John Garamendi

Mr. GARAMENDI

Mr. GARAMENDI. By the way, there are about a million and a half veterans out there that will be able to get medical insurance through the various programs that are created by this legislation. They presently are not in the Veterans Administration process for many, many reasons. They will have access to it. So on the whole, A, we have had time to read these bills; B, the corrections that are in the reconciliation process, which will be voted on along with the Senate bill, have been around for some time, for 72 hours minimum, and in many cases over 3 and 4 months. So read the bill.

Mr. GARAMENDI. I have the great privilege and honor of representing Travis Air Force Base and the more than 20,000 active service men and women on that base. Their mission is one of supplying the necessary equipment and armaments and food and other materials to men and women that are in the front zone of fighting. They also provide extraordinary support for humanitarian efforts, most recently those in Guam. And they may very well be heading to Chile on missions there. So I honor them and call our attention to their work. Again, I remain really saddened that my colleagues on the Republican side have used this time, and instead of honoring the work of our active duty men and women in the Armed Forces, they are using it to debate a bill of which there is plenty of time. Most recently the discussion about the availability. The Senate bill has been available to all of us since Christmas Eve. Three months to read the Senate bill. And that is a large portion of those documents that you have there on your table. The House bill has been available since November 6. So those two bills have been available to be read all that time. There are about 156 or 160 pages of corrections to the Senate bill that are before us. There are explanations, to be sure. And I suppose all of us would like to see the explanations from the committee. That has been available to us also. This was not done in the dark of night. This has been done over a long period of time. And that big stack of material before you has been available. And perhaps you have not had or taken the time to read it, but if you had, much of the misinformation that has been presented this evening you surely would not have put before this House because it simply is not reflected in the bill. Specifically, the issue of the veterans. The veterans are fully protected in the legislation. TRICARE is fully protected.

Mr. GARAMENDI

Mr. GARAMENDI. A moment ago, I asked, Madam Speaker, if we could focus on the issue before us, which is certainly a meritorious issue. But apparently our colleagues from the Republican Party want to debate health care so, okay, guys, let's debate health care. A moment ago, the speaker from wherever you were from spoke about somehow limiting the MRIs. You are absolutely right. The legislation does limit MRIs that are ordered by a doctor that owns the MRI machine. There is blatant fraud going on, and there's blatant overuse and payments by the taxpayers to the Medicare and Medicaid program as a result of physician-owned practices, pharmaceuticals, pharmacies, as well as the MRIs and hospitals, and this legislation does limit it. You're quite right. We must limit that kind of overuse. I've been at this a long time. I was the chairman of the health committee in California in the 1980s when we limited it. I was the insurance commissioner. I've seen these pernicious practices over and over. Announcement by the Speaker Pro Tempore

Mr. GARAMENDI. I grew up in the forties and fifties, and I remember the men and women that came back from the war, some gravely wounded, carrying those wounds the rest of their lives, and some having survived but survived behind enemy lines. This resolution honors those that fought in so many different ways, and particularly those behind enemy lines and were unable to really be recognized for the extraordinary contributions they made to the war effort. And it's perfectly appropriate. What is not appropriate is what our colleagues on the Republican side have done with this debate and with the previous debate. We're honoring our soldiers. We're honoring our men and women that have fought. We will soon be debating the health care issue, and in the appropriate time, we should be taking that up. But to somehow demean, to somehow demean the courage, the resolution, and the extraordinary sacrifice made by these people is just plain wrong. I would ask our colleagues to set it aside. In a few moments we will pick up the health care debate, and then I would be delighted to join you in that debate. But now let's focus on those who have served this country in time of war.

Mr. GARAMENDI

Mr. GARAMENDI. Nine years. Okay. We added that one here. Medicare Advantage, we talked about that. The bonus to the insurance companies is gone. And that money is not sent off to some other program, that savings stays in the Medicare program. Reduce senior premiums, improve access, expanded benefits, extend Medicare's fiscal--I did have it here. I just didn't read it. Here is the Medicare fiscal health. And finally, the issues you were talking about, prevention, organizing the care so we have continuity of care. I yield to the gentleman from Ohio.

Mr. GARAMENDI. So we add to the bill that the Medicare trust fund is made solvent for something either 7 to 9 years.

Mr. GARAMENDI. It's not on my list. Do you want to add to my list another benefit?

Mr. GARAMENDI. I really want to home in on what you are saying, but let me wrap up the senior part here if I might. Let's be very, very clear about the Medicare program. First of all, the AARP, American Association of Retired Persons, say that this legislation is going to lower costs and improve care for seniors. Secondly, it is in the bill, no benefit cuts. It is in the bill. Two hundred fifty dollars in the pocket of seniors who have got their medical prescriptions in the doughnut hole to help pay for that. And that is this year. Not 10 years from now, this year. Medicare part D doughnut hole is beginning to close. It is going to take time because it is expensive and it does take a lot of money, but it is going to close by 2018. And there will be significant drug discounts for seniors who use generic drugs this year, saving seniors, just as you said, millions of dollars out of their pocket. And that is not in the CBO score. I yield to the gentleman from New York.

Mr. GARAMENDI. Thank you very much, Representative Watson. It has been a joy to work with you these 35 years and work with you this evening. This is a historic moment. This is something you and I and many others have worked to try to provide health insurance for all Americans. Some 32 million Americans will receive health insurance as a result of this. There will be the incredible tax cuts for working men and women. For small businesses, they, too, will receive significant tax credits so that they can provide insurance for their employees. And there will be programs to promote wellness. There will be programs to create better information technology so that we don't have to waste money every time you present yourself with a different doctor. And you have the freedom to choose your own health insurance company, and your health insurance company no longer has their freedom to deny you benefits and coverage. There are serious insurance reforms in this. Finally, I just want to add, I have seen this sign so many times around the Capitol, so many times, and it says, ``We the people.'' Those are the first three words of the preamble of the United States Constitution. And it goes on to say, ``We the people of the United States, in order to form a more perfect union.'' That is what we're doing here. A more perfect union within our families so that we don't have to fear bankruptcy and the loss of health because we have no health insurance; a more perfect union in our communities so that everyone in our communities has health care and access to health insurance. It establishes justice. Thank you so very much.

Mr. GARAMENDI. Thank you, Representative Watson, for making it so personal to your district. The same savings are to be found in every one of our districts. We have different percentages of seniors in our districts, but the fact is that there are very, very significant savings in this. I want to take up one other issue that has been raised over and over again by the Republicans in the most disingenuous and I think rather dishonest way. And that is the reduction of some $500 billion over the 10 years in Medicare expenses. Now, where do those reductions come from? They would let us believe that those savings are from the reduction of benefits. That is not true. There is explicit language here that benefits will not be reduced. I will tell you where the money is going to come from. It is going to come out of the pockets of the insurance companies that have ripped the Federal Government off to a fare-thee-well for the last 6 years, ever since the George W. Bush administration created the Medicare Advantage program, which they did, incidentally, in reconciliation. It is abominable that this government has had to pay a bonus to the insurance companies to provide Medicare Advantage programs when in fact they said they could do it cheaper than the fee-for-service Medicare program. Sixteen percent bonus over and above the average cost of Medicare for seniors is given to the insurance company for no good reason. Those days, that bonus, that unintended and unnecessary profit is going to be over. Secondly, there is fraud and abuse in the Medicare system not from the seniors who are striving to get their benefits, but rather from purveyors, doctors, medical device people, and out and out fraudsters. We are going to be hiring. Some of those people that were talked about earlier from the IRS and the CMS, the Medicare office, those folks are going to be out there chasing after criminals that are ripping the Medicare system off to a fare-thee-well. That is where the reductions are coming from, from those two places. I yield to the gentleman from New York.

Mr. GARAMENDI. I might add that between now and 2018, some of us are going to be around here, and we are going to give the Federal Government the power to negotiate drug prices. We are not there today. It is one of the things that is missing in this legislation that I wish was in it. But it will happen. No longer will they be free from competition. I yield to the gentlewoman from California.

Mr. GARAMENDI. Thank you, Mr. Ryan. One of the things that we have heard all day is about Medicare cuts, somehow the Medicare system is going to be cut. I would like to get into that a little bit because this bill specifically helps Medicare. We have talked about the doughnut hole. This is the prescription drug benefit which, by the way, my Republican colleagues, which I guess are not here at the moment, when the prescription drug benefit part D was put in place, the Republicans controlled this House with the President and they never bothered to pay, never bothered to pay for that benefit. And so you want to know where the deficit came from? It came from there and it came from the two wars that the Bush administration started and didn't bother to pay for either, so we ran up the deficit. But here is the thing for seniors, to go back on my point here, is that the program provides very specific benefits to seniors. It provides $250 this year, a $250 additional benefit for seniors to pay for drugs. Those that fall into the doughnut hole, that doughnut hole begins to close this year, and in 5 years it is totally gone. In addition to that, it is explicit in this legislation that the Medicare benefits will not be reduced. I yield to Mr. Tonko.

Mr. GARAMENDI. Representative Tonko and Representative Ryan, both of you have spoken to the American economy in Youngstown and the effect that 30 years of recession has had on that town. One of the fundamental problems in the American economy is the extraordinary growth in the health care sector. This little chart here really explains why many parts of the American economy are not competitive. This little red line here is the growth in the percentage of the wealth of this Nation, the GDP, that is now in health care. We heard earlier one-sixth. Well, it is 16, almost 17, percent of the total wealth of the Nation that is tied up in health care. We are growing faster in this sector than any other sector of the American economy. Our competitors around the world are down in the 10-11 percent range. President Clinton, explaining this in a speech in California that I had the pleasure of attending, indicated that this gap here between the 16- 17 percent of the American economy that goes into health care versus the 10-11 percent that our competitors are spending is like giving a $80 billion a year gift to our competitors around the world. And so when the industries in the manufacturing of America go out, the car industry, other heavy industries go out to compete, they are saddled with this extraordinary additional cost because of the growth in the health care sector. The fact is the more inflation in the health care sector, the fewer people are insured. This is why we are seeing small businesses shedding health care, and why we see the extraordinary run up of the uninsured as the economy goes down. It is not just losing your job; it is the small businesses being unable to continue to purchase health care. One of the most important things that is going to happen in this legislation for small businesses is a specific tax reduction, a credit, of up to 35 percent in year one and then rising to 50 percent for every employee that they provide health care for. So it is an enormous benefit and incentive to provide the insurance, to maintain the insurance, and that is what is going to go on in the years ahead. So all of the talk about this bill being bad for business, it is simply not true. This is what is bad for business. There is serious cost containment in this legislation through a variety of ways. I yield to Mr. Ryan.

Mr. GARAMENDI. Representative Watson, thank you so very much. I am appalled and personally offended and I think all owe an apology to those Representatives who were demeaned, who were spat upon, who were cursed, and who were called the ugliest of names. It is totally unacceptable. I yield to Mr. Tonko.

Mr. GARAMENDI. I appreciate your passion on this no less than Mr. Ryan's.

Mr. GARAMENDI. We've got about 6 minutes left, so let's each take about 2 minutes. Mr. Tonko.

Mr. GARAMENDI. Thank you. We've discussed here the issue of bankruptcy, and I got a call from my daughter this afternoon. She said, Dad, thank God I'm a nurse and I have insurance. Matteo's arm, which was badly broken and required surgery, will probably be a $70,000 event. She said, If I didn't have insurance, we would have lost our house. That's the situation that's faced by every family. Thankfully this was not the situation that my daughter and grandson faced, but it is faced by tens of thousands, if not hundreds of thousands of Americans. And it's right here. The insurance companies dominate these markets. Lifetime benefits. She probably has already run through her lifetime benefit. That child is probably going to be uninsurable because he has a preexisting condition, a badly broken arm. Those days are over. I would like now to yield to my colleague from California, a magnificent Representative with whom I have worked with for more than 34 years. She was a California State senator and took over my position when I left the chairmanship at the California State Senate Health and Welfare Committee, Representative Watson.

Mr. GARAMENDI. It's interesting to observe the effect of that. This is Blue Cross of California. Two years ago, their profit was almost $300 million. The effect of those rate increases--the first rate increase, not the second one, but the first one which was around 50 percent--was to increase their profits to $2.3 billion, and now they want to add another about 30 percent average on top of that. So what will their profits be after all of that? It's shameful. What the legislation does is to reign in the excessive increases in the insurance companies' premiums. It does that by requiring that a higher percentage of their total premiums go to medical services. Now if you want, go check Wall Street, go on Charles Schwab, check the Wall Street thing. If you want to make an investment, they will say, Invest in the companies whose medical loss ratio is low and trending downward. That simply means that they're paying less for medical care and more for profit. We're going to turn that on its head. We're going to force the insurance companies to pay for medical services and less for profits.

Mr. GARAMENDI. And we should also remember in that competition model, we will be creating exchanges in which insurance companies will be there, they'll have to compete, and they'll compete on a standard policy. Let me now call on our colleague from Ohio (Mr. Ryan).

Mr. GARAMENDI

Mr. GARAMENDI. The gentleman could not be more correct. And those are very, very common. Along the same lines, we often consider America to be the country of entrepreneurs. We know the statistics are clear, the evidence is there, the polling has indicated that tens of thousands, perhaps even hundreds of thousands of Americans do not begin their own small businesses because they fear that they will be unable to get insurance. They don't want to leave the big corporate family. I know a specific fact of a fellow that worked at the university and wanted to start his own business. He and his wife wanted to start their own business for 10 years, and yet with small children and she with a preexisting condition, they did not do so. And so that entrepreneurial spirit was stifled by the insurance system we have in America. Under this legislation they will be able to get insurance, either directly with an insurance company or as soon as in this case the State of California develops its exchange, which is a pooling. You talked about this when you spoke earlier. And we really ought to have a better discussion and a more thorough discussion about the exchanges, which is a method of setting up a mechanism in which standard benefit insurance policies will be available from different companies, the information will be readily available, and the insurance companies will be forced to compete with each other on quality and price and availability. Those exchanges are an extremely important way to create competition and availability of insurance.

Mr. GARAMENDI. Green card or H-1B visa, et cetera. So if you are illegal, you don't qualify.

Mr. GARAMENDI. Let me get that straight. Qualified means that you are a citizen or you are legally in the country with the appropriate immigration papers.

Mr. GARAMENDI. Twenty-three million jobs were created during that period of time. Excuse me. Do you remember the statistics for the Bush, George W. Bush years?

Mr. GARAMENDI. Let's talk about that.

Mr. GARAMENDI. As you said at the outset, I was the insurance commissioner in California for 8 years, '91 to '95 and 2003 to 2007. I saw this problem over and over again, where corporations push aside, literally discriminate against people because they may be more expensive. A particular problem in the smaller companies, where the risk cannot be spread out. This piece of legislation provides an opportunity for those risks to be adjusted, to be smoothed out among all of the people that are insured, all of the companies, thereby reducing the incentive for companies to discriminate in their hiring, discriminate against people that have a sickness or who may become sick because they happen to be 50, 55 years of age. There is another thing in this legislation that is extremely important to every single qualified, to use your term earlier, qualified American, or qualified person in this country.