Congressional Record, Volume 157 Issue 54 (Wednesday, April 13, 2011)

[Congressional Record Volume 157, Number 54 (Wednesday, April 13, 2011)]
[House]
[Pages H2633-H2648]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

REPEALING PREVENTION AND PUBLIC HEALTH FUND

The SPEAKER pro tempore. Pursuant to House Resolution 219 and rule
XVIII, the Chair declares the House in the Committee of the Whole House
on the State of the Union for the consideration of the bill, H.R. 1217.

{time} 1520

In the Committee of the Whole

Accordingly, the House resolved itself into the Committee of the
Whole House on the State of the Union for the consideration of the bill
(H.R. 1217) to repeal the Prevention and Public Health Fund, with Mr.
Conaway in the chair.
The Clerk read the title of the bill.
The CHAIR. Pursuant to the rule, the bill is considered read the
first time.
The gentleman from Pennsylvania (Mr. Pitts) and the gentleman from
New Jersey (Mr. Pallone) each will control 30 minutes.
The Chair recognizes the gentleman from Pennsylvania.
Mr. PITTS. Mr. Chairman, I yield myself such time as I may consume.
Section 4002 of PPACA establishes a Prevention and Public Health
Fund, which my bill, H.R. 1217, would repeal. The section authorizes
the appropriation of and appropriates to the fund from the Treasury the
following amounts: $500 million for FY 2010; $750 million for FY 2011;
$1 billion for FY 2012; $1.25 billion for FY 2013; $1.5 billion for FY
2014; and for FY 2015 and every fiscal year thereafter, $2 billion.
The Secretary of Health and Human Services has the full authority to
use this account to fund any programs or activities that she chooses
under the Public Health Service Act without having congressional input,
approval or oversight. HHS has already made disbursements from the
fund, spending

[[Page H2634]]

$500 million last year, and she has $750 million available for her to
spend this year to fund prevention activities, the Nation's public
health infrastructure, workforce expansion, increasing immunizations,
and preventing a variety of diseases.
The goals of some of these disbursements are laudable, but we must
remember that this funding is over and above the amount that Congress
has already authorized and appropriated for these activities. There
have also been questionable projects that have been financed with these
funds, including ``placing signs directing people to bike paths.''
When Secretary Sebelius testified before my subcommittee, I asked her
whether she needed further congressional approval to spend the money
from the section 4002 fund, and she answered no.
I then asked her if she could fund activities above and beyond the
level Congress appropriated, and she stated yes.
This should concern every Member that we have created a slush fund
from which the Secretary can spend without any congressional oversight
or approval. No one here can tell us how this funding will be used next
year or 5 or 10 or 20 or 50 years from now. We can't predict how the
money will be spent--and worse, we can't even influence it.
I would suggest to my colleagues that, if you wanted more funding to
go towards smoking cessation or to any other program, the health care
law should have contained an explicit authorization, because you are
not guaranteed that a dime of the money in this fund will go to your
particular activity.
By eliminating this fund, we are not cutting any specific program or
activity. I am not against prevention and wellness. This is not what
this is about. This is about reclaiming our oversight role of how
Federal tax dollars should be used.
I urge support for my bill, H.R. 1217.
I reserve the balance of my time.
Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the ranking member of
the Energy and Commerce Committee, the gentleman from California (Mr.
Waxman).
Mr. WAXMAN. Mr. Chairman, this bill represents the Republicans'
newest line of attack to disrupt, dismantle, and to ultimately destroy
the Affordable Care Act. Today, they are doing so by sacrificing
longstanding bipartisan policies to push a narrow partisan ideology.
For many years, Republicans have joined with Democrats in supporting
programs to prevent disease, to promote health and, in turn, to cut
health care costs. But today, the House will vote to end funding for
the first and only Federal program with dedicated, ongoing resources
designed to make us a healthier Nation.
Every State in the Union is already benefiting from the resources
made available from the fund to fight chronic and costly conditions,
such as obesity, heart disease and diabetes. Repealing the prevention
fund is a blow against seniors. In States like California, Michigan,
Iowa, Maine, North Carolina, and Massachusetts, they are using these
funds to train personal home care aides who assist the elderly with
Alzheimer's disease and other disabling conditions.
Terminating the prevention fund is not only extremely shortsighted;
it will also prove to be fiscally irresponsible. The return on this
kind of upfront investment--targeted resources to help keep people
healthy for as long as possible--will over time save precious health
care dollars.
We need to preserve the prevention fund because it can serve as a
cornerstone for a health care system that finally recognizes that
preventing illnesses is as important as treating them. Until now,
prevention has too often been just a mere afterthought.
American families support prevention. They want programs to educate
seniors to use preventive health services, such as mammograms and
colonoscopies, which can help extend their lives; and they want
programs that focus on preventing childhood obesity and diabetes, which
will help their children to grow up healthy and strong. The American
people want us to start working together to solve the real problems
facing our Nation.
I urge my colleagues to oppose this partisan and divisive
legislation.
Mr. PITTS. Mr. Chairman, I yield 3 minutes to the distinguished vice
chairman of the subcommittee, the gentleman from Texas, Dr. Burgess.
Mr. BURGESS. I thank the chairman for yielding.
Mr. Chairman, I do rise in support of H.R. 1217. The bill, as we have
already heard, repeals the public health slush fund that was included
in the Patient Protection and Affordable Care Act, which was passed
just a little over a year ago.
This fund, called the Prevention and Public Health Fund, is almost
$18 billion, which accounts for the next 8 fiscal years, and the
Secretary of Health and Human Services gets to spend this money on any
program that he or she deems worthy. What the money will be used for
and how it will be used are, essentially, unknowns. Neither this
Congress nor subsequent Congresses have any earthly idea.
It is yet, once again, an abdication of our authority here in the
United States Congress. It is an abdication of power in deference to
the executive branch. If that's what people think we were sent here to
do, to simply carve off greater and greater pieces of our authority and
hand it over to the White House, then I hope I'm wrong in that; but
over and over again, with the health care bill, with the financial reg
bill, it seems like that is the mantra here. It does put way too much
discretion in the hands of the Secretary of the Department of Health
and Human Services.

{time} 1530

We've got a predicted shortfall in the Nation's health care provider
workforce. Some of this money is going to go for scholarships, but it
sets up a big problem. Under the Public Health Fund, some of those same
students could receive a scholarship for 1 year, only to find that the
Secretary has bigger and better things to spend it on next year. Maybe
there's a new bike path that needs a sign, and that student would find
their education unfunded because all of the discretion rests with the
Secretary.
Now, just a moment ago, the ranking member of the full committee
stood up and said that it seems like all the Republicans want to do is
defund and remove the Affordable Care Act. Well, I appreciate his
noticing, because, Mr. Chairman, that is what the election of November
2, 2010, was all about. We were elected to come here and do that work
for the American people.
And the duplication contained within the slush fund, the ranking
member talked about smoking cessation. That's a good idea. I believe in
that. I lost two parents due to tobacco-related illness. But wait a
minute. What about the duplication? When the ranking member was
chairman last year, last Congress, he created the Center for Tobacco
Products at the Food and Drug Administration. We funded that lavishly
with a brand-new tax, and now we're going to come back and fund it yet
again with this public health slush fund?
The ranking member asked about what programs we wanted to cut.
Really, it's a question of do we want to be accountable to the American
people who elected us here to do this job. They sent us here to ensure
their money was spent responsibly and that every penny would be
accounted for and justified before being spent. With the current state
of the economy, Mr. Chairman, I'm not sure how the American people feel
about the Secretary choosing to spend money on signs to direct people
to bike paths. I know how they would feel about it in my district.
The CHAIR. The time of the gentleman has expired.
Mr. PITTS. I yield the gentleman 30 additional seconds.
Mr. BURGESS. In this law that was signed in the East Room of the
White House just a little over a year ago, section 4002 takes from
Congress the oversight of spending, and it becomes a blank check for
the Secretary to do with as she wishes without any other input from
Congress. By doing that, it takes that authority away from the American
people, because we are the closest contact the American people have
with their Federal Government. And by taking us out of the equation,
guess what, Madam Secretary? You've got a blank check. It's all yours.
Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentlewoman from
California (Mrs. Capps).
Mrs. CAPPS. I thank the ranking member of my subcommittee for
yielding me time.

[[Page H2635]]

Mr. Chairman, I rise in strong opposition to H.R. 1217, a bill that
would defund a key strategic investment in our Nation's long-term
fiscal and physical health, the Prevention and Public Health Fund.
Simply put, this fund is a critical effort to make our Nation healthier
and, in turn, to bring down health care costs.
This misguided bill would return our Nation to a system of ``sick
care,'' a system that hasn't worked, rather than one focused on health
and wellness. That's something we can't afford to do. We all know that
health care costs are rising at an unsustainable rate. In fact, the
Republican majority has cited these costs as a reason to propose ending
Medicare as we know it, by turning it into a voucher program and by
whacking away at poor people's health care by block-granting Medicaid.
But one of the key drivers in entitlement spending growth is chronic
disease, the exact problem addressed by this prevention fund. Yet this
bill shortsightedly cuts back our efforts to reduce chronic illness and
promote wellness programs.
In California, we are putting these funds to work to slow the
alarming rise in obesity rates, to train our next generation of public
health professionals, to curb our tobacco use and improve our capacity
to respond to disease outbreaks.
At a time when counties have laid off thousands and struggled to
maintain essential public health services, the need for this fund
becomes even more critical. That's why numerous local governments and
national organizations, including the National Association of Counties
and the American Public Health Association oppose this shortsighted
bill.
Furthermore, the fund is a sound investment. Trust for America's
Health Research has shown that investments in proven, community-based
programs to increase physical activity, to improve nutrition, and to
prevent tobacco use could save the country more than $16 billion
annually within 5 years. This is a return of over $5 for every dollar
invested.
Not only do these programs add to our constituents' quality of life,
but it can also increase their economic output by keeping them healthy
and in the workforce.
These are some of the reasons I stand with these folks and urge a
``no'' vote.
Mr. PITTS. Mr. Chairman, at this time I yield 3 minutes to the
gentlewoman from Tennessee (Mrs. Blackburn), who is on the Health
Subcommittee.
Mrs. BLACKBURN. Mr. Chairman, I do rise in support of H.R. 1217. I
think this is an important bill for us to bring forward. And I want to
thank the chairman for bringing it forward and for helping to lead this
Congress in the repeal of ObamaCare. It is a message that the American
people sent loud and clear last November. They do not want to see
government coming in and controlling their health care choices. That is
something that should be made by individuals, their family members, and
their physicians and not by the Federal Government.
I have found it so interesting, as we have been through the hearings
on this and through the markups, that we continue to hear, well, this
$17\3/4\ billion, well, it's just not that much money. Isn't that
amazing that in the middle of a CR crisis and a debt crisis that we are
hearing such rhetoric?
I think it is amazing that we are being told, and through what we
know--yes, and some of us did read the bill and so we do know what was
in that bill--that the Secretary can spend this however she wants to.
She does not have to come back to Congress another time to get
permission for spending this slush fund. And isn't it amazing that some
of our colleagues think that a fund will make people healthier? Money
doesn't make people healthier. We all know that.
And isn't it amazing that in the middle of all of this, we are out of
money at the Federal level? We all know that the cost of health care is
rising, and we know that one of the reasons that the cost of health
care has risen so much in the last few years is government
intervention. Those are some of the known components that we have.
I think it's important to realize too, Mr. Chairman, eliminating the
slush fund does not cut any specific program. And proponents of this
fund want to claim that we're cutting, we're cutting, we're cutting.
What we're doing is saying, no, you can't allow the Secretary to have
control and just give it out. This needs to go through the normal,
regular funding processes. That is very important. And it's time that
we realize we have to do that.
Yes, let's move forward. Yes, let's repeal ObamaCare. Yes, let's get
it off the books. Let's do everything we can to get the Federal
Government out of your pocket, out of the middle of your health care
decisions. Let's make certain that those choices go to individuals and
to their physicians and that they are not going to be dictated by the
Secretary of Health and Human Services, who has a slush fund of $17.75
billion to spend as she or he sees fit over the next 10 years.
We need to be changing the way health care is going to work, and we
need to do it with putting individuals in charge.
Mr. PALLONE. Mr. Chairman, I now yield 2 minutes to the gentlewoman
from Illinois (Ms. Schakowsky).
Ms. SCHAKOWSKY. Here they go again. The Republicans failed in their
efforts to repeal the Affordable Care Act, and now they are reversing
course and trying to cripple implementation by attacking individual
provisions of the law.
The United States has a health care system designed to treat the
sick, not to prevent disease from occurring in the first place. The
Prevention and Public Health Fund is a crucial component of the health
reform law's effort to remedy that weakness and transform today's sick
care system into a prevention-focused health system.
The Prevention and Public Health Fund will avert future illness, save
lives and restrain the rate of growth of health care costs. It's a
dedicated investment in community prevention and is a much-needed down
payment on the health and economic well-being of all Americans.
Federal investments from the Prevention and Public Health Fund have
already begun to address improvements in the Nation's health status by
supporting essential and proven prevention activities, such as
immunization--immunization and tobacco cessation.
The Prevention and Public Health Fund holds great promise to improve
the capacities of State and local health departments to protect
communities from health threats through the use of technology. It will
increase numbers of highly skilled scientists and other public health
professionals.
I want to be very clear, and you've heard it yourselves. This is
simply another attempt by Republicans to defund the Affordable Care Act
and stop its implementation. I urge my colleagues to vote against this
bill to repeal the Prevention and Public Health Fund.

{time} 1540

Mr. PITTS. Mr. Chairman, the gentlelady kept saying it will, it will,
it will. The simple fact is we don't know where the money is going to
go.
I yield 3 minutes to the distinguished gentleman from Georgia (Mr.
Gingrey), who is a member of the subcommittee.
Mr. GINGREY of Georgia. I thank my chairman for yielding.
Mr. Chairman, at least some Members of this body can remember ads
back years ago touting the miraculous benefits of Sal Hepatica and
Carter's Little Liver Pills. Probably all of the Members can remember,
because it was just a year ago, Andy Griffith touting the new health
care reform bill. And those of us who are on Medicare remember getting
those glossy mail outs, very expensive, slick-looking ads touting the
benefits that ObamaCare has brought to Medicare, even though the new
bill, the new entitlement creation took something like $550 billion out
of Medicare, and yet they had the audacity to send these ads out, these
fliers saying that it improved Medicare. ObamaCare improves Medicare;
go figure. Well, that is a concern here. That is why I am standing in
strong support of Chairman Pitts' bill, H.R. 1217.
The Prevention and Public Health Fund is established under the
Patient Protection and Affordable Care Act, ObamaCare, for prevention,
wellness, and public health activities authorized in the Public Health
Service Act and administered by Secretary Sebelius, the Secretary of
Health and Human

[[Page H2636]]

Services. But she can use those funds in any way she deems appropriate
as long as she says it is for public health.
Can it pay for political TV advertising for President Obama ahead of
the 2012 elections? Absolutely she could. Nothing could stop her; the
Congress couldn't as long as she deems it is necessary for public
health. Pay for thousands of signs in communities all across the
country declaring that PPACA is a success, nothing could stop this
Secretary, or any Secretary from doing so, as long as they call it for
public health. No, not even Congress.
And as the chairman said, Mr. Chairman, the amount of $17 billion,
almost $18 billion, is just a down payment, if you will, because in
perpetuity $2 billion a year continues to be appropriated. And you do
that with a bill that quite honestly this Member thinks will be
declared within a year and a half, hopefully sooner, unconstitutional.
So we are spending money that is absolutely unnecessary at a time when
we are sitting here with $14 trillion worth of debt and listening to
the Secretary of the Treasury say within 6 weeks we are going to have
to raise the debt ceiling so we can borrow more money. And here we are
spending $17 billion, with a ``B,'' and that is not just chump change
by any stretch of the imagination.
Last year in 2010, the CDC actually spent some of $500 million to
promote an increase in the excise tax on tobacco to the States;
basically saying to the States, you need to make sure you raise taxes
on tobacco.
The CHAIR. The time of the gentleman has expired.
Mr. PITTS. I yield the gentleman an additional 30 seconds.
Mr. GINGREY of Georgia. I thank the chairman for yielding me this
additional time.
Let me just conclude that clearly this is a necessary bill to let
Congress once again have the opportunity to control spending. That is
our responsibility. That is our constitutional right. That's what the
American people want. I think the chairman is absolutely right with
this bill, and I fully support it. I urge all of my colleagues to do so
as well.
Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman
from Connecticut (Ms. DeLauro), the ranking Democrat on the Labor,
Health Appropriations Subcommittee.
Ms. DeLAURO. I urge my colleagues to vote against this bill. It will
cost money and endanger the health of the American people.
We included the Prevention and Public Health Fund in the Affordable
Care Act because we know preventive health care reduces health care
costs. It dramatically increases Americans' quality of life.
Preventable causes of death such as tobacco smoking, poor diet,
physical inactivity, and the misuse of alcohol have been estimated to
be responsible for 900,000 deaths annually, nearly 40 percent of total
yearly mortality in the United States. Further, 7 in 10 deaths in
America are from chronic diseases. And by 2020, the U.S. may spend $685
billion a year on these chronic diseases. This fund works to bring down
these numbers and to help Americans live longer, healthier lives.
Preventive care is fiscally responsible. One example that would be
impacted by this misguided legislation is vaccines. Estimates indicate
that we save up to $400 for every illness averted by vaccination. And
that does not even take into account the costs of further transmission
in the case of a serious public health epidemic.
By supporting our public health workforce and building health
infrastructure, by promoting exercise, reducing tobacco use, the
Prevention and Public Health Fund will go a long way towards reducing
the surging costs of health care for Americans families and for our
Nation. It is shortsighted folly to repeal this fund now, especially
when you consider all the oil subsidies and breaks for corporate
lobbyists that the majority has included in their budget. We should not
be putting political ideology before public health. I urge my
colleagues to oppose this bill.
Mr. PITTS. Mr. Chairman, I yield 2 minutes to the gentleman from New
Jersey (Mr. Lance), a member of the subcommittee.
Mr. LANCE. Mr. Chairman, I rise today in support of H.R. 1217. As
members of the Energy and Commerce Health Subcommittee, my colleagues
and I have participated in a number of hearings that have explored the
fiscal impact of the new health care law.
These hearings have revealed the existence of several programs and
mandatory spending provisions contained in the law. Health and Human
Services Secretary Sebelius said during testimony that she had the sole
discretion over billions of dollars in direct, unlimited mandatory
spending under the law. This means without any congressional hearings,
without any language in appropriations bills, and without any
oversight, the executive branch has been granted unprecedented spending
authority.
Today's legislation, H.R. 1217, will repeal one of those little-known
programs called the Prevention and Public Health Fund and subject it to
the annual appropriations process. The aim may be worthy, Mr. Chairman,
but this should be subjected to the annual appropriations process. This
action, according to the Congressional Budget Office, will save
American taxpayers $16 billion over the next 10 years.
Mr. Chairman, as we all know, the Federal Government is $14 trillion
in debt. Our deficit for this year will be at least $1.5 trillion. We
must get Federal spending under control. We can start by repealing
programs that run afoul of congressional oversight. I urge Members to
support H.R. 1217.
Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentlewoman from
Colorado (Ms. DeGette).
Ms. DeGETTE. Mr. Chairman, I am frankly stunned to have to come to
the House floor today to talk about a bill that defunds the largest
investment we have ever made in our population's health: the prevention
and public health trust fund. The trust fund specifically says what it
is going to be used for: reducing tobacco use, expanding opportunities
for recreation and exercise, bringing healthier foods like fruit and
vegetables to communities in need; and helping kids to eat healthier
meals at school.
All of us who have been involved in health issues for many years know
that the biggest public health epidemic that we have right now is
obesity. If we don't do anything to reverse these trends, then for our
children and our children's children, we are not going to have good
outcomes. Seventy-five percent of all health care costs are spent on
the treatment of chronic diseases, many of them preventable. Our
Nation's youth are confronting unprecedented levels of obesity, placing
them at ever-increasing risk for those very same chronic health
conditions. I think it is pathetic that we have children in this
country who only have access to playgrounds at McDonald's with their
8,000 playgrounds in this country. And so what this trust fund does is
it supports research that examines evidence-based practices relating to
prevention, including the translation of interventions from academic
settings to real-world settings.

{time} 1550

This is not, as the opponents of this trust fund say, a slush fund or
something that is simply willy-nilly spending. Instead what it is, it's
evidence-based and it's looking at ways that we can prevent childhood
obesity and nutrition, reduce tobacco use, and expand opportunities for
recreation and exercise.
This is something all of us can get behind. This is something we
should all support. I am sorry that it has become caught up in this
partisan web, because frankly we should all support this for our kids.
Mr. PITTS. Mr. Chairman, I have the copy of the law the gentlelady
referred to. She says the trust fund refers to spending for fresh food
and vegetables and other things. There's none of that in the language.
I would welcome her to point it out.
I reserve the balance of my time.
Mr. PALLONE. I yield 1\1/2\ minutes to the gentlewoman from
California (Ms. Roybal-Allard).
Ms. ROYBAL-ALLARD. Mr. Chairman, H.R. 1217 is an attack on public
health and disease prevention in this country. The prevention fund is
our first national proactive, strategic commitment to changing the
focus of our health care system from one of treatment to one of keeping
Americans healthy.
This change in focus is essential, because keeping people healthy
improves

[[Page H2637]]

the quality of their lives and that of their family, and it is our best
means of controlling preventable chronic diseases, which account for
seven out of 10 deaths and 75 percent of our Nation's annual health
care costs, totaling $1.7 trillion.
If H.R. 1217 passes, we lose a critical opportunity to control health
care costs and we lose the opportunity to reduce unnecessary suffering
and death from preventable chronic diseases. Adding to the assault of
H.R. 1217 on public health and prevention is the FY 2011 continuing
resolution which cuts CDC's budget by over $700 million.
The result of these proposals is that millions of Americans will
needlessly continue to suffer from preventable chronic diseases, costly
treatments and costly hospitalizations. Prevention saves lives and
prevention saves money. Defeat H.R. 1217 and continue to build a
healthier America.
Mr. PITTS. I continue to reserve the balance of my time.
Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentlewoman from
the Virgin Islands (Mrs. Christensen).
Mrs. CHRISTENSEN. Mr. Chairman and colleagues, I cannot believe that
we are here debating a bill that would repeal the Prevention and Public
Health Fund. At a time when we should be championing legislation to
strengthen the health and well-being of Americans and this Nation, my
colleagues on the other side of the aisle are doing the exact opposite
with H.R. 1217.
Currently, we have tens of millions of hardworking Americans who
suffer and some die from preventable diseases, and without prevention
and public health efforts, the very services this fund was created to
support, tens of millions more will be affected in the future.
With so much at stake--and we are talking about human lives--we
should not be here fighting about the merit and value of keeping the
Prevention and Public Health Fund in place. We would do better for our
country in terms of health and savings if we were instead discussing
increasing it.
If my colleagues on the other side of the aisle are not moved by the
disastrous human impact, then perhaps they will be moved by the equally
disastrous economic impact that it will have, because not having
prevention and effective public health measures in place costs money,
and a lot of it.
On the other hand, the Journal of Health Affairs reported that
increasing the use of proven preventive services from their current
levels to 90 percent would result in $3.7 billion in savings in just 1
year. And we know from a Joint Center study that reducing health
disparities, which this fund would help to do, could save as much as
$1.24 trillion in direct and indirect medical costs in just a 3-year
period.
This bill to repeal the Prevention and Public Health Fund is not just
misguided legislation, it is harmful and unjust. It is contrary to our
values and a disrespect of the value of human life. It will not save
money. In fact, it will cost this Nation more, both in human health and
wellness as well as in actual health care spending.
I strongly urge my colleagues to vote to protect all Americans and
the moral standing of this country by voting ``no'' on H.R. 1217.
Mr. PITTS. Mr. Chairman, may I ask how much time is remaining.
The CHAIR. The gentleman from Pennsylvania controls 15\1/4\ minutes,
and the gentleman from New Jersey controls 17\1/2\ minutes.
Mr. PITTS. I continue to reserve the balance of my time.
Mr. PALLONE. I yield myself such time as I may consume.
Mr. Chairman, it's been 100 days of the Republicans' no jobs agenda
and they've chosen to devote time and energy to bills and resolutions
that would defund the Affordable Care Act, eliminate mandatory support
for preventive care, and abolish any and all Federal support for
Planned Parenthood. House Republicans know that these measures won't be
approved by the Senate and would never be signed by the President. It's
just another political gesture at a time when we should be working to
create jobs and promote economic recovery.
The bill on the floor this week, H.R. 1217, would abolish the
affordable care law's Prevention and Public Health Fund. This is a fund
that prevents disease, that detects it early, and that helps manage
conditions before they become severe. All empirical data, all
experience and plain old common sense informs us that prevention and
early treatment not only save lives, they also save money. In fact, the
Prevention and Public Health Fund addresses one of the major
deficiencies in our approach to health in America, and that's
preventing illness before people get sick.
The Republican assertion that mandatory funding, which I've heard
over and over again today and also in the Health Subcommittee, that
this is somehow mandatory funding and it's unprecedented, that's
completely not true. Medicaid and Medicare are funded with mandatory
support, and there are a lot of other programs within our committee's
jurisdiction and in Congress in general that are funded through
mandatory funding.
I don't know how many times I'm going to come to the floor and hear
about repealing the health care reform. I understand tomorrow there's
going to be an enrolled bill that goes along with the CR that's going
to defund the whole Affordable Care Act. Here today we're going to
defund one piece, the prevention fund. Tomorrow we've got another
enrollment resolution that defunds the whole bill. Again, another
resolution tomorrow to defund Planned Parenthood.
How many times are we going to keep voting on the same thing over and
over and over again? Meanwhile, I don't see a single piece of
legislation coming to this floor that addresses jobs or the economy.
When I go home, people want to know what we're doing about the economy.
They know that their health care reform has passed, that they're
benefiting from it, that it's gradually unfolding before them. They
don't want us to continue to debate the same thing over and over again.
Repeal, defund, and no suggestion about what you would do to replace it
either, by the way.
I reserve the balance of my time.
Mr. PITTS. Madam Chair, I continue to reserve the balance of my time.
Mr. PALLONE. I yield 2 minutes to the gentlewoman from Texas (Ms.
Jackson Lee).
Ms. JACKSON LEE of Texas. Let me thank the distinguished gentleman
from New Jersey and let me thank the chairman of the committee as well.
Madam Chairwoman, we just have a disagreement. I would venture to say
that the bulk of sick people in America and others who every day
struggle to maintain their health so they can provide for their
families would vigorously disagree as well.
I think there are two points that I would like to make, and that is
that what we lose when we repeal this Affordable Care Act and the
funding of it is more than the glory that we get from going home and
bragging that we have undermined America's health care system, or some
would say that we have taken away ObamaCare. Preventative care is an
unbelievable plus that this bill has generated.
I went to one of my emergency centers, a new one, that is crafted
under the public health system. It is to take the load off the
emergency centers, the emergency centers that ambulances go to. What an
amazing sight, of people coming with broken toes and fingers and feet
and bruises, maybe the beginning of heart disease and other problems.
But it was a lower level emergency room, not particularly preventative
care but the kind of intervention that can save millions of dollars.

{time} 1600

I want to go even lower than that--and I don't use that terminology--
but I want people to be able to go and check on their cholesterol,
check on their high blood pressure, understand whether they have sickle
cell, understand what stage of diabetes they are in or understand what
stage of heart disease they are in in a preventative care cycle. And
everyone knows that economists document how many billions of dollar
that will save. How can we vote against that?
And then secondarily, there are two elements that the Affordable Care
Act provides that is being repealed; research and training for health
professionals that we absolutely need--whether you're in the private
care system or not--and then of course protecting our most precious
resource, and that is our children. If you can raise a

[[Page H2638]]

child in a healthy manner in terms of nutrition, in terms of
immunization, in terms of regular doctor visits, then you are able to
save billions of dollars.
This is wrong, headed in a wrong direction. Many of us are fasting. I
said on this floor, we must pray because this is the wrong direction to
go.
Mr. PALLONE. Madam Chairwoman, I yield myself the balance of my time.
Madam Chair, we are simply never going to bend the cost curve on
health care or improve America's quality of life until we focus much
more on disease prevention, and that's what this prevention fund is
for.
I always thought that both Democrats and Republicans wanted to keep
people out of the hospital, off of disability, leading productive
lives, and trying to prevent diseases before they occur. I never
thought this was a partisan issue. Because we need to have a system of
well care, not sick care, if we're really going to have success in
saving money and bending the cost curve.
So I don't understand why my Republican colleagues so many times in
the committee would talk about prevention, but all of a sudden now they
want to abolish the prevention fund. It just doesn't make any sense.
Before the Affordable Care Act, prevention activities were
chronically underfunded, accounting for only 2 to 4 percent of the
national health care expenditure by some estimates. Considering that
chronic diseases eat up an estimated 75 percent of our $2 trillion in
annual health care spending, to spend an additional $2 billion for
wellness and prevention is a wise investment.
Since the Affordable Care Act was enacted, every State has benefited
from the prevention and wellness fund. This year, over $750 million in
grants were dispersed--building on a $500 million investment last
year--and repealing this program would mean putting the brakes on
investments that are already beginning to make a difference.
In my home State of New Jersey, many of my constituents have
benefited from over $15 million in prevention and public health grants,
funding for such things as HIV prevention, tobacco cessation, mental
health care, critical public health infrastructure improvements, as
well as support for primary care training and workforce development.
I could do the same, I have a sheet here--I'm not going to read it,
but I have a similar sheet for Mr. Pitts and Dr. Burgess and others on
the Republican side who specified these are the types of grants that
are being made available in their States.
I simply don't understand. There are 600 national, State, and local
organizations supporting the fund as a primary vehicle for making
public health investments that would create jobs and help lower long-
term health care costs. The Energy and Commerce Committee and the
Health Subcommittee have heard me many times say that we can never
calculate the huge savings that come from prevention.
We had the CBO in the other day and I said to the CBO, why don't you
calculate prevention, because we would save trillions of dollars? Well,
they don't do it. But the bottom line is we all know that prevention
saves money. If you concentrate just on chronic diseases, this law
helps move the Nation from a focus on sickness and disease to one based
on wellness and prevention. And if you take away this critical new
investment in prevention, it's going to be harmful to the health of
Americans now and also in the future.
Madam Chairwoman--and I will address this directly to my Republican
colleagues--in the last few weeks, when we had hearings in the Health
Subcommittee on the various measures that the Republicans wanted to
defund--and I know they want to repeal the whole bill and I know they
want to defund everything, and that's what they're going to try to do
again tomorrow. I understand all that. I totally disagree with it, but
I understand that they're against the Affordable Care Act. They want to
defund it, they want to do whatever they can to get rid of it.
But it just seems to me that to pick the one fund that deals with
prevention is really the worst thing you could have done today because
what we're trying to do with the Affordable Care Act--and what I've
sought to do in everything that we've done in the subcommittee since
I've been on it--is to really stress prevention because we can avoid
people going to hospitals, we can avoid people going to nursing homes.
They can lead a better quality of life and we save money.
So I just think it is really unfortunate today that after so many
years of a bipartisan effort to deal with prevention, to fund
prevention issues, that this is the one fund that's actually picked on
today to come to the floor. I think it's really a horrible thing that
that is the case.
So I would urge my colleagues to vote against this resolution because
if you really believe in prevention, if you really believe that we can
make a difference in making people well and preventing them from
getting sick, then you should vote against this bill.
Madam Chairwoman, I yield back the balance of my time.
Mr. PITTS. Madam Chair, it's time for a fiscal reality check. The
Federal Government is now borrowing 42 cents of every dollar it spends.
Washington is spending more than $1 of every $4 this country produces
and we are facing a third straight year with a $1 trillion deficit.
Yet, when the subcommittee voted on this straightforward bill to strip
billions in unaccountable spending from the health care law based on
the simple premise that Congress should fund prevention and wellness
activities by prioritizing them in the regular annual spending process,
the response from the other side of the aisle was to say, we're not
broke. Madam Chair, I beg to differ.
Our debate today is not about the virtue of preventive health care
and wellness programs. I support prevention. The real question is
whether our Nation can afford to authorize the Secretary of Health and
Human Services to spend nearly $18 billion over and above what Congress
appropriates over the next decade on programs of the administration's
choosing.
H.R. 1217 does not cut a single program because this fund does not
guarantee funding for any particular program. Every Member who supports
this fund on the assumption that it provides additional money for a
project they deem worthy should understand that no one knows where this
money will be spent. Perhaps it could be used to combat obesity, or for
cancer screenings, or perhaps it will be used to post signs about the
location of bike paths. The point is, Congress abdicates our authority
and responsibility for investing in prevention by handing a perpetual
blank check to the Secretary.
Governing and solving our fiscal problems is difficult; it requires
hard choices. It is easy to spend. The easy choice was to assign
mandatory advanced appropriations to these initiatives rather than
making them a budget priority. But it's only easy until the bill is due
and the credit card is maxed out. Well, the bill is due and the credit
card limit is approaching fast. Congress needs to reassert its role and
set spending priorities rather than give the executive branch
unfettered power to spend as it wishes.
I urge my colleagues to support the bill.
Mr. LANGEVIN. Madam Chair, I rise to express my strong support for
the Prevention and Public Health Fund and to ask my colleagues to
reconsider the elimination of a program whose sole purpose is not only
to improve the overall health of Americans, but to help ``restrain the
rate of growth in private and public sector health care costs.''
If my colleagues across the aisle want to effectively cut spending
and fix our long-term deficit, then I would remind them that health
care costs are one of the biggest drivers of federal spending; and
chronic diseases, such as heart disease, cancer, stroke and diabetes,
account for 75 percent of the cost of care. If we invest in preventing
these chronic diseases now, we could save our health care system
hundreds of billions of dollars, reducing the costs to Medicare and
Medicaid and saving countless lives.
Instead, we are taking a penny-wise and pound-foolish approach by
considering H.R. 1217, which repeals investments in prevention and
primary care services to combat mental illness, obesity, cancer, as
well as HIV and other acquired infections. Rhode Island has already
received over $800,000 to support primary care, mental health services
and health information technology that will improve the health of Rhode
Island families before they are forced to seek treatment in the
Emergency Department.

[[Page H2639]]

Our nation cannot afford to cut now and worry about the consequences
later. That approach has only earned our country the unfortunate
distinction of being the nation with the highest adult obesity rate in
the developed world with the highest mortality rates for various
preventable chronic diseases. It has also done nothing to reign in our
long-term deficits.
Further, we are almost 100 days into the 112th Congress and Speaker
Boehner has not put forward a single bill to create jobs. If my
colleagues in Congress are serious about balancing the budget and
creating a better health care system, then I hope we will move on from
trying to dismantle the health reform law and focus on job creation. I
ask my colleagues to oppose this measure and bring up a bill that will
put Americans back to work.
Mr. DINGELL. Madam Chair, today we rise to debate irresponsible
legislation cloaked in fiscal responsibility, legislation that will
assuredly put the nation's public health at risk.
Today's debate is not one over concerns of mandatory funding for our
nation's public health investments, it is another shot at the
Affordable Care Act.
Our health system is inherently designed to provide treatment for the
sick and ill, but does not currently contain the incentives necessary
to keep consumers from becoming sick in the first place.
Just two years ago total health expenditures in the U.S. was $2.5
trillion, and only 3 percent of that funding was spent on preventive
health care services and health promotion.
If we want to cut down on the costs of hospitalizations and
inappropriate emergency room visits, we have to help American families
better manage their chronic diseases like diabetes or asthma and help
them stay well through vaccines and screenings.
This was the purpose behind the Prevention and Public Health Fund--to
make a strong investment into prevention and wellness programs and
promote innovative prevention that will help to save our health system
costs in the long run.
And now we are seeing the good work that the Prevention and Public
Health Fund is doing in our states.
Michigan has received over $2 million for public health activities--
building capacity in our health departments, hiring and training
epidemiologists and scientists to study infectious diseases, improving
access and quality of health services in medically underserved
communities, and helping to promote better primary care for those in
need.
Thus, the Prevention and Public Health Fund is not only creating
much-needed jobs in my home state, but also undertaking meaningful
projects that will help to improve the health of our country.
Let us be clear that this legislation will not become law, and rather
than use the time of this body for valuable legislation such as
creating jobs and improving our economy and the health of our nation,
my colleagues choose to focus their efforts on another vehicle to
defend the Affordable Care Act.
I urge my colleagues to vote against this legislation.
Mr. ENGEL. Madam Chair, I rise in strong opposition to H.R. 1217.
This irresponsible and short-sighted legislation would repeal the
Prevention and Public Health Fund which is a fundamental component to
the Affordable Care Act.
The Prevention and Public Health Fund is a critical investment in
public health and demonstrates a historic commitment to changing our
health system from one that focuses on treating the sick to one that
focuses on keeping people healthy in the first place. We all agree that
prevention is one of the most effective ways we can reduce health costs
in the long run, rather than by simply cutting spending.
My friends on the other side of the aisle claim that eliminating the
fund does not cut any specific prevention programs and that the reason
they want to repeal the Prevention and Public Health Fund is to recoup
the funding appropriated for it.
I would like to know from the Majority, are the short term cost
savings from this bill worth the long term costs to our financial
future and health? How do they plan to solve the public health problems
of the future if they intend to gut programs like this one?
The Prevention and Public Health Fund is one of a number of
Affordable Care Act initiatives that is already in place and producing
positive results. Currently, all 50 states and the District of Columbia
are receiving Fund support. These valuable dollars are being used to
support community-based initiatives to reduce tobacco use and obesity,
prevent HIV infection, build epidemiology and laboratory capacity to
track and respond to disease outbreaks, and train the public health
workforce.
Madam Chair, I know that we face difficult economic decisions, and I
would be happy to have a discussion with my friends on the other side
of the aisle on how we can reduce the deficit, but I feel that H.R.
1217 is the wrong approach.
Seventy-five percent of the two trillion dollars we spend in health
care costs are spent on treatment of chronic diseases. Many of which
can be prevented. Obesity alone costs us 147 billion dollars a year and
chronic illness can cost us an additional 1 trillion dollars each year
in lost productivity. In addition, studies have shown that proven
community-based diabetes prevention programs can save as much as 191
billion dollars over 10 years. So the fact is prevention saves money.
Now, those are just the dollars and cents of the value that the
Prevention and Public Health Fund bring. We know that prevention saves
money, but what about the improvements to the health of our nation's
citizens. Prevention saves lives, improves quality of life and is the
most cost-effective way to spend our health care dollars. No matter
what arguments the Majority may make, we cannot put price-tag on that.
I urge my colleagues to vote ``no'' on H.R. 1217.
Mr. VAN HOLLEN. Madam Chair, today we are considering a piece of
legislation that will roll back important gains for public health and
prevention. Specifically, today's bill proposes to repeal the
Prevention and Public Health Fund under the Affordable Care Act.
According to the Centers for Disease Control and Prevention, more
than 75 percent of health care spending in the United States is due to
chronic conditions, such as stroke, diabetes, and cancer. One of the
ways to control health care spending is to invest ways to prevent
disease and improving the public health of our nation. By investing in
preventive health care services, we can reduce the number of people
with chronic diseases while saving lives and money.
Currently, funding from this program is being used by states and
communities to prevent smoking, obesity, heart disease, and to increase
physical activity and train the public health workforce. The Prevention
and Public Health Fund presents a significant opportunity to rein in
our health care spending and to promote healthy lifestyles and
communities. In my judgment, repealing it will only increase
preventable health care costs over time.
Madam Chair, I urge my colleagues to oppose this misguided bill so
that we can continue to protect the health of all Americans.
Ms. JACKSON LEE of Texas. Madam Chair, I rise today in opposition to
H.R. 1217, which would repeal the provision of the Patient Protection
and Affordable Care Act (``Affordable Care Act'') that established the
Prevention and Public Health Fund, a fund which serves as a great
stride toward turning our ``sick-care'' system, where we focus on
treating the injured and ill, into a true ``healthcare'' system that
puts focus on keeping the population well.
It is because of all that the Prevention and Public Heath Fund
accomplished in its first year, the overwhelming support the Fund has
received from hundreds of organizations, and how essential prevention
is to reducing the overall cost of healthcare for the American people,
that I oppose the repeal of this Fund.
Despite my general opposition to this bill, yesterday in the Rules
Committee meeting, I offered amendments to H.R. 1217, in order to
remind this chamber and emphasize to the American people the importance
and benefits of preventative care for the American public.
My amendments reaffirm to the American people that we as lawmakers
understand the importance of preventative care by stating that it is
the sense of Congress that prevention of disease and injury is
overwhelmingly effective in improving our healthcare system and keeping
that system affordable. Furthermore, preventative health care is an
effective means for detecting and treating illnesses before they become
serious and life threatening.
My amendments also make us as lawmakers accountable to the American
people who have been and would be benefitting from the services and
support provided through this fund. It gives notice to the public,
through the Department of Health and Human Services' website, of the
rescission of funds and the amount rescinded, increasing government's
accountability.
I think most of my colleagues on both sides of the aisle would agree
with me, as evidenced by the intense debate at the end of last week,
when I say that we must address our nation's spending and growing
deficit. However, it is of great concern to me that my friends on the
other side of the aisle are attempting to do so by cutting cost-saving
programs that are also essential to the health and wellbeing of
Americans. This attempt, through H.R. 1217, to defund this essential
program which was created under the Patient Protection and Affordable
Care Act is of particular concern.
Today's youth may be the first generation to live shorter and less
healthy lives than that of their parents, and this is largely due to
increased rates of diseases and conditions which are preventable with
proper and consistent healthcare. 75% of our country's healthcare costs
are attributed to treatment of chronic diseases, most of which are
preventable. However, less than 5% of our healthcare

[[Page H2640]]

spending goes towards preventing these diseases. Loss of productivity
in the workforce attributed to chronic disease is estimated to cost the
United States over $1 trillion each year.

With that being said, the 111th Congress, with the intent of seeing
these grim statistics changes, appropriated $16.5 billion to be used,
over the next ten years to support preventative care and research.
Since its establishment the Fund has already begun to strengthen the
infrastructure of our healthcare system on the state and national
level.
The Prevention and Public Health fund, though it has only been in
existence for one year, has already been used for:
Programs to promote tobacco control and implement tobacco cessation
services and campaigns;
Obesity prevention which directly decreases risk for Diabetes;
Improving nutrition and access to fresh fruits and vegetables;
Increasing opportunities for recreational and physical activity;
HIV prevention;
Support of clinical and community-based disease prevention; and
Bolstering the health workforce by increasing health care personnel.
Money towards finding health solutions, rather than treating health
problems, comes back to society in terms of increasing productivity,
creating jobs, and reducing Medicare, Medicaid, and overall healthcare
costs. With just a $10 per person investment towards improving
community based activity, nutrition, and other preventative measures
would create a return of $56 per person within only 5 years. That
translates to a savings of $5.60 for every $1 invested in preventative
health care. Most importantly, cost benefits extend beyond government
to both American businesses and families; providing savings and an
improved quality of life.
As a result of the Prevention and Public Health Fund, Texas received
$6 million last year that went towards creating committees, testing
facilities, laboratories, and training centers which brought over $2
million to the health prevention capacity of Houston alone.
Congress must maintain that the prevention of illness, the saving of
lives, and the securing of a healthy public are top priorities, and
that prevention is an undeniably effective means to achieve these ends.
My amendments will do just that.
The total loss of $16 billion of funding for prevention efforts, an
effective total eradication of our country's prevention program, will
be unfortunate, and thus I urge my colleagues not to lose sight of
importance of the Prevention and Public Health Fund's accomplishments
and goals. Including:
The improvement of state and local health departments, giving them
the capacity to respond to infections, natural disasters, and terrorist
threats;
Creating a strong and healthy workforce that will be competitive in
the global market; and
Saving families, businesses, and the government money, opposed to
simply cutting costs.
While I do not support what H.R. 1217 purports to do, I urge my
colleagues to join me in support of these essential changes to H.R.
1217 to acknowledge the need for preventative care and hold ourselves
accountable for what would most certainly be a great loss to the
public.
Mr. PITTS. Madam Chairman, I yield back the balance of my time.
The Acting CHAIR (Mrs. Emerson). All time for general debate has
expired.
Pursuant to the rule, the bill shall be considered read for amendment
under the 5-minute rule.
The text of the bill is as follows:

H.R. 1217

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. REPEALING PREVENTION AND PUBLIC HEALTH FUND.

(a) In General.--Section 4002 of the Patient Protection and
Affordable Care Act (42 U.S.C. 300u-11) is repealed.
(b) Rescission of Unobligated Funds.--Of the funds made
available by such section 4002, the unobligated balance is
rescinded.

The Acting CHAIR. No amendment to the bill is in order except those
printed in House Report 112-61. Each such amendment may be offered only
in the order printed in the report, by a Member designated in the
report, shall be considered read, shall be debatable for the time
specified in the report, equally divided and controlled by the
proponent and an opponent of the amendment, shall not be subject to
amendment, and shall not be subject to a demand for division of the
question.

{time} 1610

Amendment No. 1 Offered by Ms. Jackson Lee of Texas

The Acting CHAIR. It is now in order to consider amendment No. 1
printed in House Report 112-61.
Ms. JACKSON LEE of Texas. I have an amendment at the desk.
The Acting CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:

In section 1, add at the end the following:
(c) Notice of Rescission of Unobligated Funds.--Not later
than 10 days after the date of the enactment of this Act, the
Secretary of Health and Human Services shall post on the
public website of the Department of Health and Human Services
a notice of--
(1) the rescission, pursuant to subsection (b), of the
unobligated balance of funds made available by such section
4002; and
(2) the amount of such funds so rescinded.

The Acting CHAIR. Pursuant to House Resolution 219, the gentlewoman
from Texas (Ms. Jackson Lee) and a Member opposed each will control 5
minutes.
The Chair recognizes the gentlewoman from Texas.
Ms. JACKSON LEE of Texas. Madam Chair, I know sometimes in the rush
of legislating, many Members are faced with any number of challenges in
understanding legislation, but I do know that the majority has come
with their own roadmap. And I do want to respect the different
viewpoints, and I don't say this in any way to malign.
First of all, I'm grateful that this amendment was made in order, but
I wish it wasn't because I understand that all legislation that passes
needs to have in fact--or often has those who agree with it and those
who do not. And that's fair enough.
And the process that we usually use to handle that is to amend, not
repeal. There are some sections here that I have looked at and have
concern with. And many have heard me on the floor of the House
discussing a number of issues regarding my local hospitals. But I will
say to you that the repeal of this bill is putting us on the road to
ruin.
And my amendment is simple. It asks the HHS to place on its Web site
the moneys rescinded so that the American people can see. For some it
may be to see the great success of taking away money. For others, it
may be to see what has happened to the resources that they need to take
care of themselves.
Very quickly, this amendment requires for fiscal years 2010, 2011,
2012, 2013, 2014 to list the amount of money that is being taken away
from good health care. But, Madam Chair, it will also hopefully point
people to what they're losing.
For example, look at this beautiful baby here. We will not have,
under the repeal of this Affordable Care Act, the bounty of
preventative care. For those with chronic diseases, Americans who are
subject to chronic disease such as heart disease, cancer, stroke and
diabetes, their only care will be the emergency room, high-priced
emergency room when they're in a diabetic coma or they're in a stroke
or they have a heart attack, rather than be able to go to their
doctors.
But we start early on with this little baby being able to go to
wellness clinics or to their community health clinics. That's what the
money that is being rescinded is going to do to you.
In addition, you will find that chronic diseases resulted in $75.3
billion loss in productivity in the State of Texas alone. This is going
to be across America.
The rescissions will also impact all of the States. I have a list of
almost 50 States that have begun to receive dollars from the Affordable
Care Act--from Alabama, to Alaska, to Pennsylvania, to Massachusetts,
to Michigan, to Rhode Island, and South Carolina, and Tennessee, and
Texas. All of the States that my good friends come from, they are
receiving money right now.
In addition to this issue of taking away money, Prevention for
Healthy America concluded that investing $10 per person per year in
proven community-based programs that increased physical activity, for
example, improved nutrition, and prevents smoking and other tobacco
could save the country more than $16 billion annually within 5 years.
When you see how much money was taken away, just realize that you
multiply that. If it's a total of $16 billion, you're going to lose $16
billion a year because there will not be any wellness program.
Community and clinical prevention, which is about $2 million. And so
you will take away money from HIV

[[Page H2641]]

prevention, and that is a very costly proposal.
You'll take away from public health infrastructure; you'll take away
from primary care residential expansion programs training residents and
doctors. You'll take away from other medical assistance programs,
expansion of physician assistant training. You'll take away from public
health departments where they link people to needed health care. You'll
take away childhood and adult immunizations and protecting the water we
drink and the food we eat.
Let me just say to you that my amendment is to shine the light on
what will be happening to the health care of Americans. I want my
colleagues to tell their constituents, not those that are already
focused on negative aspects of what we're trying to do here, but those
who are just simply hardworking mothers and fathers who are trying to
make a living and who need this health care.
Madam Chair, I would first like to state my clear position that I am
adamantly opposed to H.R. 1217 and its repeal of the important
Prevention and Public Health Fund created under the Affordable Care
Act. The Fund saves lives and saves money.
If H.R. 1217 to repeal the Prevention and Public Health Fund provided
under section 4002 of the Patient Protection and Affordable Care Act is
enacted into law:
What my amendment does is: Requires the Department of Health and
Human Services to post public notice on its official website of the
Unobligated Funds from section 4002 of the Patient Protection and
Affordable Care Act including the amount of the funds that will be
rescinded.
This amendment will provide the public with important information
about Preventive Health Care funding that will no longer be available
for them to receive necessary preventive health care services.
This amendment also assists my Republican colleagues by permitting
them to easily show the American public that they are cutting
government spending, by how much they are cutting spending, and where
they are cutting government spending. So I expect that my Republican
colleagues will fully support this amendment.

Purpose of the Prevention and Public Health Fund (Section 4002 of the
Affordable Care Act)

When Congress passed the Affordable Care Act in 2010 and the
President signed it into law, the Department of Health of Human
Services was given the power to administer the program to provide for
expanded and sustained national health investment in prevention and
public health programs to improve public health programs and help
restrain the growth in private and public health costs. This was
already a cost cutting measure.
Nearly 11.7 million cases of seven common chronic diseases--cancers,
diabetes, heart disease, hypertension, stroke, mental disorders, and
pulmonary conditions--were reported in Texas in 2003.
The cost of treating those with chronic disease in Texas totaled
about $17.2 billion.
Chronic diseases resulted in $75.3 billion in lost productivity and
economic costs to Texas.
A new focus on prevention will offer Texas and the rest of our nation
the opportunity to not only improve the health of Americans, but also
control health care spending. A report from Trust for America's Health
entitled Prevention for a Healthier America concluded that investing
$10 per person per year in proven community-based programs that
increase physical activity, improve nutrition, and prevent smoking and
other tobacco use could save the country more than $16 billion annually
within 5 years. This is a return of $5.60 for every $1 spent on
preventive health care.

How the Fund Improves Wellness and Prevention for Texans

Since enactment of the Affordable Care Act on March 23, 2010, the
Department of Health and Human Services has awarded approximately
$17.63 million in grants to organizations in Texas through the
Prevention and Public Health Fund to help improve wellness and
prevention efforts, including:
Community and Clinical Prevention ($2,956,000): This funding supports
prevention activities that have been shown to be effective in reducing
health care costs and promoting health and wellness.
Primary and Behavioral Health Integration ($495,000). Assists
communities with the integration of primary care services into
community-based mental & behavioral health settings.
HIV Prevention ($2,359,000). Focuses on HIV prevention in high risk
populations and communities by increasing HIV testing opportunities,
linking HIV-infected persons with appropriate services, and filling
critical gaps in data and understanding of the HIV epidemic.
Tobacco Cessation ($102,000). Strengthens Texas's ability to move
towards implementing a plan to reduce tobacco use. It also enhances and
expands the national network of tobacco cessation quitlines to
significantly increase the number of tobacco users who quit each year.
Public Health Infrastructure ($2,084,000): These grants strengthen
state and local capacity to prepare health departments to meet 21st
century public health challenges and support the training of existing
and next generation public health professionals.
Public Health Infrastructure ($800,000). Supports state, local, and
tribal public health infrastructure to improve information technology,
workforce training, and policy development.
Epidemiology and Laboratory Capacity ($634,000). Builds state and
local capacity to prevent, detect, and respond to infectious disease
outbreaks.
Public Health Training Centers ($650,000). Improve the public health
system by enhancing skills of the current and future public health
workforce.
Primary Care Training ($12,586,000): These funds support the
expansion of the primary care workforce.
Primary Care Residency Expansion Program ($7,680,000). Increases the
number of residents trained in family medicine, general internal
medicine, and general pediatrics.
Advanced Nursing Education Expansion Program ($1,426,000). Increases
the number of primary care nurse practitioners and nurse midwives who
graduate by expanding class sizes and accelerating graduation rates for
part-time students.
Expansion of Physician Assistant Training ($1,980,000). Improves
access to primary care by funding the training of primary care
physician assistants and expanding the primary care workforce.
Nurse-Managed Health Clinics ($1,500,000). Provide primary care and
wellness services to underserved and vulnerable populations through
clinics that are managed by advanced practice nurses and provide
valuable clinical training sites for primary care nurse practitioners.
If the Prevention and Public Health Fund is cut and its Unobligated
Funds Rescinded our health care costs will soar and the results will be
catastrophic. The Fund saves lives and saves money.

if the funds are rescinded

America's local health departments need the Prevention and Public
Health Fund to help prevent diseases and protect health in ways that
health insurance companies or medical care providers cannot.
Local health departments:
Link people who need healthcare with ways to get it.
Detect and stop outbreaks of disease.
Help people make healthier choices in diet, exercise, and tobacco use
to prevent and reduce chronic disease.
Provide childhood and adult immunizations.
Protect the water we drink and the food we eat.
Help new parents give babies a healthy start at home.
Inspect schools and day care centers for health and safety.
Conduct screenings for cancer, heart disease, diabetes, childhood
lead poisoning, tuberculosis, and other infectious diseases.
The Prevention and Public Health Fund is critically needed to
stabilize the ability of local health departments to protect their
communities from health threats and help individuals and families lead
productive and healthy lives. Please oppose this attempt by H.R. 1217
to eliminate funding for the Prevention and Public Health Fund. A
healthy future depends on it.
If H.R. 1217 passes this Chamber and is enacted into law, it is
important for the American People to have notice of the rescission of
funds for the Prevention and Public Health Fund program. Since the
Department of Health and Human Services administers the Fund, it is
only appropriate that public notice be given on the official HHS
website and include the amount of funds rescinded. In this way, the
American public will know that the public funding they rely upon has
been cancelled for preventive health care and the Transparency of
Spending Cuts will be further promoted in a manner that my Republican
Colleagues will also appreciate.
I would urge all Members of Congress to support my amendment.
I yield back the balance of my time.
Mr. PITTS. Madam Chair, at this point I rise in opposition to the
amendment.
The Acting CHAIR. The gentleman from Pennsylvania is recognized for 5
minutes.
Mr. PITTS. I will just mention to the gentlelady all of the wonderful
programs that she mentioned are not mentioned in this section of the
law. There is no guarantee that this money will be spent for any of
that.
H.R. 1217 repeals the Prevention and Public Health Fund and rescinds
unobligated balances. The Jackson Lee amendment would require the
Secretary of Health and Human Services

[[Page H2642]]

to post on the HHS public Web site a notice of the rescission of
unobligated balances of the Prevention and Public Health Fund and the
amount of the rescission.
I support transparency in government. I actually wish there was more
transparency in how HHS has already spent the money from this fund. The
lack of transparency and accountability regarding this fund is a
primary reason I support H.R. 1217. And if the author feels this would
increase transparency, then I support the amendment.
I yield back the balance of my time.
The Acting CHAIR. The question is on the amendment offered by the
gentlewoman from Texas (Ms. Jackson Lee).
The amendment was agreed to.

Amendment No. 2 Offered by Ms. Castor of Florida

The Acting CHAIR. It is now in order to consider amendment No. 2
printed in House Report 112-61.
Ms. CASTOR of Florida. I have an amendment at the desk.
The Acting CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:

At the end of the bill, add the following:

SEC. 2. GAO STUDY ON THE IMPACTS THAT FUNDING THROUGH THE
PREVENTION AND PUBLIC HEALTH FUND WOULD HAVE ON
PREVENTING CHRONIC DISEASES AND PROMOTING
HEALTH.

The Comptroller General of the United States shall conduct
a study to determine the impacts that providing prevention,
wellness, and public health activities under the Prevention
and Public Health Fund, using the funding made available
under section 4002 of the Patient Protection and Affordable
Care Act (42 U.S.C. 300u-11), would have on preventing
chronic diseases and promoting health in the United States,
if such funding were not repealed and rescinded under section
1. Not later than the expiration of the 90-day period
beginning on the day of the enactment of this Act, the
Comptroller General shall submit to the Congress a report
setting forth the results and conclusions of the study under
this section.

{time} 1620

So I would encourage all of my colleagues to take a look at the
grants that are being made. How are your local communities making these
investments work in your own districts to invest in the long term
health of our neighbors and the economic prosperity of our communities?
For example, in my hometown in my district, the Pinellas County
Health Department has brought together neighborhoods and all the
nonprofits to determine--you know what's going to work best in Pinellas
County is encouraging healthier lifestyles, because we have an obesity
epidemic. So they want to build sidewalks, trails, bike lanes, better
lighting to encourage people to exercise. They are going to make
improvements to parks so children have the opportunity to get out and
play after school instead of sitting in front of the television.
I also have a great public university, the University of South
Florida, in my district. They are training the modern health care
workforce in Florida. These are professionals fighting on the front
lines of our communities, and yes, creating jobs. This is creating jobs
to encourage the healthier lifestyles that work. USF is able to
identify where the gaps in training might be, develop updated curricula
to ensure the public health care workforce receives the most up-to-date
research, and then they can spread the word throughout the churches,
the grocery stores, and our neighborhoods.
The Florida Department of Health is also using these grants in
checking on all of our strategies Statewide to determine what works.
See, this is one of the important goals of the Affordable Care Act, to
promote wellness and prevention, to ensure healthier outcomes for our
families and neighbors. And the examples I have just shared with you
are only a few of what's happening all across the country.
We are smarter, Madam Chair. Prevention works. It saves taxpayers
money. It saves families money. It saves lives.
I reserve the balance of my time.
Mr. PITTS. Madam Chair, I rise in opposition to the Castor amendment.
The Acting CHAIR. The gentleman from Pennsylvania is recognized for 5
minutes.
Mr. PITTS. Madam Chair, the amendment before us directs the GAO to
pontificate on the effectiveness of unspecified prevention, wellness,
and public health activities financed by funds under section 4002 of
PPACA.
As we have pointed out, section 4002 gives the Secretary of HHS
complete discretion to spend the slush fund with little limitation. Any
program within the Public Health Service Act, regardless of its merit
or effectiveness, is eligible for funding under section 4002. How can
we ask the GAO to determine the effectiveness of spending dollars when
we simply don't know how those dollars will be spent? Is GAO supposed
to assume that funds will be used to train doctors or build jungle
gyms? Will their report make the assumption that the money will be used
to advocate for soda tax increases in States or build signs that direct
people to bike paths? All of these activities can be funded through
this slush fund.
According to the Energy and Commerce minority views, Pitt County,
North Carolina, received a grant from the fund that will be in part
used to ``place signage within communities to point out public parks,
other recreational opportunities, and the availability of bike lanes.''
This amendment underscores the major problem with section 4002.
Rather than letting Congress weigh the relative value of programs
through the annual appropriations process, my friends on the other side
of the aisle decided to throw dollars to a political appointee at HHS
to spend billions of dollars on any program with no oversight. The
amendment also places an unrealistic timetable on the GAO to issue a
report within 90 days of enactment. It is simply a waste of money to
ask GAO to conduct a study with little time to complete what is clearly
an impossible task.
I urge my colleagues to vote ``no.''
I reserve the balance of my time.
Ms. CASTOR of Florida. Madam Chair, how much more time do I have?
The Acting CHAIR. The gentlewoman from Florida has 1 minute remaining
and the gentleman from Pennsylvania has 2\1/2\ minutes remaining.
Ms. CASTOR of Florida. Who has the right to close?
The Acting CHAIR. The gentleman from Pennsylvania has the right to
close.

[[Page H2643]]

Ms. CASTOR of Florida. Madam Chair, what a waste of money it would be
if we do not act on education and knowledge, because we know that
prevention works in America. When you educate someone on healthier
lifestyles, the likelihood is that they are going to live a healthier
life. They can prevent disease. Maybe they get early detection of their
cancer. And that would save them a lot of money. You know, it also
would save the government a lot of money. So let's be smart about this.
Prevention works.
It reminds me now of my friends across the aisle, their proposal to
end Medicare as we know it, because that is not smart. Again, like
prevention, Medicare works. It saves families money. And the plan to
privatize Medicare and turn it into a voucher program is not going to
save any money. Indeed, it will shift the costs to families. They will
have to pay more. So let's do what's smart. Prevention works.
I urge adoption of my amendment.
Mr. PITTS. Madam Chair, the simple fact is everything the gentlelady
just mentioned she doesn't know will be funded. There is no guarantee
to fund any of those things.
I urge a ``no'' vote on this amendment.
I yield back the balance of my time.
The Acting CHAIR. The question is on the amendment offered by the
gentlewoman from Florida (Ms. Castor).
The question was taken; and the Acting Chair announced that the noes
appeared to have it.
Ms. CASTOR. Madam Chair, I demand a recorded vote.
The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further
proceedings on the amendment offered by the gentlewoman from Florida
will be postponed.

Amendment No. 3 Offered by Ms. Castor of Florida

The Acting CHAIR. It is now in order to consider amendment No. 3
printed in House Report 112-61.
Ms. CASTOR of Florida. Madam Chair, I have an amendment at the desk.
The Acting CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:

At the end of the bill, add the following:

SEC. 2. GAO STUDY ON THE ECONOMIC IMPACTS THAT FUNDING
THROUGH THE PREVENTION AND PUBLIC HEALTH FUND
WOULD HAVE ON STATES AND COMMUNITIES.

The Comptroller General of the United States shall conduct
a study to determine the economic impacts that providing
prevention, wellness, and public health activities under the
Prevention and Public Health Fund, using the funding made
available under section 4002 of the Patient Protection and
Affordable Care Act (42 U.S.C. 300u-11), would have on States
and communities in the United States, if such funding were
not repealed and rescinded under section 1. Not later than
the expiration of the 90-day period beginning on the day of
the enactment of this Act, the Comptroller General shall
submit to the Congress a report setting forth the results and
conclusions of the study under this section.

The Acting CHAIR. Pursuant to House Resolution 219, the gentlewoman
from Florida (Ms. Castor) and a Member opposed each will control 5
minutes.
The Chair recognizes the gentlewoman from Florida.
Ms. CASTOR of Florida. Madam Chair, my amendment requires a
Government Accountability Office study within 90 days of enactment of
this bill to examine the economic impact Prevention and Public Health
grants have on States and local communities.
Now, I can tell you we don't really need a study to understand how
important prevention is and how important it is to empower our
hometowns, local governments, nonprofits, whoever can come together on
a local level and make these decisions about encouraging healthier
lifestyles.
The beauty of the Public Health and Prevention initiative is it's not
Washington dictating all across the country a cookie-cutter approach,
one size fits all. Instead, we empower our neighbors to make these
decisions on what works best for them. I would say that what works best
in my hometown back in Tampa probably would not work quite as well in
Fargo or in Missouri.
Prevention of disease is smart. It saves families money, and it saves
taxpayers money as well. Now, over time we have all gotten smarter
about preventing chronic diseases. Much of this cost-saving and life-
saving focus was brought to bear in the landmark Affordable Care Act
and this Prevention and Public Health initiative, which is the most
historic investment in public health of our communities in the history
of our country.
Now, far from the extreme arguments against prevention from my
colleagues across the aisle, the Prevention and Public Health
initiative empowers States, hometowns, and local communities to
determine what works best for them. The annual treatment cost of
chronic diseases costs the United States over $270 billion. And our
economy has lost over $1 trillion in lost productivity. In Florida
alone, we have lost over $68 billion in lost productivity and economic
costs due to chronic diseases like heart disease, diabetes, and cancer.
So not only does prevention help us reduce costs, it can be an
economic boost to our communities. I can tell you back in Florida we
need as many economic boosts as we can get. We still have a high
unemployment rate. We have a large number of uninsured. So what could
be smarter than targeting some of our communities and encouraging them
on healthier lifestyles so they can get back to work?
We are creating jobs through doing this. For example, at the
University of South Florida College of Public Health, they've received
one of the Prevention and Public Health grants where they're hiring and
training the modern public health workforce. These are the folks with
the most updated knowledge that are able to go out through communities
and encourage them and educate them on what it would mean if they
didn't smoke, if they didn't drink. Oftentimes, these initiatives have
a great impact. They can save us money, and they can save us lives.

{time} 1630

In Pinellas County they are combating childhood obesity, and they are
already making a big economic impact in the community. Richard Curtin
is the program manager for the Communities Putting Prevention to Work--
Pinellas. He informed me they have created already 18 jobs as a direct
result of this lifesaving work.
So I would encourage all of you to ask your folks back home what
works best for them. Apply for these grants. We can make a difference
all across America, save taxpayers money, save our families money, and
save lives while we are at it.
I reserve the balance of my time.
Mr. PITTS. Madam Chair, I rise in opposition to the amendment.
The Acting CHAIR. The gentleman from Pennsylvania is recognized for 5
minutes.
Mr. PITTS. Madam Chair, the Castor amendment directs the Government
Accountability Office to make assumptions on the economic impacts of
providing prevention, wellness, and public health activities under
section 4002 of the PPACA. However, section 4002 gives the Secretary of
HHS complete discretion to spend this slush fund with little
limitation. The amendment asks the GAO to determine the economic impact
of spending when no one except the Secretary knows how those dollars
will be spent.
What will GAO base their assumptions on? Does placing signage for
bike paths produce economic activity or does advocating higher soda
taxes benefit the economy? These activities have been financed by
programs eligible for funding under section 4002.
Members and the GAO cannot determine the economic impact of the fund
because the Secretary controls how it is to be spent. Will GAO be
charged with determining whether borrowing 42 cents of every dollar
this fund spends has a positive economic impact?
This amendment underscores the major problems with section 4002.
Rather than letting Congress weigh the relative value of programs
through the annual appropriations process, my friends on the other side
of the aisle have decided to throw dollars to a political appointee at
HHS to spend billions on any program with no oversight.
The amendment also places an unrealistic timetable on the GAO to
issue a report within 90 days of enactment. Like the previous
amendment, we are not spending our resources wisely when we ask the GAO
to conduct a study

[[Page H2644]]

with little time to complete what is clearly an impossible task.
I urge Members to oppose the amendment.
I reserve the balance of my time.
Ms. CASTOR of Florida. Madam Chair, we are spending our dollars
wisely when we are investing in prevention and wellness because
prevention works. Prevention saves money, it saves the taxpayers money,
it saves families money and it saves lives.
Now, there has been a great debate all across America about health
care over the past few years. I think we can all agree on that. Part of
the importance of the health care debate was that our health care
system for too long has focused and spent money at the end game on
sickness, when people have cancer, and that's fine, but we can be
smarter about it. We have a lot more knowledge and a lot of experts
that have advised us all that if you invest in prevention to encourage
folks not to smoke, not to drink, those easy things, very easy in
lifestyle, but oftentimes they need a little extra help. Parents should
turn off the TV and the kids should go out and play. They should
exercise.
But sometimes it's that little extra push. And if we can make a dent
in childhood obesity, diabetes, cancer, a stroke, because we have
encouraged healthier lifestyles with this very modest investment, that
will be a great accomplishment. And that's part of what the health care
debate was about, taking this modest investment in public health and
empowering our communities to make those decisions on what works for
them. Prevention works. It's smart.
I urge the adoption of my amendment.
I yield back the balance of my time.
Mr. PITTS. Madam Chair, once again the gentlewoman made my point. She
has no guarantee that in the year 2015 the Secretary will fund programs
like cessation of smoking or obesity. She has not a clue. What if the
Secretary decided to use the whole $2 billion for abstinence education
in 2015? She has no clue what it will be used for.
I urge the Members to oppose this amendment.
I yield back the balance of my time.
The Acting CHAIR. The question is on the amendment offered by the
gentlewoman from Florida (Ms. Castor).
The question was taken; and the Acting Chair announced that the noes
appeared to have it.
Ms. CASTOR of Florida. Madam Chair, I demand a recorded vote.
The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further
proceedings on the amendment offered by the gentlewoman from Florida
will be postponed.

Announcement by the Acting Chair

The Acting CHAIR. Pursuant to clause 6 of rule XVIII, proceedings
will now resume on those amendments printed in House Report 112-61 on
which further proceedings were postponed, in the following order:
Amendment No. 2 by Ms. Castor of Florida.
Amendment No. 3 by Ms. Castor of Florida.
The Chair will reduce to 5 minutes the time for the second electronic
vote after the first vote in this series.

Amendment No. 2 Offered by Ms. Castor of Florida

The Acting CHAIR. The unfinished business is the demand for a
recorded vote on the amendment offered by the gentlewoman from Florida
(Ms. Castor) on which further proceedings were postponed and on which
the noes prevailed by voice vote.
The Clerk will redesignate the amendment.
The Clerk redesignated the amendment.

Recorded Vote

The Acting CHAIR. A recorded vote has been demanded.
A recorded vote was ordered.
The vote was taken by electronic device, and there were--ayes 187,
noes 237, not voting 8, as follows:

[Roll No. 261]

AYES--187

Ackerman
Andrews
Baca
Baldwin
Barrow
Becerra
Berkley
Berman
Bishop (GA)
Bishop (NY)
Blumenauer
Boren
Boswell
Brady (PA)
Braley (IA)
Brown (FL)
Butterfield
Capps
Capuano
Cardoza
Carnahan
Carney
Carson (IN)
Castor (FL)
Chandler
Chu
Cicilline
Clarke (MI)
Clarke (NY)
Clay
Cleaver
Clyburn
Cohen
Connolly (VA)
Conyers
Cooper
Costa
Costello
Courtney
Critz
Crowley
Cuellar
Cummings
Davis (CA)
Davis (IL)
DeFazio
DeGette
DeLauro
Deutch
Dicks
Dingell
Doggett
Donnelly (IN)
Doyle
Edwards
Ellison
Engel
Eshoo
Farr
Fattah
Filner
Frank (MA)
Fudge
Garamendi
Gonzalez
Green, Al
Green, Gene
Grijalva
Gutierrez
Hanabusa
Harris
Hastings (FL)
Heinrich
Higgins
Himes
Hinchey
Hinojosa
Hirono
Holden
Holt
Honda
Hoyer
Inslee
Israel
Jackson (IL)
Jackson Lee (TX)
Johnson (GA)
Johnson, E. B.
Kaptur
Keating
Kildee
Kind
Kissell
Kucinich
Langevin
Larsen (WA)
Larson (CT)
Lee (CA)
Levin
Lewis (GA)
Lipinski
Loebsack
Lofgren, Zoe
Lowey
Lujan
Lynch
Markey
Matheson
Matsui
McCarthy (NY)
McCollum
McDermott
McGovern
McIntyre
McNerney
Michaud
Miller (NC)
Miller, George
Moore
Moran
Murphy (CT)
Nadler
Napolitano
Neal
Olver
Owens
Pallone
Pascrell
Pastor (AZ)
Payne
Pelosi
Perlmutter
Peters
Peterson
Pingree (ME)
Polis
Price (NC)
Quigley
Rahall
Rangel
Reyes
Richmond
Ross (AR)
Rothman (NJ)
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Schakowsky
Schiff
Schrader
Schwartz
Scott (VA)
Scott, David
Serrano
Sewell
Sherman
Shuler
Sires
Slaughter
Smith (WA)
Speier
Stark
Sutton
Thompson (CA)
Thompson (MS)
Tierney
Tonko
Towns
Tsongas
Van Hollen
Velazquez
Visclosky
Walz (MN)
Wasserman Schultz
Waters
Watt
Waxman
Weiner
Welch
Wilson (FL)
Woolsey
Wu
Yarmuth

NOES--237

Adams
Aderholt
Akin
Alexander
Altmire
Amash
Austria
Bachmann
Bachus
Barletta
Bartlett
Barton (TX)
Bass (NH)
Benishek
Berg
Biggert
Bilbray
Bilirakis
Bishop (UT)
Black
Blackburn
Bonner
Bono Mack
Boustany
Brady (TX)
Brooks
Broun (GA)
Buchanan
Bucshon
Buerkle
Burgess
Burton (IN)
Calvert
Camp
Campbell
Canseco
Cantor
Capito
Carter
Cassidy
Chabot
Chaffetz
Coble
Coffman (CO)
Cole
Conaway
Cravaack
Crawford
Crenshaw
Davis (KY)
Denham
Dent
DesJarlais
Diaz-Balart
Dold
Dreier
Duffy
Duncan (SC)
Duncan (TN)
Ellmers
Emerson
Farenthold
Fincher
Fitzpatrick
Flake
Fleischmann
Fleming
Flores
Forbes
Fortenberry
Foxx
Franks (AZ)
Frelinghuysen
Gallegly
Gardner
Garrett
Gerlach
Gibbs
Gibson
Gingrey (GA)
Gohmert
Goodlatte
Gosar
Gowdy
Granger
Graves (GA)
Graves (MO)
Griffin (AR)
Griffith (VA)
Grimm
Guinta
Guthrie
Hall
Hanna
Harper
Hartzler
Hastings (WA)
Hayworth
Heck
Heller
Hensarling
Herger
Herrera Beutler
Huelskamp
Huizenga (MI)
Hultgren
Hunter
Hurt
Issa
Jenkins
Johnson (IL)
Johnson (OH)
Johnson, Sam
Jones
Jordan
Kelly
King (IA)
King (NY)
Kingston
Kinzinger (IL)
Kline
Labrador
Lamborn
Lance
Landry
Lankford
Latham
LaTourette
Latta
Lewis (CA)
LoBiondo
Long
Lucas
Luetkemeyer
Lummis
Lungren, Daniel E.
Mack
Manzullo
Marchant
Marino
McCarthy (CA)
McCaul
McClintock
McCotter
McHenry
McKeon
McKinley
McMorris Rodgers
Meehan
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Mulvaney
Murphy (PA)
Myrick
Neugebauer
Noem
Nugent
Nunes
Nunnelee
Olson
Palazzo
Paul
Paulsen
Pearce
Pence
Petri
Pitts
Platts
Poe (TX)
Pompeo
Posey
Price (GA)
Quayle
Reed
Rehberg
Renacci
Ribble
Rigell
Rivera
Roby
Roe (TN)
Rogers (AL)
Rogers (KY)
Rohrabacher
Rokita
Rooney
Ros-Lehtinen
Roskam
Ross (FL)
Royce
Runyan
Ryan (WI)
Scalise
Schilling
Schmidt
Schock
Schweikert
Scott (SC)
Scott, Austin
Sensenbrenner
Sessions
Shimkus
Shuster
Simpson
Smith (NE)
Smith (NJ)
Smith (TX)
Southerland
Stearns
Stivers
Stutzman
Sullivan
Terry
Thompson (PA)
Thornberry
Tiberi
Tipton
Turner
Upton
Walberg
Walden
Walsh (IL)
Webster
West
Westmoreland
Whitfield
Wilson (SC)
Wittman
Wolf
Womack
Woodall
Yoder
Young (AK)
Young (FL)
Young (IN)

NOT VOTING--8

Bass (CA)
Culberson
Giffords
Maloney
Meeks
Reichert
Richardson
Rogers (MI)

{time} 1701

Mr. WHITFIELD and Mr. HANNA changed their vote from ``aye'' to
``no.''
Messrs. CARSON of Indiana, McINTYRE, DINGELL, SMITH of Washington,
ISRAEL, HINOJOSA, Ms. LORETTA SANCHEZ of California, Ms.

[[Page H2645]]

PINGREE of Maine, and Ms. LINDA T. SANCHEZ of California changed their
vote from ``no'' to ``aye.''
So the amendment was rejected.
The result of the vote was announced as above recorded.
Stated for:
Ms. RICHARDSON. Madam Speaker, I was unavoidably detained earlier
today and therefore was not present to be recorded on rollcall vote No.
261. Had I been present I would have voted as follows:
On rollcall No. 261, I would have voted ``aye'' (April 13) (Castor
(FL) Amendment, Requiring the U.S. Government Accountability Office to
conduct a study of the impact funds awarded through the Prevention and
Public Health Fund would have on preventing chronic diseases and
promoting health).

Amendment No. 3 Offered by Ms. Castor of Florida

Recorded Vote

The Acting CHAIR. A recorded vote has been demanded.
A recorded vote was ordered.
The Acting CHAIR. This will be a 5-minute vote.
The vote was taken by electronic device, and there were--ayes 188,
noes 238, not voting 6, as follows:

[Roll No. 262]

AYES--188

Ackerman
Andrews
Baca
Baldwin
Barrow
Bass (CA)
Becerra
Berkley
Berman
Bishop (GA)
Bishop (NY)
Blumenauer
Boren
Boswell
Brady (PA)
Braley (IA)
Brown (FL)
Butterfield
Capps
Capuano
Cardoza
Carnahan
Carney
Carson (IN)
Castor (FL)
Chandler
Chu
Cicilline
Clarke (MI)
Clarke (NY)
Clay
Cleaver
Clyburn
Cohen
Connolly (VA)
Conyers
Cooper
Costa
Costello
Courtney
Critz
Crowley
Cuellar
Cummings
Davis (CA)
Davis (IL)
DeGette
DeLauro
Deutch
Dicks
Dingell
Doggett
Donnelly (IN)
Doyle
Edwards
Ellison
Engel
Eshoo
Farr
Fattah
Filner
Frank (MA)
Fudge
Garamendi
Gonzalez
Green, Al
Green, Gene
Grijalva
Gutierrez
Hanabusa
Harris
Hastings (FL)
Heinrich
Higgins
Himes
Hinchey
Hinojosa
Hirono
Holden
Holt
Honda
Hoyer
Inslee
Israel
Jackson (IL)
Jackson Lee (TX)
Johnson (GA)
Johnson, E. B.
Kaptur
Keating
Kildee
Kind
Kissell
Kucinich
Langevin
Larsen (WA)
Larson (CT)
Lee (CA)
Levin
Lewis (GA)
Lipinski
Loebsack
Lofgren, Zoe
Lowey
Lujan
Lynch
Maloney
Markey
Matheson
Matsui
McCarthy (NY)
McCollum
McDermott
McGovern
McIntyre
McNerney
Michaud
Miller (NC)
Miller, George
Moore
Moran
Murphy (CT)
Nadler
Napolitano
Neal
Olver
Owens
Pallone
Pascrell
Pastor (AZ)
Payne
Pelosi
Perlmutter
Peterson
Pingree (ME)
Polis
Price (NC)
Quigley
Rahall
Rangel
Reyes
Richardson
Richmond
Ross (AR)
Rothman (NJ)
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Schakowsky
Schiff
Schrader
Schwartz
Scott (VA)
Scott, David
Serrano
Sewell
Sherman
Shuler
Sires
Slaughter
Smith (WA)
Speier
Stark
Sutton
Thompson (CA)
Thompson (MS)
Tierney
Tonko
Towns
Tsongas
Van Hollen
Velazquez
Visclosky
Walz (MN)
Wasserman Schultz
Waters
Watt
Waxman
Weiner
Welch
Wilson (FL)
Woolsey
Wu
Yarmuth

NOES--238

Adams
Aderholt
Akin
Alexander
Altmire
Amash
Austria
Bachmann
Bachus
Barletta
Bartlett
Barton (TX)
Bass (NH)
Benishek
Berg
Biggert
Bilbray
Bilirakis
Bishop (UT)
Black
Bonner
Bono Mack
Boustany
Brady (TX)
Brooks
Broun (GA)
Buchanan
Bucshon
Buerkle
Burgess
Burton (IN)
Calvert
Camp
Campbell
Canseco
Cantor
Capito
Carter
Cassidy
Chabot
Chaffetz
Coble
Coffman (CO)
Cole
Conaway
Cravaack
Crawford
Crenshaw
Davis (KY)
DeFazio
Denham
Dent
DesJarlais
Diaz-Balart
Dold
Dreier
Duffy
Duncan (SC)
Duncan (TN)
Ellmers
Emerson
Farenthold
Fincher
Fitzpatrick
Flake
Fleischmann
Fleming
Flores
Forbes
Fortenberry
Foxx
Franks (AZ)
Frelinghuysen
Gallegly
Gardner
Garrett
Gerlach
Gibbs
Gibson
Gingrey (GA)
Gohmert
Goodlatte
Gosar
Gowdy
Granger
Graves (GA)
Graves (MO)
Griffin (AR)
Griffith (VA)
Grimm
Guinta
Guthrie
Hall
Hanna
Harper
Hartzler
Hastings (WA)
Hayworth
Heck
Heller
Hensarling
Herger
Herrera Beutler
Huelskamp
Huizenga (MI)
Hultgren
Hunter
Hurt
Issa
Jenkins
Johnson (IL)
Johnson (OH)
Johnson, Sam
Jones
Jordan
Kelly
King (IA)
King (NY)
Kingston
Kinzinger (IL)
Kline
Labrador
Lamborn
Lance
Landry
Lankford
Latham
LaTourette
Latta
Lewis (CA)
LoBiondo
Long
Lucas
Luetkemeyer
Lummis
Lungren, Daniel E.
Mack
Manzullo
Marchant
Marino
McCarthy (CA)
McCaul
McClintock
McCotter
McHenry
McKeon
McKinley
McMorris Rodgers
Meehan
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Mulvaney
Murphy (PA)
Myrick
Neugebauer
Noem
Nugent
Nunes
Nunnelee
Olson
Palazzo
Paul
Paulsen
Pearce
Pence
Peters
Petri
Pitts
Platts
Poe (TX)
Pompeo
Posey
Price (GA)
Quayle
Reed
Rehberg
Renacci
Ribble
Rigell
Rivera
Roby
Roe (TN)
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Rokita
Rooney
Ros-Lehtinen
Roskam
Ross (FL)
Royce
Runyan
Ryan (WI)
Scalise
Schilling
Schmidt
Schock
Schweikert
Scott (SC)
Scott, Austin
Sensenbrenner
Sessions
Shimkus
Shuster
Simpson
Smith (NE)
Smith (NJ)
Smith (TX)
Southerland
Stearns
Stivers
Stutzman
Sullivan
Terry
Thompson (PA)
Thornberry
Tiberi
Tipton
Turner
Upton
Walberg
Walden
Walsh (IL)
Webster
West
Westmoreland
Whitfield
Wilson (SC)
Wittman
Wolf
Womack
Yoder
Young (AK)
Young (FL)
Young (IN)

NOT VOTING--6

Blackburn
Culberson
Giffords
Meeks
Reichert
Woodall

{time} 1709

So the amendment was rejected.
The result of the vote was announced as above recorded.
The Acting CHAIR (Mr. Bishop of Utah). Under the rule, the Committee
rises.
Accordingly, the Committee rose; and the Speaker pro tempore (Mr.
Westmoreland) having assumed the chair, Mr. Bishop of Utah, Acting
Chair of the Committee of the Whole House on the state of the Union,
reported that that Committee, having had under consideration the bill
(H.R. 1217) to repeal the Prevention and Public Health Fund, and
pursuant to House Resolution 219, reported the bill back to the House
with an amendment adopted in the Committee of the Whole.
The SPEAKER pro tempore. Under the rule, the previous question is
ordered.
The question is on the amendment.
The amendment was agreed to.
The SPEAKER pro tempore. The question is on the engrossment and third
reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.

Motion to Recommit

Mr. LOEBSACK. Mr. Speaker, I have a motion to recommit at the desk.
The SPEAKER pro tempore. Is the gentleman opposed to the bill?
Mr. LOEBSACK. I am opposed to the bill in its current form.
Mr. PITTS. Mr. Speaker, I reserve a point of order on the motion to
recommit.
The SPEAKER pro tempore. A point of order is reserved.
The Clerk will report the motion to recommit.
The Clerk read as follows:

Mr. Loebsack moves to recommit the bill H.R. 1217 to the
Committee on Energy and Commerce with instructions to report
the same to the House forthwith with the following amendment:
Strike all after the enacting clause and insert the
following:

SECTION 1. PRESERVING PREVENTION AND PUBLIC HEALTH FUND FOR
ACTIVITIES FOR SENIORS, SUBJECT TO AVAILABILITY
OF APPROPRIATIONS.

(a) In General.--Section 4002 of the Patient Protection and
Affordable Care Act is amended--
(1) in subsection (a), by striking ``It is the purpose''
and inserting ``Subject to subsection (c), it is the
purpose'';
(2) in subsection (b), by striking ``, and appropriated'';
and
(3) in subsection (c)--
(A) by striking ``shall'' and inserting ``may, to the
extent and in the amounts made available for use by an
appropriations Act,''; and
(B) by striking ``for prevention, wellness, and public
health activities including'' and all that follows through
the period at the

[[Page H2646]]

end and inserting ``for prevention, wellness, and public
health activities for individuals 65 years of age or
older.''.
(b) Rescission of Unobligated Funds.--Of the funds
appropriated by such section 4002 before the date of the
enactment of this Act, the unobligated balance is rescinded.

The SPEAKER pro tempore. The gentleman from Iowa is recognized for 5
minutes in support of his motion.
Mr. LOEBSACK. Mr. Speaker, while I oppose the underlying bill, I am
offering this final amendment on a topic that I know is important to
all of us--our Nation's seniors. Our seniors have worked hard all their
lives. Many of them have lived through some of the most trying times in
American history, including the Great Depression and two world wars.
They have also been a part of some of our country's proudest
achievements and moments, like putting the first man on the Moon.
Along the way, our seniors have made incredible sacrifices for their
families and for their country. My own grandmother helped take care of
me while I was young, making sure that my siblings and I had a safe
place to live and food on the table. That is why our seniors deserve
the best care and treatment available as they age.
I have visited seniors all across my district in Iowa, delivering
Meals on Wheels in Cedar Rapids and Muscatine, serving lunch at senior
dining in Marion, and hosting events at senior centers and retirement
communities like Westgate Towers in Ottumwa and Cedar County Senior
Center in Tipton where this photo was taken.
One of my proudest moments in Congress in fact was when I met with a
group of World War II veterans who were here from Iowa on an honor
flight tour. I was privileged to thank them for their service.
When I talk to seniors in my district, I hear far too often that many
of them are struggling. This is unacceptable. No senior should retire
into poverty or have difficulty paying their medical bills. While we
may disagree on the Republican budget, which would end Medicare as we
know it, I think we can all agree that we owe seniors access to the
preventive health care and public health efforts that the underlying
bill would repeal. I am determined to fight for our seniors and to make
sure that we keep our promises to them. That is why this final
amendment will ensure that the repeal of the Prevention and Public
Health Fund will not apply to prevention, wellness, and public health
activities for individuals 65 years of age or older.
This funding can be used for programs that promote wellness, that
empower seniors to take personal responsibility for staying healthy as
they age. It can also be used for prevention, including screenings for
cancer, heart disease, and Alzheimer's disease. The fund can also be
used for public health activities to ensure that seniors have the
information they need to make the best possible decisions about their
health. These funds can also be used for research, so we can find ways
to prevent health problems associated with aging. What's more, by
focusing on public health and prevention, this fund can reduce costs in
the long run.
We all know that early detection improves patient outcomes and saves
money, and successful public health campaigns have demonstrated that we
can decrease unhealthy behaviors by equipping people with good
information. That is why I believe the underlying bill, itself, is
penny wise but pound foolish. In the long run, the underlying bill only
serves to hurt the Nation's seniors. It is unfortunate that some are
choosing to make this shortsighted decision when the health of our
seniors is at stake.
Madam Speaker, the American people, we should keep in mind, sent us
here not to fight with each other over critical issues such as the one
before us today but to fight together for them. I urge all Members to
join me in ensuring that our Nation's seniors have access to the
preventive health care that will keep them healthy, allowing them to
enjoy their friends and families and remain active in their
communities. We owe the seniors in our districts at least that much.
The passage of this amendment will not prevent the passage of the
underlying bill. If the amendment is adopted, it will be incorporated
into the bill and the bill will be immediately voted upon. I believe,
Madam Speaker, that now is the time to show the American people that we
as a body can indeed work effectively for them, and I urge all of my
colleagues to vote for this commonsense final amendment.
I yield back the balance of my time.
Mr. PITTS. Madam Speaker, I withdraw my reservation and rise in
opposition to the motion.
The SPEAKER pro tempore (Mrs. Emerson). The reservation is withdrawn,
and the gentleman from Pennsylvania is recognized for 5 minutes.
Mr. PITTS. Thank you, Madam Speaker.
Yesterday, we heard the House minority leader say that ``elections
shouldn't matter as much as they do.''
I strongly disagree. Members were brought here to get runaway
spending under control; but rather than help us avoid a fiscal crisis,
House Democrats have brought forward an MTR that guts the underlying
bill and continues the runaway spending that the American people have
rejected.
As we have pointed out, section 4002 gives the Secretary of HHS
complete discretion to spend the slush fund with little limitation. Any
program within the Public Health Service Act, regardless of its merit
or effectiveness, is eligible for funding under section 4002.
Will section 4002 help train doctors, or will the money be used to
build jungle gyms? Will the Prevention and Public Health Fund be used
to advocate for soda tax increases in States or build signs that direct
people to bike paths? All of these activities can be funded through
this slush fund.
This MTR underscores the major problem with section 4002. Rampant
spending on the Federal credit card cannot continue. The Federal
Government will be borrowing 42 cents of every Federal dollar spent
from this fund. We are facing a $1.6 trillion deficit. The President's
irresponsible budget will double the national debt from $14 trillion to
$26 trillion. This endless spending is fiscally irresponsible and
morally bankrupt. Spending today is debt that our children and
grandchildren will pay tomorrow.
I urge my colleagues to vote ``no'' on the MTR and ``yes'' on the
underlying bill so we can help get our fiscal house back in order.
I yield back the balance of my time.
The SPEAKER pro tempore. Without objection, the previous question is
ordered on the motion to recommit.
There was no objection.
The SPEAKER pro tempore. The question is on the motion to recommit.
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.

Recorded Vote

Mr. LOEBSACK. Madam Speaker, I demand a recorded vote.
A recorded vote was ordered.
The SPEAKER pro tempore. Pursuant to clause 9 of rule XX, the Chair
will reduce to 5 minutes the minimum time for any electronic vote on
the question of passage.
The vote was taken by electronic device, and there were--ayes 189,
noes 234, not voting 9, as follows:

[Roll No. 263]

AYES--189

Ackerman
Altmire
Andrews
Baca
Baldwin
Barrow
Bass (CA)
Becerra
Berkley
Berman
Bishop (GA)
Bishop (NY)
Blumenauer
Boren
Boswell
Brady (PA)
Braley (IA)
Brown (FL)
Butterfield
Capps
Capuano
Cardoza
Carnahan
Carney
Carson (IN)
Castor (FL)
Chandler
Chu
Cicilline
Clarke (MI)
Clarke (NY)
Clay
Cleaver
Clyburn
Cohen
Connolly (VA)
Conyers
Cooper
Costa
Costello
Courtney
Critz
Crowley
Cuellar
Cummings
Davis (CA)
Davis (IL)
DeFazio
DeGette
DeLauro
Deutch
Dicks
Dingell
Doggett
Donnelly (IN)
Doyle
Edwards
Ellison
Engel
Eshoo
Farr
Fattah
Filner
Frank (MA)
Fudge
Garamendi
Gonzalez
Green, Al
Green, Gene
Grijalva
Gutierrez
Hanabusa
Hastings (FL)
Heinrich
Higgins
Himes
Hinchey
Hinojosa
Hirono
Holden
Holt
Honda
Hoyer
Inslee
Israel
Jackson (IL)
Jackson Lee (TX)
Johnson (GA)
Johnson, E. B.
Kaptur
Keating
Kildee
Kind
Kissell
Kucinich
Langevin
Larsen (WA)
Larson (CT)
Lee (CA)
Levin
Lewis (GA)
Lipinski
Loebsack
Lofgren, Zoe
Lowey
Lujan
Lynch
Maloney
Markey
Matheson
Matsui
McCarthy (NY)
McCollum
McDermott
McGovern
McIntyre
McNerney
Michaud
Miller (NC)
Miller, George
Moore
Moran
Murphy (CT)
Nadler
Napolitano
Neal
Olver
Owens
Pallone
Pascrell
Pastor (AZ)

[[Page H2647]]

Payne
Pelosi
Perlmutter
Peters
Peterson
Pingree (ME)
Polis
Price (NC)
Quigley
Rahall
Rangel
Reyes
Richardson
Richmond
Ross (AR)
Rothman (NJ)
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Schakowsky
Schiff
Schrader
Schwartz
Scott (VA)
Scott, David
Serrano
Sewell
Sherman
Shuler
Sires
Smith (WA)
Speier
Stark
Sutton
Thompson (CA)
Thompson (MS)
Tierney
Tonko
Towns
Tsongas
Van Hollen
Velazquez
Visclosky
Walz (MN)
Wasserman Schultz
Waters
Watt
Waxman
Weiner
Welch
Wilson (FL)
Woolsey
Wu
Yarmuth

NOES--234

Adams
Aderholt
Akin
Alexander
Amash
Austria
Bachmann
Bachus
Barletta
Bartlett
Barton (TX)
Bass (NH)
Benishek
Berg
Biggert
Bilbray
Bilirakis
Bishop (UT)
Black
Blackburn
Bonner
Bono Mack
Boustany
Brady (TX)
Brooks
Broun (GA)
Buchanan
Bucshon
Buerkle
Burgess
Burton (IN)
Calvert
Camp
Campbell
Canseco
Cantor
Capito
Carter
Cassidy
Chabot
Chaffetz
Coble
Coffman (CO)
Cole
Conaway
Cravaack
Crawford
Crenshaw
Davis (KY)
Denham
Dent
DesJarlais
Diaz-Balart
Dold
Dreier
Duffy
Duncan (SC)
Duncan (TN)
Ellmers
Emerson
Farenthold
Fincher
Fitzpatrick
Flake
Fleischmann
Fleming
Flores
Forbes
Fortenberry
Foxx
Franks (AZ)
Frelinghuysen
Gallegly
Gardner
Garrett
Gerlach
Gibbs
Gibson
Gingrey (GA)
Gohmert
Goodlatte
Gosar
Gowdy
Granger
Graves (GA)
Graves (MO)
Griffin (AR)
Griffith (VA)
Grimm
Guinta
Guthrie
Hall
Hanna
Harper
Harris
Hartzler
Hastings (WA)
Hayworth
Heck
Heller
Hensarling
Herger
Huelskamp
Huizenga (MI)
Hultgren
Hunter
Hurt
Issa
Jenkins
Johnson (IL)
Johnson (OH)
Johnson, Sam
Jones
Jordan
Kelly
King (IA)
King (NY)
Kingston
Kinzinger (IL)
Kline
Labrador
Lamborn
Lance
Landry
Lankford
Latham
LaTourette
Latta
Lewis (CA)
LoBiondo
Long
Lucas
Luetkemeyer
Lummis
Lungren, Daniel E.
Mack
Manzullo
Marchant
Marino
McCarthy (CA)
McCaul
McClintock
McCotter
McHenry
McKeon
McKinley
McMorris Rodgers
Meehan
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Mulvaney
Murphy (PA)
Myrick
Neugebauer
Noem
Nugent
Nunes
Nunnelee
Olson
Palazzo
Paul
Paulsen
Pearce
Pence
Petri
Pitts
Platts
Poe (TX)
Pompeo
Posey
Price (GA)
Quayle
Reed
Rehberg
Renacci
Ribble
Rigell
Rivera
Roby
Roe (TN)
Rogers (AL)
Rogers (MI)
Rohrabacher
Rokita
Rooney
Ros-Lehtinen
Roskam
Ross (FL)
Runyan
Ryan (WI)
Scalise
Schilling
Schmidt
Schock
Schweikert
Scott (SC)
Scott, Austin
Sensenbrenner
Sessions
Shimkus
Shuster
Simpson
Smith (NE)
Smith (TX)
Southerland
Stearns
Stivers
Stutzman
Sullivan
Terry
Thompson (PA)
Thornberry
Tiberi
Tipton
Turner
Upton
Walberg
Walden
Walsh (IL)
Webster
West
Westmoreland
Whitfield
Wilson (SC)
Wittman
Wolf
Womack
Woodall
Yoder
Young (AK)
Young (FL)
Young (IN)

NOT VOTING--9

Culberson
Giffords
Herrera Beutler
Meeks
Reichert
Rogers (KY)
Royce
Slaughter
Smith (NJ)

{time} 1736

So the motion to recommit was rejected.
The result of the vote was announced as above recorded.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.

Recorded Vote

Mr. PITTS. Madam Speaker, I demand a recorded vote.
A recorded vote was ordered.
The SPEAKER pro tempore. This is a 5-minute vote.
The vote was taken by electronic device, and there were--ayes 236,
noes 183, not voting 13, as follows:

[Roll No. 264]

AYES--236

Adams
Aderholt
Akin
Alexander
Altmire
Amash
Austria
Bachmann
Bachus
Barletta
Bartlett
Bass (NH)
Benishek
Berg
Biggert
Bilbray
Bilirakis
Bishop (UT)
Black
Blackburn
Bonner
Bono Mack
Boren
Boustany
Brady (TX)
Brooks
Broun (GA)
Buchanan
Bucshon
Buerkle
Burgess
Burton (IN)
Calvert
Camp
Campbell
Canseco
Cantor
Capito
Carter
Cassidy
Chabot
Chaffetz
Coble
Coffman (CO)
Cole
Conaway
Cravaack
Crawford
Crenshaw
Davis (KY)
Denham
Dent
DesJarlais
Diaz-Balart
Dold
Dreier
Duffy
Duncan (SC)
Duncan (TN)
Ellmers
Emerson
Farenthold
Fincher
Fitzpatrick
Flake
Fleischmann
Flores
Forbes
Fortenberry
Foxx
Franks (AZ)
Frelinghuysen
Gallegly
Gardner
Garrett
Gerlach
Gibbs
Gibson
Gingrey (GA)
Gohmert
Goodlatte
Gosar
Gowdy
Granger
Graves (GA)
Graves (MO)
Griffin (AR)
Griffith (VA)
Grimm
Guinta
Guthrie
Hall
Hanna
Harper
Harris
Hartzler
Hastings (WA)
Hayworth
Heck
Heller
Hensarling
Herger
Herrera Beutler
Huelskamp
Huizenga (MI)
Hultgren
Hunter
Hurt
Issa
Jenkins
Johnson (IL)
Johnson (OH)
Johnson, Sam
Jones
Jordan
Kelly
King (IA)
King (NY)
Kingston
Kinzinger (IL)
Kline
Labrador
Lamborn
Lance
Landry
Lankford
Latham
LaTourette
Latta
Lewis (CA)
LoBiondo
Long
Lucas
Luetkemeyer
Lummis
Lungren, Daniel E.
Mack
Manzullo
Marchant
Marino
McCarthy (CA)
McCaul
McClintock
McCotter
McHenry
McIntyre
McKeon
McKinley
Meehan
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Mulvaney
Murphy (PA)
Myrick
Neugebauer
Nugent
Nunes
Nunnelee
Olson
Palazzo
Paul
Paulsen
Pearce
Pence
Peterson
Petri
Pitts
Platts
Poe (TX)
Pompeo
Posey
Price (GA)
Quayle
Reed
Rehberg
Renacci
Ribble
Rigell
Rivera
Roby
Roe (TN)
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Rokita
Rooney
Ros-Lehtinen
Roskam
Ross (FL)
Royce
Runyan
Ryan (WI)
Scalise
Schilling
Schmidt
Schock
Schweikert
Scott (SC)
Scott, Austin
Sensenbrenner
Shimkus
Shuster
Simpson
Smith (NE)
Smith (NJ)
Smith (TX)
Southerland
Stearns
Stivers
Stutzman
Terry
Thompson (PA)
Thornberry
Tiberi
Tipton
Turner
Upton
Walberg
Walden
Walsh (IL)
Webster
West
Westmoreland
Whitfield
Wilson (SC)
Wittman
Wolf
Womack
Woodall
Yoder
Young (AK)
Young (FL)
Young (IN)

NOES--183

Ackerman
Andrews
Baca
Baldwin
Barrow
Bass (CA)
Becerra
Berkley
Berman
Bishop (GA)
Bishop (NY)
Blumenauer
Boswell
Brady (PA)
Braley (IA)
Brown (FL)
Butterfield
Capps
Capuano
Cardoza
Carnahan
Carney
Carson (IN)
Castor (FL)
Chandler
Chu
Cicilline
Clarke (MI)
Clarke (NY)
Clay
Cleaver
Clyburn
Cohen
Connolly (VA)
Conyers
Cooper
Costa
Costello
Courtney
Critz
Crowley
Cuellar
Cummings
Davis (CA)
Davis (IL)
DeFazio
DeGette
DeLauro
Deutch
Dicks
Dingell
Doggett
Donnelly (IN)
Doyle
Edwards
Ellison
Engel
Eshoo
Farr
Fattah
Filner
Frank (MA)
Fudge
Garamendi
Gonzalez
Green, Al
Green, Gene
Grijalva
Gutierrez
Hanabusa
Hastings (FL)
Heinrich
Higgins
Himes
Hinchey
Hinojosa
Hirono
Holden
Holt
Hoyer
Inslee
Israel
Jackson (IL)
Jackson Lee (TX)
Johnson (GA)
Johnson, E. B.
Kaptur
Keating
Kildee
Kind
Kissell
Kucinich
Langevin
Larsen (WA)
Larson (CT)
Lee (CA)
Levin
Lewis (GA)
Lipinski
Loebsack
Lofgren, Zoe
Lowey
Lujan
Lynch
Maloney
Markey
Matheson
Matsui
McCarthy (NY)
McCollum
McDermott
McGovern
McNerney
Michaud
Miller (NC)
Miller, George
Moore
Moran
Murphy (CT)
Nadler
Neal
Olver
Owens
Pallone
Pascrell
Pastor (AZ)
Payne
Pelosi
Perlmutter
Peters
Pingree (ME)
Polis
Price (NC)
Quigley
Rahall
Rangel
Reyes
Richardson
Richmond
Ross (AR)
Rothman (NJ)
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Schakowsky
Schiff
Schrader
Schwartz
Scott (VA)
Scott, David
Serrano
Sherman
Shuler
Sires
Slaughter
Smith (WA)
Speier
Stark
Sutton
Thompson (CA)
Thompson (MS)
Tierney
Tonko
Towns
Tsongas
Van Hollen
Velazquez
Visclosky
Walz (MN)
Wasserman Schultz
Waters
Watt
Waxman
Weiner
Welch
Wilson (FL)
Woolsey
Wu
Yarmuth

NOT VOTING--13

Barton (TX)
Culberson
Fleming
Giffords
Honda
McMorris Rodgers
Meeks
Napolitano
Noem
Reichert
Sessions
Sewell
Sullivan

{time} 1743

So the bill was passed.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.

[[Page H2648]]

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