Date: 2011-01-18
Speaker: JACKSON LEE (democrat)
Chamber: H
State: Texas

Mr. Chairman. you are absolutely right. This is a constitutional question that has been raised. and as I came to the floor earlier. I mentioned my predecessor. Congresswoman Jordan. who believed in this Constitution without question. I mentioned the 14th Amendment. I now mention the Fifth Amendment. First of all the commerce clause covers this bill. but the Fifth Amendment speaks specifically to denying someone their life and liberty without due process. That is what H.R. 2 does. and I rise in opposition to it. And I rise in opposition because it is important that we preserve lives and we recognize that 40 million plus are uninsured. In my own county. Harris County. this bill will allow some 800.000 uninsured members of Harris County. citizens of Harris County. to be insured in Texas. In addition. the Texas Department of Insurance. as many other States. have already begun implementing this bill. the patient protection bill. gladly so. and saying it will help save lives and provide for the families of their States. Can you tell me what is more unconstitutional than taking away from the people of America their Fifth Amendment rights. their 14th Amendment rights. and the right to equal protection under the law? I know that Mr. Land. who suffers from schizophrenia with his family. Ms. Betty. who had to go to the ER room in Texas because of no insurance. Mrs. Smith who was on dialysis. or Mrs. Fields whose mother couldnt get dental care. I know they would question why were taking away their rights. Today we stand before this body. we beg of them to ask themselves whether this is all about politics or about the American people. I am prepared to extend a hand of friendship. standing on the Constitution. to enable us to provide for all of the citizens of this country. This bill has been vetted. this bill is constitutional. and it protects the constitutional rights of those who ask the question: Must I die. must my child die because I am now disallowed from getting insurance? To our seniors. there are no death panels. This is about your primary care doctor. This is about closing the doughnut hole that will allow you to be able to get discounts on your prescription drugs that some of you have avoided because you have to pay your rent and you have to buy your food. Texas. a big State. has already said through a governmental agency. we need this bill. And we hope that those who come from our State and many other States will not vote against the protection of patients. Vote against H.R. 2 and provide yourself with the protection of the Constitution. Madam Speaker. I stand in strong opposition to the Patients Rights Repeal Act. As a Member of Congress I take seriously my responsibility and sworn oath to serve my constituents and improve the lives of all citizens of this country for the better. The Fourteenth Amendment of the U.S. Constitution states that. "No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States. nor shall any State deprive any person of life. liberty. or property. without due process of law. nor deny to any person within its jurisdiction the equal protection of the laws." The last portion of this amendment. commonly called the Equal Protection Clause. is one of the most important portions of the Constitution. which was added after the Civil War and was the basis for most of the civil rights decisions that transformed this country. Furthermore. many of the legal arguments for demanding medical treatment have also rested on this clause. which the U.S. Supreme Court relied on in its Roe v. Wade decision. Repealing the healthcare reform we enacted last year would be a violation of the Equal Protection Clause of the 14th Amendment of the U.S. Constitution since it would be abridging the fundamental right of U.S. citizens to have health care and would be denying them the equal protection under the law guaranteed to them by the 14th Amendment. Furthermore. even the Founding Fathers more than two centuries ago emphasized the fundamental importance of good health. Thomas Jefferson stated that. "Without health there is no happiness. And attention to health. then. should take the place of every other object . . . The most uninformed mind. with a healthy body. is happier than the wisest valetudinarian." I urge President Obama that should any repeal of any beneficial portion of the Patient Protection and Affordable Care Act come to his desk. he should utilize his presidential prerogative to veto this legislation which would harm the fundamental rights of Americans. As health care reform takes a particularly partisan tone. this Nation. as of January 2011. still has more than 20 million Americans according to the U.S. Census Bureau who live without health insurance. To my colleagues across the aisle. have you truly considered what this repeal would mean and who this would affect? Sadly to say. in my district. the 18th Congressional District of Houston. Texas. the repeal would be devastating. To highlight a few major effects of the repeal for my district. please listen as I explain several devastating changes to health care coverage that a number of populations throughout the 18th Congressional District of Houston. Texas. will face. The repeal would increase drug costs for seniors. There are 5.300 Medicare beneficiaries in my district who are expected to benefit from these provisions. Repeal would increase the average cost of prescription drugs for these Medicare beneficiaries by over $500 in 2011 and by over $3.000 in 2020. The repeal would deny seniors new preventive and wellness care improving primary and coordinated care. and enhancing nursing home care. The repeal would eliminate these benefits for 70.000 Medicare beneficiaries in the district and cause the Medicare trust fund to become insolvent in just six years. The repeal would eliminate tax credits for small businesses. The health reform law provides tax credits to small businesses worth up to 35 percent of the cost of providing health insurance. There are up to 14.600 small businesses in my district. small businesses that are eligible for this tax credit. This repeal would force these small businesses to drop coverage or bear the full costs of coverage themselves. The repeal would increase retiree health care costs for employers. The health reform law provides funding to encourage employers to continue to provide health insurance for their retirees. As many as 5.500 district residents who have retired but are not yet eligible for Medicare could ultimately benefit from this early retiree assistance. The repeal would increase costs for employers and jeopardize the coverage their retirees are receiving. The repeal would increase the cost of uncompensated care born by hospitals. The Health Reform Law benefits hospitals by covering more Americans and thereby reducing the cost of providing care to the uninsured. The repeal would undo this benefit. increasing the cost of uncompensated care by $27 million annually for hospitals in my district. As evidenced in the recent elections. the public has indicated they want less spending and a balanced budget. The Congressional Budget Office estimates the budget will be negatively impacted to the tune of $230 billion dollars over a 10 year period if healthcare reform is repealed. Additionally. more than four million small businesses would lose health insurance tax credits as a result of repeal. and the cost of offering employerbased health insurance could increase by more than $3.000 annually. according to the U.S. Public Interest Research Group. As a Congress we have continued to debate this issue for decades without resolve. The uninsured. the underserved. vulnerable and minority communities are particularly at risk. Lest we forgetin 1999 we asked the Institute of Medicinethe independent organization whose reports are considered the gold standard for health care policymakersto investigate disparities in health and health care among racial and ethnic minorities. The results were damning: the ensuing study. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. found that minorities had poorer health and were consistently receiving lowerquality health care even when factors such as insurance status and income werent involved. As stated by Newsweek. minorities and the underserved were less likely to get lifesaving heart medications. bypass surgery. dialysis. or kidney transplants. They were more likely to get their feet and legs amputated as a treatment for latestage diabetes.-Mary Carmichael. The Great Divide. Newsweek. February 15. 2010. In our current system. most people do not choose to be uninsured but are priced out of insurance. These people cannot. as free market proponents often argue. "pull themselves up by their bootstraps." Instead. they and their families are too often cyclically and systemically trapped in their economic situation. As a result. minority communities suffer grave health disparities that would otherwise be limited but for lack of access to affordable and quality care. What is the price for improving the life expectancy of millions of Americans of all ages? In 2007. only 49 percent of AfricanAmericans in comparison to 66 percent of nonHispanic whites used employersponsored health insurance. according to the Department of Health and Human Services. During the same year. 19.5 percent of AfricanAmericans in comparison to 10.4 percent of nonHispanic whites were uninsured. Hispanics have the highest uninsured rates of any racial or ethnic group within the United States. In 2004. the Centers for Disease Control and Prevention reported that private insurance coverage among Hispanic subgroups varied as follows: 39.1 percent of Mexicans. 47.3 percent of Puerto Ricans. 57.9 percent of Cubans. and 45.1 percent of other Hispanic and Latino groups. Health care reform also is critical to ensure that women have access to affordable health care coverage. An estimated 64 million women do not have adequate health insurance coverage. About 1.7 million women have lost their health insurance coverage since the beginning of the economic downturn. Nearly twothirds lost coverage because of their spouses job loss. And nearly 39 percent of all lowincome women lack health insurance coverage. Women also are more likely to deplete their savings accounts paying medical bills than men because they are more likely to be poor. This bill gives women access to the health care that they need and deserve. Health care reform is a critical step in helping to reduce such health disparities. Are we now telling the American public we will not? Lower costs for minority families and all Americans should forget about preventive care for better health. Racial and ethnic minorities are often less likely to receive preventive care. Vietnamese women. for example. are half as likely to receive a pap smear. and twice as likely to die from cervical cancer as are whites. Obesity rates are also high among certain minority groups. By ensuring all Americans have access to preventive care and by investing in public health. health insurance reform will work to create a system that prevents illness and disease instead of just treating it when its too late and costs more. Are we telling the citizens of this country that we will not? Make health care accessible to everyone. African Americans. Hispanics. and Native Americans are roughly twice as likely to be uninsured as the rest of the population. By providing health insurance choices to all Americans and providing premium assistance to make it affordable. health insurance reform significantly reduces disparities in accessing the best quality for health. We will you tell your constituents that you will not: Control chronic disease and promote primary care. Nearly half of African Americans suffer from a chronic disease. compared with 40 percent of the general population. Chronic illness is growing in other minority communities as well. Health insurance reform is slated to include a number of programs to prevent and control chronic disease. including incentives to provide medical homes and chronic disease management pilots in Medicare. By investing in the primary care workforce (including scholarships and grants to increase diversity in health professions). health reform will make sure that all Americans have access to a primary care doctor and strengthen the system of safetynet hospitals and community health centers to ensure accessible care. The people of my home State of Texas. in particular. with 6 million uninsured persons. and 26 percent uninsured in my district. have been hit especially hard when it comes to lack of access to quality. affordable care. Many Americans continue to be forced from their health care plans due to decisions by insurance companies that consider profit over people. So how do the million plus Houston residents without an insurance company get health carethe emergency room. ER! Emergency rooms have become the health care providers of last resort for well over 100 million Americans annually. Will we allow this trend to continue? Over a 10 year period from 1994 to 2004. ER visits on a national level saw an 18 percent jump. according to the Centers for Disease Control and Prevention. Emergency rooms in Houston hospitals are routinely overcrowded as overused as throngs flock seeking care for ailments that may range from a heart attack or gunshot wound to an ear infection or toothache. ER overcrowding is so bad in the Houston area. that patients have called 911 from one ER to get to another. according to one report. When the President signed the health care bill into law. he ensured that Americans who have been flocking to emergency rooms for primary care will have another optionaffordable and accessible health care. Repealing the health act is not in the best interest of Americans. Health is not partisan and we should not treat it as such. Will we tell the citizens of this great Nation. we will not? Bar insurance companies from discriminating based on preexisting conditions. health status. and gender. create health insurance exchangescompetitive marketplaces where individuals and small business can buy affordable health care coverage in a manner similar to that of big businesses today. offer premium tax credits and costsharing assistance to low and middle income Americans. providing families and small businesses with the largest tax cut for health care in history. insure access to immediate relief for uninsured Americans with preexisting conditions on the brink of medical bankruptcy. invest substantially in community health centers to expand access to health care in communities where it is needed most. empower the Department of Health and Human Services and State insurance commissioners to conduct annual reviews of new plans demanding unjustified. egregious premium increases. expand eligibility for Medicaid to include all nonelderly Americans with income below 133 percent of the federal poverty level (FPL). replace the socalled "cornhusker" deal with fair assistance for all States to help cover the costs of these new Medicaid populations. maintain current funding levels for the Childrens Health Insurance Program (CHIP) for an additional two years. through fiscal year 2015. and increase payments to primary care doctors in Medicaid. Increased costs for families and business in the current economy cannot be best for the Nation. Before we rush headlong toward repeal. we must consider the consequences and look for solutions that hold down costs. not increase them. In opposition to H.R. 2. I offered several amendments to protect the millions of Americans who are at risk of the legislation that is before the body of Congress today. Specifically. my amendments would amend the legislation to make no further reduction in Medicare and Medicaid fraud and would prevent the abuse of activities below the level that would be provided under Title VI and Subtitle F of Title X of the Patient Protection and Affordable Care Act and Sections 1106 and Subtitle D of Title I of the Health Care and Education Reconciliation Act of 2010. Public Law 111152. My amendment stated that this repeal shall not take effect unless and until the Director of Office of Management and Budget in collaboration with the Director of the Congressional Budget Office certifies to Congress that this repeal will not result in any decrease in Medicare and Medicaid fraud and abuse prevention activities below the level provided in the Patient Protection and Affordable Care Act. Health care fraud and abuse has been a national problem. prevalent in Federal. State and private insurance programs. costing this Nation billions of dollars each year. Fraud can result in improper payments. but it is not the only cause of wasteful spending in Federal health care programs. Payments for unnecessary medical services. for claims with insufficient documentation. for ineligible patients and to ineligible providers. are examples of improper expenditures that waste taxpayer dollars and drive up health care costs. Fraud and abuse account for onefifth. an estimated $125 to $175 billion of that waste. This is staggering. Continuing to uncover fraud and abuse will assist in covering the costs of health reform. allowing us to keep the services so many Americans rely upon. while reducing the deficit. The Congressional Budget Office estimates that every $1 invested to fight fraud yields approximately $1.75 in savings. Through FY 2009. the Department of Justices civil division and U.S. Attorneys Offices have recovered nearly $16 billion in matters alleging fraud against government health care programs. As we look to make nonpartisan decisions that will benefit the American people and guarantee fair and equitable health care coverage. the Obama administration has taken steps to significantly improve oversight of the Medicare Part C and Part D programs. These steps have sought to tailor interventions towards the areas where fraud and abuse are the greatest. Efforts have been implemented to invest in critical data infrastructure. enhanced field operations at Centers for Medicaid and Medicare Services. the Office of Inspector General. and Department of Justice. and initiated new efforts to reduce improper payments. On July 2010. U.S. Health and Human Services Secretary. Kathleen Sebelius and U.S. Attorney General. Eric Holder launched a series of regional health care fraud prevention summits. These summits brought together a range of Federal. State and local partners. beneficiaries. providers. and other interested parties to discuss innovative ways to eliminate fraud within our U.S. health care system. Tools contained in the Affordable Care Act serve to safeguard taxpayer dollars and ensure health care coverage for seniors. families and children are secure. The Nations health care system has been victimized by health care fraud perpetrators whose objective is to line their pockets at the expense of the American taxpayer. patients. and private insurers. This not only drives up costs for everyone in the health care system. it cripples the long term solvency of Medicare and Medicaid. two programs upon which millions of Americans depend. This particular amendment was essential to hold State and local partners. beneficiaries. providers. and others accountable to their patients and communities and ensure these new policies are used in an effective manner to yield the best possible outcome. Regarding community health centers. I offered an amendment that would prevent Section 2 of House Bill H.R. 2 from taking effect unless and until the Director of the Office of Management and Budget. in consultation with the Director of the Congressional Budget Office. certifies to Congress that the repeal of the Patient Protection and Affordable Care Act (Public Law 111148) will not result in an elimination of any increased funding to community health centers provided under the Patient Protection and Affordable Care Act or the Health Care and Education Reconciliation Act of 2010 and will not result in any decrease in the number of community health centers. and will not otherwise disallow further expansions of community healthcare centers. It is important to protect the historic healthcare legislation which we fought so hard to enact in order to provide the accessible. affordable and quality healthcare that all Americans deserve and so many Americans receive through community healthcare centers. Community health centers are poised to play a vital role in the implementation of the Affordable Care Act and emphasize coordinated primary and preventive services. These centers also provide preventive services. Routine health care that includes screenings. checkups. and patient counseling to prevent illnesses. disease. or other health problems. Offer a medical home to the most vulnerable and medically underservedlowincome individuals. racial and ethnic minorities. rural communities and other underserved populations to address and reduce health disparities. Community health centers continue to show their ability to manage patients with multiple health care needs. and implement key quality improvement practices. including health information technology. For more than forty years. health centers have delivered quality. comprehensive preventive and primary care to patients regardless of their ability to pay. With a proven track record of success. and the advent of 350 new community health care centers being established in fiscal year 2011. a repeal of the Affordable Care Act will threaten the very fabric of this Nations health care system. Currently. more than 1.100 community health centers operate 7.900 service delivery sites and provide care to nearly 19 million patients in every state. the District of Columbia. Puerto Rico. the U.S. Virgin Islands. and the Pacific Basin. The Affordable Healthcare Act included enhanced funding for operations and startups of federally qualified health centers in the Harris County Hospital district. which is in the 18th Congressional District of Texas. my home district. thereby increasing the availability of primary health care and preventive health care services. The Affordable Healthcare Act also provided funding for and policy direction to increase the number of primary care providers in the Harris County Hospital district and the state of Texas. inclusive of physicians and physician extenders (advanced nurse practitioners). The Affordable Healthcare Act also directed states to increase provider payment rates to physicians in the Medicaid program. This is significant in that rates are so low in Texas many physicians are unwilling to take Medicaid patients. According to the Texas Health and Human Services Commission Study. there are currently 1.1 million uninsured in Harris County. Texas. Full implementation of health care reform would reduce that number to a little over 390.000. That represents a 65 percent reduction in the number of uninsured residents. Diminished access to primary and preventive health care services that in turn will lead to a moreover use of acute care hospital inpatient services and emergency center encounters at much higher costs to county taxpayers and higher Medicaid per capita expenditures for the state and Federal government. Without reform. cuts to the Medicare and Medicaid program will put a greater strain on existing safety net providers and local tax payers. Without expanded care and insurance reforms. people will not have access to affordable. lower cost health care services. Specifically. in my Congressional district. the South Central Houston Community Health Center has been serving the Houston community since 1994 and has locations in the Sunnyside and Third Wards areas of Houston. By being the oldest. Federally qualified health center in the city of Houston. the community health center has grown to receive over 1.2 million in annual Federal funds. which is instrumental in providing quality health care to the medically underserved. uninsured. and underinsured people of the greater Houston area. The South Central Houston Community Health Center has made tremendous progress towards eliminating healthcare disparities and increasing access to healthcare services to the Houston community. The Legacy Community Health Center in my Congressional district has also benefitted greatly from the Affordable Healthcare Act. The Legacy Community Health Center is a fullservice. community health center that provides comprehensive. primary healthcare services to all Houstonians in a culturally sensitive. judgmentfree and confidential environment. Legacy has specialized in HIV/AIDS testing. education. treatment and social services since the early 1980s. They also provide care for other chronic health conditions like diabetes and high blood pressure disparately impacting minorities. Generous financial support from individuals. businesses and charitable foundations allows Legacy to provide nocost or lowcost healthcare services to over 30.000 men. women and children each year. The Good Neighbor Healthcare Center also in my Congressional district offers a wide array of services to families living in the greater Houston area. Services include primary health care. dental care. optometry. and behavioral health services. Good Neighbor Healthcare Center has a special mission to the community that goes right to the heart of providing quality. accessible primary health care and dental care to those in need. Good Neighbor Healthcare Center serves patients from virtually every zip code in Harris County. and the diverse staff is ready to assist patients with all of their health care needs. Good Neighbor Healthcare Center assists patients in Spanish or English as needed as well. Community health centers are an integral part of our communities providing a source of local employment and economic growth in many underserved and lowincome communities. In 2009. community health centers across the Nation provided more than $11 billion in operating expenditures directly into their local economies. Community health centers employ more than 9.100 physicians and more than 5.700 nurse practitioners. physician assistants. and certified nurse midwives to treat patients through culturally competent. quality and integrated care. And lastly. I offered an amendment that would be essential to an unprecedented opportunity to serve more patients. retain existing and support new jobs. meet the significant increase in demand for primary health care services among the nations uninsured and underserved populations and address essential construction. renovation. and equipment and health information technology systems needs in community health centers. I cannot turn my back and shut the door on the constituents I represent in securing accessible. affordable and quality healthcare services in my Congressional district. If the Healthcare Repeal Bill were to pass. this amendment would ensure that insurance rates do not increase from those rates that would have applied if the law is left intact. Health care reform is something that people have fought for fervently for years. and it would be a great disservice to the American people if the health care law were repealed as a result of politics. The Patient Protection and Affordable Care Act insure access to quality. affordable healthcare for all Americans. It also makes necessary changes that will make our system of health care more efficient. Children are allowed to stay on their parents health insurance until the age of twentysix. Patients cannot be refused health insurance coverage because of preexisting conditions. Insurance premiums were lowered and mechanisms are in place to avoid them getting any higher. Repealing health care reform would reverse all of this good that has been done. However. if the Patient Protection and Affordable Care Act is repealed. it is important that certain provisions of the law remain intact. For aforementioned reasons. I urge my colleagues to reason with the American people and provide an opportunity for every American in every state to receive affordable and quality healthcare. If the Healthcare Law is repealed without the inclusion of my amendment. that would ensure that insurance rates do not increase from those rates that would have applied if the law is left intact. we are left great potential for health insurance rates to rise. much like they did in the past. to levels which make coverage inaccessible and unaffordable for many Americans. Before the Healthcare Reform Bill was signed into law. increasing healthcare costs were crushing the budgets of families and American businesses. making us less competitive in the ever growing global market. placing Medicare and Medicaid in serious danger. damaging our longterm fiscal stability. and worse of all. causing Americans to continue to go without basic health care coverage. This broken health care system was driving up health care costs and weakening our economy. Minorities in general were more in danger of being uninsured and falling victim to frequent emergency visits. increasing debt that leads to bankruptcy. and premature death. Without healthcare reform. a devastating number of citizens would have had to continue to live without healthcare. No American citizen should have to face a decision of whether to buy food or pay healthcare premiums. Putting a face to healthcare is recognizing Iris Williams from Houston. Texas. For many mothers. finding a good doctor for their children can be quite difficult. especially if they dont have health insurance. When the child has fears of going to the doctor. the difficulty only worsens. Iris Williams first brought her son. Simon. to Legacy Community Health Services in 2007. As a resident in the surrounding area. Iris liked the convenience of Legacys Community Health Center on Lyons Avenue in the heart of her neighborhood. When she found out Legacy offered school physicals. even to those without health insurance. she was thrilled. "My son had a bad experience with a doctor when he was younger and did not like going to the doctor." Iris sighed. "But Legacy was able to schedule a physical for Simon within the week. and I was told it would only cost $45." Now that Iris had an appointment for her son at an affordable cost. she only had to worry about whether Simon would like the doctor. "I just love Dr. Levine. he is so kind and wonderful." Iris continued. "he not only made my son feel at ease but he also treated him like a young man. That made us both feel really good." This past summer Simon hurt his finger at a summer program. Iris had to take him to the emergency room to get his fingernail removed. For his followup care Iris sought out Legacy to clean the wound and make sure it was healing properly. "Again the staff at Legacy was great and the finger is healing nicely." Iris glowed. "I am so glad Legacy had a doctor to care for him after the visit to the ER." When people in Iriss neighborhood ask her where to go for quality and affordable healthcare. Iris doesnt hesitate to refer them to Legacy. She knows they will get great care. Iris stated. "it gives me great satisfaction knowing that Legacy is here for all of us and will take care of our health care needs." Madam Speaker. what do you expect I say to constituents similar to Iris Williams? Madam Speaker. before the Healthcare Reform Bill passed. the need for more efficient healthcare was dire. especially within my home State of Texas. One in four Texans. about 5.7 million people. or 24.5 percent of the States population. had no health insurance coverage. An estimated 1.339.550 Texas children20.2 percent of Texas childrenwere uninsured. According to the U.S. Census Bureau. Texas had the Nations highest percentage of uninsured residents. This posed consequences for every person. business. and local government in the State who were forced to bear extra costs to pay for uncompensated care. If the Patient Protection and Affordable Care Act is repealed. Texas. like many other States. runs the risk of a reoccurrence of statistics such as these. Over the years. I have had the opportunity to meet with health care providers who have been on the front lines of health care debates from day one. It is no surprise that they enthusiastically endorsed healthcare reform. and many are still holding out hope for progressive changes to the current healthcare laws as we move forward in this new Congress. These health professionals have seen the pain and frustration of hardworking Americans who faced financial collapse. physical suffering. and sometimes the loss of their life simply because they did not have decent health care coverage. The repeal of healthcare reform could lead our Nation back down a similar path. and I am confident that no health care professionals. nor I. or any of my colleagues would want to see situations like that reoccur. The late Congresswoman Barbara Jordan. who once held the seat that I so proudly and humbly hold today said. "What the people want is very simple. They want an America as good as its promise." These words resonate in our time and the American people only ask for simple things. Therefore. I and my fellow colleagues are striving to maintain something we fought for tirelessly for years and were finally able to secure in the last Congressthe ability to provide all Americans with affordable and accessible healthcare. For these reasons. I urge my colleagues to allow their conscious to recognize the greater need to work across the aisles with one another and strengthen our healthcare system to one day provide universal healthcare for all Americans. Again. I am in opposition of H.R.