[Congressional Record Volume 157, Number 58 (Tuesday, May 3, 2011)]
[House]
[Pages H2952-H2969]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    REPEALING MANDATORY FUNDING FOR STATE HEALTH INSURANCE EXCHANGES

  The SPEAKER pro tempore. Pursuant to House Resolution 236 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. 1213.

                              {time}  1349


                     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. 1213) to repeal mandatory funding provided to States in the 
Patient Protection and Affordable Care Act to establish American Health 
Benefit Exchanges, with Mr. LaTourette 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 Michigan (Mr. Upton) and the gentleman from New

[[Page H2953]]

Jersey (Mr. Pallone) each will control 30 minutes.
  The Chair recognizes the gentleman from Michigan.
  Mr. UPTON. I yield myself such time as I may consume.
  Mr. Chairman, this bill is part of our effort to restore fiscal 
accountability to the Federal Government. In the rush to pass some 
kind, any kind of health care reform, the 111th Congress enacted a 
massive law, 2,000 and some pages, that gave the Secretary of HHS 
unprecedented new authority.

                              {time}  1350

  Although it got little attention at the time, one of those new powers 
is an unlimited tap on the Federal Treasury.
  Section 1311(a) of PPACA provides the Secretary of HHS a direct 
appropriation of such sums as necessary for grants to states to 
facilitate the purchase of qualified health plans in newly created 
exchanges. Shockingly, the Congress gave an executive branch official 
the sole authority to determine the size of the appropriation. Without 
any further Congressional action, the Secretary can literally spend 
hundreds of billions of dollars at the Department's discretion. The 
only real restriction on this unlimited appropriation is the 
Secretary's imagination. Given Washington's reckless fiscal habits, 
Americans concerned about record spending, deficits, and debt have much 
to fear from section 1311(a) of PPACA.
  This unprecedented tap on the Federal Treasury should never have been 
granted to one individual, and given the huge uncertainty regarding 
PPACA, it certainly should not be continued now. Two Federal district 
courts have struck down the law. State AGs have asked for an expedited 
review of the litigation, but this administration has refused to let it 
happen. As a result, the future of the law remains certainly murky. 
Both supporters and opponents should be able to agree that resolving 
the case expeditiously in the courts, the Supreme Court, is in the best 
interest of the country.
  But, in the interim, we should not be spending billions of dollars, 
billions of dollars of taxpayers' dollars on something that might never 
happen. Repealing the fund will protect precious taxpayer resources at 
a time of record red ink. Rampant spending on the Federal credit card 
is unsustainable and certainly dangerous. And the Federal Government is 
now going to be borrowing 42 cents of every dollar for these grants, 
$58,000 every second. Just think about this. We're facing a $1.6 
trillion deficit, and the President's budgets will nearly double the 
national debt from $14 trillion to $26 trillion.
  This program in PPACA is a prime example of the hidden costs of the 
health care law. While the program itself, remember, was billed as 
costing taxpayers $2 billion, CBO confirmed to us last week that 
repealing the program will reduce the deficit by $14 billion. That's 
because fewer Americans will be pushed into the exchanges, and a 
million more Americans will retain their employer-provided health care 
coverage.
  This bill is about accountability to taxpayers and fiscal 
responsibility in the Congress. I urge my colleagues to support this 
bill that will reduce the deficit by $14 billion.
  At this point, Mr. Chairman, I would ask unanimous consent that all 
of my remaining time be given to Dr. Burgess to manage the bill on the 
floor.
  The CHAIR. Without objection, the gentleman from Texas will control 
the time.
  There was no objection.
  Mr. PALLONE. I yield myself 3 minutes.
  Mr. Chairman, this is just another in the Republican series of 
efforts to try to repeal the Affordable Care Act. I don't need to say, 
but I will say over and over again how effective the Affordable Care 
Act has been.
  We have already put in place most of the anti-discriminatory aspects 
of the Affordable Care Act so that people now can have their children 
up to 26 on their insurance policy. They don't have lifetime or annual 
limits on care. We've ended arbitrary rescissions. We're giving 
patients access to preventive services without cost. We've begun the 
process of filling up the doughnut hole by giving seniors a $250 rebate 
last year, and now a 50 percent discount on the drugs. The list goes on 
and on. People are starting to see the benefits of the Affordable Care 
Act.
  But as you know, over the next few years, until 2014, one of the 
major benefits of it is that we will now cover almost every American; 
32 more million Americans that have no insurance now, with a guaranteed 
good benefits package, lower costs, and help in paying their premiums.
  The fact of the matter is, the Republicans want to eliminate all 
this. And when they talk today about bringing up a bill that would 
eliminate the grants or the funding for the state exchanges, this is at 
the core of the Affordable Care Act because, without effective state 
exchanges, robust state exchanges that are actually tailored, if you 
will, to individual States, it will be more difficult to do the things 
that I mentioned that are the commitment and the promise of the 
Affordable Care Act.
  Now, what I don't understand though is that my colleagues on the 
other side of the aisle have always been advocates for States' rights. 
The consequence of their legislation today if it were to become law 
would mean that States, and 49 States and most of the territories have 
asked for these grants, would be denied these grants to set up the 
State exchanges. Most likely, what will happen then is that, rather 
than have a State exchange which is tailored to their own State and 
their own constituents, they will end up having a Federal or national 
exchange.
  Now frankly, I don't have a problem with that. But if you're a States 
rights advocate, which is what a lot of the Republicans have been 
saying all along, why would you want to force the States to not have 
their own flexibility, not set up their own State exchanges and instead 
set up a Federal exchange?
  The exchanges aren't going to go away with this legislation. It's 
simply going to mean that the States can't do a good job, or that 
they're going to yield that power to the Federal Government and you're 
going to have a national exchange.
  This is the worst time to do this. As we know, States are hurting. 
They don't have money. Most of them have a crisis in terms of balancing 
their budget. Why would you want to deny them the money to set up the 
exchange?
  I'll give you an example in my own State. My own State has applied 
for some of these grants. They are using it to do demographics to find 
out what kind of people they have, what their health care needs are, so 
they can tailor the State exchange in a way that's most effective to 
cover the most Americans and provide them good quality health care at a 
low cost. That's what this is all about.
  And for the Republicans today to bring this bill up in their effort 
to try to repeal the whole package, it absolutely makes no sense 
whatsoever. I just don't understand it.
  They talk about mandatory funding. Well, we have mandatory funding 
for Medicare, for Medicaid, for all kind of things in this Congress. 
All they're going to do with this is make it more difficult for the 
States to establish their own exchange.
  I reserve the balance of my time.
  Mr. BURGESS. Mr. Chairman, I would just remind the gentleman, the 
ranking member from New Jersey, in our committee hearing earlier this 
year we heard from the Governor of Utah who had been setting up a state 
exchange prior to the passage of the Patient Protection and Affordable 
Care Act, and now was left with an uncomfortable situation where it has 
been ruled unconstitutional by two district courts. He's waiting for 
whatever happens in the court system. But as he told us in committee, 
``I'm walking on shifting sands. I no longer know where to go. Passage 
of the Patient Protection and Affordable Care Act has made my life 
infinitely harder.''
  I would now yield 2 minutes to the gentleman from New Jersey (Mr. 
Lance).
  Mr. LANCE. Mr. Chairman, I rise today in support of H.R. 1213. We 
currently have a debt in this country of $14 trillion and it is rising 
rapidly. The annual deficit this year will be $1.65 trillion, the 
largest as a percentage of gross domestic product since 1945.
  Current levels of Federal spending are simply unsustainable. We 
cannot continue on this fiscal path that we have been traveling.
  To this end, the House Energy and Commerce Committee has spent nearly

[[Page H2954]]

the entire portion of its spring session identifying excess and 
unaccounted spending within programs, particularly the President's 
health care bill, in an effort to decrease Federal expenditures, in an 
effort to put our Nation on a path of fiscal responsibility.
  This is one of the legislative fruits of the committee's efforts. 
According to the nonpartisan Congressional Budget Office, passage of 
this bill to repeal the Federal health care insurance exchange funding 
requirements would save American taxpayers $14 billion over the next 10 
years.
  I urge my colleagues here in the House to pass this fiscally 
responsible piece of legislation that takes an important step in 
defunding the health care law and reduces Federal spending and the 
deficit, and I hope that at an early date the Supreme Court will rule 
on the constitutionality of the health care law.

                              {time}  1400

  Mr. PALLONE. Mr. Chairman, I yield 4 minutes to the ranking member of 
our full Energy and Commerce Committee, the gentleman from California 
(Mr. Waxman).
  Mr. WAXMAN. Mr. Chairman, we are not focusing on the big issues that 
the American people care about with this bill. Instead, what we have 
before us is not a bill to increase jobs or to help those lives torn 
apart by the recent natural disaster storms or to address the country's 
high energy costs. Unfortunately, what the Republican leadership offers 
up, once again, is a debate on the Affordable Care Act. This is another 
piece of legislation that is going nowhere. The Senate will never pass 
it, and the President will never sign it. This bill, H.R. 1213, was 
analyzed by the Congressional Budget Office, and the budgetary estimate 
shows this bill diminishes coverage and raises costs. It punishes the 
States, and especially hurts working Americans and their families.
  First, the bill will leave people uninsured. This legislation, 
according to the Congressional Budget Office, will result in lower 
enrollment by an estimated 5 percent to 10 percent below the levels 
expected under current law between 2014 and 2016. In other words, there 
would be almost 2 million fewer people enrolled in State exchanges.
  Second, it will increase the costs to employers as they continue to 
fight off a sluggish economy.
  Third, it will increase costs to consumers through increased premiums 
in the individual market.
  Fourth, without Federal assistance, fewer States would be able to set 
up and operate State-run exchanges. Currently, 49 States, the District 
of Columbia and four territories have gotten beyond the ideological 
debate that we are having over and over again in this House, and they 
have responded by asking for funds so they can do the job of setting up 
a marketplace in which it would be best for families and businesses to 
choose their health insurance.
  Fifth and notably, 85 percent of the total $14 billion in cuts comes 
at the expense of low- and moderate-income Americans who are not able 
to access health insurance through exchanges.
  It is time to stop debating bills that move the country in the wrong 
direction for political reasons. This bill takes a direct shot at the 
heart of health reform and at the new marketplace that marks the end of 
insurance company abuses, and it puts Americans in charge of their 
health care.
  This is the wrong bill at the wrong time. It accomplishes nothing. We 
still don't know what the Republican proposal would be for health care. 
They said they were going to repeal it and then replace it. We don't 
know what they would replace it with. What we do know is that, for 
health care like Medicare and Medicaid, which insure millions of 
Americans, their proposal would be to decimate those two programs. With 
this bill, they would like to be sure, evidently, that States and 
working families don't have access to private insurance and that they 
don't have the ability to choose the best deal for them and their 
families.
  I urge the defeat of this bill.
  Mr. BURGESS. Mr. Chairman, I yield 2 minutes to the subcommittee 
chairman of the Oversight and Investigations Subcommittee, the 
gentleman from Florida (Mr. Stearns).
  (Mr. STEARNS asked and was given permission to revise and extend his 
remarks.)
  Mr. STEARNS. Mr. Chairman, there are two points or arguments that 
I've heard from the other side.
  One, they are talking about States' rights. It's really almost 
pathetic to think that they are arguing on States' rights, because the 
health care bill that they and the administration are advocating forces 
State governments to pay for existing established exchanges. No States 
rights there. That's part of what the Secretary of Health and Human 
Services will do, and she will use this money as an incentive to bribe 
them, which is unlimited to her, to force States to pay for existing 
established exchanges. But once they do it, the money will stop.
  The other point is that they are saying we aren't talking about jobs 
and that we're focusing on this particular bill that's not really 
getting us jobs. Yet this bill does focus on spending. It's limiting 
spending. With the national debt of the United States just increased by 
$262 billion at the start of this year, we need to handle our debt here 
in this country and control spending.
  So I am pleased that we are taking up H.R. 1213, which would 
eliminate uncapped, unlimited programs in the Patient Protection and 
Affordable Care Act, which is ObamaCare. This provision grants far too 
much in budgetary authority to the Secretary of Health and Human 
Services and far too few program requirements to ensure proper 
oversight. That's why we need to pass this bill. This is fiscal 
responsibility. It is fiscally irresponsible to argue, as they say, for 
giving any one in the Administration as an individual unlimited, 
mandatory spending authority, which is what is in ObamaCare.
  I am glad we have an opportunity to correct this legislative error. 
We must gain fiscal control over our government programs, starting with 
these exchanges. Whether it's recapturing wasteful stimulus program 
dollars, eliminating fraud or using the appropriations process to set 
budgetary priorities rather than mandatory spending, we must all 
exercise fiscal restraint, and that is what this bill does. Just 
because we followed Greece into democracy does not mean that we should 
follow them into bankruptcy.
  Mr. PALLONE. I now yield 1\1/2\ minutes to the gentleman from New 
York (Mr. Engel).
  Mr. ENGEL. I thank my friend for yielding to me, and I rise in strong 
opposition to this bill.
  As Ronald Reagan used to say, There you go again.
  And there my Republican colleagues go again.
  We sat through days and days of this in the Health Subcommittee and 
in the Energy and Commerce full committee. This is--I don't know--the 
third or fourth or fifth or sixth bill on the floor which is trying to 
destroy the health care bill. I proudly support the health care bill, 
and I think it's time to stop scaring the American people. This is 
political theater. The Senate is not going to pass this, and the 
President certainly would veto it if it passes. So all we are having 
is, once again, another debate about health care on the House floor 
again and again and again.
  I think my friends on the other side of the aisle have made their 
point. They oppose health care reform. Okay. Fine. How many times do we 
have to vote on it? It would repeal the Affordable Health Care Act, a 
bill which puts the American people back in charge of their health care 
by requiring insurance companies to be more transparent and accountable 
for their costs and actions, thus ending many of the worst abuses by 
the industry and improving the quality of care.
  I urge my colleagues to vote against this bill.
  Mr. BURGESS. Mr. Chairman, I yield 2 minutes to the gentlelady from 
Tennessee (Mrs. Blackburn).
  Mrs. BLACKBURN. Mr. Chairman, I rise in support of the bill because 
this is the right step at the right time. If you're listening to the 
American people, one of the things they have said loud and clear is 
that they do not want the ObamaCare bill on the books. They want this 
repealed.
  When my colleagues ask ``how many times do we have to revisit this 
issue?'' we are going to keep revisiting this issue until we get every 
single piece of this bill off the books, because it is too

[[Page H2955]]

expensive to afford. A great example of this is exactly what we're 
dealing with, which is the little slice of it that gives as much as may 
be needed, as much as may be consumed, as much as the HHS Secretary 
says they will need for this unlimited slush fund to give money to the 
States for these grants.
  Now, I will remind my colleagues from across the aisle that our 
former Democrat Governor has called this program the ``mother of all 
unfunded mandates.'' Mr. Chairman, there is a reason he called this 
program such. It is because he knows that putting this burden onto the 
States is far too expensive for the States to afford. It doesn't make 
it right to set up a slush fund, which will have no congressional 
oversight. The HHS Secretary can spend as much as she thinks is 
necessary, and she does not have to come back to us in Congress for 
this.
  We do not need legislation with this nebulous language, and we do not 
need to give that authority of spending taxpayer money on this to the 
HHS Secretary. It is important that we distinguish: Are we for 
reforming health care? There are portions of health care that need to 
be reformed; but what happened in ObamaCare? PPACA is not health care 
reform. It is a movement away from patient-centered health care to 
government control. It is time for us to get back on the right track.

                              {time}  1410

  Mr. PALLONE. Mr. Chairman, I yield myself 15 seconds.
  I hold the gentlewoman in a lot of respect, but it bothers me that 
you say we are going to come back and keep voting and voting again on 
repeal, repeal, repeal. We know this isn't going to pass the Senate.
  When I went home the last 2 weeks, all I heard was: What are you 
doing to create jobs? Deal with the economy.
  When we deal with this and keep doing the same thing over and over 
again, we don't deal with jobs.
  I yield now 1\1/2\ minutes to the gentlewoman from California (Mrs. 
Capps).
  Mrs. CAPPS. I thank my colleague for yielding.
  Mr. Chairman, I rise in the strongest opposition to this shortsighted 
legislation. We all know that the only reason this bill is before us 
today is to try to derail the Affordable Care Act, which is already 
helping so many. And the exchanges this bill targets will make a clear 
impact, making it easier for individuals and small businesses to shop 
for insurance based on quality and price. They will provide the key 
structure to ensure the numerous consumer protections in the law are 
followed, and they will make the health insurance market both more 
competitive and more transparent.
  Furthermore, the exchange program gives States flexibility to build 
the best plan they can to meet the unique needs of their residents. But 
this bill would defund that, resulting in an unfunded mandate. Forty-
nine States have already received funds to begin this process. Many 
States are poised to move from planning to implementation. However, 
repeal would stop this development in its tracks.
  What is clear is that a vote for this bill does not reduce costs; it 
just shifts them onto the backs of already cash-strapped States. It 
means delays: Delays that CBO has noted will lead to increased costs 
for consumers; delays that will result in 2 million more Americans 
being uninsured through 2015 alone.
  I find it ironic that my Republican colleagues, who for so long have 
called for increasing a State's autonomy, are here to vote down a 
program that does exactly that, especially when their vote will lead to 
increased costs and more Americans being uninsured.
  I urge my colleagues on both sides of the aisle to vote against H.R. 
1213.
  Mr. BURGESS. Mr. Chairman, I yield 2 minutes to a valuable member of 
the committee, the gentleman from Kansas (Mr. Pompeo).
  (Mr. POMPEO asked and was given permission to revise and extend his 
remarks.)
  Mr. POMPEO. Mr. Chairman, I rise today in strong support of H.R. 
1213, a repeal of a mandatory piece of spending inside of ObamaCare 
that will do a great deal to not only destroy health care in America 
but destroy jobs in Kansas and all across our country.
  I spent the last couple weeks back in the district. I was in 
Greenwood and Elk and Chautauqua and Montgomery County, in Butler 
County and Sedgwick County. I heard the ranking member today say he 
wants us to do the people's work. I will tell you that every day I 
heard about people that were frightened by ObamaCare. I talked to 
business leaders that understood that the last thing they wanted to do 
was to hire a full-time employee because of the burdens and obligations 
that would come from this piece of legislation.
  I was proud at the very beginning of my time in Congress to vote to 
repeal the entire bill, and I am equally proud today to attempt to put 
back in the box this mandatory spending provision. This spending 
provision gives, without any oversight, any restraints, the Secretary 
of Health and Human Services powers that are very, very large. I happen 
to have a special perspective on that.
  Today's Secretary of HHS was my Governor for the last 8 years. The 
last thing that we want to do in health care is to give my former 
Governor an unlimited checkbook. We have seen what that has done to 
Kansas. I know what that will do to the United States of America.
  This is very clear. When we talk about health care, what we are 
talking about is trying to find a way to reduce costs. The absolute 
worst thing you can do if you are trying to reduce costs is give the 
government an unlimited checkbook. They will spend it. They will spend 
it every day. They will spend it all the time.
  I urge the strong support of H.R. 1213 so that we can stop this 
horrible piece of mandatory spending.
  Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman 
from Wisconsin (Ms. Baldwin).
  Ms. BALDWIN. I thank the gentleman.
  Mr. Chairman, I rise in opposition to this Republican proposal 
because it will not create jobs, it will not stimulate our struggling 
economy, and it will not put the middle class back to work. Instead, 
the bill that we are considering today would take away funding for 
States to offer new affordable insurance options for their citizens. 
And this bill would lead to job loss, hindering our fragile economic 
recovery.
  Bait and switch--that is what it is called when you say one thing and 
do another, when you run for office promising to create jobs and 
bolster the economy and get elected and start doing something entirely 
different.
  Last election was about jobs and the economy, and Congress should be 
at the forefront. But instead of leading and putting Americans back to 
work, we are considering a bill to repeal funding that will create jobs 
and provide families and small businesses with access to affordable 
health care options.
  Forty-eight States, including my home State of Wisconsin, have 
already received up to $1 million each to get health insurance 
exchanges up and running, including hiring key staff for 
implementation. In other words, this funding is creating jobs.
  This Republican bill raises a very important question: Are we going 
to ask cash-strapped States to return the money they have already been 
awarded? Are we going to prevent these States from receiving further 
funding that will create jobs?
  I fail to see how rescinding these dollars that will be used to 
create jobs is the right thing to do to get our economy back on track, 
and I urge my colleagues to stand up for Americans looking for work and 
looking for affordable health care and vote against this bill.
  Mr. BURGESS. Mr. Chairman, I would just point out that this bill only 
rescinds monies that have not been obligated. Monies that have been 
obligated would not be rescinded.
  I now yield 2 minutes to the gentleman from Iowa, Steve King.
  Mr. KING of Iowa. I thank the gentleman from Texas for yielding, and 
I also thank Dr. Burgess for the leadership role that he has taken 
nationally in opposition to ObamaCare. His voice is essential to this 
and putting this unconstitutional bill behind us one day, taking us 
down the path of liberty and freedom with a constitutional path.
  I rise in strong support for H.R. 1213, Mr. Chairman.
  I would point out that much has been made of $105.5 billion in 
automatic spending that was written into ObamaCare. That is a number 
that was

[[Page H2956]]

kind of like a mirage; it was hard to pin down. Over time and working 
with CRS, we produced, finally, that number: $105.5 billion in 
automatic spending written into a bill that I don't think any Member of 
Congress--in fact, I am certain not a single Member of Congress--was 
aware of that figure when ObamaCare was passed about 13 months ago.
  However, this bill, H.R. 1213, doesn't address that $105.5 billion in 
automatic, irresponsible, unconstitutional spending. It addresses an 
open slot where the drafters of ObamaCare just simply overlooked 
writing a figure in when they granted, there, unlimited authority to 
the Secretary of Health and Human Services, Kathleen Sebelius, to spend 
the amount of money that she sees fit to carry out the provisions of 
this section that are repealed by H.R. 1213.
  It wasn't just a blank check, Mr. Chairman. It is a series of blank 
checks--in fact, an infinite number of blank checks that an infinite 
amount of money could conceivably be written into. That is how bad this 
is. That's how unquantifiable it is. I know that CBO has attempted to 
put a number on it, but it requires some assumptions to even do that.
  The 112th Congress has been bound by the 111th Congress by this term 
we call ``mandatory spending.'' I don't concede that there is anything 
such as mandatory spending in this Congress. No previous Congress can 
bind a subsequent Congress. This Congress has to approve all spending 
of every Federal dollar before it can be expended, and we need to stand 
on that principle, Mr. Chairman, this unlimited and mandatory spending 
that is unconstitutional.
  The CHAIR. The time of the gentleman has expired.
  Mr. BURGESS. I yield the gentleman an additional 30 seconds.
  Mr. KING of Iowa. I thank the gentleman from Texas.
  I would make the point also that the funding that would go to set up 
the State exchanges, we need to be very well aware of what that can be. 
If the States take this free money, so to speak, from this unlimited 
slush fund of Kathleen Sebelius and set up the State exchanges, even 
though they believe they have control of these exchanges, it sets them 
up to be nationalized by a far more powerful Federal Government. And 
even though they oppose ObamaCare, they might be complicit in its 
implementation if they accept this money.
  I urge adoption of H.R. 1213, and I thank the gentleman from Texas.
  Mr. PALLONE. Mr. Chairman, I yield myself 30 seconds.
  I would just like to point out to the gentleman, 49 States and the 
District of Columbia, along with 4 territories, have been awarded $54 
million in planning grants. So all you are doing here--these exchanges 
are still going to exist even if this bill passed and became law. All 
you are doing is taking away the money, in almost every case, from your 
own State to try to set up these exchanges and not have it become a 
national exchange.
  So the gentleman can talk all he wants about the funding, but the 
fact of the matter is it is most likely his own State is asking for 
this funding so they can get these exchanges established. Why do the 
Republicans want to take money away from their own State?
  I yield now 1\1/2\ minutes to the gentlewoman from the Virgin Islands 
(Mrs. Christensen).

                              {time}  1420

  Mrs. CHRISTENSEN. Mr. Chairman, today I rise with great 
disappointment to speak out against yet another attempt to repeal an 
Affordable Care Act provision that is at the very core of increasing 
access to health care for the over 30 million uninsured Americans.
  As my colleague said, almost $54 million in planning grants have been 
awarded to help 49 States, the District of Columbia and four 
territories, including $1 million to the Virgin Islands, to create 
unique State and territorial-based solutions to improve our States' and 
territories' health insurance markets. We must not repeal this funding, 
as H.R. 1213 would do, because by placing the burden entirely on the 
already-overburdened States, it will make it more difficult for them to 
establish changes, and it will increase the costs to families who are 
seeking to insure themselves. This is really another effort to get rid 
of exchanges altogether.
  In deciding how to vote today, I ask my colleagues to think about all 
of their constituents who suffer unduly from health conditions that 
could be prevented or controlled if only they had access to health 
insurance, preventive care, and treatment. These constituents, our 
fellow Americans, demand that we stand up and fight for their access to 
affordable health insurance, as Democrats have always done and are 
doing today.
  I urge all of my colleagues to vote against this legislation that 
would undermine the ability of millions of Americans to have access to 
health insurance and access to needed health care services.
  Mr. BURGESS. Mr. Chairman, I yield myself 1 minute.
  How many times did we hear over the runup to the passage of the 
Patient Protection and Affordable Care Act, If you like what you have, 
you can keep it? It turns out nothing could be further from the truth. 
In fact, the real truth is they don't want you to keep your current 
insurance.
  We have heard Members on the other side of the aisle claim that 2 
million fewer people will be enrolled in the exchange and that the bill 
will increase costs to the employers. So here is some shocking news: 
These assertions that during the health care debate many people said 
repeatedly that under the bill you will not be able to keep your health 
insurance you like, in spite of promises made by the Democrats, people 
were concerned that the new law would encourage employers to drop 
health care coverage for workers.
  In fact, we received some memos to that effect as part of an 
investigation that then-Chairman Waxman actually initiated right after 
the passage of the bill. But then when trying to pass the bill, the 
Democrats repeatedly denied those claims. Now they seem to relish the 
fact that employers will drop coverage, and they actually see it as a 
negative that 1 million people will continue to have employer-sponsored 
insurance, the coverage that they precisely wanted to keep.
  I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, can I inquire how much time remains on 
both sides?
  The CHAIR. The gentleman from New Jersey has 17\3/4\ minutes 
remaining. The gentleman from Texas has 15 minutes.
  Mr. PALLONE. I yield now 2 minutes to the gentleman from Texas (Mr. 
Green).
  Mr. GENE GREEN of Texas. I thank my colleague on the Energy and 
Commerce Committee for yielding to me.
  To follow up what my colleague also from Texas and on Energy and 
Commerce talked about employers dropping insurance, that is why we need 
these insurance exchanges. Even before the Affordable Care Act, 
employers were dropping insurance for their employees or making it cost 
prohibitive for them to cover themselves. So that is why we need the 
exchanges.
  Here they are defunding it today, and H.R. 1213 would repeal the 
section of the Affordable Care Act that provides funding for the 
creation and facilitation of State-based health insurance exchanges. 
Those are not government insurance companies. Those are private sector 
exchanges.
  During the health reform debate, the Republicans spent most of their 
time saying health reform would limit the ability to tailor their own 
health care systems. The Affordable Care Act would ensure States would 
have the ability to create their own health insurance exchanges, meet 
the health care needs of their State, and still provide consistent 
basic health coverage nationally.
  We provided States with planning grants to come up with proposals on 
how they will run their health insurance exchanges so States will run 
their own exchanges rather than the Federal Government doing it. Yet 
here we are today stripping the ability of the States to run their own 
health insurance exchanges by eliminating those planning grants, just 
another example of the hypocrisy of the Republican Party.
  This is yet further political messaging by the Republican majority in 
an attempt to defund health reform. They are playing games with funds

[[Page H2957]]

dedicated to our States, forcing them to spend their own money when 
State budgets are already limited. The majority has the wrong 
priorities, and I think the American people know it.
  Mr. BURGESS. I yield myself 3 minutes.
  Mr. Chairman, States are coming to the realization that there is no 
flexibility in these grants. They are coming to understand that the 
mere words that a State gets to develop an exchange that fits their 
individual needs, in fact, just rings hollow.
  The other side has used the word ``flexibility'' as a big bait-and-
switch, just similar to the words ``if you like what you have, you can 
keep it.'' The authors of the bill praised these words, but they are 
simply not true. The law clearly puts Washington in control, in firm 
control, in absolute control, of these exchanges.
  For example, section 1302, the Secretary will choose the essential 
benefits that must be paid for by individuals and families in the State 
exchange.
  Section 1302 (d)(2), the Secretary will control whether an HSA can be 
offered.
  Section 1311(h), the Secretary can by regulation select the doctors 
and other health professionals that are allowed to provide care in the 
exchange plans. As a physician, I find this one of the more chilling 
provisions in this legislation.
  Section 1311(i), the Secretary--the Secretary--decides whether a plan 
provides linguistically appropriate and culturally sensitive 
information. If they do not meet the Secretary's approval, they cannot 
have that plan.
  Section 1311(c)(1) and section 1311(e), the Secretary--the 
Secretary--determines the process and requirements for certifying 
whether a plan can be sold in the exchange.
  Section 1311(c)(1)(I)(6), the Secretary can decide when individuals 
can enroll in the exchange plan.
  Section 1311(d)(4), the Secretary will judge the adequacy of an 
exchange Internet Web site.
  Section 1311(k), the Secretary will determine whether an exchange 
establishes rules that conflict with or prevent the application of 
regulations promulgated by the Secretary. In other words, not only do 
they get to make the rules; they get to be the referee.
  Concerns were raised prior to the passage of the Patient Protection 
Affordable Care Act that the law was designed, designed, for employers 
to drop coverage so Washington would control health care through 
ObamaCare exchanges. Now the other side protests when 1 million people 
will keep their employer-sponsored insurance because they would rather 
have them under the direct and absolute control of Washington, D.C., 
rather than their State capitals.
  I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield myself 30 seconds.
  Again, I don't understand what Dr. Burgess is trying to say, the 
point he is trying to make. If we don't have this funding under this 
bill, States are not going to be able to choose the type of marketplace 
that is best for their families and businesses. By passing this bill, 
you take away ultimately the States' right to make the decisions about 
what kind of plans they have and how they want to tailor these plans.
  All he is doing with this bill is handing it over to the Federal 
Government, exactly the opposite of what he is saying. What he is 
reading is essentially what is going to happen if there is no State 
exchange and there is a Federal exchange. So why deny the States the 
money, when they can tailor the exchange with those grants?
  I yield now 2 minutes to the gentlewoman from Connecticut (Ms. 
DeLauro), the ranking member on the Labor-HHS appropriations 
subcommittee.
  Ms. DeLAURO. Mr. Chairman, I rise in opposition to this attempt to 
defund one of the central cost-cutting reforms of the Affordable Care 
Act. Like so much in the majority's budget, this bill takes money out 
of families' pockets and gives it to the health insurance industry.
  The exchanges will give all Americans the chance to prosper from what 
Members of Congress and large employers have enjoyed for years: large 
group rates, lower administrative costs, greater transparency. They 
also expand choices, giving everyone access to a much fuller range of 
plans. The exchanges work to create real competition in the health 
industry and thus drive costs down for everyone.
  But my colleagues on the other side of the aisle want to place the 
control again in the hands of the health insurance industry and the 
insurance companies. Given what they are prepared to do in the 
Republican budget by ending Medicare and throwing seniors to the 
private insurance market, this is in the same vein.

                              {time}  1430

  This bill wants to eliminate this free market reform and allow 
insurers to continue to act as monopolies. According to the CBO, the 
Congressional Budget Office, which is independent and nonpartisan, it 
will knock 2 million people out of the exchanges, increase health 
insurance premiums, and leave 50,000 more Americans uninsured. In fact, 
85 percent of the so-called savings here comes from cutting off 
Americans' access to health insurance.
  This is not the direction we want to go. We want to cover more 
people, reduce health care costs. This bill raises premiums; it raises 
the number of uninsured in America. I urge my colleagues to reject it.
  A final point. We in this body are very fortunate. We have health 
insurance. Our kids have health insurance. When we get ill, we go to 
the head of the line, the same as our families. Every single time we 
take to this floor, the majority in this body wants to repeal health 
care reform, wants to take away the opportunity from millions of 
Americans to have the same kind of health care coverage that Members of 
Congress and their families have.
  Mr. BURGESS. I yield myself 1 minute, Mr. Chairman.
  I would remind my colleagues on the other side of the aisle that the 
Governor of Utah coming to our committee hearing said that he was 
setting up exchanges prior to the passage of the Patient Protection and 
Affordable Care Act. The passage of the Patient Protection and 
Affordable Care Act has limited his ability to provide those exchanges. 
In fact, he went so far as to say now, with the nebulous future 
surrounding the Patient Protection and Affordable Care Act, because of 
activity in the courts--not in the United States House of 
Representatives, but in the courts--remember them, the third branch of 
government that gets to decide if something is constitutional or not--
because of the ambiguity surrounding the cases in the courts, the 
Governor of Utah felt that he could not go forward with the plan that 
he was implementing, and he worried that the money he had already 
spent, his own State's money on developing State exchanges, would now 
be for naught. He does not know what the rules will be going forward if 
the Patient Protection and Affordable Care Act is allowed to stand 
because those rules have yet to be written. Those rules have yet to be 
interpreted.
  So in a very perverse way, we have made it harder for a State to 
provide exchanges by passing the Patient Protection and Affordable Care 
Act.
  I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield myself 1 minute.
  I have heard Dr. Burgess talk about Governors. I just want to give 
you some quotes from some Governors--Republican Governors. Nathan Deal, 
a former member of the Energy and Commerce Committee, former chairman 
of the Health Subcommittee, this is what he said with regard to the 
State exchanges and the grants. He says: ``One of the real problems 
that some of us as Governors foresee is if the mandates on States 
remain in place, the funding from the Federal level to carry out those 
mandates is withheld. That's the worst possible condition that States 
could be left in.''
  That is exactly what my colleague from Texas is proposing. The States 
will continue to have the mandate to set up the exchange or, without 
money and therefore not be able to tailor to exchange to the State or 
alternatively letting it go to the Federal Government, having the 
Federal Government run a Federal exchange.
  Nathan Deal, one of our own Members, chairman of the subcommittee, 
said, Worst possible scenario. I don't understand. Again, I keep saying 
the same thing, but I have to repeat it, Mr. Chairman. To say that 
we're going to have State exchanges without having

[[Page H2958]]

the funding means the State exchange will either be lousy, or it simply 
won't exist and the Federal Government takes over.
  I yield now 2 minutes to the gentleman from Michigan (Mr. Levin), the 
ranking member on the Ways and Means Committee.
  (Mr. LEVIN asked and was given permission to revise and extend his 
remarks.)
  Mr. LEVIN. Thank you, Mr. Pallone. Thank you for your efforts.
  I have been listening to the debate here, and the majority, I would 
describe it this way: You're so single-minded about the health care 
reform that you really have become mindless. You come here and talk 
about Federal control, but essentially what this bill would do would be 
to increase it. CBO says, Pass this bill and you will have more Federal 
control--not less--and less State control. It makes no sense. It's 
mindless. And you come here and say there's one governor who says 
something about his exchange. But every State but one has applied for 
and received a grant for their exchange. It's mindless, your position.
  My State has already received the grant, the State of Michigan; and 
they have used it to bring everybody to the table, including private 
industry, including consumers, hospitals, et cetera, to develop a plan 
that's right for our State. It's mindless for you to come here and say 
you want to pass a bill that withdraws from our States the ability to 
plan for the health care for our citizens in a way that is helpful to 
our State. So maybe there will be a mindless ``yes'' vote here. It's 
happened before. Where are the jobs bills?
  Mr. BURGESS. I yield myself such time as I may consume.
  Mr. Chairman, I would not presume to put words into the mouth of the 
Governor of Georgia, but I do know from a long association with him 
that he was very abhorrent of any mandates that were placed on the 
States. So I do not doubt the fact that he said the worst of all 
possible worlds would be to get the mandate and not get anything else 
to help him back that mandate. But to be very clear, the mandates 
themselves are the anathema.
  Why would those mandates be a problem for the Governor of Georgia or 
the Governor of any other State? Because now the decisionmaking does 
not rest with the State. The State is mandated. The State is mandated 
to set up these changes. And yet the Health and Human Services 
Secretary will choose the essential benefits that must be paid for by 
individuals and their families.
  That's no longer a State decision. That's no longer a gubernatorial 
directive. That is now a directive from the Secretary of Health and 
Human Services. They would also decide whether their planned provider 
network is adequate, regardless of whether or not it covers the doctor 
that you use and you like. The Secretary--not the Governor, not the 
Governor's chief of staff, not someone in the State legislature--the 
Secretary of the Department of Health and Human Services, who has that 
now unprecedented power and is only limited by her own imagination.
  The Secretary would impose price controls on health coverage. The 
Secretary would pick who gets a waiver from the annual limit 
requirements. The Secretary would establish cost-sharing requirements 
regardless of their effects on premiums, not a gubernatorial directive, 
not something established by the State Commission of Insurance, not 
something contributed to by the Governor's chief of staff, not 
something decided by any State legislature, but by the Secretary of the 
Department of Health and Human Service.
  Again, Chairman Upton in his opening remarks said the spending would 
only be limited by the imagination, by the limits of the imagination of 
the Secretary of the Department of Health and Human Services. We know 
who that is this year. We don't know who that is next year. We 
certainly do not know who that is in 2 years' time.
  It is the responsibility of this Congress to exercise the due 
oversight over these programs. We abnegated that authority by the 
forward funding of these programs. As Mr. King pointed out in his 
remarks, we abnegated that authority. It's now time for Congress to 
claim that back. That's not mindless. The mindlessness, I might remind 
the Chair, was when this bill was passed a year ago without due proper 
authorization and oversight.
  I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield myself 1 minute.
  Again, I listened to the gentlewoman from Tennessee (Mrs. Blackburn) 
before, and basically she said we're just going to keep repealing and 
repealing and repealing. I understand that you want to get rid of the 
whole bill. But why do you bring up legislation today that, again, I 
guess you're doing it because you don't want to keep repealing the 
whole bill over and over again because it becomes ludicrous. So instead 
you take pieces out--in this case, the State exchanges--and you say 
we're not going to give States the grants to actually follow up.
  It's obvious, when we talked about Nathan Deal, he doesn't like the 
law. He'd like to see it repealed. But he's saying if you're not going 
to repeal it, then don't defund it because then the States can't carry 
out their functions in an effective way.
  So all I'm saying to my colleague from Texas is if you just want to 
keep repealing and repealing, like Mrs. Blackburn said, go ahead and do 
it. We'll waste time, which doesn't make sense. But if you're going to 
then take pieces out, then don't say to the States, We're going to 
defund you and not allow you to do what you're already required to do 
or set this over to the Federal Government.
  You see, this is the absurdity of what the other side of the aisle is 
trying to do. It's just a complete waste of time.
  I yield now 2 minutes to the gentleman from California (Mr. Miller).
  Mr. GEORGE MILLER of California. I thank the gentleman for yielding.
  What is it about the Republican Party that insists that its mandate 
in Washington, D.C. is to keep the American public away from affordable 
health care? First, they start by ending Medicare so that senior 
citizens who retire will have to pay much more for their health care 
than they would otherwise. Those on Medicare, because they'll be closed 
in, an aging population, their health care costs will continue to go up 
in the future far beyond their ability to pay.
  They have decided that they're going to raise the price of 
prescription drugs to senior citizens. They have decided that they're 
going to decrease the access of young people to health care by not 
providing for school-based clinics, health care clinics. They've 
decided they'll roll back preexisting conditions to prevent women from 
getting coverage of health care, young children from getting coverage 
of health care from life-threatening diseases that they were born with.
  What is it about the Republican Party that they don't want people to 
have access to health care in this country that's affordable? They 
don't mind them being in the lottery. If they can find it and afford 
it, maybe they can have it. But if they can't, it's tough.
  So now we come to a time when they said they don't want one-size-
fits-all in Washington. The States should have a right to set up the 
exchanges. The States have an option: they can set up an exchange or 
not set up an exchange. Some 49 States have stepped forward and said, 
We want a right to customize the exchange for the purposes of the 
people we represent, the nature of our State, the economy of our State, 
the age of our State. We want to do this.

                              {time}  1440

  And now they're saying, well, that's good, but we're not going to 
give you any money to plan to do that. So what are they doing, 
according to CBO? They're now threatening, once again, the access to 
affordable health care for 50,000 or more Americans.
  So they've threatened the access to health care for women. They've 
threatened the access to health care for children. They've threatened 
the access to health care for seniors. They've threatened the access to 
health care for those who are about to become seniors. They just can't 
stop doing this.
  The CHAIR. The time of the gentleman has expired.
  Mr. PALLONE. I yield the gentleman an additional 30 seconds.
  Mr. GEORGE MILLER of California. They want to say they're just 
repealing the health care bill that was passed. They're just repealing 
that.
  No, what they are doing is they're standing in the way, the very same

[[Page H2959]]

rights that they have as Members of Congress to have a federally setup 
exchange for Federal employees where policies pass muster, that you get 
real value if you buy one. Whether you buy a health savings account or 
whether you buy a plan for your family or for an individual, you get 
real value. You get access. The rights they have as Members of 
Congress, once again they're stepping into the breach to make sure that 
their constituents won't have that right at the State level because 
when there are no State exchanges, they won't have that right.
  It's a really strange view of their obligations to the American 
public, to working families, to children, and to seniors. And it's a 
real strange view about their position of privilege that they would 
have all of this for themselves but not for their constituents.
  The CHAIR. The time of the gentleman has again expired.


                       Announcement by the Chair

  The CHAIR. The Chair would ask all Members to heed the gavel.
  Mr. BURGESS. Mr. Chairman, I will direct my remarks to the Chair and 
not to anyone in particular, which I believe is one of the habits of 
the House; and I yield myself 1 minute for this purpose.
  I was always taught growing up that if you're going to tell a story, 
you ought to begin it with ``once upon a time.'' I think I should have 
heard a few ``once upon a times'' in that last tirade that was just 
leveled upon the House.
  Their hypocrisy knows no bounds, Mr. Chairman. The other side claims 
that the health care law is about State flexibility, but they oppose 
H.R. 1213 because some States might assess a health plan fee to fund 
the operation of exchanges that the State wants to set up. If you're 
for flexibility, then eliminate complete control that the Secretary has 
over the State exchanges. Let States establish exchanges without 
onerous and costly Federal mandates and finance them according to how 
each State feels is appropriate.
  Now, to talk about hypocrisy, what the other side fails to mention is 
that the Patient Protection and Affordable Care Act advocates taxing 
health care plans that sell insurance in the exchanges. Rather than 
being silent on how States should fund their exchanges once the grant 
money runs out, the Democrat health care bill actually spells out that 
the States should consider charging taxes on health insurance premiums 
for plans sold in the exchange.
  The CHAIR. The time of the gentleman has expired.
  Mr. BURGESS. I yield myself an additional 30 seconds.
  The hypocrisy could be tolerable if it just simply ended there. 
However, the other side also fails to mention that the Patient 
Protection and Affordable Care Act directly charges a $60 billion tax 
on Americans' health insurance premiums, in section 9010, or that 
imposes tens of billions of dollars in direct taxes on medical devices 
and drugs that people will use that will increase their health care 
premiums, according to the CMS actuary.
  I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield 3 minutes to the gentleman from 
California (Mr. Garamendi).
  Mr. GARAMENDI. I thank my friend from New Jersey.
  Mr. Chairman, this is all about creating a mechanism for 
competition--fair, open, fully disclosed competition.
  The exchanges actually come from maybe 20 years ago. I know that in 
California when I was elected insurance commissioner in 1991, we 
established an exchange program. It passed the legislature. 
Unfortunately, Governor Wilson vetoed that legislation. Had it gone 
into place, there would have been a marketplace for insurance 
consumers. Right now consumers are at the whims of the market. They 
have no power.
  An exchange is simply a way to accumulate the purchasing power of 
thousands or hundreds of thousands of individuals and small businesses 
so that their risk is spread out over that large population. Right now 
small businesses and individuals simply are at the mercy of the 
insurance companies. They have no way to spread their risk, and, 
therefore, their rates are exceedingly high, and in many cases it's 
impossible to get insurance.
  For the life of me, I don't understand why the Republicans want to 
repeal the exchanges. I always hear from them competition and free 
market. This is exactly that. This is competition, in which the health 
insurance companies have to compete with a similar policy, four 
different kinds of policies, a very rich one and a very basic one, and 
they have to compete on quality. What's the problem with that? And 
they'll be able to get insurance. Right now they can't. So they're 
going to repeal it. It makes no sense.
  It also makes no sense that the Republicans would go out and 
terminate Medicare. Hello? You're going to terminate Medicare, a 
guaranteed insurance policy for everyone over 65? Oh, I know, only 
those who are below 55 years of age will never see Medicare. It's gone. 
It's history. Oh, you're going to give them a voucher, a small 
percentage of the total cost 10 years out? Good luck. And you throw 
them to the whims of the insurance companies without an exchange.
  What's this all about? I think Congressman Miller may have had it 
right. How do you view the world? People need health care. Insurance is 
a way to get health care. An exchange is a way to spread the risk for a 
large pool of people so the risk isn't there and access to the market.
  California has an exchange. California last year established a law to 
put in place an exchange. It was signed by a Republican Governor, 
folks. Are you listening? Governor Schwarzenegger signed the exchange 
program. It's going into operation in a year and a half so that people 
in California can get insurance. Two million people will not be able to 
get insurance if this bill were to pass. And the only thing you offer 
is the termination of Medicare? Oh, and by the way, you're going to 
reduce Medicaid by $700 billion.
  Mr. BURGESS. Mr. Chairman, I yield myself 1 minute.
  Although the issue of Medicare is not the subject of this debate 
today, I can recall a time about 20 years ago when Paul Tsongas, a 
former Senator, came to Dallas to talk to a group called the Dallas 
Business Group on Health. It was the day after President Clinton had 
come to this House and addressed a joint session of the House and 
Senate and unveiled his health care plan in September of 1993. Senator 
Tsongas came to talk to us in Dallas, and he said, ``It was a beautiful 
speech. There wasn't a dry eye in the house. The only problem was that 
the President proposed five new entitlement programs, and we cannot pay 
for the ones that we have.''

                              {time}  1450

  Former Senator Tsongas then went on to articulate how the rate of 
rise of entitlement spending was going to cripple this country in the 
future such that by at some point between 2015 and 2020 this country 
would see intergenerational conflict the likes of which it had never 
seen before.
  Yes, it is incumbent upon us to recognize that train wreck that is 
coming and deal with it. Representative Ryan put forward a very 
thoughtful plan 2 weeks ago. Let's see the plan from the other side. So 
far that's been lacking.
  I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, may I inquire how much time is remaining?
  The CHAIR. The gentleman from New Jersey has 4\1/4\ minutes 
remaining. The gentleman from Texas has 6\1/2\ minutes remaining.
  Mr. PALLONE. I yield myself the balance of my time.
  Mr. Chairman, I am pleased that my colleague on the other side, Dr. 
Burgess, got up and talked about the Ryan budget, or the Republican 
budget, I should say, because as far as I know every Republican voted 
for it, and most Democrats voted against it, and he also mentioned, I 
think, President Clinton's efforts to achieve health care reform.
  The Democrats over the years--Harry Truman, President Clinton, 
President Obama--have all been reaching out to try to achieve health 
care reform and find a low-cost way of providing a good benefit package 
to all Americans, and it's sad to think that on the other side of the 
aisle, when they became the majority, the first thing they did was to 
pass this Republican budget that actually puts an end to Medicare and 
really jeopardizes the future of Medicaid as well.
  I think it says a lot about the fact that the Democrats are trying to 
expand health care choices and options

[[Page H2960]]

and provide low-cost health care with a good benefit package. The 
Republicans are taking the plans that exist now like Medicare and 
Medicaid and either ending them in the case of Medicare or in the case 
of Medicaid really making it so it's going to be very difficult for 
Medicaid to continue.
  We already have in place, as I mentioned in the beginning of this 
debate, many of the positive aspects of the Affordable Care Act, all 
those things that eliminate discrimination, let you put your children 
on your policy, start to plug up the donut hole for prescription drugs 
for seniors. This is working. This is legislation that's working and 
making a difference for the American people and making it possible now 
with these State exchanges, once they're up and running with the tax 
credits that are available, for even those other 32 or 30 to 40 million 
Americans who don't have health insurance insurance now to finally have 
it.
  Now, why do the Republicans want to eliminate this? I listened to Dr. 
Burgess. He says it costs too much. The fact of the matter is the CBO 
said the Affordable Care Act was going to save money, reduce the 
deficit over 10 years. I know they only like to look at the CBO numbers 
when they think they're beneficial to their point of view, but the fact 
of the matter is the CBO is a nonpartisan arm of this Congress and they 
say that the Affordable Care Act reduces the deficit over 10 years. At 
the same time, we're covering everyone and we're providing a good 
benefit package just like, say, Blue Cross or Blue Shield does today.
  What this bill does is to eliminate choices, because if the States 
are allowed to tailor a program in exchange for their own constituents 
in their State, I believe it will be more robust, it will be a better 
plan tailored to those people from New Jersey, in my case, or Texas, in 
the case of Dr. Burgess. By taking away the money for the exchanges, 
all you're going to do is make that more and more difficult. States 
will still have to do it, but they won't have a good plan. They may 
limit their choices. They may not have a lot of choices which they 
would have if they have some money to plan and be rational about how 
this works.
  Of course, the more likely scenario is that we will simply have a 
Federal exchange and a lot of States will opt out and not even have 
their own State exchange. I think that would be a mistake to do. I 
really do. As much as I'd rather have a Federal exchange than no 
exchange, I do think it makes sense to have State exchanges.
  So, again, I think that what the Republicans are doing now, and I 
think that Mrs. Blackburn said it earlier--she said we're just going to 
repeal this, and we're going to take a piece of it and repeal something 
else until we get rid of the whole thing. Well, don't waste the time of 
the Congress on doing the same thing over and over again. I was home 
for the last 2 weeks. We all had a break. We're at home for 2 weeks. 
All I heard, I didn't hear about health care. I heard about jobs and 
how the economy was starting to sputter again.
  You know, the last quarter was not as good as it could have been, and 
the fact of the matter is that since the Republicans have come into the 
majority here they're not doing anything to create jobs. We don't have 
a bill to create jobs. We keep doing the same thing every day. Today, 
it's going to be defund health care; tomorrow it's going to be abortion 
again. I don't know how many times we're going to have these same bills 
that come out of our Health Subcommittee and the Energy and Commerce 
Committee.
  It is unfortunate. I urge my colleagues to vote ``no'' on this bill.
  The CHAIR. The time of the gentleman has expired.
  Mr. BURGESS. Mr. Chairman, at this point, I would like to yield 4 
minutes to the chairman emeritus of the full committee, the gentleman 
from Texas (Mr. Barton).
  (Mr. BARTON of Texas asked and was given permission to revise and 
extend his remarks.)
  Mr. BARTON of Texas. Thank you, Congressman Burgess, and it's good to 
see you in the Chair there, Mr. Chairman. I feel empowered and 
confident that you're going to make the right rulings as the day goes 
on.
  We're going to have more amendments offered on this small part of the 
repeal effort of the new health care law than the Democratic majority 
allowed in the last Congress on all the health care legislation they 
brought to the floor. After general debate, we're going to have at 
least five amendments that were made in order under the rule. That's 
five more than Speaker Pelosi and then-Rules Committee Chairwoman 
Slaughter made in order in the last Congress when we were debating 
these issues.
  Republicans are not necessarily opposed to the concept of these 
exchanges, Mr. Speaker. What we are opposed to is the process in the 
last Congress where the actual bill that became law was dumped in the 
dead of night, with no amendments made in order, little debate, in an 
up-or-down vote as soon the Speaker twisted enough arms on the then-
majority side of the Democratic party to move the bill.
  So we're trying to repeal it piece by piece; once that's done, then 
to replace it. This particular bill that's before us is pretty 
straightforward. It repeals the authority of the Secretary of Health 
and Human Services to obligate such sums as necessary to fund these 
exchanges. This ``such sums as necessary'' could be $50 million, could 
be $100 million, could be $200 million, could be a half a billion 
dollars. We just don't know. Those of us on the now-majority side, the 
Republican side, think that's bad management: such sums as necessary.
  So we're not really having a debate on whether exchanges are good or 
bad. I can agree with my friend from New Jersey that, in concept, 
exchanges are good. Now, I could have a debate that if you are going to 
have exchanges you ought to let the market operate and determine what's 
offered in the exchanges and not mandate what has to be qualified in 
order to be a part of the exchange. And we could have a debate on what 
the premiums are and what the coverage is and whether you allow 
flexibility or whether you put these Federal mandates on what has to be 
in the health care plan to be part of the exchange, but that's a 
different debate.
  The debate today, Mr. Chairman, is should the Secretary of Health and 
Human Services have the ability to obligate, without any constraints by 
the Congress, such sums as necessary to empower and fund these health 
exchanges. We say ``no.'' So we're going to urge a ``yes'' vote at the 
appropriate time so that we can take away that authority, send this 
bill to the other body, and hopefully have that pass, and then at some 
point in the future bring back a reform bill where we have the policy 
debate which, again, I think you can say that there will be some 
agreement between the majority and the minority side on the underlying 
policy. But on the fact that the Secretary of Health and Human Services 
shouldn't be able to just obligate with no oversight by the Congress 
how much money goes into the creation and maintenance of these 
exchanges, we think the answer to that is, the current Secretary or any 
future Secretary should not have that authority, and that is why we 
have put forward the bill.

                              {time}  1500

  Mr. BURGESS. I urge an ``aye'' vote on the measure.
  Mr. BLUMENAUER. Mr. Chair, I rise in opposition to H.R. 1213, which 
repeals grant programs established in the Affordable Care Act to 
support State efforts to set up health insurance marketplaces. The 
Affordable Care Act calls for these ``exchanges'' to be established by 
January 1, 2014. Under H.R. 1213, fewer States will have the resources 
necessary to create these marketplaces, and in the wake of this 
legislation, fewer people will get help buying insurance. As a result, 
500,000 more people will be uninsured in 2015.
  These exchanges are designed to allow Americans to compare prices and 
health insurance plans and decide which option is right for them. These 
grants are critical to help States develop and begin operation of 
exchanges able to perform these functions. In fact, nearly all States 
have already received grant funding to begin establishing their own 
marketplaces, including my State of Oregon, which will receive $48 
million. The Affordable Care Act establishes these exchanges to 
negotiate prices for a large volume of individuals, securing the kind 
of group discounts that large employers now enjoy. In addition to 
providing consumer protections, the exchanges actually provide for a 
robust private insurance market. This price competition plays a 
critical role in reducing health care costs.

[[Page H2961]]

  Rather than making refinements to improve the law, H.R. 1213 simply 
proposes to eliminate funding. It would not advance the key objectives 
of the Affordable Care Act or offer alternative solutions for meeting 
these important objectives, and this legislation makes it more 
difficult to achieve better and more affordable care.
  Many of the ill-founded criticisms of the Affordable Care Act stem 
from concerns about the country's burden of public debt. While I share 
many of these concerns about our public debt, I cannot condone this 
approach to balancing the nation's books. The Congressional Budget 
Office finds that the vast majority of the bill's $14 billion in 
savings results from reduced spending on premium and cost-sharing for 
low-income people to buy insurance, not from the elimination of the 
$1.9 billion in grants to help set up the exchanges. This legislation 
continues the Republican effort to balance our nation's books on the 
backs of the poor and I oppose this legislation.
  Mr. DINGELL. Mr. Chair, I rise in opposition today to H.R. 1213, 
which would repeal funding available to States to establish health 
insurance Exchanges. Repealing this funding will dramatically hamper 
States' efforts to provide critical access to affordable and high 
quality insurance for the uninsured or underinsured.
  The Exchanges are a vital component to the Affordable Care access in 
that they will help simplify the process of purchasing insurance for 
American families and small businesses.
  For the first time, individuals, families and small business alike 
will be able to shop for their coverage like they would for any other 
product--comparing the benefits, the services and prices side-by-side 
so that they can make a decision about what coverage will best fit 
their needs and their budget. These marketplaces will be transparent 
and competitive.
  It is ironic that my colleagues across the aisle continually claim 
that the States best know the needs and challenges facing their 
population, yet today's legislation would hamstring the ability of 
States to plan and prepare their own exchanges.
  HHS has already made available more than $296 million to 48 States, 
the District of Columbia and four territories to begin this work, and 
my home State of Michigan received more than $999,000 to begin their 
planning.
  This funding will help Michigan determine who will be eligible for 
the Exchange, review the technical components needed to run the 
Exchange, develop a model and structure, as well as begin stakeholder 
discussions on implementation.
  Repealing this funding will not only hurt Michigan's efforts, but 
also the efforts of the other States and territories that have already 
begun planning and building their own marketplace and delaying 
implementation.
  According to CBO, such a delay would prevent almost two million 
people from enrolling in state exchanges, and increase the number of 
uninsured by 500,000 in 2015. Further, CBO found that 85 percent of the 
cuts in H.R. 1213 will come on the backs of low and moderate income 
families through subsidy reductions for the purchase of health 
coverage.
  More importantly, the successes of critical consumer protections that 
make up the Patients Bill of Rights in the Affordable Care Act depend 
on working Exchanges by 2014.
  These reforms will end the worst abuses in the insurance industry:
  Ending discrimination for pre-existing conditions, gender, health 
status or family history;
  Requiring coverage of preventative care services;
  Protecting the patients' choice of doctors;
  Preventing rescissions of coverage as a patient is being wheeled into 
the operating room; and
  Prohibiting arbitrary limits on coverage, among other things.
  If we want the States to be able to pave their own path forward in 
creating a robust and successful exchange designed to help employers 
and consumers to navigate the purchase of health coverage, than we 
cannot vote in favor of defunding these critical grants.
  I urge my colleagues to vote against this attempt to defund the 
Affordable Care Act.
  Mr. STARK. Mr. Chair, I rise in opposition to H.R. 1213, legislation 
being brought forth by my Republican colleagues in the House as another 
step in their ongoing march to undo health reform. Like those that have 
come before it, this bill is going nowhere in the U.S. Senate. Yet, we 
are here wasting taxpayer dollars and government resources debating it.
  This bill would repeal health reform's mandatory funding to states to 
help them establish health insurance exchanges. Exchanges are the new, 
fair marketplaces established in health reform to ensure that people 
have access to quality, affordable health insurance. The law provides 
grants to states to help them develop these new marketplaces which are 
to begin operating on January 1, 2014. CBO estimates that HHS will 
spend $1.9 billion on these grants between 2012 and 2015, after which 
grant monies are no longer available.
  This legislation is the strangest of the repeal bills they've brought 
up so far. In fact, it is downright comical. If this bill were to be 
enacted into law, it would actually create a federal takeover of the 
American health care system--the very thing Republicans campaigned 
against in the last election cycle!
  That's right. This bill would cause states to lose funding to create 
health insurance exchanges. However, a key fact that Republicans fail 
to highlight is that if States don't establish them, the law requires 
the Federal Government to do so. As most States are facing budget 
crises, a lack of Federal funds to develop exchanges would lessen the 
chance that many States move forward with such plans. Therefore, it 
would fall to the Federal Government to take over. That's what CBO 
presumes in their analysis as well.
  So, we have before us today a bill that I predict all House 
Republicans will support that would actually mandate a Federal takeover 
of health care and it's being considered as part of their effort to 
repeal health reform.
  Are you confused? I am too. With this bill before us today, House 
Republicans have officially ``jumped the shark'' with their health 
reform repeal efforts.
  It is disgraceful that we are wasting taxpayer dollars and precious 
time we could use tackling the real issues facing America--like 
creating jobs, withdrawing our troops from Afghanistan, or addressing 
rising gas costs by reducing corporate welfare for the oil industry--in 
order for House Republicans to continue paying lip service to their 
repeal efforts.
  I urge my colleagues to join with me and oppose this Republican bill 
to repeal funding for health insurance exchanges.
  Mr. VAN HOLLEN. Mr. Chair, today we are considering yet another bill 
in the Republican majority's efforts to repeal the Affordable Care Act. 
H.R. 1213 would repeal the funding from the Affordable Care Act for 
States to establish competitive and transparent insurance exchanges.
  This legislation will gut meaningful health insurance reform. A 
critical piece of the Affordable Care Act was to allow States to create 
insurance exchanges that will allow individuals and small businesses to 
comparison shop for affordable and quality health insurance coverage, 
just like what Members of Congress can currently do through the Federal 
Employees Health Benefits Program.
  Many states--including Maryland--have already used Federal funding to 
set up these exchanges. Repealing this funding would have negative 
consequences for States and consumers. According to the non-partisan 
Congressional Budget Office, without Federal assistance, fewer States 
will be able to establish an insurance exchange, and the establishment 
of the exchange, enrollment and operations will be significantly 
delayed.
  Mr. Chair, I urge my colleagues to oppose this misguided legislation.
  Mr. GUTIERREZ. Mr. Chair, this bill would increase both health care 
costs and the number of American families who would be unable to 
purchase health insurance.
  A central pillar of the Patient Protection and Affordable Care Act 
are the flexible, state-based health insurance exchanges that will 
bring greater competition, consumer protection and choice into the 
health insurance marketplace. Exchanges drive down premium costs for 
consumers and small business owners, and will empower all Americans to 
shop for the best available health insurance plan for their families. 
If repealed, half a million Americans who would be covered under the 
current law will find themselves unable to purchase insurance.
  For the record, I strongly oppose H.R. 1213 and any effort to de-fund 
the Health Benefit Exchanges or the Patient Protection and Affordable 
Care Act.
  Mr. BURGESS. I yield back the balance of my time.
  The CHAIR. All time for general debate has expired.
  Pursuant to the rule, the bill shall be considered for amendment 
under the 5-minute rule and shall be considered read.
  The text of the bill is as follows:

                               H.R. 1213

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

     SECTION 1. REPEALING MANDATORY FUNDING TO STATES TO ESTABLISH 
                   AMERICAN HEALTH BENEFIT EXCHANGES.

       (a) In General.--Section 1311(a) of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 13031(a)) is repealed.
       (b) Rescission of Unobligated Funds.--Of the funds made 
     available under such section 1311(a), the unobligated balance 
     is rescinded.

  The CHAIR. No amendment to the bill is in order except those printed 
in House Report 112-70. 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,

[[Page H2962]]

shall not be subject to amendment, and shall not be subject to a demand 
for division of the question.


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

  The CHAIR. It is now in order to consider amendment No. 1 printed in 
House Report 112-70.
  Ms. JACKSON LEE of Texas. Mr. Chairman, I have an amendment at the 
desk.
  The 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 section 
     1311(a) of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18031(a)); and
       (2) the amount of such funds so rescinded.

  The CHAIR. Pursuant to House Resolution 236, 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. Mr. Chairman, listening to the general 
debate, I would have to say that I am concerned and not supportive of 
this legislation and would hope that we would vote against the 
underlying bill.
  But I have an amendment that I believe my colleagues on both sides of 
the aisle would appreciate, and it's very simple. This amendment will 
provide the public with important information about mandatory funding 
to States for health benefit exchanges that will no longer be available 
for the public and small businesses to use in order to obtain 
competitive health coverage for their necessary health care, post the 
moneys that are rescinded, and let the public judge for themselves: 
Good health care or not.
  This particular amendment deals directly with the concern that we 
don't have the ability to move forward on health exchanges that will 
help the vast numbers of Americans. For example, the American health 
benefit exchanges make it easier for small businesses and the public to 
obtain competitive health insurance on the basis of price quality 
rather than to be subject to the abuses of insurance companies who 
would charge exorbitant, prohibitive rates. The health care exchange 
program is a key element of the Affordable Care Act, aimed at providing 
coverage to the uninsured.
  There are 6.2 million residents in my home State of Texas that do not 
have health care insurance. Of the 26 percent of the Texas population 
that is uninsured, 18 percent are children. Insurance exchanges would 
also be available to small businesses with fewer than 100 employees. 
Texas is home to nearly 400,000 small businesses employing less than 
500 people and nearly 2 million self-employed entrepreneurs. Letting 
everyone know that we are making a good dent in the deficit, which we 
can do in many, many other ways, will also show them why I don't have 
good health care. Meaning, why don't small businesses and farmers?
  So at this time, Mr. Chairman, I would ask that my colleagues support 
an amendment that is transparent to let you know what the savings are. 
But what's the question? What's happening to the accelerating rate of 
health care and the sick people who are getting sicker?
  With that, I reserve the balance of my time.
  Mr. BURGESS. Mr. Chairman, I rise in opposition to the amendment.
  The CHAIR. The gentleman from Texas is recognized for 5 minutes.
  Mr. BURGESS. I supported a seemingly similar amendment 3 weeks ago 
when the House considered H.R. 1217, a bill related to the public 
health slush fund in the Patient Protection and Affordable Care Act. 
However, I have to oppose this amendment because, despite the seeming 
similarity of the two amendments, this really is an apples-to-oranges 
comparison. The public health slush fund considered under H.R. 1217 
provided a specified amount in mandatory funding for the Secretary in 
fiscal year 2011 and each year thereafter. In Ms. Jackson Lee's 
amendment 3 weeks ago, it would be possible to determine the amount of 
funds that would be rescinded in fiscal year 2011 if H.R. 1217 had been 
enacted into law. But the amendment offered today by Ms. Jackson Lee 
actually strengthens the arguments in favor of passing H.R. 1213, the 
bill before us today.
  Section 1311 of the Patient Protection and Affordable Care Act 
provided the Secretary with an unlimited amount of money with virtually 
limitless discretion to spend on establishing exchanges or what 
activities could facilitate enrollment in what are known as qualified 
health plans. Giving the Secretary a blank check to spend is an 
abdication of our responsibility here in the House of Representatives. 
This blank check also makes it impossible to implement the Jackson Lee 
amendment. There is no dollar figure for how much the Secretary can 
spend on this program. It is simply an unknown unknown. The Secretary 
could decide tomorrow to spend another $100 million or another $100 
billion. In 2013 the Secretary could take the advice of CMS and funnel 
money into any amount of activities. Congress and, for that matter, the 
general public won't know that until the money is spent.
  I think the gentlelady from Texas has good intentions with her 
amendment. Unfortunately, because Congress decided to leave it entirely 
up to the Secretary of Health and Human Services and the Secretary 
alone to determine the amounts of money that can be spent, the 
amendment does not work in this circumstance. I urge my colleagues to 
oppose the amendment.
  Ms. JACKSON LEE of Texas. I thank the gentleman from Texas. But he 
well knows that we have had mandatory appropriations, and it is not 
difficult to indicate what money you are allegedly saving. So if the 
American public can juxtapose those so-called savings on the backs of 
the elderly, losing Medicare of course, on the backs of sick families 
and sick children, and to see how we can stop the normal primary 
medical care that you would get for children that are in need that 
these health exchanges would provide, and as well neonatal care for 
children who are born prematurely, this is what the Republicans would 
like us to do as we eliminate our health exchanges.
  Frankly, he should look at what has already happened. Forty-nine 
States, including the State of Dr. Burgess and myself, the State of 
Texas, have applied for funding for health exchanges. And so to stop in 
the middle and suggest that you are now impacting the deficit--no, you 
are killing and losing and indicating that you want to close down the 
good health care that we are trying to promote. Insurance exchanges 
would also be available again to small businesses, and Texas is home to 
nearly 400,000 of them. The Kaiser Foundation says 23 percent of the 
Texas population lives in poverty. They would be able to participate in 
these exchanges. I would make the argument that it's good to put how 
much money you are allegedly saving so you can see how much you are 
losing by all the sick people who would not have care.
  I reserve the balance of my time.
  Mr. BURGESS. Again, I would just simply point out that the 
gentlelady's amendment under the legislation that was considered 
previously was appropriate because there were actually funding levels 
that were mentioned in the legislation.
  Now, reading from the Patient Protection and Affordable Care Act here 
in section 4002, under the Prevention and Public Health Fund, in 
paragraph B, which discusses funding: There are hereby authorized to be 
appropriated and appropriated to the fund out of any moneys in the 
Treasury not otherwise appropriated, one, for fiscal year 2010 $500 
million; two, for fiscal year 2011 $750,000, and so on and so forth. In 
other words, the funding is explicit under the previously considered 
legislation.
  Under the legislation today, which is the health benefits exchange, 
here is how the funding language reads: For each fiscal year, the 
Secretary shall determine the total amount that the Secretary will make 
available for each State for grants under this subsection. Well, we 
have no earthly idea. Is that $10, $100, $100 million, $100 billion, 
$13 trillion? We have no earthly idea.
  So while the intent of this amendment in previous legislation was one 
which the majority could accept, in this case, it actually becomes 
meaningless because there is no dollar figure

[[Page H2963]]

specified as the upper limit as to what the Secretary can spend.
  I reserve the balance of my time.
  Ms. JACKSON LEE of Texas. I thank my good friend from Texas, and he 
has made my argument because the Secretary of Health and Human Services 
can explicitly state the funding that might be used. In addition, isn't 
it interesting that this is being repealed on the basis of savings, and 
yet the Republicans can't explain whether there are going to be any 
savings or not.
  At the same time, sick people are going to get sicker. And in my 
State, 444 people out of every 100,000 have cancer. Of the population, 
9.3 percent are diabetic, 32 percent are overweight; and they will not 
be able to have the coverage. I am going to ask my colleagues to vote 
on a sensible amendment. Show us what you are going to save. Let it be 
put on the Web site. Let the American people see it. And explain why 
you would rather put these dollars on while you raise the cost in an 
unbelievable way. And because of the fact that people will not have 
insurance, they will get sicker and sicker and sicker and sicker. God 
forbid if we take out Medicare and all the seniors will wind up being 
sick and lose their lives as well.
  I reserve the balance of my time.

                              {time}  1510

  Mr. BURGESS. I reserve the balance of my time.
  Ms. JACKSON LEE of Texas. Mr. Chairman, let me just say that, if H.R. 
1213 passes, it will severely harm cash-strapped States who cannot 
afford to establish the health benefit exchanges which, by the way, 
will help people of all backgrounds, and particularly our small 
businesses, our farmers and, yes, the children that you've seen on 
these posters.
  I ask my colleagues to support this important amendment. Show your 
cards. If we're saving money, let it be on the Web site, and let us 
compare those savings against the thousands and millions of individuals 
who will be blocked from having health exchange opportunities. While 
some of us will have savings accounts, others will have nothing, 
absolutely zero.
  Vote for the Jackson Lee amendment to really show the cards of what 
happens when you cut out and repeal health care coverage for America.
  Mr. Chairman, I would first like to state my clear position that I am 
adamantly opposed to H.R. 1213 and its Repeal of the Mandatory Funding 
Provided to States to Establish American Health Benefit Exchanges under 
the Affordable Care Act. The funding for American health benefit 
exchanges curbs insurance company abuses, saves lives and saves money.
  If H.R. 1213 to Repeal Mandatory Funding Provided to States to 
Establish American Health Benefit Exchanges Provided under Section 
1311(a) of the Patient Protection and Affordable Care Act is enacted 
into law:


                      i. what my amendment does is

  Requires the Department of Health and Human Services to post public 
notice on its official website that the funds from Section 1311(a) of 
the Patient Protection and Affordable Care Act that will be rescinded 
including the amount of the funds rescinded.
  This amendment will provide the public with important information 
about mandatory funding to States for health benefit exchanges that 
will no longer be available for the public and small businesses to use 
in order to obtain competitive health coverage for their necessary 
health care.
  This amendment also assists my Republican colleagues by permitting 
them to easily and transparently 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.


  ii. purpose of the mandatory funding to states for American health 
   benefit exchanges created under the affordable care act (section 
                  1311(a) 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 and Human 
Services was mandated to provide funding by making Grants to States for 
the purpose of establishing ``American Health Benefit Exchanges,'' so 
to make it easier for small businesses and the public to obtain 
competitive health insurance on the basis of ``Price & Quality'' rather 
than be subject to the abuses of insurance companies who would charge 
exorbitant, prohibitive rates for coverage. This was already a cost 
cutting measure. This is sorely needed insurance reform.
  The health insurance exchange program is a key element of the 
Affordable Care Act aimed at providing coverage to the uninsured. Six 
million two hundred thousand residents in my home state of Texas do not 
have health care coverage. Of the 26 percent of the Texan population 
that is uninsured, 18 percent are children.
  Insurance exchanges would also be available to small businesses with 
fewer than 100 employees. Texas is home to nearly 400,000 small 
businesses employing less than 500 people, and nearly 2 million self-
employed entrepreneurs who would certainly benefit from a health 
insurance exchange.
  According to the Kaiser Family Foundation, 23 percent of Texas' 
population lives in poverty. Health insurance exchange programs would 
provide relief to those living at less than 133 percent of the poverty 
level, about $14,484 dollars annually, by making them eligible for 
Medicaid in all states. More than 30 percent of impoverished Texans 
would be eligible for Medicaid under this provision.
  The Health Benefit Exchange Programs were championed as a means for 
people to get affordable health care and now they are opposing that 
very principle in H.R. 1213.
  If H.R. 1213 passes, it will severely harm cash-strapped states who 
cannot afford to establish the health benefit exchanges on their own.
  The Affordable Care Act requires all State Health Benefit Exchanges 
to be self-sustaining by Year 2015 and no further Federal grants will 
be made to states for health benefit exchanges after January 1, 2015. 
This sounds like the State's rights that my Republican colleagues have 
been championing on this Floor for a very long time in the course of 
debating health care reform. Now, they are opposed to the very State's 
rights contained in the Affordable Care Act that pertain to health 
benefit exchanges.
  This bill takes away the ability of States to provide cost-saving 
health coverage through Health Benefit Exchanges.
  This bill deals a severe blow to America's middle class and small 
businesses who simply seek to obtain affordable health insurance so 
they can do their part to help keep America healthy and contribute to 
our continued national economic growth.
  I urge all of my colleagues to support my amendment to H.R. 1213 to 
facilitate transparency in government spending cuts and notice of 
funding that will no longer be available to them.
  The CHAIR. The time of the gentlewoman has expired.
  The gentleman from Texas has 1\1/2\ minutes remaining.
  Mr. BURGESS. Mr. Chairman, the real travesty here is the fact that 
there is no upper limit on what the Secretary of Health and Human 
Services can spend on the exchanges. It is pointless to put up on the 
Web site how much money has been saved when the actual amount of money 
to be spent equals infinity.
  We are borrowing 42 cents out of every dollar that we spend at the 
Federal level from the Chinese and handing the bill to our children and 
grandchildren. That has to stop. That's what this legislation is about 
today. That is why I urge my colleagues to vote against the Jackson Lee 
amendment and vote for the underlying bill.
  I yield back the balance of my time.
  The CHAIR. The question is on the amendment offered by the 
gentlewoman from Texas (Ms. Jackson Lee).
  The question was taken; and the Chair announced that the noes 
appeared to have it.
  Ms. JACKSON LEE of Texas. Mr. Chairman, I demand a recorded vote.
  The CHAIR. Pursuant to clause 6 of rule XVIII, further proceedings on 
the amendment offered by the gentlewoman from Texas will be postponed.


                 Amendment No. 2 Offered by Ms. Waters

  The CHAIR. It is now in order to consider amendment No. 2 printed in 
House Report 112-70.
  Ms. WATERS. Mr. Chairman, I have an amendment at the desk.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       At the end of section 1, add the following new subsection:
       (c) Report.--Not later than 6 months after the date of the 
     enactment of this Act, the Secretary of Health and Human 
     Services shall submit to Congress a report on the extent to 
     which States are expected to have difficulties establishing 
     Health Benefit Exchanges without Federal assistance repealed 
     and rescinded under subsections (a) and (b).

  The CHAIR. Pursuant to House Resolution 236, the gentlewoman from 
California (Ms. Waters) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from California.

[[Page H2964]]

  Ms. WATERS. Mr. Chairman, my amendment requires the Secretary of 
Health and Human Services to submit to Congress a report on the extent 
to which States are expected to have difficulties establishing health 
benefit exchanges without the Federal assistance repealed by this bill.
  The Affordable Care Act requires the establishment of health benefit 
exchanges in every State. These exchanges will be a marketplace where 
individuals, families, and small businesses can purchase health 
insurance. The exchanges will feature a variety of health plans offered 
by different insurance companies, all of which must offer a 
comprehensive set of essential health benefits at affordable prices. 
The purpose of these exchanges is to enable American consumers to 
compare premiums, out-of-pocket expenses and benefits, and make 
informed choices among competing health plans.
  The Affordable Care Act places an emphasis on State-based health 
reform. The Affordable Care Act allows States to set up their own 
health benefit exchanges and offers grants to States to assist them in 
doing so. A total of 49 States, the District of Columbia, and four 
territories have already applied for these exchange grants. These 
States and territories are working hard to determine what type of 
health insurance marketplace will be best for their families and 
businesses.
  Without Federal funding, some States could have difficulty 
establishing exchanges in a timely manner. This could lead to poor 
management of the exchanges, fewer health plans included on the 
exchanges, and years of delay in getting the exchanges up and running.
  Some States might simply refuse to establish exchanges at all in the 
absence of Federal assistance. This would result in greater costs for 
the Federal Government because the Affordable Care Act requires the 
Federal Government to set up health exchanges in those States that do 
not set up their own exchanges.
  According to the Congressional Budget Office, States that attempt to 
set up health exchanges without Federal funding may face challenges in 
making their exchanges fully operational by 2014, as the law requires. 
These challenges could limit the desirability of the exchanges for 
consumers and reduce the capacity of some exchanges to process 
enrollment. As a result, CBO estimates that by 2015, there will be 
almost 2 million fewer people enrolled in State exchanges.
  Many States are already facing declining revenues and budget 
pressures as a result of the Great Recession. Some States were forced 
to make painful choices, increasing taxes or cutting spending in order 
to make ends meet. Budget pressures have forced States to consider 
closing public health facilities, postpone transportation and 
infrastructure projects, and lay off teachers, law enforcement officers 
and other public employees. If the Federal Government expects States to 
set up health exchanges without any assistance, it will only compound 
their budgetary problems.
  My amendment requires the Secretary of Health and Human Services to 
report to Congress, within 6 months of enactment, on the difficulties 
States will encounter while trying to set up these exchanges without 
Federal help. If Congress is going to deny States the funding that was 
mandated for them to set up their health exchanges, Congress needs to 
know the extent of the difficulties States will face without these 
funds.
  I urge my colleagues to support this amendment.
  I yield back the balance of my time.
  Mr. BURGESS. Mr. Chairman, I rise in opposition to the amendment.
  The CHAIR. The gentleman from Texas is recognized for 5 minutes.
  Mr. BURGESS. I stand in opposition to the Waters amendment because it 
does perpetuate the fallacy that the Patient Protection and Affordable 
Care Act will actually provide affordable health care options.
  We've had this debate for some time, and my colleagues on the other 
side of the aisle have argued that the way to provide an affordable 
coverage option to the uninsured is through a massive 2,700-page law 
authorizing thousands of pages of new regulations. Yet we've learned 
that merely one costly requirement of the many contained in the Patient 
Protection Affordable Care Act has forced the Secretary to issue over 
1,200 waivers.
  Now, Mr. Chairman, I want you to take a minute with me and to 
envision in your mind's eye, I want you to visualize a central planner, 
maybe a very benevolent central planner, but a central planner 
nevertheless, moving data points around on a spreadsheet. That's what 
we're going to have under this.
  Washington will literally impose thousands of new requirements on 
plans that kindly bureaucrats are kind enough to allow poor Americans 
to buy in the Patient Protection and Affordable Care Act's exchanges. 
The only way to make these federally controlled health plans affordable 
is through the massive subsidy contained in the Patient Protection and 
Affordable Care Act. Yet every Member of this body should know that we 
can no longer afford the ``business as usual'' spending binge to which 
my Democrat friends are clearly affixed.
  I also reject the premise of this amendment. Remember, a few moments 
ago when debating the baseline bill, I said, you know, we've given the 
Secretary of Health and Human Services the ability to write all the 
rules of the game and then to function as the referee to interpret the 
rules. That's what we're furthering with this amendment.
  The underlying assumption of this amendment is that the Secretary of 
Health and Human Services should issue a report to judge the benefits 
of the regulations. Oh, by the way, regulations that her own department 
writes. Given the politically charged reports being issued by the 
Department of Health and Human Services since the passage of the 
Patient Protection and Affordable Care Act, we shouldn't pay for 
another taxpayer-financed advertisement for their health care law.
  I urge my colleagues to oppose the Waters amendment.
  I yield back the balance of my time.
  The CHAIR. The question is on the amendment offered by the 
gentlewoman from California (Ms. Waters).
  The question was taken; and the Chair announced that the noes 
appeared to have it.
  Ms. WATERS. Mr. Chairman, I demand a recorded vote.
  The CHAIR. Pursuant to clause 6 of rule XVIII, further proceedings on 
the amendment offered by the gentlewoman from California will be 
postponed.

                              {time}  1520


                 Amendment No. 3 Offered by Mr. Ellison

  The CHAIR. It is now in order to consider amendment No. 3 printed in 
House Report 112-70.
  Mr. ELLISON. I have an amendment at the desk.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Add at the end of section 1 the following new subsection:
       (c) Report.--Not later than 6 months after the date of the 
     enactment of this Act, the Secretary of Health and Human 
     Services shall submit to Congress a report that contains the 
     results of a study on the possible delays and potential 
     enrollment reductions into Health Benefit Exchanges as a 
     result of the repeal and rescission of funds under 
     subsections (a) and (b).

  The CHAIR. Pursuant to House Resolution 236, the gentleman from 
Minnesota (Mr. Ellison) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Minnesota.
  Mr. ELLISON. Mr. Chair, today I rise to offer an amendment to H.R. 
1213, and I rise in opposition to the underlying bill.
  My amendment is very simple. It directs the Secretary of Health and 
Human Services to submit a report to Congress 6 months after the 
enactment of the bill, a report which examines the possible delays and 
potential enrollment reductions in the health care exchanges that will 
result from this bill. Yet, before I dive into my amendment, Mr. Chair, 
let's review just for a moment.
  From the year 2000 to the year 2006, the Republicans controlled the 
House, the Senate and the White House. They controlled all three of 
those institutions at a time when Americans were literally going 
bankrupt because of medical debt. The fact is that the Republicans 
refused to do anything at all to try to help Americans within our

[[Page H2965]]

health care system, which was dysfunctional and broken.
  They did nothing.
  They stood back and watched 60 percent of all bankruptcy filings 
happen as a result of medical debt. They sat back and watched 47 
million uninsured Americans as they faced nothing more than emergency 
rooms as relief. They sat back and watched small businesses either have 
to offer no health care insurance at all or have to stomach enormous 
health care burdens as premiums just galloped along day after day. They 
sat back and watched while auto companies produced vehicles where as 
much as $2,100 per car went to nothing but health care costs.
  This is the Republican Conference that now seeks to try to take away 
what the Democratic Caucus and the United States Congress passed the 
last time. Instead of trying to say ``we're here to do something; we're 
here to offer some solutions,'' all they want to do is to strip away 
from Americans that little bit of protection from the vicissitudes of 
the health care insurance industry that they have been subjected to for 
so many years. Instead of saying ``we're here to help,'' they're here 
to help the insurance companies. That's whose side they're on. It is a 
shame and a disgrace, and I am very, very sad to see this bill on the 
floor today. So what I'd like to do is to offer an amendment, Mr. 
Chairman.
  I offer an amendment to say, if we're going to do this, if we're 
going to take away from the American people these exchanges that are 
going to give them a little bit of relief, let's at least know what 
we're doing. Let's at least figure out what the effects are going to be 
on the American people instead of just snatching out of their hands 
these exchanges that are designed to give them a little bit of relief 
from the health care insurance companies. Let's find out who is going 
to be delayed and what potential enrollment reductions are going to 
exist. Let's figure it out.
  This is an important and a meritorious amendment, and I think the 
least the Republican Conference can do is to say, You know what? If we 
are going to go back to the bad old days, which was before the 
Affordable Care Act was passed, at least we ought to know what harm we 
are going to be doing to the American people.
  So I urge support of this amendment.
  I reserve the balance of my time.
  Mr. BURGESS. Mr. Chairman, I rise in opposition to the Ellison 
amendment.
  The CHAIR. The gentleman from Texas is recognized for 5 minutes.
  Mr. BURGESS. Mr. Chairman, I do feel obligated to point out that the 
insurance companies of this country love the Patient Protection and 
Affordable Care Act. Look what happened to their stock on March 24 of 
2010. It went through the roof. The reason is that they got individual 
mandates, not supported by any Republican I'm aware of. They got 
individual mandates that every man, woman and child in this country now 
has to purchase their products. They were suddenly released from 
creating products that people might actually want, and now you have to 
buy their products because the Federal Government tells you you must, 
and the Internal Revenue Service is going to be the enforcer; but let's 
confine our remarks to the business at hand, which is the Ellison 
amendment.
  The amendment would require the Secretary of Health and Human 
Services to submit a report on the possible delays and potential 
enrollment reductions in health benefit exchanges. Now, here is a bit 
of irony. The reason we need this bill is that the authors were either 
inadvertently providing the Secretary of HHS an unprecedented unlimited 
tap on the Federal Treasury for these grants or they meant to provide 
this blank check to the Secretary. Now the amendment would ask the same 
Secretary to evaluate the impact of taking away their authority to 
spend unlimited money.
  I wonder how they're going to rule on that?
  Not one amendment has been offered this afternoon that would actually 
ask the Secretary to report on how the Secretary is going to spend 
these funds or provide information regarding how much money the 
Secretary actually intends to spend in this section. People should be 
aware that the amendment does not ask for a report on the benefit of 
health insurance exchanges. Rather, the amendment asks the Secretary to 
evaluate only the exchanges contemplated under the Patient Protection 
and Affordable Care Act, which gives the Secretary the authority to 
determine what plans can be sold and what benefits must be offered.
  The Secretary is even given the authority to limit your choices of 
doctors. That's not rhetoric. That's in section 1311(h) of the Patient 
Protection and Affordable Care Act. Some States may want to create 
exchanges that look nothing like the centrally controlled exchanges 
called for in PPACA. Yet this amendment only wants the Secretary to 
report on exchanges that the Secretary is charged with creating. Some 
States may want to create exchanges that actually provide people real 
choices and that actually let people keep their doctors. Some States 
may feel that reforms other than exchanges fit their States better.
  I also oppose the amendment because it is a conflict of interest to 
ask the Secretary to report on whether the Secretary believes that 
unlimited funding and numerous authorities to control the exchanges are 
a bad or a good thing. I also reject the notion that only an exchange 
designed and controlled by Washington, D.C., can reduce the number of 
uninsured.
  I reserve the balance of my time.
  The CHAIR. The gentleman from Minnesota has 2 minutes remaining.
  Mr. ELLISON. Mr. Chair, why all the attacks on the Secretary of 
Health and Human Services? I believe our Secretary of Health and Human 
Services is an honorable person, and there is no basis to attack her 
integrity on the House floor. That again is a disgrace and a very sad 
occasion. This Secretary of Health and Human Services was appointed by 
a duly-elected President, and was confirmed by the Senate. Yet the 
Secretary has to withstand all of these attacks on her integrity.
  The fact is that this is still nothing but a diversion and a 
distraction. This is an attack on the American people's legislation to 
fix this health care system. As the gentleman goes on and on about 
government, look, health insurance companies, which have absolutely no 
accountability except to their stockholders and their highly paid CEOs, 
are denying care, denying treatment, denying doctors. This is the 
tragedy that Americans are living through every single day.
  By the way, to the tune of as many as 52 million people, Americans 
have gone bankrupt, have lost their livelihoods, and have been 
uninsured. What is the gentleman's answer to that? We've heard nothing 
about this--only what's wrong, only blaming government. In this 
democratic Nation, which I am proud of, he attacks our government, the 
American people's government. This again is an abomination and a sad 
thing.
  Let me just say, if the insurance companies love the bill so much, 
why have they lobbied against it to the tune of $14 million a day? I 
remember standing on this House floor, seeing the insurance company 
lobbyists here every day. They spent as much as $14 million a day to 
defeat the Affordable Care Act. This is the bill that, according to the 
gentleman, they love so much. The fact is that that, again, is not 
accurate. It's untrue.
  This is a good amendment. It just adds a little bit of sunshine which 
will help people get into exchanges to get affordable health care 
insurance policies. As that is stripped away and snatched out of their 
hands, Americans will at least know why and the impact of it.
  I yield back the balance of my time.
  The CHAIR. The gentleman from Texas also has 2 minutes remaining.
  Mr. BURGESS. Mr. Chairman, I will direct my remarks to you and will 
try not to make them personal, but I am offended that the previous 
speaker would say that I am attacking the Secretary of Health and Human 
Services. Nothing could be further from the truth.
  The fact of the matter is, Mr. Chairman, that the Patient Protection 
and Affordable Care Act that was pushed through this Congress by then-
Speaker Pelosi and members of the Democratic Caucus gave the Secretary 
of Health and Human Services unprecedented power. With regard to every 
man, woman and child in this country, the most intimate aspects of 
their lives are now controlled by the Secretary of

[[Page H2966]]

Health and Human Services. Further, every time in this law where it 
reads ``and the Secretary shall--'' and I believe there are almost 
2,000 of those phrases--there is a new episode of a Federal rulemaking. 
There are thousands of pages that go in the Federal Register.

                              {time}  1530

  Now, I know most people spend part of their nights reading the 
Federal Register every evening; but for those who don't, these 
regulations are coming at you at an alarming rate.
  Let's be honest about the insurance companies. The insurance 
companies love this bill. They get an individual mandate: you've got to 
buy their product. You have no choice. It is a mandate enforced by the 
Secretary and, oh, by the way, by the Internal Revenue Service.
  Look, this is a bad amendment. Let us defeat this amendment. Support 
the underlying bill.
  I yield back the balance of my time.
  The CHAIR. The question is on the amendment offered by the gentleman 
from Minnesota (Mr. Ellison).
  The question was taken; and the Chair announced that the noes 
appeared to have it.
  Mr. ELLISON. Mr. Chairman, I demand a recorded vote.
  The CHAIR. Pursuant to clause 6 of rule XVIII, further proceedings on 
the amendment offered by the gentleman from Minnesota will be 
postponed.


                 Amendment No. 4 Offered by Mr. Pallone

  The CHAIR. It is now in order to consider amendment No. 4 printed in 
House Report 112-70.
  Mr. PALLONE. Mr. Chairman, I have an amendment at the desk.
  The 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) GAO Report on Impacts That Funding Would Have on States 
     Establishing Exchanges, if Not Repealed and Rescinded.--
       (1) Study.--The Comptroller General of the United States 
     shall conduct a study to determine the impacts that 
     expenditures by States, using the funding made available 
     under subsection (a) of section 1311 of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18031), would 
     have in establishing State-run American Health Benefit 
     Exchanges (as described in subsection (b) of such section) 
     that reflect the marketplace of the specific State (as 
     opposed to State exchanges established and operated by the 
     Federal Government), if such funding were not repealed and 
     rescinded under subsections (a) and (b) of this section. In 
     determining such impacts, the Comptroller General shall at a 
     minimum address--
       (A) whether employers with over 50 employees are permitted 
     in such Exchanges to purchase insurance over time;
       (B) what type financing mechanisms will be used to operate 
     such Exchanges;
       (C) whether such Exchanges will be active negotiators in 
     selecting health plans to obtain the best price and quality 
     for citizens;
       (D) whether States will operate such Exchanges together 
     with one or more other States; and
       (E) whether there will be more than one such Exchange 
     (subsidiary exchanges), each serving a geographically 
     distinct area, in some States.
       (2) Report.--Not later than 1 year after the date 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 paragraph (1).

  The CHAIR. Pursuant to House Resolution 236, the gentleman from New 
Jersey (Mr. Pallone) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from New Jersey.
  Mr. PALLONE. I yield myself 3 minutes.
  Mr. Chairman, my amendment requires the Comptroller General of the 
Government Accountability Office to study the impacts of the exchange 
grants on allowing States to set up State-run exchanges, as opposed to 
having the Federal Government establish and operate the States' 
exchanges.
  Dr. Burgess and I have had a colloquy on this back and forth all 
afternoon, and I know he just mentioned it again. My whole point today 
has been that if we are going to have exchanges, which I know many of 
my Republican colleagues would not want to do, but they are not 
repealing the State exchanges. They are simply saying that they are not 
going to give them any money to proceed.
  I think that is a very shortsighted plan because the fact of the 
matter is that the State exchanges would work best if they had the 
flexibility and they had the money so that they could figure out what 
was the best way to tailor the health care exchange program to their 
needs in their State. My view is that by denying them that money 
through the State grants, we are simply letting the Federal Government 
come in and essentially run the exchange.
  My colleague Mr. Burgess keeps mentioning over and over again, well, 
the Health and Human Services Secretary is going to do this and is 
going to do that. Well, if he doesn't like that, then why in the world 
would he let her do it by saying they are not giving the States the 
money to do their own thing? I mean, if you believe in States' rights, 
if you don't want the Health and Human Services Secretary to control 
the process, then let the States do their thing, and the only way they 
are going to be able to do that is if they get some money to accomplish 
that goal.
  I mentioned my home State of New Jersey has already received some 
money through these grants. They are doing demographic surveys. They 
are trying to find out who the clientele are, what the health concerns 
are of the clientele so that they can make decisions about what kinds 
of plans they would have on the exchanges, what they would offer on the 
exchanges. This is the type of thing that is allowed and encouraged if 
you have State grants. Without the State grants, that won't be 
possible.
  All I'm saying with my amendment is to let us see what the GAO says 
would happen if the Federal Government comes in and runs these 
exchanges rather than the States. I don't think it is going to be a 
good thing by comparison, but I would like the GAO to certainly study 
it.
  I would point out, 49 States, the District of Columbia, and four 
territories have gotten beyond the ideology and have applied for these 
exchange grants. There is almost nobody on either side of the aisle 
that doesn't have their State applying for these grants, because the 
States know that if they are going to set up these exchanges, they 
might as well have the money so they can have the flexibility to do it 
the right way. So all you are doing by repealing these grants is 
pulling the rug out from the States, your own State in almost every 
case, whether you are a Democrat or a Republican.
  I don't want to repeat what Mr. Deal said, now the Governor of 
Georgia, but my colleague from Texas often mentions the Governor of 
Utah, and I just wanted to read a quote from the Governor of Utah.
  The CHAIR. The time of the gentleman has expired.
  Mr. PALLONE. I yield myself an additional 30 seconds, Mr. Chairman.
  Governor Herbert of Utah stated at a recent hearing in the Energy and 
Commerce Committee on March 1--and he was commenting on Governor 
Barbour, who also appeared before the committee--he said: I am not 
saying it is the approach. It is an approach. And I would just echo 
what Governor Barbour said. You know, all States ought to have the 
opportunities to find the solutions to the problem.
  So again, even the Governor of Utah, which Dr. Burgess has mentioned 
many times, has said: I may not like the Affordable Care Act; I may not 
even like exchanges. But if you are going to have exchanges, it 
certainly makes sense for States to operate them and have the money to 
do it in a right way.
  That is what this bill would stop. That is why we need the GAO 
report.
  Mr. BURGESS. Mr. Chairman, I rise in opposition to the Pallone 
amendment.
  The CHAIR. The gentleman from Texas is recognized for 5 minutes.
  Mr. BURGESS. Mr. Chairman, I yield myself 4 minutes.
  The description provided by the author to the Rules Committee states 
that the amendment ``would require the Government Accountability Office 
to report on benefits of funding in setting up State-run exchanges that 
reflect the State's marketplace, as opposed to State exchanges 
established and operated by the Federal Government.''
  That description sounds appealing enough in its own right; but sort 
of like the health care reform law of last year, you have to read the 
amendment to find out what is in it.

[[Page H2967]]

  The amendment does not ask the Government Accountability Office to 
examine the benefits of State-run health insurance exchanges. Rather, 
the amendment asks the GAO to report only the exchanges called for in 
the Patient Protection Affordable Care Act, whose rules and structure 
are dominated by Washington rather than States or individuals.
  The amendment description speaks to ``setting up State-run exchanges 
that reflect the State's marketplace.'' However, talk about State 
flexibility in the Patient Protection and Affordable Care Act is just 
that: it is merely talk.
  I would remind my colleagues about the Golden Rule: He with the gold 
makes the rules.
  So let's once again look at just a few areas where Washington will 
dictate operation and structures of the exchanges.
  For the purposes of comparison, let me use Washington versus Austin, 
the capital of my State.
  So will Washington or Austin choose the essential benefits that must 
be paid for by the individuals and families? Section 1302 of the 
Patient Protection Affordable Care Act says that responsibility is 
Washington's.
  Will Washington or Austin control whether health savings accounts and 
other consumer-driven plans can be offered? Section 1302(d)(2) says 
Washington wins that round.
  What about, will it be Washington or Austin that will select the 
doctors and other health care professionals that are allowed to provide 
care in the exchange plans? Well, section 1311(h) gives that authority 
to Washington, not Austin.
  Washington or Austin to decide if your plan's provider network is 
adequate regardless of whether or not it covers your doctor? Section 
1311(c)(1)(B) gives that authority to Washington, DC.
  Will it be Washington or Austin to decide whether a plan provides 
linguistically appropriate and culturally sensitive information? 
Section 1311(i) gives the nod to Washington.
  Will it be Washington or Austin that determines whether a State plan 
is properly accredited? Well, once again, section 1311(c)(1)(B), 
Washington wins that round also.
  Washington or Austin, who do you think is going to win this one, can 
decide when individuals can enroll in an exchange plan? Section 
1113(c)(1)(I)(6), Washington, DC wins that one.
  Washington or Austin, impose certification and decertification plan 
requirements written by the Department of Health and Human Services? 
Well, that's hardly fair because HHS is in Washington, and, you guessed 
it, Washington wins that round.
  Washington or Austin, who do you think is going to win this one: 
judge the adequacy of an exchange Internet Web site? That's something 
that the States should be able to decide. After all, who knows the 
residents of the State better than Austin in the State of Texas? Well, 
Washington actually wins that round.
  How about this one: Washington or Austin, force State government to 
pay for existing benefit requirements? Well, guess what, Washington, 
not the State. Washington will be the one making that determination.

                              {time}  1540

  Then under section 1321, If the Secretary determines a State has not 
taken the necessary steps, as determined by the Secretary, to meet all 
the requirements set forth by the Secretary, then the Secretary will 
take over the State exchange.
  I think, Mr. Chair, you begin to get the impression that this is not 
State flexibility; this is of and run by Washington, DC.
  I reserve the balance of my time.
  The CHAIR. The gentleman from New Jersey has 1\1/2\ minutes 
remaining.
  Mr. PALLONE. Mr. Chairman, I yield myself such time as I may consume.
  My colleague on the other side, I don't understand. You are saying 
that you want Austin to do it, you want Austin to have the flexibility 
to frame a program that is done best because you think that Austin and 
the State are going to do it best. Well, if that is the case, why in 
the world are you putting this bill on the floor? Because my whole 
point in this amendment is that, by passing this bill, you are simply 
abdicating the right of the State to make a decision and to have the 
flexibility to set up a good program that is tailored to the State. It 
is the exact opposite of what you are saying you want to do.
  If you believe that the Secretary of Health and Human Services in 
Washington is going to make the wrong decision, I don't think she 
would, but if you believe that, then you shouldn't be offering this 
bill, because this bill takes away the flexibility and the power of 
Austin or the States to make the right decisions. It is totally 
contrary to the purpose of what you are trying to accomplish. To me, it 
is mind-boggling.
  Now, I think what you are really trying to do, of course, is just say 
let's forget about the exchanges, let's defund the exchanges, let's get 
rid of the whole Affordable Care Act. Obviously, that would be very 
unfortunate because so many more people are going to be covered at a 
low cost with a good benefit package and all the benefits and the 
antidiscriminatory practices that have already been in place would be 
gotten rid of.
  I would say again, if you are totally opposed to the bill, that is 
one thing. But if you feel strongly that the State exchanges should be 
run by the States, then your legislation today is totally misplaced.
  The CHAIR. The time of the gentleman has expired.


                       Announcement by the Chair

  The CHAIR. The Chair would remind all Members to address their 
remarks to the Chair.
  The gentleman from Texas has 1 minute remaining.
  Mr. BURGESS. I yield myself the balance of my time.
  The Patient Protection and Affordable Care Act, as seductive as the 
title sounds, does not empower the States. In fact, it does just the 
opposite.
  Some States have created or are in the process of creating State 
exchanges that would not meet the requirements set forth by Washington. 
For these and other States that don't believe that Washington knows 
best, I oppose this amendment. I urge my colleagues to oppose the 
amendment. I urge my colleagues to support the underlying bill.
  I yield back the balance of my time.
  The CHAIR. The question is on the amendment offered by the gentleman 
from New Jersey (Mr. Pallone).
  The amendment was rejected.


                  Amendment No. 5 Offered by Mr. Welch

  The CHAIR. It is now in order to consider amendment No. 5 printed in 
House Report 112-70.
  Mr. WELCH. Mr. Chairman, I have an amendment at the desk.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. PRESERVING EXCHANGE GRANTS FOR STATES THAT APPLY 
                   FOR EARLY INNOVATOR GRANTS BEFORE 2012, SUBJECT 
                   TO AVAILABILITY OF APPROPRIATIONS.

       (a) In General.--Section 1311(a) of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18031(a)) is amended--
       (1) in paragraph (1)--
       (A) by striking ``shall be appropriated to the Secretary, 
     out of any moneys in the Treasury not otherwise 
     appropriated'' and inserting ``is authorized to be 
     appropriated'';
       (B) by inserting ``(not to exceed $1,900,000,000)'' after 
     ``an amount''; and
       (C) by inserting ``that apply for an early innovator grant 
     (as described in the January 20, 2011, Department of Health 
     and Human Services funding opportunity announcement) before 
     December 31, 2011,'' after ``States'';
       (2) in paragraph (2), by striking ``available to each 
     State'' inserting ``available, subject to the amounts made 
     available by an appropriations Act pursuant to paragraph (1), 
     to each State described in paragraph (1)'';
       (3) in paragraph (4)(A), by inserting ``, subject to the 
     amounts made available by an appropriations Act pursuant to 
     such paragraph,'' after ``under paragraph (1)''; and
       (4) in paragraph (5), by striking ``provide technical 
     assistance to States'' and inserting ``, subject to the 
     amounts made available by an appropriations Act pursuant to 
     paragraph (1), provide technical assistance to States 
     described in paragraph (1)''.
       (b) Rescission of Unobligated Funds.--Of the funds 
     appropriated under such section 1311(a) before the date of 
     the enactment of this Act, the unobligated balance is 
     rescinded.

  The CHAIR. Pursuant to House Resolution 236, the gentleman from 
Vermont (Mr. Welch) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from Vermont.
  Mr. WELCH. Mr. Chairman, this Congress and the last Congress are at 
odds

[[Page H2968]]

about health care. It is a fundamental question of fundamental 
importance to the people of this country.
  The last Congress passed the Patient Protection and Affordability 
Act. The first act of this Congress, of the House of Representatives, 
was to repeal that act. We have got disagreement about what should be 
done. The House legislation is pending in the Senate, likely to go 
nowhere. This legislation before us today is a further effort to 
unravel the law that was passed by the House, the Senate, and signed by 
the President last year.
  Acknowledging that there is a serious debate within this body about 
the future direction of health care, this amendment would allow for the 
State health exchanges, where there have been applications by 13 States 
for early innovator grants, to go forward. It would exempt from the 
defunding $1.9 billion that would be then subject to appropriations up 
to that amount. It wouldn't guarantee it. It would be subject to 
appropriations. My preference, quite frankly, was to make that 
mandatory, as it was in the original bill, but that was not permitted 
under the rules in order to make this amendment in order.
  The advantage to doing this is it does, and I speak to my friend the 
gentleman from Texas, it allows the local States to be making decisions 
about how best to design their health care. Just to go through some of 
the recitation by the gentleman from Texas, the early innovator grants 
have been awarded to 11 States. Again, it allows them to decide what is 
the best design of these health exchanges. And these States include 
what we might call red States and blue States. It is Kansas and 
Wisconsin. It is Maryland and Massachusetts. It does include Vermont, 
my State, that has taken on responsibility to try to move forward to 
design a health care system that is good for business, good for 
consumers, and good for taxpayers.
  So the fundamental question here is: Do you think that States can be 
a laboratory of experimentation and policy? The States take action. 
They implement a plan according to the design in Boston if it is 
Massachusetts, or Hartford if it is Connecticut, or Tulsa if it is 
Oklahoma, or Montpelier if it is Vermont; and the folks in that State, 
where they have fundamental responsibility for the citizens of that 
State, will be making the decision.
  This allows us to be partners with the States where they take on this 
responsibility. They get some help from the Federal Government to 
implement these health benefit exchanges, and we are allowed, then, to 
basically get the benefit of the Federal system where States make 
decisions and the Federal Government is a partner.
  I reserve the balance of my time.
  Mr. BURGESS. Mr. Chairman, I rise in opposition to the amendment.
  The CHAIR. The gentleman from Texas is recognized for 5 minutes.
  Mr. BURGESS. I yield myself 4 minutes.
  My colleagues on the other side of the aisle have argued that these 
grants encourage flexibility by promoting State control of the 
exchanges. Yet this argument is based on the premise that States can 
actually design the right health care plan for their citizens under the 
Patient Protection and Affordable Care Act. But when you look at the 
law, you understand that this concept is actually not true.
  In reality, the relationship between the States and Washington, the 
States are the servant, not a partner of Washington under this health 
care law. The Secretary of Health and Human Services will control what 
benefits must be bought, must be bought, in an exchange.
  A benevolent central planner, and I underscore the word 
``benevolent,'' but a benevolent central planner will decide whether 
you, your doctor, your nurse, your clinic, your hospital can provide 
care to you through an exchange plan. A regulation writer at the 
Department of Health and Human Services will decide whether or not your 
health savings account complies with their rules.
  Rather than promote local control, the Patient Protection and 
Affordable Care Act's exchanges have only the veneer of providing 
States flexibility, and they certainly rob an individual and they rob 
families of health care choice, even if they are happy with the 
coverage that they currently have.
  The Welch amendment does not authorize a grant program for States to 
establish exchanges, that is exchanges written with a lower case E, 
but, rather, Health Benefit Exchanges, all caps, that are contemplated 
in the Patient Protection and Affordable Care Act.
  Section 1321 of the bill has the title ``State Flexibility in 
Operation and Enforcement of Exchanges,'' but a reading of that section 
shows the title could not be anymore misleading. The section is 
littered with phrases such as ``other requirements the Secretary 
determines appropriate,'' or words such as ``the Secretary determines 
that an electing State has not taken the actions the Secretary 
determines necessary.''
  Section 1311(k), I have referenced that previously, section 1311(k) 
states that ``an exchange may not establish rules that conflict with or 
prevent the application of regulations issued by the Secretary.''

                              {time}  1550

  Mr. Chairman, I am encouraged that the supporter of the amendment 
believes that we should not provide the Secretary with a blank check. 
However, I oppose this amendment because it perpetuates the idea that 
the Federal Government should dictate how States establish exchanges.
  Last year, we were told we need to read the bill to know what is in 
it. Today, I ask those here in this body to ignore the rhetoric and 
actually read the bill. Those who do will clearly see that any 
suggestion that the Patient Protection and Affordable Care Act provides 
States flexibility does not hold up to the words in this 2,700-page 
bill.
  I reserve the balance of my time.
  Mr. WELCH. How much time do I have remaining?
  The CHAIR. The gentleman has 2 minutes remaining.
  Mr. WELCH. Thank you.
  I want to talk a minute about Social Security. You have access to 
Social Security whether you live in Texas or you live in Vermont. It's 
a program that benefits every single citizen of this country. The 
underlying premise of Social Security is that we're all in it together. 
We all pay into the benefit program and we all benefit, whether you're 
rich or whether you're poor. We're all in it together.
  Our amendment acknowledges that this is a stronger and better country 
if all of us have access to affordable health care, whether you live in 
Texas or you live in Vermont. So, yes, it is true that in the Welch 
amendment we maintain that national commitment to all Americans being 
covered and all Americans benefiting by access to health care, which we 
know they need. But what it also does is say that in the implementation 
and in the delivery of health care, driving decisions and authority 
down to the local level will help us be successful. It will allow 
States to show that maybe they have the better way of achieving this 
goal of access to health care for every citizen in the country.
  So, yes, I say to the gentleman from Texas, we do embrace in my 
amendment the concept that every American should have access to 
affordable health care. But what we also do, I say to the gentleman 
from Texas, is acknowledge that States can experiment; that folks at 
the local level may have a better way to make decisions and actually to 
deliver care. And if they design a plan in Texas to do it one way and 
we design a plan to do it in Vermont another way, why not? Why not let 
the States figure out how to make good on this promise to America that 
every one of us can have access to the health care that we need.
  I yield back the balance of my time.
  The CHAIR. The gentleman from Texas has 2 minutes remaining.
  Mr. BURGESS. I thank the chairman.
  I would just say, once again, the flexibility does not exist. It's a 
veneer, it's a falsehood that under this plan the States would maintain 
flexibility. The Secretary determines whether or not the States are 
complying. The Secretary determines whether or not the plans are in 
compliance with what the Secretary thinks is a reasonable plan to be 
offered. If we want to talk about the ability of people to buy 
insurance across State lines, that's an argument that we can and should 
have. I don't

[[Page H2969]]

know why your side rejected that in the debates over the Patient 
Protection and Affordable Care Act. The fact of the matter is, they 
didn't. We are where are. Let's defeat this amendment and support the 
underlying bill.
  I yield back the balance of my time.
  The CHAIR. The question is on the amendment offered by the gentleman 
from Vermont (Mr. Welch).
  The amendment was rejected.
  Mr. BURGESS. Mr. Chairman, I move that the Committee do now rise.
  The motion was agreed to.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Burgess) having assumed the chair, Mr. LaTourette, 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. 1213) to 
repeal mandatory funding provided to States in the Patient Protection 
and Affordable Care Act to establish American Health Benefit Exchanges, 
had come to no resolution thereon.

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