Phil Roe

Mr. ROE of Tennessee

Mr. ROE of Tennessee. That sounds like a southern comment.

Mr. ROE of Tennessee. They're in bed with them.

Mr. ROE of Tennessee. Well, let's talk about a couple of solutions. We've talked about a lot of problems. If you did two things, you could cover almost two-thirds of what the Senate bill does and would not have one new program. Actually, one new bill would do it. Number one: Allow your adult-aged children when they're above 18 years of age or when they've graduated from college--and I've had three who have had this problem. For their first jobs, they didn't have health insurance. Just let them stay on their parents' plans. That's in the House bill. Pick your number--26, 27, 28 years old. You would cover 7 million young people by doing that. Number two: Adequately fund and simply sign up the people who are eligible for SCHIP, the State Children's Health Insurance plan, in Medicaid right now. You would cover 10 to 12 million people. In this way, you'd cover almost 20 million people without this massive, incomprehensible, 2,700-page bill with all the special deals in it.

Mr. ROE of Tennessee. You are describing me. When I worked for myself in a group of physicians, we had 70 physicians and 350 employees. I retired to run for Congress, and I am on my own. So that year that I ran, whatever my tax bracket was, my health insurance cost me that much more money, because as an individual I couldn't deduct my health insurance premiums. But a large company could do that. And my business could do that. I have experienced that very thing.

Mr. ROE of Tennessee. So what could you do very briefly and very simply? Number one: Increase competition. You have to do away with State lines and allow competition to occur across State lines.

Mr. ROE of Tennessee. Yes.

Mr. ROE of Tennessee. I know you were.

Mr. ROE of Tennessee. Well, the three things we have mentioned right there would cover this bill. Anyway, one, you've got State lines. Two, you've got association health plans, or groups, which would allow individuals or groups to form. Three, you've got the tax deduction allowing an individual to deduct it from his tax. Four, you've got tort reform. Five, which we've just mentioned, will allow adult-aged children to stay on their parents' plans. These are five simple things you can do without having all of the special interest groups and everything else. Then guess what? One of the things would be to expand the health savings account. You would be putting individuals in charge of their health care and of their health care decisions. Who should make them? A health care decision should be made between a physician, the family, and the patient. That's who should be making the decisions--not insurance companies, not the government.

Mr. ROE of Tennessee. That's absolutely right.

Mr. ROE of Tennessee. No.

Mr. ROE of Tennessee. You're stuck.

Mr. ROE of Tennessee. Yes. I had a very successful medical practice, and I understood who I worked for--not the insurance company, not the hospital. I worked for the patient. We are losing that because we are putting insurance companies and we are putting the government in between those decisionmakers.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. I thank the gentlewoman for yielding, and I rise in strong opposition to this resolution. If passed, this would send a terrible message to our troops in harm's way and only serve to boost morale among our enemies who now have to face the reality that they are being tracked night and day. I served in the Army in 1973 and 1974 in the infantry in Korea. I felt abandoned at that time by my country. I never want a soldier to feel like I felt at that time. I saw what happened in Vietnam when Washington bureaucrats and lawmakers micromanaged the war and prevented commanders from having the resources available which they thought would win. I will never support a plan for this or any other war in which I think we are tying the hands of our brave servicemembers. In my judgment, the strategy devised by our military leaders and being implemented by our Armed Forces is the correct one. I have always said I will support this military plan so long as we do not set arbitrary dates for withdrawal from the country, which will only set a target date for those who would try to kill our young men and women. It is important that we do not forget why we are in Afghanistan. We are fighting this war because a previous Afghan regime allowed al Qaeda, the terrorist group responsible for countless attacks around the globe, including the September 11 attacks against the United States, to operate freely within its borders. If the coalition forces leave, the Taliban could regain control of the country and once again provide safe harbors for those who hate America and want to destroy our country. Winning the war in Afghanistan will also help deter a radical Islamic government from taking over Pakistan, a country with over 15 nuclear weapons. It seems that in recent months, since our surge in force has begun, we have seen Pakistan become more willing to confront the radical elements within its own borders. And while there is much work left to be done, there is no question that our more aggressive strategy against the enemy is having many positive results. In April of 2009 I participated in a congressional delegation to visit Afghanistan to observe our operations firsthand. I can tell you without hesitation that we have every reason to be proud of our men and women serving in Afghanistan; they're doing a great job. What they need now is support and a clear signal from Washington that the job they are accomplishing is appreciated and in our national interests. By soundly defeating this resolution today, hopefully we will send such a message. And it is my hope and prayer that we never have to enter another war.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Madam Speaker, Democrats are once again rushing to meet an artificial deadline to pass their government takeover of our Nation's health care system, and it is clear that the majority of the American people don't want this bill. Republicans have been clear about why reforms being proposed should be scrapped. This proposal will increase costs, decrease quality, and decrease access to care for the vast majority of Americans. I can say this unequivocally as a physician and as a Tennessee resident who has experienced TennCare, our State Medicaid program, firsthand. Small businesses that are dealing with the worst recession in decades will have to lay off workers and cut back on wages to deal with the new mandates. The end result is what we are dealing with in Tennessee right now: rationed care. To meet its budget, the State is limiting TennCare patients to eight visits per year to a physician and $10,000 paid to providers, no matter what the costs. While we can't make our State Medicaid program work as is, Democrats in Congress want to expand it. In the end, what is happening in Tennessee will happen to everyone in America, and that is the wrong solution.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. I yield myself such time as I may consume. I rise today in support of House Resolution 1117, commending and congratulating the California State University system on the occasion of its 50th anniversary. The Weekly Normal School, today San Jose State University, became the first institution of higher education established by the State of California in 1862. The California State University system was established in 1960 as the California State College system. Today, the system is comprised of 23 campuses, with almost 433,000 students and 44,000 faculty and staff. Cal State's campuses stretch from Humboldt in northern California to San Diego. It is the Nation's largest and one of the most affordable university systems. The California State University system offers more than 1,800 degree programs in 357 different subjects. CSU draws its students from the top two-thirds of California's high school students and graduates 91,000 students annually. The CSU system prepares approximately 60 percent of the teachers in the State, 40 percent of the engineering graduates, and more graduates in business, agriculture, communications, health education, and public administration than any other college or university in California. The California State University system undoubtedly makes an invaluable contribution to the education of the people of California and the Nation. California State University also makes significant outreach efforts to inform and promote college attendance to middle and high school students, minority populations, and veterans. CSU's outreach to growing and underserved communities also provides a pathway for students from diverse backgrounds to pursue an education. I am pleased to congratulate CSU on the 50th anniversary of the University system's founding. I extend my congratulations to the California State University system, all the alumni, students, faculty, and staff at each of the 23 campuses, and to the people of California. I urge my colleagues to support this resolution. I reserve the balance of my time.

Mr. ROE of Tennessee. Mr. Speaker, just one comment. There are a lot of things about our education system in America that is not right. And we deal with it every day. We had the Secretary in front of our committee this afternoon. But one of the things that is right is the higher education system in America. And I will tell you that without a system like California's, I wouldn't be standing here today. I was given an opportunity to succeed. And I know so many students in California that don't have the opportunity because of cost to attend a private university, get a great education in that system. And not only is the State of California better, America is better because of this. I would urge my colleagues to support this. I once again congratulate the CSU system. I yield back the balance of my time.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Will the gentleman yield?

Mr. ROE of Tennessee. Thank you, Dr. Gingrey, for yielding. As I was sitting here, I think what we should do is go back a year. Obviously, last year when we first began this session we knew that health care reform was going to be on the front burner. The arguments that I heard for the need of it being on the front burner were the same as I heard over 20 years ago, which were rising costs of care, decreased access to care. And we have viewed those things, I think, over a period of time and understand that we have the best quality health care in the world in the United States, but it is expensive. So the cost is a huge issue. And that's one of the things that I think in this current bill is not being addressed adequately, or has not been. One of the great disappointments I had during the debate on this health care bill was the fact that in our Doctors Caucus on the Republican side we have 14 Members, now 10 physicians. We have an optometrist, dentist, psychologist. And not any of us were consulted in any meaningful way in putting together, on the House side, an over-2,000-page bill. Let's summarize that bill a little bit. The House bill that was passed has a public option in there. That is not the case in the Senate bill. In the Senate bill and the House bill there are both individual and business mandates to purchase insurance. We have never in the history of this country on a Federal level--and you hear it compared to a State issue of car insurance. It's not the same thing. We've never done that before. So there are some distinct differences in these two bills. And they are now coming to the House. It passed in the House by 220-215; and in the Senate, 60-40. Now the President, and Dr. Gingrey mentioned this, several of us have attempted on numerous occasions to go to the White House and sit down in a bipartisan manner and lay out literally hundreds of years of experience and go over with him what we saw work and what didn't work. And what I saw in my State in Tennessee back 16 years ago was we looked at access, we look at rising costs, and people's inability-- losing their insurance. The same issues as today. We asked for a waiver from the Health and Human Services to start a new managed care plan called TennCare. I've discussed it here on the House floor, and I'm not going to go into the details, but just to say that bill, that project, when it first started, was a $2.6 billion project in the State of Tennessee to cover people. We had a lot of uninsured people. We wanted to get as many people covered as we could. In doing that, in 10 budget years in the State of Tennessee that had gone to an $8 billion program. It had tripled in costs. And so we found out unless people had some skin in the game, unless they had some different incentives than we had, the costs would escalate. As a matter of fact, it escalated so much that it took up one-third of the State budget, and every new State dollar we took in went to the health care. So the Governor, who's a Democrat, and the legislature, which was Democrat and Republican, split, had to do something about it because the State simply couldn't afford it. What I see in this current Senate bill is a massive expansion of the same program that failed in the State of Tennessee. And to show you how bad it is right now in our State, we're having to limit doctors visits. That's right now, currently, I'm talking about. Not with this added part. Remember, in the Medicaid program, the State has a match. That's why the Nebraska carve-out was such a problem for other States, because there is a match that's required in Medicaid: the Federal Government provides so much money, the State provides so much. Well, our State can't provide any more. So we've cut the rolls of over 200,000 simply because the State of Tennessee doesn't have the money for the current plan, not the very expansive plan that we've talked about. I think last week--I agree with you, Dr. Gingrey, it was a year overdue. It should have happened a year ago. It was good going to show that there are philosophical differences between how you approach health care. Basically, do you want a larger--I won't say nanny State-- but ever-expanding government to make those decisions, or individuals to make those decisions? Certainly, I believe that individuals should. When you look at this plan that's there now, I can tell you it says it's budget neutral. There's some gimmicks that have been played. Paul Ryan very clearly pointed those out in the $500 billion that is being carved out of an already underfunded, failed Medicare plan; 2016, that goes upside down. In other words, more money is going out than coming in. If you take $500 billion out of that, you've just created another liability for the Medicare program. I will tell you, if you take that much money out, three things will occur. One, there will be decreased access to care because doctors are not going to be able to take the patients. They won't pay. Number two, the quality will go down if you can't go in. And, thirdly, the seniors will pay more for the care they're going to get because they'll have to. There won't be any other choice. We talked about some simple things that I think we could do. As you pointed out already, there's a 2,700-page Senate bill out there. We can cover two-thirds of the people in that Senate bill with two paragraphs. Number one--and it's in the House bill--it's simply to allow young people who don't have health insurance after they get out of high school or college to stay on their parents' plan until they're 26 or 27 years old. Just pick your number. That will cover 7 million young people. Number two, sign up the people who are already eligible for SCHIP, the State Children's Health Insurance Plan, or Medicaid. Already you have got those plans in place. Have adequate funding. That will cover, Dr. Gingrey, almost 20 million people. This complicated Senate plan covers 31 million people. You hear people talk about bending the cost curve, keeping costs down. Dr. Gingrey talked about it a little bit on medical liability reform. Without liability reform you will never be able to completely reverse this cost escalation. Why? Because doctors will order tests to protect them in case there's no disincentive for them not to. Again, an experience we've had in our State: 35 years ago we formed a mutual company, State Volunteer Mutual Insurance Company, to protect physicians. When I first went into practice, my premiums were about $4,000 a year, probably much like yours were. When we left, a physician who took my place was $74,000. It's gone up almost 18 times, over that period of 30 years, the increase in premiums. And what have we gotten for that? Well, over half the premium dollars that I paid in for 35 years, gone for attorneys, both defense and plaintiff attorneys, not to the injured party. Less than forty cents on the dollar actually went to the injured party. So we've got a bad system to basically compensate people who have been legitimately injured. So until you get that fixed, you're not going to ever completely bend the cost curve. You've got that to deal with. I think the waste and fraud, everyone agrees with that. There's waste, fraud, and abuse in the Medicare program, absolutely. I do have the President's letter. And the four things that he agreed to discuss were waste, fraud, and abuse. I think we all agree on that. Both sides. I don't think you'll get any disagreement there. The liability reform is just more study. The study that he was talking about was to not limit attorneys' contingency fees and caps on damages. Well, that's the two problems that are causing the problem right now. And in Texas, which we've already done the experiment, in 2003 they passed liability reform. And what's happened in Texas? Well, premiums have gone down 30 percent and physicians have streamed into Texas. Almost 15,000 new doctors have applied for practice in Texas. Mr. Speaker, the third thing that the President has in his letter is the inadequate payment for Medicaid patients. In our State, they pay less than 60 percent of the cost of actually providing the care. So physicians are not able to take as many of those patients, and many of them limit or don't see Medicaid patients. He said he would be willing to look at that if it's fiscally responsible. The other is to encourage health savings accounts, which has been one of the centerpieces of personal responsibility. One of the things that has bothered me in this bill, that supposedly the President said in this chair here not long ago, that he wouldn't sign any legislation that wasn't budget neutral. Well, the sustainable growth rate, as you and I both know, are how doctors are paid by Medicare. As a matter of fact, right now there is no--we have had no ``doc fix,'' we call it. There's a 21 percent cut in the budget right now for that that will occur this week if we don't do something this week. If there's a 21 percent cut in those payments to our physicians, then you're going to see a lot less Medicare patients have access to their doctors. And that is a very bad thing. So I think there are some good things about what the President said here. I agree with that. Then there's some things that just don't mesh with the current legislation. I want to talk about one other thing, and then I'll yield back. One of the things that when you see CBO and you see all these estimates, you have to go back and just look at history. When Medicare was first debated on this very floor right here, and passed, it was a $3 billion program. 1965. The estimates then were it would be a $15 billion program in 1990. Flash forward to 1990. It was over a $90 billion program. Today, it's over a $400 billion program. So if you look at those estimates and look at the history of our estimate in Tennessee that we were going to actually save money, keep premiums down. And, Dr. Gingrey, what's happened when the bigger--these programs that come along that don't pay the cost of the care. Medicare pays about 80, 90 percent of the cost of providing the care, and TennCare or Medicaid pays about 60 percent of the cost. Those costs get shifted. And they get shifted to business and individuals. We think, in Tennessee, it might add as much as $1,800 per family who have private health insurance. So it's a hidden tax. We can't continue to do that, or you'll drive the insurance companies out of business. Certainly, the insurance companies, we have every right, I think, to look at them very seriously. I know when I left practice, I had a case, and one of the last cases I did, I spent as much time getting the case approved as I did actually doing the case, almost. So there's some insurance reforms that need to be out there. You've experienced the same exact thing. A lot of frustration on my part there, also. I yield back to the gentleman.

Mr. ROE of Tennessee. You make a great point. We are not here defending them. But to put this in perspective, if you took all the profits that the health insurance industry made, it would be 2 days of the health care of this country. That is how much it is: 2 days out of 365.

Mr. ROE of Tennessee. I would like to go on record tonight with you as naming this ramming this bill through this month March Madness. And I am not talking about basketball. It would be madness to do that now. And I will just tell you why I believe that. Six o'clock the night after that summit last week, I just happened to have a telephone town hall and had 1,100 people vote in a poll. There were four questions: Number one, do you want to pass this bill as it is? Number two, do you want to take a clean sheet of paper and start over? Number three, do you want to just scrap it and work on jobs? Or number four, do you not have an opinion on this? Five percent of those 1,100 people who voted said to pass the bill as is. Thirty-eight percent said get a clean piece of paper and start over. Fifty-two percent said just stop altogether and let's get to working on getting people back to work in this country; start on jobs. And then 5 percent were undecided. As you can see, that CNN poll right there showed 73 percent of Americans think we should start all over or do nothing. So it is not that much different than the very poll I did of 1,100 people voting. Mine was not a scientific poll. I want to point that out. It was just a telephone town hall poll. I don't want to pass it off as anything it is not.

Mr. ROE of Tennessee. Thank you for yielding. One of the things that is not mentioned in the President's letter that I am looking at here is that certainly people who are either pro- choice or pro-life do not want, a vast majority do not want taxpayer dollars spent on federally funding abortions. The way the Senate bill is written, the way the House bill without the Stupak amendment, it does do that. The Stupak amendment in the House bill forbids that. The Senate bill does not. And nowhere in this language--why can't we just come out and say a vast majority of the people do not want that? And we should be able to come out and say that no Federal dollars will be used to fund abortions in this health care takeover. I think that is fairly simple. We saw how the Stupak amendment passed with an overwhelming majority in the House. It did not do so in the Senate. But I think that is fairly simple. We ought to be able to say that. The President ought to be able to say that right now, tomorrow. He should be able to come out and say just that. The second thing you brought up a moment ago were preexisting conditions. That is for you and I, where I would see it as a physician would be in a patient I diagnosed and would have a breast cancer and maybe lost her job or retired from teaching or whatever it may be, and then she is uninsurable. Well, that is unacceptable. That is absolutely unacceptable. I fought with that for 30 years in practice. Preexisting conditions are a problem in the individual market. The year I ran for Congress, I was in the individual market. It was tough to find insurance. It is expensive, and most people can't afford it. And small businesses. Seventy percent of our jobs are from small businesses. So how do you create a situation where small businesses can afford this and become larger groups? Well, I know it doesn't make sense, and I have never been able to understand why anybody would care if you sell insurance across the State line. I use the example of Bristol, Tennessee and Virginia. There is a city in my district where State Street has a line right down the middle of the street. On one side, you are in Virginia, and on one side, you are in Tennessee. One side you've got a different insurance policy than the other side of the street. That makes absolutely no sense. You don't get your homeowners that way, your life insurance. Car insurance you can buy across State lines. It makes no sense. I can see why the insurance industry wouldn't want you to do that because it creates competition. And then what you allow people to do once they can shop across State lines, because there are vast differences, you can get on the Internet and find out what a life insurance policy costs you anyplace in the country. You can evaluate whether the company is solid or not, and you know what you're buying. You can find out. It is transparent. We need transparency in insurance rates, and we need to allow small businesses to form groups. You can call them association health plans, group plans or whatever. But if you can spread those risks over thousands of people, then the preexisting condition goes away. And I can't imagine why anybody would object to that. That's not here in the President's plan. He's got this exchange that's government regulated instead of the free market regulation. I think that's a huge difference in the way we look at this. Do we want government regulating it? Yeah, you want some. We have antitrust laws. Absolutely you do. But we want the free market to work because it works much more efficiently, and that's two of the basic differences in these two----

Mr. ROE of Tennessee. I can't imagine why anybody would mind if you bought your health insurance exactly like you buy any other insurance policy you want to. I don't know how you could possibly object to that. Let's take Realtors, for instance. Almost all realty shops are small businesses. In our community, 10 or 15 people would be a large realty store. There are over 500,000 Realtors in America. If they could come together as an association and buy their insurance through that exchange or through that association, I should say, preexisting conditions would go away. It's just not an issue if you've got 100,000, 200,000 people. People talk about the FEHBP, the plan that the Federal Government has. That is the same thing. You have 9 million people in that plan. You share those risks, and you can then negotiate lower rates. Another thing I think that we need to talk about tonight are health savings accounts. I want to talk about that for just a minute because most people don't really understand it. You hear it's just for rich people and so on. That's a big argument you hear. Let me explain to people what a health savings account really is. You are given money, whatever the number is. The way we've done since World War II is that we've gotten our insurance and we pay a small copay or deductible, and it is 80 percent up to a certain point and then it's 100 percent after that. Well, that means at the end of the year, if you have been totally well, the insurance company keeps all your money. That's your money you are paying in, and you are getting some of that in lieu of a salary. What that HSA does is, let's say you put $3,000 or $5,000 in. I have had a health savings account, and we put $5,000 in that health savings account. If you got sick and used the $5,000, you would pay 100 percent after that. So that is my money I am dealing with. At the end of the year, if I have been healthy, I have had a healthy lifestyle, I don't smoke, I exercise, I eat well, take care of myself, I get to keep the money. I roll it over, and then next year I can use it. And after a number of years, you may have many thousands of dollars that you can use for long-term care. Now, again, the argument I hear is that only rich people do that. Well, let's look at my own office. We have 300 or so people that get insurance through our medical practice, and 84 percent use a health savings account. They manage their own health care dollars. They like it a lot because they then become negotiators for their health care costs. They come to my office, and they may negotiate a price for a visit. They may go to whatever procedure they may have. They may go to the hospital and say, I want your lowest price, and they can get that by negotiations, and that will bend the cost curve down. What continually makes the cost curve go up is that we're shielded from all the costs of the health care.

Mr. ROE of Tennessee. I thank the gentleman for yielding. I will just point out the California experiment. They did caps on pain and suffering in 1976, and premiums across the country for malpractice have gone up over 1,000 percent during that time. In California, it was about 300 percent. So it's been a huge decrease. Texas was similar. They have had a 30 to 50 percent reduction in malpractice premiums. And doctors--especially high-risk doctors like yourself and myself--many counties in Texas now have an obstetrician which before they did not have. Over half the counties in the State of Tennessee do not have an OB/GYN doctor in the county. So it is an access inequality problem when you can't get to a doctor. And many of our physicians are leaving the practice, which is very worrisome, because you want your most experienced people staying with it. We have another problem, I think, with this plan. I do believe that from what I have heard in my own district, there is no question. I came out of church the week before Christmas, and one of my friends there said, Doc, he said to me, What's the Senate going to do with this health care bill? This is after the House had passed it, and it was about Christmas Eve when they were getting ready to vote. And I said, Well, I think that they're going to try to fix it. He grabbed me by my shirt, by my coat lapels, and he said, You fix your cat. You kill this bill. What he was saying was that this comprehensive, almost incomprehensible bill needed to be shelved, and we needed to start from scratch and go all over. I think last week was a start, but it was a year too late. You had so many people that had put their neck out and said this absolutely has to be in a bill when it didn't have to be. I can think of four or five things we ought to be able to agree on in a minute, and those would be selling across State lines. I think certainly forming association health plans, doing away with preexisting conditions. I think we all can agree on that. I think meaningful malpractice reform we can agree on. I think letting young people stay on their parents' health plan until age 27. I think just signing up people who currently are eligible for the current programs we already have. Those are five things right there that we ought to be able to agree on in a minute and we can do.

Mr. ROE of Tennessee. Would the gentleman yield?

Mr. ROE of Tennessee. One of the things that this plan does, it mandates a certain level of coverage. You have to purchase a certain level of coverage, and it is a fairly expensive piece of coverage. An example would be for fertility. I can assure you that in my family, we don't need that coverage. I should be able to purchase the coverage that I need. There are issues in there that I just don't need any more. For example, pregnancy coverage is something I don't need. I should be able to go buy, or a person should be able to go buy, just like when they buy the homeowner's policy that they need, that is what they purchase. You should be able to do the same thing for health insurance. That is one of the problems with mandates. Some States have as many as 60 State mandates that you have to have in an insurance policy to sell insurance in that State. One of the problems with it is if you are allowed to buy across State lines, you can go buy a policy that fits your needs and your family's needs. You make that decision; the government doesn't make it for you.