Phil Roe

Mr. ROE of Tennessee

Mr. ROE of Tennessee. I just spoke to a physician today from Massachusetts. He said what had happened there, and what's not clearly understood by the public--unless you're in this line of work you don't--is how the payers pay. Medicaid, for instance, pays about 60 percent of the cost of actually providing the care. Let's say private insurance is a 1. Medicare would pay about 90 percent. The people they added in Massachusetts paid about the same as Medicaid. What happened was big insurers, big corporations with lots of employees could negotiate a really good price, but small business could not. So when the hospital had bills to pay, they shifted those costs to private business, forcing their premiums up and up and up and up. That's why you are seeing those premiums for small business escalate until you really force them out of business. We talk about the exchange, and what absolutely frustrates me is that, on the 1st of October--and this is a person who works in Congress, who is a doctor who understands health care--I can't even tell the people who work for me here in the Washington office and in my office back in the district in Tennessee what their health care premiums are going to be or how they're going to get their health insurance coverage, and that is 90 days from now I can't tell them. You can imagine what other businesses are going through. I can tell them this: that I bet it's going to cost them a lot more money.

Mr. ROE of Tennessee. And they do not. They should get the same care and deserve the same care that anyone else has. Maybe the President when he said, I'll go over this bill line by line with anybody who wants to, maybe he should have taken that up with us and gone over it with the Doctors' Caucus line by line, because we came here in a totally nonpartisan way. Health care should not be a partisan issue. Dr. Bucshon has taken care of numerous cardiac patients with heart attacks. He doesn't know whether they're Republicans or Democrats. He could care less. They are just patients who need care. I yield back to the gentleman.

Mr. ROE of Tennessee. Will the gentleman yield?

Mr. ROE of Tennessee. I've always thought this: Why do our lower- income patients deserve different care than somebody else? They don't.

Mr. ROE of Tennessee. I thank the gentleman. Mr. Speaker, I would now like to take the opportunity to yield to my good friend from Indiana, a cardiothoracic surgeon, Dr. Larry Bucshon.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Mr. Speaker, I stand today to express my horror at the accusations made in the trial of Kermit Gosnell, an abortionist in Pennsylvania. If these charges are true, they're horrific. Let me speak from my heart. I am an OB/GYN physician who has delivered almost 5,000 babies. In my heart of hearts, I cannot imagine what must have gone on in the guise of health care in that abortionist clinic. It is physically nauseating for me to think about what this doctor did. Life is a precious miracle, and the children who lost their lives in Philadelphia were blessed with this miracle only to have it so cruelly ripped away from them. Regardless of whether one is pro-life or pro- abortion, we should all agree that these children deserved a chance at life. This country carries a responsibility and duty to protect those who do not have a voice, including the unborn children of America that represent our greatest silent minority. They're the most innocent among us and deserve the protections we afford to all other people in this great country. One of government's most important duties is to protect the most vulnerable among us. I pledge to continue to remember and to strive toward this. If found guilty, I expect the full weight of the law to be used to punish the accused. I simply will finish by saying, as a reminder to all of us, what a precious gift of life our children are.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Mr. Speaker, I rise today in strong support of H.R. 1120, the Preventing Greater Uncertainty in Labor-Management Relations Act. First, some history. The National Labor Relations Act was passed in the mid-thirties, and the National Labor Relations Board of five members--three from the majority party and two of the minority party-- are to act as a fair arbiter. Basically, the referee for disputes. And there was a ruling of the Supreme Court not long ago with regard to New Process Steel that said that two members--one Democrat and one Republican--both who agreed on over 600 decisions, that a quorum was not present and all of those decisions had to be thrown out. Therein calls the question. The President made a pro forma recess appointment. Presidents, as has been stated here many times, have made recess appointments to various boards and they had the constitutional right to do that; but no President has ever made a recess appointment during a pro forma session. Let me read here from the Senate Congressional Record of November 16, 2007. This is Leader Reid: Mr. President, the Senate will be coming in for pro forma sessions during the Thanksgiving holiday to prevent recess appointments. The recent ruling of Noel Canning stated that the appointments were unconstitutional. The unique part of the National Labor Relations Board is that any other court circuit ruling in the country can be appealed to the D.C. circuit. So they have standing, and the standing says that the aggrieved party can do one of two things: they can ask for a vote of the entire court or they can appeal it to the Supreme Court. This is a very simple bill. It does several things, and it asks the following: One, that the Supreme Court rule; Two, that the President go ahead and make the appointments; Three, that the Board not issue any further rulings that may be overturned and create this uncertainty; and that once a board is approved, that it goes back and reviews all of the various rulings that have been made in order to get rid of this uncertainty. We need the certainty for both labor and management to move forward. It's a very confusing time, and I would ask for the support of this bill.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. One of the things I noticed with our Democratic Governor, Phil Bredesen, who is a health care specialist and was the Governor of our State of Tennessee 8 years during the 2000s, the Obama administration would have been well-served to pay attention to Governor Bredesen, because Governor Bredesen was forced with a situation where he had to balance a budget. The health care costs were eating up this budget, and he had to cut the rolls. That's how the Governor elected to take care of this. After they cut the providers until there weren't any providing, he then had to cut the rolls from the TennCare program. That was very painful and hard to do. And I would certainly warn Governors out there, when you massively expand these rolls, let me tell you, politically that was very difficult for the legislature and for our Democratic Governor. My hats are off to him for the decisions he had to make. Those were not easy for him to make. And you're absolutely right, the Governors are really the thought processes and the experiments in the local governments and State governments that you can actually do something and see whether it works instead of this massive mess that we have. I just got a schematic of this yesterday. It's a 21-page--and I should have brought it down here on the House floor--schematic about trying to figure out whether you qualify for health insurance. Let me tell you how it was when I hired somebody in my office. When I hired a new employee, guess what I did? They came in said, Dr. Roe, do you have health insurance? I said, Yes, we provide health insurance; go sign up on the way out. It took 5 minutes. This thing is going to take you a week to go through to figure out whether you belong in the Medicaid box, whether you belong in the private insurance box, whether you're going to get it at all, whether you get the subsidy or you don't. It's maddening. And it provides nothing to increase the quality of the care that we are required to do to give to our patients.

Mr. ROE of Tennessee. There's no question, Dr. Burgess. What we saw happen in our State was--the way governments always fix their problem when they overpromise--is they put a plan out there, more people sign up than they thought, as will happen in the exchanges and the subsidies and so forth; and when that happens, the way they balance the budget is they cut the providers--the doctors, the nurse practitioners, the hospitals, the home health care. The people that actually give the care get cut. They finally cut it enough that it doesn't cover the cost of the care. And when that happens, the providers can no longer afford to see you, which means if you lose access, even if you've got the prettiest looking card in the world but you can't get a doctor to see you, the quality of your health care goes down, and ultimately it increases the cost because the severity of your problem which goes undiagnosed, untreated, is more severe to take care of. And then you show up in the emergency room, which is exactly the wrong place. We saw this over and over in our State. For instance, in New Jersey right now, I think 60 percent of the primary care providers don't take Medicaid. What good does it do to expand Medicaid in a State when you don't have providers that will see those patients.

Mr. ROE

Mr. ROE. If you look at Massachusetts, we were told that the number of ER visits were going to go down. They didn't. They went up. That's exactly where they end up. They end up in the emergency room for primary care, which is where they should not be.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. I thank the gentleman for yielding. I appreciate the opportunity to speak again here on the House floor about health care, something that I've dedicated my life to, as many of us have here on the House floor--Dr. Burgess, Dr. Harris, and others. I think the thing that has bothered me so much about this, and the reason I've made a choice to come to Congress, is to work on health care. There are many other things I wanted to work on, but this was primary. And I've brought a wealth of experience from our State that tried health care, a program called TennCare, where we reformed our Medicaid program in the '90s and then re-reformed it in the mid-2000s when we realized it didn't work. What happened? What was the argument? Well, the argument and the promise. What was the promise that the President and the opposing party made during the health care debate? We want to include--which is a good thing--more people in health care, provide coverage for more people. As Dr. Burgess just pointed out, we had 160 million people in the private insurance market that needed a little tweaking, but didn't need to be blown up, as we are seeing has happened right here. We have our Medicare patients, 47 million of them, already covered. Medicaid, which we tried to reform in Tennessee, is an entirely different issue because Medicaid doesn't provide, in my opinion, the best quality of care for lower-income people. There are studies out there. I read one this morning: 900-and- something-thousand patients who were uninsured actually got better health care outcomes than those patients covered by Medicaid. There is something wrong with a plan that you're expanding that doesn't work now. So I think that was one of the things. What did we find out in Tennessee? What did we discover? Well, we found out we were spending $2.5 billion a year on TennCare in our State; 10 years later we were spending $8.5 billion, over three times what we started out. Half the people that got on TennCare had health insurance and dropped it. This is exactly what you are going to see in the market. And quality of care went down. Why did it go down? Because when Medicaid paid less, doctors saw less, patients lost access. That is one of the great concerns I have here now, is that right now we don't have enough primary care people, and you are going to see access lost in this State. I certainly think we have a plethora of ideas about how to improve the health care system. Three years ago, I stood out with Michele Bachmann at midnight outside this Capitol with thousands of people who passionately did not want the Federal Government making their health care decisions. They're still out there. When you go home, you will find out that 55 percent of the folks do not want this and they want it reformed. They want health care reform; they do not want this plan. I appreciate the opportunity to be down here and speak on this extremely important issue on the third anniversary of ObamaCare.

Mr. ROE of Tennessee. Will the gentleman yield?

Mr. ROE of Tennessee. Dr. Burgess, one of the great frustrations I've had in my short 4-year political career here--this is my third term-- was there were nine of us in the Physicians Caucus when I showed up here. Not one of us was asked about this bill. I spent my life out there in the private world, 31 years, practicing medicine, providing care for patients, not bureaucracies and this, but actually seeing one patient right after another, delivering their babies, operating on them. And what happens is, when you have a public program that promises more than it can produce, guess what? You get that patient in the hospital, and because it doesn't pay for the cost of the care, what happens? You shift that cost to the private sector, not only taking in inflation, but that cost shifting, to force it up. And you were led to believe it was the ``free riders.'' It's the public programs that are the biggest problem there, that are forcing those shifts in costs, and hospitals are caught in a dreadful situation. They agreed to take the cuts in Medicare because they thought they were going to get an increase in insured people. It turns out what Congresswoman Bachmann brought up about how can you lose your private insurance, there may be as many people that lose their private insurance as we increase in Medicaid, which is a failed program now. How bad is that when you take people who had insurance they liked, and they lost it, and now they are forced to no program or a Medicaid program that is fading?

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Mr. Speaker, I submit these remarks today to recognize Mr. David Pickler, who has recently been elected as President of the National School Boards Association for 2013-2014. David has served on the Shelby County Board of Education since 1998 and has served as Chairman of the Board for 12 years. In 2008, David was elected to the National School Boards Association's Board of Directors and served as the Southern Region Representative. In 2009, David served as President of the Tennessee School Boards Association and has held several positions of leadership with It. David is an excellent example of the spirit of volunteerism, which we Tennesseans hold close to our hearts. His community service and philanthropic endeavors are both numerous and extraordinary, casting a legacy of selflessness and determination to better education across Tennessee. Perhaps the highlight of this legacy is the creation of the Shelby County Schools Education Foundation, which has provided more than $1 million in financial support for public education. David's awards and accolades at the local, state and national level are extensive and serve as a testament to the positive impact he has had on the children of Tennessee. Mr. Speaker, I commend Mr. Pickier for his unwavering commitment to improving education for the students of Shelby County, Tennessee, and the United States of America.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Mr. Speaker, I was not present for votes on March 18, 2013 due to a declared state of emergency in my district. Had I been present, I would have voted yea on rollcall votes Nos. 76, 77, and 78.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. I thank the chairman for yielding. I wanted to finish by saying there are things that work today out here--today--that we can emulate. And we need to streamline this. You should read all these 35. I agree with Ranking Member Miller. We do need to reform these, and that's what this is an attempt to do. I want to commend Dr. Foxx and Chairman Kline for the leadership on this issue, and I encourage my colleagues to support this bill.

Mr. ROE of Tennessee. I thank the chairman. Madam Chair, today, there are more than 12 million Americans who are out of work. These lives are on hold until the economy gets better-- provided that we here in Washington can stop ourselves from taxing, borrowing, spending, and regulating it to a standstill. But even in this time of economic uncertainty, there are 3.6 million job openings in this country that remain unfilled--unbelievable when you have 12 million people out of work. I support the bill on the floor today, H.R. 803, the SKILLS Act, because it will help give some of our neighbors the sense of dignity and satisfaction that only comes from a hard day's work done well. This legislation will help to bridge the gap between unemployment and work in three significant ways. First, the SKILLS Act will ensure that workers can access job training programs immediately, eliminating the need to navigate a complicated bureaucracy. By cutting through the red tape, we can get workers trained and back into the workforce more quickly. At the same time, this bill removes some of the burdens on State and local officials by repealing 19 mandates that impact who can serve on workforce training boards, the entities that oversee local job training programs. Second, the SKILLS Act will require State and local leaders to use common performance measures to measure the quality of services offered to workers. This will ensure that there's accountability in workforce training programs, ensuring a good return on taxpayer dollars. The bill also empowers job creators by requiring that two-thirds of workforce board members are from the business community. Giving more say to the people who know the needs of their businesses and the local economy is just plain good common sense. Finally, the SKILLS Act will ensure that taxpayers are seeing a good return on investment by eliminating or streamlining 35 ineffective or duplicative Federal programs. It also gives Governors additional flexibility to further consolidate any additional employment and job training programs at the State and local level to ensure efficiency and cut waste. Let me just, Madam Chair, go through a few of these. We talk about duplicative programs. This will help consolidate some of these. These are the names of the programs: Reintegration of Ex Offenders; Grants to States for Training for Incarcerated Individuals; Second Chance Act Prisoner Reentry Initiative. It looks to me like we could have one program for all of these. Let me read a few more: Refugee and Entrant Assistance--Targeted Assistance Grants; Refugee and Entrant Assistance--Social Services Program; Refugee and Entrant Assistance--Targeted Assistance. And I could go on and on with 35 programs. We heard our chairman speak that one in five actually completes one of these programs here. Let me just tell you what happens in our State of Tennessee. Every Tennessean is within 1 hour of a technology center. These are all across our State. Even in today's economy, with the economy being what it is and hard to find a job, 90 percent of these people get a job, are hired right now today, not one in five.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. I thank the chairman for yielding. Mr. Speaker, I rise today in support of H.R. 890 and preserving one of the most significant and successful Federal reform initiatives in the last 20 years. Seventeen years ago, a Republican-led Congress worked with President Clinton to fix a broken welfare system. The bipartisan law that resulted established the Temporary Assistance for Needy Families block grant program. This law also required individuals to work, prepare for work, or look for work as a condition of receiving public assistance. In the years following passage, the number of individuals receiving welfare dropped by a whopping 57 percent. The poverty level among single mothers fell by 30 percent, and I saw this in my practice as an OB-GYN physician. No question that it worked. And this is while their income and earnings increased significantly. Poverty levels among young African Americans dropped to its lowest level in 2001. Last July, the Department of Health and Human Services issued an unprecedented guidance indicating that it would allow States to waive welfare work requirements. The law and the historical record are clear: the administration does not have this power. But if there's any confusion, H.R. 890 will dispel it. This commonsense bill would prohibit the Secretary of HHS from moving ahead with this illegal waiver plan. More than 80 percent of Americans support the work requirements included in welfare reform, and this legislation ensures the hard work of the 104th Congress and President Clinton isn't undone by this administration. Mr. Speaker, we should celebrate work in this country. We should help those who are down on their luck find a job--something all the House will do later this week when it considers the SKILLS Act. And for those Americans who need help, we should offer it--but not as a permanent entitlement. I commend Chairmen Camp, Kline, and Scalise, along with Mr. Southerland, for their leadership on this issue, and I urge my colleagues to vote ``yes'' on this bill.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Dr. Gingrey, thank you, and it's good to see you moving your arm well and recovering from your surgery so well. I think the question that comes up, and Dr. Gingrey and other Members and I have discussed this, when I got here--and I've been here 4 years, and Dr. Gingrey came a couple terms before I did--we did this for a reason because we wanted to impact the health care system in our country. The problem with the health care system in our country was that costs were exploding. If you look, as he pointed out, the Affordable Care Act has been anything but affordable. It's suggested that by 2016 the average family of four, when you have to buy an essential benefits package--which the government will determine what that is--will cost a family of four $20,000. That's unbelievable when you think that the per capita income in my district is $33,000. So I think we're at a point or we're going to be at a point where no one can afford it. Well, what Dr. Gingrey is mentioning in the SGR, sustainable growth rate, what is that? What does that mean, and why should I care if I'm a senior? And Dr. Gingrey and I both have Medicare as our primary source of insurance. Well, Medicare started back in 1965, a great program for seniors who did not have access to care. It met a great need there and has met a great need since then. It started as a $3 billion program. The estimates were from the government estimators that in 25 years this program would be a $12 billion program--we don't do millions here, billions--and the real number in 1990, Madam Speaker, was $110 billion instead of $12 billion. They missed it almost 10 times. So there have been various schemes throughout this time in which to control the cost, always by reducing the payments to providers. And who are providers? Well, those are the folks who take care of us when we go to the doctor's office--nurse practitioners, it may be a chiropractor, it could be a podiatrist, and it can be your hospital. So when you say providers, those are the folks and institutions that care for us when we're ill. So in 1997, the Ways and Means Committee brought together something called the Budget Control Act. This is a very complex formula based on how you're going to pay doctors--their zip code, where they live, the cost of an office, the humidity in the air--I know it's an incredibly complicated scheme to pay doctors. The idea is this: We have this much money to spend in Medicare, and so we've put a formula together to only spend this much money. If we spend less than that money, that will go as a savings. If we spend more than that much money, then we will cut the doctors and the providers that amount of money to make that line balance.

Mr. ROE of Tennessee. I have just one quick statement, Dr. Gingrey. And when you brought this up in 2003--and I want to thank you, because I can remember sitting at my desk in my office in 2003 working, and I could take this pen right here, and in about a minute or a minute and a half, I could write two or three prescriptions that might take up a patient's entire monthly income. That was the decision patients were having to have. And Republicans stepped up to the plate, made a very difficult decision. Like you said, maybe we should have some criticism for not having offsets. But seniors out there today don't have to make that decision about whether I break this pill in half or whether I don't take it today or whether I buy food. And you ran across that in your practice. I mean, I would look in our area, many widows that I would see would have a $600, $700 a month Social Security check and maybe a $100 or $200 a month pension. And you write three prescriptions, and the first thing they say is, Dr. Roe, it's gone. And you could easily do that. So I want to thank you for your vote.

Mr. ROE of Tennessee. Dr. Gingrey, I think one of the things I know you did and I know one of the things that I did was to come here to this body, this great body, to work on the repair of our health care system and improve on it. One of the major pieces of our health care system is our Medicare system. I cannot tell you the patients I have seen in my career that have benefited, whose lives have been helped and saved by the Medicare system and by the doctors and nurses and hospitals and other providers who've cared for them. You have, too. I've operated on them, and I've seen them get cardiac care, renal, whatever it may be, that has improved the quality, improved and lengthened the quality of their life, not just to live longer, but to live better. My goodness, look at the number of patients that we see of our orthopedic friends that we have that are mobile, that are active who've had joint replacements and so forth. Look, if you're 80 years old, 75 or 80 years old, you understand that your life is not going to be that much longer, but you also want the quality of that life to be the absolute best it can be. And it cannot be if you can't get your knee fixed if you're in pain, or your hip fixed if you're in pain. One of the things that I think our side of the aisle is committed to, I believe the other side, we may have differences of opinion, but one of the things I want to do is to be sure that we shore up and save this great system of Medicare. I had a meeting today just after lunch about the Medicare part D program that was passed by the Republicans at some political risk for them. That's been a plan that has actually come in under-budget. It came in under-budget because seniors are able to go shop and purchase exactly what they want that meets their needs. That is exactly what we want to do in the Medicare system. And when our budget is published next week, we are going to look at a system where we help fix and save and sustain Medicare, as you pointed out, not only for your mother, who's 95, and my mother who is 90, but for my two grandchildren who are 7 and 9. They also deserve the same great system, and we're going to have to change it; but I think we can make it better. I really believe it can be more responsive. You see what patients do when they get Medicare Advantage. You saw what they did. There was a little confusion, I admit, when Medicare part D first came out. There is no confusion now. People shop for the best value that meets their needs, and that's exactly what we should do. Let me give you an example, Dr. Gingrey. I turned 65 a very short time ago. What happened to me when I turned 65? Nothing. I got one day older. Except what happened was I had a plan now that had an alphabet soup--A, B, C, D. The day before I had a health care plan. Why, when you turn 65 years of age, don't you have a health care plan? And in that health care plan I can pick out I don't need fertility coverage at age 65, thank you very much. And I think that's the kind of thing--allow seniors to be able to pick what meets their needs and meets their family's needs at that particular point in their life; not just one-size-fits-all, but what they need. And seniors have done that. They do it with everything else in their life. There's no reason it should change when you hit 65. You should pick out what plan--just like you and I can do up here with the Federal Employees Health Benefits plan. There's no reason that a senior shouldn't have exactly the same plan. It will be cheaper. It will be a better plan for them, and that's one of the things I think we're going to be discussing in the next several months when the Republican budget is published.

Mr. ROE of Tennessee. Actually, the IPAB board of 15 bureaucrats will make $165,000 a year with a 6-year term, and they can be appointed twice to that term. And it's something, and what bothers me about it is, no, it says in the bill you can't ration care, but we are the elected representatives. We should be able to go back home, as Congressman Bilirakis said, we should be able to go back home and face our constituents, and they're going to say: Dr. Roe, we have a situation where I can't go see my doctor. I can't go in and see them because they aren't accepting patients, and they aren't accepting patients because of this particular board that's cut their reimbursements enough to where they can't afford to see patients. Now, another couple of things I want to talk about in the Affordable Care Act, not just SGR formula effects, but there is a tax out there in the Affordable Care Act that hasn't been very well discussed, and that tax is on individual insurance accounts. For instance, there are companies out there that are self-insured, and they're going to get a bill for each person that has insurance. Let's say a family of four or five, they'll get a bill for four or five people, and one company in particular, this will add--and they have no reinsurance. They cover everything. They're totally self-insured, but this basically is a tax that will go into a fund to indemnify insurance companies so that they won't have a loss of more than $60,000 a year, and this is billions of dollars when you stretch it across the country. And these insurance companies are going to not have the loss to encourage them to accept patients on the exchange. That's as wrong as it gets to take a company that is doing everything right, they're going ahead and providing the health insurance coverage for their employees, and to penalize them for that. So there are many, many issues in the Affordable Care Act we could talk about, but I want to basically finish my comments on the sustainable growth rate by saying in the past, since 2001, just so that our viewers out there will understand this, since 2001, your Medicare doctor at home has gotten an average increase in his or her payments when you come see them of 0.29 percent per year, 0.29 percent per year. When you look at all that graph that Dr. Gingrey has down there and you do all the math, that's how much of an increase. It's a very minimal increase. It hasn't even come near to covering the cost of inflation. So again, Dr. Gingrey, I want to conclude by saying that the major concern I have, and I saw it in my practice, is the cost of care, and, number two, access to care. I'm concerned as our patients age and our population ages--and look, a good thing is happening in America: almost every 10 years we live, we're adding 3 years to our life expectancy. In 1908, the life expectancy in America was 48 years old, 47-48. In 1922 when my mother was born--and she's still living, I might add. She's living alone, by herself, doing great. She has Medicare. And I'm going to tell my mother now that later today I'm going to call her prescription in. She notified me today that she needed some medicine called in, and so I will do that for her today. I look at her and I think about her need for access to care, and if it's cut off, what does she do.

Mr. ROE of Tennessee. I had the misfortune of going from paper to an electronic record. I was in the process, at our practice, of converting. It's a very difficult conversion. I think if you started with just an electronic medical record, it would be much easier than transferring tens of thousands of patient charts to an EMR. But when you start from scratch, it's a little easier. Certainly I think the electronic ePrescribe, which I like, I didn't have the pharmacist call me and tell--I can't believe he couldn't read my prescription. Anyway, they claimed they couldn't, and this solves that problem. I think there are some disadvantages to it, but overall, I think it is the wave of the future. I think you are correct. I'm going to bring up something now about: let's say we go ahead and we do fix the SGR payment that's based on quality and that's based on outcomes and transparency, on hospital re-admissions, and so forth--on all those metrics we've talked about to better serve our patients. There will still be fee-for-service. I'm sure, Dr. Gingrey, you're a rural Georgia Representative as I'm a rural east Tennessee Representative. I have counties that have one doctor, and you can't do an accountable care organization--or all of these things--in a small, rural county. So fee-for-service medicine will still be there for those patients so they can have access in small, rural counties and don't have to drive long distances. Let's say we do all of this wonderful stuff and that we fix this payment model and that it all looks good. The Affordable Care Act has in it one little thing called the Independent Payment Advisory Board. This Independent Payment Advisory Board trumps what we just did--all of the things that you're going to do in your Energy and Commerce. Also, thank you very much for what you're doing on that. As to all of these cuts that you see right here, let me just give you the data.

Mr. ROE of Tennessee. That's correct. I had the privilege of being in the chambers when a good part of this health care debate was going on in front of the Supreme Court. It was the first time I'd ever been there. Fascinating. I'd totally misread it. As you pointed out, it was the first time in American history that the Supreme Court said that you had to purchase a good or service--even if it's good for you, that you had to purchase it. We've never forced anybody into commerce before like this. As an individual, I think you have a right to make good decisions and bad decisions. I agree with you. I think a good decision is, if you can afford health insurance coverage, you should purchase it. I think there is no question. I have for my family my entire life, and I would recommend it strongly and encourage people to protect themselves in that way. But does the government have the right to do it? This Court said 5-4 that they did. The Court also said that they did not have the right to force States into expanding their Medicaid if they did not want to, and the IPAB specifically was not brought up. I believe it will be challenged and should be. No one has standing yet because it hasn't gone into effect. In other words, they haven't issued any rulings--or the Secretary hasn't--to say that I've been harmed by that ruling so that, therefore, now I have standing in the Court and that I can bring a case.

Mr. ROE of Tennessee. That is correct, Dr. Gingrey. Unless you are very deeply buried into this--meaning, if you're a Medicare recipient out there today--you don't see this. I go home, and I see my physician friends and talk to my friends who are on Medicare. They don't know this has happened or that it could potentially happen to them, but it can and it will, and it is the law right now unless we change the law. I would strongly encourage my colleagues on both sides of the aisle-- and we have bipartisan support for the appeal of the IPAB--to put that constitutional authority back in the hands of the people who are directly responsible and responsive to the American people--us, the Representatives. Let us make those changes and, the Senate, the same thing.