected by this very bad bill. It was the worst of processes. This was a bill that came over here from the Senate. The House really never debated this thing. The House passed a bill, H.R. 3590, in July of 2009, but it was a housing bill. H.R. 3590 got over to the Senate. Harry Reid said, I need a bill number for my health care bill. Here's H.R. 3590. What does it do? Oh, housing. Strip all the language out. So he amended it: strike all after the enacting clause and insert. And what was inserted? The rest of the health care law. The Senate had to digest it and pass it in a few days' time right before Christmas Eve. A big snowstorm was bearing down on Washington. They all voted for it to get out of town--60 votes in the Senate. It passed. Nancy Pelosi said, What is this thing? It's garbage. I haven't got 100 votes for this over in the House. But over the next 3 months, they twisted enough arms and they broke enough knees that this thing finally got the votes 3 years ago yesterday, and 3 years ago today it was signed into law. It was signed into law to the detriment of the entire country. I thank the gentlelady for joining me. I thank all the other Members who are here. Mr. Speaker, I yield back the balance of my time.

Mr. BURGESS. Not only are you not getting health insurance, you're fined on top of it. You pay a fine, and you're still uninsured. At the end of the day, you're still uninsured.

Mr. BURGESS. I thank the gentleman for his participation. I'd like to point out that the continuing resolution just passed by this House a few moments ago to fund the government for the rest of the year actually contained an almost $1 billion reduction in the implementation fund. It also contained a $360 million reduction to the Department of Treasury for their implementation of their rules. So there were some serious blows dealt to the implementation side-- not by Republicans; this was a pretty bipartisan vote. I think it had 320 votes at the end of the voting period. But this reduction is seen, in a bipartisan fashion, as being important because the gentleman is right: the torrent of regulations that has come out since the President's reelection has been nothing short of just astounding. No wonder the Governors wouldn't participate. The administration hid the ball until Election Day, and then said, oh, now we're going to give you the rule for essential health benefits. In other words, they wouldn't tell the Governors what you are going to be required to cover, what you are going to be required to pay for. The Governors had no way of knowing until 2 days after Election Day. And then they said: You've got to be nuts; we're not going to sign up for that. So Health and Human Services said, okay, you've got another month. They said: You've got to be nuts; that's Christmas, Thanksgiving. Everybody's on vacation, nobody can evaluate it. So they gave them another month, and then they finally said time's up. So 26 States said we're not going to do an exchange. The Governors just flat refused. You wouldn't be honest with us about what was going to be required, so we're not playing ball with you. And that is the right decision for them to make. I applaud that decision. We're closing down on the final moments of the hour. I do want to point out to people this is not a filibuster; this is a regular activity of the House of Representatives. We can come to the floor and talk about a topic that the majority leader and the leadership allowed us the time to talk about--the 3-year anniversary of the signing of the Affordable Care Act. Who could ever forget the Vice President standing up and saying ``this is a big darn deal'' down at the White House, but--third anniversary of a big darn deal. The gentlelady from Minnesota is recognized for her comments.