Washington | July 15, 2009 - Statement of Michael N. Castle

Committee on Education and Labor

H.R. 3200, “America’s Affordable Health Choices Act of 2009”

July 15, 2009

Mr. Chairman, While there is broad agreement on improving access to quality, affordable health care for all Americans, there is growing disagreement over achieving and paying for these goals.     

As details of this legislation have trickled out, cost has eclipsed almost all other concerns.  Frankly, I don't understand how this Committee can consider adding another trillion dollars to the federal debt, while continuing to ignore the increasing entitlement programs.  There may be politically charged proposals to alter Medicare and Medicaid but this is not true reform.  Making tough decisions about entitlement programs is imperative for ensuring their solvency.  These programs are kept afloat by deficit spending.  As we debate this bill, our annual deficit has grown to $1.1 trillion.  

Americans watching this debate must understand the costs, for families and the government, associated with U.S. health care.  The U.S. spends over $2.2 trillion on health care, more than 16% of GDP, exceeding any other industrialized country.  Projections suggest spending would rise to 25% of GDP in 2025, with no changes.  

Reforms should be paid for by lowering costs within our health care system, not outside.  Surtaxes on certain taxpayers which could end up harming small business owners and taxing employer sponsored health benefits do not seem prudent.  Deficit neutral is not just a gimmicky-goal, it reflects the need for larger reform, and tough choices.  System savings and focusing on prevention and chronic disease management are essential.  

To understand the problems we face, we must drill down on the 46 million uninsured—only 26 million Americans were uninsured for an entire 2-year period; over 9 million uninsured are not US citizens; and 12 million uninsured Americans are eligible for public programs.  There are over 100,000 uninsured people in the State of Delaware and 27,000 are already eligible for existing programs like Medicaid or S-CHIP, highlighting the need to ensure qualified Americans get enrolled.                                                                                    

I am not convinced that a public insurance option is the best immediate solution.  Keeping the health insurance you have is a promise of President Obama, and while all Americans should have good choices, I remain concerned that a public plan, as currently envisioned, could compete unfairly, eroding coverage for 170 million working Americans.

I also have concerns about the employer mandate.  Ramifications of requiring employers to provide health care for their employees or pay a tax could be that employers drop coverage altogether, or that the costs force them to make difficult choices regarding hiring and retention decisions.   

In my home state of Delaware, I have heard stories of people struggling with cost and access—a non-profit with 15 employees is paying close to $100,000 annually to insure its employees instead of putting it toward carrying out its mission in the community; a recent college graduate with Type-1 diabetes, whose employer doesn't offer health insurance, cannot purchase insurance because of a "pre-existing" condition; and a woman recently diagnosed with cancer is facing such high out of pocket costs that she simply cannot afford to continue with treatment.  We must find solutions, so people can have peace of mind.           

I support a system where every American can access health care, where individuals are not denied coverage based on preexisting conditions or put in financial peril because of out of pocket medical costs, but a one size fits all solution will not succeed.  With universality we must retain choice, including the choice to keep our current coverage if we so choose.  As we make the transition to providing this universal coverage—we must continue to rely on state/federal health programs, like SCHIP and Medicaid, and community health centers—and the safety nets on which the neediest Americans rely.

Prevention and wellness, and chronic disease management deserve increased attention and resources to encourage healthier lifestyles.  I look forward to discussing the role of prevention in employer-sponsored plans during consideration of my amendment.

Finally, Americans must have confidence in what is put forth by the Congress.  For this to transpire, the process must be more bipartisan than it has been.  While there is momentum for meaningful reform, I remain disappointed with the direction the legislation currently takes.  We must move forward with great care to balance the needs of all Americans in receiving access to the best and most affordable health care options.