John Shadegg

Mr. SHADEGG

Mr. SHADEGG. Not fixing in this bill?

Mr. SHADEGG. You know, it stuns me that you just said that, under current law in America, if you work for an employer who gives you health care through your employment, it's tax free. There's no income tax paid on it by your employer, no tax paid on it by you when you receive it. But you can go on the Internet and you can buy health insurance on your own, but you've got to buy it with after-tax dollars, making it a third more expensive. Isn't it shocking? Then, or more accurately, not to be cynical about it, isn't it pretty logical then that the health insurance companies don't compete? They don't care about our individual business because they know you and I can't afford to buy with after-tax dollars what we can get from our employer for free. Tell me, I guess I just do not understand why we wouldn't want to fix the Tax Code so that every single American could buy their health insurance tax-free just like their employer, so they could hire it and fire it and hold it accountable. The gentleman mentioned preexisting conditions and the Commerce Committee. I think the gentleman knows full well that, in 2006, we passed legislation through that Commerce Committee which dealt with the problem of preexisting conditions. We, as Republicans, in 2006, said, You know what? No one in America should go uninsured or go without care because they don't--because they have a preexisting condition. So we passed legislation encouraging all 50 States to create a State high- risk pool. Under a State high-risk pool, the State would be required to accept and insure anyone that had a preexisting condition. I happen to have an older sister who is a breast cancer survivor. She's now lived 20 years beyond her breast cancer. She has a preexisting condition. If Arizona had taken advantage of that legislation, the State would have created a high-risk pool and she could have, if she was denied coverage, or if she was told her premium would cost too much, she could have applied to the State high-risk pool. She would have been entitled to be admitted to the State high- risk pool. She could not have been charged more than 110 percent or 120 percent of the cost of health insurance for a healthy person. But all of her care would have been paid for, and the extra cost of her care, as a member of that State high-risk pool, would have been shared; that is, would have been spread, the extra cost would have been spread amongst every single person in the State of Arizona who purchased health insurance, or would have been spread over the State tax base and subsidized by State revenues. That legislation passed the Commerce Committee, passed the floor of this House by voice vote, passed the United States Senate by unanimous consent, and was signed into law, and is the law today. It didn't force the States to create high-risk pools, but 33 States have. Now, we can improve upon that. I'd like to make them mandatory. But we've already dealt, or we can deal with preexisting conditions without a mandate, an individual mandate compelling people to buy health insurance from the same health insurance companies that are already doing a lousy job of offering us health insurance. And yet, when the President of the United States--this is very important. When the President of the United States held his health care summit--and I note you didn't get to go and I didn't get to go. But at the health care summit, the President misdescribed, and so did Secretary Sebelius, a high-risk pool. Both of them said, if you put all the sick people in and give them no help, of course their premiums are going to go up. But no State high-risk pool in America puts the sick people in and says to them, Now pay your own premiums. What high-risk pools do is they put in the sick people; they guarantee them coverage; they cover their preexisting conditions, and then they spread the extra cost amongst all the taxpayers or all the people who buy health insurance in that State. And the reason people are willing to do that is because, but for the grace of God, you and I don't know that tomorrow we won't need to be in that high-risk pool. And I know you've dealt with high-risk pools.

Mr. SHADEGG. Federal legislation already passed in 2006 offered all 50 States some Federal money to help set up the State high-risk pool to care for those people with preexisting conditions and offered Federal money to subsidize or to underwrite the cost of those high-risk pools. The reality is, every Republican plan, every Democrat plan deals with preexisting conditions because it's something that we, as a society, have already decided that we should do. Every single one of us knows that any moment we could be struck with a heart condition or diabetes or, like my oldest sister, breast cancer. We might be in the position and we oppose the, even, concept of someone being denied care because of a preexisting condition. But I don't think the answer is a mandate. You said you don't like mandates. Okay. Some people may like mandates. I guess the issue is do they work. And of course the answer is, in Massachusetts, they worked to provide coverage, but the cost of care goes up.

Mr. SHADEGG. The gentleman started by commenting about the shutting down of the switchboards and whether or not individual citizens could get through to their Member of Congress today and express their feelings, and I would suggest right now maybe their intensely felt feelings in opposition to or in support of this bill. It seems to me that the American people, who are frustrated by that process, maybe ought to think about what organizations or groups they are a member of that might be able to get through. I am a little concerned that individual Members of this body maybe aren't taking phone calls right now, maybe aren't reading the faxes or the emails they are getting right now. But everybody who sits on this floor listens to the big organizations in their district. They listen to the Chamber of Commerce in their district. They listen to the farm bureau in their district. They listen to the cattle growers in their district. They might listen to the homebuilders, who by the way under the Senate bill are singled out for particularly mean or unfair treatment, high taxes, in this bill. They might listen to the contractors association. It seems to me that anybody who wants to make their voice heard and is a member of any kind of a professional association or a political association that has contact with Members of Congress, if you can't get through to your Member of Congress, maybe you ought to call the local Chamber of Commerce and say, hey, I read where Congressman Smith or Congresswoman Jones is going to vote ``yes'' or ``no''. That is not what I want. You supported that, Congressman. Why don't you call him or call her and say, hey, I want a ``yes'' vote or I want a ``no'' vote. Because I will bet those Members of Congress will take calls from, for example, the local Chamber of Commerce or the local farm bureau or the local cattle growers association or some other organization in their congressional district that has spoken to them in the past, maybe supported them in the past. It seems to me that now is the time that you can use those organizations to reach out and talk about some of the issues in this bill. You and I haven't talked so far tonight about some of the procedures. We haven't talked about the Slaughter solution, under which it appears the majority is going to push this bill through and try to say that they are really not voting for the Senate bill, or, for that matter, some of the special deals in the Senate bill. I find it interesting, yesterday apparently Speaker Pelosi said, quote, ``Nobody wants to vote for the Senate bill.'' She actually held a meeting with the press and said, quote, ``Nobody wants to vote for the Senate bill.'' I guess that is why they have come up with the Slaughter solution. Let me ask you this question. Doesn't the Constitution say that for the Senate bill to pass the House, Members of the House have to actually vote for it or vote on it? Don't they have to pass that bill?

Mr. SHADEGG. The exact same bill.

Mr. SHADEGG. Because of one word difference? One word difference. The Senate has already passed the Senate bill, the House has to pass that exact bill word for word. It can't have one word missing?

Mr. SHADEGG. I kind of think the American people are fairly bright. I think they see through this. If you are deeming a bill passed in a rule, aren't you actually passing that bill and aren't you voting for that bill? And isn't this just a trick or a scheme to get around the requirement that Members actually vote for the Senate bill? I guess Ms. Pelosi says, this is a quote, it is right here, ``Nobody wants to vote for the Senate bill.'' But when they vote for a rule that says it's deemed passed, aren't they voting for the Senate bill?

Mr. SHADEGG. An elaborate charade. Trickery. If the American people think we are engaged in trickery, why not engage in trickery.

Mr. SHADEGG. There we go. So the reason you wouldn't want to stand on the floor and vote for that Senate bill is not just because of the policy in it, it is because that bill will contain the Cornhusker Kickback, right?

Mr. SHADEGG. It will contain the Louisiana Purchase.

Mr. SHADEGG. Right. It will contain Gator Aid. It apparently contains $100 million for a local hospital in Connecticut that Chris Dodd got in. It contains $1.1 billion for Medicaid in Vermont and Massachusetts. I guess not Arizona or Texas. Our States didn't get that deal, right? No, just those States got the deals because Dodd or Sanders and Kerry got them in, right? It contains, I like this one, $1 billion that Senator Bob Menendez got in for New Jersey drug companies. Pretty good deal. I am not sure I would want to vote for that. My constituents might say, well, Congressman, why didn't you get a billion dollars for some companies in Arizona? It contains $1 billion for Menendez. We are talking serious money when you go to John Kerry and Debbie Stabenow. They got in $5 billion for union health care plans in Massachusetts and Michigan. You already talked about the provision, the Florida Gator Aid, I guess, Medicare Advantage. I will tell you this is one that my constituents find offensive. Arizona has lots of people on Medicare Advantage. Apparently Senator Bill Nelson of Florida got in a provision saying Medicare Advantage won't be cut in Florida. I don't know how I go home and explain to my Arizona colleagues that it will be cut in Arizona. But I really don't know, since I am going to vote against this bill, how my Arizona colleagues go home--by the way, the press reported that the President wanted some of these special deals taken out. But AP reported over the weekend that these Senators don't want those special deals taken out. I think I agree with Nancy Pelosi. She said nobody wants to vote for the Senate bill because of all this junk, all of these secret special deals. So somehow they are going to not vote for it but they are still going to pass it? How do you do that under the Constitution? Maybe our colleague from Texas can tell us how you can pass something without voting on it. I guess Newt said it today, there was a point in time when Members of Congress didn't read the bills that they passed. Now they are not going to vote on the bills that they pass. So what do we need to be here for?

Mr. SHADEGG. I am trying to understand this. So if the Medicare Advantage participants in Arizona who are having their Medicare Advantage cut, and the Medicare Advantage participants in Florida who are not, under the Gator Aid that Senator Bill Nelson cut, that special deal, having their Medicare Advantage cut, if the House only deems the bill passed, can they sue and can they win? Or will the courts say, well, no, no, no, your Congressman may have said he didn't vote for the bill, he just deemed it passed, but trust me, we, the courts say he did vote for the bill. And so Arizona taxpayers on Medicare Advantage lose out, Florida taxpayers because of Bill Nelson and the special deal he cut currently in the Senate bill, which you say can't have a word changed when it comes here, they win out. Pretty good deal. By the way, I look at some of these other deals, there is special funding for coal miners in Montana. There is just provision after provision. In North Dakota there are special provisions providing higher Medicare payments there. There are special provisions for Hawaii that apparently the two Hawaii Senators got in. There are special provisions for longshoremen in Oregon. You know, this thing looks to me like it is chockablock full of special deals for special Members, special Senators who say, well, you know, I want a special deal or I won't vote for it. No wonder Ms. Pelosi says, and I quote, ``Nobody wants to vote for the Senate bill.'' But doesn't the Constitution say they either got to vote for it or it don't pass?

Mr. SHADEGG. Wait. Wait. Let me guess. Could it be AARP?

Mr. SHADEGG. Maybe they got a better deal out of this.

Mr. SHADEGG. So AARP likes it and PhRMA, which are big drug companies, like it. All of the big insurance companies like it because you're mandated to buy their product. And there is no public option competing with them, and they don't have to compete across State lines. Looks to me like all of the big guys really like this bill. They like the fact that they are getting lots out of it. What does Joe Six-Pack get? Let me make a point. I put up a quote here from Speaker Pelosi. She said it on March 9. ``But we have to pass the bill so that you can find out what is in it, away from the fog of the controversy.'' Wow. Pretty stunning quote. Maybe those are things she doesn't want you to find out until after we pass it. I know the gentleman has a point to make. I just want to point out. Talking about deals in the bill and special deals for health insurance companies. According to The Boston Globe of December 22, 2009, the Senate bill waives from any annual fee on health insurance companies certain additional fees, and this provision exempts two insurance companies, Blue Shield-Blue Cross of Nebraska and Blue Cross-Blue Shield of Michigan. That might be one more of those special deals put in there by a couple of powerful Senators, Ben Nelson of Nebraska and Debbie Stabenow of Michigan, cut a little deal for a couple of Blue Cross-Blue Shield Nebraska and Michigan companies--maybe that is what Mrs. Pelosi meant when she said, But we have to pass the bill so that you can find out what is in it.

Mr. SHADEGG

Mr. SHADEGG. I thank the Speaker. I would like to begin an hour where I hope to discuss with my colleagues and with the American people the extraordinary situation we face with respect to health care reform here in the United States House. I believe most people across America know that we have been debating health care reform for almost a year now--actually, quite frankly, a little over a year now. And I think most Americans agree with me and probably with almost everybody who comes to this floor that our health care system needs to be reformed. I have been a passionate advocate for health care reform since I was elected in 1994. I believe I have written more health care reform proposals and introduced them in this Congress than perhaps any other Member who began serving in 1995 or thereafter. I began working on patients' bill of rights legislation, and have moved onto comprehensive reform legislation because I think our system can be much better than it currently is. Indeed, if you look at it, the President is absolutely right that the cost of health care is going up dramatically faster than the cost of all of the other goods and services we buy in our society. And the President is right that that increase in cost is not sustainable over time. We have got to rein in this spiking cost of health care, the spike in the cost of health insurance premiums. Unfortunately, I don't believe the President is right about the manner in which he wants to go about it. I believe we are being confronted with an effort now to cram through this House, as early perhaps as next week, legislation which is proposed to reform health care in America, but will not do that. Certainly it will not rein in costs. I want to reiterate I am a supporter of health care reform. I not only think we need to take steps to rein in the cost of health care, I believe we need to address other problems, such as preexisting conditions. I happen to have an older sister who is a breast cancer survivor, thankfully. She is now almost a 20-year breast cancer survivor. And she at certain points in her career, because of her breast cancer, could have been placed into a situation where she would have been denied care or denied coverage by a health insurance company because she had a preexisting condition of breast cancer. But there are lots of ideas out there to deal with the problem of preexisting conditions rather than the heavy-handed edict or mandate which is in the President's legislation. I am joined right now by one of my colleagues, Dr. Roe from Tennessee, and I would like to conduct this particular hour in an informal fashion where each of us talk about issues within the health care bill that is going to be before us as early as next week and kind of banter those back and forth and try to make this interesting for the people of America to look at what we are being confronted with to confront the issue of is this a better bill to pass than so-called ``doing nothing.'' And I think the answer to that is fairly clear. I believe this bill would be disastrous. Let me begin by yielding some time to my colleague, Mr. Roe, and let him give you some of his thoughts on what we confront at this point.

Mr. SHADEGG. If I can jump in, let me just talk about an update with the experience of the State of Arizona. I happen to have here a letter dated yesterday from the Governor of Arizona. And she explains, Governor Janice Brewer of the State of Arizona, my Governor, explains that our State is already taking a deep financial hit as a result of the economy. We have had a loss of State revenues in excess of 30 percent. This letter is from the Governor to the President of the United States. And I just think some of the points the letter makes reiterate what you have just said, Doctor, and I think they are important for the people of America to understand. She writes, ``As the Governor of a State that is bleeding red ink,'' this is a direct quote, ``I am imploring our congressional delegation to vote against your proposal to expand government health care and to help vote it down. The reason for my position is simple: we cannot afford it.'' She said, based on our own experience with government health care expansion, we doubt the rest of America can afford it. She then goes on to lay out the extra burdens that that legislation will place unfairly, in her view, on the State of Arizona. She says, ``Unfortunately, your proposal to further expand government health care does not fix the problem we face in Arizona. In fact, it makes our situation much worse, exacerbating our State's fiscal woes by billions of dollars.'' And she cites a series of points. One, it makes Arizonans pay twice to fund other States' expansions. She writes, ``Your proposal continues the inequities established in the Senate health bill''--by the way, that is the very bill we are being asked to pass verbatim without changing so much as a comma, because we can't change a comma--``with regard to early expansion States. It is clear it will not fully cover the costs we,'' the State of Arizona, ``will experience as a result of the mandated expansion. Therefore, Arizona taxpayers will have the misfortune to pay twice: once for our program and once more for the higher match for other States.'' She then says, ``It makes States responsible for financing national health care.'' I won't read the entire paragraph, but she says, ``For 28 years, Arizona and the Federal Government have been partners in administering the Medicaid program. However,'' she writes, ``under your proposal, more power is centralized in Washington, D.C., and the States become just another financing mechanism.'' Now, that might not be bad, but she points out, ``Not only will States be forced to pay for this massive new entitlement program, but our ability,'' Arizona's ability, ``to control the costs of our existing program will be limited.'' She then says it creates a massive new entitlement program which our country cannot afford. And her letter says, Your proposal creates a program that does not have the resources and our country does not have the resources to support. I think the point is made that it is great to have good intentions, but it is important to be able to pay for these programs. And this is simply one Governor of I think many Governors who are deeply concerned that what we are doing is expanding the health care entitlement on the backs of States already in deep financial trouble.

Mr. SHADEGG. I think it is important to understand the burden that this legislation does place on our economy at a time when we ought to be focused on jobs. I know when I go home on the weekends, I encounter many of my constituents. I get to see them at the Safeway or the Home Depot. I have to tell you, quite frankly, and I don't understand why the President and the majority don't get this message, but they do not come up to me and say: Congressman, when are you going to fix health care? I'm deeply worried about it. What they come up to me and say is: Congressman, what are you doing about this economy? I need a job. My son just graduated from college, and he can't get a job. That is where they are. But one of the issues I want to focus on in this hour goes to how we propose to pass this legislation because I think it shows that we are not a functioning institution and are not doing what the people want, and that they have reason to be, quite frankly, very upset with us. Speaker Pelosi, when she ran and captured the majority in 2006, said she was going to have the cleanest, most ethical Congress in history. You can debate that issue. I personally believe it has been the least procedurally open Congress I have ever seen. But I at least hoped that she would fulfill the promise Republicans had made of no special deals. And when President Obama campaigned and said he was going to bring America change we could believe in, and he was, for example, going to negotiate this bill on C- SPAN, I had hoped that, well, maybe you might not attain that goal but that at least there would be fewer backroom deals. But it is absolutely stunning to me, and I think it ought to be stunning to every Member of this body, and stunning to every American, that not only have we not cleaned the process up, but we have seen in the year that we have debated this bill, the most outrageous examples of backroom deals in the composition or construction of this bill ever in at least the history that I have been here since 1995. It is important to understand that every one of those backroom deals, every one of those special deals cut with Members of the United States Senate and put into the Senate-passed bill, will have to be voted upon as a part in the bill that passes the U.S. House. We are now being asked to vote for, my colleagues on the Democrat side, are being asked to vote for a bill that contains the Corn Husker Kickback and that contains the Louisiana Purchase, that contains a special provision for a Connecticut hospital. Let me just document those because I think it is important to understand. The latest trick is somehow we are going to avoid that because the majority is going to simply pass a rule deeming the Senate bill passed. If that is not a charade to trick the American people, I don't know what is. But I will tell you this, these provisions are in that bill: number one, the Louisiana Purchase. According to The Washington Post on November 22, 2009, their headline, ``Sweeteners For the South.'' The bill in section 2006 provides a special adjustment of $300 million to aid or to provide for the State Medicaid program, and the only State that would qualify, the State of Louisiana. It sounds like a sweetheart deal to me. It sounds like a backroom deal that the American people thought wasn't going to happen any more. Second, according to Politico, December 20, 2009, ``Health bill money for hospitals sought by Dodd.'' Section 10502 of the bill, this is the bill we will vote upon or we will deem passed, so you can go on the Internet and look at it, go and look at section 10502, provides $100 million for the University of Connecticut Hospital. I don't know about you, Dr. Roe, but I didn't get $100 million for a hospital in the State of Arizona in this bill. Item number 3, Politico, February 3, 2010, headline, ``Democrats protect backroom deals.'' This one is pretty interesting. It appears that Vermont, represented by Senator Bernie Sanders, John Kerry representing Massachusetts, were able to find in the bill, or put into the bill in section 10201, $1.1 billion for the States of Vermont and Massachusetts for their Medicaid program. Now I have had my staff go over the bill and I am looking for Arizona's $1.1 billion. Or, since those two States split it, it turns out to be $600 million for Vermont and $500 million for Massachusetts. I looked around to see if I could find $500 million or $600 million for Arizona, but it is not there. But every Member of this body, I think as early as next week, or maybe the week after, is going to get to vote on that special deal. They can't change a word of it. So if your congressman says oh, no, I'm not voting for that, that is wrong because it will be in the bill. I have many more of these to go over.

Mr. SHADEGG. Wait, wait. So you are suggesting that they find the bill a bad idea, so they had to find a special deal, or a sweetener, to get their vote? Shocking.

Mr. SHADEGG. I think you make a fascinating point. Clearly, the American people get it. They believe the health care system delivers quality care, but a lot of people are left out. Indeed, many of my friends in Arizona point out, way too many people are left out. The uninsured are left out. Many of the uninsured are people who are just not lucky enough to get employer-provided care. One of the moral outrages I find in America's political system is that we say if you work for a big employer, let's say you work for General Motors or you work for in my State Intel or Motorola. You get employer-provided health care. You know what that is? It is tax free. But if you own a lawn service or a small corner garage and you don't get employer-provided health care, and your employees don't get employer-provided health care, they have to go out and buy health care on their own. That might be okay. I actually think it is better when you buy your own policy, but here is what the Federal Government does to those people. They say we want you, the guy who works for the lawn service or the guy who works for the corner garage that can't provide employer-provided health care, we want you to go out and buy health care, and we want it so much that we are going to make you buy it with after-tax dollars. That is to say that we are going to charge you at least a third more. I want to make the point that we can fix that inequity and let every American buy health care tax free, just like their employers can, but this bill doesn't do it.

Mr. SHADEGG. If that bill solved that one thing, if it just said to the average American who doesn't get employer-provided insurance, we will let you buy it tax free, like the people who get it from their employer, we would solve a huge amount of the problem of uninsured Americans who can't get care. But it doesn't do that. Let's talk about what it does do, because I only went through some of them. Let's talk about how this is the cleanest, most ethical Congress in history, and how we have change you can believe in. Well, here are some of the things you can believe in. The bill has $1 billion, according to The Wall Street Journal in an article published on October 15, called ``States of Personal Privilege.'' This article says that there is $1 billion in the bill to assist New Jersey's biotech companies, and they get that subsidy, put in there, according to the article, by Senator Bob Menendez, Democrat from New Jersey. Apparently he didn't think it was a particularly good bill, not good enough until he got $1 billion in there for drug company research, at least according to The Wall Street Journal, one more special deal. But wait, there is more. Let's look at an article in The Wall Street Journal, same article, October 15, 2009, ``States Of Personal Privilege.'' It points out that Massachusetts--one of their United States Senators is John Kerry--or Michigan--one of their Senators is Debbie Stabenow--get, and these guys are not pikers, they get $5 billion, with a ``b,'' $5 billion in a, I would suggest, a special deal, backroom deal, certainly a deal I didn't get, for union members that happen to live in Michigan and Massachusetts. You know, I guess it is a good deal if you can get it. You suggest maybe that persuaded them to support this bill that we now get to vote for, and I assume my Democrat colleagues are going to say, Look, we want all that stuff stripped out of the bill. The President says he is going to strip some out. But, quite frankly, I don't think that he is talking about stripping out many of these. They won't be stripped out from the bill we vote upon.

Mr. SHADEGG. I presume that makes those Senators who got these deals into the bill that aren't going to be stripped very happy.

Mr. SHADEGG. Pretty stunning when you discover that, for example, lots of people can't find a doctor that will take them as a Medicare patient. And even more so, unfortunately America's poorest, who do get Medicaid, a program that some would advocate expanding, cannot find a doctor who will treat them under Medicaid because the reimbursement rates are so low. You know, we're mixing a discussion here of kind of the things that are procedurally wrong with the bill because they must pass, here in the House, the Senate bill exactly as it passed the Senate. We're talking about the special deals that are in that bill. But I think we ought to also be talking about this whole notion about do Republicans have any ideas. What is it that we would do? I've already talked about one. I said, look, if you fix the Tax Code so that every single American could buy health insurance tax free, just like those who get it from their employer, you would go, instantaneously, just with that one fix, toward solving I think the single biggest inequity in American Society. We say to the lucky, who work for big employers, you get tax-free health care. We say to the unlucky, you don't; you've got to buy it with after-tax dollars. But that isn't fixed in this bill. But let's talk about another, since Republicans don't have any ideas--I'm saying that facetiously--let's talk about another Republican idea. I mentioned in my introductory remarks that I have an older sister who is a breast cancer survivor. Fortunately, she has now survived breast cancer for more than 20 years. That has focused my attention on the issue of preexisting conditions. I don't know a single Republican bill that does not solve the problem of preexisting conditions. Now, let me see if I understand this: the Democrats want to solve the problem of preexisting conditions; Republicans want to solve the problem of preexisting conditions. I know of nobody on that side of the aisle who says, yup, you ought to be able to be denied care because you once had and survived cancer or heart disease. I don't know anybody on this side of the aisle who says you ought to be able to be denied care because you once had cancer or heart disease. We all agree it's a problem that needs to be solved. Indeed, back in 2006, this Congress, when there was a Republican majority, passed legislation to deal with preexisting conditions and the Senate adopted it. It passed the House by a voice vote, it passed the Senate by unanimous consent, and it was signed into law by the President. Nobody remembers it. I happen to remember it because I wrote it. But let's talk about what it would do because, unfortunately, my colleagues on the other side of the aisle and President Obama and Secretary Sebelius apparently don't understand it. Let me explain how it works. This is legislation that would create high-risk pools. The bill offered money to every State in the Nation to create a State-based high-risk pool, do the administrative work of creating that pool, and then it offered additional money to help pay for the pool. Now, the average American out there listening might not know how a high-risk pool works. Well, here is how a high-risk pool works: If you live in the State of Tennessee and they created a State-based high-risk pool, or the State of Arizona, my home State, and you are denied coverage like my older sister because you had breast cancer or denied coverage because you had, say, heart bypass surgery, you would have a right to go to the State-based high-risk pool, you would have the right to buy insurance, you could not be denied coverage, and you could not be charged more than, we'll say, 110 or 120 percent of what they would charge someone that didn't have that preexisting condition. Now, that would mean that everyone with a preexisting condition could join the high-risk pool. Now, here's how a high-risk pool works: the people in the high-risk pool do not pay the cost of its care because naturally if there is a cap on their premiums of 110 or 120 percent of the cost of a healthy person, they wouldn't have enough money to pay. So the extra cost for those people who are admittedly high risk, admittedly sick, is borne either by all of the taxpayers in the State through a tax subsidy, or by all the people in the State who purchase insurance because it is a levy on all the insurance companies in the State. There is also risk readjustment that's been proposed. But all of these are concepts whereby the healthy in a given State help pay for the care of the sick. Now, here's what I'm stunned by: at the White House summit on health care, the President described State high-risk pools, or high-risk pools, and he said, oh, those don't work very well because you just put all the sick people in them and over time their premiums go up. Secretary Sebelius said, no, high-risk pools don't work because you put the sick in them and you give them no help with their premiums. I've got news for the President and news for Secretary Sebelius: no high-risk pool in America works the way the President described it, one. No high-risk pool in America works the way Secretary Sebelius described it. In point of fact, they don't work by putting the sick people in and expecting the premiums paid by the sick people to take care of their care. They are put in the high-risk pool so that healthy people can be assessed a fee to help care for the extra care and services needed by the sick. And in point of fact, they work quite well. We could and should expand them dramatically, and the costs are spread amongst the healthy. Now, why do people agree to that? Well, it's very obvious. It's because you and I don't know that tomorrow we won't be the one with breast cancer or the one with heart disease and need to be in the high-risk pool ourselves. So we are supposedly having an educated debate where the Secretary of Health and Human Services and the President, who sponsored the summit, don't even understand how a high-risk pool works. That's an idea that Republicans have put on the table. I guess if Democrats are going to say we don't have ideas, it's because they don't understand our ideas. Does Tennessee have a high-risk pool, and is that how they work?

Mr. SHADEGG. As I understand it, we first talked about a Republican idea of saying let everyone buy health insurance tax free. Republican idea. That would take care of the little guy who's paying an outrageous after-tax price for his health care. One Republican solution not in this bill. We've talked about high-risk pools so that people who have a preexisting condition--and they may have diabetes or something very expensive to treat--they can get help from those who are healthy in the State; they actually get a subsidy. Second Republican idea not in this bill. The President says it's in, but it's in as a temporary measure and taken right back out. Now you're talking about a third Republican idea, which is that we allow people in the individual market to buy health insurance across State lines, increase their competition. It sounds to me like there are ideas coming from our side of the aisle. I guess I would like to know, why don't we, rather than doing one big massive bill some 2,000 pages long that according to what I've read at least 56 percent of Americans don't want, that at least 78 percent of Americans believe will cause the cost of government to go up and cause the cost of their premiums to go up, why don't we just pass individual bills, one, to allow people to buy health insurance tax free; two, one to allow people to join either a State or a national high-risk pool; three, a bill that will allow people to buy health insurance in the individual market across State lines and enjoy the competition of not having to pick from just Blue Cross Blue Shield of Alabama, but be able to pick from Blue Cross Blue Shield across the country or 20 other companies. Couldn't we do that on a piece-by-piece basis, do one bill and then the other bill and then the other bill?

Mr. SHADEGG. I don't think I could eat an elephant in one bite.