[Congressional Record Volume 152, Number 101 (Thursday, July 27, 2006)]
[House]
[Pages H5962-H5972]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PROVIDING FOR CONSIDERATION OF H.R. 4157, HEALTH INFORMATION TECHNOLOGY
PROMOTION ACT OF 2006
Mr. LINCOLN DIAZ-BALART of Florida. Mr. Speaker, by direction of the
Committee on Rules, I call up House Resolution 952 and ask for its
immediate consideration.
The Clerk read the resolution, as follows:
H. Res. 952
Resolved, That at any time after the adoption of this
resolution the Speaker may, pursuant to clause 2(b) of rule
XVIII, declare the House resolved into the Committee of the
Whole House on the state of the Union for consideration of
the bill (H.R. 4157) to amend the Social Security Act to
encourage the dissemination, security, confidentiality, and
usefulness of health information technology. The first
reading of the bill shall be dispensed with. All points of
order against consideration of the bill are waived. General
debate shall be confined to the bill and shall not exceed one
hour, with 35 minutes equally divided and controlled by the
chairman and ranking minority member of the Committee on
Energy and Commerce and 25 minutes equally divided and
controlled by the chairman and ranking minority member of the
Committee on Ways and Means. After general debate the bill
shall be considered for amendment under the five-minute rule.
In lieu of the amendments recommended by the Committees on
Energy and Commerce and Ways and Means now printed in the
bill, the amendment in the nature of a substitute printed in
part A of the report of the Committee on Rules accompanying
this resolution, modified by the amendment printed in part B
of such report, shall be considered as adopted in the House
and in the Committee of the Whole. The bill, as amended,
shall be considered as the original bill for the purpose of
further amendment under the five-minute rule and shall be
considered as read. All points of order against provisions in
the bill, as amended, are waived. Notwithstanding clause 11
of rule XVIII, no amendment to the bill, as amended, shall be
in order except those printed in part C of the report of the
Committee on Rules. Each such amendment may be offered only
in the order printed in the report, may be offered only by a
Member designated in the report, shall be considered as read,
shall be debatable for the time specified in the report
equally divided and controlled by the proponent and an
opponent, shall not be subject to amendment, and shall not be
subject to a demand for division of the question in the House
or in the Committee of the Whole. All points of order against
such amendments are waived. At the conclusion of
consideration of the bill for amendment the Committee shall
rise and report the bill, as amended, to the House with such
further amendments as may have been adopted. The previous
question shall be considered as ordered on the bill and
amendments thereto to final passage without intervening
motion except one motion to recommit with or without
instructions.
Sec. 2. After passage of H.R. 4157, it shall be in order to
consider in the House S. 1418. All points of order against
the Senate bill and against its consideration are waived. It
shall be in order to move to strike all after the enacting
clause of the Senate bill and to insert in lieu thereof the
provisions of H.R. 4157 as passed by the House. All points of
order against that motion are waived. If the motion is
adopted and the Senate bill, as amended, is passed, then it
shall be in order to move that the House insist on its
amendments to S. 1418 and request a conference with the
Senate thereon.
Sec. 3. House Resolution 924 is laid upon the table.
The SPEAKER pro tempore. The gentleman from Florida (Mr. Lincoln
Diaz-Balart) is recognized for 1 hour.
Mr. LINCOLN DIAZ-BALART of Florida. Mr. Speaker, for the purpose of
debate only, I yield the customary 30 minutes to the gentlewoman from
California (Ms. Matsui), pending which I yield myself such time as I
may consume. During consideration of this resolution, all time yielded
is for the purpose of debate only.
(Mr. LINCOLN DIAZ-BALART of Florida asked and was given permission to
revise and extend his remarks.)
Mr. LINCOLN DIAZ-BALART of Florida. Mr. Speaker, the rule provides 1
hour of general debate with 35 minutes equally divided and controlled
by the chairman and ranking minority member of the Committee on Energy
and Commerce and 25 minutes equally divided and controlled by the
chairman and ranking minority member on the Committee on Ways and
Means. The rule also provides one motion to recommit with or without
instructions.
Mr. Speaker, the information age has greatly changed our economy by
bringing about increased efficiencies in productivity. Virtually every
sector of our economy benefits from the use of new information
technologies.
Right here in Congress, for example, the use of technology has opened
up access to the workings of our democracy like never before.
Technology allows our constituents to quickly view the status of a bill
or to look up our voting records.
Mr. Speaker, the health care industry has not fully embraced the
advantages and benefits of information technology. According to a study
by the RAND Corporation, only 15 percent of physicians and 20 percent
of hospitals use computerized patient files.
Broad use of information technology in the health care system would
certainly improve the quality and efficiency of health care delivery.
The use of health information technology is increasingly necessary to
deliver the best care possible to individuals with chronic illnesses.
The use of health care IT would also promote interoperability between
providers and payers.
Efficiencies from coordinated development of health IT will
accelerate and advance private and public efforts to improve quality,
lower costs, reduce fraud and abuse, and promote the coordination of
care. The synergy of these efficiencies will help achieve better health
outcomes for patients.
The Health Information Technology Promotion Act, which we bring to
the floor today, will improve the quality of care Americans receive
through national adoption of electronic medical records and e-
prescribing systems.
The legislation promotes the adoption and use of interoperable health
information technology that prevents medical and prescription errors
and costly duplicate tests, eliminates lost medical records, simplifies
our administrative system, and improves medical care and the treatment
of chronic illnesses.
The legislation we bring to the floor today provides grants for the
use of health information technology to coordinate care among the
uninsured and to implement technology in small physician practices. It
also updates diagnostic coding, systems for the digital age, and
provides for an expedited process to update standards.
Mr. Speaker, this legislation was introduced by Congresswoman Nancy
Johnson, my dear friend, who is a true expert in the field of health
care. It was reported out of the House Energy and Commerce Committee.
We believe it is time that the health care industry moves to a digital
future, and this legislation is an important step in seeing that to
reality.
Mr. Speaker, I would like to thank Congresswoman Johnson and Chairman
Barton and Chairman Thomas for
[[Page H5963]]
their leadership on this important issue. I urge my colleagues to
support the rule that brings this legislation forth as well as the
underlying legislation.
Mr. Speaker, I reserve the balance of my time.
Ms. MATSUI. Mr. Speaker, I thank my good friend, the gentleman from
Florida, for yielding me time; and I yield myself such time as I may
consume.
(Ms. MATSUI asked and was given permission to revise and extend her
remarks.)
Ms. MATSUI. Mr. Speaker, every Member of Congress recognizes the
importance of health information technology. It holds the potential to
save lives by reducing medical errors, and it can make our health care
system more efficient by providing better care while keeping costs
down.
In short, we could revolutionize the way our health care is
delivered. What exactly is the potential? Physicians could have access
to every relevant part of a patient's medical history at the precise
moment a life-or-death decision needs to be made.
It is the tens of thousands of lives saved because of fewer medical
errors. It means the newest ``Physicians Desks Reference'' and the most
cutting-edge medical research on a hand-held device that a doctor can
have at the patient's bedside.
This is not pie-in-the-sky ambition. Some health care leaders have
already begun to adopt these ideas with great success. In the year
2000, the Veterans Administration implemented the most advanced
electronic medical records system in the United States.
A recent article in Business Week noted that ``while studies show
that 3 to 8 percent of the Nation's prescriptions are filed
erroneously, the VA's prescription accuracy rate is greater than 99.99
percent, a level most hospitals only dream about.''
It should not be surprising that while many patients lost their paper
medical records in the terrible aftermath of Hurricane Katrina,
veterans did not. Veterans living in New Orleans were able to access
their medical records at other VA hospitals because of health
information technology.
Another example comes from my hometown of Sacramento. The UC Davis
Medical Center has a world-renowned telemedicine program which connects
patients in 80 rural areas across California to an immense amount of
specialty care in Sacramento.
Let me tell you the story of Levi, a child who lives on a ranch in a
nine-person town 60 miles north of Sacramento. After accidentally
suffering third-degree burns on his leg, his parents took him to the
closest hospital. Because of UC Davis's telemedicine program, Levi was
treated by one of the few pediatric burn specialists in this country
remotely from Sacramento.
Information technology could make this amazing program even better.
Widespread adoption of this technology would enhance this expert advice
by allowing the rural doctor to send Levi's medical history to the
specialists at UC Davis instantly.
UC Davis has begun to implement electronic medical records, but many
of these outlying areas cannot afford this technology without seed
money.
That is the goal of establishing a national health information
infrastructure. But we know such a comprehensive program isn't cheap.
It could cost individual hospitals several million dollars and
individual physicians $20,000 or $30,000 apiece.
So the issue needs more than Federal guidelines. It needs Federal
financial support, seed money in a sense. Unfortunately, the bill we
will debate today falls far short. It provides only $40 million in
Federal grants. In a $1.3 trillion health care system, this does not
even scratch the service.
In fact, the nonpartisan Congressional Budget Office, CBO, says the
bill, as written, will do almost nothing to encourage health
information technology. According to their analysis, it will not
significantly influence the rate at which health information technology
is adopted, nor will it ensure better quality technology.
Democrats have proposed a more effective proposal, backed by Federal
seed money, just like the bipartisan Senate bill does. We would also
add new privacy laws to strengthen patient protections. This would
prepare us for the health information age.
It would require patients to give their consent before their health
information could be shared with other people. It also requires data
encryption to protect these health information networks from hackers.
It sides with patients by making sure that everyone, every individual
and every health entity, complies with privacy protections.
Unfortunately, late last night the Rules Committee denied the House
the opportunity to debate the Democratic alternative on the floor. As a
result, I will be urging my colleagues to defeat the previous question
and defeat this rule.
{time} 1100
Mr. Speaker, information technology will bring our Nation's health
care system tremendous benefits, but the devil is often in the details.
This technology will not install itself. It will spread only with the
right kind of Federal leadership. So, I urge my colleagues to support
the Democratic substitute and support the responsible approach to
national health information technology.
Mr. Speaker, I reserve the balance of my time.
Mr. LINCOLN DIAZ-BALART of Florida. Mr. Speaker, I reserve the
balance of my time.
Ms. MATSUI. Mr. Speaker, I yield 2 minutes to my good friend, the
gentlewoman from California (Mrs. Capps).
Mrs. CAPPS. I thank my colleague for yielding.
Mr. Speaker, I rise in strong opposition to the rule for H.R. 4157.
As a nurse, of course I want to see the expanded use of health
information technology, such as electronic medical records. Expanded
use of health IT holds great promise for facilitating better care,
reducing medical errors, and eliminating burdensome paperwork, but the
bill before us today has a glaring omission: It has no privacy
protection for patients.
A privacy amendment I sponsored along with Representatives Markey,
Emanuel, Doggett, and Kennedy was killed by the Republicans on the
Rules Committee even though there is bipartisan support for this
measure. As usual, the House won't be voting on a measure because the
Republican leadership opposes it but is afraid that if we debate and
vote on it in the House, they might lose the vote.
Let's be clear, there is no comprehensive privacy protection in this
bill before us today. That means your personal sensitive health
information is vulnerable. That means there is no recourse you could
take to hold individuals accountable if they improperly obtain or
disclose your most personal private information.
Opponents of privacy protection will argue that current HIPAA
regulations are adequate. That argument is flawed. The lack of
enforcement of privacy protections is widely known in the health
community. Because of that, surveys show fewer entities are complying
with HIPAA because they fear no consequences for privacy violations.
And, these violations are occurring. Our privacy amendment would have
guaranteed that you would be notified if your information is improperly
disclosed and it would have allowed you recourse.
The amendment should have been made in order because its provisions
are essential to protecting patients' rights during the nationwide
adoption of health information technology. So I urge my colleagues to
oppose the rule until we are allowed to consider a bill that protects
our rights as patients and, indeed, the rights of all patients.
Mr. LINCOLN DIAZ-BALART of Florida. Mr. Speaker, I reserve the
balance of my time.
Ms. MATSUI. Mr. Speaker, I yield 3 minutes to the gentlewoman from
California, my good friend (Ms. Eshoo).
Ms. ESHOO. I thank our distinguished member of the Rules Committee.
Mr. Speaker, I rise this morning in opposition to the rule and in
opposition to the bill, and I want to state very clearly why. I believe
that this bill is deeply deficient. And I am very disappointed because
I had high hopes for this bill. At one time I was a cosponsor of it,
but I removed my name from the bill when I saw what the deficiencies
were and that the majority would not address them.
[[Page H5964]]
My colleague, Mrs. Capps, has just eloquently outlined the deep
deficiency relative to privacy. If you ask any American about privacy
and if they want it protected in their financial records and their
medical records, there will be a resounding yes. This bill has no
protection for the American people relative to privacy.
The second point, which is really a shame, that an HIT, health
information technology bill, does not assure interoperability. My
colleague from Florida mentioned this in his statement. There isn't
going to be any point, it won't matter if every doctor, every hospital
in our country has invested in robust IT technology if they can't
communicate with one another. What this bill provides is that down the
road, down the road 3 years, 5 years there may be interoperability.
Does the majority not understand that in the market in terms of
information technology that products change 6 months, 8 months. And so
there isn't anything in the bill that assures that interoperability is
going to take place.
I offered an amendment in the Rules Committee that was turned down.
It ensured that purchasers and vendors in the HIT marketplace will be
able to rely on representations about compliance with the
interoperability standards adopted under this legislation by creating a
voluntary certification process for HIT products.
Dr. David Brailer, the first national coordinator for health IT, said
last month that if the government does not immediately employ
interoperability standards in its purchasing, the adoption of the
standards in the marketplace could take 5 to 7 years instead of 1 or 2
to implement.
So this is a wonderful vehicle, it sounds terrific, it is all shiny
and waxed up. Everyone looks at it and says, doesn't this look
terrific? I hate to dampen your spirits, but there isn't any gas in the
engine and this dog is not going to hunt. It is an opportunity that has
been squandered, and I reluctantly oppose the rule and the bill.
Mr. LINCOLN DIAZ-BALART of Florida. Mr. Speaker, I reserve the
balance of my time.
Ms. MATSUI. Mr. Speaker, I yield 4\1/2\ minutes to my good friend the
gentleman from Massachusetts (Mr. Markey).
Mr. MARKEY. I thank the gentlewoman. The great Irish poet, William
Butler Yeats, used to say that, ``In dreams begins responsibility.''
There is a dream here that we can place all of the medical records of
all Americans online, that can have an IT world where for the sake of
patients we can move medical information across hundreds, thousands of
miles to save the patient's life. And that is great. That is a great
dream. But that dream will replace something that exists today, which
is that when each of us goes in to visit a physician, when our family
member's private medical records are inside a cabinet with a nurse that
has a key that can open that drawer and pull out your family's private
records, that you have confidence that that physician, that that nurse
is not going to tell everyone else in town what the secrets are of your
husband, of your wife, of your child, of your mother or your father,
that there are protections, that privacy is sacred, that your physician
is a privacy keeper and not a data mining information seeker.
As we move to this new era where information is being abrogated by
medical insurance companies, HMOs, medical consultants, medical data
mining companies, that we build in at the beginning of this era the
privacy protections, the guarantees that each individual's family has a
right to say, ``I don't want my family's psychiatric records, I don't
want my child's medical records, I don't want this information, mental
health, prescription drug records or other personal medical data put
online without my permission. I just don't want it spread around
without my permission, without my family's permission.''
So I went to the Rules Committee, and Congressmen Kennedy, Emanuel,
Doggett, Capps, we requested that we have that debate here on the House
floor, and the Republican leadership said no. No, we are just going to
listen to the insurance industry. We are going to listen to the HMO
industry. We are not going to allow a debate on medical privacy on the
House floor as we move to this new era.
And I will tell you something, this is about as serious an issue as
people can imagine affecting their family, and there are 84 million
good reasons why we should have this debate: Because 84 million is the
number of times over the last 2 years we have seen the compromise of
the financial records of American people, from the ChoicePoint scandal,
these you can go right down the whole line. But now we have the big
enchilada, and that is the medical records of people's families.
And, by the way, this is not an issue that divides along Democrat or
Republican lines, liberal or conservative lines. It polls out at over
80 percent of all Americans that want the right to be able to protect
their own personal medical records.
So what has happened then? Well, what has happened is the Republican
party is ignoring the fact that it polls out at 80 percent Democrat and
Republican. And what they decided to do is to side with the insurance
industry, side with the HMOs who want to use our personal medical
records as a product, as something that allows them to go through and
to identify useful information for the insurance industry, for HMOs.
William Butler Yeats once said that, ``In dreams begins
responsibility.'' That should happen here on the House floor today. But
the Republicans are abdicating that responsibility. They are saying,
let's give the HMOs, let's give the data miners, let's give these
consultants, let's give these insurance companies what they want now,
and we will come back and revisit the privacy issue after there is a
catastrophic compromise of privacy affecting millions of American
families. That is not exercising the responsibility that should be
exercised. Vote ``no'' on this rule. Vote ``no'' on this bill.
Mr. LINCOLN DIAZ-BALART of Florida. Mr. Speaker, I yield myself such
time as I may consume.
Mr. Speaker, Yeats wrote many wonderful, beautiful things. We in the
Rules Committee deal with reality. The reality of the rule that we
bring to the floor today in order to bring the underlying legislation
on information technology for the health care industry brings forth and
authorizes six amendments, six amendments to be debated by this House.
Our function is to listen, and we listened hour after hour after hour
after hour, with great respect, in the Rules Committee to our
colleagues who come forth with multiple ideas. We bring forth six
amendments for the consideration of this entire body today. Of the six
amendments, four are authored by Members of the opposition, of the
Democrat Party; one is a bipartisan amendment, Republican and Democrat;
and one is a Republican amendment. We think we are being fair, Mr.
Speaker.
So we seek not to bring forth the beauty of Yeats, but in dealing
with reality, in dealing with listening to hours of testimony from our
colleagues, in authorizing four amendments of Democrats, one of a
Republican, one of a bipartisan nature, we think we have done a fair
job. And that is what we have authorized for consideration, for debate
by this House in the rule that brings forward this very important
legislation that we will be hearing about, and we will be hearing about
as the authors of the legislation explain it in detail.
I am very proud to be a supporter of the legislation. It is important
that information technology reach as much of the health care industry,
patients, as possible so that mistakes are avoided, and so that access
to the great advances of technology are made available to the largest
number of people. There are important issues that this legislation is
going to be bringing forth and dealing with and that this debate will
entail.
{time} 1115
Now, obviously in order for debate to begin, we have to pass the rule
which sets the terms of the debate. We are proud of those terms of
debate, the extraordinarily fair nature of the terms of that debate. As
I have said, Mr. Speaker, four amendments made in order are Democrat
amendments, one is a Republican amendment, one is a bipartisan
amendment.
Mr. Speaker, I reserve the balance of my time.
Ms. MATSUI. Mr. Speaker, I yield 4 minutes to my good friend, the
gentleman from Rhode Island (Mr. Kennedy).
[[Page H5965]]
Mr. KENNEDY of Rhode Island. Mr. Speaker, I thank the gentlewoman for
yielding me this time.
Mr. Speaker, I have been working on this issue for several years. I
have met with countless groups across this country. I have forged
bipartisan relationships to bring a solid piece of legislation before
this House, and today I am disappointed to say that this legislation
does not meet the mark.
The Congressional Budget Office itself has said this legislation,
quote, would not significantly affect either the rate at which the use
of health technology will grow or how well that technology will be
designed and implemented.
So what is the point? If we cannot get this technology in the hands
of the providers, what are we doing here? This legislation does not
require us to adopt standards that are interoperability standards for
all on a date certain. We need to do this within the next year and a
half. We could do this within the next year.
We should be taking this opportunity and passing real health care
information technology legislation; but, instead, we are passing a
shadow of a bill that misses the opportunity to pass real opportunities
for savings, both in people's lives and in countless dollars across
this country.
Mr. Speaker, we spend twice what every other industrialized nation
spends on health care. It is the worst system when it comes to
employers paying incredible premiums. We see employees paying
incredible premiums. We are seeing providers complain. Nobody is happy
with the current health care system; and, yet, what are we doing about
it? We are missing the opportunity today.
We could provide technology today that would help us implement
quality standards so that when you are being treated, whether it is in
Iowa or Rhode Island or New York, you get the same standard of care.
But are those quality provisions in this bill? No, they are not.
We can make sure that we have provisions in this bill to have the
privacy protections in place, as Mr. Markey just talked about. Are they
in this bill? No, they are not.
How can we have an IT bill that does not set a date certain for
technology, that does not have quality provisions in place so that we
can use technology to bring the best and evidence-based medicines to
the bedside? How can we not have provisions to protect privacy in an
age when we are going electronic in health care records?
Mr. Speaker, this bill falls way short of our opportunities to make a
fundamental change in our health care system. I am sorry I am going to
have to oppose this rule. I am going to have to oppose this bill
because I think it falls way short of the opportunities we have been
given to make the most of this chance to get a better health care
system today. We are squandering that chance. For that reason, I will
oppose the rule and oppose the underlying bill.
Ms. MATSUI. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I am asking Members to vote ``no'' on the previous
question so I can amend this rule and allow the House to consider the
Dingell-Rangel substitute. This substitute was offered in the Rules
Committee last night, but was blocked on a straight party-line vote.
Mr. Speaker, I ask unanimous consent to print the text of the
amendment and extraneous materials immediately prior to the vote on the
previous question.
The SPEAKER pro tempore (Mr. Price of Georgia). Is there objection to
the request of the gentlewoman from California?
There was no objection.
Ms. MATSUI. Mr. Speaker, I believe the Dingell-Rangel substitute
offers Members a far better choice than the underlying bill.
This substitute is based on the bipartisan bill that was introduced
by Senators Frist, Enzi, Kennedy and Clinton and passed unanimously by
the Senate last November. This substitute also contains important
privacy protections necessary in this new electronic world.
The Democratic substitute requires the Federal Government to take a
leading role in the adoption of standards for technology and adopting
technology that will permit providers and others to communicate to each
other electronically. This substitute will provide $257 million in
grants and loans for providers and regional collaboratives to buy and
implement health information technology.
This substitute also provides privacy protections beyond those in
current law to ensure that patients' health information is secure. It
requires that all individuals and entities with access to personal
health information must comply with privacy protections to maintain
patient confidentiality. The substitute also requires data encryption
to prevent security breaches and the notification of patients in case
of a security breach. Finally, it allows patients to seek redress when
their privacy is breached.
I want Members to be aware that a ``no'' vote will not stop us from
considering H.R. 4157. A ``no'' vote will simply allow the Dingell-
Rangel substitute to be considered by this House by an up-or-down vote.
Vote ``no'' on the previous question so we can consider this
important and responsible substitute.
Mr. Speaker, I yield back the balance of my time.
Mr. LINCOLN DIAZ-BALART of Florida. Mr. Speaker, I yield myself such
time as I may consume.
I thank all of my colleagues who have participated in this very
interesting debate today. Much has been made by opponents of the
legislation of arguments with regard to privacy protections. I think it
is relevant and should be pointed out that the very significant and
extensive privacy protections contained in the Health Insurance
Portability and Accountability Act of 1996 are not reduced in any way
by this legislation that we bring forth to the floor today.
In fact, the American Psychiatric Association, the American
Psychological Association, the National Association of Social Workers,
the National Mental Health Association have said in a letter to the
Energy and Commerce Committee, ``The Energy and Commerce language
ensures that the current protections in the Health Insurance
Portability and Accountability Act of 1996 are maintained, and we wish
to commend the approach to privacy protections that the Energy and
Commerce Committee proposes to take.''
I mean, it is relevant to point this out because much has been said
that would seem or could be interpreted to contradict what I have just
read from the American Psychiatric Association, the American
Psychological Association, the National Association of Social Workers,
the National Mental Health Association, very responsible entities that
look out for the interests of many citizens who receive health care.
So, Mr. Speaker, urging the support of the underlying legislation, I
also urge all of my colleagues to support this rule, which is very
fair, makes more than twice as many amendments by Democrats than by
Republicans in order. It is precisely in our interest to go the extra
mile for fairness.
Mr. DINGELL. Mr. Speaker, I rise in strong opposition to this rule.
There once was a time when we considered legislation under open rules.
Any Member could offer an amendment. That was the way I, as chairman of
the Committee on Energy and Commerce, brought bills to the House floor.
Eventually amendments were limited, perhaps under the guise of
efficiency. But certainly the minority should be allowed to offer an
alternative. Democrats brought an alternative to the Committee on
Rules. It was supported by every Democrat on our committee.
It was not a radical alternative. It was identical to the bill that
passed the Senate unanimously, with the addition of language to protect
patient privacy. Yet this rule blocks the offering of our proposal.
If my Republican colleagues disagree with this substitute, fine--vote
against it, but don't hide behind a rule that prevents us from offering
it.
If we had an open rule, we could fairly debate this important issue.
All of us want to improve health information technology. One hundred
Senators voted for a bill to do so, but under this closed rule, if a
Member of the House wanted to offer that Senate bill, which was
sponsored by Republican Majority Leader Frist, along with Senator Enzi,
Kennedy, and Clinton, he or she could not do so.
That's right--my rubber stamp Republican colleagues are about to pass
a rule that makes sure that a bill that passed unanimously in the
Senate cannot even get a vote in the House. It is a closed rule and
that
[[Page H5966]]
means only amendments that the Republican leaders can accept will get a
vote.
I have read that many of my Republican colleagues are trying to
distance themselves from the policies of the House Republican
leadership. Well, here is your chance. Reject a rule that prohibits
Members from offering a substitute that consists of a bill passed
unanimously by 100 Senators. Reject a rule that prohibits an amendment
dealing with the privacy of personal medical records.
But we know the fix is in. Why else did not a single Republican
Member go to the Rules Committee to ask for a rule to allow them to
offer a bill supported by 100 Senators? Why else did not a single
Republican Member care to offer an amendment to protect the privacy of
medical records?
A vote for this closed rule is, quite simply, a vote against
bipartisanship. It is a vote against privacy protections for Americans.
And it is a vote against getting a bill signed into law this Congress.
The material previously referred to by Ms. Matsui is as follows:
Previous Question for H. Res. 952--H.R. 4157 Health Information
Technology Promotion Act of 2006
At the end of the resolution, add the following:
Sec. 4. Notwithstanding any other provision of this
resolution the amendment specified in section 5 shall be in
order as though printed after the amendment numbered 6 in the
report of the Committee on Rules if offered by Representative
Dingell of Michigan or Representative Rangel of New York or a
designee. That amendment shall be debatable for 30 minutes
equally divided and controlled by the proponent and an
opponent.
Sec. 5. The amendment referred to in section 2 is as
follows:
Amendment in the Nature of a Substitute to H.R. 4157, as Reported
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Wired for Health Care
Quality Act''.
SEC. 2. IMPROVING HEALTH CARE QUALITY, SAFETY, AND
EFFICIENCY.
The Public Health Service Act (42 U.S.C. 201 et seq.) is
amended by adding at the end the following:
``TITLE XXIX--HEALTH INFORMATION TECHNOLOGY AND QUALITY
``SEC. 2901. DEFINITIONS.
``In this title:
``(1) Health care provider.--The term `health care
provider' means a hospital, skilled nursing facility, home
health entity, health care clinic, federally qualified health
center, group practice (as defined in section 1877(h)(4) of
the Social Security Act), a pharmacist, a pharmacy, a
laboratory, a physician (as defined in section 1861(r) of the
Social Security Act), a practitioner (as defined in section
1842(b)(18)(CC) of the Social Security Act), a health
facility operated by or pursuant to a contract with the
Indian Health Service, a rural health clinic, and any other
category of facility or clinician determined appropriate by
the Secretary.
``(2) Health information.--The term `health information'
has the meaning given such term in section 1171(4) of the
Social Security Act.
``(3) Health insurance plan.--The term `health insurance
plan' means--
``(A) a health insurance issuer (as defined in section
2791(b)(2));
``(B) a group health plan (as defined in section
2791(a)(1)); and
``(C) a health maintenance organization (as defined in
section 2791(b)(3)).
``(4) Individually identifiable health information.--The
term `individually identifiable health information' has the
meaning given such term in section 1171 of the Social
Security Act.
``(5) Laboratory.--The term `laboratory' has the meaning
given that term in section 353.
``(6) Pharmacist.--The term `pharmacist' has the meaning
given that term in section 804 of the Federal Food, Drug, and
Cosmetic Act.
``(7) Qualified health information technology.--The term
`qualified health information technology' means a
computerized system (including hardware and software) that--
``(A) protects the privacy and security of health
information;
``(B) maintains and provides permitted access to health
information in an electronic format;
``(C) incorporates decision support to reduce medical
errors and enhance health care quality;
``(D) complies with the standards adopted by the Federal
Government under section 2903; and
``(E) allows for the reporting of quality measures under
section 2908.
``(8) State.--The term `State' means each of the several
States, the District of Columbia, Puerto Rico, the Virgin
Islands, Guam, American Samoa, and the Northern Mariana
Islands.
``SEC. 2902. OFFICE OF THE NATIONAL COORDINATOR OF HEALTH
INFORMATION TECHNOLOGY.
``(a) Office of National Health Information Technology.--
There is established within the Office of the Secretary an
Office of the National Coordinator of Health Information
Technology (referred to in this section as the `Office'). The
Office shall be headed by a National Coordinator who shall be
appointed by the Secretary and shall report directly to the
Secretary.
``(b) Purpose.--It shall be the purpose of the Office to
coordinate with relevant Federal agencies and private
entities and oversee programs and activities to develop a
nationwide interoperable health information technology
infrastructure that--
``(1) ensures that patients' individually identifiable
health information is secure and protected;
``(2) improves health care quality, reduces medical errors,
and advances the delivery of patient-centered medical care;
``(3) reduces health care costs resulting from
inefficiency, medical errors, inappropriate care, and
incomplete information;
``(4) ensures that appropriate information to help guide
medical decisions is available at the time and place of care;
``(5) promotes a more effective marketplace, greater
competition, and increased choice through the wider
availability of accurate information on health care costs,
quality, and outcomes;
``(6) improves the coordination of care and information
among hospitals, laboratories, physician offices, and other
entities through an effective infrastructure for the secure
and authorized exchange of health care information;
``(7) improves public health reporting and facilitates the
early identification and rapid response to public health
threats and emergencies, including bioterror events and
infectious disease outbreaks;
``(8) facilitates health research; and
``(9) promotes prevention of chronic diseases.
``(c) Duties of the National Coordinator.--The National
Coordinator shall--
``(1) serve as the principal advisor to the Secretary
concerning the development, application, and use of health
information technology, and coordinate and oversee the health
information technology programs of the Department;
``(2) facilitate the adoption of a nationwide,
interoperable system for the electronic exchange of health
information;
``(3) ensure the adoption and implementation of standards
for the electronic exchange of health information to reduce
cost and improve health care quality;
``(4) ensure that health information technology policy and
programs of the Department are coordinated with those of
relevant executive branch agencies (including Federal
commissions) with a goal of avoiding duplication of efforts
and of helping to ensure that each agency undertakes health
information technology activities primarily within the areas
of its greatest expertise and technical capability;
``(5) to the extent permitted by law, coordinate outreach
and consultation by the relevant executive branch agencies
(including Federal commissions) with public and private
parties of interest, including consumers, payers, employers,
hospitals and other health care providers, physicians,
community health centers, laboratories, vendors and other
stakeholders;
``(6) advise the President regarding specific Federal
health information technology programs; and
``(7) prepare the reports described under section 2903(i)
(excluding paragraph (4) of such section).
``(d) Detail of Federal Employees.--
``(1) In general.--Upon the request of the National
Coordinator, the head of any Federal agency is authorized to
detail, with or without reimbursement from the Office, any of
the personnel of such agency to the Office to assist it in
carrying out its duties under this section.
``(2) Effect of detail.--Any detail of personnel under
paragraph (1) shall--
``(A) not interrupt or otherwise affect the civil service
status or privileges of the Federal employee; and
``(B) be in addition to any other staff of the Department
employed by the National Coordinator.
``(3) Acceptance of detailees.--Notwithstanding any other
provision of law, the Office may accept detailed personnel
from other Federal agencies without regard to whether the
agency described under paragraph (1) is reimbursed.
``(e) Rule of Construction.--Nothing in this section shall
be construed to require the duplication of Federal efforts
with respect to the establishment of the Office, regardless
of whether such efforts were carried out prior to or after
the enactment of this title.
``(f) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section,
$5,000,000 for fiscal year 2007, $5,000,000 for fiscal year
2008, and such sums as may be necessary for each of fiscal
years 2009 through 2011.
``SEC. 2903. AMERICAN HEALTH INFORMATION COLLABORATIVE.
``(a) Purpose.--The Secretary shall establish the public-
private American Health Information Collaborative (referred
to in this section as the `Collaborative') to--
``(1) advise the Secretary and recommend specific actions
to achieve a nationwide interoperable health information
technology infrastructure;
``(2) serve as a forum for the participation of a broad
range of stakeholders to provide input on achieving the
interoperability of health information technology; and
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``(3) recommend standards (including content,
communication, and security standards) for the electronic
exchange of health information (including for the reporting
of quality data under section 2908) for adoption by the
Federal Government and voluntary adoption by private
entities.
``(b) Composition.--
``(1) In general.--The Collaborative shall be composed of
members of the public and private sectors to be appointed by
the Secretary, including representatives from--
``(A) consumer or patient organizations;
``(B) organizations with expertise in privacy and security;
``(C) health care providers;
``(D) health insurance plans or other third party payors;
``(E) information technology vendors; and
``(F) purchasers or employers.
``(2) Participation.--In appointing members under paragraph
(1), and in developing the procedures for conducting the
activities of the Collaborative, the Secretary shall ensure a
balance among various sectors of the health care system so
that no single sector unduly influences the recommendations
of the Collaborative.
``(3) Terms.--Members appointed under paragraph (1) shall
serve for 2 year terms, except that any member appointed to
fill a vacancy for an unexpired term shall be appointed for
the remainder of such term. A member may serve for not to
exceed 180 days after the expiration of such member's term or
until a successor has been appointed.
``(4) Outside involvement.--With respect to the functions
of the Collaborative, the Secretary shall ensure an adequate
opportunity for the participation of outside advisors,
including individuals with expertise in--
``(A) health information privacy;
``(B) health information security;
``(C) health care quality and patient safety, including
individuals with expertise in utilizing health information
technology to improve health care quality and patient safety;
``(D) data exchange; and
``(E) developing health information technology standards
and new health information technology.
``(c) Recommendations and Policies.--Not later than 1 year
after the date of enactment of this title, and annually
thereafter, the Collaborative shall recommend to the
Secretary uniform national policies for adoption by the
Federal Government and voluntary adoption by private entities
to support the widespread adoption of health information
technology, including--
``(1) protection of individually identifiable health
information through privacy and security practices;
``(2) measures to prevent unauthorized access to health
information, including unauthorized access through the use of
certain peer-to-peer file-sharing applications;
``(3) methods to notify patients if their individually
identifiable health information is wrongfully disclosed;
``(4) methods to facilitate secure patient access to health
information;
``(5) fostering the public understanding of health
information technology;
``(6) the ongoing harmonization of industry-wide health
information technology standards;
``(7) recommendations for a nationwide interoperable health
information technology infrastructure;
``(8) the identification and prioritization of specific use
cases for which health information technology is valuable,
beneficial, and feasible;
``(9) recommendations for the establishment of an entity to
ensure the continuation of the functions of the
Collaborative; and
``(10) other policies (including recommendations for
incorporating health information technology into the
provision of care and the organization of the health care
workplace) determined to be necessary by the Collaborative.
``(d) Standards.--
``(1) Existing standards.--The standards adopted by the
Consolidated Health Informatics Initiative shall be deemed to
have been recommended by the Collaborative under this
section.
``(2) First year review.--Not later than 1 year after the
date of enactment of this title, the Collaborative shall--
``(A) review existing standards (including content,
communication, and security standards) for the electronic
exchange of health information;
``(B) identify deficiencies and omissions in such existing
standards; and
``(C) identify duplication and overlap in such existing
standards;
and recommend new standards and modifications to such
existing standards as necessary.
``(3) Ongoing review.--Beginning 1 year after the date of
enactment of this title, and annually thereafter, the
Collaborative shall--
``(A) review existing standards (including content,
communication, and security standards) for the electronic
exchange of health information;
``(B) identify deficiencies and omissions in such existing
standards; and
``(C) identify duplication and overlap in such existing
standards;
and recommend new standards and modifications to such
existing standards as necessary.
``(4) Limitation.--The standards and timeframe for adoption
described in this section shall be consistent with any
standards developed pursuant to the Health Insurance
Portability and Accountability Act of 1996.
``(e) Federal Action.--Not later than 90 days after the
issuance of a recommendation from the Collaborative under
subsection (d)(2), the Secretary of Health and Human
Services, the Secretary of Veterans Affairs, and the
Secretary of Defense, in collaboration with representatives
of other relevant Federal agencies, as determined appropriate
by the Secretary, shall jointly review such recommendations.
If appropriate, the Secretary shall provide for the adoption
by the Federal Government of any standard or standards
contained in such recommendation.
``(f) Coordination of Federal Spending.--
``(1) In general.--Not later than 1 year after the adoption
by the Federal Government of a recommendation as provided for
in subsection (e), and in compliance with chapter 113 of
title 40, United States Code, no Federal agency shall expend
Federal funds for the purchase of any new health information
technology or health information technology system for
clinical care or for the electronic retrieval, storage, or
exchange of health information that is not consistent with
applicable standards adopted by the Federal Government under
subsection (e).
``(2) Rule of construction.--Nothing in paragraph (1) shall
be construed to restrict the purchase of minor (as determined
by the Secretary) hardware or software components in order to
modify, correct a deficiency in, or extend the life of
existing hardware or software.
``(g) Coordination of Federal Data Collection.--Not later
than 3 years after the adoption by the Federal Government of
a recommendation as provided for in subsection (e), all
Federal agencies collecting health data for the purposes of
quality reporting, surveillance, epidemiology, adverse event
reporting, research, or for other purposes determined
appropriate by the Secretary, shall comply with standards
adopted under subsection (e).
``(h) Voluntary Adoption.--
``(1) In general.--Any standards adopted by the Federal
Government under subsection (e) shall be voluntary with
respect to private entities.
``(2) Rule of construction.--Nothing in this section shall
be construed to require that a private entity that enters
into a contract with the Federal Government adopt the
standards adopted by the Federal Government under this
section with respect to activities not related to the
contract.
``(3) Limitation.--Private entities that enter into a
contract with the Federal Government shall adopt the
standards adopted by the Federal Government under this
section for the purpose of activities under such Federal
contract.
``(i) Reports.--The Secretary shall submit to the Committee
on Health, Education, Labor, and Pensions and the Committee
on Finance of the Senate and the Committee on Energy and
Commerce and the Committee on Ways and Means of the House of
Representatives, on an annual basis, a report that--
``(1) describes the specific actions that have been taken
by the Federal Government and private entities to facilitate
the adoption of an interoperable nationwide system for the
electronic exchange of health information;
``(2) describes barriers to the adoption of such a
nationwide system;
``(3) contains recommendations to achieve full
implementation of such a nationwide system; and
``(4) contains a plan and progress toward the establishment
of an entity to ensure the continuation of the functions of
the Collaborative.
``(j) Application of FACA.--The Federal Advisory Committee
Act (5 U.S.C. App.) shall apply to the Collaborative, except
that the term provided for under section 14(a)(2) shall be 5
years.
``(k) Rule of Construction.--Nothing in this section shall
be construed to require the duplication of Federal efforts
with respect to the establishment of the Collaborative,
regardless of whether such efforts were carried out prior to
or after the enactment of this title.
``(l) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section,
$4,000,000 for fiscal year 2007, $4,000,000 for fiscal year
2008, and such sums as may be necessary for each of fiscal
years 2009 through 2011.
``SEC. 2904. IMPLEMENTATION AND CERTIFICATION OF HEALTH
INFORMATION STANDARDS.
``(a) Implementation.--
``(1) In general.--The Secretary, based upon the
recommendations of the Collaborative, shall develop criteria
to ensure uniform and consistent implementation of any
standards for the electronic exchange of health information
voluntarily adopted by private entities in technical
conformance with such standards adopted under this title.
``(2) Implementation assistance.--The Secretary may
recognize a private entity or entities to assist private
entities in the implementation of the standards adopted under
this title using the criteria developed by the Secretary
under this section.
``(b) Certification.--
``(1) In general.--The Secretary, based upon the
recommendations of the Collaborative, shall develop criteria
to ensure and certify that hardware and software that claim
to be in compliance with applicable standards for the
electronic exchange of
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health information adopted under this title have established
and maintained such compliance in technical conformance with
such standards.
``(2) Certification assistance.--The Secretary may
recognize a private entity or entities to assist in the
certification described under paragraph (1) using the
criteria developed by the Secretary under this section.
``(c) Outside Involvement.--The Secretary, through
consultation with the Collaborative, may accept
recommendations on the development of the criteria under
subsections (a) and (b) from a Federal agency or private
entity.
``SEC. 2905. PRIVACY AND SECURITY PROTECTIONS.
``(a) In General.--The Secretary shall provide for
standards for health information technology (as such term is
used in this title) that include the following privacy and
security protections:
``(1) Except as provided in succeeding paragraphs, each
entity must--
``(A) expressly recognize the individual's right to privacy
and security with respect to the electronic disclosure of
such information;
``(B) permit individuals to exercise their right to privacy
and security in the electronic disclosure of such information
to another entity by obtaining the individual's written or
electronic informed consent, which consent may authorize
multiple disclosures;
``(C) permit an individual to prohibit access to certain
categories of individuals (as defined by the Secretary) of
particularly sensitive information, including data relating
to infection with the human immunodeficiency virus (HIV), to
mental health, to sexually transmitted diseases, to
reproductive health, to domestic violence, to substance abuse
treatment, to genetic testing or information, to diabetes,
and other information as defined by the Secretary after
consent has been provided under subparagraph (B).
``(2) Informed consent may be inferred, in the absence of a
contrary indication by the individual--
``(A) to the extent necessary to provide treatment and
obtain payment for health care in emergency situations;
``(B) to the extent necessary to provide treatment and
payment where the health care provider is required by law to
treat the individual;
``(C) if the health care provider is unable to obtain
consent due to substantial barriers to communicating with the
individual and the provider reasonably infers from the
circumstances, based upon the exercise of professional
judgment, that the individual does not object to the
disclosure or that the disclosure is in the best interest of
the individual; and
``(D) to the extent that the information is necessary to
carry out or otherwise implement a medical practitioner's
order or prescription for health services, medical devices or
supplies, or pharmaceuticals.
``(3) The protections must prohibit the improper use and
disclosure of individually identifiable health information by
any entity.
``(4) The protections must provide any individual a right
to obtain damages and other relief against any entity for the
entity's improper use or disclosure of individually
identifiable health information.
``(5) The protections must require the use of reasonable
safeguards, including audit capabilities, encryption and
other technologies that make data unusable to unauthorized
persons, and other measures, against the risk of loss or
unauthorized access, destruction, use, modification, or
disclosure of individually identifiable health information.
``(6) The protections must provide for notification to any
individual whose individually identifiable health information
has been lost, stolen, or used for an unauthorized purpose by
the entity responsible for the information and notification
by the entity to the Secretary.
``(b) List of Entities.--The Secretary shall maintain a
public list identifying entities whose health information has
been lost, stolen, or used in an unauthorized purpose as
described in subsection (a)(6) and how many patients were
affected by such action.
``(c) Construction.--Nothing in this section shall be
construed as superseding, altering, or affecting (in whole or
in part) any statute, regulation, order, or interpretation in
effect in any State that affords any person privacy and
security protections greater than that the privacy and
security protections described in subsection (a), as
determined by the Secretary.
``SEC. 2906. GRANTS TO FACILITATE THE WIDESPREAD ADOPTION OF
INTEROPERABLE HEALTH INFORMATION TECHNOLOGY.
``(a) Competitive Grants to Facilitate the Widespread
Adoption of Health Information Technology.--
``(1) In general.--The Secretary may award competitive
grants to eligible entities to facilitate the purchase and
enhance the utilization of qualified health information
technology systems to improve the quality and efficiency of
health care.
``(2) Eligibility.--To be eligible to receive a grant under
paragraph (1) an entity shall--
``(A) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require;
``(B) submit to the Secretary a strategic plan for the
implementation of data sharing and interoperability measures;
``(C) be a--
``(i) not for profit hospital, including a federally
qualified health center (as defined in section 1861(aa)(4) of
the Social Security Act);
``(ii) individual or group practice; or
``(iii) another health care provider not described in
clause (i) or (ii);
``(D) adopt the standards adopted by the Federal Government
under section 2903;
``(E) implement the measures adopted under section 2908 and
report to the Secretary on such measures;
``(F) agree to notify patients if their individually
identifiable health information is wrongfully disclosed;
``(G) demonstrate significant financial need; and
``(H) provide matching funds in accordance with paragraph
(4).
``(3) Use of funds.--Amounts received under a grant under
this subsection shall be used to facilitate the purchase and
enhance the utilization of qualified health information
technology systems and training personnel in the use of such
technology.
``(4) Matching requirement.--To be eligible for a grant
under this subsection an entity shall contribute non-Federal
contributions to the costs of carrying out the activities for
which the grant is awarded in an amount equal to $1 for each
$3 of Federal funds provided under the grant.
``(5) Preference in awarding grants.--In awarding grants
under this subsection the Secretary shall give preference
to--
``(A) eligible entities that are located in rural,
frontier, and other underserved areas as determined by the
Secretary;
``(B) eligible entities that will link, to the extent
practicable, the qualified health information system to local
or regional health information plan or plans; and
``(C) with respect to an entity described in subsection
(a)(2)(C)(iii), a nonprofit health care provider.
``(b) Competitive Grants to States for the Development of
State Loan Programs To Facilitate the Widespread Adoption of
Health Information Technology.--
``(1) In general.--The Secretary may award competitive
grants to States for the establishment of State programs for
loans to health care providers to facilitate the purchase and
enhance the utilization of qualified health information
technology.
``(2) Establishment of fund.--To be eligible to receive a
competitive grant under this subsection, a State shall
establish a qualified health information technology loan fund
(referred to in this subsection as a `State loan fund') and
comply with the other requirements contained in this section.
A grant to a State under this subsection shall be deposited
in the State loan fund established by the State. No funds
authorized by other provisions of this title to be used for
other purposes specified in this title shall be deposited in
any State loan fund.
``(3) Eligibility.--To be eligible to receive a grant under
paragraph (1) a State shall--
``(A) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require;
``(B) submit to the Secretary a strategic plan in
accordance with paragraph (4);
``(C) establish a qualified health information technology
loan fund in accordance with paragraph (2);
``(D) require that health care providers receiving such
loans--
``(i) link, to the extent practicable, the qualified health
information system to a local or regional health information
network;
``(ii) consult with the Health Information Technology
Resource Center established in section 914(d) to access the
knowledge and experience of existing initiatives regarding
the successful implementation and effective use of health
information technology; and
``(iii) agree to notify patients if their individually
identifiable health information is wrongfully disclosed;
``(E) require that health care providers receiving such
loans adopt the standards adopted by the Federal Government
under section 2903;
``(F) require that health care providers receiving such
loans implement the measures adopted under section 2908 and
report to the Secretary on such measures; and
``(G) provide matching funds in accordance with paragraph
(8).
``(4) Strategic plan.--
``(A) In general.--A State that receives a grant under this
subsection shall annually prepare a strategic plan that
identifies the intended uses of amounts available to the
State loan fund of the State.
``(B) Contents.--A strategic plan under subparagraph (A)
shall include--
``(i) a list of the projects to be assisted through the
State loan fund in the first fiscal year that begins after
the date on which the plan is submitted;
``(ii) a description of the criteria and methods
established for the distribution of funds from the State loan
fund; and
``(iii) a description of the financial status of the State
loan fund and the short-term and long-term goals of the State
loan fund.
``(5) Use of funds.--
``(A) In general.--Amounts deposited in a State loan fund,
including loan repayments and interest earned on such
amounts, shall be used only for awarding loans or loan
guarantees, or as a source of reserve and security for
leveraged loans, the proceeds of which
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are deposited in the State loan fund established under
paragraph (1). Loans under this section may be used by a
health care provider to facilitate the purchase and enhance
the utilization of qualified health information technology
and training of personnel in the use of such technology.
``(B) Limitation.--Amounts received by a State under this
subsection may not be used--
``(i) for the purchase or other acquisition of any health
information technology system that is not a qualified health
information technology system;
``(ii) to conduct activities for which Federal funds are
expended under this title, or the amendments made by the
Wired for Health Care Quality Act; or
``(iii) for any purpose other than making loans to eligible
entities under this section.
``(6) Types of assistance.--Except as otherwise limited by
applicable State law, amounts deposited into a State loan
fund under this subsection may only be used for the
following:
``(A) To award loans that comply with the following:
``(i) The interest rate for each loan shall be less than or
equal to the market interest rate.
``(ii) The principal and interest payments on each loan
shall commence not later than 1 year after the loan was
awarded, and each loan shall be fully amortized not later
than 10 years after the date of the loan.
``(iii) The State loan fund shall be credited with all
payments of principal and interest on each loan awarded from
the fund.
``(B) To guarantee, or purchase insurance for, a local
obligation (all of the proceeds of which finance a project
eligible for assistance under this subsection) if the
guarantee or purchase would improve credit market access or
reduce the interest rate applicable to the obligation
involved.
``(C) As a source of revenue or security for the payment of
principal and interest on revenue or general obligation bonds
issued by the State if the proceeds of the sale of the bonds
will be deposited into the State loan fund.
``(D) To earn interest on the amounts deposited into the
State loan fund.
``(7) Administration of state loan funds.--
``(A) Combined financial administration.--A State may (as a
convenience and to avoid unnecessary administrative costs)
combine, in accordance with State law, the financial
administration of a State loan fund established under this
subsection with the financial administration of any other
revolving fund established by the State if otherwise not
prohibited by the law under which the State loan fund was
established.
``(B) Cost of administering fund.--Each State may annually
use not to exceed 4 percent of the funds provided to the
State under a grant under this subsection to pay the
reasonable costs of the administration of the programs under
this section, including the recovery of reasonable costs
expended to establish a State loan fund which are incurred
after the date of enactment of this title.
``(C) Guidance and regulations.--The Secretary shall
publish guidance and promulgate regulations as may be
necessary to carry out the provisions of this subsection,
including--
``(i) provisions to ensure that each State commits and
expends funds allotted to the State under this subsection as
efficiently as possible in accordance with this title and
applicable State laws; and
``(ii) guidance to prevent waste, fraud, and abuse.
``(D) Private sector contributions.--
``(i) In general.--A State loan fund established under this
subsection may accept contributions from private sector
entities, except that such entities may not specify the
recipient or recipients of any loan issued under this
subsection.
``(ii) Availability of information.--A State shall make
publicly available the identity of, and amount contributed
by, any private sector entity under clause (i) and may issue
letters of commendation or make other awards (that have no
financial value) to any such entity.
``(8) Matching requirements.--
``(A) In general.--The Secretary may not make a grant under
paragraph (1) to a State unless the State agrees to make
available (directly or through donations from public or
private entities) non-Federal contributions in cash toward
the costs of the State program to be implemented under the
grant in an amount equal to not less than $1 for each $1 of
Federal funds provided under the grant.
``(B) Determination of amount of non-federal
contribution.--In determining the amount of non-Federal
contributions that a State has provided pursuant to
subparagraph (A), the Secretary may not include any amounts
provided to the State by the Federal Government.
``(9) Preference in awarding grants.--The Secretary may
give a preference in awarding grants under this subsection to
States that adopt value-based purchasing programs to improve
health care quality.
``(10) Reports.--The Secretary shall annually submit to the
Committee on Health, Education, Labor, and Pensions and the
Committee on Finance of the Senate, and the Committee on
Energy and Commerce and the Committee on Ways and Means of
the House of Representatives, a report summarizing the
reports received by the Secretary from each State that
receives a grant under this subsection.
``(c) Competitive Grants for the Implementation of Regional
or Local Health Information Technology Plans.--
``(1) In general.--The Secretary may award competitive
grants to eligible entities to implement regional or local
health information plans to improve health care quality and
efficiency through the electronic exchange of health
information pursuant to the standards, protocols, and other
requirements adopted by the Secretary under sections 2903 and
2908.
``(2) Eligibility.--To be eligible to receive a grant under
paragraph (1) an entity shall--
``(A) demonstrate financial need to the Secretary;
``(B) demonstrate that one of its principal missions or
purposes is to use information technology to improve health
care quality and efficiency;
``(C) adopt bylaws, memoranda of understanding, or other
charter documents that demonstrate that the governance
structure and decisionmaking processes of such entity allow
for participation on an ongoing basis by multiple
stakeholders within a community, including--
``(i) physicians (as defined in section 1861(r) of the
Social Security Act), including physicians that provide
services to low income and underserved populations;
``(ii) hospitals (including hospitals that provide services
to low income and underserved populations);
``(iii) pharmacists or pharmacies;
``(iv) health insurance plans;
``(v) health centers (as defined in section 330(b)) and
Federally qualified health centers (as defined in section
1861(aa)(4) of the Social Security Act);
``(vi) rural health clinics (as defined in section 1861(aa)
of the Social Security Act);
``(vii) patient or consumer organizations;
``(viii) employers; and
``(ix) any other health care providers or other entities,
as determined appropriate by the Secretary;
``(D) demonstrate the participation, to the extent
practicable, of stakeholders in the electronic exchange of
health information within the local or regional plan pursuant
to paragraph (2)(C);
``(E) adopt nondiscrimination and conflict of interest
policies that demonstrate a commitment to open, fair, and
nondiscriminatory participation in the health information
plan by all stakeholders;
``(F) adopt the standards adopted by the Secretary under
section 2903;
``(G) require that health care providers receiving such
grants implement the measures adopted under section 2908 and
report to the Secretary on such measures;
``(H) agree to notify patients if their individually
identifiable health information is wrongfully disclosed;
``(I) facilitate the electronic exchange of health
information within the local or regional area and among local
and regional areas;
``(J) prepare and submit to the Secretary an application in
accordance with paragraph (3); and
``(K) agree to provide matching funds in accordance with
paragraph (5).
``(3) Application.--
``(A) In general.--To be eligible to receive a grant under
paragraph (1), an entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may require.
``(B) Required information.--At a minimum, an application
submitted under this paragraph shall include--
``(i) clearly identified short-term and long-term
objectives of the regional or local health information plan;
``(ii) a technology plan that complies with the standards
adopted under section 2903 and that includes a descriptive
and reasoned estimate of costs of the hardware, software,
training, and consulting services necessary to implement the
regional or local health information plan;
``(iii) a strategy that includes initiatives to improve
health care quality and efficiency, including the use and
reporting of health care quality measures adopted under
section 2908;
``(iv) a plan that describes provisions to encourage the
implementation of the electronic exchange of health
information by all physicians, including single physician
practices and small physician groups participating in the
health information plan;
``(v) a plan to ensure the privacy and security of personal
health information that is consistent with Federal and State
law;
``(vi) a governance plan that defines the manner in which
the stakeholders shall jointly make policy and operational
decisions on an ongoing basis;
``(vii) a financial or business plan that describes--
``(I) the sustainability of the plan;
``(II) the financial costs and benefits of the plan; and
``(III) the entities to which such costs and benefits will
accrue; and
``(viii) in the case of an applicant entity that is unable
to demonstrate the participation of all stakeholders pursuant
to paragraph (2)(C), the justification from the entity for
any such nonparticipation.
``(4) Use of funds.--Amounts received under a grant under
paragraph (1) shall be used to establish and implement a
regional or local health information plan in accordance with
this subsection.
``(5) Matching requirement.--
[[Page H5970]]
``(A) In general.--The Secretary may not make a grant under
this subsection to an entity unless the entity agrees that,
with respect to the costs to be incurred by the entity in
carrying out the infrastructure program for which the grant
was awarded, the entity will make available (directly or
through donations from public or private entities) non-
Federal contributions toward such costs in an amount equal to
not less than 50 percent of such costs ($1 for each $2 of
Federal funds provided under the grant).
``(B) Determination of amount contributed.--Non-Federal
contributions required under subparagraph (A) may be in cash
or in kind, fairly evaluated, including equipment,
technology, or services. Amounts provided by the Federal
Government, or services assisted or subsidized to any
significant extent by the Federal Government, may not be
included in determining the amount of such non-Federal
contributions.
``(d) Reports.--Not later than 1 year after the date on
which the first grant is awarded under this section, and
annually thereafter during the grant period, an entity that
receives a grant under this section shall submit to the
Secretary a report on the activities carried out under the
grant involved. Each such report shall include--
``(1) a description of the financial costs and benefits of
the project involved and of the entities to which such costs
and benefits accrue;
``(2) an analysis of the impact of the project on health
care quality and safety;
``(3) a description of any reduction in duplicative or
unnecessary care as a result of the project involved;
``(4) a description of the efforts of recipients under this
section to facilitate secure patient access to health
information; and
``(5) other information as required by the Secretary.
``(e) Requirement To Achieve Quality Improvement.--The
Secretary shall annually evaluate the activities conducted
under this section and shall, in awarding grants, implement
the lessons learned from such evaluation in a manner so that
awards made subsequent to each such evaluation are made in a
manner that, in the determination of the Secretary, will
result in the greatest improvement in quality measures under
section 2908.
``(f) Limitation.--An eligible entity may only receive one
non-renewable grant under subsection (a), one non-renewable
grant under subsection (b), and one non-renewable grant under
subsection (c).
``(g) Authorization of Appropriations.--
``(1) In general.--For the purpose of carrying out this
section, there is authorized to be appropriated $116,000,000
for fiscal year 2007, $141,000,000 for fiscal year 2008, and
such sums as may be necessary for each of fiscal years 2009
through 2011.
``(2) Availability.--Amounts appropriated under paragraph
(1) shall remain available through fiscal year 2011.
``SEC. 2907. DEMONSTRATION PROGRAM TO INTEGRATE INFORMATION
TECHNOLOGY INTO CLINICAL EDUCATION.
``(a) In General.--The Secretary may award grants under
this section to carry out demonstration projects to develop
academic curricula integrating qualified health information
technology systems in the clinical education of health
professionals. Such awards shall be made on a competitive
basis and pursuant to peer review.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a), an entity shall--
``(1) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require;
``(2) submit to the Secretary a strategic plan for
integrating qualified health information technology in the
clinical education of health professionals and for ensuring
the consistent utilization of decision support software to
reduce medical errors and enhance health care quality;
``(3) be--
``(A) a health professions school;
``(B) a school of nursing; or
``(C) an institution with a graduate medical education
program;
``(4) provide for the collection of data regarding the
effectiveness of the demonstration project to be funded under
the grant in improving the safety of patients, the efficiency
of health care delivery, and in increasing the likelihood
that graduates of the grantee will adopt and incorporate
health information technology, and implement the quality
measures adopted under section 2908, in the delivery of
health care services; and
``(5) provide matching funds in accordance with subsection
(c).
``(c) Use of Funds.--
``(1) In general.--With respect to a grant under subsection
(a), an eligible entity shall--
``(A) use grant funds in collaboration with 2 or more
disciplines; and
``(B) use grant funds to integrate qualified health
information technology into community-based clinical
education.
``(2) Limitation.--An eligible entity shall not use amounts
received under a grant under subsection (a) to purchase
hardware, software, or services.
``(d) Matching Funds.--
``(1) In general.--The Secretary may award a grant to an
entity under this section only if the entity agrees to make
available non-Federal contributions toward the costs of the
program to be funded under the grant in an amount that is not
less than $1 for each $2 of Federal funds provided under the
grant.
``(2) Determination of amount contributed.--Non-Federal
contributions under paragraph (1) may be in cash or in kind,
fairly evaluated, including equipment or services. Amounts
provided by the Federal Government, or services assisted or
subsidized to any significant extent by the Federal
Government, may not be included in determining the amount of
such contributions.
``(e) Evaluation.--The Secretary shall take such action as
may be necessary to evaluate the projects funded under this
section and publish, make available, and disseminate the
results of such evaluations on as wide a basis as is
practicable.
``(f) Reports.--Not later than 1 year after the date of
enactment of this title, and annually thereafter, the
Secretary shall submit to the Committee on Health, Education,
Labor, and Pensions and the Committee on Finance of the
Senate, and the Committee on Energy and Commerce and the
Committee on Ways and Means of the House of Representatives a
report that--
``(1) describes the specific projects established under
this section; and
``(2) contains recommendations for Congress based on the
evaluation conducted under subsection (e).
``(g) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section, $5,000,000 for
fiscal year 2007, and such sums as may be necessary for each
of fiscal years 2008 through 2010.
``(h) Sunset.--This section shall not apply after September
30, 2010.
``SEC. 2908. QUALITY MEASURES.
``(a) In General.--The Secretary shall develop quality
measures, including measures to assess the effectiveness,
timeliness, patient self-management, patient centeredness,
efficiency, and safety, for the purpose of measuring the
quality of care patients receive.
``(b) Requirements.--The Secretary shall ensure that the
quality measures developed under this section comply with the
following:
``(1) Measures.--
``(A) Requirements.--In developing the quality measures
under this section, the Secretary shall, to the extent
feasible, ensure that--
``(i) such measures are evidence based, reliable, and
valid;
``(ii) such measures are consistent with the purposes
described in section 2902(b);
``(iii) such measures include measures of clinical
processes and outcomes, patient experience, efficiency, and
equity; and
``(iv) such measures include measures of overuse and
underuse of health care items and services.
``(2) Priorities.--In developing the quality measures under
this section, the Secretary shall ensure that priority is
given to--
``(A) measures with the greatest potential impact for
improving the quality and efficiency of care provided under
this Act;
``(B) measures that may be rapidly implemented by group
health plans, health insurance issuers, physicians,
hospitals, nursing homes, long-term care providers, and other
providers; and
``(C) measures which may inform health care decisions made
by consumers and patients.
``(3) Risk adjustment.--The Secretary shall establish
procedures to account for differences in patient health
status, patient characteristics, and geographic location. To
the extent practicable, such procedures shall recognize
existing procedures.
``(4) Maintenance.--The Secretary shall, as determined
appropriate, but in no case more often than once during each
12-month period, update the quality measures, including
through the addition of more accurate and precise measures
and the retirement of existing outdated measures.
``(5) Relationship with programs under the social security
act.--The Secretary shall ensure that the quality measures
developed under this section--
``(A) complement quality measures developed by the
Secretary under programs administered by the Secretary under
the Social Security Act, including programs under titles
XVIII, XIX, and XXI of such Act; and
``(B) do not conflict with the needs and priorities of the
programs under titles XVIII, XIX, and XXI of such Act, as set
forth by the Administrator of the Centers for Medicare &
Medicaid Services.
``(c) Required Considerations in Developing and Updating
the Measures.--In developing and updating the quality
measures under this section, the Secretary may take into
account--
``(1) any demonstration or pilot program conducted by the
Secretary relating to measuring and rewarding quality and
efficiency of care;
``(2) any existing activities conducted by the Secretary
relating to measuring and rewarding quality and efficiency;
``(3) any existing activities conducted by private
entities, including health insurance plans and payors;
``(4) the report by the Institute of Medicine of the
National Academy of Sciences under section 238(b) of the
Medicare Prescription Drug, Improvement, and Modernization
Act of 2003; and
``(5) issues of data collection and reporting, including
the feasibility of collecting and reporting data on measures.
``(d) Solicitation of Advice and Recommendations.--On and
after July 1, 2007,
[[Page H5971]]
the Secretary shall consult with the following regarding the
development, updating, and use of quality measures developed
under this section:
``(1) Health insurance plans and health care providers,
including such plans and providers with experience in the
care of the frail elderly and individuals with multiple
complex chronic conditions, or groups representing such
health insurance plans and providers.
``(2) Groups representing patients and consumers.
``(3) Purchasers and employers or groups representing
purchasers or employers.
``(4) Organizations that focus on quality improvement as
well as the measurement and reporting of quality measures.
``(5) Organizations that certify and license health care
providers.
``(6) State government public health programs.
``(7) Individuals or entities skilled in the conduct and
interpretation of biomedical, health services, and health
economics research and with expertise in outcomes and
effectiveness research and technology assessment.
``(8) Individuals or entities involved in the development
and establishment of standards and certification for health
information technology systems and clinical data.
``(9) Individuals or entities with experience with--
``(A) urban health care issues;
``(B) safety net health care issues; and
``(C) rural and frontier health care issues.
``(e) Use of Quality Measures.--
``(1) In general.--For purposes of activities conducted or
supported by the Secretary under this Act, the Secretary
shall, to the extent practicable, adopt and utilize the
quality measures developed under this section.
``(2) Collaborative agreements.--With respect to activities
conducted or supported by the Secretary under this Act, the
Secretary may establish collaborative agreements with private
entities, including group health plans and health insurance
issuers, providers, purchasers, consumer organizations, and
entities receiving a grant under section 2906, to--
``(A) encourage the use of the quality measures adopted by
the Secretary under this section; and
``(B) foster uniformity between the health care quality
measures utilized by private entities.
``(3) Reporting.--The Secretary shall implement procedures
to enable the Department of Health and Human Services to
accept the electronic submission of data for purposes of--
``(A) quality measurement using the quality measures
developed under this section and using the standards adopted
by the Federal Government under section 2903; and
``(B) for reporting measures used to make value-based
payments under programs under the Social Security Act.
``(f) Dissemination of Information.--Beginning on January
1, 2008, in order to make comparative quality information
available to health care consumers, health professionals,
public health officials, researchers, and other appropriate
individuals and entities, the Secretary shall provide for the
dissemination, aggregation, and analysis of quality measures
collected under section 2906 and the dissemination of
recommendations and best practices derived in part from such
analysis.
``(g) Technical Assistance.--The Secretary shall provide
technical assistance to public and private entities to enable
such entities to--
``(1) implement and use evidence-based guidelines with the
greatest potential to improve health care quality,
efficiency, and patient safety; and
``(2) establish mechanisms for the rapid dissemination of
information regarding evidence-based guidelines with the
greatest potential to improve health care quality,
efficiency, and patient safety.
``(h) Rule of Construction.--Nothing in this title shall be
construed as prohibiting the Secretary, acting through the
Administrator of the Centers for Medicare & Medicaid
Services, from developing quality measures (and timing
requirements for reporting such measures) for use under
programs administered by the Secretary under the Social
Security Act, including programs under titles XVIII, XIX, and
XXI of such Act.''.
SEC. 3. LICENSURE AND THE ELECTRONIC EXCHANGE OF HEALTH
INFORMATION.
(a) In General.--The Secretary of Health and Human Services
shall carry out, or contract with a private entity to carry
out, a study that examines--
(1) the variation among State laws that relate to the
licensure, registration, and certification of medical
professionals; and
(2) how such variation among State laws impacts the secure
electronic exchange of health information--
(A) among the States; and
(B) between the States and the Federal Government.
(b) Report and Recommendations.--Not later than 1 year
after the date of enactment of this Act, the Secretary of
Health and Human Services shall publish a report that--
(1) describes the results of the study carried out under
subsection (a); and
(2) makes recommendations to States regarding the
harmonization of State laws based on the results of such
study.
SEC. 4. ENSURING PRIVACY AND SECURITY.
Nothing in this Act (or the amendments made by this Act)
shall be construed to affect the scope, substance, or
applicability of--
(1) section 264 of the Health Insurance Portability and
Accountability Act of 1996;
(2) sections 1171 through 1179 of the Social Security Act;
and
(3) any regulation issued pursuant to any such section.
SEC. 5. GAO STUDY.
Not later than 6 months after the date of enactment of this
Act, the Comptroller General of the United States shall
submit to Congress a report on the necessity and workability
of requiring health plans (as defined in section 1171 of the
Social Security Act (42 U.S.C. 1320d)), health care
clearinghouses (as defined in such section 1171), and health
care providers (as defined in such section 1171) who transmit
health information in electronic form, to notify patients if
their individually identifiable health information (as
defined in such section 1171) is wrongfully disclosed.
SEC. 6. STUDY OF REIMBURSEMENT INCENTIVES.
The Secretary of Health and Human Services shall carry out,
or contract with a private entity to carry out, a study that
examines methods to create efficient reimbursement incentives
for improving health care quality in Federally qualified
health centers, rural health clinics, and free clinics.
SEC. 7. HEALTH INFORMATION TECHNOLOGY RESOURCE CENTER.
Section 914 of the Public Health Service Act (42 U.S.C.
299b-3) is amended by adding at the end the following:
``(d) Health Information Technology Resource Center.--
``(1) In general.--The Secretary, acting through the
Director, shall develop a Health Information Technology
Resource Center to provide technical assistance and develop
best practices to support and accelerate efforts to adopt,
implement, and effectively use interoperable health
information technology in compliance with section 2903 and
2908.
``(2) Purposes.--The purpose of the Center is to--
``(A) provide a forum for the exchange of knowledge and
experience;
``(B) accelerate the transfer of lessons learned from
existing public and private sector initiatives, including
those currently receiving Federal financial support;
``(C) assemble, analyze, and widely disseminate evidence
and experience related to the adoption, implementation, and
effective use of interoperable health information technology.
``(D) provide for the establishment of regional and local
health information networks to facilitate the development of
interoperability across health care settings and improve the
quality of health care;
``(E) provide for the development of solutions to barriers
to the exchange of electronic health information; and
``(F) conduct other activities identified by the States,
local or regional health information networks, or health care
stakeholders as a focus for developing and sharing best
practices.
``(3) Support for activities.--To provide support for the
activities of the Center, the Director shall modify the
requirements, if necessary, that apply to the National
Resource Center for Health Information Technology to provide
the necessary infrastructure to support the duties and
activities of the Center and facilitate information exchange
across the public and private sectors.
``(4) Rule of construction.--Nothing in this subsection
shall be construed to require the duplication of Federal
efforts with respect to the establishment of the Center,
regardless of whether such efforts were carried out prior to
or after the enactment of this subsection.
``(e) Technical Assistance Telephone Number or Website.--
The Secretary shall establish a toll-free telephone number or
Internet website to provide health care providers and
patients with a single point of contact to--
``(1) learn about Federal grants and technical assistance
services related to interoperable health information
technology;
``(2) learn about qualified health information technology
and the quality measures adopted by the Federal Government
under sections 2903 and 2908;
``(3) learn about regional and local health information
networks for assistance with health information technology;
and
``(4) disseminate additional information determined by the
Secretary.
``(f) Authorization of Appropriations.--There is authorized
to be appropriated, such sums as may be necessary for each of
fiscal years 2007 and 2008 to carry out this subsection.''.
SEC. 8. REAUTHORIZATION OF INCENTIVE GRANTS REGARDING
TELEMEDICINE.
Section 330L(b) of the Public Health Service Act (42 U.S.C.
254c-18(b)) is amended by striking ``2002 through 2006'' and
inserting ``2007 through 2011''.
____
The Vote on the Previous Question: What it Really Means
This vote, the vote on whether to order the previous
question on a special rule, is not merely a procedural vote.
A vote against ordering the previous question is a vote
against the Republican majority agenda and a vote to allow
the opposition, at least for the moment, to offer an
alternative plan. It is a vote about what the House should be
debating.
[[Page H5972]]
Mr. Clarence Cannon's Precedents of the House of
Representatives, (VI, 308-311) describes the vote on the
previous question on the rule as ``a motion to direct or
control the consideration of the subject before the House
being made by the Member in charge.'' To defeat the previous
question is to give the opposition a chance to decide the
subject before the House. Cannon cites the Speaker's ruling
of January 13, 1920, to the effect that ``the refusal of the
House to sustain the demand for the previous question passes
the control of the resolution to the opposition'' in order to
offer an amendment. On March 15, 1909, a member of the
majority party offered a rule resolution. The House defeated
the previous question and a member of the opposition rose to
a parliamentary inquiry, asking who was entitled to
recognition. Speaker Joseph G. Cannon (R-Illinois) said:
``The previous question having been refused, the gentleman
from New York, Mr. Fitzgerald, who had asked the gentleman to
yield to him for an amendment, is entitled to the first
recognition.''
Because the vote today may look bad for the Republican
majority they will say ``the vote on the previous question is
simply a vote on whether to proceed to an immediate vote on
adopting the resolution . . . [and] has no substantive
legislative or policy implications whatsoever.'' But that is
not what they have always said. Listen to the Republican
Leadership Manual on the Legislative Process in the United
States House of Representatives, (6th edition, page 135).
Here's how the Republicans describe the previous question
vote in their own manual: Although it is generally not
possible to amend the rule because the majority Member
controlling the time will not yield for the purpose of
offering an amendment, the same result may be achieved by
voting down the previous question on the rule . . . When the
motion for the previous question is defeated, control of the
time passes to the Member who led the opposition to ordering
the previous question. That Member, because he then controls
the time, may offer an amendment to the rule, or yield for
the purpose of amendment.''
Deschler's Procedure in the U.S. House of Representatives,
the subchapter titled ``Amending Special Rules'' states: ``a
refusal to order the previous question on such a rule [a
special rule reported from the Committee on Rules] opens the
resolution to amendment and further debate.'' (Chapter 21,
section 21.2) Section 21.3 continues: Upon rejection of the
motion for the previous question on a resolution reported
from the Committee on Rules, control shifts to the Member
leading the opposition to the previous question, who may
offer a proper amendment or motion and who controls the time
for debate thereon.''
Clearly, the vote on the previous question on a rule does
have substantive policy implications. It is one of the only
available tools for those who oppose the Republican
majority's agenda to offer an alternative plan.
Mr. LINCOLN DIAZ-BALART of Florida. Mr. Speaker, I yield back the
balance of my time, and I move the previous question on the resolution.
The SPEAKER pro tempore. The question is on ordering the previous
question.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Ms. MATSUI. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further
proceedings on this question will be postponed.
____________________