Date: 2010-03-21
Speaker: JACKSON LEE (democrat)
Chamber: H
State: Texas

In the name of my mother. Ivalita Jackson. I affirmatively support this bill for all of America. Mr. Speaker. I have the great honor and privilege to rise in strong support of H.R. 4872. "The Health Care & Education Affordability Act of 2010." a bill that will make health care affordable for the middle class. provide security for seniors. and guarantee access to health insurance coverage for the uninsuredwhile responsibly reducing the federal deficit over the next decade and beyond. I would like to thank President Obama and the leadership in the House and Senate for guiding us through this journey. Mr. Speaker. when I stand here today and reflect upon what we are about to embark upon. I cannot help but think of some of the last words that the Great Senator Edward Kennedy shared in his letter to President Obama. The Senator said. "And so because of your (Obamas) vision and resolve. I came to believe that soon. very soon. affordable health coverage will be available to all. in an America where the state of a familys health will never again depend on the amount of a familys wealth. And while I will not see the victory. I was able to look forward and know that we willyes. we willfulfill the promise of health care in America as a right and not a privilege. Well. Senator. your lifes work shall today be proven to not be in vain. Though it has been a long journey to get to this place and many have suggested that we need to start over and wait until some other time in the future to address the health care crisis. In the words of the great civil rights leader. Dr. Martin Luther King. Jr.. that "we have also come to this hollowed spot to remind America of the fierce urgency of now." We cannot wait. We will not wait any longer to provide the citizens of this great Nation access to affordable. quality health care. Today when we pass this bill. it will be a historic day not only for tens of millions of uninsured Americans. but also for our great Nation. As Speaker PELOSI has reiterated. we as Members of Congress. are "humbled to stand here at a time when we can associate ourselves with the work of those who passed Social Security. those who passed Medicare. and now we will pass health care reform." Many parallels exist between that time in history and today. Throughout this journey. we have listened to a parade of Republicans warn that this bill will bring the downfall of American society. of the American way of life. This. however. is not the first time that the Republicans have been on the wrong side of history. In an interview in 1975. David L. Kopelman. who played a prominent role in the early administration of the Medicare Program. remarked that his colleagues were often criticized by Republicans. "Communist." he recalled. "was the designation all too liberally applied to anyone with a progressive idea. Well. after all. when we went around making contact with employers in those early years that was the designation not delicately applied by many. if not most of them. to the social security program. It must be some communist scheme foisted on the American people." AIf Landon. the Republican candidate for President in 1936. even campaigned on the fact that not a dollar in social security benefits would ever be paid. Mr. Speaker. unfortunately. such ad hominem attacks are as prevalent as ever. The Republicans want you to believe that our country is descending into an abyss of socialism. but nothing could be further from the truth. Today. I am proud to support a bill that is distinctly American. We the people. Thomas Jefferson wrote in the Declaration of Independence are endowed "with certain unalienable Rights that among these are Life. Liberty and the pursuit of Happiness.-That to secure these rights. Governments are instituted among Men. deriving their just powers from the consent of the governed . . ." I believe that it is no coincidence that life is listed firstfor without it. the Founders realized. no other rights can be realized. Over many years. the millions of Americans who could not access medical services were denied their right to lifea life with access to quality and affordable health care. Let me set the record straight. this bill is good for the American people and will go a long way to ensuring access to quality and affordable care to those millions of Americans who for far too long have been left out of the health care equation. This health insurance reform legislation (the Senate bill as improved by the Reconciliation Bill) that the House is considering today will not only ensure that Americans have access to quality. affordable health care. but will also significantly reduce long term health care costs. The nonpartisan Congressional Budget Office (CBO) has determined that it will provide coverage to 32 million more people. or more than 95% percent of Americans. while lowering health care costs over the long term. This historic legislation will reduce the deficit by $138 billion over the next ten years. with $1.2 trillion in additional deficit reduction in the following 10 years In the words of the great President John F. Kennedy. "the voters selected us. in short. because they had confidence in our judgment and our ability to exercise that judgment from a position where we could determine what were their own best interest. as a part of the nations interest." Mr. Speaker. while my colleagues on the other side of the aisle claim that this bill will harm Americans. nothing could be further from the truth. This bill will: Make health insurance affordable for middle class and small businessesincluding the largest middle class tax cuts for health care in historyreducing premiums and outofpocket costs. Strengthen consumer protections and rein in insurance company abuses. Give millions of Americans the same types of private insurance choices that members of Congress will havethrough a new competitive health insurance market that keeps costs down. Hold insurance companies accountable to keep premiums down and prevent denials of care and coverage. including for preexisting conditions. Improve Medicare benefits with lower prescription drug costs for those in the "donut hole". it also provides better chronic care. free preventive care. and nearly a decade more of solvency for Medicare. As President Obama says. "we must act now" and put American families and small businesses. not health insurance companies. in control of their own health care. This bill will do exactly that. Many of my colleagues on the other side of the aisle claim that we are passing a bill that nobody really knows what is in it. Well. Mr. Speaker. let me just take a minute to list a few things that are in the bill. The bill provides quality. affordable health care for all Americans that:a Bars insurance companies from discriminating based on preexisting conditions. health status. and gender. Provides Americans with better coverage and the information they need to make informed decisions about their health insurance. Creates 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. Offers 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. Insures access to immediate relief for uninsured Americans with preexisting conditions on the brink of medical bankruptcy. Creates a reinsurance program in support of employers who offer retirees age 5564 health coverage. Invests substantially in community health centers to expand access to health care in communities where it is needed most. Empowers the Department of Health and Human Services and state insurance commissioners to conduct annual reviews of new plans demanding unjustified. egregious premium increases. Expands eligibility for Medicaid to include all nonelderly Americans with income below 133 percent of the Federal Poverty Level (FPL). Replaces the socalled "Cornhusker" deal with fair assistance for all states to help cover the costs of these new Medicaid populations. Maintains current funding levels for the Childrens Health Insurance Program (CHIP) for an additional two years. through fiscal year Increases payments to primary care doctors in Medicaid. The bill improves medicare by: Adding at least nine years to the solvency of the Medicare Hospital Insurance trust fund. Filling the Medicare prescription drug donut hole. In 2010. Medicare beneficiaries who go into the donut hole will receive a $250 rebate. After that they will receive a pharmaceutical manufacturers 50 percent discount on brandname drugs. increasing to a 75% discount on brandname and generic drugs to close the donut hole by 2020. Providing new. free annual wellness visits. and eliminates outofpocket copayments for preventive benefits under Medicare. such as cancer and diabetes screenings. Providing better chronic care. with doctors collaborating to provide patientcentered care for the 80 percent of older Americans who have at least one chronic medical condition like high blood pressure or diabetes. Improving Medicare payments for primary care which will protect access to these vital services. Reduces overpayments to private Medicare Advantage plans. Medicare currently overpays private plans by an average of 14 percent. This legislation reins in those overpayments to ensure a fair payment system that rewards quality. Encouraging reimbursing health care providers on the basis of value. not volume. The bill includes a number of proposals to move away from the "a la carte" Medicare feeforservice system toward paying for quality and value while reducing costs for Americas seniors. The bill prevents chronic disease and improves public health that promotes preventive health care at all ages and improves public health activities that help Americans live healthy lives and retrain the growth of health care costs over time. The legislation eliminates costsharing for recommended preventive care. provides individuals with the information they need to make healthy decisions. improves education on disease prevention and public health. and invests in a national prevention and public health strategy. The bill improves health care workforce by making key investments in training doctors and nurses and other health care providers. Currently. 65 million Americans live in communities where they cannot easily access a primary care provider. An additional 16.500 practitioners are required to meet their needs. The legislation addresses shortages in primary care and other areas of practice by making necessary investments in our Nations health care workforce. Specifically. it will invest in scholarship and loan repayment programs through the National Health Service Corps to expand the health care workforce. The bill also includes incentives for primary care practitioners and for providers to practice in underserved areas. The bill provides for transparency and program integrity by providing consumers with information about physician ownership of hospitals and medical equipment companies. as well as nursing home ownership and other characteristics. The bill also includes provisions that will crack down on fraud. waste. and abuse in Medicare. Medicaid. SCHIP and private insurance. It establishes a private. nonprofit entity to identify priorities in patientcentered outcomes research that will provide doctors with information on how to best treat patients and end wasteful overspending. This bill also improves access to innovative medical therapies and establishes a regulatory pathway for FDA approval of biosimilar versions of previously licensed biological products. The bill also provides community living assistance services and support that makes longterm support and services more affordable for millions of Americans by providing a lifetime cash benefit that will help people with severe disabilities remain in their homes and communities. CLASS is a voluntary. selffunded. insurance program provided through the workplace. For those whose employers participate. affordable premiums will be paid through payroll deductions. Participation by workers is entirely voluntary. The Congressional Budget Office confirms that the program. which has been revised from earlier versions. is actuarially sound. The bill provides revenue provisions that: Reduce the deficit in the next ten years and beyond. The bill is fully paid for with revenue provisions that focus on paying for reform within the health care system. Tighten current health tax incentives. collect industry fees. institute modest excise taxes. and slightly increase the Medicare Hospital Insurance (HI) tax for individuals who earn more than $200.000 and couples who earn more than $250.000. The taxable base of the HI tax is also broadened by including net investment income. The HI tax increases will not only help fund health care reform. but. when combined with other provisions in the bill. will also extend the solvency of the Medicare Trust Fund by at least nine years to 2026. Include a fee on insurance companies that sell high cost health insurance plans. The fee is designed to generate smarter. more costeffective health coverage choices. The reconciliation bill delays this new fee until 2018 so that plans have time to implement reform and begin to save from its efficiencies. Change health care tax incentives by increasing penalties on nonqualified distributions from HSAs. capping FSA contributions. and standardizing the definition of qualified medical expenses. The industry fees and excise taxes reflect responsible contributions from health care stakeholders who will benefit from the expanded coverage of millions of additional Americans under health care reform. The bill also assesses a small excise tax on indoor tanning services. In total. the revenue provisions in the bill represent a balanced. responsible package of proposals that bend the health care cost curve by putting downward pressure on health spending. close unintended tax loopholes. and promote tax compliance. Mr. Speaker. who among us can say with sincerity that the quality of ones life. which certainly includes ones health. is not heavily dependent upon the access to quality. affordable health care. According to the National Academy of Sciences. Institute of Medicine. there is a "consistent and statistically significant relationship between health insurance coverage and health outcomes for adults. These factors. in turn. improve the likelihood of disease screening and early detection. the management of chronic illness. and the treatment of acute conditions ...." Recently. a study published in the American Journal of Public Health by researchers at Harvard University Medical School concluded that nearly 45.000 excess deaths of Americans can be linked each year to lack of health insurance. According to the U.S. Census Bureau. 27 million Americans live without health insurance. and an additional 1.1 million parttime workers lost their health insurance in 2008. Implementing this legislation will instantly improve the life expectancy of millions of Americans of all ages. It is impossible to put a price on that. When we talk about the right to healthcare. we are actually talking about the right to lifea life that includes access to quality health care. The bill contributes to reducing health disparities. Minority communities are particularly vulnerable to being left uninsured and underinsured. In our current system. most people do not choose to be uninsured but. instead. 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. According to a 2003 National Health Disparities Report released by the Agency for Research Quality and Care: Minorities are more likely to be diagnosed with latestage breast cancer and colorectal cancer compared with whites. Patients of lower socioeconomic position are less likely to receive recommended diabetic services and more likely to be hospitalized for diabetes and its complications. When hospitalized for acute myocardial infarction. Hispanics are less likely to receive optimal care. Many racial and ethnic minorities and persons of lower socioeconomic position are more likely to die from HIV. Minorities also account for a disproportionate share of new AIDS cases. The use of physical restraints in nursing homes is higher among Hispanics and Asian/ Pacific Islanders compared with nonHispanic whites. Blacks and poorer patients have higher rates of avoidable hospital admissions (i.e.. hospitalizations for health conditions that. in the presence of comprehensive primary care. rarely require hospitalization). This historic bill is particularly important for minorities and womenwho have gone without health care coverage for too long. 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. Passage of this bill will be a critical first step in helping to reduce such health disparities. This bill will: 1. Lower costs for minority families and 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. 2. Provide greater choices and more affordable choices and competition. African Americans. Hispanics. and Asians are all more likely to need a referral in order to see a specialist and they are less likely to get coverage for seeing a doctor outside of the insurance network. Health insurance reform will create a health insurance exchange so you can compare prices and health plans and decide which quality affordable option is right for you and your family. It will include a competitive public option that increases choices and holds private insurers accountable. 3. Allow for quality. affordable health care for minorities and eliminates discrimination in obtaining health insurance. Health insurance reform will prevent any insurance company from denying coverage based on a persons medical history. including genetic discrimination which can disproportionately hurt minority populations. 4. 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 will significantly reduce disparities in accessing highquality health care. 5. Control chronic disease. 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 includes a number of programs to prevent and control chronic disease. including incentives to provide medical homes and chronic disease management pilots in Medicare. 6. Promote primary care. By providing health insurance choices through a health insurance exchange and 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 so they stay healthier. longer. It will also strengthen the system of safetynet hospitals and community health centers to ensure highquality. accessible care. Health reform legislation will require any health care program to report on race. ethnicity. gender. and socioeconomic status in order to better understand health disparities. and devote funding to addressing these issues. The uninsured in Texas. The people of my home state of Texas. in particular. with 6 million uninsured persons. and 26 percent uninsured in my district. the 18th Congressional District. have been hit especially hard when it comes to lack of access to quality. affordable care. And just what causes such a massive loss of health care coverage? Job layoffs are partially to blame especially in the face of the economic downturn. Yet. we know that the uninsured problems existed way before the devastating recession. Many Americans continue to be forced from their health care plans due to decisions by insurance companies to put profits over people. Policy cancellations rather than paying for expensive yet necessary medical treatment is just one of the many techniques used by large insurance companies to rack up huge profits annually. According to the latest figures analyzing the profits of health insurance companies. 10 of the countrys largest publicly traded health insurance companies enjoyed a rise in profits of 428 percent. from 2000 to 2007. From filings with the U.S. Securities and Exchange Commission. it was revealed that in 2007. these insurance companies alone generated $12.9 billion in profit. That same year. the chief executive officers at these companies collected combined total compensation packages of $118.6 millionan average of $11.9 million each. That is 468 times more than what an average American worker made that year. Since 2007. there has been a 10 percent increase in the uninsured rate in Texas alone. Today. 6.240.000 Texans are without even basic health insurance. And this broken health insurance system has cost the Texas economy dearly. This year. Texas lost $30 billion in productivity as a result of its millions of uninsured residents. Those in our state who are blessed to have insurance coverage have in some ways been losers as well. Specifically. the average Texan family pays insurance premiums of over $1000 a month. This figure is set to nearly double to $1920.75 per month by 2019. that is. unless we succeed in passing health care reform legislation. Today. when we pass this bill. the people of Texas and all over this nation become winners. We know that many of our colleagues in this body do not want to reform the health care system and are on the side of the big insurance companies. We choose to stand on the side of the Americans who need our help. President Franklin D. Roosevelt said it best when he said. "the test of our progress is not whether we add more to the abundance of those who have much. it is whether we provide enough for those who have little." While the statewide numbers are shocking. on the local level. the health care figures are even worse. The 18th Congressional District and the rest of Houston. account for 1.1 million of the states uninsured residents. Nationally. more than 15 percent are uninsured. In Texas its nearly 24 percent. Here in Harris County. its 30 percent. according to state figures. the highest rate among the nations top 10 metropolitan areas. So how do the million plus Houston residents without insurance company get health careemergency rooms of course. Emergency rooms have become the health care providers of last resort for well over 100 million Americans annually. 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. The Texas Hospital Association reports that ERs in the state experienced a 33 percent increase. in the Houston area. it was more than 50 percent. During this ten year period. the number of hospital emergency departments dropped by more than 12 percent nationally. Emergency rooms in Houston hospitals are routinely overcrowded and overused as throngs flock seeking care for ailments that may range from a heart attack or gunshot wound to an ear infection or toothache. Ambulances pile up outside emergency rooms before unloading their patients. Its reported that a wait of an hour or two to move a patient from the ambulance to the ER is common in Houston. David Persse. the Houston Fire Departments medical director. confided with a reporter recently that the record wait to unload an ambulance at Houston area hospital is six hours. Ben Taub. the Houston areas preeminent trauma care facility. has seen the brunt of the problem. In a recent USA Today article. one Ben Taub nurse reported arriving to work one morning to find ER patients waiting to be seen who arrived the day before. over 24 hours earlier. ER overcrowding is so bad in the Houston area. that patients have called 911 from one ER to get to another. according one report. When we pass this bill tonight. these Americans who have been flocking to emergency rooms for primary care will have another optionaffordable and accessible health care. The benefits to the 18th congressional district: In my district. the health care bill will: Improve coverage for 279.000 residents with health insurance. Give tax credits and other assistance to up to 186.000 families and 14.600 small businesses to help them afford coverage. Improve Medicare for 70.000 beneficiaries. including closing the doughnut hole. Extend coverage to 180.500 uninsured residents. Guarantee that 27.600 residents with preexisting conditions can obtain coverage. Protect 500 families from bankruptcy due to unaffordable health care costs. Allow 62.000 young adults to obtain coverage on their parents insurance plans. Provide millions of dollars in new funding for 20 community health centers. Reduce the cost of uncompensated care for hospitals and other health care providers by $27 million annually. As we reach this great milestone today. I am still reminded of the unfinished work that is left to do. We must ensure that physicianowned hospitals are allowed to maintain operations that allow them to serve the most vulnerable and underserved communities. I am committed to working with the Speakers office and Senatorial leadership now that we are taking the first step in stemming the rising tide of the many uninsured. The protection of physicianowned hospitals is an issue of national interest. We have a lot of work to do as we move toward the Senate and to the conference. I was gratified to meet with the Speaker to discuss the continued protection of the very viable physicianowned hospitals and believe that we have a real opportunity to address this issue in the very near future. I offered three amendments that would have gone a long way to save physicianowned hospitals. My first amendment would have preserved physicianowned facilities that have a greater percentage of Medicaid inpatient admissions than the state average in operation and allows them to expand. My second amendment is extremely critical for minority communities and high poverty. This amendment would prevent physician safetynet hospitals from closing and preserves critical care access for impoverished communities and the disabled. My third amendment. supported by Physician Hospital Association of America. would effectively prevent the closure of 230 existing hospitals. save $2.9 billion in total payroll. $608 million in federal taxes. $3.5 billion in trade payables. and preserves 62.000 full- and parttime jobs by striking all language that prohibits grandfathered facilities from expanding. During the ongoing healthcare debate. discussions about physician ownership of hospitals have ignored the positive impact these facilities have had on minority communities and minority physicians. Physicianowned general acute care hospitals. who have unprecedented amounts of minority owners. have allowed Hispanic. Black. and Asian Americans to enter into the field of hospital ownership. The largest physicianowned hospital. Doctors Hospital at Renaissance. is over 50 percent minority owned. To help my colleagues understand what is at stake. I would like to highlight some of these success stories: In Houston. St. Josephs Hospital. a fullservice general acute care center. is the only hospital that serves one of the most incomechallenged and AfricanAmerican sections of the city. Within the last few years. a forprofit corporation abandoned this hospital and the surrounding community. Physician ownership provided an avenue for it to stay open and prevent a critical loss for the neighborhood. In South Texas. outofstate corporations forced over 700.000 Texans to travel more than 250 miles to receive lifesaving medical procedures. Decisions not to offer needed services by outofstate healthcare conglomerates and the lack of public or county hospitals. left patients with two options: go without or to transfer to another facility up to 350 miles away. Incomechallenged families who could not afford the travel were placed in great peril. Physician ownership enabled a group of local doctors to open a new hospital with advanced medical capabilities that reduced the need for travel to seek care. Doctors Hospital at Renaissance. a 506bed premiere general acute care center. now provides some of the best care in the Nation and consistently has been recognized by Thompson Reuters as a Top 100 Hospital in the Nation. In the Chinatown section of Los Angeles. California. the Pacific Alliance Medical Center (PAMC). a 142bed fullservice hospital. has been the communitys main hospital for 140 years. This facility was purchased by a group of physicians 20 years ago after the existing hospital board planned to close and demolish the facility. Physician ownership once again provided an avenue for the hospital to stay open and serve an atrisk community. I will continue to work on behalf of these Americans and to to save physicianowned hospitals that are currently treating patients or under significant development. to ensure that Americans can continue to receive healthcare at the local hospitals they have come to depend upon. Physicianowned hospitals take care of patients covered by Medicare and Medicaid. as well as patients who are uninsured or cannot pay for their care. They also provide emergency departments access for their communities. At a time when we are concerned about the shortage of hospital beds in the face of epidemics like the swine flu. my amendment to this landmark bill will make sure no hospital is forced to shut its doors or turn away Medicare or Medicaid patients. The benefits that will come from our efforts to protect physicianowned hospitals are far reaching and will prevent any further losses to local economies. Not only do physician hospitals deliver highquality medical care to the patients they serve. they also provide much needed jobs. pay taxes. and generate significant economic activity for local businesses and communities. Existing physicianowned hospitals employ approximately 51.700 individuals. have over 27.000 physicians on staff. pay approximately $2.421.579.312 in payroll taxes and $512.889.516 in other federal taxes. and have approximately $1.9 billion in trade payables. Hospitals currently under development would employ approximately 21.700 more individuals. With approximately 50 physicianowned hospitals. Texas leads the Nation in the number of physicianowned hospitals. The Texas economy could lose more than $2.3 billion and more than 22.000 jobs. In my district. the 18th Congressional District of Houston. Texas. St. Joseph Medical Center is a general acutecare hospital that treats all patients. In fact. its 40 percent Medicaid patient population is double the average hospitals patient population in the entire State of Texas and is one of the highest in the country. St. Josephs was operated by the Sisters of Charity for many years until it was scheduled to be closed because the order could no longer support it. The hospital was offered to forprofit and notforprofit hospital systems but no one would accept responsibility for operating St. Josephs. A plan was developed to convert the hospital into condominiums. I refused to allow that to happen. It was only at that point that the physicians who had practiced there for many years came together to buy the hospital to save it from closing. St. Josephs takes care of patients covered by Medicare and Medicaid. as well as patients who are uninsured or cannot pay for their care. The emergency departments of many physicianowned "specialty hospitals" have been criticized for not having a true emergency department. St. Josephs has a department which is open 24 hours per day. 7 days per week. providing an access point for patients in need of emergency services. In fact. St. Josephs admissions through the emergency department are double the State average. St. Lukes hospital in Houston. which is churchowned. has three new facilities under development. the nonprofit religious mission has the controlling interest. One fullservice hospital has one phase already operating. but would be under the growth restrictions. the hospital cannot be completed if the new restrictions apply. The hospital brought approximately 300 new jobs to the community. and Baylor Health Care System. based in Dallas. has found that their partnership with physicians has increased measurable quality. increased patient satisfaction. and decreased the cost in the delivery of their excellent care. This joint venture model has produced a heart hospital that has the lowest readmission rate in the entire United States. And yet this bill would deny Baylor Health Care System the right to add a single operating room or procedure room to meet its communitys need. During the moratorium on physicianowned hospitals some years ago. Baylor wanted to add a badly needed OB/GYN service at its Frisco. Texas. hospital. This service is a moneylosing service. but there was no such service within many miles for those peopleBaylor fulfilled the need. It was prohibited from adding this service simply because the hospital had physicians holding a minority of the ownership of the hospital. After the moratorium was lifted. the service was added and is currently working at its capacity. Mr. Speaker. can we imagine witnessing an impact. of no patient beds. 6- to 8hour waiting times. to extend even to 10hour waiting times. turning emergency patients away at the door? Can we imagine the dramatic case. when patients are not able to have access to quality care? This is true of the most serious trauma. of the most serious medical cases. Physicianowned hospitals serve in many cases at least 40 percent of the citys population. I dont just mean the citys population. We are discussing a population that is between 500.000. which is the indigenous population. and the population of 1.5 million thats in the city every day. When a hospital downsizes in a particular city. it extends beyond the boundaries of that city. and in doing so. with this hospital being downsized. its impacting all of the hospitals. not only in the city. but those hospitals in nearby jurisdictions. Were seeing the epicenter of a catastrophic event. and unless we realize the importance of this one medical facility. but look at it not from the perspective that it serves this city. but we have to realize that it serves the world. It serves the Nation. At the very least. it serves the Nation. at the very most. it most serves the world. So when you start looking at it from those perspectives. then it becomes more than just a problem of Houston. Texas. but a problem of this Nation. And it should be addressed in that manner. If we do not work closely together to look deeper at this issue. we will face a number of medical facility closures that is a disservice to the American people. So. we see that there seems to be a phasingback or cutback in all of the major services. but the most important of those services. which directly affect the health and wellbeing of the citizens. or again. those 1.5 million people who visit and work in the city every day. So. we hear the same thing time and time again. even though individuals are saying that the patient caseload can be handled by the surrounding hospitals. You need but step into any emergency room on any day. at any time. and just see the impact of this one hospital being downsized. The impact will reach out throughout the city of Houston. Mr. Speaker. through all the debate. namecalling. threats. and fearmongering. we will once again be on the right side of history and put the American people first. In the midst of it all. some of my colleagues have been called derogatory names. including racial epitjets. have been spat on and have been threatened that there will be blood in the streets. But there is something that I must say to my fellow Americans as we stand on the threshold of the door that opens up to access to quality and affordable care and. in turn. a better quality of life for all Americans. Heeding one of this countrys greatest leaders in history. Dr. Martin Luther King. Jr.. I urge us to remember that "in the process of gaining [life. liberty. and the pursuit of life]. we must not be guilty of wrongful deeds. Let us not seek to satisfy our thirst for freedom by drinking from the cup of bitterness and hatred. We must forever conduct our struggle on the high plane of dignity and discipline . . . we must rise to the majestic heights of meeting physical force with soul force. Mr. Speaker. I urge my colleagues and I to stand strong. support this bill on behalf of all Americans.