that's 12 million people. they have chosen not to participate in those programs. you know, this is the freest, greatest country in the world. we are allowed in this country to make decisions, lots and lots of decisions. and i find it really interesting that our friends on the other side want to push choice that destroys unborn babies, but when it comes to choice for school, when it comes for choice not to participate in a government program, they're not so keen on that. but we do have 12 million people who have chosen not to go into medicare, medicaid or schip. that's their choice. then we have 9.1 million who are only temporarily uninsured. that means for maybe a month out of the year in between jobs or

for other reasons, they might be uninsured, but they are not uninsured all the time. that is just for a brief period of time. that is another 9.1 million. . then there are 7.3 million who make over $70,000 a year. but most of them are young people who don't feel the need to do it. i talked to a lady on the phone tonight who used to own a small business and she said that it was all men and they were between the ages of 20 and 35. and she said, we had the lowest rates for insurance of anybody because those people don't get sick very often and don't need a lot of insurance and insurance obviously is calibrated on facts related to the age and the usage and so she said it was very low

rates at that time. so a lot of people who are in that age range don't see the need to get insurance. so that's 7.3 million. that brings us down to 7 dollar 8 million who have -- 7.8 million who have lower income and long-term uninsured. these are people who probably would like to have insurance but they feel they can't afford it. that's the number of people that we need to be serving in this country. we do not need to turn our culture completely upside down, which is what the proposal from the democrats is in terms of health care. give government control of our lives to take care of 7.8 million people. that would be a relatively inexpensive thing to do when you're talking about trillions of dollars. now, i believe as my colleague

has mentioned that we need to reform medicare and medicaid, i believe in that, i think we should be doing better in those areas, we could make those programs better. we could have a higher quality of care, i believe, and, again, more choices for our seniors and for those who need those programs. but we simply do not need to redo the entire health care system in this country to take care of 7.8 million people. we know that american people are hurting, republicans know that we need reform. and i want to go back to what our colleagues on the other side of the aisle keep saying, but saying it isn't going to make it true. they keep saying, republicans don't want to do anything. they talk about our being the do nothing group. that is simply not true. it was republicans who

instituted health savings accounts and it's one of the things that the democrats most hate because, again, it gives people choices. it allows people to build wealth. if they put that money into health savings accounts and they don't use it, they keep it. if you put money into insurance and you don't use it, it's gone. we believe in building wealth and allowing individuals to do that. we believe in continuing the good habits that this country has fostered over the years, again, keeping the government out of our lives, keeping the government from running our lives, from cradle to grave, and letting people make their own decisions and continuing to make this country the great country that it is. the only country i know of where people are struggling to get into.

and i'd like to yield back to my colleague from texas because i know he has some great stories to tell about issues related to health care and some experiences, more experiences to talk about and so i'd like to yield back. mr. gohmert: i thank the gentlelady for yielding back, but i thank her even more for her insightful comments and explanations about those who are without insurance and what the real number is that we're talking about. and the real number that we really need to do something to assist. that is so immensely helpful. but i was struck last week, too, that during debate over the health care issue and some on this side of the aisle were giving story after story, true stories, of just terrible things that had happened and people died, suffered immensely under health care in england or canada because the long waiting lists

that people get put on to get either diagnosed, to find out if there's a problem or what the problem is, and then whatever the therapeutic need is, whether it's surgery, radiation, whatever, how long they waited and some died while waiting for that. and we had a friend across the aisle get up and say that, you know, gee, folks here are talking about canada and england and their health care, no, we're not going to be like them. we're america, we always do things better. and i was so struck by that comment because for a couple of decades we've been hearing people on the other side of the aisle talk about we need health care like england, we need health care like canada. and that's been going on for a number of years, pointing to canada, look, we need to be like canada. we heard that over and over and then when we start getting into the nitty gritty and just

exactly how people are getting treated in canada and england, the great examples we've heard for so many years, and we start pointing out, these are not good systems you've been telling us we need to imitate and emulate, then we get the response, well, we're america, we'll certainly do it better than they did. well, the trouble is, it doesn't matter what your country is, when you pursue socialism and the united states government or any other government, try to -- trying to take over health care and run health care, you're headed for trouble. it's socialized medicine. i was an exchange student in the soviet union back in 1973 for a summer. we went to hospitals, medical schools, there were eight of us allowed in on that program in the soviet union that year. and, anyway, i don't want socialized medicine.

i've seen it. and now we have friends across the aisle who have admitted this week that really, you know, the public option they've been pushing for, it's just a way to finally get to the single payer health care where the government runs everything. and my friends, mr. speaker, should know that once the government pays for everybody's health care, then they will have every right to tell you how to live. to tell you what you can eat, tell you where you can go, if it's too dangerous, not -- once they pay the health care then freedom and liberty that has been known in this country will be so dramatically impeded. we don't have to go there. we don't have to go there. and when you use common sense, which i'm told in washington is not so common, you use common

sense and you see that we're already probably by now spending $10,000 from every household in america on average to just give 90 million people health care and you realize, good grief, we could do better than that. if we just bought them the best sterling silver golden health care in the world, gave them that kind of coverage, and there are some things that need to be done so the insurance companies don't create problems and impede your freedom there, too, and you give them money for their own health savings account that they completely control and it ends up being cheaper, that's a real solution. you give senior citizen complete control for the first time since medicare came into existence and then you give them complete coverage like they've never had. never had. so that's a rather significant

development. and a few other things i'd like to point out that are proposed in my bill, because i am sick of people saying -- sitting across -- saying across the aisle that we don't want to do anything about health care, we like the status quo. folks, we cannot stand to do the status quo. we have got to make some changes or it is going to bankrupt this country. we can do better. and this is one proposal that will. one of the things we've got to have is complete transparency in health care costs because we sure don't have it now. not even close. you know, i've asked before myself, you know, what's this going to cost? well, it all depends. and it does. which insurance company you got, if you don't have insurance, then that's another cause, but they may give you a little discount but even if they do, it's not as cheap as could you if you were an insurance company like blue cross.

well, under my proposal, under this plan, you would have complete transparency because every health care provider would have to disclose to you exactly what the cost is. and if they're proposing a cost that's different to you than what they've charged to some insurance company then they have to tell that you and they have to tell you how much they charge to these other entities. that's part of the bill. because we got to get away from this insane billing system where a hospital may bill $1,000, $1,500 for a room for a night hoping they'll get back $100 or $150. but i'm personally aware, was involved in a situation, not my personal situation, but very familiar with it, i was involved with with where there was a car wreck and a man ran a stopsign -- stop sign and the

hospitalization for two days, testing, all the doctors, the ambulance, everything came to around $10,000. that was the total of all the bills. and as an attorney you gather together all those bills and you provide them to the insurance company of the auto insurance company that it is of whoever's at fault and they provide, often they'll work out of settlement with you and in that case money was put into escrows a parishionered -- required under state law and then the state law requires before any of the proceeds of the settlement can be dispushed, it has to first refund any money that any health care provider or insurance company has provided on behalf of the injured party. so in accumulating the documentation, again, it was around $10,000 total, the

documentation came back from all of the providers, that they had everyone been paid in full, paid in full, by the health insurance company of the injured driver. so then what's required is everybody's been paid in full under their agreement with the health insurance company, so then you have to get documentation from the health insurance company, ok, show us how much you paid to all these different health care providers, hospital, ambulance, tests, doctors, all that stuff, show us how much you paid to satisfy the $10,000 in health care costs and you'll be cut a check for that amount, be sent right on out to you, and the documentation came as to how much the insurance company paid and full satisfaction of $10,000 in health care costs and it was right at $800.

to satisfy $10,000 in claims in medical claims. so if you're the party and you get these claims, you go, oh, my word, this is $10,000 of health care costs? thank goodness i have insurance. i sure couldn't afford $10,000, when if you knew the real truth, that it was being paid in full with $800, you might realize, gee, you don't need as much insurance as you thought you did. you could buy cheaper insurance and have a high deductible and your insurance would be cheaper. with the proposal for everybody would cover everybody, medicare, medicaid, and schip, any combination, we give them cash in their account they control and then buy insurance on top of that. and it will save this government money, states money, and it

gives dignity back to seniors who have had to beg the government, beg their supplemental carriers, get in arguments -- that would have to cease and that would cease and it should and as a federal government we should see to that, not creating greater slaves to the federal governments. another thing that this bill would do, and, again, a republican bill, as i'm tired of hearing people say, nobody on our side -- there were numerous wonderful plans that are being proposed on the republican side of the aisle, but we're not the majority so the majority can control and keep everyone of these great ideas from coming to the floor. but in my proposal it also addresses and provides great incentives for employers to pay money into individuals' health savings account. .

it would be yours. it's in the bill. coded to cover things that are health-care related. and then you would have a high deductible insurance to cover things above the health savings account amount. but since young people hardly cost anything, young people in their 20's, 30's, they would be accumluating vast amounts of money in their health savings account, so by the time they got to be seniors, the government wouldn't need to pay anything, because they have already got so much in their health savings account, they can buy their own health insurance and pay for whatever they need, have high deductible insurance and there are some statistics that have been put together that show that young people can pay for the best assisted living they could ever need, special needs. it would be addressed. and that would be the way you get off this road to $22

trillion it's been estimated we are heading toward with the medicare system we're on right now. and for those who have been desensitized by president bush requesting last fall and president obama requesting $700 billion, $400 billion omnibus bill and getting the original bailout money for secretary geithner to throw around at his friends as he sees fit. people have been desensitized. but so it can be put into percent perfecttive, the total amount received by the u.s. treasury for tax year 2008 was going to be around $2.5 trillion. and we have medicare that is

running through the roof and will break this country at the same time seniors, relatives of mine that i love and care about, they're having to buy supplemental insurance because it doesn't care of what they need. they are fussing with their insurance company, fussing with medicare. it is ridiculous to get your last days on earth and fuss over that kind of stuff, it's absurd. we don't have to do that. another issue with regard to health care, not only transparency of costs, but it is an issue with regard to migrants, legal and illegal getting free health care. we have seen clearly, health care costs will bankrupt this country if we don't do something to save this nation, and we can. it's doable. but we have got to get back to reality.

it's estimated that there are over 1.5 billion people in the world who would like to come into the united states legally or illegally. they would like to come into this country. well, we have over 300 million americans right now. if 1.5 billion came in, it would overwhelm everything and we would be bankrupt overnight, because we could not absorb that kind of thing. so at some point, we have got to go back as our forefathers did and say, the rule of law means something. that's why we have a top economy in the world and the friends in mexico don't. they have hard working people. they've got incredible national resources, but they're not one of the top 10 economies because they have not been a nation of laws, where the rule of law

mattered. they have been a country where graft and corruption all too often was the rule of the day, not the rule of law. you could bribe your way out of things. and that is why they have not advanced. well, we don't need to foresake the rule of law. i'm all for having all the visas we need to supply the workers we need. right now, we don't need a lot of workers, because there are a lot of out-of-work americans. all this talk about jobs americans won't do, we had a hearing in the crime subcommittee in the last couple of weeks and we found out that just over 200,000 people incarcerated in federal prison, 53,000 of them are migrants,

immigrants in the country and we were told most of them were illegal immigrants. we didn't get the exact number. but over 25% of people in federal prison are not american citizens and most of those 53,000 are illegally here. well, people who are illegally here and are not paying for health care will bankrupt this country if we allow this to go unabated. and some of us care enough about our contribution as the greatest fill and thropic country in the world's history and we would like to continue to dworld's hi like to continue to do that that we need thm economy going forward in good measure. part of this proposal and part of this bill is that if you are seeking a visa to come into this country, you will have to show proof that you have a health savings account, health

insurance to cover your health needs while you're here. there is a provision rgs, employers can set up health care costs to cover health care costs while they're here and that will satisfy the requirement. you can show proof that the household you will be living in will allow you to be part of their household insurance and health savings account, but you are going to have to provide that or else you don't get a visa and not one renewed. not only that, the supreme court in this caring nation says if you present yourself while you are here illegally in this country, we'll provide the health care needs. that's the law. but once we got you well enough to travel, you will be deported. and because a bankrupt nation is a matter of national security, then if you come back after you have been illegally here and

required free treatment, free to you, but at a huge cost to the american taxpayer, that will be a crime, that you came in illegally, got free health care and after being deported, you came back in, that is a crime. we have got to stop that, so we continue to be the kirnede of nation that 1.5 billion people would like to come to and people around the world can receive the charity of this nation otherwise a bankrupt nation can't help anybody. mr. speaker, i would like to inquire how many minutes do i have left? the speaker pro tempore: six minutes. mr. gohmert: thank you, mr. speaker. i'd also like to point out that

under this health care plan, insurance whether purchased by the employer, purchased by the federal government, purchased by the individual, it will be totally owned by the individuals that have the insurance, which means it's fully portable. there will be provisions that you can't be dropped because of pre-exist iing conditions because we have to get things back on keel and it would be helpful to do that. i would just like to encourage, mr. speaker, those who are beginning to think -- and i was on a telephone town hall conference tonight before i came over that had thousands of people on that call and we asked the question, how many would like for the government to run health care and we had right at 98% say they absolutely did not want the government running health care. they know too much about it

themselves. we asked how many people were satisfied with their own health insurance or their health care situation, and the vast majority were. so, we don't have to redo the entire system. we don't. but we can do better than we are. and my republican friends i have talked to especially in the last couple of weeks, like this idea. and we will be getting that filed. and we'll get it scored. but there's an opportunity to show the caring heart of americans. and in a different way from what my colleagues acss the aisle was saying when he said as americans we can do what he was talking about socialized medicine better here than they've done it, not as socialized medicine, but as americans, we can do better.

i never seek to impose my religious beliefs on anyone else, but i think it's important to know history and where we are and i would like to conclude that it may be a word of encouragement to people that when the washington monument was dedicated, there was a four-sided capstone that was put on there. there is writing on all four sides, but on the side facing the capitol up here this way are the latin words, praise be to god. that's on top of the washington monument. that is the tallest point in washington, d.c. those people back then put praise be to the god on the side facing the capitol for this reason. this is east of the washington monument. this is the side from which the side comes up. they wanted to make sure that

when god first raised a son that anything in this nation's capitol, it was the words, boom, praise be to god. and that is what i hope americans will be able to say with our founders for many centuries to come. with that, mr. speaker. i yield back. the speaker pro tempore: does the gentleman have a motion to adjourn? mr. gohmert: mr. speaker, before we do any more damage today, i would move now that the house do now adjourn. the speaker pro tempore: the question is on the motion to adjourn. those in favor say aye. those opposed, no. the ayes have it. the motion is agreed to. the motion is agreed to. accordingly, the house stands

>> tomorrow, members are scheduled to consider executive compensation. live coverage when the house returns here on c-span. you are watching public affairs programming on c-span. created by america's tv companies offered as a public service. we will shoot some of today's congressional discussion on health care legislation, including comments from nancy pelosi, and minority leader john binyaboehner.

>> tomorrow, congressman don edwards will take your questions about health care legislation. michelle malkin talks about her book about the obama administration. washington -- "washington journal" is live on c-span every day at 7:00 a.m. eastern. more coverage tomorrow as the health care debate continues in the house. see that live starting at 10:00 a.m. eastern. >> george with signed the declaration of independence. he was also murdered. join us for q&a at 8:00 p.m. eastern and pacific on c-span. >> sunday night, british prime minister gordon brown before the 30 members of the house of

commons liaison committee. he is answering questions on the british economy, the banking crisis, and foreign affairs at 9:00 p.m. on c-span. >> president obama hosted a harvest of -- harvard professor henry louis gates and massachusetts police officer james crowley for a beer at the white house on thursday afternoon. the route the center of a discussion on race and sgt crowley recently arrested mr. gates at his home. the charges were later dropped. the president's comments about the incident led him to invite both men to the white house for what some media outlets referred to as the beer summit. house speaker nancy pelosi says that the health care bill that eventually comes to the floor will be supported by both liberal and as -- and conservative democrats. she spoke with reporters for about 15 minutes. [captioning performed by national captioning institute]

[captions copyright national cable satellite corp. 2009] >> as a mother and grandmother, i'm very excited but the food safety bill that will pass the house later this afternoon. so important, so long overdue and now we will have a president to help sign the bill. today is also a day of celebration. -- for another reason. 40 years ago today, president johnson signed the medicare bill. just think of all the good that has done for our country and for our seniors. we now find ourselves in a similar place to be able to move forward with universal health insurance for all americans. quality, affordable, accessible health care for all. it is pretty exciting, i have to say. it is historic and is a big

challenge. as members go home, they're sending them with a card. i do not have it here. it talks about what is in it for the american people. i think it is important for people to know because this is a kitchen table -- these are kitchen table issues. people's economic security is affected by their health security. under this legislation, no discrimination for pre-existing conditions, no dropping of your coverage because you are sick, no refusal to renew your coverage if you have paid in full. no more job losses or job decisions makinbeing made on the basis of who has health insurance. no excess of out of pocket expenses, the deductible or co pay, you're the caps on what you

pay, but no cap on your benefits. very exciting. these are initiatives that are very important this legislation and they are to correct what the insurance companies have done to america and to the health of our people over the years. it is very clear that what a strong public auction in the legislation. insurance companies are out there in full force, corporate bond in shock and doc against the public option. so much so that when you ask about the plan, they're on certain of it until they tell you what is in it. -- until you tell them what is in it. but when you tell them what is in the plan that changes in 56

in favor. we have great diversity in our caucus, geographic and otherwise, that will be reflected in the legislation. the education and labor committee has reported out its bill and now we're waiting on the energy and commerce committee to put out their bill. these will be posted -- two of them have been posted on the internet for awhile. the third one is reported our, it will be. and the american people will have a chance to see what is in it for them and our members will have a chance to discuss this with their constituents and when they come back into deborah, it will take up the legislation and make it another historic decision for the american people similar to the

legislation that lyndon johnson signed 44 years ago. i will be pleased to take any questions. >> [unintelligible] a lot of liberal members in your caucus, some of them now indicating they will not vote for the reform if it looks like this. what are you telling them and how are you going to reconcile these two different wings of your party that seems so far apart right now? >> first, let me say i do not see it that way. i do not see us as different means. i do not think there was any deal with chairman waxman the proposals made by some in our caucus and who served in our committee was to be a reflection of what they thought would work for their district and i respect that. çbut this is one piece of a try

committee process -- a tri- committee process. at the end of the day, i tell my members that we have to have universal, quality affordable health care for all americans, and we will do that. we will do so working together. >> if you could please give me a yes or no answer on whether or not you personally support expressly prohibiting the funding of abortion through the federally subsidized health care. today, energy and commerce, tomorrow as their work on that bill, may be addressing that issue. >> a congressman says we are

opposing our leadership on the health care bill. how're you going to solve this? >> i'm sorry, i did not hear his statement. he is a valued member of our caucus, a serious member of the energy and commerce committee. he has worked hard to have all views reflected in the bill that will come out of our committee. >> if the agreement with the blue dogs holds up in the final bill, how will the public option insurance be able to compete if it has to negotiate reimbursement rates? >> i am for the strongest possible public option because the president said that is the way you keep the private sector honest, it is how you have true competition as you achieve universal quality, accessible health care for all americans. the language that is in the

proposal by the blue dogs is the exact same language as the bill in the senate. i think there is plenty of common ground as we move forward on this for people who share a common goal and are supportive of common goaloption. >> [unintelligible] does that meet your test of a robust public option? >> senator kennedy's bill is one that i think would be ok. it is not my preference. my preference is a stronger bill. it meets the test of having an effective public option.

we're talking about one committee year and another here and we have to other committees that have a stronger haveoption in them. as the members go home and the public makes their voice heard, then we will see where we go from there. i have enormous respect for senator kennedy. i know he has a lot of support for a public option. i would prefer the language in the ways and means committee or the education and labor committee. >> it was suggested that it might not have been a good idea to set a deadline. do you think a deadline, in retrospect, was a good idea? >> it does not matter. we have worked toward the deadline. if we did not have a deadline, we would not be as far along as we are now with two committees on the verge of doing so.

we're waiting to see what the senate will do. that had some impact on our ability to move forward. and we're still waiting to hear what that is. you have a number of things to do by the time a bill gets to the president's desk. you can be very prepared by the time you vote to go to conference, having a clear understanding of what the other body has to say about it. a lot can be achieved by having a day preparing us to move forward. >> [inaudible] will they be allowed to charge higher premiums? and if so, will there be a cat?

ç>> the competition is an important part as well and thank you for the question because it points to why we need this legislation certainly, for all the reasons that i mentioned and many more, but unless we have this legislation, the upward spiral of health care in our country would not only harm our families and the competitiveness of our businesses, harm the vitality of our economy, but also increase the cost of entitlements. the idea was to have stiffer competition for the insurance companies. >> no discrimination against people with pre-existing

conditions. >> there have been objections to the public's option, but they're also talking about what they think is a disproportionate amount of influence by the blue dogs. do not agree with them that they have had a disproportionate clout in this process? but this happens to be a proposal of four people who happen to be members of the blue dog coalition. the blue dog coalition has not put this proposal forward. these are four individuals of the committee who have said, this is how the bill would work better for me in my district. the treatment of public'soption and its provision works better in certain districts. this is about health care reform that will work.

i do not think there is any disproportionate influence when members speak out in favor of their own constituents. we are not a rubber-stamp congress and we are not able numbers -- a rubber-stamp caucus. nor would i want to be among the leadership of such a caucus. we have tremendous ginettdiversd all of these forces come to bear. it is a great kaleidoscope some days, this half of the room is working these evita's half of the room, some gates it is the back of the room to the front of the room. we are all the resources to each other. every one of our members is valued. everyone of our constituents has our right to be heard as we develop this legislation. it is pretty exciting.

i have been meaning to tell you this for a while, i have a great but that a friend of mine gave me. it has, you might call it a dictionary, but it has big descriptions of how words came into being, or phrases. and one of the phrases is called "thank you, ma'am." franklin roosevelt' use it when they hit a bump in the road. it is just a bump in the road. power became a "thank you, ma'am" is that it probably came from the fact that when a young man was courting a young woman and they were driving down the road and they would hit a bump in the road and she would fall toward him and he would say, thank you, ma'am. so, a bump in the road became equated with "thank you, ma'am.

so, we have a few of those going on around here when we are dealing with a bill of this size. this is all in a day's work. the legislative process, are democrats will be together to vote on comprehensive health care for all americans. it is very exciting. and today will be exciting as the committee moves forward. but do not forget as you go home tonight, food safety, very important. very important to moms and grandparents and dads, too, i'm sure. this is historic. it is about health, as was the regulation of tobacco. it is about health. tomorrow, we'll be talking about the accomplishments in his first seven months of the year and that will be part of how we have advanced not only health care, but the good health of the american people. thank you all very much.

>> thank you, ma'am. ç>> [laughter] >> more about health care legislation from a news conference with a house of liberal democrats from the progressive caucus. the loss a year from the chairs of the black, hispanic, and asian caucus, also known as the tri-caucus. >> hello, everybody, and thank you for being here, tri-caucus and progressive caucus members hanging very strong for reform

that takes care of all americans. we have one major announcement today. we have a letter to the leadership and to the three committee chairs that will during this break -- we will pull the three committees together and all the bills together. >> we have gathered here today to demand that the final health care reform legislation has a robust public option. [applause] cantu gah we will vote against it if it does not. [cheers and applause] the insurance companies have at

the gates to provide the kind of compromise that we need. they have shown that they cannot or will not do it. and 46 million americans do not have insurance. another 25 million are underinsured. costs are skyrocketing. over the last decade, health care costs on average more -- have risen on average more than four times faster than the average worker's wages. in the current medicare provider network and infrastructure and rates -- through the current medicare provider network an industry trend rates will be able to change this. it will provide much-needed competition and it will force the jurors to control the costs. using the medicare provider network we will reduce our costs by $75 billion and ensure the public plan can begin when the new health care exchange is set and ready to go. many of us favor a single payer

system standing up here today. [applause] but we have compromised. we have rallied because we want a plan with a meaningful public option and we can compromise no more. [applause] when leaders of the house meet in august to consider the three bills and produce a final one, we expect that it will retain a row -- a robust public option. if it does not, we will vote against it. [applause] we're gonna have all of the chairs of the caucasus speak today and that we will have a few other members who want to say a few words and then questioned for of long as you choose. barbara lee, chair of the progress of black caucus. [applause] >> thank you very much and thank you for being here.

i am from the nine congressional this trick of california. chair of the congressional black caucus, 42 members strong. for many years, members of the congressional black caucus and our members here have been leading the charge on comprehensive and for comprehensive and health care reform. today, we're closer to providing quality health care to all americans than ever before, but the fight is not over. we must continue to reject these claims that the cost of reforming health care in america is something that our nation cannot afford. we reject that. the money is there to pay for coverage for all americans. to the contrary, if we act -- and if we fail to act now, we do so at the peril of the american people the american taxpayer will continue to suffer from the economic consequences of observing health care costs that are spiraling out of control.

we must act because the quality of life for millions of americansç and the health of or economy hangs in the balance. but to understand all of this, the cornerstone of comprehensive health care reform is a robust public health plan option similar to medicare. medicare has worked. let me be clear, there are many of us who will continue to fight any efforts to water down a robust public health plan option like medicare. we will fight this with every bit of our strength that we have now and until we come together with this three-pronged a bill in the timber. -- in september. [applause] the benefits of a public health plan are obvious. they will guarantee coverage regardless of pre-existing conditions. a public health plan would give patients a choice of doctors and hospitals. and it will build in incentives

for private insurers to lower health-care costs. that is what we want, lower health-care costs. and that is why public health care plan is extremely important. when it comes to the public plan, we know that the congressional black caucus, congressional and hispanic caucus, the congressional asian american pacific caucus speak with one voice. [applause] health care should not be a privilege, as it has been in the past. it is a basic human right and should be a basic human right. that is what we're saying, it should be. [applause] in the wealthiest and most powerful country in the world. i give you know my colleague who chairs the congressional hispanic caucus, the congresswoman from new york. greg thank you, thank you so much. -- >> thank you, thank you so

much. for working families in america, the message is clear, the american public expects for us to pass comprehensive health care reform, one that really provides access to quality health care to every american, especially those working families and the most vulnerable. it is amazing in the richest, most powerful country in the world, 47 million americans every day goes by without access to health insurance. we are here to say we cannot support any deal that short changes in working families and the most vulnerable in our country. i stand here and say that, you know, business as usual is not going to work. it will not be able to support nothing less than a real comprehensive health care. taos is strong -- that has a strong, robust ,optpublic optio.

the only way we can do this is by providing competition and the on the weekend provide competition is by having a public option. [laughter] [applause] we must ask in all of this, where is the accountability for the insurance companies. how do we insure that they are held to higher standards. i know that we're going to go home and i will ask the public to visit members of congress and to share with us is strong commitment and a strong desire to do what is right for all americans. we cannot achieve anything less, nothing less how that will not cover the working poor and the malls to vulnerable. thank you. [applause] >> mike honda, where are you?

from the asian american caucus, come up here. >> thank you, congresswoman. i'm always behind you. first, i want to thank the media for being here because it is true that we will be able to get our stories out. we stand here to support the progressive colleagues in the energy and commerce committee and in the house of representatives to firmly state my unequivocal support for a robust public option. i have listened to the so-called compromise being pushed by the four members of the house. the reason compromise will, one, cost more than the original bill, two, and pose a greater burden on working families, and three, get the public plan, eliminating access to subsidies for families between 300% and 400% of poverty. the people in my district are relying on us to bring to reform

to our district and this is not it. every day, i received calls and the mails to preserve a pop -- a strong publicç option that woud drive down the cost of care and allow more families the protection of health coverage. the private insurance companies have decades -- have had decades to provide meaningful reform to our system. they have failed and congress must now act boldly in order to save lives. at 11% of my constituents in my district, better known as silicon valley, are left without health care coverage completely and more are underinsured. they need a meaningful subsidy structure. my constituents and into joyous across this country will continue to struggle with the high cost of private care. in my district, families below 400% of poverty are barely at the median income level and struggle to buy homes, make

rent, pay for food and gas. a strong public option is necessary to truly reform our health care system and i will not vote for reform without one. let me close with this one thing. a lot of us have come to congress and a lot of us are in office right now because people wanted to change -- wanted a change. we said in the last campaign, "we can do with." now we have to fulfill that word. thank you. [applause] >> thank you very much. i represent the seven districts -- the seventh district in arizona and i am co-chair of the congressional hispanic caucus. all of us know how important -- those of us that are here -- we are at a crossroads in this country. we are at a point where there is no retreat and we can and must hold the line. what are we holding the line on?

we are holding the line on the fact that we come from the beginning, have been promoting single pair and an absence of that -- and that is what happened. we all have to be honest with each other. we are now saying that we must have a mustoption that is -- must have a public option that is meaningful, that has medicare as it provider network, that has medicare plus five as it's great, that we do not negotiate with private insurance companies for the raid on the public option. and this will not be paid off. this will not be paid off the backs of small businesses, working people and poor families. [applause] we are supporting what happened out of ways and means. we are supporting what happened out of education and labor and refined what is happening in energy and commerce unacceptable. we are not obstructionist.

we are advocates. we are here to advocate for the simple right of every person and every american to have an opportunity to have quality health care and equality live in this country. we are not obstructionists. we are not here to divide or embarrass our party. but we are here to remind our party that has democrats, we have some basic values and one of those values is to care in the shared responsibility we have for each other. i am proud to be with the caucus. i'm proud to be with my colleagues today. it is a robust plan. we've got to be clear that we are not in the process of threatening people. we are in the process of confirming. we told you months and months ago, leadership, administration, months and months ago, we are on this ride with you because of the commitment to a strong,

meaningful, robust public option. if it is not there, we are not there. [applause] . . >> we took the seven members that our energy and commerce that are part of the blue dog coalition and looked at their districts collectively. in their districts there were 671,000 people that are uninsured.

6500 families lose their homes and their businesses because of bankruptcy, because of health care costs. we had over 3200 people, almost 40,000 people trapped in that medicare don't hold that with the public auction would not be there. that will cost almost $1 billion or more of compensation for their facilities in their providers. there 99000 small districts -- small businesses that would receive a tax credit. that is part of the strategy. sometimes we play too much chess and do not talk enough with the public. i think the public are going to talk to those same members and say, give us a break, too. right now is about insurance companies and what they need. this is about communicating the general public in saying this is what is in it for you. we have to put that kind of

political pressure on. >> i am curious as to, it allows them to negotiate within a range. >> it detracts from having a strong public auction. >> the problem with the deal that has been struck is that when you negotiate from medicare rates upwards to where the private insurers are, that is sending the cost value up. the goal of a public plan, in addition to all of that coverage we talked about, is to lower costs for all americans. those of us who have health insurance and all americans. the only way that you do that is to have a set rate, medicare plus five, and then you have a competition that is real. and not understand what the

insurers are afraid of. they are afraid of the competition. what i say is that we have a medicare plus 5% set rate that will ensure that we bring the cost curve down. it will insure that we bring people into the system, and will provide quality care. if the insurers believe in the market, we believe in the market. it is important to compete downward on cost and not upward on cost. >> have any of the progressive caucus members signed that letter, and if not, have they given you any indication whether they will support or oppose the deal? >> it would not be appropriate for them to sign the letter. they are in marked right now. -- they are in a mark up right now. we do expect the bill to get out of committee. >> in the month of august, those who are opposed to various forms of health care reform are going

to unleash an onslaught -- that would make it difficult for almost anything to pass. >> there will be a lot of ads. we stand here for americans. we want to save lives. we want a bill that can save lives and reduce costs and is competitive with private insurance. the deal they set out yesterday set a limit on what a public plan would be, and said that private companies can raise their premiums as much as they want. we want an insurance bill that will cover most of americans that is fair, that lowers costs, and you all know the pre- existing conditions and all that is in there. write a good story. 53 boats, and we do not believe we are born to get any republican votes in this bill. -- 70% of americans want a

strong, robust public plan. >> you said you cannot support the bill as it stands without a public auction. are each of the chairman of the various caucuses saying they will not vote as a group unless it has an option? >> we have a letter signed by 53 members saying they will not vote for a plan that does not have a public option. >> the speaker said today that she was for the kennedy public option. is that enough to satiate everyone? >> there is a great deal of affection and love for senator kennedy and the work that he is doing and has done. but i also know the pathway that

senator kennedy family's has walked in. they have walked against the odds and stood for those who could not stand for themselves. i will stand here in the name of senator kennedy, and i believe that in standing in that name, we are standing for those -- i think the numbers are as high as 83% who want a public option because they know that $1,800 are being lost by families every year. do we want to take the flesh of the working people of america by $100 billion on the plan that is being proposed by the blue dogs by cutting the subsidies so that these low income families cannot have a public auction? -- a public option. i stand with the nurses, doctors, health workers, the sick and the downtrodden, the children, i stand with the

victims of h1n1 who have not been able to get into the hospitals today because there is no public option. i will close on this, because i think senator kennedy will understand this. i said this before, and people a quizzical when i say it. i am here today because of the voting rights act of 1965. if we could not unify or push to do the right thing, it could have been a voting rights act that said let's do a study as to whether african-americans need the right to vote. i am not going to support that. we want a vigorous wantoption. -- a vigorous public option. >> what do you think pelosi and reid should do right now to get the needed votes? >> votes on what? >> to be able to pass the health care? >> they have a ways to go.

the next step is to take the three committees and put those bills together. they need a bill that has a robust public option, and then they will have the votes that they need. >> in education and labor their state amendment that passed that did not cost a single vote in the committee that would allow states to do single payer. are you all going to fight to keep that language in the bill? >> i am, and i will let somebody else speak to that. >> absolutely, we will fight to keep the state's right to single paper -- single payer. we are born to vote against a bill that does not have a robust robustoption. we made it very clear. we are wrong to stick together,

and most of all, we want the american people to get out there and let the government know that they want a robust public option. >> wasn't it a mistake not to draw a line in the sand on single payer? >> in terms of a strong option, we understand some are saying no more than one trillion dollars and have added $100 billion. the costs have been added while the expenses for this proposal have been reduced. we are saying, on whose backs does this $100 billion lie. we are insisting that included in a strong and robust public plan, we have to have the resources to pay for that, and prevention is a large part of that. we are not going to accept the most vulnerable, the working

poor to pay for the insurance industry and the profits that they will make if, in fact, this works the way this latest proposal is presented. >> thank you very much. thank you all for coming. >> health care legislation was also one of the toppings at a briefing with house minority leader john boehner. >> good morning, everyone. in february, i said that the era of big government is back, and democrats expected to pay for it. that is exactly what has happened this year. if we look at what has happened , they passed 81 trillion dollars in stimulus package that

no one read, and has not created the jobs the democrats said that it would. as a matter of fact, we have lost some 3 million jobs this year already. in the house passed a national energy tax that will kill jobs by driving up costs for families and small businesses. now they are cutting deals on a government takeover of health care that will raise costs, drive up the deficits, and destroy jobs in america. on health care, it is clear that the more americans hear about the president's health- care plan, the less they like it. in a new npr poll, it shows that more americans oppose the plan and support it. a new gallup poll was out also indicating that the more americans hear about it, the less support it has. the majority of americans are opposed to their plan. higher health-care costs are the

key issue for most americans. they like the coverage they have, but they want lower cost. they do not want to expand government. there is nothing in the democratic proposal that will reduce costs of health insurance for the average american. none of the committee chairmen who are writing this bill have any private sector experience, and for that matter, neither does the president. they have never met a payroll that was not provided by the taxpayer. they have never negotiated a package of benefits or health care package with their employees. nor have they ever had to make a decision about whether to hire an employee or how to handle an increase in insurance premiums. the bill they are writing, i think, reflects that. it is going to raise costs of doing business is for smaller firms, forcing them to make tough decisions like cutting

jobs or cutting benefits. i think the deal cut by some of the blue dogs really does not make it any better. it still includes a job killing small business tax and a health care mandate for those small businesses. it still cuts medicare and choices for seniors, and it still puts the government is are in charge of personal medical decisions that only patients and their doctors ought to be making. it is the same plan that democrats have been trying to ram down americans throats all year. clearly, the american people did not want the government involved in delivering their health care. the one real reforms a drive down costs for themselves and their families. democrats appear ready to leave town for the august recess with a so-called deal in hand. i think it is safe to say that over the august recess, as more americans learn more about their

plan, they are likely to have a very hot summer. with that, i will be happy to take your questions. [inaudible] >> we all know in this town is a lot easier to increase spending and taxes than to cut spending. we saw the president's cabinet come along with their cuts. they have ignored the hundreds of billions of dollars rather cuts that we supplied to the president in a letter several months ago. i am not at all surprised we have not seen any action on the part of the democratic chairman in terms of how that would cut spending.

we do have a reconciliation plan that should be under way this fall and it will be interesting to see how many programs are eliminated or cost savings are found as they move their bill, which inevitably is going to lead to higher taxes. >> it is pretty clear that the big government run program they want is eventually going to crowd out the private sector. in their bill it says that after five years, you cannot buy a health insurance policy on your own. you have to go to one of the government exchanges to buy a plan designed by the government. it is right there in the bill. all you have to do is read it. it is pretty clear that we will have a big, government run system that will eventually drive out the private sector plans we have today. it also says that after five

years, every employer sponsored health-care benefit has to be approved by the department of labor and the new health choices czar to make sure that it meets federal standards. it is pretty clear the government is going to design the health insurance policies that will be out there. >> [inaudible] >> i think the comments are a bit bizarre, but i believe the management of this to the president. >> [inaudible]

>> there are hundreds of health insurance companies out there today that provide a service. they certainly are not lily white in this fight, but most americans like the health insurance they have. they think it costs too much, and i understand that, but there is nothing in their proposal to drive down costs. at the end of day, that is what the american people expect. >> [inaudible]

>> i have a lot of things on my plate, like making sure that our economy gets rolling again, making sure that we get jobs growing in america, trying to stop their national energy tax, trying to stop the government take over of health insurance. i have a lot of things i focus my efforts on. i cannot focus my efforts on everything that happens. >> [inaudible] >> i think the polls are saying clearly that the american people -- >> republicans are not out there criticizing medicare.

>> if you look at both of the plans, they are both going bankrupt at a very fast pace. one of the concerns i have with regard to medicare is that they are going to cut medicare advantage and limit the choices that seniors have today. in my district i have tens of thousands of seniors who are enrolled in a medicare advantage program that they like. it will be severely cut, if not eliminated in their proposal. if you look at their medicaid expansion, they will expect the states to put up tens and tens of billions of dollars more. this is not the direction the american people what. at the end of the day, finding a

way to put these programs on a financially sound basis will probably be the most important thing we can do. >> [inaudible] >> this is not about republicans. this is the american people oppose the opposition that is growing. you see it in the polling. i walked airports. i go to home depot. i have people who stop me nonstop to voice their concerns and their outrage. i spend time traveling around the country. there is a lot about rage out there.

>> are you worried there will be a blue dog deal? >> [inaudible] >> do you think the private sector is divided? >> from most of the private sector associations i have talked to in town, they have serious concerns about the house

democrats' proposal. most of these people have been involved in conversations with the white house. i think they continue to be in conversations in the white house. we have seen muted opposition from a lot of these groups, because they basically have a foot in each camp. these companies and these associations understand that the american people want us to deal with health care reform. both republicans and democrats on capitol hill want to deal with health reform, but we want to do it in a responsible way. throwing the current system under the bus and replacing it with a giant bureaucracy is not what the american people want. we could make the current system work better for more americans at lower-cost, but that has to be the focus, not having 53 new agencies, boards, commissions, and programs, as we see outlined in their bill.

>> [inaudible] >> i have tried to make sure i understand what is in every bill. while i may not have read every word in every bill, the fact is when you file an 1100 page bill at 2:00 a.m. in the morning and you are passing it that day, it is pretty clear no one had read it. when you file a 316-page amendment to the energy bill in the middle of the night, it is pretty clear that no one had read it. yesterday, when you file three different versions of a food safety bill, the morning of the day you are going to pass the bill, it is just not the way legislation should be considered. i was the majority leader at one point. i understand what the

responsibility is. i do not remember an instance, not one instance where we did not make sure that the bill laid over for a least 24 hours so members had a chance to read it. the american people expect us to know what we are voting on. i think it is our obligation and responsibility as members to know what it is we are going on. thank you.

>> our coverage of the health- care debate on capitol hill continues over the next nine minutes with the house energy and commerce committee's's markup of the bill. one is offered by cumbersome michael rogers that would leave treatment decisions up to patients and their doctors. another discovers -- studies the revenue from wealthy individuals. >> on "washington journal", democratic congresswoman donna edwards will take your questions about health care legislation. michelle malkin talks about her book about the obama administration, and mark knoller looks at the obama administration's first six months.

"washington journal" is live every day at 7:00 a.m. on c- span. more coverage more morning of the health care debate as the house energy and commerce committee continues work on its version of health-care legislation. see that live on c-span3 starting at 10:00 a.m. eastern. >> president, conservation is, wilderness warrior. douglas brinkley's look at teddy roosevelt. two-hour saturday on "book tv." >> this week, as expected, the senate judiciary committee voted to recommend the confirmation of sonia sotomayor s. supreme court justice. what's the committee debate and see the vote this saturday on c- span at 7:00 eastern. next we come her confirmation moves to the senate floor. live coverage of the full senate debate on c-span2. coming in october, tour the home to america's highest court, the

supreme court. >> the health-care debate continued on thursday as the house energy and commerce committee marked up its version of the bill. over the next several hours, we will show you some of the debate over amendments, including one offered by nathan deal of georgia. it would require new enrollees of medicaid to prove they are not illegal aliens. this is a half-hour. >> mr. deal, do you have an amendment? >> yes, i do, mr. chairman. >> the clerk will call jim clarke will inform us whether -- gillon >> it was submitted in a timely fashion. >> without objection, the amendment will be considered red.

the gentleman from georgia is recognized for five minutes. >> this amendment is designed to make sure that there is not an unintended loophole or drafting error in the underlying bill. the reason for the amendment is that the underlying bill would require millions of people to be automatically enrolled in medicaid without any guarantees that these new enrollees will be united states citizens are certain legal, permanent residents as required under current law. specifically, the section of the underlying bill requires that the state shall except without further determination the enrollment, under the medicaid program, an individual determined by the commissioner to be a non traditional medicaid eligible individual. however, nowhere in the bill is a condition required to applied to existing citizenship and identity verification that exist in the current bill. the men that i am offering is simply designed to ensure that

the requirements that have been the requirements of the past are maintained in this new legislation. we certainly know that there are approximately 11 million individuals who are illegally in our country, and we want to make sure that this taxpayer- sponsored legislation that provides coverage for a variety of individuals does not extend that coverage to people who are not eligible, and that the verification of eligibility is something that is tangible and not simply somebody swearing they are a citizen with no requirement of proof that they in fact are. we know that the verification requirements that were inserted in the deficit reduction act of 2005 have proven successful, and we want to make sure that this legislation does not either intentionally or unintentionally remove those requirements for citizenship

verification in two categories, the first being the general category of proof of citizenship or medicaid eligibility, and then the qualified alien status where there are nine categories of aliens who are eligible, that the verification under the system that is already in place must be applied to determine their eligibility under this legislation as well. the purpose is to ensure that the taxpayers' dollars are well spent and that they are legally -- that individuals are legally and talk to benefits. with that i will yield back. >> mr. chairman, could i just ask the staff and counsel, does anything in this bill change any of the requirements that were placed in 2005 or under current law and document and whether someone is undocumented or not

for medicaid purposes? under current law on documenting whether someone is undocumented or not for medicaid purposes. do we amend the previous law to eliminate any of those restrictions in this legislation. >> i don't believe so. okay. >> mr. chairman, the concern i have is that from counsel, i want to make sure we weren't touching whatever previous law was in place under the new legislation on medicaid. the state already has enforced the restrictions on noncitizens not being eligible for medicaid. i can't sit here and say somebody doesn't sneak through with a fake social security card -- >> gentleman yield to me. >> as i understand this amendment, it would require people to show they are citizens. the law is if you're an

undocumented alien, you're not eligible for services under medicaid, period. that's not being changed. but this would require people to come and establish whether they are citizens. the people that get hurt are u.s. citizens who don't have a passport or can't find their birth certificate and go to the hospital and trying to get medical care and not going to be able to get medical care unless they can show they are u.s. citizens. this amendment we know has done a lot of harm. it got to the point where it was being enforced in some areas where children who were born in the united states at the hospital were not being eligible for services as u.s. citizens unless they could prove their citizenship. so this is an amendment that is very substantive and harmful to

u.s. citizens. if you're an undocumented alien, you're not eligible, unless it's an emergency. and if you get brought into an emergency room, i would like counsel to respond to this, as i understand this amendment, if you're brought into an emergency room, you have to establish whether you're a u.s. citizen. is that an accurate statement? >> or if you are a qualified alien. >> well, counsel said if you're going to an emergency room to get medical care after an auto accident or whatever, you have to be able to establish that you are a u.s. citizen or a legal alien. >> i would imagine someone would bleed to death before you can get the documentation. i would certainly oppose the amendment. i yield time back to the gentleman from texas, mr. green who still has time available. >> mr. green? >> i'll be glad to yield.

you raised the same questions i have and i've yield to the chairman of the subcommittee. >> mr. chairman, just following up on what you said, the problem is right now the references that are in here to section 1903. those provisions about establishing citizenship and what you do, those were all things that were included at the request of the republicans before and they are in -- they are the law now. and what's happening is as you've said, a lot of people who are citizens are not getting care because of these requirements and there's no evidence that people who are illegal are getting the care. i don't need point of adding another burden when the evidence suggests that illegal can't get the care and citizens are having a hard time getting the care and we've -- we're operating under republican provisions as how you establish your citizenship already. this just adds another layer, maybe, which is not necessary and is going to make it more of a burden for people who are

citizens to get care. doesn't add anything at all. i don't see the point. i would oppose it. i yield back. >> gentleman? >> from texas, yield to me on this 45 seconds. i thank you very much for yielding. the point is that the law now requires, if you go in for medical care under medicaid, you have to show you're a citizen or you have to show you're a legal alien. that's the law. what this amendment would do, any time you go into any institution any any circumstances, even in an emergency room, you of would have to establish either citizenship or you're right to be in the united states. and the people who have been harmed by the existing law hav been u.s. citizens, often times from poor rural areas where they don't have the birth certificate or passport and people are -- if you're anticipating going in for medical care, can you get that f you're not anticipating it, you could be in deep trouble.

>> mr. chairman, i rise in support of the amendment. i want to just try to focus the committee's attention on the real world. we put citizenship verification provisions into the deficit reduction act of 2005. those went into effect in 2006. there was a great cry that people had lost their birth certificate or born before there were birth certificates and wouldn't be able to prove. we added by regulation a volumous way of identification besides the birth certificate issued by county -- or a state. well in the medicaid s chip debate last year, the verification procedure was suspended. and now for s chip children just

have their parents have to affirm that they are here in this country legally. it's personal affirmation. that's the standard. personal affirmation. we still have for adults on medicaid the citizenship verification that we put into place back in 2005. having said that, section 1802 of this bill says that the state shall accept without further determination the enrollment under the medicaid program of an individual determined by the commissioner to be a nontraditional medicaid eligible individual. the states are going to automatically enroll millions of people automatically. and what the deal amendment says is before those millions are automatically enrolled, that we use the verification procedure to make sure that they are eligible. that's all it says. now, people bleeding to death in emergency rooms and all of that,

that's not happening in my public hospital in tar rant county, texas in john peter smith hospital, it's somewhat anecdotal but i believe it to be true, 70% of the births last year were to undocumented residents of tar rant county, 70% because jps has chosen, that if you come into that hospital and you're about to have a baby, they are going to deliver that ba baby. people are not being turned away if they don't walk in with the birth certificate. what we should do, if we're going to expand medicaid eligible for child with adults and all of these new, as you put it in the bill, nontraditional medicaid eligible individuals, it makes sense to insist that the verification procedures that are on the books be used for

these automatic enrollees. that's all this amendment does. >> gentleman, yield. >> yield to mr. shimkus. >> allowing states to use records such as dmv, we know california providesimmigrants, they can use those to say they are a citizen. this is a clear amendment to say if you want taxpayer funds to go in this health system for illegal immigrants than vote no. if you want the taxpayer on the hook of paying health care for illegal immigrants than vote against this amendment. it's really simple much and the fact is states are allowed to waive verification requirements by a statement by a family member. so the choice is clear and i would yield back to the ranking

member. >> thank you, mr. chairman. real quickly. oregon was the only state that allowed for an audit to be done on this issue of medicaid enrollment, when it was done in 2005, the state found 3% were illegal aliens and that the 2005 report by the inspector general at hhs found 46 states in the zringt of columbia to allow self-de self-declaration and this is a real issue if you're paying the bill. we're trying to get people to take care of people who are here legally. i yield back. >> thank you, just to add some local flavor in omaha, my sister was a social worker who signed up people into the system. and she brought a group of her co-employees to me several years ago and said they aren't even

allowed to ask about citizenship. they knew therapeuty were signia lot of those undocuments. we're talking about taking it to the level where they are allowed to ask for verification. >> gentlemen, it's time -- i yield back. >> the chair recognizes. mr. barton and i had a discussion, right now the verification is in effect. but what i'm concerned about and express concern about, is emergency room. and he thought that was, if i could repeat our private conversation, the emergency room is an exceptional situation. and when we passed the chip bill, we made a modification for children. i would like to question that unanimous consent that we limit

this amendment -- let me put it this way, that the amendment be changed to make an exception for emergency rooms and care and for care for children. >> mr. chairman, reserving the right to object? >> i would like to make an inquiry of counsel in that regard. is there anything in this amendment that in any way repeals the statute which requires emergency rooms to treat individuals regardless of their status, regardless of whether or not they have insurance or regardless of any other circumstances, is there anything in this amendment that would repeal the requirements that currently apply to emergency room snz. >> no. >> gentleman yield to me. >> it won't eliminate the requirement for the emergency room to treat somebody in the emergency but it will eliminate the hospital from getting reimbursed mr medicaid for

having given that care. the hospital is not going to be able to verify in an emergency that the person is eligible or not ineligible. >> reserving the right to object. >> be recognized. >> mr. chairman, i don't know there's any reimbursement question here. if you're not covered by medicaid and you go to an emergency room, the hospital still doesn't get reimbursed. that's not an issue. you get the care and you're not reimbursed if you're not covered by medicaid and private insurance and other people make up that gap. that's part of the whole problem of eliminating the private system. nobody is left to fill the gap of people that the emergency room and the hospital are not reimbursed for. i would. >> jae yield to me. >> i would. i'm talking to my counsel and he

asserts to me, that if you're on medicaid and you go to the emergency room, they pay. you're arguing you wouldn't be on medicaid. there are people on medicaid. >> mr. chairman, that would be paid for and those people wouldn't be impacted from this amendment in any way. >> go ahead. >> reservation is noted. >> i yield to the gentleman. >> frankly, i want to re-ask the counsel, it says that no service furnitured under this title may be granted, not no reimbursement, no service online 16, the answer is yes, this amendment does limit the services that can be offered. i would suggest that the amendment being offered might bring us to a place began vote

for it is being noted. limits the service that can be offered to anyone you cannot show their document. for someone who is hit by a car in the not bring their wallets would have to wait until the service was provided. >> if i still control the time, i would just like to say that that question has been asked and answered. there is nothing here that repeals the access to emergency care. this is a question of coverage and taxpayer funded reimbursement at some future time. the jones amendment would just required documentation be part of a cover program -- the gentle man's a minute. >> i disagree with you. i will withdraw my unanimous consent request and urged members to oppose the amendment. i was recognized for five minutes, so i want to further

debate this matter. i just think this is going to be a bureaucratic nightmare for people at emergency rooms and hospitals. a bureaucratic nightmare for people at emergency rooms of hospitals to try to decide when somebody is brought in unconscious, whether they have their birth certificate to show they are a u.s. citizen. and i think the people that are going to be hurt are u.s. citizens who are going to be denied coverage. now, there may be a requirement for the hospital to give them care, but i think we're putting the hospitals in a very precarious situation. and i don't think it's necessary, existing law requires that there be a documentation when you sign up in medicaid. you have to show it. you have time to do it under those circumstances. you don't have time in an emergency room. >> will the gentleman yield? >> who's asking me to yield?

>> i guess on your time with your yield, i would like to ask counsel again, it provides that everyone that shows up at an emergency room is entitled to care and entitled to care before their ability to pay can be verified. if that is not repealed and i thought i heard counsel say nothing in that was reappealpea about mr. deal's amendment. is there anything that repeals the requirement that care be provided? >> no, but he brings up the language online 15 and 16 which deal with eligible for an item or service. but the intent of this appears to be deal with eligibility for medical assistance which is the payment for it. i guess the ambiguity would be, is there any intent in the first

sentence -- >> what you're saying is his point might result in an issue of who pays for the service. but the chairman's point you might not get the service is not accurate but it is not repealed. there are big issues about payment for services rendered right now. many of us believe those costs are shifted to people who pay for insurance. i don't think we're dealing with the cost issue. the concern of the chairman was are people going to be denied care as they are sitting there bleeding in the emergency room and the answer is they will not be denied the care. >> reclaiming my time. i am concerned that hospitals all over the country are closing emergency rooms because they cannot deal with the uncompensated care they give. they have to give it. we agree to that. a lot of them are trying to become specialty hospitals or

don't have emergency rooms open. that just means that when people go to the emergency rooms that are open, there are such congestion of people coming in for all sorts of reasons that it would be a bureaucratic nightmare for them not to know whether they are going to get reimbursed if somebody is a u.s. citizen, would appear to be on medicaid. and they make the judgment that that's the situation. i just think that pointed out, i'll yield to him further on the issue, figured out a flaw that is a serious one. perhaps we didn't provide emergency care to -- to people who may be undocumented. that's may be all to the good but that's not the law. they have to get the emergency care. hospitals have to give it and we're having unintended consequences which are

foreseeable because it's a reality. we're getting fewer and fewer places available for anybody and most of the people who need it are u.s. citizens to get the care and have the institution get the payment for the care. >> mr. baldwin, you want me to yield to you on that? >> i want to add, when wisconsin was implementing the current law, they took very close track of the problems they encountered. there were 19,000 people, the vast majority of them u.s. citizens who are unable to secure a passport or a birth certificate, maybe don't live in the same state or county that therapeut they were born in. had to seek that documentation. 19,000 u.s. citizens in wisconsin turned away for care in various settings as that paperwork was being assembled and put together. this has -- i would hope you

agree, unintended consequences that injure the health of u.s. citizens and i would therefore strongly urge my colleagues to oppose this amendment. >> my time has expired. are we ready for a vote. let's go to a roll call vote. >> mr. waxman. >> no. >> mr. marky. >> no. >> mr. dingell. >> no. >> mr. boucher. >> mr. palone. no. >> mr. gordon. mr. gordon votes no. mr. rush. miss eshu. no.

mr. stupack. no mr. engle. mr. green, no. mr. gets no. mr. doyle? mr. doyle, no. miss harmon. no. miss schakowsky no. mr. gonzalez no. mr. ensly no. mrs. baldwin. no. mr. ross? mr. ross votes aye. mr. wean er, no. mr. mathson. aye. mr. butterfield?

mr. butter field votes no. mr. barrow? mr. barrow, aye. mr. hill? mrs. mat suey, no. christianson no. mr. murphy of connecticut? no. mr. space? mr. mcnernny. mrs. sutton. no. mr. braley. no mr. welch, no.

mr. barton, aye. mr. hall? mr. hall, aye. mr. upton. mr. upton aye. mr. stern? aye. mr. deal. aye. mr. whitfield, aye. mr. shimkus? mr. shimkus, aye. aye. mr. blunt? mr. blunt, aye. mr. boyer? mr. ra don vich, aye. mr. pipp, aye. mrs. bono mack, aye.

mr. terry. aye. mrs. myruck. aye. mr. sullivan, aye. mr. murphy of pennsylvania. aye. mr. burgess. aye. ms. blackburn, aye. mr. gin gri, aye. aye. >> mr. rush? >> he is not recorded. mr. rush, no. mrs. capp, no.

mr. mcnerny, no. mr. boyer? mr. boyer, aye. mr. space? mr. space votes no. >> mr. who? >> mr. hill, aye.

>> will the clerk call the roll of those who have not responded the vote? call the names of those who have not been recorded? >> mr. boucher, mr. engle. >> the clerk will call them. >> thank you, mr. chairman. i believe that's everyone, mr. chairman. >> any member wish to respond to the vote who has not voted? any member wish to change his or her vote? the clerk will tally the vote and report it.

>> mr. chairman there were 28 yk >> republican congressman mike rogers offered an amendment that would leave treatment decisions up to patients and their doctors. this is 20 minutes. >> i think we can all agree that comparative effectiveness research can be a useful resource for doctors and their patients, but it should not be used as a tool to limit or deny coverage of treatments. this bill creates an entire new federal regime to conduct ce research. alarmingly, the bill has no restrictions on how the federal government can use this research. this is a dangerous open-door policy that will almost certainly lead to compare to the effectiveness research being used to make coverage decisions. here is what it can teach us.

what treatments are generally more effective than others, which procedures might work better for a particular disease than others, of which drugs have a bigger impact and treating one disease over another. this was important. comparative research is about general, average assumptions. it cannot determine anything about an individual patient with a unique condition looking for a unique treatment. we cannot allow the federal government to use a calculator or bureaucratic standard to get in the middle of patients and doctors. here are some examples of how they do it and other government run systems. a 23-year-old woman was -- british woman was diagnosed with cervical cancer. she had asked for a pass near three times and was denied. because it only provides service to women over the age of 25. they do that for cost reasons, not because it is best for that patient >> that woman did get

cervical cancer at age 23. an ontario court -- ontario woman was diagnosed with colon cancer. her doctor suggested treatment that targets cancer cells exclusively. the canadian government would not cover that drug on the claim that the treatment was unproven, even know that drug is a standard cancer treatment covered by insurance companies in the united states. a 46-year-old montreal woman was denied access to the only drug that would keep her alive as she battled a tough form of a bearing cancer. canada denied the treatment because it said they wanted to see a more rigid and more prolonged survivor rate. the government made a life-and- death decision on that patient, and the reason they do it is because the only way the government can control costs is by denying access or denying

treatment. . >> there are horror stories on

broadsides, but it is undeniable -- on both sides. the same arguments we heard today it were to establish this national bureaucracy in the u.k., which rations care. this amendment says you cannot use these statistics, these figures to ration care, and i applaud the gentleman from michigan, and i yield back my time. >> mr. chairman? will the gentleman yield? would this amendment and limit private health-insurance companies based on misinformation? -- would this amendment limiting them? >> it takes care of the government plan, and by your bill, all plants must comply. >> i notice that the language does say "by the federal government." it seems that it would assume

that you're trying to exclude -- millan >> again, in your bill, all plans must comply. -- all plants must comply. -- all plans. >> will the gentleman yield back this time? -- back his time? >> the gentleman is recognized for five minutes. >> this is a friendly comment. but it is always, when we are considering amendments and legislation, the devil is in the details. now, the amendment would deal with the research from being used to deny or ration care. now, i appreciate the concerns of the gentleman, and i do not want this research misuse, and my feelings on that are the

same -- i do not want this research misused. but not all denials are misuse of research. i want to note not all denials are a misuse of research. i would like to give the gentleman a couple of concerns he should share with me. first, it was a it was a study that showed that vioxx caused heart attacks, there we really want to limit that use of science? another study, fen-fen actually caused heart valve damage. do we want to limit that kind of science and that kind of use of science? >> now, fortunately, these kinds of research findings are rare but if a study shows that a treatment it dangerous, should we be denying ourselves the

ability to deny that treatment? so i understand what my good friend from michigan is trying to do and i'm -- i share his concerns. but i also many concerned that it is a bit too broad. and i'm wondering if my friend would be willing to strike the word to deny. that would enable us to support the amendment because it would say that research that says that an amendment -- that a particular treatment or particular kind of pharmaceutical is in fact dangerous, would probably be precluded under the amendment. i yield -- >> does the gentleman yield, thank you for your time. i respect the gentleman greatly. couldn't agree more with the interpretation of the language. the fda stepped in and this would not prohibit that at all from happening.

and more importantly, it protects the doctor/patient relationship. if a doctor knows fen fen is a problem, they are not going to use that in the treatment of their patient. i wouldn't take my word for it. if you'll yield to the doctor, ke give you a doctor's perspective as well. >> i'm sorry the gentleman and i disagree on the interpretation of his language but i just -- i think if the gentleman could accord with me on removing the words denied, we could support the amendment. otherwise, i have to oppose it. i'm sure night colleagmy collea join me in opposition. it has a great deal of merit if it has that changed. i want to support it both as his friends and i'm convinced it is a sound amendment. >> would the chairman yield? >> i'm glad to yield.

>> my comment is this, you mentioned in fact several drugs that were approved after market after fda approval to be harmful to patients and of course, the fda moved pretty darn quickly to take those drugs off the market and in fact, that's the whole purpose of the fda, to make sure that products that have been approved that are found to be harming patients and in fact in some cases even calls them their death, that these products are removed. and the other thing, of course, you might say self-policing. physicians, you know, every physician is practicing under the hypocritic only in first place, do no harm and clearly is not going to be prescribing

medications that would harm them. >> i can't yield further to the gentleman and with respect i would observe physicians are deceived like everybody else is. and when we have research that says that certain practices are dangerous, or certain pharmaceuticals are dangerous, we ought to permit that research to be communicated to the doctors so that they can put it to work and so that they can achieve the help of research. remember doctor's major function is the application of scientific research and new learning in the area of science with regard to the profession of which they are very important and valuable part. i yield back the balance of my time. >> further discussion? ms. baldwin. >> the chair would yield to himself to see -- because i've been listening to this discussion and see if we could come to terms on this.

mr. rogers? >> yes, sir, mr. chairman. >> the examples that mr. dingell pointed out were fda examples. your amendment says that the research could not be used by the federal government to deny or ration care and i think he was pointing out that there are sometimes information where we ought to deny care when we find it's harmful. one way to resolve this is to strike the word deny and say be used by the federal government to ration care. then we won't have that problem. is that something that you could accept? >> no, sir, just an absolute philosophical difference that we run into. in the cases that i gave you and the wise the n.i.c.e. board operates, they denied pap smears when she asked for it three

different times. comparative effectiveness research can be made available and the doctor can take that in the course of his practice. but for the government to deny coverage based on the effectiveness research board, you can't, 19-year-old cancer recipient, you're statistically you shouldn't get that treatment, we're not going to do it. they do it in the united kingdom and canada. we won't agree on this fill sofally. >> you're saying we shouldn't deny care to ration or to use this information in a way that would give care that people need. but deny care when we find out that a procedure is harmful is something that we would want the federal government to do. i don't think we have a philosophical difference -- >> that's not denying care, that's the practice of good care. you are don't do more harm to

your patient. you wouldn't give a treatment that you know is harmful. >> if you do what you suggestside being done elsewhere, that is bad medicine as well. >> let me take another stab, what you described is rationing, didn't see no pap smears, they said not for this person, they'll give it to this person. i think the offer being made by mr. dingell gets to where you want to go. prevents them from making a decision that they are not going to allow something that's harmful but still allows them to say, that prevents them from saying, you get it or you don't. it does get there by -- rationing would be left in, which would say they can't do what you described. one more thrust of trying to get there. >> would the gentleman yield. >> i disagree they were denied access because the research says statistically it's not very likely to happen. therefore, we're going to ugs the calculator and not the

doctor's determination -- >> let me reclaim my time. >> i feel passionate about it as a cancer survivor myself. >> why don't we say, government deny care that may be harmful or rationed care. because you want a mixture that we're not denying care that's beneficial. >> again, mr. chairman, i don't read the amendment the same way you do, again, as somebody who would have fit the criteria to be denied care, i feel extremely passionate about this. >> you're not interested -- >> i apologize on this one as somebody who would have been in this boat, would have been denied care under the system, i passionately believe we should send a clear signal. >> you would have been denied helpful care not harmful care.

>> mr. chairman, i object to the amendment based on the fact that the comparative effectiveness research is designed -- those treatments that are most effective and in no way dictate to physicians or providers which treatment they should or should not use. and the same way that a harmful treatment being made known to a provider would enable them to make a decision not to use that medicine, favorable treatment, effective treatment being made known to comparative effectiveness research, would allow to use the medication, but there's no place in there that would cause a denial or rationing. remember, we're not operating under the british system

where -- we're not creating a single payer here. it's atmosphere to insurance coverage. we will create an amendment that we would ask our colleague to consider supporting, which may address some of his issues. and i yield to mr. wienor if he wants to be recognized. >> i thank the gentle lady for yielding i think our concern about this amendment, on its face, it seems pretty straight forward and intuitive. and in the context in which you placed it, it has some attraction i guess. but i'm concerned about the way it could be interpreted. you heard one expression of concern about the

interpretation. it could be made with respect to this amendment that might prevent you from taking steps with respect to harmful care. i can envision a scenario whereas a result of research kind of flowing through the system, determination would be made that there's now a more effective kind of treatment that should be paid for because the research shows that it's getting very good results. and it becomes a kind of new treatment to replace an old treatment. but, replacing the old treatment with the new replacing the old treatment with something more effective under these -- under this language could be interpreted as denying care, now maybe you're not going to reward for that old treatment any more. and so you're stopping what was progress in terms -- >> would the gentleman yield?

>> you have just hit on my biggest concern. because that old treatment may apply if a doctor looks at that particular case and says, you know what, this is the right course of action, not the new treatment. and a one size fits all is the most dangerous way you can practice medicine. it's dangerous. people will die and that's why if you look at cancer rates in canada and the united kingdom and compare them to the united states, they die a lot more frequently than we do on certain cancers because they say, we have a new treatment, old treatment can't do it. even though the doctor may say, this is the right treatment for my patient. that's why i feel strongly and you have hit on the one reason we ought to be -- >> reclaiming my time. if you take your perspective to the logical extreme, you can never do anything to improve the sort of con stelation of treatments out there and make judgments about the kinds of

treatment that ought to be supported versus something else. and that's the interpretation that concerns me here. and that's why i would oppose it. i yield back. >> gentle lady yields back her time. mr. rogers you want to close? >> mr. chairman. >> the problem is that we had more than ten minutes on the democrat side and to the unanimous consent we're supposed to have ten minutes on each side. are you ready to vote? all those in favor of the rogers amendment will say aye. >> aye. >> oppose, no. >> no./1hnxbld >> .the new ranking minibus -- the ranking member talked about a surtax on wealthy individuals. this is 25 minutes.

>> before i began, let me recognize the distinguished chairman of the ways and means committee, mr. charlie rangel, who is in the room, since this amendment relates to the jurisdiction of his committee. it is good he would be in attendance when i discuss it. [captions copyright national cable satellite corp. 2009] [captioning performed by national captioning institute] mr. chairman, under the pending bill, there is a tax on american citizens depending on their incomes status. if this bill goes into effect, there would be an immediate tax, a surtax, on incomes of citizens who make between $350,000.500000 dollars per year. there -- a tax of 1% -- the make between $350,000.500000 dollars. -- between $350,000 and

$500,000. the taxes on the lower two income brackets would double in the year 2013, if there is a study by the omb that determines that certain savings have not occurred. what the barton amendment does is direct the study to find that regardless of the savings that the taxes on the lower two income brackets, the tax increases do not go into effect, said the effect of the barton amendment, if adopted, -- so the effect would be beginning in 2013, only those citizens who make over $1 million would have their taxes increased by the surtax. over $1 million would have their increased by the surtax.

the reason that we don't just repeal the tax increase, and that's why i'm glad the chairman of the ways and means committee is here, is that we don't have the jurisdiction to repeal but we have jurisdiction over studies. so we use the study as a hook to at least save those citizens who make more than the -- who make less than $1 million to try to save them some money beginning in the year 2013 been so this is the $1 million taxpayer protection amendment, those that make less than $1 million. >> mr. chairman. >> the gentleman yields back his time? >> i would yield to mr. walters. >> i just have to speak up on this in support of it. if you look at the chart that is being held up here, my home state of oregon would have the second highest income tax rate in the world. and we already have the

second -- i think the highest income tax marginal tax rate in the united states of any state, which is a great benefit for mr. emsley's state because we're having to build a whole new bridge so people can move to washington state. you would think our tax policy was written by the vancouver chamber of commerce. this adds to that pressure and i think is one of the reasons why oregon is second to michigan in unemployment. and so i will be supporting the gentleman's amendment. >> and seeing no hands on my side, i would yield back. >> the gentleman yields back his time. >> thank you, mr. chairman. i'm not sure i know exactly how mr. barton is trying to create jurisdiction over this issue, you know, and this committee. i really don't think it belongs here. but the basic problem that i see is that, you know, he's doing some kind of gimmick to undercut the work done by the revenue

committee and it is sort of interesting that the chairman, mr. rangel is here. what i want to point out and i and the reason i oppose this amendment is that from the very beginning of this debate -- when president obama talked about the need for health care reform, he pointed out that a good need of the cost of this was going to be from cuts in existing programs, medicare in particular. but at the same time, there was going to be a need for new revenue. and the reason there was a need for new revenue was in order to cover more people and provide assistance to middle income families to a subsidy that at least up front in the beginning, a certain amount of money was going to have to be available. down the road as the health reform bill kicks in, we save more and more money as time goes on. but at least initially, there would have to be a certain

amount of money provided and that figure was about $1 trillion and part of it would be paid for through program cuts and part of it through new revenue. and i think that we would be kidding ourselves if we didn't realize or acknowledge that some revenue source is needed. now, if you look at a revenue source, i think what the ways and means committee came up with is probably the most responsible way of doing this that i can imagine. if you look at this surcharge, it only applies to the top 1.2% of all households in the united states. it would have no effect on 98.8% of all households in the united states. now, of those families making between $350,000 and $1 million, they would contribute less than 1% of their annual income to help provide access to affordable health care for all americans. i don't think that's much of a contribution when you're going to cover all these people who

have no insurance plus a significant number of people who would get a subsidy to help their -- help them pay and make noorp insurance affordable to them. we're a community. everyone should help to a certain extent. and i think that this is the least offensive way of doing it. i know it's not before our committee. maybe we shouldn't be talking about it today. but of all the proposals we've seen out there, this is the least offensive. and if you think you're not going to be able to do this you would be kidding yourself. i don't represent a poor district. i have a lot of people who would be impacted by this. but i still think it's important to recognize that this is a good way of doing it and that something has to be done. this is not all going to be paid for through program cuts. i yield to the gentleman. >> and the gentleman fails to point out one other thing. american citizens' taxes are going to go down as a result of this bill. and let me explain why.

because right yao your states are paying too much for health care. >> the republicans are acting like british parliamentarians. >> so long as they don't start acting like south koreans ones, i'll be fine. the cost so citizens will go down because the costs they're paying for their products won't have the same costs. the amounts of uninsured are going to go down so more efficient care will be provided. the amounts for cities like mine and states that have shares of medicaid are going to go down. so overall, tax expenditures are going to go down, down, down, and so are nontax expenditures. the way americans should look at this effort is will their overall cost of life be reduced or go up, health care is on the track to double in the next five years, to double. if we don't fix that, everything we have is going to go up in cost. so the question is not what column is going to go up. some may go up a little.

but everything is going to go down appreciably a lot. so i welcome the chance to study this. now, you can write in an amendment that says here is what the conclusion of the study shall be. >> will the gentleman yield? >> but the fact is that health care costs are driving everything in this country to be too expensive. when you buy a car, you're paying a tax. when you're buying food, you're paying a tax. when you go into the office, you're paying a tax. you want those taxes to stay in place. we say no, that's not a good policy and we're trying to change it and what this amendment refers to is the effort to make -- >> will the gentleman yield? >> i don't control the time, but bring it on. >> all right. i thank the gentleman for yielding and i thank the gentleman -- >> the gentleman's time has expired. >> mr. chairman? >> let me go to mr. blonton. perhaps he can yield to you on the last five minutes of debate. >> i'll yield time to my colleagues after i mistake a couple of comments. one is that there is no study that i'm aware of that indicates that there is anything that

saves money or bends the cost curve. we heard the cbo testify with conclusively that the cost curve does not go down, the gentleman's suggestion that somehow this is guaranteed to contain costs is not supported by any information i'm aware of and the tax year we're talking about is a tax that absolutely falls on most of the small businesses in america that get beyond that two or $300 that you say level and their tax will be impacted by this dramatically. the job creating engine of the country, i think the former chairman's amendment, the ranking member's amendment just simply up here is going to be this tax, tries to move it into an area where it doesn't impact the job-creating aspects of small businesses that have -- that do have income that might xooet exceed $250,000 or $300,000. we had a meeting with a number of those people this week about the 8% surcharge that was in the bill, if you didn't provide

insurance. all of them saw these as job costing measures at a time when they would like to be creating jobs and certainly the economy would like to see those jobs created. i'd yield to the gentleman from georgia. >> and i thanks the gentleman from missouri for yielding opinion and i think as i understand the gentleman's amendment, it basically states that if this surtax, particularly on those making less than $1 million a year, many of whom, maybe a third are small business men and women, if it's found by study in 2012 that more than enough taxes have been raised for paying for this health care reform act, then we should not continue to tax these individuals. the speaker was asked the same question on sunday morning talk show about a week ago and her response to mr. chairman was,

well, you know, we would use that excess money to pay down the deficit. well, goodness gracious, it would seem to me that we would reef that money in the pockets of the small business men and women so they can continue to create jobs and we have more and more revenue coming in so this is a pretty straightforward amendment. >> will the gentleman yield? >> and let me but gagne and thomas from florida. >> i yield from the gentleman from florida. >> this is a study by the joint economic committee. senator brownback's is a ranking member. mr. williams should probably look at this. -- senator brown but -- senator brown backed -- brownback.

you are welcome to get a copy, but i do not think there is any evidence to say that this bill will bring down health-care costs. in fact, it will increase its dramatically. when you look at what the president said about not supporting any bill that did not bring health-care costs down, i do not know how this bill could be supported. this analysis shows health-care costs going up. >> i yield to the gentleman from louisiana, and if there is time, the gentleman from illinois. >> i suggest that actually go and read the bill if they think taxes will go down, because if you look right here in section 41, it is called a tax on individuals without acceptable health-care coverage, so that means they can actually impose a tax of 2.5% of your incomes. it is such a large tax that the

congressional budget office actually said in this grim, unfortunately, republic was kicked out -- said in this room, that one section alone is going to add over $20 billion of new taxes on to the backs of people who are not insured today, and most of those people are making well below $50,000 this year. today. and most of those people are people making well below $50,000 a year. if you look at the congressional budget office's own testimony, maybe some radical blog is telling you you're not going to pay more taxes. the congressional budget office has said you'll pay backside 800 billion in new dollars if this pass he not to mention the rationing of care. >> i'd yield to the gentleman from illinois. >> and i want to follow up. the cbo director said that obama's cost savings are an illusion. and that is a nonpartisan congressional budget office, an illusion. so i wouldn't allude to savings.

>> the gentleman's time is expired. the chair recognizes himself for the last five minutes of debate on this amendment. this is a very confusing amendment. one would think that we shouldn't be in the jergz of this committee. but the parliamentarian said it was crafted in a way that allowed it to be germane. i don't know if that's why the ways and means committee is here or not, but this is strange. the bill said that if we don't achieve the savings that we need to achie, then we would look to revenues. now, this amendment says if we do a study, we're going to determine that if the savings -- if we do achieve savings, that we're going to reduce the revenues. well, the whole bill that we

have is paid for at a programmatic savings of cuts of medicare and medicaid and since that's not enough, new revenues. well, this amendment would reduce the revenues. well, if we make a reduce in the revenue side, then we have to look to see whether we're going to get the savings. if we don't get the savings, this amendment would cost us several hundred billion dollars. if it worked. and there's a lot of confusion whether it works. so i think this is a message amendment and i don't even understand the message. but the impact of this amendment would be very destructive of the bill that we have before us. and if the study shows that we didn't achieve this saving and if we did achieve the savings, we would then make a decision or redelegate this decision as to

how much money would be available. and then we would have to go make additional cuts in medicare and medicaid. that may or may not be possible. so i just think that we -- i urge members to oppose this aempt. it's what we call gimmicky. it says it's doing something. it says the omv would find at least $700 billion in savings had been generated, and if they did, we change the surtax and individuals making less than $1 million would never face a tax. well, i don't know what the revenue provisions will be once we get to the house floor. no one wants to raise revenues. we would rather get program cuts, but we're not going to get enough program cuts. >> will the gentleman yield? >> i will in a second. this gentleman says if we don't get the program cuts, reduce the revenues, and if it turns out

that that is inaccurate, we have to reduce revenues even more. who is asking you? >> the gentleman. >> thank you. >> you know, the committee, the majority committee provided members with a description of what this bill does for the district. including talking about the surtax. and i would suggest that your side do the same thing. for example, in -- i've got a whole bunch of them here. it tells a number of small businesses that would receive tax credits. every one of these that i'm holding is more -- is about $12,000 plus. small businesses that helped. how many seniors would avoid the doughnut hole in medicare part c? that's thousands. how many families would escape bankruptcy? that's in the hundreds. and how many uninsured people in the district that will get coverage and in all cases, it's over 100,000 and in every single case, 99% plus people in the

district will not pay the surcharge. we're talking about a tiny number compared to the hundreds of thousands of people that we'll help because finally they'll get insurance. you ought to look at this description so that you can take a good look at how your district will be helped by this bill and i -- >> well, i would just say that under this amendment, after you get some analysis, the first priority would be to reduce taxes rather than make sure we keep those promises. and if we can't keep those promises, then we have to look at further reductions in medicare and medicaid. this is going to cost us hundreds of billions of dollars and not make the plan work. now, i suppose that's the goal. mr. weaner -- >> well, i just want to point out one tax that the minority side refuses to point out. we have a $2. 2 trillion in 2007 for health care. that's going to go up unless we do something to $3.1 trillion by

2012. i have this high tech chart here to demonstrate it. doerchbt forget, if you don't act on legislation to get health care under control, that tax will be passed on. i say to my colleague from louisiana, yes, you can find charges in this bill, but you have to balance it, again, close to $1 trillion of taxes that you seem to want to -- >> will the gentleman -- the time has expired and we've complete today debate time. we'll now proceed to vote. mr. barton informs me he would like a roll call vote. the clerk will call the roll. >> mr. waxman. >> no. >> mr. waxman votes know. no. mr. dingal. mr. did i ngal votes no. mr. markey. no. mr. boucher.

mr. balone. though. mr. gordon. mr. brush. miss essue. votes no. mrs. supak. mr. stupak, no. mr. angle. mr. angle, no. mr. green. mr. green no. ms. degett. mrs. cap. mrs. cap, no. mr. doyle. mr. doyle no. ms. shakowski, no. mr. gonzales. mr. ensley.

no. ms. baldwin. ms. baldwin, no. mr. ross. mr. ross no. bl weaner? mr. weaner, no. mr. mathison. mr. butterfield. mr. butterfield no. mr. malazon, aye. mr. barrow, mr. barrow aye. mr. hill. mr. hill no. ms. matsui. ms. matsui, no. mrs. christianson. mrs. christianson no. ms. caster. ms. caster, no. mr. sarbain. mr. sarbain no. mr. murphy of connecticut. mr. murphy no. mr. space. mr. space no.

mr. mcnurney. mr. mcnurney no. ms. sutton. ms. sutton, no. mr. braillely. mr. braillely no. mr. welsh, mr. welsh no. mr. barton. mr. barton votes aye. mr. hall. mr. hall aye. mr. upton. mr. upton aye. mr. sterns. mr. sterns votes aye. mr. deal. mr. deal aye. mr. whitfield. mr. whitfield aye. mr. shimkus, mr. shimkus aye. mr. shatti gb. mr. blunt. mr. blunt aye. mr. bowyer. mr. bowyer aye. mr. radovonich.

mr. hadovonich, aye. mr. walden, mr. walden aye. mr. terry. mr. terry aye. mr. rogers. mr. rogers aye. mrs. myrick, mrs. myrikk aye. mr. murphy of pennsylvania. mr. murphy aye. mr. burgess. mr. bernlgess aye. ms. blackburn. ms. blackburn votes aye. mr. gingrey, aye. mr. skulley. aye. ms. degettz. degettz votes no. mr. gonzalez. no. mr. mattheyson, no.

mr. rush. mr. rush votes no. mr. shaddik. mr. shaddik, aye. >> have all members responded at the call of the roll? >> mr. gordon. >> any member wish to change his -- >> mr. gordon. mr. gordon votes no. >> the clerk will tally the votes and report. yes? >> on that vote,]b >> a texas congressman who was a doctor offered an amendment that would cap a non economic damages

to no more than 250 thousand dollars b this is about 25 minutes. -- no more than 250 thousand dollars. this is about 25 minutes. >> this was an amendment that would affect liability in the practice of medicine, and that amendment was ruled not germain e, and we were allowed to report it to achieve terminus -- that. the protections provided each of the subsections shall apply in the case of a health-care provider with respect to items, services, treatments, for which a provider seeks reimbursement under medicare, under title 18 of the social security act. t under medicare, under title 18 of the

social security act or under state plan under title 19 of such act. just to recapitulate the issues this were brought up two weeks ago on the first offering of this amendment, that many doctors report the practice of defensive medicine, which results in millions of dollars of unnecessary tests and procedures, seasoned medical professionals are retiring early because staying in practice is no longer financially feasible, further contributing to our physician manpower shortage, that national across-the-board changes to the medical justice system would lower costs and improve care by lessening the threat of lawsuits and unmerited lawsuits they often bring b and specifically, cap noneconomic damages $250,000 for the physician, $250,000 for the hospital, $250,000 for the nursing home or a second hospital, if a second hospital was involved a cap on wrongful death awards, $1.4 million, expert opinion s relating to physicians may only be provided by actively practicing

physicians. payment of future damages on a periodic or a basis, limitations on liability for good samaritans providing emergency health care. mr. chairman this is patterned after legislation that was adopted in my home state of {dopted in my home state of access to i-quality affordable health care is, indeed, our goal, and i think the commissioner for allowing us to rework the amendment, and with that, i will yield back the balance of my time.

>> thank you. were ithere any other amendment? >> thank you. i strongly oppose this amendment. we all know the most indian way to reduce the cost of medical malpractice is to emphasize patience a deeper reducing the number of preventable errors. way to reduce the cost of medical malpractice is to emphasize patient safety by reducing the number of preventible medical errors. according to the institute of medicine in its seminal report preventing medication errors, this other report, to err is human, building a safer health system and other report, patient saving, achieving a new standard of care, americans should be able to count on receiving health care that is safe. to achieve this, a new health care delivery system is needed. a system that both prevents errors and learns from them when they occur. this requires, first, a commitment by all stake holders to a culture of safety, and

second, needed improved information systems. according to the institutes of medicine, every year, preventible medical errors kill as many as 98,000 americans. the center for disease control, if it included preventible medical errors, would be the sixth leading cause of death in america. the number of americans injured each year by preventible medical errors is much larger. the institute for health care improvement estimates that 15 million incidents of medical harm occur each year. according to the institutes of medicine, every day, tens if not hundreds of thousands to errors occur in the u.s. health care system. to address this problem, its institutes of medicine concluded patient safety is indistinguishable from the delivery of quality care and it recommended that a new delivery system must be built to achieve substantial improvement in patient safety. drug errors are the most common error of all. the institute of medicine estimates that on average, every

hospital patient in america is subject to one medication error each day they are in the hospital. these are called a verse drug events and the institute of medicine estimates that each year, at least 1.5 million preventible adverse drug events occur in u.s. hospitals that add nearly $5,000 to the cost of each admission of. the defensive medicine claim that is constantly being made by my friends on the other side has been researched thoroughly by the gao and cbo and the institutes of medicine. they have questioned the validity of the defensive medicine claim. cbo noted in its 2008 report that the evidence on defensive medicine is not conclusive and whether it limits malpractice torts have an impact on the practice of medicine has been subject to some debate. gao issued a similar statement in its report earlier this decade, noting the overall prevalence and cost of defensive medicine have not been reliably

measured. researchers from the dartmouth atlas project reached similar conclusions this year, noting that fear of malpractice suits is reported by many physicians to influence their practice, but differences in the malpractice environment explain only 10% of state variation in spending. one of the other things that's often claimed is that the number of physicians is declining because of this problem. when reality, using the ama's own physician characteristic and distribution data, these conclusions are undisputed. one, the number of doctors is increasing and has been increasing every year in the past decade. the number of doctors is increasing faster than population growth. the number has climbed steadily for decades and is twice the number of doctors per 100,000 in the 1960s. the number of doctors is increasing in every state. the ratio of doctors to population is higher in states without caps on damages in medical negligence case.

in states that have caps on damages, the number of doctors per 100,000 population is 319, while states with caps on damages have a lower ratio of 283. another known fact is that rising insurance premiums are related to market conditions and not to any claimed benefit from tort reform. how do we know this? well, mr. burgess has cited the tort reform efforts in texas. after that tort reform legislation was passed in 2003, the dallas morning news did an investigation and found that while hospitals and medical malpractice insurance carriers made millions of dollars over the next few years, no hospital or doctor cut the prices they charged patients or health insurers to reflect any savings from tort reform. and finally, the national practitioner data bank, which collects statistics on medical errors and case settlements has shown that there has been a steady decline in the number of

payouts between 2002 and 2006. from the number in 2002, which is 14,391 to 2006, when those payouts were down to 11,759. so mr. chairman this is a problem that has much effort being devoted to it but it is a problem that is not in need of a solution. we need a safer patient safety system and that's what we should be focusing on. >> gentleman's time has expired. mr. chairman. >> mr. burgess recognized. >> mr. chairman, if i can just have a minute to respond to a few of the things that were just said. the institute of medicine study to err is human was published, when, 1998, 1999, relied on data collected in two hospitals, one in 1984, one in 1992. they collected data in two hospitals over that period of time. they extrapolated to the rest of the country, doubled it, made sure that they hadn't missed anything and the fact is the institute of medicine has not

seen fit to do another study in the ten years since that one was released. they were relying on data that was collected in 1984. i to would submit to you the practice of medicine has changed significantly since 1984 and if you don't believe me, i encourage you to believe the health care facilities in your district and get to know them. i would further submit that if you think that medical lie bill sit not an issue for your physicians in your district to have a visit with your county medical societies and get their tack on this. i know that this bill before us has been endorsed by the american medical association, but i would submit to you that doctors across this country want us to face and fix this problem. they are tired of waiting and they should make their voices heard to members on this committee. and i will yield back. >> gentleman yields back his time? why don't you yield to mr. gingrich. the last five minutes. >> mr. chairman, thank you. and i thank the gentleman from texas, my fellow physician,

fellow ob/gyn for yielding. the gentleman from iowa i just heard the end of his remarks and he said that there is no evidence that doctors lowered their charges to patients in states where, such as texas, such as georgia, such as florida, where the states had meaningful medical liability reform. but you know it is kind of like the situation with all these jobs going to be grown by the economic stimulus package. now, the majority and the president says, well, we are going to have a growth and preserve the ones that we've go i submit to the gentleman from iowa that not necessarily by cutting fees to patients but just keeping them level, the lowering of the malpractice premium is very important. but the most important point is

to cut down on the amount of testing that is unnecessary and in some cases, downright harmful and risky to patients and clearly, doctors, those of us who spent 30 or more years practicing medicine know this all too well. you order tests and you know they are not necessary, but you do that in a defensive way. the president went to the ama in chicago and spoke to them and when that issue was raised by the ama leadership, the president admitted, yes, we do need meaningful liability reform. he made no specific promises but this is the opportunity for this committee to change this, add to hr 3200 and improve it based to on what the president said to the ama. so i thank the gentleman for yielding, i yield back. i support -- >> yield a minute to mr. boyd. >> thank you, dr. burgess, for yielding. in the state of indiana in 1975,

we became the first state of the union to enact comprehensive malpractice reforms it is called the indiana compensation act for patients it became a model for other states as it balanced the need for physicians for affordable liability insurance premiums with the need for patients for good access to all kinds of care. our law contains components very effective for three decades. our statute of limitations limits on recovery, patients compensation fund, a medical review panel and the limit on attorneys' fees. when you balance indiana's success, the state of indiana contiguous is very expense is city of practice medicine, meaning people who live in indiana have greater access to health care. now, when you think about the trends and jury awards and settlements, overall, 74% of the medical liability claims in 2004 were closed without payments to the plaintiff. the plaintiff lost a majority of the cases that went to the jury.

of the 6% of the claims that went to a jury in 2004 to a jury verdict in 2004, the defendant won 91% of the time. so, when the gentleman from iowa was talking about that there suspect a problem here that needs in search to of a solution, i think it is completely false. we all know that doctors are having to practice defensive medicine because of very aggressive plaintiff [ inaudible ]. >> i want to add it is not just defensive medicine it is the doctors on the won't show and care. last week, i spoke with a doctor in phoenix who was an e.r. doc answered explained to me that in their emergency room, they could not get many specialists they could not get hand surgery specialists they can could not get in some instances neurologists they can could not get many doctors to show in the emergency room to handle cases in the emergency room because they did not want to expose themselves to liability of presenting themselves there and indeed, people were getting hurt as a result of those. people who needed a hand surgeon

in an emergency room needed one. people who had a stroke and needed a neurologist in an emergency room couldn't get one. this goes beyond the issue of defensive medicine and cost it goes to the issue of people not getting health care services. >> gentleman's time has expired. for the last five minutes, mr. gonzalez. >> thank you very much, mr. chairman. first of all, let's get straight what we are talking about we are talking about meritorious lawsuits were there is negligence and talking about capping damages. we are not talking about trying to stem some imaginary prices for frivolous lawsuits. we are talking about defensive medicine. we can talk about that. and so what are these great savings that we are going to realize if we impose these kinds of restrictions for the right of people to seek redress from negligent acts? well, i'm from texas also. and the beauty of that law that we passed in 2003 is truly in the eyes of the beholder, mr. chairman. and it is the eyes belong to the victim, i assure you, they don't look at it in glowing terms as

have been described here today. now one would expect if this was so successful that cost once brought down, health care insurance would be available at reasonable prices, premiums would go down, all of that would be, i guess, an outcome. but let me -- 2003 goes into effect. from 2000 to 2007, texas health care insurance increased 86.8%. the average health insurance policy went from $6,638 to $12,403. now, because of these tremendous savings that texas has been able to realize because of this incredible law, this far-sighted law, let me give you the texas experience. and this is what the other states aspire to go at t 4.2 million texans do not have

insurance. 30% of our population. 1.5 million children, 21%, don't have coverage of any type. now, if that's what this law has produced, go ahead and replicate it in all 50 states. it's a great experiment that did not work, but go ahead. the real sad thing about this law is that it shifts the responsibility and the liability from the negligent party to innocent parties, not just the victim, but all of those that will have to incur the cost to care for that victim. to truly compensate that victim for that injury. that's the injustice of these laws, that the negligence, culpable party is set free without truly paying for the neck limp jent acts. now, since when do you want to re so i would