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EXAMINING THE IMPACT OF OBAMACARE ON 

DOCTORS AND PATIENTS 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH CARE, DISTRICT OF 

COLUMBIA, CENSUS AND THE NATIONAL ARCHIVES 

OF THE

COMMITTEE ON OVERSIGHT 

AND GOVERNMENT REFORM 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED TWELFTH CONGRESS 

SECOND SESSION 

JULY 10, 2012 

Serial No. 112–183 

Printed for the use of the Committee on Oversight and Government Reform 

( 

Available via the World Wide Web: http://www.fdsys.gov 

http://www.house.gov/reform 

(II) 

COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM 

DARRELL E. ISSA, California, Chairman 

DAN BURTON, Indiana 

JOHN L. MICA, Florida 

TODD RUSSELL PLATTS, Pennsylvania 

MICHAEL R. TURNER, Ohio 

PATRICK T. MCHENRY, North Carolina 

JIM JORDAN, Ohio 

JASON CHAFFETZ, Utah 

CONNIE MACK, Florida 

TIM WALBERG, Michigan 

JAMES LANKFORD, Oklahoma 

JUSTIN AMASH, Michigan 

ANN MARIE BUERKLE, New York 

PAUL A. GOSAR, Arizona 

RAU ́ L R. LABRADOR, Idaho 

PATRICK MEEHAN, Pennsylvania 

SCOTT DESJARLAIS, Tennessee 

JOE WALSH, Illinois 

TREY GOWDY, South Carolina 

DENNIS A. ROSS, Florida 

FRANK C. GUINTA, New Hampshire 

BLAKE FARENTHOLD, Texas 

MIKE KELLY, Pennsylvania 

ELIJAH E. CUMMINGS, Maryland, Ranking 

Minority Member 

EDOLPHUS TOWNS, New York 

CAROLYN B. MALONEY, New York 

ELEANOR HOLMES NORTON, District of 

Columbia 

DENNIS J. KUCINICH, Ohio 

JOHN F. TIERNEY, Massachusetts 

WM. LACY CLAY, Missouri 

STEPHEN F. LYNCH, Massachusetts 

JIM COOPER, Tennessee 

GERALD E. CONNOLLY, Virginia 

MIKE QUIGLEY, Illinois 

DANNY K. DAVIS, Illinois 

BRUCE L. BRALEY, Iowa 

PETER WELCH, Vermont 

JOHN A. YARMUTH, Kentucky 

CHRISTOPHER S. MURPHY, Connecticut 

JACKIE SPEIER, California 

LAWRENCE J. BRADY, Staff Director 

JOHN D. CUADERES, Deputy Staff Director 

ROBERT BORDEN, General Counsel 

LINDA A. GOOD, Chief Clerk 

DAVID RAPALLO, Minority Staff Director 

SUBCOMMITTEE ON HEALTH CARE, DISTRICT OF COLUMBIA, CENSUS AND THE

NATIONAL ARCHIVES

TREY GOWDY, South Carolina, Chairman 

PAUL A. GOSAR, Arizona, Vice Chairman 

DAN BURTON, Indiana 

JOHN L. MICA, Florida 

PATRICK T. MCHENRY, North Carolina 

SCOTT DESJARLAIS, Tennessee 

JOE WALSH, Illinois 

DANNY K. DAVIS, Illinois, Ranking Minority 

Member 

ELEANOR HOLMES NORTON, District of 

Columbia 

WM. LACY CLAY, Missouri 

CHRISTOPHER S. MURPHY, Connecticut 

(III) 

C O N T E N T S 

Page 

Hearing held on July 10, 2012 ............................................................................... 1 

WITNESSES 

The Honorable Jeff Colyer, M.D., Lt. Governor of Kansas 

Oral Statement ................................................................................................. 7 

Written Statement ............................................................................................ 9 

Mr. Richard A. Armstrong, M.D., Chief Operating Officer, Helen Newberry 

Joy Hospital 

Oral Statement ................................................................................................. 16 

Written Statement ............................................................................................ 18 

Mr. Ron Pollack, Founding Executive Director, Families USA 

Written Statement ............................................................................................ 23 

Oral Statement ................................................................................................. 25 

Ms. Sally Pipes, President and CEO, Pacific Research Institute 

Oral Statement ................................................................................................. 29 

Written Statement ............................................................................................ 31 

Mr. Eric Novack, Phoenix Orthopaedic Consultants 

Oral Statement ................................................................................................. 36 

Written Statement ............................................................................................ 38 

Mr. Kelvyn Cullimore, Jr., Chairman, President and CEO, Dynatronics 

Oral Statement ................................................................................................. 47 

Written Statement ............................................................................................ 49 

APPENDIX 

Testimonials from Physicians ................................................................................. 78 

Graph on the Average annual cost of family health insurance premium in 

the U.S., Rhetoric vs. Reality on Premium cost ................................................ 82 

Letter sent to The Honorable Trey Gowdy and The Honorable Danny Davis 

from the Doctors For America ............................................................................. 83 

(1) 

EXAMINING THE IMPACT OF OBAMACARE ON 

DOCTORS AND PATIENTS 

Tuesday, July 10, 2012 

HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON HEALTH CARE, DISTRICT OF

COLUMBIA, CENSUS, AND THE NATIONAL ARCHIVES, COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM, Washington, D.C. 

The subcommittee met, pursuant to call, at 10:00 a.m., in Room 

2154, Rayburn House Office Building, Hon. Trey Gowdy [chairman 

of the subcommittee] presiding. 

Present: Representatives Gowdy, Gosar, DesJarlais, Walsh, Issa 

(ex officio), Davis, Norton, Clay, and Murphy. 

Also Present: Representatives Chaffetz, Gingrey, Benishek, Fleming, Harris, Speier, and Maloney. 

Staff Present: Ali Ahmad, Communications Advisor; Brian Blase, 

Professional Staff Member; Molly Boyl, Parliamentarian; John 

Cuaderes, Deputy Staff Director; Adam P. Fromm, Director of 

Member Services and Committee Operations; Mark D. Marin, Director of Oversight; Laura L. Rush, Deputy Chief Clerk; Noelle 

Turbitt, Assistant Clerk; Jason Bourke, Minority Director of Administration; Yvette Cravins, Minority Counsel; Adam Koshkin, 

Minority Staff Assistant; Suzanne Owen, Minority Health Policy 

Advisor; and Safiya Simmons, Minority Press Secretary. 

Mr. GOWDY. Good morning. This is a hearing entitled ‘‘Examining the Impact of ObamaCare on Doctors and Patients.’’ The committee will come to order. I will recognize myself for the purpose 

of making an opening statement, and then the ranking member, 

the gentleman from Illinois. Good morning, again, and thank you 

for being here. 

The recent Supreme Court decision focuses anew our attention 

on health care and the role of government therein. People are 

rightfully concerned about how the rising cost of health care is 

crowding out other financial priorities for their families; however, 

in the ongoing debate over increasing health costs and taxes, we 

will do well to study the impact on doctors and patients. 

Today we will examine an often neglected, but very relevant aspect of the Affordable Care Act. We will hear from doctors whose 

primary concern is that the Affordable Care Act significantly increases government’s role in healthcare. For example, the law creates 159 new agencies, boards, and committees to control how physicians do their jobs. Additionally, the Affordable Care Act has already generated over 12,000 pages in regulations and administrative requirements that only serve to distract and delay a doctor’s 

2 

primary objective, which is to provide care to patients. These requirements disproportionately hurt small practice doctors the most, 

since larger practices have more leverage with insurance companies and larger staff to handle the burden of an ever-increasing paperwork. 

According to the American Association of Medical Colleges, 

America will experience a doctor shortage of 124,000 to 159,000 

physicians by 2025. Compounding this problem will be a surge in 

demand. The Affordable Care Act spends nearly $2 trillion subsidizing health insurance over the next decade. The result of this 

new spending will be a massive increase in the demand for 

healthcare services, which will inevitably mean longer wait times 

for appointments and less time doctors are able to spend with each 

patient. 

Without fundamental reform our Nation’s healthcare infrastructure will not be able to handle this surge in demand. The problem 

of access to care is especially troubling for participants in government programs; namely, for those on Medicaid and Medicare. The 

Affordable Care Act increases Medicaid enrollment by nearly 20 

million Americans. Medicaid is already in dire need of reform. It 

is too large and complicated to effectively serve its patients. In fact, 

it is so overburdened right now less than half of all physicians accept new Medicaid patients because of the low payment rates and 

high administrative cost. Under the new healthcare law, enrollees 

will continue to overwhelm emergency rooms because of a lack of 

access to primary care physicians. 

The Affordable Care Act is also bad for seniors on Medicare. 

First, the law cuts Medicare Advantage, reducing choices for seniors; secondly, the law cuts overall Medicare spending by $500 billion over the next decade and uses these savings for new government spending. 

In fact, these effects are so disparaging that the chief actuary at 

the Center for Medicare and Medicaid Services believes the cuts to 

Medicare will lead to 15 percent of providers closing their doors by 

the end of the decade. 

At point, a personal digression, and in the interest of full disclosure, my father was a physician. I suspect it is best to characterize 

him as still being a physician. He just doesn’t practice medicine 

anymore. 

I remember when I was a kid he was paid in vegetables. He was 

paid by people who would cut the grass at our home in exchange 

for him taking care of their children because they couldn’t pay in 

cash, some of which is now illegal. He never refused to see anyone 

regardless of their ability to pay, and he didn’t need the government telling him that it was the right thing to do. He did it because medicine was, and is, a noble profession. It is a helping profession. Regrettably, it now looks more like a business. 

I have scores of friends back home who are doctors, which is unusual for a lawyer, but nonetheless I do, and I don’t know a single 

one who would recommend to his or her kids that they pursue a 

career in medicine. 

So I will look forward to hearing from our witnesses about the 

Affordable Care Act’s impact on doctors’ ability to effectively practice medicine and the key challenges they face from the law. InVerDate Aug 31 2005 08:53 Nov 06, 2012 Jkt 000000 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 C:\DOCS\76366.TXT APRIL
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stead of retroactively addressing the impediments of the Affordable 

Care Act, it is my hope that this hearing will aid the committee 

in its efforts to move forward in implementing genuine healthcare 

reform, reform that is backed by doctors that empowers patients 

and that lowers healthcare cost for everyone. 

With that, I would recognize the ranking member, the gentleman 

from Illinois, Mr. Davis. 

Mr. DAVIS. Thank you very much, Mr. Chairman, and let me just 

say that, you know, I think that people like your father were absolute jewels. They were the salt of the earth, pillars of the universe. 

As a matter of fact, I encountered a few of them where I grew up. 

There was one doctor in our county, named Dr. Crandall, and you 

couldn’t get a better physician than he was. 

Mr. Chairman, let me thank you for calling this hearing, and let 

me state up front that I believe that healthcare should be a right 

and not a privilege afforded to just a few. And I am absolutely and 

firmly convinced that because of the Affordable Health Care Act 

millions of Americans will live better, longer, healthier, and higher 

quality lives. 

Now that the United States Supreme Court has held the law to 

be constitutional, millions of Americans can know that their health 

coverage is on the way and that it is here to stay. 

I must confess that I am somewhat mystified by what the majority thinks it’s doing. Today the Republican leadership scheduled 

the House to begin debate on a bill to repeal the Affordable Care 

Act. This will be the 31st time that House Republicans voted to repeal the Affordable Care Act, and it will be the 31st time it will 

not be repealed. 

Today’s subcommittee hearing purports to examine the efforts of 

doctors and patients. But for a serious discussion of the impact of 

mandated care on doctors and patients we need to look no further 

than Massachusetts. Since 2006, Massachusetts under Governor 

Romney mandated near universal coverage for its population. Curiously, the majority did not invite a single doctor or patient from 

Massachusetts to share their experiences. 

In fact, the majority invited no patients at all. The lone patient 

representative invited today was chosen by the Democrats of the 

committee. The majority has granted us only one witness. Why are 

there no physicians on the panel from the only State in the union 

with mandated care? Perhaps it is because the majority know that 

you do not hear complaints from physicians there. In fact, polls 

show that Massachusetts’ doctors in large numbers support the 

healthcare law. The New England Journal of Medicine published a 

poll recently, conducted by the Blue Cross/Blue Shield Foundation, 

of over 2,000 doctors, and 88 percent believe the reforms improved 

or did not affect negatively the quality of patient care in Massachusetts. 

So in order to complete the record to date, I am supplementing 

the hearing record with actual testimony from Massachusetts doctors. Many Americans are already benefiting from the protections 

provided to patients in the ACA. Eighty-six million Americans have 

free preventive care; 6.6 million college students remain on their 

parents’ insurance policy; 105 million Americans have no lifetime 

coverage limits; and 16 million are no longer vulnerable to rescisVerDate Aug 31 2005 08:53 Nov 06, 2012 Jkt 000000 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 C:\DOCS\76366.TXT APRIL
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sion of insurance coverage after precipitated health events. For doctors the ACA provides grants to States to increase the healthcare 

workforce. There are incentives for primary care physicians, nurses 

and healthcare practitioners, and doctors are no longer saddled 

with debts from uninsured patients. 

I want the American public to know that Massachusetts doctors 

firmly believe the bill has gone through thousands of hours and 

they believe that the doctors there think it’s necessary, that it’s 

beneficial, and that it is helpful. 

So today, we will hear from physicians who have not had the 

same experiences as the doctors in Massachusetts. But I certainly 

thank you for the hearing, and thank the witnesses for their participation. 

Mr. GOWDY. I thank the gentleman from Illinois. Members may 

have 7 days to submit opening statements and extraneous material 

for the record. It is now our pleasure to—— 

Mr. ISSA. Mr. Chairman. 

Mr. GOWDY. Yes, sir, Mr. Chairman. 

Mr. ISSA. If I could seek recognition for one minute. 

Mr. GOWDY. Without objection. 

Mr. ISSA. I appreciate that. Listening to the ranking member, I 

do have to comment that when ObamaCare was being rammed 

down the throat of the minority we were denied any witnesses. 

When ObamaCare was being put together in the dark of night 

without Republicans in the room, or even the public in the room, 

we were denied all activity. 

In fact, when the Speaker said, we have to pass it to find out 

what is in it, we knew exactly what we were in for. Something that 

purported not to be a tax, and then had to be distorted into being 

a tax in order to pass constitutional muster. 

So as the ranking member said, yes, the Supreme Court has spoken, and yes, with 12,000 new pages, and growing, of additional 

bureaucracy and requirements, and costs going up logarithmically, 

the gentleman in fact is correct that maybe no one is complaining 

in Massachusetts, a State with only 4 percent at the time of the 

enactment uninsured, but the Nation and my State, with over 16 

percent uninsured, finds itself with no cost controls, Medicaid, a 

very ineffective program from a cost-containment standpoint, and 

other programs driving up the cost while in fact driving out doctors 

from practicing. And people like the chairman’s father are choosing 

to retire rather than live under ObamaCare. 

So I certainly hope that the ranking member when he complains 

about the one witness, which is the custom, would try to remember 

that under Chairman Towns, the minority was given no witnesses 

repeatedly, and ObamaCare was not even offered for this committee to have an opportunity under the previous chairman. 

And I thank the gentleman and yield back. 

Mr. DAVIS. Will the chairman yield? 

Mr. ISSA. Of course I yield. 

Mr. DAVIS. Thank you, Mr. Chairman, and let me just say that 

I certainly appreciate your comments, and you know, I remember 

my mother telling us when I was growing up that right is right, 

if nobody is right and wrong is wrong if everybody is wrong. 

Thank you. 

5 

Mr. ISSA. Well, I’m glad to hear that you realize that you were 

all wrong. I yield back. 

Mr. GOWDY. I was a little premature in beginning to introduce 

our panel of witnesses. We will recognize the vice chairman, the 

gentleman, the doctor, from Arizona, and then the gentleman from 

Missouri for opening statements as well. Dr. Gosar. 

Mr. GOSAR. Thank you, Mr. Chairman, and thank you for calling 

this hearing today. We certainly appreciate it. And thanks for all 

of the distinguished witnesses. I want to offer a special welcome to 

Dr. Eric Novack from the State of Arizona. It is an absolute privilege, Eric, for all you have done for Arizona, the patient/doctor relationship and across the country. So thank you so very, very much. 

It was great seeing you traverse Arizona all those times. 

You know, we need a patient-centered reform, not reform dictated to every doctor’s office in the country from bureaucrats. In 

fact, as a dentist for over 25 years of private practice before coming 

here to Congress, most of the symptoms of our ailing healthcare 

system come down to one root cause; the fracturing of the doctor/ 

patient relationship. When President Obama set out to pass a 

healthcare reform package he promised doctors that little would 

change for them in their practices and that the folks who didn’t 

have insurance would now have it. Today’s hearing will examine 

the ways in which this promise has rung false. 

The President’s healthcare law is full of reporting requirements 

and regulations for practicing physicians. It stands to reason that 

the larger practices or hospitals will have greater leverage to handle these requirements than a sole practitioner. Physicians in my 

district are worried that the private practice model will erode and 

eventually be unsustainable. Such a development would be devastating to the practice of medicine. 

The law also contains over 100 new boards, panels, and groups 

of bureaucrats to manage and dictate healthcare decisions, and 

gives the Secretary of Health and Human Services unprecedented 

authority to dictate standards of care across the country. Imagine 

a Washington bureaucrat sitting with you in the doctor’s office as 

you are examined, as you discuss delicate issues concerning your 

health. That is the effect that this law will have on the doctor/patient relationship. 

Furthermore, the proposed expansion of an unreformed broken 

Medicaid system will be unmitigated disaster. What good is expanding Medicaid if the program is such a bad deal for providers 

that a Medicaid card isn’t worth the paper it is printed on. When 

I was a dentist practicing in a low income area of a rural community, I found that I was better able to deliver care to people of all 

incomes and ages when I took the Medicaid system out of the equation entirely. 

We need to come together as a nation, and find ways to lower 

the cost of health care for the young, the old, the healthy, and the 

sick, not pursue party-line legislation, that enriches bureaucrats 

and special interests at the expense of our healthcare system. Let’s 

reenervate the doctor/patient relationship with a patient-centered 

patient-friendly healthcare system, and I yield back the balance of 

my time. 

6 

Mr. GOWDY. Thank the gentleman from Arizona. The chair would 

now recognize the gentleman from Missouri, Mr. Clay. 

Mr. CLAY. Thank you, Mr. Chairman, and thank you for conducting this hearing. And in response to the last two speakers on 

your side, Chairman Issa as well as Dr. Gosar, I think it would 

have been relevant if we could have had a doctor from Massachusetts to be a part of this hearing. You know, their views would 

have been relevant since for the past 5 years they have been living 

with comprehensive healthcare reform, signed into law by Governor Mitt Romney, that is substantially similar to the Affordable 

Care Act. 

But the Democratic staff gathered testimonials of numerous Massachusetts physicians relating to their experience and the impact 

upon their patients and let me share just a few of them. 

From a Boston cardiologist, I quote him, ‘‘I have never felt more 

confident when my patients and I together are making the best decision for them without influence of outside agents.’’ 

Another Boston primary care physician, quote, ‘‘Before health reform my patient was not able to see a physician and tried to avoid 

care except in the case of emergency. Now, I or a colleague can see 

her for both preventive and urgent care since insurance is within 

her reach.’’ 

A physician from Brookline, Massachusetts states, ‘‘Instead of 

worrying about getting paid for each individual visit, we reach out 

to patients to prevent repeat office visits, hospitalizations, and deteriorations. My patients feel cared for and I know they are receiving better evidence-based care.’’ 

So there are benefits to a law like the Affordable Care Act when 

you look at how the insurance industry has come on board, and voluntarily, seeing some of the benefits in this. It speaks volumes 

about how this law will help hundreds of millions of Americans, 

and it also speaks volumes about the majority in this House who 

has decided that they want to repeal this law. And it kind of defines where we are going with this debate; that we are going to divide this country between the haves and the have-nots, and that 

this is a class struggle. 

If you are fortunate enough to be able to afford health insurance, 

then it is okay. You can take care of yourself. But if you are not, 

you are on your own, or if you have a job that doesn’t provide you 

with healthcare coverage, then too bad. And I think we are a better 

nation than that, Mr. Chairman, and we should try to follow that 

example in this institution. 

With that, I yield back, and look forward to the witnesses’ testimony. 

Mr. GOWDY. I thank the gentleman from Missouri. It is now our 

pleasure to welcome our distinguished panel of witnesses. I will introduce from your right to left, my left to right, and then we will 

recognize you for your opening statement in the same manner. Dr. 

Jeff Colyer is a physician and the Lieutenant Governor for the 

great State of Kansas. Dr. Richard Armstrong is a physician in 

Michigan and Chief Operating Officer of Docs4PatientCare. Mr. 

Ron Pollack is Founding Executive Director of Families USA. Miss 

Sally Pipes is President and CEO of the Pacific Research Institute. 

Mr. Kelvyn Cullimore, Jr., is Chairman, President, and CEO of 

7 

Dynatronics, a medical device manufacturer. Dr. Eric Novack, is an 

orthopaedic surgeon at Phoenix Orthopaedic Consultants. 

My apologies if I mispronounced anyone’s name. The lights that 

you will see mean what they traditionally mean in life. Green 

means go, yellow means go as fast as you can and try to get under 

the red light, and red means stop. So with that, we will recognize 

the distinguished Lieutenant Governor, Dr. Colyer. 

Chairman ISSA. Point of order, Mr. Chairman. Are the witnesses 

being sworn? 

Mr. GOWDY. You are correct, per usual. It is the policy of our 

committee to swear all witnesses. I would ask that you please rise 

and lift your right hands and repeat after me. Don’t repeat after 

me, just affirm or not affirm. 

Do you solemnly swear or affirm the testimony you are about to 

give will be the truth, the whole truth, and nothing but the truth? 

WITNESSES. Yes. 

Mr. GOWDY. May the record reflect all witnesses answered in the 

affirmative. Thank you. You may be seated. 

Again, please limit your testimony to the extent that you are able 

to do so to 5 minutes, keeping in mind your entire statement will 

be made part of the record. And with that, thank you, Mr. Chairman, and I would recognize the Lieutenant Governor from Kansas. 

WITNESS STATEMENTS 

STATEMENT OF THE HON. JEFF COLYER, M.D. 

Dr. COLYER. Thank you, Mr. Chairman. Thank you, Ranking 

Member Davis, and Chairman Issa, and members of the subcommittee. 

My name is Dr. Jeff Colyer. As a practicing surgeon, as Lieutenant Governor of Kansas, I care fiercely about my patients. They 

need real results. 

I had an interesting experience. Twenty-five years ago I was part 

of a team writing on Soviet military spending. The Soviets claim 

that they spent about one-fifth what the United States did to 

produce a fantastic array of tanks, planes, and millions of men 

under arms, many times more than the United States. But under 

the Soviet-style central planning, prices and costs had no relationship to production and real expenses. And to get around that economic reality they created a massive bureaucracy to ensure results, 

and it failed. 

I have learned that my patients, whether they have insurance or 

not, are economically rational. We have bureaucratized health care 

so much that it distorts health outcomes and pricing and, as I described in my written testimony, health bureaucracy misaligns our 

basic price signals and economic forces that would actually help my 

patients and consumers. For example, in my own practice, twothirds of my employees are dealing with the bureaucracy while 

only one-third of them are dealing with direct patient care. And so 

we can do a better job and we have some lessons to learn if we use 

real economic principles. 

One example is Kansas Medicaid. About a decade ago, previous 

administrations in Kansas tried a Massachusetts-style reform. 

They decided to cut our relatively low uninsured rate by dramatiVerDate Aug 31 2005 08:53 Nov 06, 2012 Jkt 000000 PO 00000 Frm 00011 Fmt 6633 Sfmt 6633 C:\DOCS\76366.TXT APRIL
8 

cally expanding the Medicaid program. In those days our uninsured 

rate was about 10 percent. Commercial insurance covered 70 percent, and government programs were about 20 percent. Ten years 

later, commercial insurance has collapsed; 59 percent of people are 

in commercial insurance, government programs have expanded 

dramatically, and guess what? The number of uninsured has actually ticked up. Those are exactly the wrong trend lines. 

So without flexibility, and with these mandated maintenance of 

effort requirements Kansas Medicaid’s budget has now ballooned 

from $2.4 billion to $3 billion. To deal with these cost increases 

previous administrations decided to increase taxes. They cut provider rates. They refused dental benefits. They created long waiting 

lists and even told Kansans if they are over the age of 18, they are 

not eligible for a heart transplant. Those bureaucratic savings certainly did nothing to improve patient outcomes. 

States have a better way. 

When Governor Brownback and I took office in January of 2011, Kansas faced a $500 million deficit, largely due to Medicaid. Furthermore, the Medicaid program was in disarray. It was scattered 

across four cabinet agencies without a common budget, without 

common health goals. Governor Brownback and I made an important decision. Rather than cut people off or make massive acrossthe-board cuts, we would try to remake Medicaid to be more consumer-oriented and provide integrated care. 

Two weeks ago, Kansas signed three contracts to provide integrated care for needy Kansans. And in those contracts, we specifically insisted on no rate cuts for providers, and that no one who 

is eligible for Medicaid would be thrown off. We estimated that we 

might save about $800 million. But the signed contracts actually 

turned out better than our original estimates. Every Kansan on 

Medicaid can keep their participating doctor. They will have at 

least three choices of different health plans and offered benefits 

like opportunity accounts and personalized health programs. Our 

projected savings are now $1 billion, and we added additional services, like preventive dental coverage, coverage for heart transplants, bariatric services for obesity, and we created an off ramp 

from Medicaid to get people back into the stable commercial insurance market. And to make sure that we achieve these health outcomes that we are after, we are actually going to hold back $.5 billion from Medicaid providers to get real results for real Kansans. 

In other words, if you let the States make those decisions on a 

local level, we can actually set and achieve real health outcomes 

and not cut providers and not throw people off of programs, and 

we can actually increase benefits. 

Of course, all of this depends on CMS approval, which we are 

still waiting for. It is clear that a global waiver tied to health outcomes would more effectively allow States to deal with these issues. 

Private insurance has decreased dramatically in the State of Kansas. Our child-only plans were cut from four plans to just two counties with one single plan. We have seen premiums increase dramatically. There is a better way, and that is to let the States do 

this. We are working on Kansas solutions and we appreciate the 

opportunity to share those with you and to work with other States. 

[Prepared statement of Dr. Colyer follows:] 

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Mr. GOWDY. Thank you, Mr. Lieutenant Governor. 

Dr. Armstrong. 

STATEMENT OF RICHARD A. ARMSTRONG, M.D. 

Dr. ARMSTRONG. Mr. Chairman, members of the committee, ladies and gentlemen, it is an honor to speak with you today on behalf of doctor/patient care and thousands of practicing physicians 

nationwide who share our deep concern about the effects of the Affordable Care Act upon the practice of medicine and specifically 

upon our relationship with patients. 

You have my written testimony and the attached information. In 

the interest of time, I will depart from the written documents. In 

response to the question, how does this law affect the physician/patient relationship, the answer is, it destroys it. 

This has been developing for many years, but this law truly 

makes it crystal clear. In fact, Dr. Donald Berwick, the former head 

of CMS, has written that for this law to work the traditional physician/patient dyad must end. 

All of you on this committee see your doctor from time to time. 

What do you expect from the visit? You would like a friendly, compassionate doctor, who will listen to you, examine you, and talk to 

you. The doctor will call on extensive training and experience to devise a plan that you both agree upon and understand. Your doctor 

simply wants to do what their training and experience has prepared them to do: Listen to your history, do a physical exam, discuss the findings and recommend a plan. 

Unfortunately, that is not how things are going in medicine. To 

illustrate how these things are changing, I would like to share 

some stories. 

The electronic medical record systems have been touted as a cure 

for many of the problems in our healthcare system today. 

Unproven and untested, these claims are simply not true. During 

a recent sales demonstration at my hospital, the presenter, a physician’s assistant, took 30 minutes to demonstrate how to document 

the patient encounter in their system. The process was unfriendly 

to both patient and doctor. One of our primary care physicians 

asked, how do you propose that I do this in the 15 minutes that 

I have with patients? He answered, the goal is to reach at least a 

level 3 visit. I will say that again. The goal is to reach at least a 

level 3 visit. 

In other words, billing trumps medical care. He added, so you 

have your nurse enter the history data. You fill in the physical 

exam, make the plan and move on to the next patient. 

Really? Where in these 15 minutes do you talk to the patient or 

listen to the patient, you, the doctor? 

As a patient, how do you feel? Did you develop a relationship, or 

are you part of an assembly line? I think that most of us know the 

answer and it should make us both sad and angry. 

And then there is this account of a fellow physician’s recent experience taking her father to visit his new primary care doctor. This 

is her story. 

I took my father, 80 years old and living independently, to meet 

his new internal medicine physician yesterday. I sent ahead a brief 

summary of the history, list of medications and request that he do 

17 

a physical exam since it had been well over 3 years since it was 

done. After introducing himself he immediately announced that 

Federal guidelines no longer allow regular exams. An exam allows 

only listening to heart, lungs, and bowel sounds with the patient 

sitting. It does nothing else unless there is a specific complaint to 

justify it. I ask if anemia, which my father has, justified a rectal 

exam. He said no. He, of course, quoted repeatedly the U.S. preventive task force recommendations as one of the standards. He recited the statistics and the societal cost arguments. He had it all 

down. A perfectly useful idiot. 

He said he only does evidence-based medicine. In fact, he had 

just had been to a conference to confirm the validity of his position. 

I did not engage him. It was not appropriate with my poor father 

sitting there listening to how he is too old for, well, anything. 

Eventually, to pacify me the doctor went through the motions of 

the rectal exam after having to leave the exam room to get gloves 

and lubricant, which are, of course, of no use to him. I doubt he 

even knows how to do a rectal exam since my dad who has had 

many of them hardly felt it. 

Again, guidelines trump medical care. This is the reality of 

ObamaCare. There is no care. This law supported by organized 

medicine, has been consistently opposed by Docs4PatientCare and 

AAPS. 

Things don’t need to be this way, ladies and gentlemen. This 

doesn’t have to occur. American physicians need to be free to do 

what they have been trained to do, excel at practicing medicine. 

American patients need to be free to choose the health insurance 

plans and medical treatments that suit their needs, not something 

coerced by a central authority. This is simply impossible under the 

suffocating burden of the Affordable Care Act. 

Thank you very much for your invitation to speak today, and I 

will be happy to entertain questions. 

[Prepared statement of Dr. Armstrong follows:] 

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Mr. GOWDY. Thank you, Dr. Armstrong. 

Mr. Pollack. 

STATEMENT OF RON POLLACK 

Mr. POLLACK. Thank you, Mr. Chairman, and thank you Ranking 

Member Davis, and members of the panel. 

I am delighted to join and serve as ballast for the five other 

members of this panel. You know, one of the questions obviously 

being asked here at this hearing is what does the medical profession think about the Affordable Care Act? I think we have a pretty 

clear answer from the groups that have expressed their support for 

the Affordable Care Act, starting with the American Medical Association, the American Academy of Pediatrics, the American Association of Family Physicians, the American College of Physicians, 

that is the umbrella of all internal medicine groups, the Association 

of American Medical Colleges, the American Congress of Obstetricians and Gynecologists; groups like Doctors for America, National 

Physicians Alliance, and the American Nurses Association. 

But with respect to patients, we also have a pretty clear example 

of how patients feel that the Affordable Care Act will serve a positive role. Groups like AARP, the American Cancer Society, Cancer 

Action Network, the American Diabetes Association, the American 

Heart Association, Consumers Union, the National MS Society, and 

many others. And why is it? It is because the Affordable Care Act 

provides patients with peace of mind, and security; security and 

peace of mind that health care will be there for them when they 

need it. 

For example, no longer can insurance companies deny coverage 

to somebody like a child with asthma or diabetes simply because 

that child has a preexisting condition. Why would we want to repeal that protection? 

The Affordable Care Act rescinds the rules that insurers have 

followed that they terminate coverage when somebody is sick or 

has an accident. Why would we want to repeal that protection? 

The Affordable Care Act prohibits insurers from charging discriminatory premiums based on health status. Why would we want 

to repeal that protection? It prevents insurers from establishing arbitrary annual and lifetime limits in what is paid out when somebody has a major illness or an accident. Why would we want to repeal that protection? 

It stops discriminatory premiums based on gender, as women 

have to pay more in premiums than men simply because of their 

gender. Why would we want to repeal that protection? 

And at the same time, in addition to providing these protections, 

it makes health coverage more affordable. It provides tax credit 

premium subsidies for middle class and working families that will 

go to tens of millions of people so that health coverage would be 

more affordable. Why would we want to repeal that and increase 

the tax burden on middle class and working families? 

It provides tax credit subsidies for small businesses so they can 

better afford providing health coverage for their workers; currently, 

a 35 percent tax credit; in 2014 that will go up to 50 percent. Why 

would we want to hurt small businesses by repealing that? 

24 

For seniors it provides a significant benefit. It closes a big coverage gap with respect to prescription drugs, the so-called donut 

hole. Why would we want to continue that big gap in coverage and 

see it grow with each passing year? 

It provides seniors with free preventive care services so they 

don’t have to pay deductibles and copays for annual physicals, 

mammograms, and cancer screenings. Why would we want to stop 

that? 

And it provides for healthier communities because it provides 

funding to increase the number of primary care doctors, nurses, 

long-term care providers, community health centers. It establishes 

school-based health centers. So it will increase the number of primary care doctors to serve patients. 

And I should add that with respect to Massachusetts, as a couple 

of you, Mr. Davis and Mr. Clay, have indicated, experience in Massachusetts has been terrific. Uninsured rate has dropped in half, 

while the rest of the country, the uninsured rate has grown. Employer coverage is stable. People are receiving more preventive 

care. They have a usual source of care. There is less care provided 

in emergency rooms. And as I think Mr. Clay indicated, 88 percent 

of the physicians in Massachusetts say it has either improved quality or it hasn’t diminished it. 

Thank you, Mr. Chairman. 

[Prepared statement of Mr. Pollack follows:] 

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Mr. GOWDY. Thank you, Mr. Pollack. 

Ms. Pipes. 

STATEMENT OF SALLY PIPES 

Ms. PIPES. Mr. Chairman and Ranking Member, I would like to 

thank you for inviting me to testify here today. I am going to focus 

on the impact of the Affordable Care Act on patients. 

The latest Rasmussen poll, by the way, shows that 54 percent of 

Americans would still like to see this legislation repealed. Everyone 

agrees we all want affordable, accessible, quality care. The question 

is, how do we achieve that goal? 

There are two competing visions when it comes to answering that 

question. One focuses on empowering doctors and patients. The 

other focuses on expanding the role of government in our 

healthcare system. 

This latter vision is the vision of President Obama. It is my belief 

that his ultimate goal is to move us all into a single-payer Medicare for all system. 

The President’s two main goals are for universal coverage and 

bending the cost curve down. On universal coverage, it is expected 

that 34 million out of 50.2 million Americans will become insured 

beginning in 2014. Approximately 18 million will be added to Medicaid, with about another 16 million receiving subsidies from the 

government. The Congressional Budget Office has estimated, 

though, that by 2021, 23 million Americans will still be uninsured. 

This is not universal coverage. 

It is also important to note that just because a person does not 

have health insurance, they do not get health care. Under the Federal law EMTALA, anyone can turn up at an emergency room and 

receive treatment, and they can also pay out of pocket to the doctor 

or hospital. 

As to cost, the U.S. spent 17.9 percent of gross domestic product, 

one-sixth of our economy on health care. An article in Health Affairs recently said that by 2020, we will be spending 20 percent, 

one-fifth of our economy on health care. The ACA will not achieve 

the goal of lowering the cost of health care. 

Spending in the U.S. is often compared to spending in Canada, 

the country where I’m from. Canada spends 11.4 percent of gross 

domestic product on health care. The question is, how do they accomplish that? Well, the government took over the healthcare system in the ’70s. The government sets a global budget of what they 

are going to spend on health care. As a result, you have rationed 

care, long waiting lists for care, and lack of access to the latest 

treatments. 

Take the case of my own mother. In June 2005, my mother felt 

that she had colon cancer. So I suggested she make an appointment with her primary care doctor, which she did. Her doctor said 

she didn’t have colon cancer, but he did order an X-ray, which she 

got. When she called me, I said you do not detect colon cancer with 

an X-ray. You need a colonoscopy. And so she went back to her doctor and said, my daughter says I need a colonoscopy. Her doctor 

said, unfortunately, as a senior, you will not be able to get a 

colonoscopy. There are too many younger people waiting for treatment. 

30 

My mother, by November, had lost 30 pounds and she started to 

hemorrhage. My mother went to the emergency room in an ambulance. She spent 2 days there at Vancouver General Hospital. She 

spent 2 days in a transit lounge waiting for a bed in a ward. My 

mother got her colonoscopy and she passed away 2 weeks later 

from metastasized colon cancer. 

By denying or rationing care, it is possible to keep costs down, 

but it does not bode well for the patient’s future health. Under the 

Affordable Care Act, it is inevitable that in order to keep costs 

down, care will be rationed and patients will suffer. 

The President wanted a health care bill that cost $900 billion 

over 10 years. The CBO has recently said the decade 2012 to 2022, 

the cost will be $1.76 trillion. Richard Foster, Chief Actuary at 

CMS, said he did not think that the Affordable Care Act would let 

everyone keep the health insurance that they have if they like it. 

This goes against the President’s oft repeated statement, if you 

like your health insurance and you like your doctor, nothing will 

change. Kaiser Family Foundation showed that from 2011—from 

2010 to 2011, the average premium for family plans went up 9 percent up to $15,073. In the previous year, they only went up 3 percent. 

Under the employer mandate starting in 2014, any employer 

with 50 or more employees who drops coverage will have to pay a 

fine of $2,000. I believe that a number of employers, the CBO said 

up to 20 million, will lose their employer-based coverage. So much 

the President’s statement. 

America needs a healthcare system that empowers doctors and 

patients. Only then will we achieve affordable, accessible, quality 

care. The question is, who do you want to be in charge of your 

health care: An HMO bureaucrat, a government bureaucrat, or do 

you yourself want to be in charge? Universal choice is the key to 

universal coverage. 

Thank you. 

[Prepared statement of Ms. Pipes follows:] 

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Mr. GOWDY. Thank you, Ms. Pipes. 

Dr. Novack. 

STATEMENT OF ERIC NOVACK, M.D. 

Dr. NOVACK. Mr. Chairman, Ranking Member, members the 

committee, thank you very much for allowing me to participate in 

this hearing today. I would preface my comments by mentioning in 

response to Mr. Pollack that the AARP recently revealed that their 

actual membership were getting phone calls and emails 14 to 1 

against the Affordable Care Act during the process. 

And so that kind of information does bring a bit into question 

whether or not the organizations that he listed actually have members that actually were in favor of it as opposed to just the leadership. 

A system that combines the spending discipline of the Defense 

Department with all of the accountability of the public education 

system, that sadly is what the President’s healthcare law’s legacy 

is going to be for the country. Patients and families are the losers, 

and none of you or your families will be immune from the consequences either. 

I would like to spend the next few minutes highlighting some 

portions of my submitted testimony. According to the administration’s own researchers, the bottom 70 percent of the healthcare 

users in this country, accounting for over 220 million Americans, 

spent only 11 percent of all healthcare dollars, or about $290 billion. The bottom 50 percent, 150 million people, spent only 3 percent of all healthcare dollars, which is $80 billion. 

The President’s healthcare law does nothing to increase transparency, heighten competition, or make the healthcare experience 

one iota better for these people. Instead, the law imposes mandates 

of nearly every kind imaginable, and creates health insurance exchanges that are by design meant to turn patients and families 

into bankable commodities for the nearly $2 trillion in direct Washington subsidies to insurers and other corporations is at stake over 

the next 10 years alone. 

Our Arizona efforts to work on the issues of transparency and 

competition have been met with a level of opposition reminiscent 

of shock and awe. Hospital CEOs, insurance company lobbyists, 

and even physician representatives essentially stated that pricing 

in health care is too complicated and that patients are simply not 

smart enough or sophisticated enough to understand. 

In my orthopaedic surgery practice I help care for many children 

who have broken bones from a fall at the park, at school, and even 

on the trampoline in the backyard. For the parents of these children, a system where doctors are competing with one another to 

provide comprehensive care at a competitive price, a savings of $20, 

$30, and even $100 would be achievable. While members of this 

committee might not think much of that, for my patients that 

money pays for gas, food, and new school clothes. 

The President’s healthcare law either directly through government or through insurance, hospital, company surrogates is making 

it harder not easier for these children to get access to timely health 

care, and the studies support it. 

37 

The administration also shows that they are high utilizers; 1 percent of the country, which is about 3 million people, spend 20 percent of all healthcare dollars and the top 5 percent spend 50 percent of all the healthcare dollars. And while we tend to spend more 

on health care as we get older, there is little evidence that low 

healthcare users necessarily enter the top 5 percent at some time. 

Rigid coverage rules and cookbook treatment plans are bad for 

patients of all types. I had a patient I treated for shoulder problems for several years. He is also has heart issues and is on a blood 

thinner. In spite of being considered safer to have a noninvasive 

colonoscopy, Medicare refuses to pay for that. Faced with little 

other options, he came off his blood thinner, subsequently had a 

blood clot, a cardiac arrest. Miraculously, he survived and has done 

well, though at great preventable cost to his system. 

Under the President’s healthcare law as the decision-makers 

move further away from the patients and instead resides in boards 

of experts, government rulemakers, and insurance and hospital administrators, to whom will doctors be listening? American medicine 

has already begun to shift to a veterinary ethic described by my 

friend and colleague Dr. Jeffery Singer. When you bring your dog 

or cat to the vet, the doctor listens to the decision-maker, the 

owner, and not the patient, the pet. The pet, of course, cannot decide for itself which treatment course will be undertaken, whether 

it is teeth cleaning or euthanasia. And within reason, the vet will 

follow the advice of the decision-maker. 

Doctors are mortal, fallible, and respond to incentives like all 

others. If the person who pays the bills creates a framework that 

patients need to be put into category A or treatment B, for the doctor to remain compliant there is little doubt that this is ultimately 

what is going to happen. 

Mr. Chairman, members of the committee, you were generous to 

ask me to speak about the impact of the healthcare law on the doctor/patient relationship. That relationship is complex, intertwined 

with many of the finer points of policy, the economy, and patient 

autonomy. We need real healthcare reform that put patients ahead 

of the special interests who wrote the healthcare law and who 

stand to profit substantially from it, both in financial wealth and 

power. Healthcare decisions belong to patients and families, not 

politicians and their pals. That is how you protect and defend the 

doctor/patient relationship. 

Thank you. 

[Prepared statement of Dr. Novack follows:] 

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Mr. GOWDY. Thank you, Dr. Novack. 

Mr. Cullimore. 

STATEMENT OF KELVYN CULLIMORE, JR. 

Mr. CULLIMORE. Chairman Gowdy, Ranking Member Davis, 

members of the committee, thank you for the opportunity to testify 

here today. My name is Kelvyn Cullimore. I am the President and 

CAO of Dynatronics Corporation, which is headquartered in Salt 

Lake City, Utah, with manufacturing also in Chattanooga, Tennessee. We are a publicly-traded company engaged in the manufacture and distribution of medical devices and products primarily for 

physical therapy and sports medicine applications, and provide employment for about 180 people. 

Dynatronics is a relatively small company with sales about $32 

million, but that is common in this industry. A majority of medical 

device companies are small companies, approximately 80 percent 

having 50 or fewer employees. Many are in the early stages of 

product development with no sales, or with sales, but no profits. 

Like many companies, we have been required to implement several 

rounds of layoffs to cope with difficult economic circumstances of 

the last few years. If policies such as the 2.3 percent medical device 

tax included in the Affordable Care Act are implemented, I fear 

this added burden will not only harm patient care and stifle innovation but threaten the very existence of companies like 

Dynatronics. 

Despite widespread economic challenges I do consider myself extremely fortunate to be part of a generally vibrant industry that 

plays a critical role in improving health care and patient care in 

this country. There are over 2 million hard working Americans who 

help make the United States the global leader in medical device 

technology. Data from the Department of Commerce shows that the 

medical device industry exported $36 billion of products in 2010 

and had a trade surplus of approximately $3.2 billion. Not many 

segments of the U.S. economy can claim to be a net exporter. 

It is probably not the first time you have heard this but I want 

to be very clear that the United States is in very real danger of 

losing our global leadership position. If this happens, it will be virtually impossible to get this position back as capital and human resources flow to new centers of innovation outside of our country. 

The challenges of an uncertain regulatory environment, reimbursement pressures, and of course the medical device tax, among 

others, have created what many describe as a perfect storm. I believe this perfect storm could quickly lead to a Class 5 hurricane 

for patients, providers, and innovators. 

The Dynatronics story in this current environment is not really 

unique, but it is illustrative of how harmful policies such as the 

medical device tax are to our ability to improve patient care and 

drive job creation. Our fiscal year just ended on June 30th. We will 

report sales in excess of $32 million, but for only the fourth time 

in 25 years will not show a profit. After reporting a pretax profit 

of over $400,000 last year, we will report a pretax loss of just under 

$300,000 for this fiscal year. 

48 

In other words, despite not earning a penny in profits this year, 

the Affordable Care Act will require that we pay hundreds of thousands of dollars in a device tax. 

Quite simply, a company such as ours and thousands of others 

that are similarly struggling or have not yet crested the hill of profitability as a startup company will have a very difficult decision to 

make in addressing this added tax if it is not repealed. 

Where do I get the money to pay the tax? Research and development are the easier short-term cuts, but they lead to less innovation and negatively impact patient care. Do I drop product lines 

that are marginally profitable that now are no longer profitable 

due to the tax but still may have benefit to patients? Some would 

say that we make it up by raising our prices. Pass it along to the 

end user. Anyone operating in the current environment knows that 

there is no appetite on the part of hospitals or practitioners to accept price increases of any kind. To the contrary, we are under tremendous pressure to lower prices. 

Because the tax is levied on sales and not profits, it will take a 

significant bite out of resources available for innovation and growth 

regardless of the company’s size, or stage of development. This 

hurts patients and providers as the ability and pace at which innovation occurs slows dramatically, reducing improved patient care 

and quality of life. 

Many of the most innovative device companies are pre-profit, and 

struggling to achieve sufficient profitability to recover the millions 

of dollars invested into research, clinical trials and other development costs or, more importantly, attract the additional capital 

needed to complete product development. This tax is a huge disincentive to attracting investors. 

If a company such as Dynatronics decides to address the device 

tax by making severe cuts to R&D, what I have essentially done 

is limit the potential for my company to have new technologies and 

devices in 3 to 5 years down the road. I cannot emphasize enough 

just how delicate the innovation ecosystem is for medical device 

makers. Any cuts to R&D today will manifest themselves down the 

road in ways that hurt patients and providers the most. 

Medical device innovation plays a central role in patient care, 

but we face many head winds and need your help to calm those 

head winds and enable the United States to maintain our global 

leadership position. I respectfully request that you recognize the 

misguided nature of this medical device tax and the effect it will 

have not only on companies like Dynatronics, but the resulting impact on technological innovation and patient care. Help us avoid 

this impending hurricane. America’s patients, providers, and workers are counting on it. 

Thank you. 

[Prepared statement of Mr. Cullimore follows:] 

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Mr. GOWDY. Thank you, Mr. Cullimore. I would ask unanimous 

consent that our colleagues, Drs. Gingrey, Benishek and Fleming 

be allowed to participate in today’s hearing. Without objection, so 

ordered. I would now recognize the distinguished chairman of the 

full committee, the gentleman from California, for his questioning, 

Mr. Issa. 

Chairman ISSA. Thank you, Mr. Chairman. Later today we will 

have a panel of business people who will also be before this committee at the full committee level on the same subject. 

No surprise, we won’t have a doctor from Massachusetts. 

Mr. Pollack, are you a doctor from Massachusetts? 

Mr. POLLACK. No, I’m not. 

Chairman ISSA. Okay, so the Democrats didn’t pick a doctor from 

Massachusetts to bring in either, did they? 

Mr. POLLACK. I’m not a doctor from Massachusetts. 

Chairman ISSA. Okay, and when you were mentioning the various groups that supported the legislation, you didn’t seem—and all 

the things we wouldn’t want to do, you didn’t seem to mention one 

thing that I’m concerned about I want each of you to address. 

Under the ACA, or ObamaCare, if somebody has 50 employees and 

doesn’t provide care, it is going to cost $2,000. Just sort of a shake 

of heads, is that true? And if somebody doesn’t buy their own insurance, whether they are offered it at their company or not, it is 

going to cost them $2,000 on their tax return, isn’t that true? 

Mr. POLLACK. Not necessarily. It really depends on the—— 

Chairman ISSA. It is a sliding scale. But if they make $50,000 in their family, they are going to pay $2,000. 

Mr. POLLACK. It depends on what portion of one’s income actually is attributed to what one has to pay. 

Chairman ISSA. Exactly. So it is based on a rather obscure household income for the entire family, not known at the beginning, but 

in fact a family of four with $50,000 will find themselves with a 

$2,000 fine if they don’t buy it. But in fact, they won’t necessarily 

know that until the end of the year. 

So let’s go through a couple of other similar questions. 

If you are an employer and you do provide a healthcare system 

under ObamaCare, and then you find that one of your employees 

went to an exchange, which they have a right to do, and did not 

go through your healthcare system even though you have a Federally complying healthcare system, isn’t it true you can be billed 

back $1,000 from the exchange because an employee with a certain 

household income chose to do that? 

For the Lieutenant Governor, are you familiar with that provision? 

Dr. COLYER. Yes, I am. 

Chairman ISSA. So included in all of this good work is a series 

of taxes that in fact can represent as much as $4- or $5,000 between the employer and employee, none of which actually goes to 

the health care. 

Now wait a second, just, Mr. Pollack, you are going to be asked 

a lot of questions by the Democrats. That is why they brought you 

here as an apologist for ObamaCare, but Dr. Colyer, I guess my 

question is, isn’t it true, and I think you can all answer this as yes, 

even Mr. Pollack, that if an employer cannot afford to offer health 

57 

care but was willing to put $2,000 into the pocket of their employee 

for health savings, or something along that line, but a non-federally 

compliant system, and the employee has $2,000 that they could put 

into a healthcare system, together they have $4,000. But if they 

don’t buy the $12,000 system they would have to buy, the government will take $4,000 in many cases from the combination of two 

of them, providing no health care for that $4,000. 

Lieutenant Governor, isn’t that true? 

Mr. COLYER. Yeah, that’s what happens when you take away 

flexibility. 

Chairman ISSA. Okay. So one of the provisions of the ObamaCare 

is, in fact, that you can tax and of course now the chief justice has 

made it clear that I guess the Democratic majority in this House 

with no Republican support could in fact tax $2,000 by the family 

and $2,000 by the employer, and provide no real solution. Isn’t that 

true? 

Mr. COLYER. Yes. 

Mr. POLLACK. So Mr. Chairman, one of the things you are missing—— 

Chairman ISSA. No, no, no, Mr. Pollack. Mr. Pollack. Mr. Pollack. 

Mr. Pollack, you can answer a question that is asked as a yes or 

no as a yes or no. If you do anything else, what you are really 

doing is being the Democrat’s witness and being obstreperous. So 

if you will please wait until they ask you a question. In my remaining moments, for the witnesses, other than Mr. Pollack, who will 

be asked by the Democrats to apologize for ObamaCare, is there 

anything so far that has occurred as ObamaCare is implemented 

that has reduced cost and thus made healthcare more affordable 

for Americans, not more subsidized, not more taxed? Is there anything that has occurred so far that has made health care less expensive for any of our witnesses. 

Mr. COLYER. No. 

Mr. POLLACK. The answer is yes. 

Chairman ISSA. The record will indicate that our witnesses all 

found it to be a no, and you obviously can answer when called on. 

Mr. Cullimore, I just have one question for you. Can you find a 

single basis, other than scoring a cheap trick in order to say 

ObamaCare didn’t cost, is there a single basis under which you 

should tax health care, inherently—healthcare products, inherently 

making them more expensive? Other than a cheap trick from Members of Congress, was there any basis to tax your products? 

Mr. CULLIMORE. I am not aware of any. 

Mr. ISSA. And any basis under which by taxing them they don’t 

inherently become more expensive? 

Mr. CULLIMORE. That seems basic economics to me. 

Mr. ISSA. So we have taxed health care, made it more expensive, 

even in your kind of products, even if you are making no profit at 

all, and that is what you are finding undeniably under 

ObamaCare? 

Mr. CULLIMORE. That is what we are finding. And more important than just making it more expensive, is it is threatening the 

ability to do research and development and provide the kinds of 

tools that our practitioners need to improve patient care. 

Mr. ISSA. Thank you. Thank you, Mr. Chairman, I yield back. 

58 

Mr. GOWDY. I thank the gentleman from California. The chair 

will now recognized the gentleman from Illinois, Mr. Davis. 

Mr. DAVIS. Thank you, Mr. Chairman, and, Mr. Chairman, I ask 

unanimous consent to insert into the record testimony from seven 

physicians who are members of— Mr. ISSA. Reserving a point of order. 

If I may state the point of order, if the gentleman would phrase 

that as anything other than ‘‘testimony.’’ Committee rules require 

that testimony be sworn. This would be unsworn. So if you would 

call them statements for the record, I would withdraw my objection. 

Mr. DAVIS. Statements for the record. 

Mr. ISSA. I withdraw. 

Mr. GOWDY. Without objection. 

Mr. DAVIS. Mr. Chairman, let me thank you again. 

Dr. Colyer, what kind of physician are you? 

Dr. COLYER. I’m a plastic and craniofacial surgeon in Kansas 

City. 

Mr. DAVIS. So you are a plastic surgeon? 

Dr. COLYER. Yes, sir. 

Mr. DAVIS. Are the services that you provide covered by the Affordable Health Care Act? 

Dr. COLYER. Yes. I spend many days, many nights in the emergency room taking care of people who have had their hands blown 

off by fireworks injuries, women with breast cancer, and a variety 

of services. 

Mr. DAVIS. So then you actually do more than plastic surgery? 

Dr. COLYER. That is plastic surgery. 

Mr. DAVIS. Yes, that is your specialty, and all of those things associated with it you do. 

Let me also ask you, you indicate in your written testimony that 

we’ve got to do something quick before irreversible harm is done 

to our health care delivery system. Could you tell me what irreversible harm is done to the more than 30 million people who for 

the first time in their lives have access to health insurance? And 

could you tell me what irreversible harm is done to those individuals who for the first time have an opportunity for a private practicing physician who becomes their primary care as opposed to the 

emergency rooms that you just mentioned? 

Dr. COLYER. Yes, sir. For example, in the State of Kansas, we 

had four insurers that provided child only policies. And since the 

formation of the ACA, those insurers, three of them have pulled out 

completely. We have one insurer. That only covers two out of 105 

counties. I doubt that those are going to be coming back any time 

soon. 

Mr. DAVIS. Well, could you tell me how those individuals are 

going to receive care? 

Dr. COLYER. How they will receive care? 

Mr. DAVIS. Yes. 

Dr. COLYER. Yes. In Kansas, doctors do take care of patients. We 

have a wide array of opportunities through qualified health clinics, 

through a number of State programs and Federal programs, and 

also the generosity and the willingness of many physicians to work 

there. There are solutions that we can deal with these problems 

59 

and we can add additional things. We are very compassionate. We 

want to work with them. It is just one solution mandated from 

someplace else may not work in Kansas. 

Mr. DAVIS. Mr. Pollack, your organization, Families USA, estimated that across the Nation 26,100 people between the ages of 25 

and 64 died prematurely due to a lack of health coverage, and that 

was from your June 2012 report Dying For Coverage. 

Could you describe how lack of health care coverage impacts premature death. 

Mr. POLLACK. Sure. Mr. Ranking Member, first, I should say the 

methodology for this report was developed by the Institute of Medicine scientific panel in 2002. But the main way this occurs is that 

when somebody does not have health care coverage, typically they 

delay getting care. At the onset of a pain, at the onset of a health 

problem, people who are uninsured often feel they can’t pay for a 

doctor or to get an exam, and so they delay care. And when they 

delay care, sometimes the illness gets worse, sometimes it spreads. 

Unfortunately, about 26,100 people pay the ultimate price because 

they were uninsured. 

One other thing I should say, this also affects people with health 

insurance, and the reason it does that is when people who are uninsured get care in an emergency room, they usually can’t pay for 

that care or at least they can’t pay for a portion of it, and a hospital has to make up for those costs. And the way they make up 

for that cost is a hidden surcharge for all of us who have health 

insurance, and that ultimately results in premiums being raised on 

average more than $1,000 per family per year. 

Mr. DAVIS. Thank you, Mr. Chairman. I yield back. 

Mr. GOWDY. I thank the gentleman from Illinois. 

The chair will now recognize himself for 5 minutes of questions. 

Eight out of 10 physicians would reconsider their decision to 

practice medicine. A significant doctor shortage is on the horizon. 

Naively, I suppose, I want the smart kids in class to be the ones 

to operate on me. And I want the smart kids in class to be the ones 

to put me to sleep, more importantly, to wake me up. One of the 

reasons—so I guess unless this administration plans to cross train 

the 13,000 IRS agents as nephrologists and pediatricians and OB/ 

GYNs, things look pretty bleak in this country. And one of the reasons I hear that doctors are frustrated is their fear of litigation and 

their requirement to practice defensive medicine. And they are in 

something of a Hobson’s choice because when my colleagues on the 

other side of the aisle ask them whether they practice defensive 

medicine, it is really a setup to admit that you engage in Medicaid 

or Medicare fraud which is why I’m not going to ask the physicians 

on this panel whether they practice defensive medicine. We all 

know that they do it. 

I heard the President in his State of the Union devote about one1000th of 1 percent of the time he took in his State of the Union 

to mention tort reform. 

So, Mr. Pollack, you didn’t mention tort reform in your opening 

statement. Do you support caps on noneconomic damages? 

Mr. POLLACK. No, we would not support that. We would support 

some changes that deal with malpractice, but not—— 

60 

Mr. GOWDY. Mr. Pollack, let me tell you the way this works. I 

ask the questions, and then you answer them. 

Mr. POLLACK. I want to give you a full answer. 

Mr. GOWDY. Well, I’m going to ask you a series of questions. 

Mr. POLLACK. Good. 

Mr. GOWDY. And I want crisp answers. Not filibusters; crisp answers. Do you support limits on noneconomic damages? That is not 

a complicated question. That is not a multi-part question. Do you 

or do you not? 

Mr. POLLACK. Do not. 

Mr. GOWDY. Do you support limits on joint and several liability? 

Mr. POLLACK. Do not. 

Mr. GOWDY. Do you support a different standard of care for 

emergency medicine as opposed to medicine where a physician has 

a robust chart or file in front of them? 

Mr. POLLACK. I’m not sure I follow the question. 

Mr. GOWDY. Emergency medicine where a physician is called 

upon in a matter of seconds to make a decision, they don’t have the 

benefit of patient history or a lot of tests, do you support a different 

standard of care for those physicians as opposed to ones who do 

have a full history in front of them? 

Mr. POLLACK. No, not—— 

Mr. GOWDY. So you would hold physicians who have a matter of 

seconds to make a decision to exactly the same standard that you 

hold physicians who have treated patients for 20 years? 

Mr. POLLACK. Most physicians have access to clinical guidelines 

as to what works, and I would expect that any physician, emergency physician or otherwise, would look at those guidelines, not 

necessarily feel bound by those guidelines, but would use those 

guidelines in order to make a thoughtful decision for his or her patient. 

Mr. GOWDY. So the answer is no? 

Mr. POLLACK. I gave you a full answer to that question. 

Mr. GOWDY. The answer was no. Do you support loser pays? 

Mr. POLLACK. I’m not sure I follow that. 

Mr. GOWDY. Loser pays? You file a lawsuit, the jury finds it frivolous. With a special verdict form, do you support a—— 

Mr. POLLACK. I think anyone who files a frivolous claim should 

pay physician costs. 

Mr. GOWDY. So you support loser pays? 

Mr. POLLACK. Anyone who files a frivolous claim should pay physician costs. 

Mr. GOWDY. Do you know where the majority of the litigation 

comes from in this country, whether it is paying patients or nonpaying patients? 

Mr. POLLACK. It comes from paying patients. 

Mr. GOWDY. No, sir, it comes from nonpaying patients. The majority of the litigation, the lawsuits filed, come from nonpaying patients. 

Mr. POLLACK. I don’t believe that. 

Mr. GOWDY. I can’t help what you believe. I can just tell you 

what the facts are. 

Dr. Colyer, what should we be doing to incentivize the best and 

brightest to go into medicine and reverse the trend that 8 out of 

61 

10 would reconsider their decision to practice medicine, and I don’t 

know a single physician that would encourage his or her kids or 

grandkids to practice medicine? 

Dr. COLYER. Let them be a doctor. Let them make the decisions. 

Let them have a relationship with their patients and really do 

their specialty their experience. That’s what would make the difference, and it is the bureaucracy that is driving us crazy. 

Mr. GOWDY. Mr. Pollack, you twice made a reference to ‘‘free’’ 

which I found to be a fascinating word. Free preventative care. 

What is free about it? Does that mean the doctor donates his or her 

time and the pharmaceutical company donate the drugs and the 

medical device company just donates it? When you say free preventive care, free contraception, what do you mean by free? 

Mr. POLLACK. Well, with free preventive care, it means that one’s 

insurance policy will pay for that without a deductible and without 

a copay. 

Mr. GOWDY. How will the insurance company make sure that it 

doesn’t go broke? It will pass the cost on to other people, right? 

Mr. POLLACK. By providing preventive care, it avoids much more 

costly and cumbersome services later on, so that somebody—— 

Mr. GOWDY. So it is free in an economic—from the futuristic economic sense it’s free? 

Mr. POLLACK. If you’re asking ‘‘free’’ in terms of dollars—— 

Mr. GOWDY. I’m just fascinated by the word ‘‘free.’’ 

Mr. POLLACK. It will save money in the long term because it 

means a problem will be diagnosed at an earlier stage and it 

means somebody will not need complex care later on, which is far 

more expensive. 

Mr. GOWDY. I’m out of time. I will now recognize the gentleman 

from Missouri, Mr. Clay. 

Mr. CLAY. Thank you, Mr. Chairman. 

Since 2001, employer sponsored health coverage for family premiums has more than doubled, crowding out other investments in 

human capital and innovation and placing coverage out of reach for 

more families. The ACA was designed to reform our system of 

health care delivery to incentivize high quality care, appropriately 

priced services, and fight waste, fraud and abuse. In fact, the ACA 

contains almost every cost-containment provision that policy analysts have considered and touted as effective in reducing the 

growth of health care spending. 

Mr. Pollack, do you believe that the provisions contained in the 

ACA to incentivize high quality care, appropriately priced services, 

and fight waste, fraud and abuse are important to a robust, affordable health care system? 

Mr. POLLACK. I do, sir. 

Mr. CLAY. Mr. Pollack, won’t access to preventative care as designed by the ACA assist in controlling the cost of overall care as 

folks no longer have to use the emergency room for treatment of 

preventable health care problems. 

Mr. POLLACK. Mr. Clay, as you are inferring, care in an emergency room tends to be the most expensive care possible. And when 

it occurs, it normally occurs when somebody has actually had a disease spread and the illness now needs heroic treatment. So I do beVerDate Aug 31 2005 08:53 Nov 06, 2012 Jkt 000000 PO 00000 Frm 00065 Fmt 6633 Sfmt 6633 C:\DOCS\76366.TXT APRIL
62 

lieve that if we can avoid that, it is both good medicine and it is 

more cost effective medicine. 

Mr. CLAY. You know today and tomorrow the Republican majority will try for the 31st time this Congress to repeal the Affordable 

Health Care Act. But what is their alternative? They have none. 

They have no solution to continue growth in health care spending 

and have offered no comprehensive approach to deal with the systemic causes of growth in health care spending. 

You know, research has shown that the uninsured are more likely to delay or forgo needed medical care than insured individuals. 

As a result, the uninsured are more likely to be hospitalized for 

avoidable medical conditions which increases overall health care 

costs for everyone. 

The CBO believes that the Affordable Health Care Act will expand coverage to 32 million Americans with approximately 19 million Americans benefiting from premium assistance credits for the 

purchase of private health insurance. 

Mr. Pollack, as you know, this vote will not repeal the Affordable 

Care Act. But it signals what would happen if Republicans were to 

win the White House, the Senate, and hold on to the House. 

Mr. Pollack, have the Republicans offered a viable plan to insure 

the uninsured and improve health outcomes while containing the 

very problematic increase in health care costs? 

Mr. POLLACK. Well, Mr. Clay, at the outset of this debate in the 

first of 31 different efforts to repeal the statute, we heard a lot 

about repeal and replace. Since that time we have only heard repeal, repeal, repeal and precious little with respect to replace. 

Mr. CLAY. Without the protections and expanded eligibility made 

possible by the ACA, how else do we guarantee that poor and working class Americans access cost effective primary care services? 

Mr. POLLACK. We do this not just by expanding Medicaid, and I 

take issue with my fellow panelists who criticize the program, but 

one of the key ways we do it is by improving private health insurance, and we make it more affordable by providing tax credit subsidies so that people can afford it. 

The chairman of the committee talked about a family with 

$50,000 in income. That family will receive huge tax credit subsidies to make health coverage affordable. If we repeal the Affordable Care Act, not only will health coverage be unaffordable, but 

there will be a tax increase experienced by those middle-class families. 

Mr. CLAY. There we go again, beating up on the little guys. 

Thank you so much, and I yield back. 

Mr. GOWDY. I thank the gentleman from Missouri. 

The Chair will now recognize the gentleman from Tennessee, Dr. 

DesJarlais. 

Mr. DESJARLAIS. Thank you, Mr. Chairman. I do thank the panel 

for coming today and giving us their insight. I also would like to 

thank some of the non-committee members, my physician colleagues, that have joined us today. You have six members of the 

Doctors Caucus sitting before you on the panel today. We have 15 

physicians in Congress now and three in the Senate. We make up 

a combined 600 years of total experience in health care. I would 

say that—I think I can say for all of us sitting here, not a single 

63 

one of us went to medical school thinking that one day we would 

be sitting in Congress. We went into medicine because we want to 

help people, and my colleagues are joining me here today because 

they want to talk about this important issue. 

Despite what Mr. Pollack said about the numerous groups that 

are in support of the health care law, I think that there are several 

doctors here and doctors across the country that clearly oppose it, 

and I think there is patients across the country that oppose it. This 

was evident by the fact that 63 percent of the people were opposed 

to this health care law when it was passed, and that continues to 

be the case. The majority of the people don’t want it. So to sit here 

and say that we should keep it is disingenuous. And now with the 

Supreme Court ruling saying that we will all be taxed, clearly the 

President has broken his promise about not raising taxes on the 

middle class with this enormous tax, and it also cuts and hurts 

Medicare. And I’m tired of these attacks as a physician because we 

care about patients having good access to care, and I don’t think 

there is a physician on the panel that thinks that this will control 

costs or improve the quality of care, and it certainly is going to 

hinder the doctor/patient relationship. Doctors, would you agree 

with that? 

All of the doctors are nodding. 

Mr. Pollack, you said that this is going to make health care more 

affordable. How do you justify that when the cost, as Ms. Pipes has 

stated, has doubled since President Obama initially said $800 billion has gone to $1.7 trillion; how do you justify that? 

Mr. POLLACK. First of all, I want to just correct one thing. The 

Chief Justice did not say this is going to be a broad tax. In fact, 

if you read his opinion, his opinion makes clear that only about 1.3 

percent of the American public would face this tax penalty. He 

cited in his—— 

Mr. DESJARLAIS. I thought it was clearly a tax, sir. 

Mr. POLLACK. I’m not disputing the language of tax or penalties. 

That’s not the purpose of what I’m saying. 

Mr. DESJARLAIS. How is it making it more affordable? How is it 

more affordable? You say it is more affordable. Ms. Pipes, I will 

give you a chance, too, to debate this. 

Mr. POLLACK. Well, it makes it more affordable because it provides huge tax credit subsidies so that people can afford private 

health coverage. 

Mr. DESJARLAIS. Who is going to pay for the subsidies? Where 

does that come from, taxes? We don’t have free. As the chairman 

said, we don’t have free in this country. You said it reduces cost, 

that isn’t free, and it is not reducing costs. 

Mr. POLLACK. There are some savings and efficiencies created in 

the Affordable Care Act. I will give you an example. 

Mr. DESJARLAIS. Do you think Medicaid is efficient, cost efficient? 

Mr. POLLACK. Yes, it is. The Congressional Budget Office made 

clear during the debate that that would be the most efficient way 

to expand coverage to people who don’t have coverage. 

Mr. DESJARLAIS. Ms. Pipes, do you think Medicaid is affordable 

or is this law affordable? 

64 

Ms. PIPES. No. As I said, the CBO said $1.76 trillion. Many 

economists, myself included, believe that in 2014, the decade 2014 

to 2024, this law will cost about $2.6 trillion because of the cost 

drivers, the exchanges, the individual mandate, the employer mandate, the ending of price discrimination based on preexisting conditions. It is going to be very, very expensive. 

On the issue of Medicaid and Medicare, the Congressional Budget Office and the Medicare trustees have shown, the Medicare 

trustees say by 2024 Medicare will cost about $1 trillion, almost 

double what it is today, Medicaid $800 billion, and these programs 

will be bankrupt. We need to make changes so that the people who 

do need Medicare and Medicaid have access. 

But interestingly, under the Affordable Care Act, Medicare is 

being cut by $500 billion over the decade to add those 18 million 

people to Medicaid. 

Mr. DESJARLAIS. Thank you. 

Dr. Colyer, do you have anything to add to that? Actually, let me 

be specific. Let’s talk about the bureaucracy. What has happened 

with ObamaCare? How much of your time is spent on bureaucracy 

versus medicine? 

Dr. COLYER. Two-thirds of my staff are dealing with the bureaucracy aspect of it. We are even seeing this in State government. 

We’ve put together health reforms that are really going to save 

money and actually reverse a lot of problems and outcomes, and it 

is going to take us months to actually get that through the bureaucracy. 

Mr. DESJARLAIS. Is there anything affordable about that? 

Dr. COLYER. No. Our State has had tremendous financial problems. 

Mr. DESJARLAIS. All right, thank you. My time has expired, and 

I yield back. 

Mr. GOWDY. Thank you, and the chair recognizes Ms. Holmes 

Norton. 

Ms. NORTON. Thank you, Mr. Chairman. In our discussions about 

doctor-patient relationships, and so we all agree that we would 

want most patients to have a doctor. And let us stipulate for the 

record that the cost of health care will go up. The question is costs 

compared under the Affordable Health Care Act compared to no Affordable Health Care Act. So throwing out trillions of dollars will 

get you nowhere unless we have a comparison to make, and one 

that is as credible as the CBO’s comparison, I might add. 

It may be, Doctor, Lieutenant Governor Colyer, you may be the 

appropriate person for this question because you serve in both 

roles. I don’t know if the Lieutenant Governor of the State of Kansas has an operational role as well, but let me ask you this question because you may be the most familiar with it. 

Some, a few Governors have said that they will not accept the 

100 percent Medicaid funding, going down gradually to 90 percent, 

to fund working class and working poor people who are now included under Medicaid and the Affordable Health Care Act. Is Kansas, by the way, one of those States that has not yet made a decision? 

65 

Dr. COLYER. No, we are in the midst of a major Medicaid reform 

and we are trying to make it so it is much more responsive to patients. 

We have got an election coming up. The Governor has said we 

need to change the system, and we are going to make a decision 

afterwards. 

Ms. NORTON. Well, I appreciate you’re thinking it through rather 

than responding the day after the Supreme Court decision, but I 

have a question about where these people, many of them, most of 

them, indeed, working people went before and will now go? Where 

they went before, of course, was to the costliest doctors, and those 

were the doctors in the emergency room, where in fact they cost 

the State and the Federal Government five and six times what 

they would cost if they had a medical home. 

My concern is with hospitals. Hospitals in big cities like my own, 

and particularly hospitals in rural areas, can hospitals survive if 

these patients are thrown back with what looks like to be now no 

uncompensated care. You do the charity care and it falls back 

mostly on the State, it fell back mostly on the State before, but 

there was a little something that the Federal Government gave for 

uncompensated care. 

Again, what are your hospitals saying about the effect on them 

if these patients are thrown back into their emergency rooms at 

greater cost to the State, and I suppose not to the Federal Government since they won’t be on Medicaid? 

Dr. COLYER. Actually, we are creating a system that does exist, 

the majority of people without insurance don’t end up in the emergency room. They get their care through a variety of clinics, 

through their private physicians in the State of Kansas. We have 

a number of federally qualified health clinics, for example, with 

very low cost. 

Ms. NORTON. We all have those. 

Dr. COLYER. And we all have those, but they are a really important safety net. But there are some other solutions. 

Ms. NORTON. And they are also often largely federally funded as 

well. 

Dr. COLYER. And also State funded. 

We are also able to create incentives for doctors to take care of 

people in their own community. It’s giving the States, the individual States the opportunity to make these solutions. That’s 

what’s so important. 

Ms. NORTON. I can understand that, Dr. Lieutenant Colyer. I just 

hope in the process the State will consult with the hospitals because they may be one of the victims in all of the play back and 

forth. We don’t know, but I appreciate the approach you are taking 

that looks at all of the factors involved. 

May I ask a question of you, Mr. Pollack? I was astounded by 

the number, almost 60 million Americans, nonelderly now, have 

what are called preexisting conditions. This is a frightening number. One in five Americans. Prior to the Affordable Health Care 

Act, where were these people receiving treatment? Were they receiving treatment? 

Mr. POLLACK. They were uninsured by and large because people 

with preexisting conditions, a child with asthma or diabetes could 

66 

not get health insurance coverage from an insurer. Now that the 

Affordable Care Act with respect to that aspect of the law is in effect for children, those children are now getting coverage and they 

are getting care. In 2014, for adults that protection will be extended. 

Ms. NORTON. Is there a way other than the way that the Affordable Health Care Act has found, putting as many people in the pool 

as possible, is there a way to provide health insurance in an affordable fashion for people with preexisting conditions? 

Mr. POLLACK. The best answer to that question is some States 

have established high risk pools and high risk pools are a substitute. But the problem is when you have a pool composed completely of people who have illnesses and health conditions, the premium costs per person skyrocket and that’s why you want to integrate them into private insurance pools that include healthy and 

young people along with sicker and older people. 

Ms. NORTON. Thank you very much. 

Mr. GOWDY. I thank the gentlelady from the District of Columbia. 

The chair would now recognizes the gentleman from Arizona, Dr. 

Gosar. 

Mr. GOSAR. I would like to run a clip first and have you watch 

this clip and then I want to get your opinions: 

‘‘And that means no matter how we reform health care, we will 

keep this promise to the American people: If you like your doctor, 

you will be able to keep your doctor; period. If you like your health 

care plan, you will be able to keep your health care plan; period. 

No one will take it away no matter what. My view is that health 

care reform should be guided by a simple principle—fix what’s broken and build on what works, and that’s what we intend to do. If 

we do that, we can build a health care system that allows you to 

be physicians instead of administrators and accountants.’’ 

Mr. GOSAR. Dr. Colyer, let me get your opinion to that comment. 

I thought the backdrop was very interesting. It was at the AMA. 

Dr. COLYER. In Kansas, you will not be able to keep your more 

affordable plan under the ACA. We’ve developed a wide variety of 

health insurance plans and opportunities, health insurance accounts, a whole variety of things. And we can expand those and do 

that. We have now got a one size fits all that is much more expensive than what we have in the State of Kansas. It may work in 

other States, but it’s not for us. 

Mr. GOSAR. How about you, Dr. Armstrong? 

Dr. ARMSTRONG. That is obviously completely false. And for the 

President to say that we are going to allow doctors to not be bureaucrats any more, when you look at what has been done so far, 

we have 12,000 pages of regulations that we don’t even know what 

they say. How can that possibly not allow doctors to be bureaucrats? That’s just ridiculous. Those two statements that he made, 

if you like your doctor, you can keep him; if you like your plan, you 

can keep it, it is obvious now that that is just false. That is just 

completely false. That was a sales pitch to the American Medical 

Association. 

I might remind everyone that the American Medical Association receives $80 to $100 million a year from their sale of CPT coding 

67 

books and CPT licensing, so they have a small amount of financial 

incentive to go along with whatever CMS thinks is a good idea. 

Mr. GOSAR. Can I ask a quick question, interject there? What 

percentage of the physicians in the country do they represent? 

Dr. ARMSTRONG. The latest numbers are that approximately 10 

percent of actively practicing physicians belong to the American 

Medical Association. 

Mr. GOSAR. I find that interesting. I am a dentist and the American Dental Association represents over 70 percent of the dentists 

across the country. 

Dr. ARMSTRONG. In 1962 when Dr. Ed Annis gave his famous 

talk against Medicare at Madison Square Garden, the American 

Medical Association represented 70 percent of American doctors. 

Mr. GOSAR. Dr. Novack, I want to get your opinion. 

Dr. NOVACK. Well, it is certainly not the case. As was mentioned 

earlier, the protection against so-called preexisting conditions for 

children means that in at least 34 States is almost impossible to 

get a child only policy. If you are a member of at least two 

branches of the SCIU in New York State and you have a child who 

is insured, you didn’t get to keep what you have because in response to this they dropped all child policies. 

If you had certain health care policies in the Midwest with a 

company that had about 900,000 members, they just stopped offered health insurance entirely. 

So people are not keeping what they have. Their costs are going 

through the roof. Ultimately, if the goal was to provide more accessible care for the people who need it at a more affordable rate, 

what I have seen in the past 2 years is that we are going in exactly 

the opposite direction. 

Mr. GOSAR. I just had two health care forums on Friday. And we 

are from Arizona, and there are large rural parts. If we are dumping so many more patients into Medicaid, and by the way, you said 

we’re going to work on things that actually work. The last time I 

looked at Medicaid, it doesn’t really work. 

Dr. NOVACK. Arizona’s Medicaid system, as people know, Arizona 

was the last State to join Medicaid in 1982, came in under a waiver, and has always existed in a managed care system. And even 

that, the system is basically at its breaking point. There was a $1 

billion shortfall in the last year or two at the legislature to try to 

cover Medicaid. The system just isn’t working. The number of cuts 

to services, because that’s really the only option that the system 

has, so now if you’re on Medicaid in Arizona, you can’t get durable 

medical equipment. So I can’t put my patients in certain kinds of 

boots to help them get around better. They have to be in a cast or 

nothing, which is a big problem for a lot of the working folks I take 

care of. You can no longer see a podiatrist if you’re on Medicaid in 

the State of Arizona. So if you have diabetes and you need regular 

footcare and you’re on Medicaid, you’re out of luck because the system simply doesn’t cover it. 

Mr. GOSAR. There are groups that are exempt from ObamaCare; 

are there not? One that we are very familiar with, the Native 

Americans? 

Dr. NOVACK. Well, there are all sorts of different waivers. There 

were things put into the law. But the real problem, and I think, 

68 

speaking from the provider side and from the policy side and from 

the government side, is that the application of the law is turning 

out to be completely arbitrary. It would be one thing if those of us 

involved in the practice of medicine could actually count on the letter of the law and try to make adaptations. But what we’ve seen 

with the nearly 2,000 waivers affecting over 4 million Americans 

who won’t get certain benefits, if we look to the fact that actually 

snuck into the law was that if you were in a self-funded insurance 

plan, which is over 100 million Americans, 60 percent of all people 

with commercial insurance, you will never get the benefits of the 

essential health benefit package that the President and the Democrats said was urgent or imperative because they were exempted 

from that entirely. 

So we are finding complete arbitrariness in the application, and 

that is making it ultimately harder for people to get care. 

Mr. GOSAR. And I find it real interesting that the group of people 

who have had government-dictated health care the longest are rebelling enormously across the board, the self-determination type 

plans. 

So thank you. 

Mr. GOWDY. I thank the gentleman from Arizona. 

The chair will now recognize the gentleman from Georgia, a distinguished physician, Dr. Gingrey. 

Mr. GINGREY. Mr. Chairman, thank you very much, and I want 

to thank you and members on both sides of the aisle, too, for extending us this courtesy to be guests today and indeed to ask some 

questions. 

Let me real quickly turn to Dr. Novack. ObamaCare does not address the problems of most Americans who have very low expected 

health care expenditures. According to the Agency for Health Care 

Quality Research, and I think you talked about this in your testimony, the bottom 70 percent of health care users in this country, 

that’s about 224 million Americans, spend only, I think you said 11 

percent of health care dollars, or about $290 billion out of $2.7 trillion. In your testimony, you stated that ObamaCare harms these 

224 million Americans that are very low utilizers. Why? 

Dr. NOVACK. Number one, costs are going up. That is number 

one. Number two is the creation of all of these new bureaucracies 

and boards and the effort to shove these people who are just occasional users of health care into very complicated medical home 

models that make it harder to get access to specialty care when 

that may be what they need, just to get in and get out, that makes 

the system more difficult to navigate. It makes the process of going 

to the doctor a less pleasant experience. 

Mr. GINGREY. Dr. Novack, thank you. 

Turning to Dr. Colyer, Lieutenant Governor Colyer, you talk 

about what you and Governor Brownback have done in the State 

of Kansas in regard to the Medicaid program. So I want to focus 

in real quickly this question to you. You spoke about the off ramp, 

I think you used that phrase, that off ramp of getting people off 

of Medicaid into private insurance. You know, part of PPACA, the 

Affordable Care Act, has this maintenance of effort requirement 

under Medicaid for at least the next 2 or 3 years before the expansion kicks in, the additional 20 million people. As I understand 

69 

that maintenance of effort, it would prevent you and Governor 

Brownback and Governor Deale of the State of Georgia and folks 

that are working on trying to solve their Medicaid problem in a 

State based way, the crucibles of innovation, that you couldn’t even 

look at your roles and determine if many people in Kansas who 2 

years ago were eligible for Medicaid but maybe today they are not. 

Indeed, maybe they are not even legal citizens, legal residents of 

this country. But more importantly, from the economic standpoint, 

they are not eligible. 

Isn’t this a tremendous problem for you to get these folks onto 

that off ramp, as you describe? 

Dr. COLYER. We want to give people the opportunity to get back 

into stable, commercial insurance that they can control, that is 

very portable, that they can take with them. Maintenance of effort 

does decrease that. But part of the problem with the maintenance 

of effort is not just that people are in, it is being really interpreted 

in very broad ways. The previous Governor asked for just a small 

increase in the premiums that were paid by certain CHIP members, and instead of a few dollars it was just a few cents. 

Mr. GINGREY. Yes. Essentially what you’re saying is you have got 

handcuffs on you that prevent you from doing some of these things 

in an innovative way to make sure that the dollars get to the people that need them the most on the Medicaid program. 

Let me utilize, Mr. Chairman, the remaining portion of my time 

to talk to and ask questions of Dr. Armstrong. 

Dr. Armstrong, thank you for wearing that white coat. That 

means a lot, believe me, to we physician members that are sitting 

up here asking the questions. On page 78 of Public Law 111–148, 

otherwise known as PPACA, Affordable Care Act, ObamaCare, 

there is a section entitled ‘‘Enhancing Patient Safety.’’ Let me read 

you the section. 

Beginning on January 1, 2015, a qualified health plan, otherwise 

known as an insurance company, may contract with a health care 

provider only if they implement mechanisms to improve health care 

quality as defined by the Secretary, indeed by regulation. 

My concern is that nowhere in the many pages of ObamaCare is 

the word ‘‘quality’’ defined. So I’m interested in the thoughts of the 

panelists. If ObamaCare gives the Secretary of Health and Human 

Services the power to invalidate the private business contracts that 

providers need to stay in business, in other words they have to be 

on the panel, what type of authority does that give the Secretary 

to direct how providers deliver care and practice medicine? 

Dr. Armstrong, in your testimony you cite the U.S. Preventative 

Services Task Force and its findings. It recommended against 

mammography screenings for women below the age of 50. I’m an 

OB/GYN, 26 years in practice. I do not believe such a recommendation is the kind of personalized medicine that my patients deserve. 

Each patient is different and therefore I would probably not adhere 

to this bureaucratic directive from Secretary Sebelius, or any other 

Secretary of Health and Human Services. I would listen to my specialty society, the American College of OB/GYNs. 

So tell me real quickly—I know I’m a little out of time—so tell 

me, Dr. Armstrong, could the Secretary of Health and Human 

70 

Services literally drive me or any other practitioner out of business 

under the authority given to her to enhance patient safety? 

Dr. ARMSTRONG. Yes. 

Mr. GINGREY. Thank you. Mr. Chairman, thank you for your indulgence, and I yield back. 

Mr. GOWDY. I thank the gentleman from Georgia. 

The chair will now recognize the gentleman from Michigan, the 

distinguished Dr. Benishek. 

Mr. BENISHEK. Thank you, Mr. Chairman. I appreciate the privilege of being here on this committee this morning. 

Dr. Armstrong, you’ve been in practice for a long time. What is 

the worst feature of practicing medicine today? 

Dr. ARMSTRONG. Probably the risk of a malpractice suit if you 

had to say what the worst risk is, but there are many. But we 

could start there. 

Mr. BENISHEK. Did the Affordable Care Act do anything to adjust 

this problem? 

Dr. ARMSTRONG. Essentially no. There was money in it to fund 

State demonstration projects for looking at different alternatives to 

tort reform, but there were some strings attached to that money 

that made it very difficult for States to do it. For instance, if your 

State proposed a cap on noneconomic damages, you couldn’t get the 

demonstration money. 

Mr. BENISHEK. All right. Dr. Novack, what do you think is the 

most difficult aspect of practicing medicine today? 

Dr. NOVACK. As was alluded to earlier, the challenge that in our 

practice where we have nine providers, we have three times that 

many allied health personnel. So as opposed to being able to devote 

the resources to try to provide as comprehensive and as widespread 

care as possible, we have large expending of our resources on 

things that really have very little to do with patient care. 

Mr. BENISHEK. Is the Affordable Care Act improving that situation then? 

Dr. NOVACK. Thus far it has made it significantly worse since 

regulations. New regulations seem to appear every week, since we 

have an environment now where the other parties in health care 

are seeking to take huge steps to really take ownership over these 

huge chunks of money. In large part we can look at the potential 

for the $900 billion in Medicaid spending that the CBO anticipates 

over the next 10 years and the $800 billion in direct insurance company subsidies. The problem there is that patients and families 

cease to become patients and families and become entities where 

if you can get them under your umbrella you can then get those 

Federal dollars. That has very little to do with patient care. 

Mr. BENISHEK. Taking care of patients and seeing what is happening with medicine now with the Affordable Care Act and just 

the third-party payer system, it concerns me that it seems that 

physicians are working less and less for the patient and more and 

more for some other bureaucracy which is going to dictate the form 

of care that they give to those patients. My feeling is that the doctor-patient relationship should be one where the patient is in control of the situation. 

71 

Dr. Armstrong, do you think that patients can be trusted to take 

care of their own health care or do you think that they need the 

Affordable Care Act to guide their care for them? 

Dr. ARMSTRONG. I think there are many concrete examples that 

show that patients can be excellent consumers in health care markets. 

Mr. BENISHEK. Okay, give us one example. 

Dr. ARMSTRONG. For instance, in Indiana with the Healthy Indiana Plan that has been established by Governor Mitch Daniels, 

under Medicaid, patients are given power accounts and they have 

to make their own decisions similar to a health savings account 

about where the money goes, and they have actually shown that 

they have reduced their health care spending but not affected outcomes. So they have reduced health care spending by up to 30 percent but have not affected their health care outcome. That is just 

one thing. This has also been done in private industry and private 

contracts and continues to be advocated in other areas. 

Mr. BENISHEK. Dr. Colyer, do you have any comments in that 

vein? 

Dr. COLYER. Yes. I think there are lots of opportunities where patients can make their own choices. And they can work with their 

doctor for good solutions. For example, if you empower a patient 

to—we can oftentimes do their procedure in the office rather than 

under certain rules it would only be paid for only if you do it in 

the hospital setting. Those are common sorts of problems. 

Mr. BENISHEK. Thank you very much. 

Dr. Novack, who do you think should be in charge of health care 

decisions, doctors and patients or the bureaucrats? 

Dr. NOVACK. I think and patients and families in conjunction 

with the treating physician and other health care personnel. 

Mr. BENISHEK. Does the Affordable Care Act encourage that? 

Dr. NOVACK. It moves it in the opposite direction. As I mentioned, when you create 150 plus new bureaucracies, when you 

manage to have 13,000 pages of regulations, and that is just the 

tip of the iceberg, on top of the 130,000 pages of regulations that 

Medicare has created since 1965, and have a health exchange network that is likely to adopt nearly wholesale the Medicare regulations, then foisting that on the patient population and the providers, you create an environment where the decision makers and 

ultimately the payers are not patients and families but people far 

removed. As I mentioned in testimony, the ultimate reality will become that the people who provide care, whether it is physicians, 

nurses, other people, are being more responsive to the decision 

makers rather than patients. I just don’t see, after 24 years of taking care of patients in almost every setting, how that is good for 

patient care. 

Mr. BENISHEK. Thank you, Dr. Novack. I certainly agree with 

you. 

My time is up. Thank you. 

Mr. GOWDY. I thank the gentleman from Michigan. 

The chair now recognizes the distinguished gentleman from Louisiana, Dr. Fleming. 

Mr. FLEMING. Thank you, Mr. Chairman. Thank you again for 

having us as guests for the panel. 

72 

I want to bring the panel’s attention to this card here. Now this, 

you may not be able to see it from there, so I will explain to you 

what it is. This is my health care card. This is Blue Cross/Blue 

Shield. Despite what you may read on the Internet, I actually pay 

28 percent of my premium and it is a private insurance plan. This 

is my on ramp into the health care system. This is my key in the 

door. 

Now, the ranking member, Mr. Davis, made a comment a moment ago that sort of tweaked my ear. He said that the 

ObamaCare would give access to care to 30 million more Americans, and therein lies the problem. There is a tremendous myth 

that just because you have a card that entitles you to coverage that 

you actually have access to care. 

Now, let’s go to you, Ms. Pipes. You made a really good point, 

a really moving story about your mom. And I am sure that some 

would like to say that that was an exception, but I have heard 

many stories like that as well in Canada where people had cancer 

and never got the treatment that they needed. In fact, if you look 

at the statistics, death rates from prostate cancer, death rates from 

breast cancer in both Great Britain and Canada where there is 

supposed to be 100 percent coverage, everybody carries a card, but 

yet the death rates as a result of late diagnosis and also inadequate treatment are much higher in those countries. So I would 

love to hear your response on this differential between carrying a 

card that says you’re covered and the actual access to care. 

Ms. PIPES. Thank you. 

Yes, the United States ranks number one in 13 of the 16 most 

prominent cancers—breast cancer, colon cancer, mammography. So 

we do extremely well compared to Canada. 

Mr. FLEMING. In terms of positive outcomes? 

Ms. PIPES. Yes, right. The 5-year survival rate. 

In a country like Canada, the Fraser Institute’s new study on 

hospital waiting list, the average wait today in Canada from seeing 

a specialist to getting treatment by a specialist is 9.5 weeks. It is 

the highest since they started reporting wait times, and it is up 

from 9.3. The average wait from seeing a primary care doctor to 

getting treatment by a specialist is 19 weeks, almost 5 months. 

In a Supreme Court case in Canada, Madam Chief Justice Beverly McLaughlin, in looking at the Province of Quebec and denied 

care, she said: Access to a waiting list is not access to health care. 

So in a country like Britain and Canada, you do have these long 

waits. You read stories in the press all the time. As my friend, the 

former head of the Canadian Medical Association, who runs an illegal orthopedic clinic in Vancouver, said a family can get a hip replacement for their dog in less than 2 weeks and for their family 

the average wait is 2 years. 

I believe unless this act is repealed and replaced with solutions 

that empower doctors and patients, we will face the same kind of 

rationed care and long waits in America. 

Mr. FLEMING. There are those who would say well, look, we don’t 

have the single payer system that they have there, therefore that 

is not going to be a problem here. But I would take everyone back 

to the health care debate. Many on the other side of the aisle, 

many Democrats, actually wished for wanted, and pushed for sinVerDate Aug 31 2005 08:53 Nov 06, 2012 Jkt 000000 PO 00000 Frm 00076 Fmt 6633 Sfmt 6633 C:\DOCS\76366.TXT APRIL
73 

gle payer, and in fact hope—and this is their words, not mine— 

hope that this evolves into that. So would it be fair to say that 

there is something different about the government takeover of 

health care under ObamaCare and single payer when it comes to 

access to care? 

Ms. PIPES. Well, as the late Senator Ted Kennedy used to say, 

his goal was Medicare for all, which is a single payer system. 

I believe, as you say, there was no public option in the Senate 

bill or in the final bill, but we’ve already seen Congressman Jim 

McDermott from Washington State introducing a single payer bill. 

We’ve seen some of the States, Vermont has, Governor Shumlin 

has a single payer bill. I think ultimately private insurers are 

going to be crowded out because they are not going to be able to 

offer insurance at the rates that they have to with the essential 

benefit plans. And even Howard Dean the other day, who said he 

was against the individual mandate, has been pushing for single 

payer. So if we don’t get an off ramp, we are on the road to serfdom 

with a single payer system, I truly believe, and I think it is going 

to happen. 

Mr. FLEMING. I only have a few moments. Dr. Novack, Dr. Armstrong, would you like to weigh in? 

Dr. ARMSTRONG. I agree with Sally. 

Mr. FLEMING. Access versus? 

Dr. NOVACK. There are multiple studies showing that people on 

Medicaid do not necessarily have any better access to certain kinds 

of care than people with no insurance at all. 

Mr. FLEMING. I would just add to that, since you brought up 

Medicaid real quickly, I am a physician and I see Medicaid patients 

all the time. The reimbursement levels are very lower in Medicaid. 

They are going lower on Medicare, and so we have a lot of people 

in this country, a lot of people in my State of Louisiana who walk 

around with a Medicaid card and now a Medicare card, and they 

ring up the doctor’s office and they are told that they don’t have 

access. Now, some would say, well, that is an arbitrary physicians. 

No, physicians all over this country are saying we’re closing our office down. We’re going to have to work in the emergency room. I’m 

going to have to do something else as an occupation because I can’t 

survive, I can’t make payroll as a doctor because of the low reimbursement rates. So where do these people end up going? They end 

up going to the emergency room which the other side of the aisle 

would be the first to tell you is where the care is the most expensive. 

Thank you, Mr. Chairman, and I yield back. 

Mr. GOWDY. I thank the gentleman from Louisiana. 

The chair would now recognize the gentleman from Maryland, 

the distinguished physician, Dr. Harris. 

Mr. HARRIS. Thank you very much, Mr. Chairman and members 

of the committee, for allowing the members of the Physicians Caucus to participate. 

Mr. Pollack, I’m a physician who has always depended on the 

conscience clause protection in my practice. Does Families USA 

support the HHS mandate that includes abortifacients and sterilizations and that is now the subject of lawsuits claiming infringement of religious freedom? 

74 

Mr. POLLACK. Families USA does support. 

Mr. HARRIS. Thank you very much. 

Dr. Novack—a simple yes or no, so you support that? 

Mr. POLLACK. We support the preventive care services in the Affordable Care Act. 

Mr. HARRIS. Sure, okay. Thank you. That’s what I needed to 

know. 

Dr. Novack, do you think the average American senior under- stands that to make ObamaCare work you’re cutting $500 billion 

out of Medicare over the next 10 years plus $300 billion in SGR 

scheduled cuts, $800 billion cut out of senior health care funding, 

do you think the average senior understands that? 

Dr. NOVACK. What I’m seeing both in my practice and doing 

some of the work I do around the country is seniors recognizing 

when they call to try to find a physician they are not finding doctors who are taking Medicare patients. 

Mr. HARRIS. Do you think ObamaCare will make that worse or 

better? 

Dr. NOVACK. It will make it worse. As you mentioned, the numbers, which were cooked, which of course in our business if you 

could cook your anesthesia concoctions—— 

Mr. HARRIS. I would live in a courtroom all my life if I did that. 

Dr. NOVACK. Yes. The supposed savings of course is predicated on these $300 billion in SGR payments, including a 30 percent in 

January of next year. 

Mr. HARRIS. Sure. 

Dr. NOVACK. If those go into effect, we will really significantly 

adversely impact access to care. 

Mr. HARRIS. Thank you. 

Ms. Pipes, we heard a lot about free preventive care, and so I 

was giving a town hall a couple of months ago and two physicians 

stand up in the back and go, we work in federally qualified health 

centers, and they told me that the free flu vaccine, they get paid 

over $200 from the Federal Government for the free flu vaccine 

that people get when you can walk down to the Rite-Aid or 

Walgreen’s and get it for $39.95. Ms. Pipes, correct me if I’m 

wrong, doesn’t this—and a very short answer—indicate that in fact 

free preventive care is not free? And not only that, when the Federal Government delivers it, it can cost five or six times as much 

as the private sector? 

Ms. PIPES. Yes. 

Mr. HARRIS. Thank you very much. 

Dr. Colyer, Lieutenant Governor, why would you possibly recommend to your Governor to participate in Medicaid, the expansion 

from 100 to 133 percent, when you know if you choose not to every 

one of those patients will be covered under a Federal health exchange at not cost to your State? No administrative cost, no cost 

at all. And you see, as the chairman pointed out, and the Congresswoman from Louisiana, in Texas right now only 31 percent of physicians will take a Medicaid patient, but a whole lot more will take 

a private patient. And, in fact, Mr. Pollack said under this plan, 

you get a private health insurance plan. Why would any Governor 

possibly do it to those people, those poor people who we heard 

about from the gentlelady of the District of Columbia, those poor 

75 

working people we heard about from the ranking member, why 

would you foist Medicaid on them when their option under affordable care is a federally subsidized health exchange plan? 

Dr. COLYER. An even better solution is win the election in November. 

Mr. HARRIS. Well, I understand that. But given the scenario, any 

Governor who does this to their poor people, to their people in that 

100 to 133 who opt to expand Medicaid, ought to talk to some of 

the docs about what, I urge and everyone listening, call up your doc 

and ask them if they take Medicaid and then decide whether you 

would want to be on Medicaid or not. 

Ms. Pipes, we heard Mr. Pollack say that ‘‘some States have high 

risk pools.’’ Don’t 35 States have high risk pools? 

Ms. PIPES. Yes, they do. 

Mr. HARRIS. Thank you very much. I just want to clarify that in 

fact the vast majority of Americans are already covered under preexisting conditions in high risk. Mr. Pollack, it is a fact, including 

Maryland. I’m not asking you a question. 

Mr. POLLACK. These are all very small. 

Mr. HARRIS. Mr. Pollack, I’m not asking you a question. Listen 

to what the chairman, how he admonished you. You are to answer 

a question when I ask you. I didn’t ask you the question. You already made the statement that some States. We understand that 

to you 35 of 50 is just some. 

Ms. Pipes, I’m an obstetric anesthesiologist. I have spent my life 

delivering health care to women. I’ve watched the caesarean section rate go from 18 when I started in 1980 to 35 now. That’s the 

C section rate. Just for all of you young ladies in the audience, you 

are twice as likely to have a caesarean section as you would have 

been when I started my practice 30 years ago. You can’t find an 

experienced OB who’s been doing it for 30 years to deliver your 

baby any more. They all gave it up. You get the inexperienced, 

well-intended young physicians because the experienced OBs have 

given up. Because of lack of tort reform, you have a doubling of the 

caesarean section rate. If any of you young ladies think that is better health care, raise your hand. I don’t think so. Does this Affordable Care Act do anything at all to address a rising caesarean section rate or the fact that experienced obstetricians are leaving the 

field? 

Ms. PIPES. No. And tort reform is one of the things that we have 

seen, the OB/GYNs in West Virginia, Pennsylvania, Nevada, the 

States that have the highest med mal insurance rates, the decline 

in OB/GYNs has been very significant. And who does that hurt? It 

hurts all women who are of child bearing age. 

Mr. HARRIS. It hurts women. I suggest, Mr. Pollack, you take 

that information back to your group that opposes tort reform. 

Thank you very much, Mr. Chairman. 

Mr. GOWDY. I thank the gentleman from Maryland. 

On behalf of all of the panelists, we want to thank our distinguished panel of witnesses. 

Mr. DAVIS. Mr. Chairman, Could I just clarify something. I was 

mentioned in terms of something that I said, and I don’t think that 

I really said that. 

Mr. GOWDY. Sure. 

76 

Mr. DAVIS. Doctor, you implied that I suggested that because individuals had access to insurance they had access to care. I’ve been 

in this business much too long to have not understood that insurance does not necessarily mean access to care. We have many—— 

Mr. FLEMING. Would the gentleman yield? 

Mr. DAVIS. Let me just finish. 

We have serious manpower shortage areas. We have areas where 

there are no physicians. We have areas where there are no facilities. And so access to insurance means that you have a way to pay 

for care. It does not necessarily mean that the care, and I’m 

amazed when I hear individuals suggest that we’re going to put 

such a burden on the health care delivery system. It just depends 

on how you look at it. If you are a young person who wanted to 

become a physician or who wanted to become a nurse, it creates a 

tremendous opportunity for you to go to medical school, to go and 

be trained so that you can provide care for these millions of people 

who don’t have any. 

I just wanted to clear that up. 

Ms. NORTON. Mr. Chairman, could I correct the record on a factual matter? 

Mr. GOWDY. Yes, the gentlelady from the District of Columbia 

can. But I think in fairness, I should give the gentleman from Louisiana a chance to respond since he attempted to do so and then 

I will recognize the gentlelady. 

Mr. FLEMING. Let me say parenthetically that a study just came 

out today that I believer 83 percent of physicians when asked, 

when polled, this was a survey, a scientific survey, said they are 

reconsidering their occupation. And I can tell you that I get questions a lot from medical students who ask me did they do the right 

thing. So again, I would just say to the gentleman that right now 

ObamaCare means for health care workers a very uncertain future. 

Yes, they do want to take care of patients, insured or not, but they 

see a very dark cloud ahead of them. 

But to respond to your statement, yes, you did say access to care. 

That is the actual term. And I’m sure we could pull it up in the 

transcript if we need to. Why that is important is because that is 

a common myth. Whether or not the gentleman meant it or not is 

beside the point. 

Mr. FLEMING. The point I needed to make with that is that 

Americans are getting that message, that once you get that card 

that means that you go into the healthcare system and you are just 

going to be taken care of, and that is the whole point. Half of the 

additionally covered Americans under ObamaCare, and this is by 

Democrat numbers, not mine, I think fewer are going to be covered 

than the 30 million that are claimed, but half of them will be covered under Medicaid. And you just heard the gentleman from 

Maryland say that very few doctors accept Medicaid, not because 

they don’t want to accept Medicaid, because they can’t afford to accept Medicaid. 

If we don’t deal with the cost realities that go with malpractice 

insurance and all of that, the access problem is going to only get 

worse. So I think that is something we need to leave with today 

that just because you have a card, just because you are in a system 

does not mean you have access, and I yield back. 

77 

Mr. GOWDY. I thank the gentleman from Louisiana, and now I 

recognize the gentlelady from the District of Columbia. 

Ms. NORTON. Thank you, Mr. Chairman. On the matter of the 

health, people on—who would receive Medicaid under the Affordable Health Care Act, going to the exchange, go to the exchange, 

you need to have some cash to pay for the health care and the exchange. These are people above the limit of Medicaid but unable 

to pay for health insurance, and my question is, the payment for 

health insurance and the high-risk pool—I’m sorry, the exchange 

will not help those people which is why they were included, in 

Medicaid. For preexisting, for those with preexisting conditions 

going to the high-risk pool, the high-risk pool is anything but affordable. It should be called the unaffordable high-risk pool because 

clustered there are all of those who have sought refuge there and 

therefore it becomes unaffordable for almost everyone who would 

want access, who have the diabetes and can’t find a podiatrist; I 

guess what he couldn’t find if he weren’t on Medicaid at all. 

So the problem, the system has its faults. But it certainly doesn’t 

have the faults that the present system, which leaves out of it 

those with preexisting condition and people who simply cannot afford health care. 

Mr. GOWDY. Thank the gentlelady from the District of Columbia. 

Anything else for the Good of the Order? The gentleman from 

Maryland. 

Mr. HARRIS. Thank you very much. Well, just to, I don’t know 

what preexisting pools and high-risk pools cover in other States, 

but in Maryland it is very affordable. It is funded by a small tax 

on hospital admissions, and in fact, when we started it, the premiums were $300, $300 and something a month for someone with 

a preexisting condition. That’s pretty darn affordable for individual 

insurance. And just to correct, I was talking about in my comments 

about Medicaid, the 100 to 133 percent of Federal poverty level 

would be 100 percent covered under the exchanges; higher up you 

need cash, but at that level, 100 percent coverage. So that was my 

point, just in that narrow range. 

Thank you, Mr. Chairman. 

Mr. GOWDY. I thank my colleagues on both sides, and again, on 

behalf of all of us, we want to thank our distinguished panel of witnesses for taking time from their busy schedules to appear before 

us today. 

With that, the committee stands adjourned. 

[Whereupon, at 12:09 p.m., the subcommittee was adjourned.] 

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