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David R.
Republican TN 1

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  • House Gop Doctors Caucus

    by Representative David P. Roe

    Posted on 2013-03-05

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    ROE of Tennessee. Dr. Gingrey, thank you, and it's good to see you moving your arm well and recovering from your surgery so well.



    I think the question that comes up, and Dr. Gingrey and other Members and I have discussed this, when I got here--and I've been here 4 years, and Dr. Gingrey came a couple terms before I did--we did this for a reason because we wanted to impact the health care system in our country. The problem with the health care system in our country was that costs were exploding.

    If you look, as he pointed out, the Affordable Care Act has been anything but affordable. It's suggested that by 2016 the average family of four, when you have to buy an essential benefits package--which the government will determine what that is--will cost a family of four $20,000. That's unbelievable when you think that the per capita income in my district is $33,000. So I think we're at a point or we're going to be at a point where no one can afford it.

    Well, what Dr. Gingrey is mentioning in the SGR, sustainable growth rate, what is that? What does that mean, and why should I care if I'm a senior? And Dr. Gingrey and I both have Medicare as our primary source of insurance. Well, Medicare started back in 1965, a great program for seniors who did not have access to care. It met a great need there and has met a great need since then. It started as a $3 billion program. The estimates were from the government estimators that in 25 years this program would be a $12 billion program--we don't do millions here, billions--and the real number in 1990, Madam Speaker, was $110 billion instead of $12 billion. They missed it almost 10 times.

    So there have been various schemes throughout this time in which to control the cost, always by reducing the payments to providers. And who are providers? Well, those are the folks who take care of us when we go to the doctor's office--nurse practitioners, it may be a chiropractor, it could be a podiatrist, and it can be your hospital. So when you say providers, those are the folks and institutions that care for us when we're ill.

    So in 1997, the Ways and Means Committee brought together something called the Budget Control Act. This is a very complex formula based on how you're going to pay doctors--their zip code, where they live, the cost of an office, the humidity in the air--I know it's an incredibly complicated scheme to pay doctors. The idea is this: We have this much money to spend in Medicare, and so we've put a formula together to only spend this much money. If we spend less than that money, that will go as a savings. If we spend more than that much money, then we will cut the doctors and the providers that amount of money to make that line balance.

    Mr. GINGREY of Georgia. Dr. Roe, if you would yield just for a second, I wanted to point out to my colleagues and to Dr. Roe the poster that we have before us. Because this is exactly what the good doctor is talking about right [[Page H970]] now in regard to what's been going on since the year 2000. Dr. Roe, you may want to refer to this slide.

    I yield to the gentleman.

    Mr. ROE of Tennessee. Well, the particular slide that Dr. Gingrey has down there is very telling. Basically what it says is that each year that we've recalculated what our physicians will be paid, we haven't met those metrics, which means that we have to cut.

    Well, what has Congress done? Well, Congress has realized that what we're talking about is not payments to doctors; what we're talking about is access to care for patients. What happens is if you go back to 2003--I think it was 2003--when there was a 5 percent cut in Medicare payments, we realized at that point right there that if you continue to do that, that access would be lost.

    So let's fast forward to 2013, what we're just facing. Doctors were facing a 26.5 percent cut, the providers were.

    Mr. GINGREY of Georgia. Dr. Roe, that would be right here.

    Mr. ROE of Tennessee. That's correct, that number right there. That was avoided by a 1-year so-called ``doc fix.'' What has happened over the last 15 or so, 16 now, years is that the Ways and Means Committee line--now law--says we have to spend this much money, but we've actually spent this much. That is a deficit in spending that we've got to make up somewhere in our budget or add it to the budget deficit.

    Now, I go back to when I was in practice just 5 years ago now in Johnson City, Tennessee. Dr. Gingrey, I don't know about you, but I was having a harder and harder time finding primary care access for my patients that I had operated on, or maybe someone who had been my patient for 30 years--if she was 40 years old when I started taking care of her, in 30 years she's 70 years old and needed a primary care doctor. That was getting harder and harder and harder to do.

    Now, when you look at today's young medical students, we're having a much harder time convincing these young people to go into primary care. What is primary care? Well, it's pediatrics. If you want someone to take care of your baby, it's family medicine. It's also internal medicine and also OB/GYN. I certainly served as a primary care doctor, as Dr. Gingrey did for his patients, for many, many years. That would be the only doctor that they would see. But that's getting harder for our patients to do. And Dr. Gingrey, that's my primary concern--access for seniors to their doctors.

    Mr. GINGREY of Georgia. Dr. Roe, if you will yield for just a second and then I will return to you, again, I wanted to point out to our colleagues that this poster, this slide that's on the easel before us is exactly what the gentleman from Tennessee is talking about in regard to shortage of primary care physicians. And as he pointed out, primary care is a family practitioner, is a general internist--of course pediatricians provide primary care to our children. But so many of these doctors are the very ones that take the Medicare, take the Medicaid, take the SCHIP, the State Health Insurance Program for children. They see them.

    {time} 1500 And what Dr. Roe is referring to, before I yield back to him, on this poster it shows in the dark blue the areas of these States, several States, including my own of Georgia--Tennessee is not quite as bad--but in my State of Georgia, there are anywhere from 145 to 508 areas of the State of Georgia where there are an insufficient number of doctors to take care of these folks. Tennessee is a little bit better. There are only 67 to 99 areas. But all of this blue are critical areas, are they not, Dr. Roe? And I yield back to you.

    Mr. ROE of Tennessee. That is correct. And so much so that in California, what they're recommending, I don't know whether they've carried it out or not, but they've recommended expanding the definition of ``primary care'' to a lower-level provider, that would be a nurse or nurse practitioner or PA or this sort of thing, this sort of designation.

    I think the other thing, Dr. Gingrey, that we haven't talked about, and we probably should spend some time on, is the age of our practitioners. In our State of Tennessee--where you see that we're not quite as dire in need as Georgia, our friends to the south--the problem with it is that 45 percent of our practicing physicians in the State of Tennessee are over 50 years of age. I'm concerned that with the advent of the Affordable Care Act, the complexity of that, the frustration that I see when I go out and talk to our providers is that I'm afraid that many of them are going to punch the button for the door.

    I know in my own practice, where we have now about 100 primary care providers in my program, in my OB/GYN group, in the last several years we've had over 120 years of experience walk out the door and retire. That's not a good thing for the American health care system that just lost access. Quite frankly, the crux of it all is that access. If you do not have access, you will decrease quality, and you will increase cost. That is our concern. Ultimately, the cost will go up if our patients can't get in to see us.

    Mr. GINGREY of Georgia. I thank the gentleman, because what the gentleman from Tennessee is talking about is having an insurance card, a health insurance card--and indeed even having a Medicare card--does you very little good if you have to spend 2 hours going through the Yellow Pages trying to find some physician, primary care doctor in your area that you wouldn't have to get in your car and drive 50 miles--if you could even drive. If you don't have that access, then you don't have anything.

    So here again, this bill, this massive bill was passed 2 years ago at the cost of almost $1 trillion. Unfortunately, a lot of that money was taken out of Medicare to create this new entitlement program, if you will, for younger people so that they can have health insurance. But what we've done is we've just made the crisis in the Medicare system that much more difficult.

    What Dr. Roe was talking about, colleagues, is in regard to not just a shortage of the physicians, but what happens in the waiting rooms all across our country. This slide shows the number of primary care physicians per 1,000 population, the number of primary care physicians per 1,000 population.

    Now, we've already gone over, we're talking about, again, general internists and family practitioners, primarily, and pediatricians for SCHIP and Medicaid. If you look at that map across the country, again, look at my State of Georgia in the deep red, and there are several States, Texas, Oklahoma, Mississippi, Alabama, Utah, Nevada and Idaho in the West where the number of primary care physicians per 1,000 of the population is fewer than one. So less than one doctor per 1,000 people that need that care. Many other States, including Tennessee, it is somewhere between one and 1.2. Now, I don't know how you get 1.2 physicians. I don't know exactly what that provider looks like. But you know how that math is calculated. Clearly, the shortage is acute, and it's only going to get worse and worse.

    With that, I want to yield to one of my good colleagues, good friends on the Energy and Commerce Committee whose father actually was the chairman of the Health Subcommittee of the Energy and Commerce Committee for many, many years before he retired and his son took his place, and now the gentleman from Florida, Gus Bilirakis, is serving on that Health Subcommittee with me on Energy and Commerce.

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