GOP Doctors Caucus

Floor Speech

Date: July 24, 2012
Location: Washington, DC


Mr. HARRIS. If the gentleman from Louisiana will just leave that one up so the American public that is watching just understands because a picture says a thousand words.

That picture is the growth of Medicaid for the next generation. My son is 12 now. When he reaches age 65, he'll be at the right-hand side of that graph. And although none of us like to think of it, we all remember when we were 12, we never thought we would retire, but here we are nearing retirement age. So it's not that far off in the future.

If I read that graph correctly, our current entire budget, in 2010 dollars, is $3.5 trillion--our entire Federal budget, paying for everything. That graph indicates that by the time my child reaches retirement age, every penny of that budget would be taken up by Medicaid, every penny--not a single penny for Medicare; not a single penny left over for Social Security; not a single penny left over for interest on a debt that is now $16 trillion and growing; not a single penny left for defense; not a single penny left for Pell Grants; not a single penny left for anything.


Mr. HARRIS. The gentleman is correct. Every single program that we have, whether it's the elderly with health care, the elderly with Social Security, whether it's food stamps, whether it's unemployment insurance, whether it's to do the things this government has to do, like pay the interest on an ever-growing debt, whether it's Pell Grants, whether it's K-12 education, which your last slide showed, every single program that we have is threatened by this one single program, a program that the President's Affordable Care Act ballooned out of control.


Mr. HARRIS. So what we have here is we have a third party looking at what's going on and saying the emperor has no clothes; that, in fact, if we continue the current policy with Medicaid--which, as the gentleman well knows, roughly doubles the number of people eligible for the safety net program under the Affordable Care Act--we will not only bankrupt the Medicaid program, future generations will no longer have the ability to be confident that Social Security will be there when they retire, that Medicare will be there when they retire.

The ratings agencies, whether it's Moody's, Standard and Poor's, all the various rating agencies will look at us and say: you don't have the ability to pay the interest back on your debt.

We know when that bill was passed, we know what happened. We know the cornhusker kickback. We know what went on--the buying and selling of votes at the expense of future generations and the ability of the Federal Government to keep their promises to future generations--the promises of Medicare, Medicaid, again, Pell Grants, K-12 education.

The gentleman showed a slide that showed a 3 percent increase in the cost--an average of 3 percent in the States' budgets--the cost of Medicaid over the past only 3 years before the President's health care bill kicks in. Well, as the President may know, 3 percent doesn't sound like much, but in Maryland that's a $1 billion increase. That's an increase we can't afford. That's an increase that means that property or income taxes would have to go up, further strangling our economy.

As the gentleman fully recognizes, this is why the President's policy with regard to Medicare and the Affordable Care Act is poorly thought out, is going to bankrupt the Nation, and really ought to be repealed and rethought.


Mr. HARRIS. Thank you very much to the gentlelady from Wyoming for bringing up that point about what Medicaid does to State governments and about what the potential is to State governments and all the other programs that they have to fund.

I will tell you that, with regard to what happens, what we know is that access under the Medicaid program is already suffering, the access of patients. Again, passing the Affordable Care Act puts an insurance card--a Medicaid card--in the hands of probably 10 to 12 million Americans, but that doesn't guarantee access to health care.

As a physician, I've taken care of Medicaid patients for almost 30 years, but increasingly what I'm finding is my colleagues who are facing decreased payment reimbursements by the governments that are under financial hardship now. Even under current conditions, as this chart will show, there are very few States in the Union that actually have extra money around to fund that Medicaid increase. This chart shows various specialties and how Medicaid patients have access to them.

Under the current reimbursement, which of course will get nothing but worse for specialists under the new Affordable Care Act, among all specialists, 89 percent of patients with private insurance have access to all specialists and only 34 percent of medical assistance patients, or Medicaid patients. That's true whether it's orthopedics, psychiatry, asthma, neurology, endocrinology, ear, nose and throat, or dermatology. In all cases, access to a physician is restricted because, when a government controls the health care budget, the way it contains costs is by decreasing reimbursements to providers.

Those are the facts. That's what happens. That's what's going to happen under Medicaid. We know, with the Independent Payment Advisory Board, that that's what's going to happen under Medicare.

I yield to the physician from Tennessee.


Mr. HARRIS. You may or may not be aware of the study done early last year that showed that, actually, whether patients have private insurance or no insurance or Medicare or Medicaid, when you compare the outcomes, Medicaid patients have the worst outcomes. In fact, they are 93 percent more likely to die of their illnesses than patients with private insurance. They were more likely to die than even patients who had no insurance. I don't know. Is the gentleman aware of that finding?


Mr. HARRIS. I thank the gentleman.

I would love to bring the gentleman from Texas into the discussion, because women actually are specifically affected by the shortfalls in Medicaid because the reimbursement rates for women's health care is frequently so low that it's actually hard to find an obstetrician to take care of those patients. I know in Maryland this is a problem we had.

In the First Congressional District on the eastern shore of Maryland for a while, before we did Medicaid payment reform, women who were pregnant in that part of the State had to drive 3 hours to find an obstetrician to take care of them because the reimbursements were so low. And we know the Affordable Care Act does nothing for medical liability.

We also know, for instance, that we have a cesarean section rate that is 35 percent now, the result of medical liability. We have obstetricians who have left the practice later in their careers of obstetrics and gravitate toward just doing gynecology where they join frequently large group practices. So we've left the practice of obstetrics to be an impersonal practice with people who generally don't have as much experience as those who have left the practice. And because of the lack of liability reform, we have a cesarean section rate that has roughly doubled over my career in dealing with obstetrics and obstetric anesthesiology.

I would like to hear the gentleman's comments on medical assistance and what it's doing for this country and for the women's health care in this Nation.


Mr. HARRIS. I thank the gentleman from Texas.

Again, we have on the floor with us now two obstetricians and an obstetric anesthesiologist. If women are ready for childbirth, we're ready on the floor of the House tonight.

The gentleman makes a great point that in the end, having an insurance card doesn't guarantee access and having an insurance card doesn't guarantee affordable care. As we know, what the Affordable Care Act did is to again pretend that, really, economics don't exist, to pretend that the laws of mathematics don't count; that we can expand this program, as the gentleman pointed out, a program that was meant to be a safety net for the poor elderly, for women, for children, and we expanded it well beyond that to the point where, as we brought up earlier in the hour, if gone unchecked, it will bankrupt everything else in government.

The time has come, as the gentleman has pointed out, for us to reconsider whether that Affordable Care Act was the right approach.

We know that just today the Congressional Budget Office has rescored the President's Affordable Care Act and has said that, as a result of the Supreme Court decision--because one of the goals was to insure as many Americans as possible--that an additional 3 to 4 million individuals will not be insured as a result of the Supreme Court, because the States will make a rational decision that they can't afford to let their budgets go bankrupt through this Federal Government-mandated expansion that does nothing to control costs. It does nothing, really, to increase access, other than putting a card in someone's hand.

And as the graph shows, that card doesn't help all the people who are in these pink bars. They're the ones with the Medicaid card currently, and their chance of seeing a specialist is somewhere between 17 percent and 57 percent because the government payment is so low and because these programs are so expensive and never adequately budgeted for, just as in the case of the Affordable Care Act.

Now, we're joined this evening by my colleague from Georgia (Mr. Gingrey), who is also an obstetrician, who has spent years taking care of patients and understands what it will take to fix the health care system in the United States. I'm very interested to hear your perspective, Dr. Gingrey, on the topic we're discussing tonight, Medicaid and its expansion under the Affordable Care Act.


Mr. HARRIS. I thank my colleague, the obstetrician from Georgia, who points out that on the graph, as the gentleman from Louisiana showed before, Medicaid expenditures now exceed K-12 education. And as the other chart we've seen shows, we're over at the left-hand side. It will only get worse over time.

I yield to the obstetrician from Texas.