Date: 2010-03-21
Speaker: GEORGE MILLER (democrat)
Chamber: H
State: California

Mr. Speaker. I rise in support of this truly historic and great legislation that addresses two of Americas greatest troubles: the crushing cost and high obstacles of obtaining both quality health care and a quality college education. Our Nation has suffered from our longstanding failure to make health care and college accessible to all American people. Americans have waited a long time for health insurance reform. nearly a hundred years. Today. Congress and President Obama will deliver on a central promise. a dream deferred. and on a crucial demand. Because of this legislation. for the first time in Americas history. never again will Americans have to worry about losing their health insurance if they change or lose their job. The insurance companies will not be able to jack up premiums or deny coverage because of preexisting conditions. They will not be able to drop peoples coverage when they get sickwhen they need it the most. Our reforms will improve the lives of every single American. those with insurance today and those without. Were also pairing this historic health reform with another opportunity that cannot be missed. the chance to make the single largest investment in college affordability ever. at no cost to the taxpayers. Were going to take $61 billion of wasteful subsidies that have gone to the banks and student lenders and instead recycle that money on behalf of students. their families who are trying to pay for education. to make that education more affordable and pay down the deficit of this country. We now face a very simple choice. We can side with Americas families and make health insurance and college more affordable and accessible while creating millions of jobs and reducing the deficit. or we can side with the insurance companies and the banks. Its a very simple choice. One is to stand with the families and the students of this country. to stand with our future. to modernize our education system. to make it more affordable. and to modernize and make more affordable our health care system. I suggest all my colleagues should stand with American families in this country. Mr. Speaker. I rise in support of this truly historic legislation that addresses two of Americas greatest troublesthe crushing costs and high obstacles of obtaining both quality health care and a college education. Our Nation and its economy have suffered from our longstanding failure to make health care and college accessible and affordable to all of the American people. Americans have waited a long time for health insurance reformnearly 100 years. Today. Congress and President Obama will deliver on a central promise. on a dream deferred. on a crucial demand. Because of this legislation. for the first time in Americas history. never again will Americans have to worry about losing their health insurance if they change or lose their job. Insurance companies will not be able to jack up premiums or deny coverage because of a preexisting condition. They will not be able to drop peoples coverage when they get sickand need it most. There is no other plan on the table today that offers Americans these vital assurances. Our reforms will improve the lives of every single Americanthose with insurance today and those without it. They will improve our economy by reducing the deficit. creating up to 4 million jobs over the next decade. and unshackling innovative business decisions from crippling health insurance costs. Our legislation offers families and employees of small businesses access to choices of affordable health plans. security and control over their health care. vital federal and state consumer protections. accountability for insurance companies. and coverage for 32 million Americans who dont have insurance today. This legislation also intends to lessen and eventually eliminate the loopholes and inconsistencies in our current system. More specifically. it seeks to begin the creation of a joint national and state health care system. Currently. we have a fragmented and unfair set of rules. If you are poor you may or may not be covered by Medicaid and your benefits will vary depending on the state you live in. If you are employed. you may or may not be offered benefits by your employer and those benefits vary from employer to employer. As providers continue to increase costs year after year. insurers. employers and states have been unable to effectively negotiate and responded by cutting benefits and increasing costs for individuals and families. This bill will help change this unsustainable and unfair dynamic. Under this legislation. every American will have an obligation and an opportunity to enjoy meaningful health benefits. The Secretary of Health and Human Services will establish an essential benefits package that will provide a basic but comprehensive set of benefits for all Americans. Although existing employer plans are not required to provide this level of benefits. it is our hope that employers will meet or exceed this standard. However. the bill does end a wide series of abuses that all health plans. including employer provided plans. must comply with. These include an end to all preexisting condition exclusions. limits on waiting periods for coverage. and elimination of annual and lifetime caps on benefits. In order to make health care more affordable for workers and employers. the bill establishes exchanges that will negotiate with insurers to offer health coverage to individuals in a given area or state. These governmentsponsored exchanges will establish a level playing field market place that will make health benefits fairer to all parties. Insurers will get organized access to large pools of individuals who are required to purchase insurance with lower income individuals receiving federal subsidies to afford essential benefits. Employers will be relieved of their current burdens of designing and negotiating for health benefits under this new health system. Employers will simply facilitate the enrollment and payroll deduction of their employees in exchange health plans with no other responsibilities. Employers may select a plan level to which any employer contribution will be limited. but employees are free to choose plans in that or a more favorable level. The health plans offered through the exchange are state licensed (with the exception of the national plans) and are not ERISA plans. States have full authority to protect their residents and enrolled individuals have state law rights and consumer protections. There is no federal preemption of any state law that does not prevent the application of any of the rights and responsibilities included in Title I of this bill. Small employers that choose to offer health coverage may be eligible for tax credits and cannot offer health benefits that discriminate in favor of highly compensated employees. For employers who use employee payroll and similar organizations (i.e. Professional Employee Organizations). I expect that the U.S. Department of Treasury will issue rules to make clear the circumstances by which the small employer may take the tax credit and satisfy the prohibition against discrimination. The bill contains an individual mandate to either obtain health insurance or pay a penalty. This provision is grounded in Congresss taxing power but is also necessary and properindeed. a critical linchpinto the overall effort to reform the health care market and bring associated costs under control throughout interstate commerce. For example. without this requirement. some reforms may create the opportunity for moral hazards. such as the prohibition on preexisting conditions. Without an individual mandate. individuals could wait to purchase health insurance until they are sickthereby driving up insurance costs and undermining the bills efforts to bring health care costs and costs to the broader economy under control. This requirement spreads risk to ensure lower costs for everyone. prevents adverse selection. helps end overpayment by the government and other consumers for the uninsured. and makes health care reform overall sustainable. I also would like to address a few other important provisions in the bill: I am pleased that the essential benefits in the Patient Protection and Affordable Care Act include rehabilitative and habilitative services and devices. as these benefits are of particular importance to people with disabilities and chronic conditions. The term "rehabilitative and habilitative services" includes items and services used to restore functional capacity. minimize limitations on physical and cognitive functions. and maintain or prevent deterioration of functioning. Such services also include training of individuals with mental and physical disabilities to enhance functional development. The term "rehabilitative and habilitative devices" includes durable medical equipment. prosthetics. orthotics. and related supplies. It is my understanding that the Patient Protection and Affordable Care Act requires the Secretary of Health and Human Services to develop. through regulation. standard definitions of many terms for purposes of comparing benefit categories from one private health plan to another. It is my expectation "prosthetics. orthotics. and related supplies" will be defined separately from "durable medical equipment." I also expect that durable medical equipment will not be limited to "inhome" use only. Pursuant to employer requests. this bill codifies the use of wellness programs. Wellness programs are proving to be an emerging area of health care reform that holds both great promise and potential for abuse. The Departments of HHS and Labor will need to issue regulations to assure that employer wellness programs meet established standards of medical treatment and patient protection. It is my understanding from discussions with my colleagues in both the House and Senate that the design and implementation of voluntary wellness programs. including the issuance of policies and procedures and the adoption of practices and methods of administration. shall not have the purpose or effect of mandating participation in such programs or punishing. denying. limiting or curtailing any rights. privileges. and protections under the Americans with Disabilities Act. the Genetic Information Nondiscrimination Act. the Health Insurance Portability and Accountability Act. the Family and Medical Leave Act. and Title VII of the Civil Rights Act of 1964. In order to ensure existing civil rights and privacy protections. regulations related to wellness programs promulgated by the Secretary of Health and Human Services should include standards and criteria developed and certified by the Attorney General. the Secretary of Labor. and the Equal Employment Opportunity Commission. I expect that nothing in the Patient Protection and Affordable Care Act shall limit the independent authority of the Attorney General. the Secretary of Labor. and the Equal Employment Opportunity Commission to issue regulations. interpretations. and guidance regarding the applicability of the Americans with Disabilities Act. the Genetic Information Nondiscrimination Act. the Health Insurance Portability and Accountability Act. the Family and Medical Leave Act. and Title VII of the Civil Rights Act of 1964 to the design and implementation of wellness programs. I urge the Department of Labor and other agencies to monitor and ensure that health plans properly comply with the standards established by this Act. I also urge the Congress to continue to review and revisit this developing area of health care. The Senate bill includes provisions that would provide for a "level playing field" between private health insurance issuers and a competing Consumer Operated and Oriented Plan ("COOP"). a community health insurance option. or a nationwide qualified health plan. These provisions would prevent unfair competition within a state where these plans compete. For example. if a COOP is established in New York State. it would have to be subject to all the same federal and state laws enumerated in these level playing field provisions as private health insurance issuers in New York State are. Or. for example. if a COOP were established in Florida and was exempted from a state law relating to licensure. private health insurance issuers in Florida would also have to be exempted from the same state law. The bill we are passing contains protections for employees who are retaliated against for reporting violations involving health insurance regulation and the operation of exchanges. and provides recourse for workers who are fired or otherwise discriminated against because they participate in the exchange and the employee receives a tax credit or a subsidy to purchase health insurance through an exchange. Under this legislation such employees can bring a complaint to and receive assistance from the Department of Labor. Section 2951 of H.R. 3590 makes an amendment to section 511 of Title V of the Social Security Act to require states to conduct statewide needs assessment and to coordinate such assessment with other appropriate assessments. and crossreferences section 640(g)(1)(C) of the Head Start Act. This should not be interpreted to provide states with any new authority over Head Start grantees or entities applying for Head Start funds. Now. were pairing these truly historic health insurance reforms with another opportunity that cannot be missed: The chance to make the single largest investment in college affordability everand at no cost to taxpayers. We are going to take tens of billions of dollars that for decades has gone to banks in the student loan program and instead give that money to students and to pay down the deficit. For decades. banks have enjoyed a sweetheart deal: They receive taxpayer money to make virtually riskfree loans to students. As we speak. the federal government is now funding 88 percent of all federal student loan volume. It has proven to be a more stable lender for students through shaky financial markets and a more costeffective lender for taxpayers. Ending these subsidies is not a radical idea. President Clinton first identified these subsidies as wasteful in the 1990s. President Bush eyed them in three of his budgets. And President Obama has correctly proposed ending this boondoggle once and for all by originating all loans through the federal direct lending programsaving taxpayers $61 billion over 10 years. And thats what our legislation accomplishes. Our reforms are good for students. taxpayers and American jobs. We will help low and middleincome students pay for college and invest in the support they need to graduate. We will be more responsible with taxpayer dollars by using $10 billion of these savings for deficit reduction. And we will end the practice of banks shipping lending jobs offshore. This bill makes unprecedented investments to expand highquality educational opportunities to all Americans. It invests in the Pell Grant scholarship award. strengthens Historically Black Colleges and Universities and minority serving institutions. and provides more resources to states for college access and completion efforts through the College Access Challenge Grant program. Further. these investments are paid for without increasing our nations deficit. through key reforms in the federal student loan programs designed to provide a stronger. more reliable. and more efficient student loan system. The legislation directs $10 billion of the savings generated under this legislation to paying down the countrys deficit. The education provisions of this legislation will convert all new federal student loans to the Direct Loan program starting in July 2010. saving $61 billion over the next 10 years. These changes will also upgrade the customer service borrowers receive when repaying their loans and promote jobs. The legislation will maintain jobs by maintaining a robust role for the private sector. allowing lenders and nonprofits to get contracts with the Department of Education to service Direct Loans. These education provisions will convert all new federal student loans to the Direct Loan program starting in July 2010. saving $61 billion over the next 10 years. These changes will also upgrade the customer service borrowers receive when repaying their loans and promote jobs. The legislation will maintain jobs by maintaining a robust role for the private sector. allowing lenders and nonprofits to get contracts with the Department of Education to service Direct Loans. The legislation significantly increases the federal Pell Grant award. the cornerstone of needbased federal student assistance since its creation in 1972. Investments in this program are essential to ensuring educational access and making college more affordable for students and families. Both the House and Senate authorizing and appropriating committees have made significant investments in increasing the maximum Pell Grant award in the past few years32 percent since 2006. The investments in this legislation build on these commitments by indexing the maximum Pell Grant award to the Consumer Price Index beginning in the 20132014 academic year. to reach an estimated maximum of $5.975 in the 20172018 academic year. The legislation invests additional resources in the College Access Challenge Grant program created under the College Cost Reduction and Access Act of 2007 to assist states working in partnership with institutions of higher education. nonprofit philanthropic organizations. and other organizations with experience in college access. to ensure that students have access to highquality. affordable higher education. It is the intent of Congress that states receiving grants under the College Access Challenge Grant program should partner with entities. including guaranty agencies (including their nonprofit subsidiaries). to provide financial literacy. delinquency and default aversion activities. and other loan counseling activities for borrowers. While this legislation seeks to ensure increased access and success for all students. we intend for the Secretary to work with states to address the unique access issues faced by underserved communities. including: lowincome individuals. individuals with disabilities. homeless and foster care youth. disconnected youth. nontraditional students. members of groups that are traditionally underrepresented in higher education. individuals with limited English proficiency. veterans (including those just returning from active duty). and dislocated workers. The legislation also includes a continuation of funding for investments in Historically Black Colleges and Universities. HispanicServing Institutions. Tribal Colleges. Alaska and Hawaiian Native. Predominantly Black Institutions. institutions serving Asian American and Pacific Islanders. and institutions serving Native Americans. first made under the College Cost Reduction and Access Act of 2007. recognizing the critical role these institutions play in serving the nations emerging majority populations. Concerning the servicing contracts with eligible notforprofit servicers. this legislation recognizes that notforprofit servicers play a unique and valuable role in helping students in their states succeed in postsecondary education and that students should continue to benefit from the assistance provided by notforprofit servicers. including customer service. financial counseling. and college access and success programs. In addition. by including more highquality servicers in the contracting process. competition will be increased thereby delivering better quality for student borrowers. Under the bill. notforprofit servicers will be allocated a minimum of 100.000 borrower loan accounts. With sufficient loan volume and competitive servicing rates. eligible notforprofit servicers can individually or collectively generate sufficient revenue to continue the valuable services they provide to borrowers. Because of the significant increase in loan volume as all federal loans are moved to the Direct Loan program. additional servicing capacity will be needed and is provided for through the contracts provision. I encourage the Secretary to implement these provisions so that many local notforprofit servicers will continue to play a role in the student loan program. As more students become increasingly dependent on loans. the Department of Education must increasingly focus on the assistance. information. and repayment tools that assist students in successful loan repayment. When evaluating the resources and services available to student borrowers and schools under the Direct Loan program. I encourage the Secretary to use existing contracting authority to contract. when appropriate. with statedesignated guaranty agencies for the delivery of services that increase student loan repayment and decrease default. Such agencies shall include those nonprofit subsidiaries of guaranty agencies that were established. pursuant to State law. on or before January 1. Community colleges serve an instrumental role in both our educational and workforce systems. providing postsecondary education and job training. particularly to individuals and families hardest hit by difficult economic times. This includes workers eligible for training under the Trade Adjustment Assistance program for communities and for individuals who are. or may become eligible for unemployment compensation. To ensure that these institutions have access to the resources they need to develop and improve educational and career training programs designed to meet the needs of these communities. the legislation directs the Secretary of Labor to award Community College Career Training Grants especially to struggling 2year public community colleges. (as defined in Section 101 of the Higher Education Act of 1965). As the legislation ensures that all States benefit from these resources with the inclusion of a state minimum. I also encourage that the Secretary strive to ensure a diverse geographical representation of community colleges in both urban and rural areas. Id like to thank RUBN HINOJOSA. our higher education subcommittee chair. TIM BISHOP. and all of our committee members for their tireless work on student loan reform. Along with all the members of our committee. Id like to especially thank ROB ANDREWS. our health subcommittee chair. for his backbreaking work over the last year on health reform. And I would like to thank the many members of my staff for their long hours and tremendous work over the last year on these two pieces of reform: Mark Zuckerman. Danny Weiss. Alex Nock. Michele Varnhagen. Jody Calemine. Denise Forte. Ruth Friedman. Megan OReilly. Julie Radocchia. Jeff Appel. Ajita Talwalker. Celine McNicholas. Meredith Regine. Lillian Pace. Kara Marchione. Helen Pacjic. Rachel Racusen. Aaron Albright. Melissa Salmanowitz. Andra Belknap. Betsy Kittredge. Mike Kruger. Amy Peake and Courtney Rochelle. Their commitment and expertise has been invaluable. We almost didnt get here today. You know that. Opponents of health care reform have said anything and done everything to distort the facts. delay the process. and try to put off what Americans have asked for and needed for generations. They have tried to sow fear into the American people. They cannot win on the merits. And they will continue to lie and distort the facts going forward. But we have made it to the final step in this processdespite all that noise. And now we face a simple choice. We can side with Americas families and college students and make health insurance and college more affordable and accessiblewhile creating millions of jobs and reducing the deficit. Or. we can side with insurance companies and banks. Thats it. Thats the choice. Im siding with the American people. I urge each of my colleagues to join me.