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Maintaining Expansion of Telemedicine

Floor Speech

Date: Nov. 17, 2020
Location: Washington, DC


Mr. SCHWEIKERT. Madam Speaker, with all the chaos and the activity going on around us, as we all know, we are all organizing our conferences. I wanted to touch on a couple of pieces of legislation that are out there right now that I am hoping, if we do some packages between now and the end of the year, we will all consider. And I love using the little boards because I think it sort of helps concentrate.

One of the things, if there is any positive of what we have gone through in the pandemic, is the skepticism that was this body about telemedicine I hope is over, if you see the adoption rate of what has happened with, particularly, our seniors in embracing, having positive experiences, and actually even demanding telemedicine services.

My understanding is now that there is open enrollment in Medicare part D, that is actually now one of the common requests: What type of telemedicine services do you provide and offer?

If we understand, as a body, that the access for our seniors to use telemedicine functionally--the expansion of the reimbursements, the rules--expires when the pandemic is declared over, I am desperately hoping that our brothers and sisters around here on the right and the left hear that and understand if the community has embraced the price efficiency, the additional access to healthcare--that is, the telemedicine--let's make sure we don't let it expire when the vaccine and those come onto the market, are widely adopted, and we start to see the declaration that the pandemic is over. So, this is just sort of the benchmark of starting.

Now, if I am making the argument that telemedicine has expanded access, and we are seeing the opportunity for some real cost efficiency--because, as we know, it is always hard to talk about, but Medicare is one of the greatest drivers of U.S. debt. As a matter of fact, it is the greatest driver of U.S. debt.

It is demographics. Our brothers and sisters who are 65 years and older--and I am going to be there soon--earn this benefit. But the fact of the matter is, the unfunded liabilities, the substantial portion of it, come out of the general fund. It is a major driver.

We should be excited that we had a proof of concept during this sort of miserable several months, that it expanded access. We are seeing the price efficiency.

And the skepticism that seniors were going to have discomfort on using FaceTime and other things on their electronic devices, the arrogance of this place was wrong. We underestimated our fellow Americans in their ability to use the technology.

Now, the next wave of what else we can be doing to actually expand, we have something that we have introduced called the Safe Testing at Residence Telehealth, because we had to come up with a title that would create the word ``START,'' as we often do around here.

As you all saw, about 2 months ago, there were some home COVID tests that received approval. If we would tie those home COVID tests with telemedicine, those who are vulnerable in our communities could actually not have to risk getting in their cars, being part of the vulnerable population going to a clinic or the drive-through, or other things where there is testing. They can do it at home with these home test kits that are approved. We think that is part of the concept of the expansion of what is telemedicine.

If we like this, I can expand the thought experiment: Americans who want to do their COVID tests at home and then use telemedicine as part of the experience, should that be allowed? Of course, it should.

Why wouldn't you also go a little bit further? I don't have a board on this next one, but we have talked about it here, the ability to use technology also to help us be part of that expansion of telemedicine. This could be everything from the oxygen patch to the portable EKG.

My understanding is that there is an American company coming up with a smartwatch that is going to do your oxygen, your temperature, your pulse rate, even your blood pressure. It turns out those things, put into an algorithm, can do some pretty amazing things to help you manage your healthcare.

That is, in many ways, the future of telemedicine. It is not just talking to a healthcare professional. It is the ability to use technology to watch yourself, to keep yourself healthy, to diagnose if you are catching something, and then use that information with your healthcare professional.

These are pieces of legislation that have demonstrated they are here. Adoption, particularly with seniors, I am hoping that the body thinks about it. If we do any type of stimulus or COVID package between now and the end of the year, that we think about telemedicine and keeping it permanently with us, the expansion.

Let's walk through a couple of other things.

Another piece of legislation we have is, if many of us have seen the economic, emotional, you know, future income, the damage we did by shutting down so much of our society, economically, in trying to slow down the spread of COVID, how do we help businesses stay operating, keep their doors open, but also know they are providing a safe workplace? We have a tax credit that would help those businesses provide testing but also get that partial reimbursement, that partial credit, quickly.

We came up with a quirky idea. Every couple of weeks or every month, most businesses have to contribute on the payroll tax. Put the credit there so the cash comes back in very, very quickly, or the credit comes in very quickly.

We have a workplace testing tax credit piece of legislation. If we are going to move forward with a package, something like that should be there because if we are trying to keep our communities open but keep them healthy, we need that testing at the small business level. This makes it affordable.

Another thing I would like us to think about, and this is more global, the White House, the administration, those of us in this body, the resources we put forward months ago, and then the management of Operation Warp Speed, other than the stock market, I thought we would see more collective joy on how quickly we are moving to a vaccine. If it is true that there is a vaccine out there that was--what?--94.5 percent effective in its first statistical abstract, this is wonderful. We have done something that has never been done before, bringing this type of vaccine and heading toward approval and emergency authorization.

If this is our benchmark, that we know we have light at the end of this tunnel, then we need to also now step up and do the things that spur the economic expansion once again. Americans deserve to live in a healthy, prosperous country. If the vaccine, Operation Warp Speed, is working, which now we know we have multiple vaccines that are on the cusp of being here with amazing efficacy, it is time to do some other things that make the economy grow.

The first one I want to give is just a simple thought. When we did tax reform, we stopped something that was part of the ObamaCare financing. The ACA had a mechanism where your ability to deduct your healthcare expenses was going to go up. You didn't get to deduct anything until your healthcare expenses were over 10 percent of your income. That was one of the mechanisms that kicked a lot of seniors, particularly, in the teeth, and that was part of the ACA financing.

When we did tax reform at the end of 2017, we held it for a couple more years at 7.5 percent. If you had $100 of income and $7.50, the next portion of that, you get to deduct. If you are under that, you don't get to take it off your taxes, if that helps explain it.

We have a piece of legislation that for the next 2 years would make it that you only have to hit 5 percent. Then every incremental dollar above that, you could deduct.

Considering how many folks in the United States this year, and potentially into next year, are going to have some unusual healthcare expenses, why wouldn't we do this as part of the package?

The other part is: Then, let's hold it at the 7.5 percent for perpetuity. Let's make that permanent.

I know that it will offend some folks who wanted to raise it because that was one of the financing mechanisms of the ACA, ObamaCare, to raise those functionally--take away that tax benefit to folks who had high medical expenses. But I think that we could all agree, with what we have been through, this would be a healthy thing, particularly for those who have had some difficulty this year and into next year.

The last one I want to give you is--in some ways, it is a little bit of a quirky idea, but I want to beg of the body to think about what we can do to spur economic expansion, to spur the animal spirits, the investment in our society, in our country, and into our communities but without piling on the debt.

We all know a number of the things we did this year were necessary. These were unprecedented times. But we are going to have to start paying for this. The amount of interest costs, the Federal Reserve creating liquidity, eventually, that does dial back. We will have to, in the future, pay for these times. So, what do you do to spur the economy?

We have a quirky idea that would say: If you would be willing to buy an asset, make investments in plant and equipment, do those sorts of things that, in today's world, I am buying this hoping I get traditional capital gains in the future--but the problem with capital gains tax holidays, from a conceptual standpoint, is you are often being given a discounted tax rate on gains you have already produced. How about you get those people who are willing to invest around the country to invest money in the hope that what they buy today will go up in value in the future? It is not guaranteed.

The idea is if we are seeing with the Federal Reserve and the Beige Book, and many of these other things, that there are stunning amounts of cash sitting in bank accounts all around this country that we need circulating, that we need that velocity back into our society and our communities, something that might be a fun incentive is saying: If you will buy assets, if you will invest in plant and equipment, if you will take a risk today, we don't know, we can't guarantee it, but a couple of years from now, if that value goes up and you sell, you will get a discounted capital gains tax rate because you invested during this window when we needed to functionally goose the economy along.

We wanted to make sure that the curve that we are seeing, where our brothers and sisters have work opportunities, and the number of small businesses that disappeared permanently, that those small business owners who now have lost their businesses have access to investors who are willing to give them another chance.

The beauty of this is it doesn't require a large check from the Treasury today. We are sort of saying: Take a risk on the American people. Take a risk on our economy today. A couple of years from now, if it worked, you get a benefit.

We need to be looking more for ideas, I believe, like this that we can demonstrate a stimulus into our society and our communities without immediately putting ourselves more into debt.

So these are just a handful of ideas that, if the body--and being in the minority, you know, sometimes we have to sort of persuade by hopefully having good ideas and just getting here on the floor and telling everyone about them. But there are ideas like this, whether it is the permanency of telemedicine, expanding the definition of such, providing individuals that ability to do testing at home, ideas like this or the previous one, and ideas of allowing small businesses to be able to get a tax credit for providing testing to their employees to keep them healthy.

But I think this one is sort of how a reverse capital gains tax holiday actually works. It is creative, and we can put in some turning rules so someone doesn't take an asset and sell it and then immediately buy it again. Those things actually already exist in the IRS Code.

But these are ideas that I am hoping the body will step up, move forward, and say we can get this economy roaring again, we can get back to the economic miracle that 2018 and 2019 were, using creativity like this.

And that is my pitch for this evening.

Madam Speaker, I thank the Chair for allowing me to tell our story, and I yield back the balance of my time.