out of my control, the date for employment has been progressively pushed back. although i could find a temporary job, i chose instead to go back to work for a professor at university of rhode island that i had previously been turned with. but this is the funding has been lost and he is no longer to -- able to pay me as he has in the past. i'm volunteering their as a research assistant working with weather balloons, ozone monitoring, and data processing, honing skills which will expand my opportunities as an atmospheric scientist. our research position does not offer health care benefits. under the new law, i was able to stay covered by going back to my mother's plan after graduation.

the truth is far different. i would have little choice in the matter. i would need to go on insured, yet i know how important health insurance is even for a healthy person like myself. 9 if i get cancer or get hurt in a car accident, what would happen to me? my parents could not afford such health care costs. i could get a private income to afford health care, but i am currently have the university. no doubt in the future job opportunities will a rise because of my experience. if i were not able to stay on my parents' plan, i would have to make a sacrifice. that is a choice no one should have to make. under this new plan i can feel

safe until 26. thank you for your time and this opportunity to speak on behalf of young americans. while my political views fall across the long-range, this is not partisan to me. i believe allowing young people to stay on their parents' insurance gives them the freedom to work toward their career goals without going uncovered. i want to say thank you for giving me a chance to stand up for something i believed in and to make my voice and the voice of young americans heard on this issue. >> thank you very much. that was a thoughtful presentation about what you face in terms of your future. scott said, we can hear from you. thank you and -- claudette, we can hear from you. thank you for being here. >> i thank you for this

opportunity to testify. my husband and i are both on medicare. a major new protection for seniors just started this month. medicare pays for preventive services with no out-of-pocket cost for us. less sure we made a decision to put of preventive care, -- last year we made the decision to put off to preventive care. the last time i had a mammogram we were left with copays and we could not afford. i was diagnosed with pre- cancerous cells in my breast a few years back, and i was told i should have won every year. i am going on two years now. i also have: polyps, and i was told i should go by every three

years. i am going on five years. richard has a number of problems. he enrolled in medicare in may of 2010. june 1 he reached sedona hall, -- the go not hold -- donut hole. this costs $993 for a 20-day supply, and he has been a diabetic for 15 years, and they have tried different medications. this is the one and it works for him. after three months of paying off of -- paying out of pocket we reached the maximum and started paying 95%.

this was for house payments for us. we had to choose between defaulting on our loans or my husband's health. now we chose my husband's health. fortunately a local charity paid the money, and i am now volunteering. changes made are starting to a in the -- end the donut hole. get a year's seniors can 50% reduction. this could have saved us thousand last year. in the past week, i spoke with a few members of our community, and i want to hear their stories. there is don of last year. he had no idea this was coming. he is working two jobs to pay for his medication.

larry has rheumatoid arthritis. she has cancer, and they wanted to retire. pauline is 61. she never heard of the doughnut hole, and i could see her face falling. she said if this was repealed, we will not be able to retire. this

they survived today and, it is the least funded of all cancers. they endured chemotherapy, and that has left them with medical issues they will have for the rest of their lives them.

the treatment are shots of growth hormone. they are very expensive. they switched to another insurer, and that insurers decided they knew more than my doctor, who was so world- renowned pediatric endocrinologist. he described the growth hormone for them. they said it was experimental. we do not care what the previous insurer did. we do not feel it is necessary, so i had to continue to fight,

and they denied again and again. my doctor had a conference. they approved them, and when the office called, they said, we should never have approved that. through shame and speaking out in public constantly about his evil practice the insurance industry seems to have, i shamed them into covering its, but fortunately in that time, the manufacturer of the human growth hormone we received, they have the bridge program, because the pharmaceutical industry knows the insurance industry does not want to cover these drugs. they have things in place.

not only are we subsidizing the insurance industry, but so are the pharmaceuticals. they're not all free of guilt, but i am very grateful to them for helping us and during that process. i intend to go off track. -- i tend to go off track. in fall of 2008 i read part of then senator barack obama hoss health-care proposal to reagan my daughter's began to cry. she said, barack obama really

understands. he is going to help us. here is a 10-year-old girl but knew what he had was the right thing to do for people. our new health care rights and freedoms really address what people like us need. our lives would have been much easier had this been in place at the time, and for the children diagnosed every year with cancer, this is what it means to them. they amassed critical protections. provisions prohibit them from denying coverage to individuals participating in clinical trials, and clinical research is key to finding a better

treatments. clinical research is never covered by insurance, so a lot of great research goes by the wayside because it is underfunded. the cornerstone of cancer research is what these are. children should no longer be denied coverage because of pre- existing conditions. that is one of our vegas fears. -- biggest fears. in the future, what are they going to do? are they going to go uncovered? not in my country.

as with all cancers, earliest detection is key to survival. we pay over $500 in copays, because we see a series of specialists, and to a family of six, $500.10 coke paid is very expensive -- of $500 copiague is very expensive. -- cancer is very expensive. it will also prohibit companies from dropping coverage if somebody get sick and giving the peace of mind that they will cover the procedures the doctors

recommend, because just because you have insurance doesn't mean they cannot deny it and say we are not going to pay for it, because in my plan they covered the growth hormone, but they could also refused to pay for itself, and wouldn't that be a breach of contract if you are paying for a service and the company says, i do not think so? they can do that. we let them do that. not under this law. i am almost done. this is so important to millions of citizens.

my children now have protection from this. they will never have to fear if they get sick. they can look forward to lower health-care costs and preventative care. no one who understands how important these and other provisions are ken -- can condone this legislation that repeals fees. -- these. i am so happy to be here to tell my story and the story of other americans who have it so much worse. i thank all of you -- i would like to urge all of you to stand up for this. thank you so much. you have no idea how much it meant to a lot of people.

i know you only got to hear the bad because that is all the news wants to play, but believe me. it was greatly appreciated. >> thank you for your testimony, and thank you to your daughters for accompanying it you today. we are glad you joined our hearings. you are right. and we encounter this in our district all the time, and that is why we are so passionate about making sure you are protected for the first time, as are your daughters, so thank you so much for your testimony. apparently you are not alone. i notice in a recent story that united health care indicates they have added new customers that are employees of businesses that employ 50 people or less

than that coventry health care out of maryland reports 115,000 new workers have the possibility of coverage with small and businesses, and blue shield in kansas city has a 58% jump in the number of small and businesses buying insurance since the legislation was signed into law with the help -- the tax credit being available, so this is a real opportunity for those employees working every day that did not have the opportunity for coverage. you are leading the way. i would like to introduce mr. andrews. >> i would like to thank our leadership for this opportunity and thanks the young ladies and gentlemen who came here to speak. it takes a lot of character and integrity to come to a public

forum and tell your story and share your soul in such a compelling way. we thank each and everyone of you. he said you are all set to step into a job that deals with research and development on aviation issues. if we had a choice tomorrow between voting on appealing the health care bill or voting on a hill but helps small distances and other employers creates jobs throughout the country, which the you think we should take upon the house floor? >> i employs to get that job, and i need health insurance now. -- i am ways to get that job, and i need health insurance now. if i get in a car accident, i am going to be looking for health insurance. i need to know i am not going to die, and that takes precedence for me.

>> she you think we should be pursuing repealing the deal that gives you the rights you have? >> it should be helping employers find more jobs. >> we would like to get you a voting card and get you on the floor tomorrow. ms. french, thank you for your reading this in france and -- miss branch, cross is for your testimony. you were talking about being a breast care -- breast cancer survivor. if you had a chance to tell your congressman what you would like him or her to do based on your experience, what would you tell them? >> i would tell him to do the right thing. he voted for health care reform,

so i know he is going to do the right thing. he is not going to repeal this law, so i expect him to listen to all of our constituents and to make sure we are all covered and that we are not discriminated against because we had a breast cancer in the past. >> finally, mr. ritter, what would you say to your representative if the person were to say that we have to appeal -- appeal obamacare -- repeal obamacare? >> you might be sorry you asked that. my representative is congressman show it. >> what would you like to say to him? >> i would like to say as passionate he is about abortion,

i wish he would be as passionate about my children who are already here and deserve and need the same kind of care and love and support said he is seeking to halt everything for for someone else who does not even exist. not to sound crass, but they are here. they need us. they are our future. we need them. i implore him to stop the games, started representing everyone in the district. when i wanted help with health care, i left my district. i went to a different district to ask for help because he was not willing. >> the thank you for this opportunity. >> thank you, mr. chairman. thank you for being here and sharing these personal and compelling stories. i have a question for you.

it sounds as if what you were describing as work experience would enhance your ability to become a meteorologist and get a good-paying job, and i wonder if you face -- if you have met other young people who face the same thing you would face if this were repealed and you would either not have insurance or would have to quit what seems like a solid career path. >> there are a lot of people in my position. that is waving the job market is now. there are a lot -- there is -- that is the way the job market is. there are a lot of people with internships. they are working in jobs and getting very little, and repealing it would mean they would have to make a choice to continue what would be a letter to a future job or sit around

and make sure their house is ok. -- their house is ok -- health is okay. >> you explain this desire -- does worry about reaching a tax -- cap. what would happen to you if this were repealed and the cap were reached? how would you access what you need, and what would be the consequences if you could not access that karen? -- care? >> the consequences have happened before. it is almost a crime to have a chronic disease in this country. instead of helping a working, taxpaying citizen, they want you

to leave your job, sell your car, sell your house and become a ward of the states, and only then will we give you benefits for health care and now that i am a parent and have a 10-year- old, when i was single we said, we will figure it out. my parents my entire life the health insurance industry says we really need you to go away. i want to work. i want to own a home. i want to be successful. the thing holding me back is a disease you are born with. then coming up with lifetime caps of $1 million a year, i was casting about -- capping out every two years. the acquisitions and mergers of

the companies, every two years i have somebody else doing the same work, and that is the only reason i was not forced to go on to medicare or medicaid. stop forcing people who want to work for a living -- i do not want new for everyone else to be paying your taxes for my health care. i want the insurance industry to ensure us. >> thank you. >> thank you very much, mr. chairman. i want to thank each of you, because you put a human face on what we are dealing with. these are problems that did not just start now. these are problems faced by millions of people, to be denied care because you have a lifetime cap, to be denied insurance coverage because you have a pre-

existing condition or you threaten to cost insurance companies more money, to be denied insurance because you do not have a job, to be denied insurance becomes rigid because some insurance company decides your gender -- because some insurance company decides your gender as a woman is a pre- existing condition. it shocks me when i hear those who want to repeal the seville talking about how they want to give -- appealed the bill talking about how they want to give more freedom. how can you consider yourself free if you have to the nightmare of not having health insurance available to you? some say government is today. government should not be involved if insurance companies were spreading of risk. we did not need government to do this except to protect the american people from the insurance companies, and when people want to repeal this bill,

the ones they want to make free are the insurance companies, who carry on these kinds of practices. i want to ask the question, and i hope -- you are on medicare? >> yes, i am. >> just being on medicare does not make you feel if you are doing anything wrong, because the u.s. government established of medicare program, and it is a government insurance program where you can go to the private doctors and hospitals. you think government should not be involved in providing medical care proceedings? >> i do not have a problem with that. >> i do not think most americans have a problem. those that are on medicare say they love it. they would be lost without it, and those that are not on medicare are paying into the

system so they will have access as well, but even with that insurance, the cost of drugs -- coming about cost of drugs -- tell me about the cost of drugs. >> $4,550, and for the both of us, i just started in january, it would be $9,100 out of pocket, and because of my husband and insulin, there is no saving money. >> the doughnut hole -- they should have made it like a regular medicare benefits. they wanted the insurance companies to run the pharmaceutical plan, and they also wanted the pharmaceutical companies to come out ok, so when they created it, you have

to buy an insurance company, and after you pay a certain amount of money, the insurance companies make you pay for the rest of it. that makes no sense to me. can you see any rationale for that? >> i do not, but speaking to people, not too many people know about the doughnut hole, and they go into medicare, and they are surprised and devastated. >> we have to preserve medicare. if it were repealed, they will want to repeal medicare next. we will be a better country when people can get jobs and not fear a lack of health care, to be able to know their insurance companies cannot deny them what they need, and when medicare is available, they will have a preventive services. that is what the republicans want to repeal, and that is why

we have to fight this. >> questions. >> first, i wanted to join with our guest, who spoke, and they the democratic leadership who gave us the opportunity to have this hearing and i appreciate your taking the time to give these presentations. i listened to your stories, and so many of us have our own personal stories about how we have been impacted by the health care system. you were probably as surprised as i was when my daughter turned 22. i did not know once you hit 23 you are removed from insurance. i think that is not publicly known until you get the letter and go into a panic. i remember when folks with your

disease did not even survive, and it was because of medical research that you are here today. unhook by looking at your daughters, and i have a 19-year- old stepdaughter who was by a nose with leukemia. i listened to use -- listened as you mentioned the test tube by past as you are due for a mammogram and colonoscopy -- the test that you missed for a mammogram and colonoscopy, and since health care reform has been passed, are you able to get those tests? are they accessible and affordable? >> yes, they are, and there is no co pay.

>> over the next several hours, three defense about the continuing debate of the future of the health care law. in a few moments, some of the opening debate on a move to repeal the law. after that a policy analysis at briefing and why they support it. the steering committee pose a panel of citizens talking about medical situation and why they support a new health-care law. china's president who jintao is in washington this week for talks with business and political leaders agreed and we will have live coverage -- and political leaders. we will have live coverage. from capitol hill, a house foreign affairs committee meeting on u.s.-china relations.

witnesses will focus on how china affects the u.s. interest, and we will be back of the white house after 1:00 p.m. eastern for a joint news conference with president obama and president hu. the house of representatives began debate tuesday on a bill that would repeal the new health care law. this part of the debate is a little more than two hours. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2011] >> i want to begin by saying why we are here. we are here because we heard the american people during the last election. ection. we are here because we believe it's really important to do in office what you said you would do. we said we would have a straight up or down vote to repeat -- to repeal this health care law and that's precisely what we are doing here today.

mr. speaker, why do we believe this? because this health care law, if left in place, will accelerate our country's path for bankruptcy. this health care law, if left in place, will do as the president's own chief act wear says will do, will increase health care costs. we're already seeing premiums go up across the board. we're already hearing from thousands of employers across the country who are talking about dropping their employer-sponsored health insurance and we're already hearing from the lack of choices that consumers will get as this new law is put into place. this new law is a fiscal house of cards and it is a health care house of cards. it does not make our health care system better. i would argue it makes it weaker. there's two ways to attack this problem. . we agree there are so many legitimate problems in health care that need to be fixing. the uninsured.

people with high health care costs and high health care risks. those need to be address. but we can fix what's working, what's not working in health care without breaking what's working in health care. with that, mr. speaker, i would simply say this. . we believe we can get to the moment of having affordable being health care for every american regardless of pre-existing condition without having the government take it over. without $1 trillion of a combination of medicare benefit cuts and tax increases. . i yield myself an additional 20 seconds to simply says -- the speaker pro tempore: the gentleman is recognized. mr. ryan: we believe thealt care ought to be individually based, ought to be patient-centered. . there's two ways to go. put the government in charge and have the government put in place the rationing mechanisms to tighten the screws and tighten health care or put the consumers in charge and have them compete four us as patients. that's a system we want and with

that, mr. speaker, i reserve the balance of my time. the speaker pro tempore: the gentleman reserves the balance of his time. the gentleman from maryland, mr. van hollen. mr. van hollen: thank you, mr. speaker. i yield myself four minutes. the speaker pro tempore: the gentleman is recognized for fourth down four minutes. mr. van hollen: thank you, mr. speaker. i hope the tenure and substance of the debate we have in this house over the next few days will be worthy of the american people and reflect well on this congress. many of us believe we should focus our efforts here today on measures to help people put back to work rather than on a bill that takes away important patient and consumer protections. and we don't think it makes a whole lot of sense to debate a bill that thankfully will go nowhere in the senate and would certainly be vetoed by the president. however, the republican majority is entitled to use its time here as it chooses and while we believe we should be doing that focused on jobs, perhaps this debate will clear up many of the myths and misinformation about the health care law that was signed by president obama.

i'm interested to hear my colleagues say that they can identify with all the problems in the health care system between the year 2000 and 2006 premiums in this country doubled, health insurance company profits quadrupled and this congress did nothing. why not put your plan on the table first so everybody can see it before you begin taking away the important patient protections in this bill, taking effect just since last march? and within that nine-month period that law has made an important and positive difference to millions of americans. in fact, we wished our republican colleagues would take a few days, maybe even just a few hours to have congressional hearings, to listen to those individuals and families. the new republican majority said it wanted to listen to the american people but it has not

invited a single american outside this congress to a hearing to testify on the repeal bill we are debating today. and as a result we on the other side of the aisle have had to schedule an unofficial hearing. it's going on right now. not 100 yards from where we debate in the capitol visitor center. and i encourage all of to you drop by because if you do you're going to hear some stories, you're going to hear stories from moms and dads of young people who tell you how they're relievinged that their sons and daughters are no longer kicked off their insurance policies when they turn age 22 or graduate from college. and can now stay on their parents' insurance plan until the age of 26. as a result if their 20-year-old child gets sick or hit by a car or another terrible accident they can get care without the familiar going bankrupt. you will hear from moms -- family going bankrupt.

will you hear from momses and dads with kids who have cancer or diabetes or other pre-existing conditions, telling you they're relievinged that finally insurance companies can't deny their children coverage because of pre-existing conditions. and will you hear from senior citizens who were unable to pay for the huge prescription costs of their bills and then as of january 1 of this year they're getting a 50% discount and they can afford to pay for the medicines their doctors say they need. and you'll hear from small businesses and the number of small businesses using the tax credit has exceeded everyone's expectation. you'll hear from those small businesses saying they can now afford to purchase affordable coverage for their employees and as a result hire more people. you would hear all that and more. and that is why it is such a mistake, it's a historic mistake, to take away these patient protections and throw

these individuals back over to the whims and the many abuses of the insurance industry. there's no doubt that the insurance industry will be popping champagne bottles if the health care law was ever to be repealed. let's put the interests of our constituents, patients and consumers first in this debate. i yield myself an additional 30 seconds. the speaker pro tempore: the gentleman is recognized. mr. van hollen: and let's make sure that as we do this we tackle the deficit and the debt. i listen to my colleague talk about the debts but we all know that the independent, nonpartisan congressional budget office in a letter to speaker boehner dated january 6, 2011, indicated that repealing this bill will increase the deficit by over $200 billion over the first 10 years and by another $1.2 trillion over the second 10 years. now our colleagues have

criticized those findings but they're the same people who they applauded when the numbers came back their way. so, mr. speaker, i thank you and i reserve the balance of my time. the speaker pro tempore: the gentleman reserves. the gentleman from wisconsin. mr. ryan: mr. speaker, at this time i'd like to yield two minutes to a new member but a seep yor member of congress, the gentleman from california, mr. calvert. the speaker pro tempore: the gentleman is recognized for two minutes. mr. calvert: mr. speaker, i rise today in support of h.r. 2, a bill that repeal the disastrous government takeover of health care. the more we learn about the new health care law, the more we understand how devastating it will be to our economy. already employers across the country have suffered increases in their health premiums as a result of the health care law. yet we were told that the bill would send or bend the health care curve downward. we were told the bill would reduce the deficit by $143 billion over 10 years. however we know the figures given to the c.b.o. did not ac radly reflect the law's real cost. when you add back the $115

billion needed to implement the law and subtract the bill's double accounting revenue and other budgetary gimmicks, the true cost is a staggering $700 billion over 10 years. we were told the bill would protect the uninsured, yet all it does is roll them into medicaid, a low-performing program that has resulted to more people turning to the e.r. for their medical needs. we were told this bill would help seniors, instead it guts medicare advantage, leaving 50% of beneficiaries on the verge of losing their courage coverage. what happened to the promise that if you like your health care plan, you can keep your health care plan? in addition to all the false promises, the health care bill will impose $52 billion in new taxes on businesses. our economy relies on the ability of businesses to grow, hire, invest and succeed. the new taxes will devastate our economy, turn the american dream into a nightmare. the bottom line is that we cannot afford this new health care law no matter how well

intentioned. we must repeal obamacare, replace it with legislation to decrease health care costs, increase competition in the marketplace, maintain the sanctity of doctor-patient relationships and truly helps those without insurance. i urge my colleagues to vote in favor of h.r. 2 and with that i yield back the balance of my time. the speaker pro tempore: the gentleman yields back. the gentleman from maryland. mr. van hollen: at this time, mr. speaker, i yield 2 1/2 minutes to the gentlelady from pennsylvania, ms. schwartz. the speaker pro tempore: the gentlelady is recognized for 2 1/2 minutes. ms. schwartz: thank you and i rise to speak very forcefully, i hope, about the importance of proceeding with the health care bill, the health care law that we have in place and the incredible protections that it is providing to literally millions of americans in each and every one of our districts. each of us have heard from them. the new health care law reduces the deficit. we're here talking about thing budget committee it is going to reduce the deficit while

promoting more efficient and higher quality care. reducing the deficit and slowing the growth of health care costs means real savings to american families, american businesses and to the federal government. and yet their first major act in the majority, congressional republicans want to repeal this law. repealing the protections for americans with pre-existing conditions, we just heard this morning "the washington post" reported on a study that says that one half of all americans under the age of 65 have a pre-existing condition. this isn't just about a few of us. it's about really almost all of us. we all know someone, we all may love someone who has a pre-existing condition. this -- the republicans got their way and they will probably in the house but fortunately not in the senate, they would repeal the protections for americans with pre-existing conditions, children can already now be covered. they would repeal the new law that says annual limits for coverage, if you have cancer,

will be repealed. it will repeal the prescription drug benefits for our seniors. and it will repeal tax credits for small businesses and in doing so they will add to the costs for american taxpayers. let's be clear on this what this means. repeal increases the deficit by $252 billion over 10 years and $1.4 trillion over 20. repeal reverses progress in getting health care costs under control, causing families and businesses and the government to face higher health care costs. it repeals the benefits for millions of americans, important consumers protections and ensures reform, such as making sure that children with bre existing condition have coverage. and the repeal means starting over. we're going to hear it over and over again over the next seven hours. what's start -- what starting over means is no consumer protections and months and maybe

years of just talk. possibly no action while the cost goes up for american businesses, go up for our families and go up for our nation. can i have another half a minute? mr. van hollen: i yield the gentlelady another 30 seconds. the speaker: the gentlelady is recognize. ms. schwartz: the new rules allow the republicans to do this, but it's going to cause greater suffering for the american people. it's a wrong course of action, let's not repeal this bill, it will hurt american, it will hurt our economic competitiveness and hurt the fiscal condition of this nation. i encourage a no vote and i yield back. the speaker pro tempore: the gentlelady yields back. the gentleman from wisconsin. mr. ryan: i want to yield myself three minute bus first, i ask unanimous consent that all members have five legislative days in which to revise and extend their remarks and include extraneous material on h.r. 2. the speaker pro tempore: without objection. mr. ryan: i'd like to yield myself three minutes to address

some of the charges i've heard. number one, they're sayings that jobs bill. half a trillion dollars in tax increases creates jobs? mandates taxes -- mandates for taxes? that creates jobs? others say, the senate is isn't going to consider it, the president isn't going to pass it, so why bother? if that's the attitude, let's just go home. let me speak to the fiscal house of cards represented by this law. the minority is saying, this reduces the deficit look at the letter from c.b.o. to speaker boehner, it reduces the deficit by $130 billion over eight years. it does that if you manipulate the c.b.o. i've heard charges of enron accounting. the only enront accounting is the previous majority gave the c.b.o. a bill full of smoke and

mirrors and made them score that here's what the c.b.o. says if you take away the smoke and mirrors, the fact that there's $78 million in class act premiums double counting, $a 53 billion in social security taxes being double counted, $153 billion needed to hire new bureaucracy that wasn't counted, cuts in medicare that are being double counted and let's not forget the doctor fix, $208 billion, that we just discounted and ignored. when you take away the smoke and mirrors this has a $701 billion deficit. if you don't believe me when i say it that way, how about this way. the c.b.o. says this raises the debt. how is that different, where they say on one hand the bill lowers this edeficit but on the other hand, it raises the debt? when a c.b.o. looks at whether or not they raise the debt, they look at everything, the interplay of all fiscal policies to look at its effect on the

debt. when they score a bill on its effect on the deficit they look at what you put in front of them, the smoke and mirrors, double counting, noncounting, and account for that. if this lowers the deficit, how does it increase the debt? you have to play a phony trick with double counting to do that. what does this bill ultimately do? it blows a hole through the deficit. when you look at the first 10 dwhreerks bill is a $1.4 trillion increase. that's because you have 10 years of tax increases and medicare cuts to pay for six years of spending. when you actually look at the full 10 years of implementation of this law, $2.6 trillion in spending, $2.6 trillion. now, mr. speaker, let me say that, jobs and the effects on this health care bill, i had an alarming conversation with a large employer in wisconsin not long ago, a privately held

company with thousands of employee, she takes good care of her employees. i yield myself an additional 20 seconds to say this the speaker pro tempore: the gentleman is recognized for 20 seconds. mr. ryan: she said to me i believe it's my obligation to offer health insurance to my employees, but my two publicly traded competitors said they're dumping their employees. instead of paying $17,000 a year for employee health care, they'll pay a tchrs 2,000 fine. that's a $15,000 difference her competitor will have as a competitive advantage against you. she said, i have no choice, i'm going to dump my employees in this exchange and thousands of employers are making the same decision. this should be repealed and with that, i reserve the balance of my time. the speaker pro tempore: the gentleman reserves. the gentleman from maryland. mr. van hollen: i yield myself three minutes. the speaker pro tempore: the gentleman is recognized. mr. van hollen: it is interesting to hear this attack on the c.b.o. numbers that came out when many of my colleagues on the other side of the aisle

just nine months ago, when the c.b.o. wasry porting deficit numbers and the cost of the bill, were singing c.b.o.'s high praises. now, let's look at some of the items just mentioned. let's look at the doctors fix payment. let's look at the s.g.r. all of us know that that's been an issue that's been with this house for years and years and years and it has nothing to do with the health insurance reform bill that was signed by the president, we're going to have to deal with that issue, whether we had health insurance reform or didn't have health insurance reform. mr. speaker, they know that. we've also heard, i do not neeled at this time. we also heard, mr. speaker, that they said we front loaded the revenue in this bill and actually -- and disguised the costs. if that were the case, how is it possible that c.b.o. would say that it actually reduces the

deficit by more in the second 10 years than in the first 10 years? the fact of the matter is, this bill will increase social security revenue as employers provide more of their compensation in the form of wages that are subject to payroll taxes. double counting is not the issue. the fact is, it reduces the deficit and c.b.o. says that. now c.b.o. is the independent referee that we use in this body. they're like the guy on the football field, the referee who calls the plays and calls, you know, when there are penalties and no penalties. sometimes we like the calls, sometimes we don't. but it is an unprecedented, it's an unprecedented step to say that we're going to totally ignore the decisions and judgments of the independent c.b.o. and we're going to replace that with our judgment

for the purposes of deficit reduction calculations in legislation that goes to reducing our debt. that is a recipe for budget anarchy. it's a recipe for fiscal chaos. and we should not go down that road. the c.b.o. has been very clear that the fiscally responsible thing to do is to move forward with the law in its place. we obviously can fix things as they come up that need to be addressed, specific item, but to repeal this wholesale will, according to the folks that we rely on, as the independent, nonpartisan judges here, say that repealing this bill, as our colleagues are proposing to do, will add $1.4 trillion to the deficit over 20 years. i reserve the balance of my time. the speaker pro tempore: the gentleman reserves. the gentleman from wisconsin. mr. ryan: i yield myself 10 seconds to say, if the doc fix

should be considered outside, why did the democrats have it in their bills in the beginning. the second thing is, either we're financing this entitlement and raiding the social security and medicare funds you can't do both. with that, i yield two minutes to a new member of the committee depr michigan, mr. amash. mr. amash: the founders were concerned with our freedom. the debate we're having today goes beyond health care. although there's no doubt that health care coverage is an important and difficult issue. what we're discussing today goes to the core of our constitution's design. it asks members of congress whether we take constitutional limits to our powers seriously. we have all witnessed every

americans' renewed interest in the constitution as they ask tough questions about the constitutionality of the law. the law's proponents have tried to dress up their answers in constitutional language. they say congress' power to tax upholds the law but when this bill was first being considered, they claimed the bill contained no new taxes. they tried to find support in congress' power of interstate commerce. if forcing americans to start commerce is the same as regulating existing commerce, it would have been news to the founders. finally, they claim that congress can do anything that is in the general welfare of the country. if this law is constitutional if congress has such broad power, our limited federal government will become limitless and all without changing our constitution or the approval of the americans whom it protects. it is not just for the courts, it is our duty as a congress to pay attention to the constitution and its limits on

its powers. i urge that we repeal this unconstitutional law. i yield back the balance of my time. the speaker: the gentleman yields his time. the gentleman from maryland. mr. van hollen: i yield one minute to the gentleman from virginia, mr. connolly. the speaker pro tempore: the gentleman is recognized for one minute. mr. connolly: i rise as a member of the budget committee to oppose this deficit-bust regular peel. i want to speak on behalf of suzanne from vienna, virginia. her daughter suffers from a debilitating disease and before this reform they could not get coverage for their daughter because she, through no fault of her own, had a pre-existing condition. while others wait to see if their insurance company would deny them, suzanne knew. she was willing to pay extra premiums but the insurance company said no. suzanne had no option until we created high risk insurance pools under health insurance

reform. her words to me after health insurance reform passed was, now at least we have hope for the future. this will take away that hope throwing suzanne's daughter off of insurance. i urge my colleagues to remember suzanne's daughter and 129 million other americans like her and stop this repeal. the speaker pro tempore: the gentleman from wisconsin. mr. ryan: i yield one minute to mr. mulvaney. the speaker pro tempore: the gentleman is recognized for one minute. mr. mulvaney: i can't tell you how excited i am to hear the language coming from the other side of the chamber this evening. i'm hearing about the importance of cutting deficits and keeping spending in line. it makes me wonder what's been happening here for the last several years. i think we've been consistent with that message over the course of this debate on this side of the aisle. i don't know where the other side was when we got the information that this bill cost trillions of dollars. i don't know where this attitude

about being fiscally responsible was when we got information from the chief actuary that medicare and medicaid who said this bill was unsustainable in its spending. i don't know where they were with this attitude when we heard that this bill raised the cost of health care versus not passing the bill. but mr. speaker, i'm extraordinarily excited to hear this level of discussion. as a member of the budget committee, i look forward to this level of debate continuing beyond this bill, beyond the health care discussion, and into the upcoming discussion on the budget. my guess is, if we have this level of discussion on health care, the budget will be an easy, easy debate this year and we'll be able to make dra maltic inroads. the speaker pro tempore: the gentleman yields back. the gentleman from maryland. mr. van hollen: i yield one minute to the gentleman from texas, mr. cuellar. the speaker pro tempore: the gentleman is recognized. mr. cuellar: in the long, rich history of congress, when a prior congress passes a piece of legislation, the prudent step is

to look at that legislation and agree on making changes on what doesn't work. i think to come today and look for repeal and not have a health care plan in place is not the prudent approach. we have to see what works and what doesn't work. that would be the prudent step to take today. we have to focus on the deficit and on jobs. deficit is important and i think we can come together and work in a bipartisan approach. this is one thing we need to look at today. jobs, we certainly have to look at coming in. but just to come in and say, this is something that kills jobs is not the right step to take. if you look at, for example, the nfib research foundation when they looked at this piece of legislation, they say that a number of health care profession jobs will be created by this legislation. this is something that we need to look at. again the prudent step to look at is to look at what works and what doesn't work. mr. speaker, that's what we need to look at. thank you, mr. speaker.

the speaker pro tempore: the gentleman from wisconsin. mr. ryan: i'd like to yield 90 seconds to a new member of the budget committee, mr. cole of oklahoma. the speaker pro tempore: the gentleman is recognized for 90 seconds. mr. cole: i rise to support h.r. 2, the repeal of last year's so-called health bill. the american people, quite frankly have never liked this bill as they demonstrated last november. you can't find a poll where it's ever cracked 50% in approval. and those wanting to repeal it have generally always been above that mark. the bill itself may be unconstitutional. over 20 states are now challenging it in federal court. it's certainly likely to be unworkable. the creation of dozens of boards, agencies and commissions with rule making authority, the fact that hundreds of companies have already asked for waivers under the legislation suggest it's going to be a bureaucratic nightmare. but finally and most importantly, the bill itself is fiscally irresponsible and unsustainable. the idea that we would take

hundreds of billions of dollars out of medicaid, social security and medicare at a time the baby boomer general riggs ration is beginning to retire is ir-- generation is beginning to retire is irresponsible. we need savings to sustain medicare. so i urge this house to take the fiscalry -- fiscally responsible course, repeal this bill and start over and give the american people the health care bill they deserve and the health care bill they can afford. thank you, mr. speaker, i yield back my time. the speaker pro tempore: the gentleman yields back. the gentleman from maryland. mr. van hollen: mr. speaker, i yield got minutes to the gentlelady from florida, ms. wasserman schultz. was was mr. speaker, rise to -- ms. wasserman schultz: mr. speaker, i rise to oppose this. reform has already made a dramatic positive difference for millions of our constituents and small businesses while tackling our ballooning national debt. we in congress must continue doing all we can to support american families and businesses as we emerge from this recession.

democrats have pledged to measure all legislation by proposals success at creating jobs. strengthen the middle class and bringing down the deficit. unfortunately the republican majority's attempts to repeal the affordable care act fails on all such accounts. repeal would hurt small businesses, canceling tax credits to help employs afford coverage. it would stall middle class job growth as 1/3 of small business owners told they were more likely to hire new employees as a result of reform and of course repeal would deepen our already exploding deficit, increasing it by $230 billion in the next 10 years and by more than $1 trillion in the following decade. many of my colleagues across the aisle have rebuffed this analysis from congress' own budgetary referee, the congressional budget office. because it doesn't fit the republican nartific or campaign promise to tackle the deficit. however, while they may be entitled to their own opinions, they are not entitled to their own facts. health care repeal is the epitome of fiscal responsibility and encounters our most basic

american values. we lose life when insurance companies can freely drop those who are sick from coverage. we lose liberty when our seniors have to choose between medications and groceries and we lose the pursuit of happiness if we return to the days when only job security guaranteed health security. our fiscal decisions, mr. speaker, must be a reflection not only of our economic future but a statement of our most essential national values. by ensuring that americans have vital coverage, rather than cruelly denying it to them, we can live up to the dreams of liberty and justice for all. thank you. i yield back the balance of my time. the speaker pro tempore: the gentlelady yields back. the gentleman from wisconsin. mr. ryan: at this time, mr. speaker, i'd like to yield main to the gentleman from kansas, mr. huelskamp, a member of the budget committee. the speaker pro tempore: the gentleman from kansas is recognized for one minute. mr. huelskamp: thank you, mr. speaker. as a result of this law, employers across america have learned that onerous reporting requirements will force them to file 10 9 forms for every vendor which they dods 600 worth

of business. i visited with an account in our business that indicatesed he would have to expand his staff by 25% to accommodate all the extra red tape and paperwork. mr. speaker, this is not the type of job creation americans envisioned. additionally, business and labor unions alike have realized obama scare a bad deal. at least 222 have sought waivers from having to comply with the law. h.h.s. secretary kath linesy billious has approved waivers. more troubles is that secretariesy billous has been tarty in --sy billous has been tarty. fortunately rather than selective waivers for the politically connected, we have a universal remedy, repeal the law. i urge my colleagues to heed the call voters made last year during the debate and at the ballot box and i yield back. thank you. the speaker pro tempore: the

gentleman from maryland. mr. van hollen: thank you, mr. speaker. i would remind the gentleman, this body voted on a majority basis to repeal the 1099 provision. with that i yield two minutes to the gentleman from texas, mr. doggett. the speaker pro tempore: the gentleman from texas is recognized for two minutes. mr. doggett: thank you. the choice here is whether to give more money to insurance monopolies or leave just a little bit in the pockets of middle class americans. but for house republicans, putting insurance companies first, putting them always first seems to be a pre-existing condition. this bill isn't repeal and replace, it's repeal and forget. forget the health care needs of millions of americans, forget the hundreds of billions of dollars that they with this repeal add to our federal debt. within a year alison, a 23-year-old in texas who is completing her college degree and caring for her mother who faces another round of breast cancer, alison would lose her health insurance. emily from women berl who is

battling cancer herself would now face lifetime limits on what doctor-recommended care her insurer will pay for. and of course if her husband loses or changes his job, she swronet any insurance at all. and charlotte, an austin senior, she would have to pay for more prescriptions and for preventative health care while the republicans reduced the volume sentsy of the medicare trust fund by over a decade. familiar budgets would be crushed by this bill as health care costs remain the leading cause of credit card debt and bankruptcy. and this same devastating republican bill would also hike the federal debt. that's why republicans have rejected pay-as-you-go budgeting and instead will borrow from the chinese to pay for today's action. yes, repeal is a priority for the insurance companies and their apologists. but neither our family budget nor our federal budget can afford it. i believe that every american is entitled to a family doctor.

not to an appointment with a bankruptcy judge because of soaring health care costs. and i yield back. the speaker pro tempore: the gentleman yields back. the gentleman from wisconsin. mr. ryan: at this time, mr. speaker, i'd like to yield 90 seconds to a member of the budget committee, the gentleman from oklahoma, mr. langford. the speaker pro tempore: the gentleman from -- the gentleman is recognized for 90 seconds. mr. langevin: a few months ago i visited with -- mr. lankford: a few months ago i visited with an employer. when asked about that, the reason they were give season the cost of implementing the new health care law. another business owner told me they will not hire new employees until they can figure out what the cost of health care is going to be so they will just stop hiring. while some in this chamber talk about universal coverage and cost controls, many people in my district are frustrated with so the called solution. every person should control their own health care options and opportunities. every young student should have the motivation and as our population ages, every doctor should have greater sbintive to take on medicare patients --

incentive to take on medicare patients. we shouldn't just move the costs to the states and put price controls on doctors and hospitals. shared pain is not what america was looking for. america was looking for solutions. the new health care law will create long-term budget issues in the days to come from a budget perspective, you can cook the numbers all you want but this bill will dramatically increase our federal debt again. we need answers. not bigger problems. this is the united states of america. intellectual we can do better than this. it's time to repeal this law and start the hard working of solving cost care delivery. i yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from maryland. mr. van hollen: mr. speaker, if i could inquire as to how much time remains. the speaker pro tempore: the gentleman from maryland has 3 1/2 minutes. the gentleman from wisconsin has 5 1/2 minutes. the speaker pro tempore: -- mr. van hollen: mr. speaker, i yield to the gentleman from kentucky.

mr. yarmuth: thank you, mr. speaker, tomorrow we will vote on the republican health care bill. this bill is another example of actions speaking louder than words. many of my republican colleagues have said they support certain health care reforms. a ban on pre-existing condition discrimination, allowing young adults to stay on their parents' health care policies, closing the prescription doughnut hole, they could have crafted this bill any way they wanted, they could have guaranteed any or all of just those important provisions, those protections they claim to support. but they didn't. they could have ensured that by 2016 annual health care premiums for the average american wouldn't be $24,000. and over the next decade, small businesses wouldn't lose more than $52 billion in profits. they could have crafted the bill that this way but they didn't. they can say whatever they want but the truth is that the republican plan is no care, no matter how desperate or how dire your diagnosis, no matter if the alternative saves money, saves jobs and saves lives.

i yield back. the speaker pro tempore: the gentleman yields back. the gentleman from wisconsin. mr. ryan: at this time, mr. speaker, i yield two minutes to the gentleman from new jersey, mr. garrett. the speaker pro tempore: the gentleman from new jersey is recognized for two minutes. mr. garrett: i thank the chair very much. i rise today in support of repealing this simply job-destroying health care bill. and replace it with a piece of legislation that addresses three main tenants. one that will grow our economy, one that will bring down costs and one that is basically constitutional. in the area of jobs, you know, i remember when minority leader pelosi, then speaker at the time, said, this bill would create four million jons -- jobs. 400,000 of them immediately. all the same the c.b.o. was saying, quote, it was likely to reduce employment. so instead of encouraging american jobs, this takeover of health care on small businesses will give us more taxes, more mandates and higher health care costs on those small businesses. look, we need to do this and work this together with a bipartisan manner will thank

will help our small businesses. in the area of costs, additionally, this health care bill is deficient in that it fails to address bringing down costs. now, companies have begun to digest this health care bill, costs have only risen. c.b.o. has found that this will actually increase health care premiums by as much as 10% to 13%. one of the areas that i looked at and i've heard from a lot of people in the medical community and i've asked them, what is one major thing you'd have liked us to put in this bill and that is tort reform. but it's missing in this legislation. it is imperative that any serious reform of the health care system take a very hard look at the issue of medical liability reform. unfortunately this bill fails in a that regard too. finally in the area of constitutionality, well the constitution -- grants congress the authority to rel regulate commerce among the several states and the supreme court is allowed congress the ability to regulate, prohibit all sorts of economic activity this bill goes even further because for the first time in the history of the u.s. government, we are

regulating inactivity. for the first time congress has mandated that individuals purchase a private good approved by the government as the price of citizenship. in the first day of congress i introduced a bill, h.r. 21, the reclaiming individual liberty act, and it would take out that individual mandate because while i believe it's -- the speaker pro tempore: the gentleman's time has expired. mr. garrett: i do believe -- the speaker pro tempore: the gentleman's time has expired. the gentleman's time has expired. the gentleman from maryland. mr. van hollen: thank you, mr. speaker. i notice the gentleman mentioned c.b.o. what c.b.o. said in that regard is that because of the exchanges there would be some people who would not seek their health care through employment, they'd be liberated to be able to get it through the exchange. i'm glad that the gentleman confirms the importance of c.b.o. numbers. with that i yield one minute to my colleague, mr. ryan of ohio. the speaker pro tempore: the gentleman from ohio is recognized for one minute. mr. ryan: i thank the gentleman. i was going out to dinner the

other night and as i was walking in one of the young folks who were working there walked up to me and said, sir, you can tell the new leaders in congress about my story? and story was that he is a 25-year-old kid who is work at a restaurant and has -- who is working at a restaurant and has seizures and could not get any medication, could not get any health care coverage but because of the law that was passed here last year, this young person now could get the medication, could stay on his parents' health care, and now is a productive member of society. and know my friends on the other side have said things like, well, this employer said their insurance was going up 50%. that's been going on for decades now. especially in the last decade. this is going to fix that and i know my namesake from wisconsin also said, you know, there are some employers who are going to have to let their people go in the exchange because their

competition is going to let people go into the exchange. the bottom line is, people were dumping workers for a decade and there wasn't an exchange. now there is an exchange that these people will have some remedy and ability to get health care. the speaker pro tempore: the gentleman's time has expired. the gentleman from wisconsin. mr. ryan: at this time i yield two minutes to the gentleman from california, mr. mcclintock. the speaker pro tempore: the gentleman from california is recognized for two minutes. mr. mcclintock: mr. speaker, the central promises -- promises of obamacare were that it would bend health costs down and wouldn't threaten existing plans. we now know that both of these claims were false. the c.b.o. warns us that the law lynn crease average private premium it's by $2100 within the next five years above what they would have been without obamacare. the administration's own actuary admits that the law bends the cost curve not down but up by $311 billion over the next 10 years. and we now know that many

existing plans are indeed jeopardized and that scores of companies will offering their -- that have been offering their employees basic plans have either dropped them or are continuing them only with labors met to the whim of the administration officials. but the most dangerous provision of this law is the federal government's assertion that it now has the power to force every american to purchase products that the government believes they should purchase, whether or not they want them, need them or can afford them. if this president prevails, the federal government will have usurped authority over every as expect of individual choice -- over every aspect of individual choice. the tragedy is that everyday we continue down this road is a day we have walked to address -- lost the ability to address the real problems, the loss of the freedom to shop across state lines, the loss of freedom to taylor plains -- tailor plans to

the needs of individuals and families and the absence of the tax advantages that families need to afford and choose their own health plans according to their own needs. churchill said, all men make mistakes but wise men learn from them. mr. speaker, the american people understand that obamacare was a huge mistake. let us acknowledge that, learn from it and move on to an act -- to enact reforms that will reduce health costs and increase health choices for american families. the speaker pro tempore: the gentleman's time has expired. the gentleman from maryland. mr. van hollen: mr. speaker, i reserve -- in that case, i yield one minute to the gentlelady. the speaker pro tempore: the gentlelady is recognized for one minute. >> i thank my colleague from maryland. this past year around june, i was speaking to a woman who is a

single mother. ms. sanchez: she has two young children. she's a real estate agent. it's been rough. but she managed to pay the premiums to have health care -- health insurance for herself and her two children. in june, her daughter had an epileptic attack for the first time. she was scared to death. she took her to the hospital. her daughter got better but she would have more of these. a month later she found out her daughter wouldn't be covered by that health care plan. she's been paying about $1,700 per month for her daughter. i said this is what health care reform is about. it's about taking care of our children and our families. i told her -- told her, her daughter would be covered.

if this was your daughter, you would not repeal this health care reform. i yield back. the speaker pro tempore: the gentlelady's time has expired. who seeks recognition? mr. van hollen: how much time remains? the speaker pro tempore: she gentleman from maryland has 15 seconds. mr. van hollen: mr. speaker, all the charts in the world can't wish away the c.b.o. letter of january 6 of this year which says that the premiums will go down in the employer market that people on average will pay less in the individual market and that this legislation will reduce the deficit and the debt over the next 20 years. again, that is the call from the nonpartisan experts we have, we shouldn't be substituting our judgment for theirs. the speaker pro tempore: the gentleman from wisconsin. mr. ryan: i yield myself the balance of my time. the speaker pro tempore: the gentleman is recognized. mr. ryan: i think we've established the fact that when you strip off the budget

gimmick, because macare is a budget buster. let's -- obama care is a budget buster. we have a crisis coming in america and the primary reason we have the mountain of debt is because of our health care entitlements which is have a huge liability. so what did the previous majority do? they put two unfunded entitlements on top. a lot of people said, health care is a right and we're giving it to the people. if we declare shutch things as a right for government to give us, it's government's right to ration these things and to pick winners and losers. health care is too important for that. i want to be in control of my and my family's health care. i want individuals to be in control of their health care and their destiny. we have to ask ourselves when we create these new programs, how much of children's future orb our grandchildren's future are we willing to sacrifice to give

them this mountain of debt that's getting worse by the passage and creation of this law? this of all reasons is why we should vote to repeal. i reserve the -- i yield back the balance of my time. the speaker pro tempore: the gentleman yields back. the speaker pro tempore: the chair recognizes the gentleman from texas, mr. smith. mr. smith: mr. speaker, i yield

myself two minutes. the speaker pro tempore: the gentleman is recognized for two minutes. mr. smith: i support this legislation that repeals the democrats' job stifling, cost increasing, freedom limiting health care law. this bill would repeal a requirement that every individual buy a certain kind of health insurance. the congressional research service confirms that the federal government has never forced all americans to buy any good or service until now. this mandate violates congress' powers under the commerce clause of our constitution of limited federal powers means anything. it's a major reason to repeal the health care bill. one particularly costly part of our health care system is the practice of so-called defensive medicine which occurs when doctors must conduct tests and prescribe drugs that are not medically required because of the threat of lawsuits. taxpayers pay for this wasteful, defensive medicine which adds to health care costs. the democrats' health care law

goes exactly the wrong direction. incredibly, it contains a provision that prohibits any new limits on litigation from being enforced because it allows lawyers to opt out of any system that limits their ability to sue. this is contrary to the best interest of all americans except trial lawyers. the health care bill can only be read as an invitation to trial lawyers to sue medical personnel. that's another reason to repeal this health care bill. the democrats' health care law will produce more litigation and more costly health care. those are two good reasons we should repeal it. i reserve the balance of my time. the speaker pro tempore: the gentleman reserves. the gentleman from michigan is recognized. mr. conyers: thank you, mr. speaker. i yield myself three minutes. the speaker pro tempore: the gentleman is recognized for three minutes. mr. conyers: ladies and gentlemen of the house, i am very pleased to defend what is

-- what has been not intended as a compliment but to defend the so-called obamacare bill. obama is going to go down in history for having taken 54 million people, according to c.b.o., off the rolls and giving them insurance. and i've been looking over my congressional district over the king holiday and talking to a lot of people about health care. i haven't found one parent in the 14th congressional district that didn't like the idea of having someone -- some one of

their children remain on their health care policy until age 26. have you found anybody that would like not to have their children extended until 26? please see me after this debate because we've got so much to be proud of. what are we talking about? pre-existing illnesses not being a basis for being denied insurance or a reason to kick one out of a health insurance policy. these are good things. i am amazed by the fact that people say this bill is going to cost jobs. well, the c.b.o. says it's going to cost us $30 billion to repeal

the bill. please, can we be a little more fiscally conservative in this body as we rush to repeal this bill? and the question of constitutionality is very interesting one for the judiciary committee. a matter we're going to go in further. but we found a very good set of arguments about the ability of this bill to be totally within the framework of our constitution. come on. we already have medicare. who do you think runs that? we already have medicaid. who do you think -- what about

social security? the speaker pro tempore: the gentleman's time has expired. mr. conyers: i'll submit the rest of my statement. the speaker pro tempore: the gentleman from texas. mr. smith: i yield two minutes to the gentleman from wisconsin, mr. sensenbrenner, the chairman of the crime subcommittee of the judiciary committee and also former committee chairman of the judiciary committee itself. the speaker pro tempore: the gentleman is recognized for two minutes. mr. sensenbrenner: as each of us have traveled back to our districts over the -- over the past several months, we have heard from our constituents from seniors to families to small businesses speak out convince glism they demanded this new congress focus on legislation that promotes job growth, cuts spending. what better way to start than by repealing the president's trillion-dollar health care law, a massive new government intrusion into americans' health care which promises to skyrocket costs even further. our immediate action today demonstrates that we are listening.

this is not to say that reforms aren't necessary. we must improve our health care system. we must enact sensible reforms that address the core problem. the rising cost of health care without increasing the size of government. we must enact real medical liability reform. allow americans to purchase health coverage across state lines. empower small businesses with greater purchasing power. ensure access for those with pre-existing conditions and create new incentives to save for the future health needs. republicans want health care reform. however, we must reform it the right way. today we take a much-needed first step. america deserves legislation that addresses our health care problems and helps our economy prosper. this bill is the first step to do that and i urge my colleagues to vote in favor of it. i yield back the balance my time. the speaker pro tempore: the gentleman yields back. the gentleman from michigan.

mr. conyers: i'm pleased to recognize a senior member of the judiciary, sheila jackson lee, of houston, texas, for one and a half minutes. the speaker: the gentlelady is recognized for one and a half minutes. ms. jackson lee: there is nothing that one can do when you're debating this bill than to be civil and to respect the american people, who, many of them are in the jaws of terrible disease, rehabilitation or maybe some have already lost their lives. this repeal of this bill, just a couple of pages, would re-emphasize that they would die. a bill that talks about jobs when we're talking about lives. so i think it is important that

we follow what the opponents of this protection and health care bill does. consumer protection. patient protection. and i think it is important for us to be able to hold this constitution and prove that it is constitutional. well, i could say that there are 1.1 million jobs already created, that the deficit will blow up $143 billion, trillion over -- a trillion over 20 years, but i want to refer to the 14th amendment that allows and guarantees equal protection under the law. if this bill is repeal, ed burke a hemophiliac will probably be questionable because he would have lifetime caps. or mr. land who is on my health care teleconference, where 18,000 people in harris county were contacted. maybe he has a family of schizophrenics and people who have children that have

schizophrenia, maybe he would not be guaranteed equal protection under the law. i say the constitution needs to be protect. the speaker pro tempore: the gentlelady's time has expired. mr. conyers: i yield the gentlelady 15 seconds. the speaker pro tempore: the gentlelady is recognized. ms. jackson lee: thank you so much. maybe they would not be able to withstand this onslaught on their rights because the constitution guarantees them equal protection and some who have insurance and some do not are not treated equally. finally, let me say that texas, the department of insurance has said that this bill helps texas. i hope my colleagues from texas will vote not to repeal this bill. the speaker pro tempore: the gentlelady's time has expired. the chair will remind all members not to traffic the well when members are speaking from the well. the gentleman from texas. mr. smith: i yield two minutes to the gentleman from iowa, mr. king a senior member of the judiciary committee. the speaker pro tempore: the gentleman is recognized.

mr. king: i thank the gentleman from texas, the chair of the judiciary committee. it's a pleasure to serve on this committee and speak in support of the repeal of obamacare. it's something i have worked on every day ince it passed last march, it's legislation i introduced, i asked for the draft the same day it passed. people thought we couldn't get to this point but we are. the bill didn't go through judiciary committee, we didn't address the tort reform that's so essential if we're going to do something to put health care back on track in this country and when i look at this, serving on the commrk i believe it was 2005, we passed legislation in the house that addressed the lawsuit abuse that drives up the cost of our health care, it didn't get taken up in the senate. here we are with a huge obamacare bill, ready to vote to repeal it and part of the discussion needs to be, why didn't it have tort reform in it? we are prepared to take a look at this as we go forward. when i look at the numbers produced in part by the health

insurance underwriters, they and others will tell me that somewhere between 3.5% and 8.5% of the overall cost of our health care goes because of lawsuit abuse and the defensive medicine that's associated with it. i have a friend who tells me that 95% of the m.r.i.'s that he orders, he knows exactly what he's going to see when he gets inside to do the surgery but he has to do them anyway to protect himself from that 5% that miami might end up being in litigation -- from that 5% that might end up being in lathe litigation. that's an additional -- litigation. that's an additional $1 million a year. we must address that if we're going to have managed costs and then the other component that is judiciary committee component of this obamacare legislation that is about to have a vote on repeal here that we're debating is the components that run constitutional. the individual mandate as the

most egregious component of obamacare that compels americans to buy a policy produced or approved by the federal government, vote no on the bill. thank you, mr. speaker. the speaker pro tempore: the gentleman's time has expired. the gentleman from michigan. mr. conyers: i'm pleased to yield to the gentleman from georgia, hank johnson, for 1 1/2 minutes, to defend the obamacare legislation. the speaker pro tempore: the gentleman is recognized for a minute and a half. mr. johnson: thank you, mr. speaker. and thank you, mr. ranking member. i rise in opposition to the repeal of health reform. repeal of health care reform would strip 32 million americans of health insurance including 139,000 residents of my district. repeal will allow insurers to discriminate against people with pre-existing conditions and re-open the doughnut hole which would devastate joseph williams, a former corrections officer in my district, who relies on

medicare for his prescription drugs. i'll be voting against repeal and i urge my colleagues to do the same. and i yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from texas. mr. smith: i yield two minutes to the gentleman from north carolina, mr. coble, who is also the chairman of the courts and commercial and administrative law subcommittee of the judiciary committee. the speaker pro tempore: the gentleman is recognized for two minutes. mr. coble: i appreciate the gentleman from texas. mr. speaker when we debated health care reform during the 111th congress, i made the statement that we need to fine tune the edge and not overhaul it. i reiterate that theory today. president obama in my opinion elevated health care to the number one issue facing america, mistakingly so in my opinion. i think the number one issue facing america then and now involves jobs or more precisely lack of jobs and reckless

spending. there is agreement from both sides of the aisle that we need to improve our health care system. these improvements must enhance the quality and accessibility of care in a fiscally responsible manner. the law implemented last year failed to meet this criteria, particularly the onerous 1099 tax incede on small businesses, that is just one glaring example. by repealing obamacare, we will have the opportunity to take more prudent approach of fine tuning our health care law to ensure that it encompasses sound principles. mr. speaker, this will likely be an obvious partisan vote. but it also serves a purpose. it sends message to the american people that we are serious about fixing our broken health care system. physicians do this daily. they make a diagnosis and fix the problem. i support the passage of h.r. 4 because congress should take the same approach.

fix the problem. much energy and attention was directed to this matter when it probably should have been directed to jobs and reckless spending. too late for that now. but we need to address it and i look forward to the vote i guess will be tomorrow and i yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from michigan. mr. conyers: mr. speaker, i recognize dr. judy chu of california, a very valuable member of the judiciary committee, for one minute. the speaker pro tempore: the gentlelady from california voiced for one minute. ms. chu: thank you, mr. chair. the health care repeal act will hurt many people but especially seniors. it raises costs for prescriptions and preventative care, it weakens medicare and it takes away your freedom to make your own decisions, returning your health back to the hands of insurance companies. at the start of this year, seniors began receiving free preventative services such as mammograms and an annual

example. if repeal succeeds, goodbye free checkups and free life-saving tests. today seniors in the medicare doughnut hole are getting half off many brand name drugs. but if repeal passes, your prescription drugs are going to double and those who get a $250 check to help cover high drug costs might even have to pay it back. the original health reform bill extended medicare's life until 2029, but if we repeal it, the medicare trust funds become insolvent in six short years. the patients right to repeal act hurts seniors. it's dangerous for america's health. the speaker pro tempore: the gentlelady yields back. the gentleman from texas. mr. smith: i yield two minutes to the gentleman from texas, mr. poe, who is actually a member of three subcommittees of the judiciary committee. the speaker pro tempore: the gentleman is recognized for two minutes. mr. poe: mr. speaker, never before in the history of our great country has the tax been levied on individual americans

by the federal government with the purpose of forcing citizens to do something the government wants them to do. and never before has the government self-righteously ordered americans to buy a product or pay a punitive fine. in my opinion the constitution does not give the federal government, even well-intentioned government, the authority to make citizens buy any product, whether it's a car, whether it's health insurance or even whether it's a box of chocolates. the individual mandate provision of the health care bill is unconstitutional. the author of the constitution, james madison, said, the powers delegated by the constitution to the federal government are few and defined. those that remain to state governments are numerous and indefinite. the health care bill is a theft of the individual freedom to control one's health, to have it now controlled by government. big government doesn't mean better shutions -- solutions. in fact, as someone has said, it

you think the problem's government -- if you think the problems government creates are bad, just wait until you see government solutions. government is partially to blame for the health care yy sis and the nationalized health care -- crisis and the nationalize health care government solution is unconstitutional. if you like the efficiency of the post office, the competence of fema and the compassion of the i.r.s., we will love the nationalized health care bill. certainly what we do here in congress should be constitutional and we should repeal the health care bill and come up with constitutional solutions for health problems. and that's just the way it is. i yield back. the speaker pro tempore: the gentleman yields back. the gentleman from michigan. mr. conyers: mr. speaker, i want to take this opportunity to congratulate lamar smith on becoming the chairman of the house judiciary committee during the 112th session of congress. and i turn now to the former chairman of the constitutional subcommittee, jerry nadler of

new york, and i recognize him for two minutes. the speaker pro tempore: the gentleman is recognized for two minutes. mr. nadler: i thank the gentleman for yielding. mr. speaker, i rise in opposition to the republican effort to deny 32 million americans health care, to deny millions of middle class americans the ability to get health care insurance if they have can pre-existing conditions and to drive up our national debt by an additional $1.4 trillion over the next 20 years. the affordable care wast act with a stave off the 55% of bankruptcy caused by health care emergencies. by banning rescissions, banning pre-existing conditions, banning lifetime coverage caps and capping annual out-of-pocket expenses this law ensures nobody will go broke if they get sick. this will save lives of the approximately 45,000 americans who die every year because they lack health insurance. for american seniors, the affordable care act strengthens the medicare program. seniors no longer pay out of pocket for preventative services and the dough null hole will be

closed. the notice to small businesses will get billions of dollars in tax credits to help them provide health coverage to their employees, unless of course the republicans are successful in enacting a massive tax increase on small businesses by repealing the law. we did all this and more while reducing the deficit by what c.b.o. now estimates will be $230 billion in the first 10 years and $1.2 trillion in the next 10 years. the republicans say the bill is an unprecedented or unconstitutional expansion of congressional power. they are wrong. there's nothing radical, dangerous or unconstitutional about the act. we have the power to enact this comprehensive plan including its minimum coverage requirement under the commerce, necessary and proper general welfare clause of article 1, section 8 of the constitution. similar attacks were levied against the social security act of 1935 saying it was unconstitutional for the same reasons. those arguments were unsounded a rejected then and will fair no better today. indeed, leading republican lawmakers championed individual

mandates as part of their health equity and access reform today act of 1983. the requirement of individual participation was valid then and it is valid now. for all of these reasons i strongly encourage my colleagues to vote no on this misguided repeal bill. i thank you and yield back. the speaker pro tempore: the gentleman's time has expired. the gentleman from texas. mr. smith: mr. speaker, i yield two minutes to the gentleman from california, mr. lungren swhorks a chairman of the house administration committee. the speaker pro tempore: the gentleman from california is recognized for two minutes. mr. lungren: thank you very much, mr. speaker. mr. speaker, in the scope of the american constitutional system of governing, the congress is a body whose power is defined within the context of imnumerated powers and this is more than a matter of structural mechanics because it goes to the heart of the issue of governmental power. or of if one prefers the slip side of the coin, personal freedom and responsibility. if government has the power to require that you buy item a, it

means that you are less able to buy item b, c, d or anything else. now economists would call this the opportunity costs or foregone goods or services. but the fundamental question is the question of freedom to choose how we as individuals will spend the fruits of our labor. certainly the commerce clause lax the elassitiesity that would accommodate a requirement that every american buy health insurance which conforms to the dictates of the federal government and the federal government would change it on a yearly basis. such an interpretation would render the nation articulated by james madison and federalist 45 that is one of limited government anality. i know we have smart people here. i know we have those in the administration who believe that this is totally constitutional.

but frankly, mr. speaker, my bet goes with james madison. he did say that the powers delegated by the proposed constitution of the federal government are few and defined. he did say that the federal government will be exercising their responsibilities principally on external objects as war, peace negotiations and foreign commerce and the states would do much else. then we have the 10th amendment, later adopted. which said again that this is a government of limited, imnumerated powers. now either the 10th amendment means something or it means nothing and either james madison knows what he was talking about or he does not. the speaker pro tempore: the gentleman's time has expired. the gentleman from michigan. mr. conyers: mr. speaker, i'm pleased to recognize and congratulate the gentleman from maryland, the ranking member of government reform, elijah cummings, for one minute.

the speaker pro tempore: the gentleman is recognized for one minute. mr. cummings: thank you very much, mr. speaker. i rise before you in opposition to the bill we are considering today. i've heard from many of my constituents and small business owners who are grateful for the benefits of this law. children with pre-existing conditions are no longer being denied access to private health insurance. mafrlede small businesses offering health insurance to their employees are eligible for a 35% tax credit. further raverpbinging member of committee on government -- further, as ranking member of committee on government and oversight reform, i know that this would eliminate the private health plan providing coverage for many uninsured americans with pre-existing conditions. i find it repugnant that republicans want to strip americans of this law's protections that will save the lives of our fellow citizens. i urge a no vote on this bill and i yield back. the speaker pro tempore: the gentleman yields back. the gentleman from texas. mr. smith: mr. speaker, i yield two minutes to the gentleman from texas, mr. gohmert. the speaker pro tempore: the

gentleman from texas is recognized for two minutes. mr. gohmert: thank you, mr. speaker. less we forget, this is the disaster that we're told would be repugnant it started out as an act to amend the internal revenue code of 1986, first time home buyers' credit of the u.s. armed forces. we took a bill that was designed to help veterans and the senate stripped it all out and stuck in this disaster of a health care bill, just as we heard in the late 1990's that you can't pass welfare reform, you'll leave women without anything, you heartless, mean people. it was because people here had hearts and wanted to see women with children doing better that welfare reform had to be done. it was sent to the president and wouldn't sign it and finally he

signed it. and for the first time since the great society legislation came about, after 30 years of flatlining when adjusted for inflation, single women with children, after welfare reform began to have increases in income. we heard all the naysayers then and we are hearing them now. it's because we want people to have the best health care. it's because we don't want what the president said when he told the democratic caucus before it passed, gee, you go to the doctor now and have five tests, after this bill, you'll go and get one test. my mother had to have six days to find her tumor. i want health care to be legislated the way the president promised it would be and once we get this disaster out of the way, no matter how many times we have to send it, it will be time

to pass a bill that gets real health care reform. i yield back. the speaker pro tempore: the gentleman from michigan. mr. conyers: i recognize representative sewell from alabama for one minute. the speaker pro tempore: the gentlewoman is recognized for one minute. ms. sewell: i rise in opposition to repeal this legislation that has helped so many constituents of mine. nearly two weeks ago, i was honored by being sworn in as a representative of the 7th congressional district of alabama. on day one, i received numerous calls from my constituents urging me to oppose this repeal and i heard from countless voices that the health care that has been enacted has helped them. let me tell you a story. both are on medicare. mr. cheetham have suffered

several heart attacks. during several of the provisions in the affordable health care act has helped them to get their prescriptions. now they don't have to choose between putting food on the table, gas in their cars or paying for their medication. the affordable care act is the first step towards strengthening our health care system and is saving the lives of many many in my district. i urge my colleagues to vote know on this resolution. the speaker pro tempore: the gentleman from texas. mr. smith: i yield two minutes to the the gentleman from virginia, mr. goodlatte. the speaker pro tempore: the gentleman from virginia is recognized for two minutes. mr. goodlatte: i thank the chame for yielding. i rise in strong support of this legislation, which repeals the sweeping health care reform law rammed through congress last year. this new law amounts to a big government takeover of our

health care system, one that will lead to fewer choices, higher prices and rationed care and creates more than 150 new government agencies and programs at a cost of well over $1.2 trillion. it includes over $560 billion indefinite stating new tax increases and cuts medicare by over $500 billion. americans are frustrated by rising health care costs. we must repeal the new health care law that kills jobs, raises taxes and causes seniors to lose the coverage they have and increases the costs of health care coverage. we must replace it with commonsense reforms that lower health care costs and empower patients. for those who argue that somehow this is going to save the taxpayers' money, think of the mandates that are not covered by the federal government. think of the fact that it is not

credible at a time when senior citizens and baby boomers are going to retire in unprecedented numbers to takes $500 billion out of the medicare program and think of the jobs being lost because the taxes on this are already being put into place. yet the benefits don't occur for four years. that legislation was smoking mirrors. this legislation repeals it. we should sort it and then start anew on commonsense reforms and i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from michigan. mr. conyers: i recognize the gentleman from iowa, mr. braley, for one minute. the speaker pro tempore: the gentleman is recognized for one minute. mr. braley: i thank the gentleman for yielding. i want to show the face of the repeal of health care. this is tucker wright from iowa, he is four years old and two years ago before the affordable care act was passed, he was diagnosed with liver cancer and

had 2/3 of his liver removed and he faces a long and uncertain medical future. but on january 2 of this year, because we passed the affordable health care act, tucker's father brett was able to change jobs because he no longer had to worry about the stigma of pre-existing conditions. now, when you talk about repealing this bill, i tell you why it's not a good deal for tucker wright, because even though our friends talk about wanting to fix some of the problems that they now think are important, the first thing that's going to happen to tucker wright and his family as soon as this bill is repealed is his family will get a recision letter from the insurance company because they will no longer be able to provide insurance to this young boy because he has pre-existing conditions. that's why this bill is a bad idea and i urge you to vote no and think about tucker wright.

i yield back. mr. smith: madam speaker, how much time remains. the speaker pro tempore: the gentleman from texas has 5 1/2 minutes. the gentleman from michigan has 8 1/2 minutes. mr. smith: i reserve our time. the speaker pro tempore: the gentleman from michigan. mr. conyers: mr. walz of minnesota is recognized for one minute. the speaker pro tempore: the gentleman from minnesota is recognized for one minute. mr. walz: thank you, madam speaker. i rise today to state my strong opposition to the repealing of the affordable care act. it will eliminate consumer protections, raise taxes on small businesses, explode deficits and put insurance c.e.o.'s between americans and their doctor. i represent mayo clinic. they are a symbol when we deliver the world's highest

quality care at the most efficient and effective costs. when we passed this law last year, they said it was a good first step and i agree. now is not the time to step backwards. folks in my district are seeing the benefits of this law. seniors have help for getting prescription drugs and saving money and just a few weeks ago, i received a letter from a dad in my district named paul. his son is 21, works part-time and has diabetes. joe couldn't get the insurance he needed to pay for the expensive equipment he needs to stay healthy and alive. paul said thank you for passing the affordable care act. because of the law, joe got back on his parents' insurance. a vote to repeal this legislation pulls that card away. the speaker pro tempore: the gentleman from texas. mr. smith: i yield one minute to the the gentleman from new york, mr. reed, new member of the judiciary committee. the speaker pro tempore: the gentleman is recognized for one minute. mr. reed: i rise today in

support of the repeal of the job-killing obamacare legislation. this bill is a whopping 2,500 pages of of new spending and government bureaucracy. rushed to approval after only 48 hours of arm twisting and deal making. unfortunately, just as republicans predicted, this legislation did absolutely nothing to address the real problem in the health care, its costs. republicans have advocated for tort reform to be included in any legislation, for just as long those who have wrote this legislation have ignored the need for tort reform. the congressional budget office estimates tort reform initiatives could save $54 billion. i will say that the other side attempted to reform tort reform by providing $50 million for states to consider the concept of tofert reform. here we go again, another example of what's wrong with

washington, spending $50 million how to figure out how to save money. republicans have a better plan, which one which reduces health care costs. the speaker pro tempore: the gentleman's time has expired. mr. smith: i yield to the jar 30 seconds. reed reed american -- mr. reed: gets lawyers and bureaucrats out of our lawyers. let's repeal the bill and focus on bipartisan initiatives like fixing the doughnut hole and without spending an additional $50 million. until we do so, jobs will continue to be lost. i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from michigan. mr. conyers: we recognize for one minute the gentleman from missouri, rust carnahan. the speaker pro tempore: the gentleman is recognized for one minute.

mr. carnahan: i rise in strong opposition to this bill that would hurt small businesses in missouri who are finally imagining access to affordable coverage for their employees. the health care coverage for small firms has increased at more than 12%. those small business owners will lose tax credits that are providing up to 50% of their health care costs and will have to drop the very health insurance they have now been able to provide employees and their families. these are real people. people like michelle barron, who owns a book store. she used to provide health care, but over the years, couldn't keep up. she had to drop employees and finally drop her own coverage because of pre-existing conditions. last year when the health care bill was signed into law, new options opened up for issue ell and other business owners like her. if we repeal health care, it will turn back the clock for small business owners.

insurers will go back to denying coverage for pre-existing conditions and small business owners would lose tax credits to make health care coverage affordable. we can't go back to insurance company control. this is not the time to step backwards. i yield back. the speaker pro tempore: the gentleman from texas. mr. smith: i yield one minute to the the gentleman from arizona, mr. quayle. the speaker pro tempore: the gentleman is recognized for one minute. mr. quayle: i rise in support of house resolution 2. last year, behind closed doors and against the will of the american people, the democratic majority of the 111th congress passed a bill that fundamentally changes the doctor-patient relationship and passed the bill that will increase the cost of health care and explode our national debt. they passed the bill that expands the scope of government well beyond the parameters set forth in the constitution. the genius of our constitution, that this will document didn't set forth what the government must do for us but rather the

government can't do to us. to require every individual to enter within a commercial contract falls within that category. the people of my district understands this, just as they understand our health care system needs reforms that will reduce costs and increase access. unfortunately, the health care bill that was passed will increase costs and increase our national debt. those who drafted the bill will try to conceal the true costs from the american people, but if you look beyond, that bill increases our debt by $701 billion. it is time to get our country back on the right track and h.r. 2 is the necessary step to fulfilling that mission. the speaker pro tempore: the gentleman's time has expired. the gentleman from michigan. mr. conyers: i recognize the distinguished gentlelady from florida, debbie wasserman schultz for two minutes. ms. wasserman schultz: thank you

madam speaker. it's important to address the notion of job killing versus job creating. we have heard a lot of talk about the title of this bill and the jobs that it supposedly kills. let's look at the facts here though, of the 1.1 million private sector jobs documented that were created last year, 200,000 of those were in the health care sector or 1/5. we had an average of 20,000 jobs per month created in the health care sector alone over the course of the last two years. there have been no job losses in the health care sector, none. and i challenge our colleagues on the other side of the aisle, on the republican side of the aisle who are advocating the repeal of health care reform on the premise that it is a job killer, to name one area of health care, one, where there had been job losses. i would suspect that we would hear crickets chirping because

there are none. there isn't a single area, not before and not since. and also, i think it is important to address the comments from the the gentleman from texas, mr. gohmert, who stated president obama told the democratic caucus that health care reform would allow us to shrink five tests performed on a patient to one. that is not true. that never happened. he never said that and at the end of the day, we need to make sure we are entitled to our opinions, but not to our own facts. i suspect that our colleagues on the other side of the aisle are making up their own facts, because their arguments don't stand on the strength of their ideas and aren't strong enough to stand on their own. i thought it was important to clear that up, mr. speaker. and i yield back. . mr. smith: mr. speaker, i yield

one minute to mr. griffin, maybe of the judiciary committee. the speaker pro tempore: the gentleman from arkansas is recognized for one minute. mr. griffith: mr. speaker, i thank -- mr. griffin: i believe we need health care reform badly. but the law we got isn't what we need. this is why i rise today in support of h.r. 2, to repeal the current health care law. the health care law provides for an increased government role and will ultimately lead to decisions made by the government instead of doctors and patients. it ignores the issue of cost. it was loaded with gimmicks to make it seem deficit-neutral. but once those are accounted for, we find that it adds over $700 billion to the deficit in the next 10 years. the health care law and especially the unconstitutional mandate handicaps our ability to grow jobs. small businesses will be hit hardest because they operate on the tightest margins and will have the toughest time complying

with the onerous regulations. many of the regulations are still not written, creating uncertainty for employers. we must repeal the law and replace it with one that lowers costs, preserves the doctor-patient relationship -- the speaker pro tempore: the gentleman's time has expired. mr. smith: i yield the gentleman an additional 30 seconds. mr. griffin: thank you, mr. chairman. lets americans keep the coverage they have, allows the private sector to create jobs and follows the constitution. thank you, i yield back the balance of my time. the speaker pro tempore: the gentleman yields back. the gentleman from michigan. mr. conyers: madam speaker, i yield rob andrews of new jersey one minute. the speaker pro tempore: the gentleman from new jersey is recognized for one minute. mr. andrews: i ask unanimous consent to revise and extend my remarks. the speaker pro tempore: without objection. mr. andrews: thank you, madam speaker. madam speaker, as we meet this afternoon there are 15 million unemployed americans. and no matter where you go in this country, you hear that the number one concern of our

constituents is creating an environment where businesses and entrepreneurs can put people back to work. so what is the house doing this week? relitigating, regurge dating, rearguing a political debate about health care again. i believe the people of this country want us to work together to get jobs back in the american economy. the republicans offer us a slogan, a job-killing health care bill. what kills jobs is paral sis in congress -- paralysis in congress. what kills jobs is ignoring the economic problems of this country. no it's not simply the right vote on the merits, it's the right vote because this is the wrong bill at the wrong time. i yield back the balance of my time. the speaker pro tempore: the gentleman yields back. the gentleman from texas. mr. smith: madam speaker, we only have one more speaker on this side and we're prepared to close. the speaker pro tempore: the gentleman from michigan. mr. conyers: how much time have we remaining?

the speaker pro tempore: the gentleman from michigan has 3 1/2 minutes remaining. the gentleman from texas has 1 3/4. the gentleman from michigan. mr. conyers: i yield myself a minute. the speaker pro tempore: the gentleman is recognized for one minute. mr. conyers: i'd like -- because this is the judiciary committee and so little has been said about the constitutionality, i am pleased to quote from the dean of the law school of the university of california who said that opposing health care reform and relying on an argument that it is unconstitutional is an inadequate way to proceed.

somebody here must remember that there is medicare, medicaid, social security. please, this is not new that the government would be intervening in this way. maybe we need to revise and revisit the questions of constitutionality. the speaker pro tempore: the gentleman from texas. mr. smith: madam speaker, we continue to be ready to close. the speaker pro tempore: the gentleman from michigan. mr. conyers: i yield to sheila jackson lee of texas, a senior member of the committee, for the remaining time. which is about one minute. the speaker pro tempore: the gentlewoman from texas is recognized for 2 1/2 minutes. ms. jackson lee: mr. chairman,

you're absolutely right. this is a constitutional question that has been raised. as i came to the floor earlier, i mentioned my predecessor, congresswoman jordan, who believed in this constitution without question. i mentioned the 14th amendment. i now mention the fifth amendment. first of all, the commerce clause covers this bill but the fifth amendment speaks specifically to denying someone their life and liberty without due process. that is what h.r. 2 does. and i rise in opposition to it. and i rise in opposition because it is important that we preserve lives and we recognize that 40 million-plus are uninsured. in my own county, harris county, this bill will allow some 800,000 uninsured members of harris county, citizens of harris county, to be insured in texas. in addition, the texas department of insurance, as many other states, have already begun implementing this bill, the patient protection bill, gladly so and saying it will help save lives and provide for the families of their states.

can you tell me what is more unconstitutional than taking away from the people of america their fifth amendment rights, their 14th amendment rights and the right to equal protection under the law? i know that mr. lamb, who suffers from schizophrenia, with his family, mrs. betty, when had to go to the e.r. room in texas because no insurance, mr. smith who was on dialysis, or mr. fields whose mother couldn't get dental care, i know they would question why we're taking away their rights. today we stand before this body, we beg of them to ask themselves whether this is all about politics or about the american people. i'm prepared to stand, extend a hand of friendship. standing on the constitution to enable us to provide for all of the citizens of this country. this bill has been vetted, this bill is constitutional and it protects the constitutional rights of those who ask the question, must i die, must my china child die because i am now

-- child die because i am now disallowed from getting insurance? this is about your primary care doctor. this is about closing the doughnut hole that will allow you to be able to get discounts on your prescription drugs that some of you have avoided because you have to pay your rent and you have to buy your food. texas, a big state, has already said through a governmental agency, we need this bill. and we hope that those who come from our state and many other states will not vote against the protection of patients, vote against h.r. 2 and provide yourself with the protection of the constitution. i yield back. the speaker pro tempore: the gentleman from texas. mr. smith: madam speaker, i yield myself the balance of my time. the speaker pro tempore: the gentleman is recognized. mr. smith: madam speaker, the democrats' health care bill squanders health care resources and taxpayer money by encouraging wasteful, defensive medicine. it explicitly prevents stage from making any -- states from

making legal reforms under its provisions and expands opportunities for lawyers to sue doctors who did absolutely nothing wrong. and it limits the supply of doctors when patients need them most. in fact, one particularly costly part of our health care system is the practice of so-called defensive medicine which occur when is doctors are forced by the threat of lawsuits to conduct tests and prescribe drugs that are not medically required. a survey released last year found defensive medicine is practiced by virtually all physicians. lawsuit abuse does more than make medical care much more expensive, it drives doctors out of business. doctors who especiallyize in inherently high-risk fields are leaving their practices and hospitals are shutting down because their high exposure to liability makes law suit -- lawsuit shine insurance unaffordable and it can have deadly consequences. hundreds and thousands of patients may die annually for lack of doctors. madam speaker, the democrats'

health care law will produce more litigation and less effective health care. that is why it should be repealed. i'll yield back. the speaker pro tempore: the gentleman yields back. the speaker pro tempore: the gentleman from missouri, mr. graves, and the gentlelady from new york, mr. velazquez, will each control 20 minutes. the chair recognizes the gentleman from missouri. mr. graves: thank you, madam speaker. madam speaker, i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized. grave grave thank you, madam speaker. madam speaker, i rise today in support of h.r. 2, legislation to repeal the job-destroying health care law that was rushed

through congress last year. the american people have repeatedly voiced their frustration over the way the health care law put the american -- or put the government between patients and their doctors. they have protested this law, they have demanded that reform of our nation's health care system focus not on bigger government, not on more bureaucrat, but on targeting commonsense changes that encourage competition and better choices. instead of listening to the people, washington gave them a law that piles more than $500 billion in tax increases on families and small businesses. this will force as much as 80% of all small businesses to give up their current coverage and could cost our economy $1.6 million -- 1.6 million jobs, one million of which could come from small businesses. all of these new regulations and restrictions included in the law will make it more difficult for small businesses to hire new workers, expand their operations and offer competitive wages. with unemployment still hovering above 9%, families and businesses cannot afford more regulations and red tape from

washington. it's going to make jobs more scarce and further slow our economic recovery. my republican colleagues and i repeatedly tried to reach across the aisle to craft a better bill when this was pushed through. and was disappointed that rather than listened to their counterparts and the american people, those in charge when this was pushed through chose to put a completely partisan, wildly unpopular bill through the people's house. we now have an opportunity to give the people what they want by repealing this law and replacing it with meaningful reforms that will cut costs and increase access without creating big problems for businesses or piling more unsustainable debt on future generations. i urge friends and members to vote in support of this and repeal this legislation and join me in implementing better solutions for improving our nation's health care stim -- system. i'll reserve the balance of my time. the speaker pro tempore: the gentleman reserves the balance of his time. the gentlewoman from new york. ms. velazquez: madam speaker, i ask unanimous consent to revise and extend my remarks. the speaker pro tempore: without objection. ms. velazquez: madam speaker, i yield myself as much time as i

may consume. i rise in opposition to the bill before us today. as we begin the 112th congress, it is unfortunate that one of the first bills before this body is more about politics than poim. this bill will not help a single small business secure a loan, open a new market for its products or invest back nits operations. -- back in its operations. the other side acknowledges this legislation is going nowhere. it is ironic this grandstanding occurs when health insurance continues to be a top challenge facing small businesses. over the last decade, small employers have seen their premiums rise by over 114% with no sign of relief. it is hard to imagine how repeal will help small businesses. in fact, it could do significant

harm. the bill before us today imposes a $40 billion tax increase by eliminatinging critical small business tax credits. these have already helped secure costs and reduced and increased coverage rates by nearly 12% in the past year. repeal will also eliminate choices for entrepreneurs. currently in the majority of states the two largest insurers have a combined market share of 70% or more. by doing away with reforms that establish new health insurance markets, it will limit small businesses' ability to secure coverage. small businesses already pay 20% more than their corporate counterparts and the laws of new safeguards will compound this

problem. because of health reform, insurers are no longer able to raise rates arbitrarily without explaining why. they cannot deny coverage based on a pre-existing condition or because an employee gets sick. passage of this bill will also strip new protections that provide small businesses we have heard how important reforms were excluded from the original legislation. they say for this reason, the house will start from scratch and enact a new health care law. however, when republicans were in control of both chambers and held the other office, they talk about their solutions for nearly a decade and yet, nothing happened. in the meantime, small businesses saw their employees'

premiums rise by an average of $700 every single year. small businesses pay nearly $14,000 for a policy that cost $6,500 in 2000. why should small businesses believe they can deliver on a promise this time? while our economy has added nearly 400,000 jobs over the past three months, more must be done. we must continue to confront the problem of health coverage for small businesses, but voting for today's bill will not do that. i urge members to oppose the bill and i urge the new leadership to find meaningful ways to address this nation's economic challenges. i reserve the balance of my time. the speaker pro tempore: the gentlman reserves the balance of his time. the gentleman from missouri.

>> i would yield one minute to the the gentleman from south carolina. mr. mulvaney: i rise in favor of h.r. 2 and it's hard to know where to begin when you are talking about how bad the current health care legislation is for small business. the current health care bill that this congress passed last year has an inp senttive for businesses to go from 50 to 49. incentive to go from 25 employees to fewer and disincentive for small businesses to go. a financial incentive to pay your employees less because the tax credits that we talked about last year goes away as you pay your folks more. it's almost as if the folks who wrote this piece of legislation last year have no idea how small business works or don't care. either way the current health care legislation is a complete disaster for small business and number one priority for small

business this year should be repealing the existing health care and passing of h.r. 2. and i yield back. the speaker pro tempore: the gentlewoman from new york. ms. velazquez: i yield as much time as necessary. in the state of south carolina, as a result of this repeal legislation, small businesses in the state of south carolina will see a tax increase of $540 million. with that, i yield two minutes to the the gentleman from, mr. cicilline. mr. cicilline: i thank the gentleman for yielding. i rise in strong opposition to h.r. 2. if we repeal, the following things will happen, children with pre-existing diseases will be denied coverage and people under the age of 26 will be denied. seniors will pay more and small businesses will pay 20% more than their corporate

counterparts for providing the same health care coverage. small businesses would lose the incentive for providing coverage to their employees and up to 50% tax credit which has increased coverage of small firms by more than 10% and would use that tax credit to hire additional employees. this law establishes consumer protections, incentivizes wellness programs and establishes cost controls and cost-cutting exchanges. for small businesses, that means driving down the cost of providing health insurance and providing assistance for small businesses that are struggling to skyrocketing premiums. small businesses pay 18% more than than large businesses for the same coverage and health insurance premiums have gone up three times faster than wages in the past 10 years. i would just -- i ask for 15 seconds. small business tax credits are critical to providing small

businesses the opportunity to provide insurance to their employees. we made a promise to those small businesses to make it yees easier to thrive and this is the first good step and i urge to vote against this repeal. >> i yield one minute to the the gentleman from tennessee for one minute. mr. fleischmann: i rise in support of the repeal of obamacare. this is my first speech on the floor as a member of congress and i thought it only appropriate that it be on this topic, a topic i campaigned hard on and a topic i believe strongly in. we must repeal this health care legislation. as a small business owner for the past 24 years, i know firsthand the kind of damage this legislation would do to american small business if it is allowed to be put in place. the national federation of independent business research foundation conducted a study that showed the employer mandate

found in obamacare could lead to a loss of 1.6 million jobs throughout the country and 66% of those lost jobs would come from the small business work force. that same study showed that small businesses would lose roughly $113 billion in output. as a member of the small business committee, i promise to use my personal experience to fight every day for small business owners everywhere. the speaker pro tempore: the gentleman's time has expired. mr. fleischmann: starting tonight, we must repeal obamacare and i yield back. ms. velazquez: i yield two minutes to the the gentleman from north carolina. the speaker pro tempore: the gentleman is recognized for two minutes. >> i rise today to speak against this bill, even before the recession, my state, north carolina, was losing one wave of jobs after another in our traditional industries and we

have needed the energy and job creation that comes from small business, from people leaving jobs whether jumped or pushed and starting their own business. half of our economy is generated by small business and even more important, small businesses create 75% of new jobs. by providing access to state high risk pools, the health care reform bill passed last year will make it possible for small businesses to start their own business without worrying they are going to lose health care for themselves and their families and i know what it's like to buy health insurance for employees. one of the greatest frustrations, trying to find something affordable and trying to figure out what you bought and you won't know until one of your employees gets sick or hurt. the bill passed last year, the legislation will make it affordable. it will provide tax credits to

35% for small businesses to provide health insurance and will go up to 50%. that will increase health care coverage among small business owners and even more important and they will know what they got, insurance that really covers what it ought to cover and not filled with small print exceptions of one kind of care after another, one condition after another. employees are going to get the care they need. reform has freed people to want to start a business, do it without worrying about what kind of shape that's going to leave them in and their family members in and i urge my colleagues to vote against this bill, to put those small businesses back in the uncertain land. thank you. i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from missouri. >> i yield one minute to another member of the small business committee, gentlelady from washington.

mr. butterfield: i rise in support of this -- ms. herrera beutler: and i rise in support of this bill. this year, we have the chance to correct mistakes made by both parties. the obamacare bill passed by the other party last year was the wrong approach and does nothing to decrease the inflationary curve of health care. it was the wrong approach. and no party is perfect last time the party had the majority, many on our side of the aisle worked diligently to reform health care, the job was left undone. getting this right is one of the reasons my constituents sent me to congress. solutions exist that can fix our health care system and bring costs down for middle-income families. today, we hit reset on health care reform and i invite my colleagues to join me in advancing solutions, solutions

like small business health plans, ending junk lawsuits that drive up the costs of everyone's cost and health savings accounts and buying insurance across state lines. the speaker pro tempore: the gentlewoman from from new york. ms. velazquez: i would like to inquire how much time is remaining. the speaker pro tempore: 12 1/4 minutes remaining and the gentleman from missouri has 15 minutes remaining. ms. velazquez: at this time, i reserve. the speaker pro tempore: the gentleman from missouri. >> madam speaker, i would yield one minute to the the gentleman from colorado, mr. tip ton. the speaker pro tempore: the gentleman is recognized for one minute. mr. tipton: thank you, madam speaker. the question is, will we accept what is or are we willing to commit for what to be. america has always been the land of self-determination. our constitutionally-guaranteed

rights as individuals, as a people, as a nation, has made us flourish. creativity are hallmarks. i rise in support of house resolution 2. it does not indict inat the present time but it does address outcome. the deeper we dig into the health care act, the more we discover that it is stopping job creation, building more government and placing tax burdens on american families who are already struggling. we can and must do better. let us commit ourselves to hold these concerns, affordability and ack set built and empower our people to make their own choices and empower private sector solutions that will lower costs and increase the quality of care and eliminate government and not build bigger government. i yield the balance of my time. the speaker pro tempore: the gentlewoman from new york.

ms. velazquez: i yield 2 1/2 minutes to the the gentlewoman from california. the speaker pro tempore: the gentlewoman is recognized for 2 1/2 minutes. ms. roybal-allard: many americans have more freedom to choose. in my congressional district, 40% of my constituents were uninsured, thousands more were underinsured and living on the brink of financial disaster when facing an illness or accident. with health reform positive change is taking place for them and for individuals, families and small businesses throughout the country. young adults can remain on their parents' insurance until 26. seniors not living in fear are thankful for discounts on brand-named drugs. families of pre-existing conditions are comforted by the new high risk insurance pool and those facing serious illnesses are relieved their insurers can no longer drop them.

small businesses which abound in my district and mainstay in the minority communities can take advantage of tax credits to offer health insurance to their employees. a 2009 study by an economist found that without reform, over the next decade, employers will pay trillions of dollars in employee health costs, potentially cut 170,000 small business jobs and lose $51.2 billion in profits. that is why the founder and c.e.o. of the small business majority supports health care reform. madam speaker, h.r. 2 will hurt small business and will repeal the freedoms and protections americans now have and it will return control of their health care to the insurance companies. i yield back the balance of my time. the speaker pro tempore: the gentlewoman yields back. the gentleman from missouri.

>> i yield one minute to the the gentleman from louisiana, mr. landry. the speaker pro tempore: the gentleman is recognized for one mind. mr. landry: >> i -- mr. landry: it is with great enthusiasm that i rise to encourage my colleagues to stand with the american people. the hard-working families and small business owners across our country and vote for repealing the job-killing health care law. in march, they passed a massive government-run health care law that will kill jobs and increase the size of our federal government. the bill calls for tax increases on american families, wasteful spending of taxpayer dollars and new mandates on small businesses. this is wrong. voters made it clear in november that business as usual must end. i submitted the necessary paperwork to decline the health care plan offered to members of congress. i rejected its benefits because

washington must work just like the american people must work. we are not above them. i hope my actions i will energize the efforts to repeal the government-run health care law and i encourage my colleagues to vote yes on this bill and promote commonsense solutions of promoting health insurance across state lines, pooling small businesses to leverage purchasing power. thank you, madam chairman. . the speaker pro tempore: the gentleman from missouri. mr. graves: at this time, i yield one minute to the gentleman from illinois, mr. walsh. the speaker pro tempore: the gentleman is recognized for one minute. mr. walsh: i rise in support of h.r. 2, repealing the job-killing health care act. i commend the leadership for simplifying this process by drafting a two-page bill for repeal.

it will be very clear where we stand on repeal. during this past campaign, i, like a lot of candidates, spoke to small businesses every single day. there's a reason why 90% of small business men and women in this country support repeal. from the billions in taxes to the needless paperwork to the burdensome regulations to the $1.6 million estimated job loss, small business men and women are adadadt than we need to repeal. finally, madam speaker, our opposition last year said if you like your plan, you can keep it. to date, there are 222 organizations, including some of obamacare's biggest supporters who have received waivers. why? why, if the law was so worthy, would there be a need for waivers? thank you, madam speaker. the speaker pro tempore: the gentlewoman from new york. ms. velazquez: i yield myself as much time as necessary.

the speaker pro tempore: the gentlewoman is recognized. ms. velazquez: as a result of this repeal legislation, small businesses in the state of illinois will see a tax increase of $1.7 billion. with that, i yield two minutes to the gentleman from connecticut, mr. murphy. the speaker pro tempore: the gentleman is recognized for two minutes. mr. murphy: thank you very much. madam speaker, when i testified against this repeal before the rules committee, i told the story of a family in my district, the husband lost his job and therefore his insurance because of a debilitating snir. his -- injury. the family faced a choice, either dip into their savings account, their high school son's college fund, or sell their house. they first chose to spend down their savings. when i told the story a republican said, whey they had money they had asset, i don't get it, why should someone else pay their bills?

she didn't get it. no one should be forced on the street because one of their family members get sick. there is a moral imtertive to be our brother's keeper but there's a fiscal imperative. when that family's savings is done, they're out on the street, we all pick up the cost. small businesses pick up the cost. that's why small businesses are paying 18% more than big businesses. that's why about $1,100 of every premium goes to cover the uninsure. there are thousands of small businesses in connecticut organized under the us a pises of a group called small businesses for health care reform calling -- crying out for this repeal to be defeated. they see the $260 billion price tag that's going to land on their head as well as the continuation of discriminatory practices that ask small businesses to pay for the uninsured like that family that i talked about. this bill isn't anything more than that political statement. families in my district, small businesses in my district, need

more than politics. they need answers. i yield back my time. the speaker pro tempore: the gentleman from missouri. mr. graves: madam speaker, at this time, i yield one minute to the gentleman from iowa, mr. king. the speaker pro tempore: the gentleman is recognized for one minute. mr. king: i thank the chairman for yielding time. i listened to this delivery ahead of me, i spent 28 1/2 years in business, i met payroll over 1,400 consecutive weeks. i never saw a regulation that made my job easier or allowed me to make more money. this is thousands of pages of regulation, it's oppress toiv small business, it should be called the entrepreneurial extinction act, not the health care plan. this is obamacare, it must be pulled out completely by the roots. the 34er7b people know this. that's why there are 87 freshman republicans on this side, nine freshmen democrats on this side. the american people have spoken resoundingly, it is our obligation to go down this path. it's not symbolic. it's very important. without this vote on this floor,

we can't move forward with the rest of the scenario to eliminate obamacare. the language in the bill is simple. it concludes with this language. act is repealed and the provisions of law amended or repealed by such law are restored as if such act had never been enacted, close quote. thank you, mr. speaker, i yield back the balance of my time. the speaker pro tempore: the gentlewoman from new york. ms. velez kezz: how much time is remaining on each side? the speaker pro tempore: the gentlewoman from new york has eight minutes remain, the gentleman from missouri has 11 minutes remaining. ms. velez kezz: i yield two minutes to the gentleman from -- ms. velazquez: i yield two minutes to the gentleman from new mexico. the speaker pro tempore: the gentleman is recognized. >> during these tough economic times it's critical we make job creation a top priority. that's why i'm concerned about the impact h.r. 2 will have on small businesses. it will repeal a tax credit for

small businesses that offered health insurance to their employees. it would allow an insurer to deny business coverage if their employees have pre-existing conditions. mr. lujan: as a result of reform, new mexicans no longer face this. if this is repealed, having cancer, diabetes or being a victim of domestic violence will be cause for losing health care. people like yvonne from santa fe would have to worry about losing their health care. yvonne lost her job when the company she worked for was shipped overseas. she was diabetic and because of the high cost of cobra, she was fored to ration her medicine. as a result, she became gravely ill and had to visit the emergency room. her doctors noticed another problem that required further examination yet because yvonne could not afford cobra and because private insurance companies would not insure her because she had diabetes, the hospital released her.

the only option yvonne had was to wait two months to be seen at the university of new mexico hospital. she was diagnosed with a form of lung cancer that would have been caught earlier had she not been kicked out. she passed away from complications resulting from the cancer having suffered through a system that discriminated against her we cannot return to the days when people like yvonne are forced to suffer because of insurance companies' bad practice. let's not turn a blind eye on people lie e-- like yvonne. the speaker pro tempore: the gentleman from missouri. mr. graves: thank you, madam speaker. at this time, i yield one minute to the gentlelady from north carolina a nurse and the new chairwoman of the subcommittee on health care and technology, mrs. ellmers. the speaker pro tempore: the gentleman from north carolina is recognized for one minute. mrs. ellmers: i ask unanimous consent that my remarks be revise and extend -- that i be able to revise and extend my remarks. the speaker pro tempore: without objection.

mrs. ellmers: when i ran for congress, i vowed to end obamacare. and with my first vote in the 112th congress, i will do so. as a nurse for 20 year, co-owner of a wounds care clinic and in practice with my husband in his general surgery practice, we know the problems that exist for americans in health care. instead of being a remedy to these problems, omaw -- obamacare has already done more harm than good to both the quality of health care in our country as well as our economy. as a nurse, i look for pathways to solutions, this is a problematic pathway, undoubtedly. in the face of rising unemployment, unsustainable federal deficits and overwhelming public opposition, it took more than a year to cobble together an unpopular government takeover of health care. so riddled with provisions that violate right-to-life principles and support government rationing of care that it cannot simply be

patched. obamacare is bad for workers, it's bad for employers and bad for america. repealing it allows us to start -- thank you very much. i yield back the balance of my time. mr. graves: i yield the gentlelady 30 more seconds. the speaker pro tempore: the gentlelady is recognized. mrs. ellmers: thank you. repealing it allows us to start with a clean slate and look at market-based reforms that will actually lower health care costs. it will increase accessibility, let americans keep their plans if they have them and they like them and it will forestall impending drastic changes that have create uncertainty in the lives of so many americans. to this congress, i will work with my colleagues on both sides of the aisle to repeal and replace the job-killing regulations and state bankrupting mandates. the bill to repeal the so-call aid fordable health plan --

the speaker pro tempore: the gentlelady's time has expired. mrs. ellmers: thank you so much. the speaker pro tempore: the gentlelady from new york. ms. velazquez: i reserve. the speaker pro tempore: the gentleman from missouri. mr. graves: i recognize the gentlelady from new york. the speaker pro tempore: the gentlelady is recognized. >> i rise in strong support of this bill to repeal the affordable care act. i can tell you that athe affordable care act will take care away from patients. it transfers power from consumers to the government. ms. hayworth: to make crucial decisions that belong in the hands of patients and their doctors. it neglects to deal effectively with reforms and medical liability that are desperately needed to reduce the

unconscionable cost of medicine. our vote to repeal is not merely symbolic, it represents the true will of the american public and will pave the way to reform our health care in a way that will allow our citizens to have the good, cost-effective health care and affordable, portable health insurance they need while maintaining the quality, choice, and innovation that represents the best of american medicine. thank you, madam speaker and i yield back the balance of my time. the speaker pro tempore: the gentlewoman from new york. ms. velazquez: i continue to reserve. the speaker pro tempore: the gentleman from missouri. mr. graves: thank you, madam speaker. at this time, i yield one minute to the gentleman from arizona, mr. bossier. the speaker pro tempore: the gentleman from arizona is recognized for one minute. mr. gosar: the health care law passed last year did not fix any problems, it only made things worse.

small businesses can barely make ends meet. now the federal government is imposing more mandates, more taxes and more red tape. enough is enough. as a health care provider, small business owner and father, i know that the way to provide more health care to individuals and create more jobs is not through government bureaucracies, deficit spending and higher taxes. rather we need to empower businesses, big and small, to band together to purchase health insurance. we need to implement real health care reform that will lower the cost of care and open up access. tort reform, red tape reform, pre-existing conditions reform. these are reforms that will work. reform the current law failed to adequately address or ignored altogether. if we are serious about putting our nation back to work, we can start by repealing this onerous health care law and work hand in hand with the american people to implement true health care reform. i yield back the balance of my time. the speaker pro tempore: the

gentlewoman from new york. ms. velazquez: i continue to reserve. the speaker pro tempore: the gentleman from missouri. mr. graves: thank you, madam speaker. at this time i yield one minute to the gentleman from pennsylvania, mr. fitzpatrick. the speaker pro tempore: the gentleman is recognized for one minute. mr. fitzpatrick: i rise in support of the repeal of the so-call aid fordable care act because the affordable care act is unaffordable for small businesses and individuals. since the passage of the act, my constituents have seen double digit premium increases. the act is unaffordable for states already billions in the red and unable to shoulder billions more in medicaid costs. it is unaffordable for seniors who will see reductions in medicare spending. and it's unaffordable for the american tabblings payer who will see a $700 billion increase in the deficit. we must enact real health care reform, tort reform for doctors,

permitting individuals real competition to purchase across state lines and enacting and enhancing health savings accounts. these are the cornerstones of real health care reform and affordability to make health care affordable and accessible for seniors, states and generations of taxpayers to come. i yield back. the speaker pro tempore: the gentlewoman from new york. ms. velazquez: how much time does each side have remaining? the speaker pro tempore: the gentlelady has six minutes remain, the gentleman from missouri has six and a half minutes remaining. ms. velazquez: i yield two minutes to the gentlelady from california. the speaker pro tempore: the gentlelady is recognized for two minutes. ms. richardson: i urge my colleagues to keep true to the -- to the call for civility. this isn't obamacare, it's called the affordable care act. at a time when americans have a

chance to see a regular doctor, to prevent sitting in hospital rooms in emergency waiting for desperate care, we have a chance. what does this mean to small businesses in california and my own home taun, 15,100 small businesses have seen a 50% tax credit to provide health care for the first time for their employees. over 16,000 additional small businesses will now be eligible for health care exchanges that will make insurance affordable. now are talking about considering something that would prevent medicare for 63,000 beneficiaries, extending coverage to 88,000 residents in my district. that's what we're talking about and when you are talking about guaranteeing 17,000 residents who had pre-existing conditions. i will vote no on h.r. 2 and i urge my colleagues to consider not reversing, it's not time to

go back,

left. our interest is in the health reform bill that was passed last spring. if -- and there are some major defects in that bill that we think are so serious and severe that congress will have to reopen the health care law and make major changes to it, even if there are no critics around. i want to briefly go over 10 of those major problems in the bill and then each of our speakers will address certain parts of it. number one is an impossible mandate. all this will be required to have a health insurance plan that will -- a cost of which will be growing at twice the rate of our income. you don't have to be a mathematician or an economist and know that, if you are forced to buy something, the cost of which is growing at twice the rate of your growth of income, eventually, it will crowd out everything else that you are

buying. barack obama did not create this problem. this problem has been going on for four decades. for the last 40 years, a health care costs have been growing at twice the rate of growth of our income. the united states is not the worst case in the world. in fact, we are just under the european average. so this is a problem for the entire developed world. but even though barack obama did not create the problem, the bill that we passed makes it worse because what it will do is lock us into that very a sustainable path. if we continue on the path indefinitely into the future, by about mid century, today's young folks will reach retirement age and health care will have crowded out everything else that they consume.

i suppose that that is not the goal that we want to reach. the problem with the bill is that it takes away from the private-sector many of the tools that are now there that allow you to control the health insurance cost, and letting the package of benefits, more cost sharing, all of that goes away and walks into a path that is unsustainable and undesirable. then we have is our system of subsidies. the hotel down the street has a lot of workers that are making only $15 per hour. they are the maids, busboys, the custodial folks, the garden folks. according to the congressional budget office, if these people make it over to the health insurance exchange that will be set up under the new health law, there will be able to acquire a health-insurance plan for a family that costs $15,000 and the government will pay almost all the premiums. then if they have a lot of out-

of-pocket costs, the government will reimburse them for those and the cbo projects that the total benefit they will get is about $19,000. on the other hand, if these employees stay with the hotel and get their health insurance from that hotel, the only subsidy they get is the subsidy that is currently in the tax law, which means the ability of the hotel to pay premiums with untaxed dollars. but since people at this way is little to not pay income taxes, we are only avoiding the payroll tax. the ability to do that is only a little more than $2,000. they could have something for free worth $19,000. where do you think people will end up? economy tells me that they will find their way into the exchange. if the marriott employees do not do it, but the others do, marriott will find it very hard to compete in the marketplace with labor costs that it% higher

than all its competitors. i do not know what firms will do, but i can conceive of a world in which firms completely reorganized to take advantage of these new subsidies. the strange thing is that, if marriott has an employee that makes 9000 that -- $90,000 or $100,000, that employee gets no subsidy if he goes into the exchange. if he gets his and assurance from the marriott, however, marriott gets the subsidy with the current tax law, the ability to pay prelims with pre-tax dollars, avoiding the payroll tax. but for the higher income, also state and local income taxes. those subsidies are about equal to half the cost of the insurance. so a higher-income employees once his intered -- once his insurance from -- once his insurance from the hotel. what will employers do?

end entirely independent contractors and such? there will be decisions that will not be good for the job market, not the kind of labor market situation that gives employers conference and lets them know what will happen. we have health insurance exchange that creates perverse incentives for the insurers. you charge everybody the same premium, regardless of health care costs, everybody's incentives are distorted. the person that has health problems and will look at the premiums and say that health insurance looks cheap to me and they will tend to over insure. the person who is healthy will look at the premiums and think that it is way too high and some will decide to under-

insured. incentives for the plans are to avoid the sick and attract the healthy. here in washington, at open season time in the late fall, what kinds of ads do you see in newspapers? you see as a young healthy people with children and the implicit message is that temecula put the people in these ads, we want you in our plan. -- the implicit message is that, if you look like the people in these ads, we want you in our plan. if you have aids or some other difficult-to-treat condition, consider us. remember the phrase "you are in good hands with all state?" they have a catastrophic seen and they say, we know that you do not care about health insurance until you have an accident. but when the really bad thing happens, they say, we will take care of you. in health care, however, it is

the other way around. we give health insurance companies an incentive to attract the healthy and tell the sick or potentially set that we hope you do not get sick at all and we wanted to go someplace else. you do not want to erect a health care sense of -- a health care system that avoids people who has problems. one that is better is the medicare advantage programs where they tried to recruit senior citizens with high health care costs because they know they will get a premium that is much higher than the premium paid by everyone else. we have in this loppers incentives for individuals. we have a fine for being uninsured, which is, quite frankly, not great enough if you want to make the premium completely independent of people's expected health care costs. in massachusetts today, people are going bare when they are

healthy. they are signing up for health insurance after they get sick. the number of people who do that is increasing each year. it is a small problem for massachusetts right now, but it will be a huge problem for dallas were coming in dallas, they find that medicaid patients end up in the emergency room. it does not matter so much to medicaid because it is taxed pair -- it is taxpayer-funded anyway. bluecross will not survive very long in the health-insurance marketplace. we have made promises that we cannot possibly keep. according to the congressional budget office estimates, we will ensure about 32 million people who would otherwise be uninsured. if the economic estimates are correct, those people go out and try to double the amount of health care that they have been consuming. we have millions of people, 90

million in the last estimate, that will have access to preventive care with no deductible and no copayment, benefits that they did not previously have. let me give you some idea how bad that is. economists at duke university estimated if everybody in america went out and got the preventive care that is prevented -- that is recommended by the preventive care task force that will set the standard for the new health plans. the estimate was that the average primary care physician in the united states would have to work more than seven hours every working day to ride these services, essentially providing services to help the people, leaving little time left over to take care of the sick. what i'm describing is a huge increase in the demand for care. in this legislation, we did little or nothing about the supply. early on, there were versions of the bill that had line-item expenditures to produce more doctors and nurses and so forth. but all of that was zero out on

the final passage, probably to keep the cost of the legislation down. the cbo that probably figured, if we do not have many more doctors, they cannot deliver more care, and we cannot spend more money. but what we will have is a large increase in demand, no change in supply, and a huge rationing problem. in this country and other countries, we do not primarily care -- we do not primarily pay for care with money. we pay it with time. please stand by

manacling to community health centers for their care. the elderly may be there. comit will be difficult for theo meet. this legislation does nothing. finally, it overregulated/ that produces affordable health insurance.

it regulates both the patients and doctors. if we really want to solve health care problems, we want to get rid of waste in the system and higher-quality care. many patients and doctors who will do it. but there will lead to a gifted and had incentives to do so. -- but there will be no incentives to do so. every patient, every doctor, every nurse, and every hospital the administrator will have to do just that, lower costs and raise quality. i want to turn the program over to my colleagues. this program is co-sponsored by the heritage foundation. robert moffitt who is here today was very kind to put this program together.

>> thank you for the chance to be here during the since -- during this event. obviously, this is a central piece of legislation and one that ought to be examined very closely. i want to echo the remarks that the john made about the impacts of the law from the perspective of health policy. but i was taught that, when one looks at legislation, it must look at it in the context of the nation's problems. the top two problems in the nation today is an economy that is badly underperforming and the need to generate jobs for americans and a federal budget outlook which is coming in and of itself, so threatening as to really cast in doubt the future prosperity and freedom of americans. this legislation is quite damaging from the perspectives. first of all, the health care sector is now moving to one- fifth of the economy. everything john set about improving incentives in that sector would constitute improve

economic policy, and getting higher quality in care and less cost and improvements in efficiency. those are things that we ought to support as a matter of economic policy in the united states. on top of that, there is sspill over to the rest of the economy. you can save $500 billion in taxes over the next 10 years. i do nothing that anybody in the room would say, if you want to create jobs, should we raise $500 billion in taxes over the next 10 years? some of those taxes will show up in the form of reduced incentives. there is a so-called medicare tax, a surtax on investment incomes for high-income americans. that is a pure trackincrease inx on marginal tax rate.

it will have the same kinds of entities that were the subject of so much discussion and recent debate over extending the 2001- 2003 tax laws. small businesses and entrepreneurs in america will create new firms and generate job growth. indebted in this bill is damaging incentives for those individuals. there are all sorts of inputs into health services that will lead to higher costs to those services when held some -- to those services. when health services are more mix and sift -- more expensive, there will be higher premiums. you will see the bottom line show up in every small business in america. every businessman will have to do the calculation that says i have to pay my workers less to cover the cost of the premium increases i am seeing. there will be some workers, those in particular with minimum

wages, where you cannot lower their cash to offset the premiums. we will see those jobs go away. again, it will be the low-income workers were primarily damaged by this bill and the economics at -- economic incentives that are in it. this is a recipe for less less jobs in america. it is a recipe for slower economic growth. is just putting the $500 billion in taxes in. there is nothing about sending out checks for $1 trillion worth of seven cities that will generate job growth in the united states. nothing about that has ever been a successful path to economic performance. i believe that the nature of the subsidies -- i want to echo what john said -- in addition to the real efficiency costs and the growth impacts of this bill, there is some deep and fairness associated with how these subsidies are distributed. the example he gave was a rare one. there are two people who are otherwise identical.

you have one woman making $70,000 and gets her entrance from air her employer and gets the tax benefit from the employer-sponsored insurance. another woman making $70,000 goes to the exchanges and get $7,000 in federal subsidies. that is an industry that is so profound that it will not be allowed to persist. one that i am deeply nervous about is that a future congress will fix that in every by giving everybody $7,000 and making the bottom line cost so much more expensive than it already is. i want to turn to the budgetary implications. they're very closely related to the economic incentives. there are many ways to look at the budgetary implications. the first one i would ask you to begin with is the last one. set up two new open-ended income of programs that will grow at 8% per year as far as the eye can see. that is faster than the economy will grow. it is faster than any notion of

revenues will grow. we will set two new programs that will grow faster than the economy for as far as the eye can see and we're supposed to believe that it reduces the deficit. it is impossible to make that claim with a straight face. we have cbo estimates of budgetary impact which showed a deficit reduction from the bill. but i do not think it is widely understood that this particular estimates and the nature and that thoserules -- thu particular estimates are forced by the nature under which the cbo has to follow the rules. if you take away those rules and look at this in any realistic

fashion, our estimate is that the bill would reduce the estimates by $500 billion the first 10 years and $1.50 trillion in the next 10 years. that is an important thing from the future the economy to the fairness perspective. the rules are so offensive and it has to do every young person in the audience. this bill is the biggest generational money grab in history. it forces every young american to buy insurance, thereby pay for the cost of those who are older and sicker than them, and then, having done that, when they get to the end of their working careers, they will inherit the trillions of dollars in debt that this bill will produce and will be saddled with paying that off as well. from any perspective of fairness, that is simply wrong. it comes at a time when it is also dangerous. everyone has heard a lot about the budget outlook. regardless of which one of the

particular forecasts you look at, the united states is in the fiscal situation that is unprecedented in its history. over the next 10 years, we are likely to run deficits that averaged nearly $1 trillion by the end and zero of -- an average over $600 billion each year. at the end of six years, we will have over a dollar trillion in deficit. we will be borrowing just to pay for the interest. that is a recipe for financial disaster. all along that path, we will meet the technical criteria for downgrade. that is the fiscal outlook before they passed this legislation. this legislation will make it worse. i stipulate that introducing a damaging bill to a stiffest -- to a dangers fiscal situation will not generate jobs. thank you. [applause] >> thomas miller is a former

senior health economist and is now with the enterprise institute. if you're interested in health policy and you look at the journals, it is hard not to find tom miller everywhere you look. let's give him a warm hand. [applause] >> thank you very much, john. there is a lot of repeal-and- replace work to be done. you can also find them at our website. coming soon also, with my co- author and others, "y obamacare is wrong for america." look for it. today, john asked me to focus on something else -- how to improve the health care delivery system and health care quality through u.s., political, and other ways

and means. we have to give chase the way we think about the issue. there should be health outcomes and value. helter quality is too often viewed in process terms, -- health care quality is too often viewed in process terms. there is no single setting. it does not mean there are not institutional process no- brainers. that is just not the big story on how to get better value. we also need to reach beyond the conventional health care delivery system. a wide range of actors shape it.

two different individuals should have exactly the same health insurance and differences in health, both initially and after getting the same diagnosis and it can be vastly different depending on where and how they go to for treatment, how to make decisions as patients, and a host of other factors earlier in their life that brought them to that particular point. " we always forget to look for the health outcome keys that are lost from the health care funding lampposts. let's be more humble about providing simple guarantee answers. the patient protection and care act is promising what is unbelievable and what is all

too predictable. in the flyover land of the law, the unicorns and health care delivery reform miracles, or science fair projects that never got out of the exhibition hall, we have various 3 iterations of repackaged centralized command and control edicts from the usual sources who issued the previous ones that failed outright or aggravated the systems pre-existing chronic conditions. the latest cliche is that every idea for dealing with health care is -- they managed to leave out a few important ideas, like choice, competition, personal responsibility, truth in labeling, market pricing, respect for personal preferences, incentives for better performance and decision making, double entry bookkeeping, and even arithmetic. most of the quality of experts

who tried to sell the message bore over that most americans do not hear or believe, yes we believe the health care costs are too much, even though you only see a fraction of the full expense directly or there are too many barriers of getting more of what we want when we wanted, but a vast majority actually think that the health care they receive is excellent or good. that is partly why you will hear politicians talk a lot more in public about high health care costs or spending on the uninjured and the patient protection affordable care act provisions. the reality is that our health care system, although excellent in many important ways, is not perfect. different approaches could increase its value. with some more on his choices, it could push forward in a more competitive and transportranspat

marketplace. the meter is running on my time. first, throttle back a good bit of the overbearing regulation. two, guarantee a socially acceptable floor of health care services for the less fortunate, but stopped attending to subsidize some much of everyone else's bill when it mostly becomes more wasteful rounds of dollar trading. 3, stop pretending that all care must be high quality and can be high quality and available to everyone all the time. instead, let's encourage more competition in seeking and delivering care whose value continues to improve from whatever it is in the moment. you cannot just imagine the merkel of a totally unfettered free market -- the miracle of a totally unfettered free market. policy changes can help private

parties compete in measuring and reporting better have different parties in the health care system performs so they can be rewarded. i have written about this in greater length elsewhere. the new law is not totally barack -- not totally moronic. but it is on a consensus standards that, by the time they are derived, they're too weak, too unrealistic, or to outdated, and perhaps all three of the same time. while other provisions drive to a more concentrated health care marketplace, it is less competitive and more politically dependent. we cannot expected to be perfect. we cannot measure everything or even most things. but we should use what is best

available within limits of current data and measures while acknowledging those limitations. we should also shut up about quality when we do not know one way or the other. decide what you really want to waste your money on. we need information much more about provider performance and about insurers and the insurance they offer. and about physicians, not always that the group level, the information needs to be a combination of measurable health outcomes or intermediate markers for them. it is the value combination that matters, not just quality, cost, or price alone. this whole area is complicated, contentious, a evolutionary, and full of caution and caveat.

but we ignore it at our peril without beginning to engage. basic sweeney are to do aggregate data and -- there are basics we need to do to aggregate data and assess it. thank you. [applause] >> thank you, tom. michael cannon is at the cato institute. some months back, he recruited a university of chicago professor to show us how we really ought to be handling the problem of pre-existing conditions. we had a lively discussion of it at my blog. i have asked him to tell you about it today. please welcome michael cannon. [applause] >> thank you, john. thank you all for coming. i may have to leave before the question and answer period. if you have any further questions about my remarks, i

encourage you to visit the cato institute web site. you may have heard today that the department of health and human services released a study that says that about half of non-elderly americans have a pre-existing condition and repealing the health care law known as obamacare would mean that those folks who have trouble getting coverage. but, in obamacare, it guarantees that those folks would get coverage and the care that they need. there is problem with that. a government survey conducted just a few years ago found that only 1% of americans had ever been turned down for health insurance. that is consistent with other research. research by the rand corporation looked at lightly regulated individual insurance markets, such as california's, and found that lots of people with pre- existing conditions get injured even when the insurance company has the ability to deny them coverage or to charge them higher premiums. it is a tricky thing, really, to

get people to keep the promises that they make too sick people. this is true whether you are talking about pollock health let's look at the record. there was a long- term promise to sick people. employer-sponsored health insurance. if you know that history come you know that this market is a creation of government. in the 1940's, the government through a series of accidents decided that employer-sponsored health insurance would be exempt from payroll taxes and income taxes, which created a huge tax break. have a corresponding penalty -- purchasing on your own -- if you want to purchase it on your own, it can cause people twice as much for the same or less

coverage compared to getting that through an employer. this is the horse the government decided to back. but if you think about it, your insurance plan for your employer does not provide you a long-term promise to take care of you when you're sick. they only provide medical care so long as you are still connected to that employer. if you get sick and cannot work, you lose that health insurance and you run your own. the individual market, researchers have found, even with various regulations, fines or secure health insurance than employer-sponsored health insurance. for people with high costs illnesses, they are likely to keep their insurance than that they had it through an employer. that is the situation the government created when it decided it would increase access

to health insurance. nine out of 10 people with health insurance or in this employer-sponsored health market where you do not get a guarantee that you'll be taken care of over the course of a long-term illness. how about another khmer -- government solution and? we heard about the medicare program 20 years later. we're going to provide secure health insurance for people in old days so they created the medicare program for people over age 65. yes, medicare provides secure access to health insurance for the time being. they do it in part by being completely fiscally unsustainable. we cannot continue to provide access to the medicare that seniors had been accessing in medicare for the past decade. in addition to that, one of the ways that medicare is so financially unsustainable is

that 33% of medicare spending does not provide any value, does not make patients healthier or happier. that is where research shows as. and it causes most of

two denied and care -- to deny and cares they can go to another insurance company. this happens wherever we see these prices. it happens in states like new york. it happens with the employment benefit programs pepc. s with the you are rich, poor, or anything in between

them and doing a better job of providing it at a lower cost. they can do more to give them a total satisfactory guarantee. picked it does not keep its promises to you when it get sick. this innovation is going to be impossible so long as obamacare remains on the books. thank you very much. >> robert moffitt is the senior

fellow at the coliseum for information at the heritage thought foundation. >> we are entering to the second phase of the mass and a health care debate there is the challenge of the entitlement .urd

this year it the first three wave of the baby boomers turn 5. they are trying to influence a largest single demand that we will see on terms of the tremendous demand the size and medicare will double in the next 20 years pepco it of public dollars. no one disputes it. it acknowledges this.

the gravity of this is greater than most really appreciate. one of the striking facts has been the medical profession purd. the mark your doctors are becoming demoralized. they do not have control over their professional life.

medicare is undertaking a record-breaking reductions in payments to doctors and hospitals. they say this will be a saving of five commanders $75 billion. what does this mean? we have not been here before. the payment reductions of this magnitude will threaten the access to care. that is the view of the actuary for the office.

further intervention, the savings will not enhance the s olvency of the program there was a letter addressed to jeff sessions of alabama. he said the unified budget shows the majority of the savings would be used to pay for other spending and therefore would not enhance the ability of the government to pay for future medicare benefits. the provisions of the law will guarantee that we will see great access problem.s they do not think the recod

breaking deductions will survive. you wan to have access to rpivate -- private sector options. it does not make sense to reduce access or maintain limitation on senior citizens ability to go outside the program. we have to go in a different and direction. we are entering the second p h ase of this national debate. congress must direct responsibility for one of the largest programs. they have to find a way to get this financial house in order.

how are we going to handle this financial challenge? nobody knows. many of you are young people. you will pay the price. they are changing it from the open ending entitlements that exist today. -- adjusts premiums, and subsidies to -- ending subsidies. to get away from what we have today. we should provide the beneficiaries with a wide range of choice in health care plans and options and at the same time make sure that in future medicare systems that we will expand access to physicians and

reduce the number who say they refuse to take medicare patients or accept new medicare patients. there are ways to do this. my own view is that many of you are enrolled in a program which is actually quite good in terms of organizing health insurance benefits, the federal employees health benefits program. it is driven by a true free market principles, direct competition. eat your dissatisfied with your health insurance package, you can fire your health insurance plan. that is not a bad option. it is not an option for the future of our senior citizens as well. if they will have to depend upon making good decisions to give them access to the quality health care that they deserve. think you very much. >> thank you, bob. that was very informative and very good.

i want to open up the floor for questions. if you will tell us you -- who you were directing your question to. let's have a handout. -- a hand up. well let me just begin by asking this question. to the panelists believe that senior citizens realize what has happened to them under this legislation, and what do you think will happen what the medicare provision? will we go forward? we carry out the way law was written or will it have to be changed? who wants to take this? >> i bet it was very interesting that both the actuary at cms and the director of the congressional budget office both publicly stated and formal,

official correspondence to the congressional leadership that they did not think that the medicare payment deductions were sustainable over time. but the cbo and the cms actuary. we have never quite gone here before at this level of payment reductions. i think that whether the survivor not, it is highly unlikely that these kinds of reductions will survive. >> let me address this question to doug holtz-eakin. what happens when you have a bill with a huge expense and the way you thought you were going to pay for it does not pan out? >> nothing good. [laughter] this is been the history of entitlement programs in the united states. they are launched with fanfare, that includes their budgetary

soundness over time, enrollments expand, benefits are added to what was originally envisioned, the incentives are such that no one is ever going to impose things on programs that cause the beneficiaries to scrap or say. so we get this enormously bloated title -- entitlement program. that is in the history and medicare, medicaid, and likely to be the future of this law unless we change course. we end up where we are today, with enormous structural deficits that are so large and so troubling that they literally threatened to cut acid -- the capacity of the u.s. economy to provide a high roll standard of living than we have now and that is something we simply cannot do. >> we value currency with economic balances. we can also the value health care -- devalue health care,

either explicitly or directed. >> you mentioned the department report that suggest that about 30% of the spending in medicare is wasteful and goes to -- is spent on care that provides no particular good for people, so my first question is -- doesn't that suggest that there is in fact allow that to be pulled out of medicare? and if so, how do we do that? steady path -- published last month looking at mcallen texas, and looking at variations in medicare spending and they found that the variations and private spending. this does not seem to exist in private spending, at least in these two locations. my understanding it that the administration, a lot of plans for obamacare were based on the

idea that this same sort of problems existed in private and public health insurance. what does this say about the reform and how will play out? >> the fat is measured crudely as an aggregate. 15 years ago, people are rediscovering that there is much variation in private-sector health care then there is and medicare. there was another program or managed care plans or there was a variation on a regional basis. the tendency of research is that there is a bias in the field. you go where the data is. we had medicare data and you could show this type of crude variants and band you prop up a lot of theories around it. it could be true that the nature of the medicare program lends itself to more of that waste and variation without -- there are two principles in dealing with this. we're not ready to go there. putting money in the hands of the patients and the consumers?

we have that that much. we do need some type of -- even though they are imperfect -- markers as to what is better or worse, not perfect, something in that regard. we're building a lot of matters which may not tell us that, but that is the general direction to go. you can always find it right here on the map in this particular area and pinpointing get that passed politically? probably not for you would probably have to decentralize that. >> let me add one thing to that. tom's answer was very good. there probably is 30% waste in medicare. maybe there is more, but when he get the bill, you do not get an item that says these items are waste. then it would be easy to get rid of the ways. you do not know where the waste is. what we mean when they say say there is ways, there is

inefficient hospital and minister are an efficient group of doctors that could have done this for 70% of the cost of was suspended. unless they have an incentive to do that, they are not going to do it. we have to get -- we cannot get rid of the waste unless it is in someone self-interest to do it. >> should congress even attempt to fix this legislation? is it possible that thinks this law or you think that tweaks as a whole cannot make it difference? the whole thing has to go? >> take your shot at it. >> the issue here is what is your vision for the future of health care in america. what i think the law represents is a very specific vision of health care policy. we know our colleagues very well who disagree with us. frankly this is their vision of what health care system should look like. they believe, many of them very strongly, that health insurance

plans should the public utilities and should be heavily regulated by the federal government, and the federal government should make the key decisions allocating resources in the health care system,-and making decisions about what will be covered and how will be financed. that is not my view and i think my colleagues here share my view. . but the bill does represent that point of view. having said that, i would say that in answer to your question that you actually cannot build a system based on free-market principles of consumer choice, and competition on a foundation which is fundamentally incompatible with that vision. a foundation which is built primarily on central planning and bureaucratic regulations. again, that is not the personal opinion. that is what the law does. i understand that our friends on the other side, they have the very different vision on this. let me make one observation

before i stop. in the early 2000's, the idea of the health insurance exchange became very popular among health policy analyst. the idea behind that was competition among private health-care plans. there had been riding on this issue. but at the university of california, a number of analysts got together and said, look, this is a great idea. if we should do is have a health insurance exchange with a taxpayer-financed public option. what was the purpose of it? it was very open and very publicly celebrated. it was a way to get to a single payer health care system by basically undercutting private health insurance. that is the image, that is the vision. we have a different one. >> this was a package deal. it was not all you can eat, it was all you could stomach before regurgitating.

you can also talk about a few appetizers. we have seen patients that probably need the entire meal. pulling one part that means the rest has to go, it's like saying i'll have one of column may, one of column b, and do not worry about the rest in that regard. we're pulling apart the most obnoxious features and playing for time. if the designers of this legislation want to institutionalize and make inevitable the early parts. this is something that can be pulled up quickly and need to get on to what we need in its place. it does not mean that nothing remains. we have to be in front of things that make sense. >> after the repeal vote in the house, voting on a resolution, are you confident that with a

goals to come up with replacement regulation will make the serious structural changes you're talking about on how health care is paid for? >> i think there is good reason to be optimistic on that front. what people not forget, given the events of the past few years, that is that if you dial back to the beginning of the roof health care reform debate in the united states, there was a tremendous amount of bipartisan consensus about the need for reform. if there was a tremendous amount of a consensus about what reform should look like, how much should provide incentives to root out low-valued care, to centralize, and equalized across states, the cost differences we have seen, provide better insurance options. none of that was in dispute. so there is no reason to be at all skeptical about the notion that you could go out and find a common objective. it is also the case that there was a tremendous amount of bipartisan agreement on a whole

lot of the delivery system reforms that would improve the quality of care in the united states. where there was great disagreement was in the nature of the insurance reforms and how doing -- how to cover more people. this legislation is by and large about ladder at the expense of the former. so we could go back and do better on a bipartisan basis by concentrating on the real problem, which is the u.s. delivery system, and not on massive expansion of check writing will power at the federal level. >> there is going to be a political gridlock in terms of repealed for over the next two years. there will be a lot of forward movement at the state level with the exchanges as they look forward to 2014. does it make sense for one state or multiple states to try experimenting with some of the models who have outlined here? resistance, one model, not just

private insurers but also medicare to participate? >> a lot does not allow enough of that experimentation. the states will have to be more aggressive than what are going to be the rule sent down from hhs. there is some leeway but you get into this plea-bargain game where you think, give me more slight, can i have a few more? it does not actually turn it around. i will be speaking tomorrow at the national congress on health insurance reform. there is a different way to do exchanges. to some extent, states have to put something on the ground which is not going to get that within the parameters of what they're told in washington to do. they need to get examples the work in the next two years and see what we actually prefer. dobie things that make sense to the people that live there or an entirely different regulatory scheme which is not where we need to go. >> the only thing i would add to

that is that the administration seems very desperate to me to get something to work. i think that is why they gave waivers to 1 million workers, including 30,000 mcdonnell's workers. they do not want to be embarrassed by bad things happening. they want to see some good things happening. that makes me think that they might be willing to be flexible. yes? >> what doctors, the physician payment cut, they are not going to get paid anything, who would want to be a doctor anymore, and how are we supposed to fix that? >> anybody want to take that one? >> let me take a shot at it. no, i honestly think that one of the most serious problems facing the country is the demoralization of the medical profession. physicians are dispirited.

many of us have an opportunity and it is a great privilege for me to have an opportunity to address and talk at professional medical meetings were members of the medical profession are gathered, and the talk among themselves a lot about the profession and how they can function in this environment. the environment for independent medical professionals is becoming increasingly hostile. you are expected now to go to work for a hospital. you are expected to join a large practice. at the same time, you are expected to absorb a massive number of people who are going to be getting care under medicaid. medicaid, really, if you want to talk about the big change in this bill in terms of insurance coverage, if what we have with all the people getting health insurance will get it through medicaid. talk to decisions about what that means. it means that every single time, the patient walks into the room,

the patient is going to incur a financial loss. it also means that more and more people, are going to end up in hospital emergency rooms. this is been completely overlooked in the past health care debate. the degree to which medicaid is a driver of hospital room overcrowding, i think the situation is very serious. the only way to change that, it seems to me, is to change the fundamental underlying financial structure of our health insurance system. where we basically have an opportunity for people to buy the health insurance which is best for them, and enter into the kind of relationship with the doctor that used to be the norm. what i am saying and it is pretty radical here, what we ought to do is make one of the goals of health care reform the restoration of the traditional doctor-patient relationship for those who wanted. not all people wanted.

but many of us do. that is why the president has spent so much time saying, in form after form, if you like your relationship with your doctor, you will be able to keep it. the problem that you and i are struck with it that you may want to keep your relationship with your doctor but your doctor may not be able to keep his relationship with you. >> i think that goal of one-to- one relationships, you can just be around doctor now. >> dr. burgess is with us here. doug holtz-eakin tells me that there are 20 doctors in the house of representatives with a margin 80 new members and the house, 20 or doctors. ted and i hope we will hear from all of you in the debate that starts later today. >> it tells you how hostile the medical profession has become

that we seek refuge in congress. [laughter] >> we are glad to see you there. >> there no requirements for reserves, class is that only have to pay $5 increments while others have to pay to under $40. can you talk of the sustainability of a program like that chris mark >> the class act is a new long-term care insurance program whose basic structure on paper is, pay premiums in what you were, it looks like a payroll tax, and once you're in for five years, you're eligible for benefits. we've seen the structure before for social security, medicare, and they are in deep trouble, given the way that they are structured. just to quote someone who would know a lot about this, kent conrad called upon the scheme.

i think that as an optimistic. because the way the program is set up, it looks like an enormous amount of adverse selection so that the people who want to claim benefits will have well above average costs. the premiums will become the were close to paying -- no where close to paying the full cost. they could get into a death spiral, but it would just be shoveling much more general revenue into it. on the quality of the policy, one the worst parts of the bill, and not any way i see to redeem. the fix this or repealed? you that just got to repeal the class act. it is underlay unworkable and dangerous. >> and we have this commission set up telling us what to do about on funded entitlement programs, and then we pass a bill that creates another one.

>> the president's on commission and its final report recommended repealing the class act. that is a very telling recommendation coming quickly after the bill became law. >> one of the debates that congress has had is about earmarked for it lobbyists come up and get special treatment and now we have hundreds of waivers being sought for the department of health and human services. is this another prescription for political favoritism in the granting of waivers, much like we've seen in the corrupt practices of earmarked. >> it is incredibly troubling. the waivers we have seen already up and that they see evidence of the and workability of the law. -- are prima facie prima evidence of the un workability

of the law. there appears to be no particular transparent process by large kurds -- by which large groups could get a waiver to keep the competition fair. it is a really troubling aspect of the implementation of blog. >> i would like to so that. if we have time for one last question. anyone want to ask it? >> the delivery reform aspects of the bill. they're a been a lot of fun coordinated care and i was curious what you think that focuses good, and if so, that consumer-directed approach, can deal with these issues? >> coordinated care, managed care, evidence-based medicine, pilot programs, do you think that the workers are more >> randomly, yes. in an organized, political fashion, and a. if you throw enough money at something, a few thing