[Congressional Record Volume 157, Number 72 (Tuesday, May 24, 2011)]
[House]
[Pages H3361-H3388]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
REPEALING MANDATORY FUNDING FOR GRADUATE MEDICAL EDUCATION
The SPEAKER pro tempore. Pursuant to House Resolution 269 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. 1216.
{time} 1442
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. 1216) to amend the Public Health Service Act to convert funding
for graduate medical education in qualified teaching health centers
from direct appropriations to an authorization of appropriations, with
Mr. Poe of Texas 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 Kentucky (Mr. Guthrie) and the gentleman from
Texas (Mr. Gene Green) each will control 30 minutes.
The Chair recognizes the gentleman from Kentucky.
Mr. GUTHRIE. I yield myself such time as I may consume.
Mr. Chairman, I rise today in support of H.R. 1216.
The health care bill that was signed into law last year spent over a
trillion dollars and empowered Federal bureaucrats more than it did the
American
[[Page H3362]]
people. As a member of the Energy and Commerce Committee, I have been
working on legislation that takes steps to peel back a few of the many
mandatory programs that were instituted in the health care law and
limit the Federal Government's unprecedented power.
Section 5508 of the health care law authorizes the Health and Human
Services Secretary to award teaching health centers development grants
and appropriates $230 million from 2011 through 2015. H.R. 1216 amends
the Public Health Service Act to convert funding for graduate medical
education in qualified teaching health centers from direct
appropriations to an authorization of appropriations.
This bill is not about the merits of graduate medical education or
teaching health centers.
Everyone agrees that there is a strong need for more primary care
physicians in our health care system, but picking and choosing one
program over another to receive automatic funding is irresponsible.
Making these programs mandatory spending is unfair to all of the other
health care programs that have to compete every year to continue to
receive funds.
For example, as HHS Secretary Kathleen Sebelius said during her
testimony before the House Energy and Commerce Committee earlier this
year, the President's fiscal year 2012 budget eliminates Graduate
Medical Education for Children's Hospitals. While children's hospitals
must go through the regular appropriations process to fight for
funding, teaching health centers will receive automatic appropriations.
We are $14.3 trillion in debt, and our deficit for this year will
approach $1.5 trillion. Congress is making difficult decisions about
which programs to fund and which to reduce. We must prioritize, and I
find it unfair that some programs are completely shielded and do not
have to prove their merit to earn continued funding.
I urge my colleagues to vote ``yes.''
I reserve the balance of my time.
Mr. GENE GREEN of Texas. I yield myself such time as I may consume.
Mr. Chairman, I rise today in strong opposition to H.R. 1216,
legislation to convert mandatory funding authorized under the
Affordable Care Act for Teaching Health Centers to authorized funding.
The Affordable Care Act authorized and appropriated $230 million for
a 5-year payment program to support accredited primary care residency
training operated by community-based entities, including community-
based health centers. This training takes place in community-based
settings such as community health centers.
Research shows that CHC-trained physicians, for example, are more
than twice as likely as their non-CHC-trained counterparts to work in
underserved areas, ensuring that that kind of training takes place,
which is what mandatory spending support for programs does. It will
help strengthen the primary care workforce in underserved areas,
particularly in areas that struggle to recruit and retain a sufficient
workforce.
The Teaching Health Center program supports the training of
individuals who will practice family medicine, internal medicine,
pediatrics, internal medicine pediatrics, obstetrics and gynecology,
psychiatry, general dentistry, pediatric dentistry, and geriatrics--
those disciplines where we're experiencing significant physician
shortages.
It's hypocritical for my Republican colleagues to take away this
funding. They continue to argue that there are not enough physicians to
provide care to people who need them in primary care services. This
program is designed to help address this very problem. But they keep
trying to have it both ways in health reform debate, and this is just
another example.
Today, the majority is going to say they have an obligation to ensure
this program is subject to the appropriations process due to the need
for transparency in our spending process and current budget process.
Let me remind the majority that we're not the only party who's directed
mandatory funding for programs. The majority must have certainly
supported autopilot spending, as Representative Foxx described the
Teaching Health Center program earlier this afternoon, when they passed
the Medicare Modernization Act of 2003, which required mandatory
funding for transitional programs. I suppose at that time, the majority
certainly felt they knew better than the appropriators that the MMA was
a worthy program and deserved mandatory funding, even though they
passed it under the cover of night with a lot of arm-twisting.
I can't understand the opposition, particularly from my Republican
colleagues. They repeatedly and inaccurately complain that we don't do
enough to promote health workforce expansions, and now they're going to
cut funding for the health workforce expansion.
Turning the Health Center program into a discretionary one will make
it challenging for these 11 programs that have already made the
decision to participate in consultation with key stakeholders, like
teaching hospitals and their boards, and based on the expectation that
continued funding will be available. Converting this program to
discretionary funding will also deter other entities from making the
business decision necessary to expand residency training, since funding
over the next few years could be subject to the annual appropriations
fight.
This is yet another political stunt by the majority to attempt to
defund health reform--this, through their playing games with funds
dedicated to ensure that we have physicians in our country.
Several weeks ago, they couldn't stop talking about how Medicaid will
be greatly improved with the Ryan budget because it provides States
with block grants to run their Medicaid programs. How great would it be
to eliminate Medicare by giving seniors vouchers to purchase health
insurance? And this week, we're busy taking away funds to ensure that
we train enough physicians to ensure all Americans have access to
affordable care. Once again, the majority has their own priorities.
Mr. Chairman, I reserve the balance of my time.
Mr. GUTHRIE. Mr. Chairman, I yield 2 minutes to the gentleman from
Pennsylvania (Mr. Pitts), the chairman of the subcommittee.
{time} 1450
Mr. PITTS. I would like to thank the gentleman from Kentucky for his
leadership on this issue.
Section 5508 of PPACA authorizes the Secretary to award grants to
teaching health centers to establish newly accredited or expanded
primary care residency training programs. The new health care law,
PPACA, provides a mandatory appropriation of $230 million for this
purpose for the period from FY 2011 through FY 2015.
You may recall that in the President's fiscal year 2012 budget, he
eliminated funding for training at children's hospitals. Because of
this, I and the ranking member of the Health Subcommittee, the
gentleman from New Jersey (Mr. Pallone) have introduced H.R. 1852, a
bill to reauthorize the Children's Hospitals Graduate Medical Education
program for an additional 5 years at the current funding levels.
While the administration couldn't find money in its budget for
training at children's hospitals, PPACA somehow was able to provide a
direct mandatory appropriation of $230 million for other teaching
health centers, with no further action, input, or approval required by
Congress. And PPACA did this with a number of funds, mandatory
appropriations.
The bill before us today, H.R. 1216, simply converts PPACA's
mandatory appropriations to an authorization, subject to the annual
appropriations process, just like the Children's Hospital GME program,
making it discretionary. Passage of the bill will also save $215
million over 5 years.
I urge support of the bill.
Mr. GENE GREEN of Texas. Mr. Chairman, I yield 2 minutes to my
colleague from the Energy and Commerce Committee, the gentlewoman from
California (Mrs. Capps).
Mrs. CAPPS. I thank my colleague for yielding.
Mr. Chairman, I rise in strong opposition to this reckless bill. I
cannot count the number of times Members on both sides of this aisle
have decried shortages in the primary care workforce of our
communities, and working, often in a bipartisan manner, to develop ways
to increase the primary
[[Page H3363]]
care ranks. Yet today, the next victim in the Republican obsession with
repealing the Affordable Care Act is a program that does deal with
these shortages. It increases our primary care physician ranks, and
trains them with special expertise in serving the community.
The bill before us would defund this program, taking many qualified
Americans out of the primary care workforce before they even have an
opportunity to join it. Moreover, cutting these training programs would
also affect already existing jobs at the 11 community-based entities
that have already expanded their programs to train these new doctors.
Taking away this funding will force possible layoffs and have a
chilling effect on other sites developing this type of program.
Yes, it is paid for through mandatory funding. But that is not
unheard of or even unusual. In fact, the federally funded Graduate
Medical Education program, which has had measured success in
strengthening our health care workforce, is a mandatory spending
program. The program the Republicans are trying to cut today is simply
a complement to this GME program, focused on community-based care and
prevention.
The choice on H.R. 1216 is clear: if you believe that we do not have
a jobs problem and that we have all the doctors we will ever need, then
go ahead and vote for this bill. But if you believe that we need to
create good jobs and the professionals to fill them, that we need more
primary care providers, you must vote against H.R. 1216 and protect
this very important program. We can't have it both ways.
I urge a ``no'' vote.
Mr. GUTHRIE. Mr. Chairman, I yield 4 minutes to my friend from
Tennessee (Mrs. Blackburn).
Mrs. BLACKBURN. I thank the gentleman from Kentucky for his
leadership on this bill.
Mr. Chairman, it is so interesting to me. We had a 2,700-page health
care bill that basically was a government takeover of health care. What
we have heard from so many people in this country is gosh, you know, I
wish somebody would have read that bill before they passed it. And the
former Speaker said we need to pass the bill, and then we can read it
and find out what is in it.
One of the things that many of the people did not like that was in
that bill was many of these mandatory provisions that were put in
place, programs that had been on the books for years that were
discretionary programs that all of a sudden became mandatory. And the
confusing thing, Mr. Chairman, is there didn't seem to be any
consistency. As the subcommittee chairman who spoke before me had said,
Mr. Pitts had said, you know, you don't tend to children's hospitals in
the same way, you don't tend to nurses and technicians in the same way.
But here was this conversion from discretionary to mandatory for
teaching hospitals, a total of $230 million, over $40 million a year.
Now, it doesn't matter if you need the money or not. It doesn't
matter if you know exactly where you are going to use it or not. The
money is going to be appropriated. It's put on autopilot. Doesn't
matter what we say is going to happen with the government, if we need
to reduce it. They're going to get that money. That is why this bill is
so important.
You will notice, Mr. Chairman, that 2,700-page bill, we are able to
delete $230 million of that appropriation, mandatory appropriation with
a bill that basically is about 2 pages long. What we do in this 2 pages
is responsibly address what the American people want to see us address.
They know that the Federal mandates are costing private sector jobs.
They know that the Federal Government coming in and taking over health
care is costing private sector health care jobs. Indeed, we have study
after study that is saying we have already lost over a million jobs.
It seems like every time we turn around, whether it is our health
care delivery systems, whether it is our hospitals, whether it is our
physicians' offices, we are hearing about the loss of jobs to health
care providers and in the health care sector because of the passage of
PPACA, or ObamaCare, as many people in our country refer to the bill.
One of the reasons we have to go about repealing these slush funds,
Mr. Chairman, is because we simply can't afford this. Every second of
every day, every single second of every single day we are borrowing
$40,000. We are borrowing 41 cents of every single dollar that we
spend. This government is so overspent, we are spending money we don't
have for programs that our constituents don't want. And instead of
eliminating, what we are saying is, look, let's eliminate a mandatory
program and turn it back to what it was for years, discretionary, so
that Members of this body bring their discretion to bear on the issues
of the day and bring the opinions of their constituents to bear on how
this Chamber spends the taxpayers' money.
Mr. Chairman, it is not Federal money; it is the taxpayers' money.
This government is overspent. We cannot afford all these Federal
mandates. It is time to move these programs back to the discretion of
this Chamber.
Mr. GENE GREEN of Texas. Mr. Chairman, I gladly yield 3 minutes to
our ranking member of the full Energy and Commerce Committee, the
gentleman from California (Mr. Waxman).
Mr. WAXMAN. Mr. Chairman, there was so much misinformation just given
out by the previous speaker that it's hard to know where to start. The
Republicans have said they don't like the Affordable Care Act. But what
do they have to replace it with? They said they're going to repeal it
and replace it. What are they going to do about the uninsured in this
country, about the high cost of health care, about the people who can't
even buy insurance even if they have the money because they have
preexisting medical conditions?
We have had no proposal from the Republicans, except in their budget
they want to take Medicare away from future seniors by making it a
block grant. And they want to cut the Medicaid program, which cuts a
big hole in the safety net for the poor to get their health care needs,
which means people in nursing homes would be dumped out of those
nursing homes.
{time} 1500
But the bill before us now is to stop the program that would train
primary care physicians. Does anybody disagree with the notion that we
need more primary care physicians? Evidently, the Republicans do
because as we heard from the last speaker, she wants to make it an
appropriated program, not a mandatory spending program.
Well, it's been in the mandatory program in spending in Medicare and
Medicaid since 1965. Training physicians should be supported with
assured funding that we could rely on. We can't train a doctor in just
1 year. Doctors need a number of years where they are going to be
assured of their continuation in medical schools, and that's why we
have had a short funding through Medicare and Medicaid. And in the The
Affordable Care Act, the purpose was to train physicians for primary
care in community settings.
That's what the Republicans want to repeal. And if they can afford it
from one year to the next, they will put in funds; but if they can't
and their mood is to give another tax break to the wealthy, we won't be
able to afford it. With all the costs to go to medical school and all
the loans that are required, we ought to ensure spending for primary
care doctors.
I urge my colleagues to oppose this bill. It's incomprehensible to me
why we even have it on the House floor. It's another one of those
efforts that Republicans have been putting up to chip away at health
care reform. They want to repeal it, they want to chip away at it, but
we don't even know what they want to replace it with.
And the American people and our constituents are entitled to know,
are they just going to leave people on their own without the ability to
buy health insurance because of preexisting conditions? Are they going
to tell the elderly they are on their own and see who they want to
insure them?
I urge a ``no'' vote on this bill.
Mr. GUTHRIE. Mr. Chairman, I yield myself such time as I may consume.
First there were a number of amendments, I think over 100 amendments,
to the health care bill that were offered by the Republicans. An
alternative was offered by the Republicans as voted on as we went
forward.
Block grants, several Governors have come to Washington and talked
about
[[Page H3364]]
block granting Medicaid to give them the opportunity to not just deal
with Medicaid in their States but there was the other part of their
budget.
But I can tell in Kentucky, because I used to be a member of the
State legislature, as Medicaid has continued to consume more of the
State budget, it becomes more difficult to adequately fund. Higher
education tuition rates are going up directly because of the pie of
Medicaid that's moving forward.
We passed medical liability reform, which saves the Federal
Government $54 billion, as estimated by the Congressional Budget
Office. We are going to have the bill tomorrow to purchase health
insurance across State lines to make health insurance more affordable
instead of more expensive on those who spend money out of their own
pocket, as we have seen the estimates for the health care bill.
Now, the one thing about relying on funding for 1 year, we do
appropriations for everything from defense to other things on an annual
basis. And I will tell you there are not people turning down Federal
money because you are only appropriating it for 1 year, we don't want
to commit to a long-term program.
But if you buy that argument, you look at what's in the bill. All we
are saying is we want the teaching health centers to be treated equally
to other parts of the bill. So if the argument is if you don't do it
automatically, you are not going to have anybody participating in the
program, which I think is what I just heard, then it means training in
general in pediatric and public health dentistry, section 5303, is an
annual appropriation; geriatric education and training, mental and
behavioral health education training; nurse retention, section 5309;
section 5316, family nurse practitioner training; section 2821,
epidemiology laboratory capacity grants; research and treatment for
pain care management, 4305; section 775 investment in tomorrow's
pediatric health care workforce.
I mean, obviously, the argument that was made was if we don't have
the teaching health centers on a 5-year automatic appropriation, then
people aren't going to participate in the program. That argument would
have to apply to these directly. And I guarantee you, I would be
willing to say, without fear of contradiction, that people will be
applying for these programs as this moves forward.
I reserve the balance of my time.
Mr. GENE GREEN of Texas. Mr. Chairman, I yield 2 minutes to a
classmate and also the vice chair of our Democratic Caucus, the
gentleman from California (Mr. Becerra).
Mr. BECERRA. I thank the gentleman from Texas for yielding me the
time.
Mr. Chairman, to put everything in perspective, we are told by the
American Academy of Family Physicians that today, today we can foresee
a shortage of some 40,000 primary care physicians in this country in
less than 10 years. Within another 5 years, that shortage will grow to
about 42,000 to 46,000 primary care physicians.
Graduate medical education funds does something very simple. It says
to some of these clinics, some of these health care providers, that if
you guarantee that you will make graduate medical training available to
our future doctors, then we will guarantee that there will be money
behind that training so that there will be a consistency so that
medical students can finish training.
Well, we just heard that this money that's available to these health
care providers, these clinics, should no longer be guaranteed. And so
the question you have to ask, if you want to become a physician and you
are going to medical training, and certainly the question you have to
ask if you are one of these clinics throughout the entire country where
you want to train someone to be a family medical doctor, an internist,
a pediatrician, an obstetrician/gynecologist, a psychiatrist, a
dentist, a pediatric dentist, someone who specializes in gerontology,
you have to ask yourself, if I am going to try to train someone, but I
don't have the resources to fully provide the education, how do I
guarantee that medical student that I could be there with the funds to
pay them for education, to pay them for the work they are going to be
doing? You can't. And that's why GME is so important.
But we were just told a second ago that this is a slush fund pot of
money. Furthest thing from the truth. We are told the real truth, when
we heard one of the speakers on the Republican side say we are going to
delete this money--that's exactly what's going to happen, because if
you don't guarantee it, it's gone.
So, Mr. Chairman, the truth is we have to make sure we can train the
next generation of medical leaders; and, therefore, I urge my
colleagues to vote against this legislation.
Mr. GUTHRIE. Mr. Chairman, I yield myself 1 minute.
The merits of having training in general in pediatric and public
health dentistry, I agree that we have to have that training. The issue
here is if you do it in a teaching health center, then you guarantee
funding for 5 years. If you do it in a children's hospital, if you do
it in a regular hospital, profit or nonprofit, then you are subject to
the annual appropriations.
Someone came before our committee to testify, a State Senator from
New Jersey, said we need this provision because we need more nurses.
I will agree with that. However, this provision doesn't cover nurses.
If you are going through a nurse training program, it's authorized in
the bill, and you go through an annual appropriations process.
All we are saying here is that we should treat graduate medical
education at children's hospitals, hospitals and teaching health
centers exactly the same and not give one an advantage over the other
two.
I reserve the balance of my time.
Mr. GENE GREEN of Texas. Mr. Chairman, I yield myself 15 seconds.
I will be glad to cosponsor the bill to make it mandatory funding for
children's hospitals. I think if health care is a priority, we ought to
do that.
I reserve the balance of my time.
Mr. GUTHRIE. Mr. Chairman, I have no further requests for time, and I
reserve the balance of my time.
Mr. GENE GREEN of Texas. Mr. Chairman, how much time remains on each
side?
The CHAIR. The gentleman from Texas has 19\1/4\ minutes remaining,
and the gentleman from Kentucky has 18\1/2\ minutes remaining.
Mr. GENE GREEN of Texas. I yield myself such time as I may consume.
When Congress dealt with The Affordable Care Act last year and the
year before, our subcommittee on Energy and Commerce spent exhaustive
hearings, late-night hearings, we had markups overnight, and so we knew
what we were doing. We knew we were going to make a priority in
providing primary care for our country.
That's why it's mandatory spending. I would assume in 2003, when we
passed the provision for the prescription drug act for Medicare, my
Republican colleagues did the same thing at the time in the majority:
they wanted to make sure that that was mandatory spending.
{time} 1510
And here we are today trying to take away mandatory spending from
primary care physicians in community-based settings. I have a great
example of this in our own district, and I know the chairman knows
this.
We have a community-based health center in Denver Harbor in east
Harris County. They have had a partnership with the Baylor College of
Medicine for a number of years, and what they have been able to do is
provide those residencies to come out to a nonwealthy area of town so
those doctors can learn that they can make a living serving folks that
are not wealthy. That's what this is all about. We found out that the
statistics showed that if they do their residency through a community-
based health center, they will actually be more likely to come back and
serve those communities. And that's why there needs to be mandatory
spending, Mr. Chairman.
I reserve the balance of my time.
Mr. GUTHRIE. Mr. Chairman, I yield 2 minutes to the gentleman from
California (Mr. Bilbray).
Mr. BILBRAY. Mr. Chairman, I wasn't planning on addressing this item,
but I heard so many of my colleagues, especially those on the other
side, talk about the crisis of providing the doctors that are going to
be essential for health care, and finally we are talking about health
care, not health care insurance.
[[Page H3365]]
As somebody who spent 10 years supervising the safety net for a
community of 3 million in San Diego County, I just wish my colleagues
on the other side, when they're worried about pediatricians and primary
health care people, would understand that if you really want to protect
those providers, why don't we sit down and talk about true tort reform,
especially for the pediatricians. This is a cost that is bearing down.
And when you're asking young people to get an education to be a primary
health care provider, especially a pediatrician, explain to them why
somebody on public assistance, on welfare, has more right to sue their
physician than those men and women who are serving in uniform.
The fact is there is no way that we should be sitting up here saying
that we really want the next generation to get into health care unless
we're willing to tell our friends who are the trial lawyers that we're
going to take the physicians off the counter; we're not going to allow
lawsuits to be part of the overhead that is driving people out of the
health care business.
And I hope to say to both sides, if you really want to make sure
there are future doctors, then let's have the bravery to stand up today
and do something about the tort that those future doctors are looking
at before they go into school.
Mr. GENE GREEN of Texas. Mr. Chairman, I yield myself as much time as
I may consume.
My colleague from California must have this bill confused with
medical malpractice. In fact, the State of California and the State of
Texas already have medical malpractice reform. That's not what this
bill is about. This bill is about training primary care physicians to
be able to serve everyone. I want them to serve the military. I want
them to serve our veterans.
In fact, again, I have a VA hospital in Houston that has a
cooperative arrangement with the Baylor College of Medicine for a
residency program. That's great. I want them also to be able to do that
in their clinics. But I also want it for community-based health
centers. And our statistics show us that if we have that example and
it's mandatory spending that they make these agreements, that those
folks will come back. They may go back to a military clinic, they may
come back to a community-based health center, or they may come back and
open up their practice in an area that's not the wealthiest part of
town. That's why this mandatory legislation is so important.
If you put a priority on making sure our constituents can go see a
doctor, I can't imagine repealing this--voting for this bill.
I reserve the balance of my time.
Mr. GUTHRIE. Mr. Chairman, I yield an additional 2 minutes to the
gentleman from California (Mr. Bilbray).
Mr. BILBRAY. Mr. Chairman, I want the gentleman from Texas to
understand that when a physician or a student is planning on getting
into a field, they not only look at will the government guarantee that
I'll be able to get the tuition, but they're looking at what field am I
moving into. And let me just tell you, as a fact, in California, even
with our tort reform, somebody who wants to volunteer as a Medicaid
volunteer has to file an $80,000 or $90,000 insurance policy just for
volunteering.
So when the gentleman talks about the educational side, that it's
essential that we encourage people to get into the field, my point for
being here is you cannot talk about the educational when you ignore the
environment that you're asking them to go into. And the fact is: What
parent would ask somebody to go into this field and be a physician with
all the education and all the expenses when they can tell their kids to
be a lawyer and sue those physicians for every cent they have ever been
able to earn?
That's why we've got to talk about both of these together. But you
can't stand up and say we want these essential services but not be
willing to get the trial lawyers off the backs of these physicians so
they can provide those essential services.
Mr. GENE GREEN of Texas. Will the gentleman yield?
Mr. BILBRAY. I will yield to the gentleman.
Mr. GENE GREEN of Texas. I thank the gentleman for yielding.
Again, this is not a medical malpractice bill, but I would be glad to
offer you to be a cosponsor. We passed the bill out of this House twice
and sent it to the Senate which would allow volunteers to go into
community-based health centers and be covered under the Federal Tort
Claims Act. Congressman Murphy from Pennsylvania is a lead sponsor of
this Congress. I've been the lead sponsor when Democrats have been in
control because we need to do that. If I could do it under this bill, I
would do it. But this came out of your conference that you want to
repeal mandatory spending to try and train primary care doctors to
serve in primary care clinics or whatever.
Mr. BILBRAY. Reclaiming my time, look, the fact is these physicians
are being held with a liability that is inappropriate, way over the
head, and it is not justifiable----
The Acting CHAIR (Mr. Fortenberry). The time of the gentleman has
expired.
Mr. GUTHRIE. I yield the gentleman 1 additional minute.
Mr. BILBRAY. We're talking about the fact that those who want to
stand up and say we'll spend Federal funds to create an environment to
provide health care but then are not willing to say, not just the fact
that we find special tort coverage--and I know that the gentleman from
Texas knows because I was at a county level providing those services.
We have Federal programs that protect those in the community clinic.
But we're not just talking about the little bit of protection we get
with our Federal protection. We're talking about the whole tort
exposure needs to be considered.
And if you want to talk about access and stand up here and have the
moral high ground on access, you've got to be willing to take on the
big guy, the powerful trial lawyers, and say, look, physicians are
going to be held harmless from your lawsuits. We're going to find a
reason to encourage young people to go to school not just by providing
Federal subsidies to their tuition, but also telling them, once you get
your degree, you'll be able to go into a field where you'll be able to
practice your art of medicine without having somebody who has never had
to make a life-and-death decision drag you before a judge and a jury
and attack you for your decisions.
Mr. GENE GREEN of Texas. Mr. Chairman, my colleague from California
again is confused. We have H.R. 5 that the majority has to federalize
medical malpractice insurance in our country. Some States have taken
care of it. The State of Texas has done it by constitutional amendment.
And that debate may come up if the majority brings up their H.R. 5.
With that, Mr. Chairman, I yield 2 minutes to my colleague from New
York, Congressman Tonko.
Mr. TONKO. Mr. Chair, the underlying legislation guts funding for
vital teaching health centers across the country. Teaching health
centers are residency programs for primary care physicians. They
provide community-based training for doctors who will go on to work in
rural and our underserved areas.
Mr. Chair, my amendment is very simple. It requires that we find out
exactly how many primary care physicians we will lose if Republicans
succeed in cutting teaching health centers across the country. My
amendment commissions the Government Accountability Office to report on
these findings so that the American people can see how drastically
these cuts will eliminate jobs and hurt the quality, access, and
affordability of primary care health options.
I'm interested to know, Mr. Chair, if some of my Republican
colleagues are aware that if H.R. 1216 is adopted, there will be fewer
primary care doctors working in their communities. For example, this
bill guts funding for 23 physicians at the teaching health center in
the heart of Scranton, Pennsylvania. These 23 individuals are being
trained to provide basic health care for constituents in the greater
Scranton area. If my Republican colleague from the Scranton area joins
the Republican leadership in eliminating this program, his community
will lose training for 23 new primary care physicians. That's 23 jobs,
jobs that they support, and 23 individuals who help serve constituents
with their health care needs.
[[Page H3366]]
Again, Mr. Chair, my amendment is a matter of effective oversight. It
asks that we find out from a nonpartisan source exactly how many
primary care physicians we will lose if the Republican leadership moves
forward to cut teaching health centers across the country.
Mr. GUTHRIE. Mr. Chair, I yield myself as much time as I may consume.
I want to point out, as we went through, what we're talking about
doing is graduate medical education in teaching health centers will be
identical to the graduate medical education in hospitals and children's
hospitals.
And I remember, I was not on the Energy and Commerce Committee but in
Education and Labor. We worked on the health care bill. And the
description that we went in through the night and went through the bill
line by line is absolutely true. I think we were 24 or 25 hours direct
on that. And I wasn't on Energy and Commerce when you went, but they
went through the night, as well, Mr. Chairman. And when this bill
passed out of the House of Representatives, the teaching health centers
were authorized subject to appropriation.
{time} 1520
The change was made in the Senate. So working late into the night and
going through the bill, we are just asking and what we are proposing is
to treat teaching health centers as the House-passed version of the
health care bill did, which is exactly the same as hospitals and
children's hospitals and many of the other programs, nurse training and
other things as well.
I reserve the balance of my time.
Mr. GENE GREEN of Texas. Mr. Chairman, I yield myself such time as I
may consume.
I have no problem with including children's hospitals , and I think
we could probably pass it on the suspension calendar if we had
legislation that would expand that mandatory funding for teaching
hospitals, and particularly children's hospitals, but that is not what
this legislation does today. It takes away that help we are providing
to train more primary care physicians in our country. That is what this
bill does: It takes away the mandatory funding.
Now there have been examples all through history of mandatory
funding. We realized during the Affordable Care Act that we need more
primary care physicians. We need a lot more health care providers. We
need more nurses. We need everything. In fact, it is a great job growth
area. But we know we need primary health care providers because we know
when somebody needs a doctor, they will see that primary care doctor.
They may need a specialist, but they still need to go to that primary
care doctor. That is why this mandatory funding is so important, and
that is why this bill is the wrong way to deal with it. That is why it
shouldn't be considered today. I would hope everybody would realize
that if you support health care and primary care physicians, you would
want that mandatory training so we can get those physicians out in the
community where they are really needed.
Numbers show that if we have a program like this where primary care
physicians will go into a community based health care center, they will
go into that area as part of their residency program, they are more
likely to come back to that community. That is why that was part of the
Health Care Act. We have people who their primary care physicians now
are the emergency rooms in hospitals in my district. I would much
rather they be able to go see a doctor down the street for their sinus
infection than showing up at midnight in an emergency room where we are
going to end up having to pay for it, even at a public hospital, where
the local taxpayers are paying for it. That is why this mandatory
spending is so important. And that is why I think it is so the wrong
way to go in health care, to take away mandatory spending for primary
care physicians. That is something that is so important in our country,
it should be mandatory.
I reserve the balance of my time.
Mr. GUTHRIE. Mr. Chairman, I want to point out again, the mandatory
spending was not in the House version of the health care bill that was
passed. Teaching health centers were treated exactly like general
pediatric and primary care physicians are in hospital settings and in
children's hospital settings--general hospitals and children's
hospitals. We are saying we are going back to the way it was
established in the Affordable Care Act as it was passed out of the
House of Representatives.
We are talking about primary care physicians as well. I agree we need
more primary care physicians. Their training at children's hospitals
and hospitals is in geriatric, pediatric, internal medicine, all the
primary care physician specialties that we know. We are just saying one
shouldn't be treated differently than the other. They are important,
and we should go through the annual appropriations process and present
the validity of programs and let the appropriations process determine
the level of funding.
Mr. Chairman, I yield 4 minutes to the gentleman from Georgia (Mr.
Gingrey).
Mr. GINGREY of Georgia. I thank the gentleman from Kentucky for
yielding me this time.
As everyone knows, the financial health of this Nation is in a very
precarious State. Unfortunately, it was made worse by the spending
decisions and actions of this last Congress. Today, the Federal
Government borrows 41 cents of every dollar it spends. We are facing a
$1.6 trillion deficit for this fiscal year, the third straight year of
trillion-dollar deficits, an all-time record in nominal terms and a new
post-World War II record as a share of the economy.
The reckless spending of the last Congress has only exacerbated this
problem. The so-called stimulus bill--that didn't stimulate much
besides a lot of wasteful spending--and ObamaCare, the Patient
Protection and I think un-Affordable Care Act, are two such examples of
legislation that spent recklessly.
Mr. Chairman, among the 2,400 pages of ObamaCare, the last Congress
created $105 billion in secret slush funds that can be used to advance
the political goals of President Obama and his administration without
our oversight, congressional oversight.
At a time when our country is facing financial ruin, my concern is
how much damage to our national budget the White House can do with
these funding streams. The time for blank checks is over. The time for
leadership is now.
Section 5508 of ObamaCare provides a $230 million direct
appropriation for teaching health centers residency programs. H.R. 1216
would simply convert the direct appropriations into an authorization of
appropriations. The legislation allows for teaching health centers to
receive funding through the normal appropriations process with proper
Congressional oversight.
Mr. Chairman, many Members of this Congress have supported medical
education--I certainly count myself among them--including graduate
medical education for children's hospital programs. However, in her
testimony before the House Energy and Commerce Health Subcommittee
earlier this year, HHS Secretary Sebelius stated that the President's
fiscal year 2012 budget eliminates children's hospital graduate medical
education programs because they duplicate the teaching center funds in
ObamaCare.
Mr. Chairman, is this the future of medical education that we want
for our children? Teaching our medical professionals in clinics that
might not be equipped to properly train them to handle emergency
situations versus in hospitals regarded as centers of excellence like
Children's Healthcare of Atlanta in my own home State of Georgia. This
is why the appropriations process is so important--we need
congressional oversight to help decide what the priorities of tomorrow
should be.
This Congress, the 112th Congress--is focused on reining in spending
and reducing our deficit. We cannot do the job of the American people
and make the spending cuts necessary unless the legislative branch has
oversight over Federal spending. If this is truly the people's House,
give back what the last Congress gave away--control over the budget. If
this body is sincere in its wishes to restore fiscal sanity in this
country, I see no reason why this body should not be voting in a
bipartisan manner to prevent this President--or any President, for that
matter--from spending our Nation into insolvency.
[[Page H3367]]
So I urge all of my colleagues to support H.R. 1216. I thank the
gentleman from Kentucky for his bill and for yielding me this time.
Mr. GENE GREEN of Texas. Mr. Chairman, I yield myself such time as I
may consume.
Let me correct some of the statements that have been made. We have
had mandatory hospital training residency programs since 1965. By
taking away direct or mandatory spending for community-based residency
programs, it is a direct attack on community-based programs. Let me
list for you the teaching hospital programs that are under mandatory
that was part of the Affordable Care Act. I joked on the floor one
night to my colleague from Georgia, I wish they would name it the Green
Act, GreenCare instead of ObamaCare, because I am so proud of that law.
The teaching hospital program supports the training of individuals
who practice in family medicine, internal medicine, pediatrics,
internal medicine pediatrics, obstetrics, gynecology, psychiatry,
general dentistry, pediatric dentistry, or geriatrics. These are
disciplines where we are experiencing significant physician shortages.
That is why we need the mandatory spending. It does cover children.
{time} 1530
Now, we have had mandatory spending for hospital training, again,
since 1965. All this bill would do would be to take it away from
community-based health centers where we know there is a shortage. The
statistics show, if you have doctors who do their residencies or
residency programs through community-based centers, they are more
likely to go back there and practice, whether they be pediatricians,
whether they be in family practice, whether they be in internal
medicine. That's where we need the growth and to have primary care
physicians. This is a direct attack on health care in our own country.
Why wouldn't we want it mandatory for community-based facilities if
it's already mandatory for hospital-trained physicians? We need
physicians in the community, not just in the hospitals.
Mr. Chairman, I yield back the balance of my time.
Mr. GUTHRIE. Again, Mr. Chairman, it is important that we have an
adequate supply of primary care physicians, and it is important public
policy for this country. It is important that we also have oversight
and control over the budget in the way the money is spent, and we do
that through the appropriations process.
I just want to point out, in the last Congress, there was great
effort in putting together the health care bill. When we passed out of
this Congress the House-passed version, this was an authorized
``subject to appropriations'' section of the bill. I know it has been
described as being against health care throughout the country, but that
was the way, through much debate, it passed out of this House of
Representatives. It treats it similarly to hospital-based education in
primary care and to children's hospital-based. It puts it on an equal
footing with nurses' programs, nurse practitioner programs and other
programs, which we all agree have shortages. We need more people in
those fields.
I just want to reiterate that this does not eliminate the program. It
authorizes it. It changes it from a direct appropriation to an
authorized appropriation through the regular appropriations process.
Mr. DINGELL. Mr. Chair, I rise today in strong opposition to H.R.
1216. As a declining number of physicians in our Nation are entering
into primary care fields, my colleagues on the other side of the aisle
are working to pass legislation that will irresponsibly impede critical
training of the next generation of primary care physicians.
A primary care physician shortage is a very real and alarming problem
looming before us. The Association of American Medical College's Center
for Workforce Studies anticipates a shortage of 45,000 primary care
physicians and a shortage of 46,000 surgeons and medical specialists in
the next decade.
Since 1965, the Medicare Graduate Medical Education program, which
has been supported by mandatory funding, has trained the majority of
resident trainees across the country in a hospital-based setting. The
Teaching Health Center program is the first medical graduate program of
its kind to allow future physicians in primary care fields to train in
the actual setting they will be practicing in--community-based health
centers.
My colleagues claim that converting the Teaching Health Center
program from a mandatory appropriation to an authorization--subject to
the annual appropriations process--will not endanger the program. We
saw during the debate on the fiscal year 2011 budget that could not be
further from the truth.
During that dreadful debate it became painstakingly clear that my
colleagues know the cost of everything, but the value of nothing.
Subjecting this program to the annual appropriations process will not
allow for a predictable and stable funding stream needed to assist
community-based health centers and resident trainees in planning and
preparing for this training.
We all recognize and agree with the need to reduce federal government
spending, but making the Teaching Health Center program a pawn in the
appropriations game is foolish at best.
Further, I find it ironic that during debate in the Energy and
Commerce Committee my colleagues expounded on their desires for more
investment in our health workforce, yet at the first opportunity they
are placing the Teaching Health Center program in the vulnerable
position of future funding reductions.
Mr. Chair, H.R. 1216 is another plan in the Republicans' repeal
health reform platform. Passing this legislation will jeopardize
funding for the Teaching Health Center program, further delaying the
fundamental training needed for our primary care physicians.
I urge my colleagues to stand up for the training of our primary care
physicians and vote no against this reckless piece of legislation.
Mrs. CHRISTENSEN. Mr. Chair, I rise today, fully disappointed that my
colleagues on the other side of the aisle are trying to move forward
with this bill. This bill has no merit; in fact, it is little more than
a part of a larger, ill-conceived strategy to undermine the progress we
have made and will likely continue to make as a result of the historic
health care reform bill that was enacted last year.
While on its face it seems harmless, we all know the reality of what
this bill will do. And, it is crucial that the very individuals who
elected us to represent them--the large majority of whom will be
directly and indirectly affected by this and in a very negative way--
also know that this bill does nothing to ensure fiscal responsibility
or improve the medical education system in health centers, and does
even less to ensure that there are trained and qualified health care
providers in their communities to serve their communities.
In fact, it jeopardizes ongoing and forthcoming efforts to ensure
that there are highly-trained and qualified health care providers
practicing in every community--especially those that suffer due to a
shortage of health care providers--across the country.
If this bill were to pass and become law, then the already-planned
primary care training programs that will be operated by community-based
entities, like community health centers, will not likely continue
beyond their first planned year because turning this program into a
discretionary one offers no guarantee of future funding. Further,
making this program discretionary will serve as a disincentive to other
community-based entities that are considering launching similar
graduate medical education programs for the same reasons.
The unfortunate element in all of this is this: These programs train
individuals who will practice in family medicine, internal medicine,
pediatrics, obstetrics and gynecology, general dentistry and
geriatrics--the very areas of medical care where the provider shortages
are the greatest.
Further, the individuals trained by these programs are very likely to
serve most underserved communities--a disproportionate number of which
are rural, low-income and/or racial and ethnic minority--across the
Nation.
Why, I must ask, would we want to end these programs, when provider
shortages are not issues that affect only our side of the aisle; it is
a public health crisis that touches every district across the Nation.
In fact, during the health care reform debates, my friends on the other
side of the aisle continually argued that there are not enough
physicians in the country to meet our current primary health care needs
and to address our current primary health care challenges. So, it seems
counterintuitive to, then, seek to compromise and put an end to the
very programs that were designed and funded to address this very
problem.
We have had and continue to have very serious health care challenges
in this country, and our primary care workforce shortages fall into
that category. All of these serious health care challenges warrant even
more serious solutions--many of which are being implemented thanks to
the Patient Protection and Affordable Care Act.
However, this bill--H.R. 1216--is not a serious solution and, if
passed, will only become a serious part of a serious problem.
[[Page H3368]]
I, therefore, urge my colleagues to vote, ``no'' on this bill. And,
in doing so, you will be voting yes for the improved and strengthened
primary health care workforce across the Nation.
Mr. BLUMENAUER. Mr. Chair, I rise in opposition to H.R. 1216, which
rescinds funding for graduate medical education in qualified teaching
health centers. The Affordable Care Act provides funding for the
training of medical residents in qualifying health centers, which will
strengthen the health care workforce and support an increased number of
primary care medical residents trained in community-based settings
across the country. This bill undermines that key objective and in so
doing, undermines public health efforts, limits access to doctors in
communities around the country, and weakens our medical workforce.
Teaching health centers are community-based patient care centers that
operate primary care residency programs, such as family medicine,
internal medicine, pediatrics, and general and pediatric dentistry.
Physicians trained in health centers are more than three times as
likely to work in a health center and more than twice as likely to work
in an underserved area than are those not trained at health centers.
Oregon's community health centers--29 clinics offer care at more than
150 delivery sites--provide high-quality, comprehensive health care to
more than a quarter-million people across my state. Services range from
medical and dental care to prescription medications to behavioral
health care. Many centers also provide such support services as
transportation and translation to ensure that everyone who needs
healthcare can access it. This legislation, however, would undermine
the ability of these centers to attract doctors and other health
professionals so vital to providing community-based care.
The Institute of Medicine reports that already there is a need for
more than 16,000 new physicians in currently underserved areas. Unless
we invest in medical education that closes this shortfall, it will
worsen in future years. The Association of American Medical Colleges
estimates that, by 2024, we will need 46,000 additional primary care
physicians. This legislation makes it more difficult to close this gap.
A recent study by Dartmouth investigators published in the Journal of
the American Medical Association found that beneficiaries living in
areas with better access to primary care physicians had lower mortality
and fewer hospitalizations. By eliminating funding to train doctors in
community-based settings, this legislation makes it less likely that
patients in underserved areas will be able to see a doctor or to get
the care that they need. This legislation will worsen health outcomes
in underserved areas.
Rather than making refinements to improve the Affordable Care Act,
H.R. 1216 merely eliminates funding. It fails to advance the key
objectives of the law to improve healthcare while lowering costs and it
fails to offer alternative solutions to meet these important
objectives. I oppose this legislation.
Mr. GUTHRIE. I yield back the balance of my time.
The Acting CHAIR. All time for general debate has expired.
Pursuant to the rule, the bill shall be considered read for amendment
under the 5-minute rule.
The text of the bill is as follows:
H.R. 1216
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. CONVERTING FUNDING FOR GRADUATE MEDICAL EDUCATION
IN QUALIFIED TEACHING HEALTH CENTERS FROM
DIRECT APPROPRIATIONS TO AN AUTHORIZATION OF
APPROPRIATIONS.
(a) In General.--Section 340H of the Public Health Service
Act (42 U.S.C. 256h), as added by section 5508(c) of the
Patient Protection and Affordable Care Act (Public Law 111-
148), is amended--
(1) in subsection (b)(2)(A), by striking ``under subsection
(g)'' each place it appears and inserting ``pursuant to
subsection (g)'';
(2) in subsection (d)(2)(B), by striking ``in subsection
(g)'' and inserting ``pursuant to subsection (g)''; and
(3) by amending subsection (g) to read as follows:
``(g) Authorization of Appropriations.--To carry out this
section, there are authorized to be appropriated $46,000,000
for each of fiscal years 2012 through 2015.''.
(b) Rescission of Unobligated Funds.--Of the amounts made
available by such section 340H (42 U.S.C. 256h), the
unobligated balance is rescinded.
(c) Technical Correction.--The second subpart XI of part D
of title III of the Public Health Service Act (42 U.S.C.
256i), as added by section 10333 of the Patient Protection
and Affordable Care Act (Public Law 111-148), is amended--
(1) by redesignating subpart XI as subpart XII; and
(2) by redesignating section 340H of the Public Health
Service Act (42 U.S.C. 256i) as section 340I.
The Acting CHAIR. No amendment to the bill shall be in order except
those received for printing in the portion of the Congressional Record
designated for that purpose in a daily issue dated May 23, 2011, and
except pro forma amendments for the purpose of debate. Each amendment
so received may be offered only by the Member who caused it to be
printed or a designee and shall be considered read.
Amendment No. 2 Offered by Mr. Tonko
Mr. TONKO. Mr. Chair, I have an amendment at the desk.
The Acting CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:
Page 4, after line 12, add the following:
(d) GAO Study on Impact on Number of Primary Care
Physicians to Be Trained.--The Comptroller General of the
United States shall conduct a study to determine--
(1) the impacts that expanding existing and establishing
new approved graduate medical residency training programs
under section 340H of the Public Health Service Act (42
U.S.C. 256h), using the funding appropriated by subsection
(g) of such section, as in effect on the day before the date
of the enactment of this Act, would have on the number of
primary care physicians that would be trained if such funding
were not repealed, rescinded, and made subject to the
availability of subsequent appropriations by subsections (a)
and (b) of this section; and
(2) the amount by which such number of primary care
physicians that would be trained will decrease as a result of
the enactment of subsections (a) and (b).
The Acting CHAIR. The gentleman from New York is recognized for 5
minutes.
Mr. TONKO. Mr. Chair, my friends on the other side of the aisle seem
steadfast and determined in their attack on access to affordable,
quality health care. Couple that with their plan to end Medicare, and
our Nation's seniors are put in quite a bind. Meanwhile, they want to
place our health in the hands of Wall Street and Big Insurance, not
between doctors and their patients. The seniors in my district and
across the country know that vouchers will not cover their health care
needs. They see the tax breaks for millionaires and billionaires and
handouts for Big Oil, and are vehemently opposed to this plan.
Today, we have yet another assault on affordable access to health
care. My Republican colleagues have found their next boogeyman: family
practice physicians. This is surprising as we have a dire shortage of
primary care physicians in our country.
The American Association of Medical Colleges has estimated that an
additional 45,000 primary care physicians are required by 2020 just to
meet America's health care needs. A few short months ago, both sides of
the aisle agreed on the need to build our Nation's primary care
workforce. This is a proven way to bend the health care cost curve by
decreasing health spending through prevention and early, simple
treatment.
Unfortunately, Republicans have since changed their tune. They have
declared that the problem is not that we have a shortage of these
crucial doctors. Instead, they must believe we have too many primary
care physicians, and so we face this call to eliminate training for
those on the front lines of the fight for quality care.
The underlying legislation guts funding for vital teaching health
centers across our country. Teaching health centers are residency
programs for primary care physicians, providing community-based
training for doctors who will go on to work in rural and in our
underserved areas. From Medicare to high gas prices to tax rates, my
friends on the other side have proposed time and time again policies
that put middle class Americans on the line and let Wall Street, Big
Oil and Big Insurance take over and earn big. The constituents in my
home district, in the Capital Region of New York State, need a break.
They are looking at the price of gas, at the price of food and at the
price of prescription drugs, and are just wondering how they will make
it through the month.
Do we need to balance the budget? Yes. Do we need to balance the
budget on the backs of hardworking Americans who play by the rules?
Absolutely not.
Mr. Chair, my amendment is very simple. It requires that we find out
exactly how many primary care physicians we will lose if Republicans
succeed in cutting teaching health centers
[[Page H3369]]
across the country. My amendment commissions the Government
Accountability Office to report on these findings so that the American
people can see how drastically these cuts will eliminate jobs and will
hurt the quality, access and affordability of primary care health
options.
I am interested to know, Mr. Chair, if some of my Republican
colleagues are aware that, if H.R. 1216 is adopted, there will be fewer
primary care doctors working in their communities. For example, this
bill cuts funding for 23 physicians at the teaching health center in
the heart of Scranton, Pennsylvania. These 23 individuals are being
trained to provide basic health care for constituents in the greater
Scranton area.
If my Republican colleague from the Scranton area joins the
Republican leadership in eliminating this program, his community will
lose training for 23 new primary care physicians. That's 23 jobs, the
many jobs they support and 23 individuals who will serve constituents
in need.
Mr. Chair, if my colleague from Pennsylvania would like to come to
the floor to defend the rights of the teaching health center in
Scranton against this shortsighted and unjust attack by the Republican
leadership, I would gladly yield him time.
The same challenge is faced by my colleague from the Billings,
Montana, area, whose district will lose funding to train seven primary
care physicians specifically for the health care needs of rural
Montanans. In Idaho, Illinois, Texas, and Washington, it's the same
story. All of these communities are seeing good American jobs put at
risk--and for what?--to fund handouts to insurance and oil companies?
to pay for even more tax breaks to millionaires, billionaires and some
of the wealthiest corporations on Earth?
I would gladly yield my Republican colleagues from these districts
time to defend their constituents.
Again, Mr. Chair, my amendment is a matter of effective oversight. It
asks that we find out from a nonpartisan source exactly how many
primary care physicians we will lose if the Republican leadership moves
forward to cut teaching health centers across our country.
When it comes to ensuring our constituents have access to basic
primary health care, when it comes to protecting Medicare and Social
Security for our seniors and to ensuring they have healthy and
comfortable retirements, there should be no disagreement.
Please join me in supporting this amendment and in standing with
middle class Americans across the country.
With that, I yield back the balance of my time.
Mr. GUTHRIE. Mr. Chairman, I rise in opposition to the amendment.
The Acting CHAIR (Mr. Campbell). The gentleman from Kentucky is
recognized for 5 minutes.
Mr. GUTHRIE. Mr. Chairman, first, I want to point out the list that
was read of teaching health centers.
The text of the bill is very clear: that we only rescind unobligated
funding. If the funding has been obligated, then it continues to move
forward. So, as to the list that was read, those will be funded.
The amendment before us directs the GAO to determine the number of
physicians who will be trained by this program if funds are not kept
mandatory. I oppose the general premise that a program must have
mandatory funding in order to be effective. This type of thinking has
led us to massive budget deficits as far as the eye can see.
During the debate on the continuing resolution, I can remember more
than a few Members complaining that reductions in discretionary
spending would have little impact on the deficit. There is some truth
to the fact that discretionary spending which Congress has more control
over comprises an increasingly smaller share of the Federal budget.
{time} 1540
It seems to me that some people's solutions to reining in the
discretionary ledger of our Federal budget is to simply shift programs
from discretionary to mandatory and let the spending cruise on auto
pilot. That is not responsible governing. In a time of $1.5 trillion
annual deficits, we must make spending priorities. However, setting
priorities involves tough choices. The people that oppose this bill do
so because they are unwilling to make the tough choices on what
programs the Federal Government should fund and what they should not.
So let's review what happened. Certain programs for training were
made mandatory in the health care act and others were subject to future
appropriations. Listening to the debate today, it is apparent that some
believe any provision in the health care act that authorized a program
subject to appropriations is essentially meaningless and did nothing at
all. I have heard Members extol the virtues of dental education
programs or training for nurse education contained in the health care
act, but they are subject to further appropriations.
Where was the amendment to the health reform bill that asked GAO to
look into how the lack of mandatory spending in section 5305 of the
health care act would affect geriatric education? There wasn't one, and
not a single Member of the other side brought the issue up. The reason
the other side didn't bring it up is because the programs were
constructed in a way to go through the normal authorization and
appropriations process. The underlying bill simply puts teaching health
centers on equal footing with a myriad of other programs.
I also oppose the amendment because it is a waste of Federal
resources. We are asking the GAO to conduct a study that is almost
impossible for it to complete. The GAO cannot determine the number of
physicians that will be trained because so much of the program is under
the discretion of the Secretary. In fact, the contours of the program
have not yet even been set. The Health Resources and Services
Administration does not even anticipate issuing a Notice of Proposed
Rulemaking on the Teaching Health Center Graduate Medical Education
Program until December.
Under my bill, supporters of the program will continue to be able to
make the case on an annual basis that the program is not duplicative,
it is effective, and warrants continued funding over other programs
like children's hospitals which the President's budget zeroed out.
I urge my colleagues to vote ``no.''
I yield back the balance of my time.
The Acting CHAIR. The question is on the amendment offered by the
gentleman from New York (Mr. Tonko).
The question was taken; and the Acting Chair announced that the noes
appeared to have it.
Mr. TONKO. Mr. Chairman, I demand a recorded vote.
The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further
proceedings on the amendment offered by the gentleman from New York
will be postponed.
Amendment No. 9 Offered by Mr. Cardoza
Mr. CARDOZA. Mr. Chairman, I have an amendment at the desk.
The Acting CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:
Page 4, after line 12, add the following:
(d) GAO Study and Report on Physician Shortage.--The
Comptroller General of the United States shall conduct a
study to determine--
(1) the impact that expanding existing and establishing new
approved graduate medical residency training programs under
section 340H of the Public Health Service Act (42 U.S.C.
256h), using the funding appropriated by subsection (g) of
such section, as in effect on the day before the date of the
enactment of this Act, would have on the number of physicians
that would be trained if such funding were not rescinded and
made subject to the availability of subsequent appropriations
by subsections (a) and (b) of this section; and
(2) the impact that the enactment of subsections (a) and
(b) will have on the number of physicians who will be trained
under approved graduate medical residency training programs
pursuant to such section 340H.
The Acting CHAIR. The gentleman from California is recognized for 5
minutes.
Mr. CARDOZA. Mr. Chairman, I rise today to offer an amendment that
would require the GAO to conduct a study that highlights the impact
that elimination of funding would have on the number of physicians that
would be trained if this program were allowed to continue as intended.
Countless studies have demonstrated a serious and growing shortage of
health professionals facing the United States--most critically a
shortage of primary care physicians and dentists. However, where I come
from, there is a
[[Page H3370]]
shortage of specialties as well. With an existing shortage well
established and an aging population increasing, our country desperately
needs investments in the health care workforce, not rescissions.
In my home State of California alone there are 567 designated health
professional shortage areas, which include a population of more than
3.8 million medically underserved individuals. In California's San
Joaquin Valley, there are already fewer than 87 primary care physicians
for 100,000 patients of population. The doctor/patient ratio in my
region is not getting better; it is getting significantly worse. That
is why I have consistently advocated for the need to improve access to
care and address this vital shortage.
All eight counties in the San Joaquin Valley have been designated as
medically underserved by the Department of Health and Human Services,
including Merced, Stanislaus, San Joaquin, Madera, and Fresno Counties.
At one point a few years ago, we were down to one pediatrician for the
entire county of Merced. With the passage of the Affordable Care Act,
we were able to include additional funding for these medical residency
programs to help address the mounting health care profession shortage
in already established underserved areas.
The new Teaching Health Centers Graduate Medical Education Program is
intended to be an investment that helps struggling underserved
communities deal with the reality of increasing demands on an already
strained health care system. Studies have shown that the most effective
way to attract and retain new doctors in underserved areas is to allow
medical students to complete their medical residency programs in the
communities that are in need. Graduating physicians most often practice
in the communities where they have completed their residency training,
which is why this program is uniquely important. My wife is a perfect
case in point, a primary care physician who stayed in our community and
practiced for 18 years after she finished the program.
Without these critical investments, the lack of care will most
certainly have a costly price on the health and well-being of many
rural underserved communities, including those I represent.
Mr. Chairman, I yield back the balance of my time.
Mr. GUTHRIE. Mr. Chairman, I move to strike the last word.
The Acting CHAIR. The gentleman from Kentucky is recognized for 5
minutes.
Mr. GUTHRIE. Mr. Chairman, this amendment is very similar to the
previous amendment we discussed, so I will be brief.
One, as I said before, it is difficult for the Government
Accountability Office--almost impossible for them--to perform this
study moving forward because there is so much discretion that is given
to the Health and Human Services Secretary. And as I said before, the
Health Resources and Service Administration does not even anticipate
issuing a Notice of Proposed Rulemaking on teaching health graduate
centers until December.
And then again, as a lot of the comments today, I don't think that
moving an authorized and mandatory spending program to an authorized
and discretionary spending program renders that program meaningless. If
it does do that, then all the other programs that I have listed earlier
in the debate--training in general hospitals, training in children's
hospitals, training in behavioral education and health, training in
nurse retention, training in nurse practitioners--that means that those
programs that were in the health care act would not have as much
strength as well. And so the comment that by moving this from one part
of the budget to the other makes it meaningless, to me, is just not
accurate.
And, second, I also want to stress again that the language of the
bill is clear: we do not rescind obligated funds; it is only
unobligated funds. So again, it wasn't my friend from California, but
someone earlier mentioned that there were programs that have already
been in place that would be hurt by that. If the funds have been
obligated, those programs move forward.
Mr. Chairman, I yield back the balance of my time.
Mr. GENE GREEN of Texas. Mr. Chairman, I move to strike the last
word.
The Acting CHAIR. The gentleman is recognized for 5 minutes.
Mr. GENE GREEN of Texas. Mr. Chairman and Members, I know there has
been talk only about obligated money. I would like to introduce into
the Record a press release issued on January 25 of this year from
Health and Human Services announcing the new Teaching Health Center
Graduate Medical Education Program. And of those programs, it lists the
ones; and that money is obligated, but there will be no future funding
for them. So you get a few months of funding, but you don't get any
more funding.
These centers--six of them are in Republican districts, five in
Democratic districts--will get a very short 3 months' worth of funding
if this bill becomes law. And it doesn't do any good. The graduate
medical education pays for the training of that physician. These
community centers will only receive a short term funding. So it may
only be talking about that obligated money, but they won't get any more
after this year if this bill becomes law. That's why it is so important
that this bill be defeated or that we adopt an amendment similar to our
colleague from California.
HHS Announces New Teaching Health Centers Graduate Medical Education
Program
Eleven centers will support primary care residency training in
community-based settings
HHS Secretary Kathleen Sebelius today announced the
designation of 11 new Teaching Health Centers in the Teaching
Health Center Graduate Medical Education program, a 5-year
program that will support an increased number of primary care
medical and dental residents trained in community-based
settings across the country. These Teaching Health Centers
will be supported by funds made available through the
Affordable Care Act and will help address the need to train
primary care physicians and dentists in our nation's
communities.
With the funds, these Teaching Health Centers can seek
additional primary care residents through the National
Resident Matching program this month and will train 50
additional resident full-time equivalents beginning in July
2011. While 3 months of funding totaling $1,900,000 is being
awarded this first program year, in future years the annual
funding will increase to cover the full-year costs, as well
as additional residents. These investments provide an
important platform for expanding the primary care workforce
and creating more opportunities to prepare physicians to
practice primary care in community-based settings, while
ensuring primary care services are available to our nation's
most underserved communities.
``The Teaching Health Center program is an integral part of
our mission to strengthen the nation's primary care workforce
and ensure that all Americans have adequate access to care,''
said Secretary Sebelius.
The new Teaching Health Centers are distributed around the
nation and will train residents in family medicine, internal
medicine, and general dentistry. Teaching Health Centers will
receive up to 5 years of ongoing support for the costs
associated with training primary care physicians and
dentists. HHS' Health Resources and Services Administration
(HRSA) will administer the program.
``Participating in this program not only provides top-notch
training to primary care medical and dental residents, but
also motivates them to practice in underserved areas after
graduation,'' said HRSA Administrator Mary Wakefield, Ph.D.,
R.N.
Eligible Teaching Health Centers are community-based
ambulatory patient care centers that operate a primary care
residency program, including federally-qualified health
centers; community mental health centers; rural health
clinics; health centers operated by the Indian Health
Service, an Indian tribe or tribal organization; and entities
receiving funds under Title X of the Public Health Service
Act.
For additional information, visit Teaching Health Centers.
2011 TEACHING HEALTH CENTERS
----------------------------------------------------------------------------------------------------------------
Organization City State Award
----------------------------------------------------------------------------------------------------------------
Valley Consortium for Medical Education.. Modesto.................... Calif...................... $625,000
Family Residency of Idaho................ Boise...................... Idaho...................... 37,500
Northwestern McGaw Erie Family Health Chicago.................... III........................ 300,000
Center.
[[Page H3371]]
Penobscot Community Health Center........ Bangor..................... Maine...................... 150,000
Greater Lawrence Family Health Center.... Lawrence................... Mass....................... 112,500
Montana Family Medicine Residency........ Billings................... Mont....................... 37,500
Institute for Family Health.............. New York................... N.Y........................ 150,000
Wright Center for Graduate Medical Scranton................... Pa......................... 225,000
Education.
Lone Star Community Health Center........ Conroe..................... Texas...................... 37,500
Community Health of Central Washington... Yakima..................... Wash....................... 75,000
Community Health Systems................. Beckley.................... W. Va...................... 150,000
----------------------------------------------------------------------
Total................................ ........................... ........................... 1,900,000
----------------------------------------------------------------------------------------------------------------
Mr. ELLISON. Mr. Chairman, I move to strike the last word.
The Acting CHAIR. The gentleman from Minnesota is recognized for 5
minutes.
Mr. ELLISON. Mr. Chairman, I rise in opposition to this underlying
bill.
As the Senate votes this week on the Republican scheme to end
Medicare, I am standing up to protect health care for our seniors. Our
seniors, they blazed the trail for all of us. They fought the wars,
they've earned the money, they've come and made America a great place;
and we have inherited what they've done. We have inherited what our
senior citizens have made for us. And now we see our Republican
colleagues want to end Medicare for these same seniors. To spend nearly
$1 trillion on handouts to millionaires not only harms American
seniors, but threatens our economic future.
{time} 1550
Medicare guarantees a healthy and secure retirement for Americans who
pay into it their whole lives, Mr. Chairman. It represents the basic
American values of fairness, decency and respect for our seniors that
all Americans should cherish.
Last month, our Republican colleagues voted to end Medicare as we
know it. According to the Congressional Budget Office--and, Mr.
Chairman, that's the office that is bipartisan and calls it straight as
they see it--this plan, this Republican plan, would raise seniors'
health care costs by more than $6,000 a year--that's a lot of money,
Mr. Chairman--more than doubling their costs. Instead of fulfilling a
promise to our seniors, a promise that the people who gave everything
for us would have something in their golden years, the plan would bring
about a corporate takeover of our health care. Insurance company
bureaucrats would be able to deny seniors care that they had paid into
for their entire lives. The GOP plan no longer guarantees seniors the
same level of benefits and choice of a doctor that they have today
under Medicare.
Mr. Chairman, this debate is not about the deficit. Only if it were.
This debate is about something else, and it is about whether we are
going to meet the promises of our seniors, of our children, of our
students, of our public employees, or not. It's a choice of whether
we're going to put America to work or not. It's a basic choice about
how we're going to live together.
Mr. Chairman, this debate is not about a deficit. And as my fellow
colleagues pound on this idea that we're broke, we're not broke. What
we are is unwilling to do the basics for people who have given America
so much. This debate is not about a deficit, because we can reduce the
deficit by putting America back to work. Two-thirds of American
corporations don't pay any taxes, including General Electric, Bank of
America, and others. If we ask people to just do their fair share,
America's not broke.
By siding with insurance industry lobbyists to raise Medicare costs
only increases the burden on our seniors while doing nothing to address
the deficit. As I said, this is not about the deficit.
Raising taxes for 95 percent of Americans to pay for a trillion-
dollar tax cut for CEOs who ship American jobs overseas sides with the
rich at the expense of the middle class.
Spending billions on handouts for corporate special interests,
including $40 billion on Big Oil, only drives up prices at the pump for
families who are already hurting the most.
The Progressive Caucus, Mr. Chair, has a plan that puts people's
priorities first. Our budget, which we call ``The People's Budget,''
strengthens Medicare and Social Security. It lets Medicare negotiate
cheaper drug prices so insurance company bureaucrats can't deny you the
medication you need. And it creates jobs by eliminating the deficit by
2021. That's right. The Progressive Caucus eliminates the deficit. That
is the fiscally responsible budget. That's a budget that Americans can
get behind. Not some budget that rewards the rich at the expense of
everybody else and doesn't do anything to end the deficit.
I'll not stand for a vision of America that throws American seniors
under the bus. We have a vision of honoring our seniors, honoring those
people, the Greatest Generation, the generation that brought us civil
rights, women's rights, human rights, the generation that brought us
Medicare. We are in a generational fight, Mr. Chairman, and generations
in the future will look back on us and ask us why did we let the
Republican Caucus take away the basic promises of America, and we will
be able to stand now and say, We didn't. We fought them back and we
fought for America where everybody does better because everybody does
better, including our seniors.
I yield back the balance of my time.
The Acting CHAIR. The question is on the amendment offered by the
gentleman from California (Mr. Cardoza).
The question was taken; and the Acting Chair announced that the noes
appeared to have it.
Mr. CARDOZA. Mr. Chairman, I demand a recorded vote.
The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further
proceedings on the amendment offered by the gentleman from California
will be postponed.
Amendment No. 7 Offered by Ms. Foxx
Ms. FOXX. Mr. Chair, I have an amendment at the desk.
The Acting CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:
Page 4, after line 12, add the following:
(d) Prohibition Against Abortion.--Section 340H of the
Public Health Service Act (42 U.S.C. 256h) is amended by
adding at the end the following new subsection:
``(k) Prohibition Against Abortion.--
``(1) None of the funds made available pursuant to
subsection (g) shall be used to provide any abortion or
training in the provision of abortions.
``(2) Paragraph (1) shall not apply to an abortion--
``(A) if the pregnancy is the result of an act of rape or
incest; or
``(B) in the case where a woman suffers from a physical
disorder, physical injury, or physical illness, that would,
as certified by a physician, place the woman in danger of
death unless an abortion is performed including a life
endangering physical condition caused by or arising from the
pregnancy itself.
``(3) None of the funds made available pursuant to
subsection (g) may be provided to a qualified teaching health
center if such center subjects any institutional or
individual health care entity to discrimination on the basis
that the health care entity does not provide, pay for,
provide coverage of, or refer for abortions.
``(4) In this subsection, the term `health care entity'
includes an individual physician or other health care
professional, a hospital, a provider-sponsored organization,
a health maintenance organization, a health insurance plan,
or any other kind of health care facility, organization, or
plan.''.
The Acting CHAIR. The gentlewoman from North Carolina is recognized
for 5 minutes.
Ms. FOXX. Thank you, Mr. Chairman.
My amendment is designed to protect life and the livelihood of those
who defend it.
Since 1973, approximately 50 million children have been aborted in
the United States. This is a tragedy. According to a CNN poll last
month, more than 60 percent of Americans oppose taxpayer funding for
abortion. This number includes many of my constituents and is
consistent with my strong
[[Page H3372]]
pro-life convictions. I am offering my amendment today to ensure that
their hard-earned money will not be used to pay for elective abortions
or given to organizations that discriminate against pro-life health
care providers.
Earlier this month, the House passed H.R. 3, the No Taxpayer Funding
for Abortion Act, which codifies many longstanding pro-life provisions
and ensures that taxpayer money is not being used to perform elective
abortions. H.R. 3 is now awaiting consideration in the Senate, but I
will not cease to fight to protect the unborn children in America at
every turn.
This amendment ensures that the grants being provided to teaching
health centers are not being used to perform elective abortions and
makes it crystal clear that taxpayer money is not being used to train
health care providers to perform abortion procedures.
Mr. Chair, when the liberal Democrats rammed through their government
takeover of health care, in an unprecedented fashion, they refused to
include longstanding pro-life provisions. With this bill, House
Republicans are seeking to restore a grant program for residency
programs to the regular appropriations process, and my amendment
explicitly and permanently ensures that should the appropriations
committee fund this program, taxpayer money will not be used to pay for
elective abortions or train abortion providers.
In addition to the need for a permanent prohibition of taxpayer
funding for elective abortions, it is also important that scarce
resources are allocated to the most worthy applicants. An applicant
that demands that individuals and institutions provide or refer for
abortions is simply not the kind of applicant that should be funded
under this program. Numerous doctors, nurses and other health care
providers refuse to perform or participate in abortions because they
believe it is wrong to kill a child. Congress should ensure that these
individuals are not discriminated against because of their beliefs. Any
form of discrimination is abhorrent, and individuals should not be
forced to act against their convictions. This amendment is similar to
previous efforts to protect pro-life health care providers and is
consistent with these efforts.
To be eligible for funding under this grant program, centers have to
agree that they will not discriminate against pro-life health care
providers.
My colleagues across the aisle may argue that we already have the
Hyde amendment that prohibits taxpayer funding for elective abortion
for programs that are included in the Labor, Health and Human Services
and Education appropriations legislation. However, this amendment must
be included every year. My amendment ends the uncertainty for this
program by providing a permanent prohibition on taxpayer funded
elective abortions and protects pro-life health care providers. Until
we have a permanent prohibition on taxpayer funding of elective
abortion and protections for health care providers who cherish life, I
will continue to offer and support efforts to support taxpayers,
families and children from the scourge of abortion.
The unborn are the most innocent and vulnerable members of our
society and their right to life must be protected. Therefore, I urge my
colleagues to vote in favor of this amendment.
Mr. Chairman, I yield back the balance of my time.
Ms. DeGETTE. Mr. Chairman, I rise in opposition to the amendment.
The Acting CHAIR. The gentlewoman from Colorado is recognized for 5
minutes.
Ms. DeGETTE. Thank you, Mr. Chairman.
Well, here we are again, forced to stand up again to protecting
women's health care against an extreme agenda. I disagree with the
whole underlying bill, Mr. Chairman, but even so, even so, how one
could tie restricting a woman's right to choose to graduate medical
education is sort of beyond me.
{time} 1600
Let me explain why this is just an extreme and direct attack on
women's health.
What it would mean is that across the country residents would be
barred from learning how to perform even a basic medical procedure
required for women's health. This amendment would jeopardize both
education and women's health care by obliterating funding for a
necessary full range of medical training by health care professionals.
And here's the thing. The Hyde amendment is the law of the land right
now. I don't like the Hyde amendment. I would repeal the Hyde
amendment. But frankly, the Hyde amendment has been in place for over
30 years, and it's not going away. And what it says is no Federal funds
shall be used for abortions except in the case of rape, incest, or the
life of the mother.
Now, there is nothing in the Hyde amendment about restricting medical
doctors' training to legal medical procedures. There's nothing about
graduate medical education in the Hyde amendment whatsoever. And if we
pass this amendment, we will not allow basic medical training that
would even allow doctors to provide the procedures that are allowed
under the Hyde amendment--life, rape, or incest.
And let me talk about why this is so incredibly dangerous for women's
health.
Ensuring that doctors and nurses are fully trained in abortion
procedures is essential to ensuring that they can be providing
lifesaving care when abortion is a medically necessary procedure to
save the life of a pregnant woman.
Now, most pregnancies, thank goodness, progress safely. But sometimes
there's an emergency. And sometimes a medical abortion is necessary to
protect a woman's health or life. For example, Mr. Chairman, in cases
of preeclampsia, hemorrhage, and severe pulmonary hypertension, or
bleeding placenta previa, which can be fatal if left untreated, an
abortion is a life-saving procedure. In addition, in managing a
miscarriage, sometimes an abortion procedure is essential to saving the
woman's life.
Now, under this amendment, virtually any type of health care facility
could face the loss of funding if they needed to provide abortion care
in an emergency situation. And moreover, Mr. Chairman, residents need
to be trained in how to handle these very complicated conditions that
could necessitate an abortion.
I'm afraid to say these examples are tragically real. The case
involving a woman experiencing severe hypertension that threatened her
life at St. Joseph's Hospital made the news when a nun, Sister McBride,
was excommunicated last year for allowing the woman's life to be saved
through an abortion.
The Foxx amendment would also greatly expand the reasons why health
care entities should give in to refusing care.
So, Mr. Chairman, here's the thing. Maybe we don't like abortions,
and all of us wish abortions would be rare. But sadly, even in the case
of a wanted child with a loving home and everything else, even in the
case of an exception under the Hyde amendment, sometimes abortions are
necessary. And if we say we are not going to train doctors how to
provide a range of women's health care services, then we are basically
allowing women to bleed to death in the emergency rooms of this
country. And I don't think that's what this Congress is about. It is
certainly not what the medical profession is about.
I would urge just for reasons of mercy for this House to reject this
amendment. It's mean-spirited and it's far, far beyond current law.
With that, Mr. Chairman, I yield back the balance of my time.
Mr. GARAMENDI. Mr. Chair, I move to strike the last word.
The Acting CHAIR. The gentleman from California is recognized for 5
minutes.
Mr. GARAMENDI. Mr. Chairman, I find myself in opposition to the
underlying bill and the amendment.
You just heard a very cogent argument. I don't understand why we
ought to have ignorant doctors. It doesn't make any sense to me.
Abortions are sometimes necessary for saving the life of a pregnant
woman. And to have a medical system in which the doctors don't know
about that procedure is really stupid. I won't say this amendment is
that, but it's really not wise to have ignorant physicians. And it's
really not wise not to have physicians at all.
What in the world are we thinking here? What's the purpose of this
[[Page H3373]]
amendment and this particular resolution? To deny American men, women,
and children the opportunity to go to a doctor? We know all across this
Nation that there is a shortage of primary care physicians. In most
every community of California, there is a shortage of primary care
physicians. Plenty of dermatologists, but not primary care physicians.
So what are we going to do here? Eliminate the funding to train
primary care physicians.
Now, that in itself is bad enough. But this is just one piece of a
much larger plan to dismantle health care in America. The repeal of the
Affordable Health Care Act will increase the cost of medical services
all across this Nation and particularly increase the cost to
government. Not my projection. The independent Congressional Budget
Office said clearly that the Affordable Health Care Act will reduce the
cost of Medicare and Medicaid.
So repeal it. Increase the deficit. Huh? Is that what this is all
about? I don't get it guys and women. Makes no sense to me.
And now in your budget, the Republicans go after Medicare and
terminate Medicare for every American who is not yet over 55 years of
age? Terminate it. And turn it over to the rapacious, greedy, profit-
before-people health insurance industry, an industry that I know a
great deal about. I was the insurance commissioner in California for 8
years, and I know those characters. It is about profit. It's not about
caring for people.
And when you say the government shouldn't make decisions, the
government does not make decisions in Medicare. The physicians make
decisions. But if you turn Medicare over to the insurance companies, it
will be the insurance companies that make decisions about medical
services.
And by the way, you also voted to repeal those sections of the
Affordable Health Care Act that protect all of us from the
rapaciousness of the health insurance industry. Eliminating a law which
eliminates such things as preexisting conditions, age, sex
discrimination, and the rest. So you repeal that and give back to the
insurance companies the opportunity to discriminate. And now you want
to throw tomorrow's seniors into that same pool of sharks.
I don't get it. It makes no sense whatsoever. It perhaps is the worst
idea I've heard in the 35 years I have been involved in public health
and in public policy. It makes no sense whatsoever.
And this bill on top of it? Come on. We're not going to train primary
care physicians? What in the world are you thinking? I don't get it. I
don't get the whole strategy. It is a strategy that will put America's
health at risk. It is a strategy that will deny benefits. It is a
strategy that will provide us, with this latest amendment, doctors that
are ignorant about basic women's health. And it is a strategy that will
deny us the necessary primary care physicians.
What in the world are my Republican colleagues doing here about the
deficit? Come on now. What you're doing is going to increase the
deficit. You're going to increase the deficit. If there are not primary
care physicians, then you'll go to the emergency room. And everybody
knows that the emergency room is more expensive than a doctor's office.
What are you doing? I don't get it, guys. I don't understand. You're
worried about the deficit; yet you take action that increases the
deficit? It makes no sense to me.
Madam Chair, I yield back the balance of my time.
Mr. GENE GREEN of Texas. Madam Chair, I move to strike the last word.
The Acting CHAIR (Mrs. Capito). The gentleman is recognized for 5
minutes.
Mr. GENE GREEN of Texas. First of all, I have utmost respect for
Congresswoman Foxx of North Carolina. But her amendment is a solution
in search of a problem. Graduate medical education does not do
abortions.
{time} 1610
The teaching hospital center program funds training for primary care
residents. There is no payment for services in the law. It's about
salaries, benefits, and paying faculty. Teaching health centers will
pay for abortions no more than Medicare Graduate Medical Education has
paid for abortions for the last 45 years.
The President signed the executive order to make all the provisions
subject to the Hyde amendment, all the provisions of the Affordable
Care Act subject to the Hyde amendment. The executive order establishes
a set of policies for all provisions of the Affordable Care Act to
``ensure Federal funds are not used for abortion services'' consistent
with the Hyde amendment. The Presidential order reinforces what we all
agree on. No one is here claiming that we should use Federal funds for
abortion, except in very limited circumstances, whether they are under
this program or elsewhere.
There is another layer of protection codified in permanent law under
section 245 of the Public Health Service Act. The Coats amendment
clearly prohibits the Federal Government from discriminating against
any physician, post-graduate physician training program, or participant
in a program of training in the health care professions because the
entity refuses to participate in abortion training. That's not an
appropriations vehicle; it's not an executive order. It's the law of
the land.
That's why I say this amendment is a solution in search of a problem.
There is not a problem with Graduate Medical Education, whether they be
teaching hospitals, whether they be community-based centers that this
bill is subject to.
I yield back the balance of my time.
Mrs. CAPPS. Madam Chair, I move to strike the last word.
The Acting CHAIR. The gentlewoman from California is recognized for 5
minutes.
Mrs. CAPPS. I rise in strong opposition to this dangerous amendment.
Last month, the Republican majority brought us to the brink of
government shutdown over its disapproval of Planned Parenthood. But
here we are again, a new week, but the same obsession with reopening
the culture wars. This time, instead of saying that Congress knows
better than a woman and her family about her reproductive health care,
this amendment takes one step further. It says that Congress knows
better than our medical doctors and medical educators about what our
medical training curricula should look like. This is an unprecedented
restriction, one that goes against the Accreditation Council for
Graduate Medical Education's guidance and against medical ethics
themselves.
Medical education is supposed to prepare our future doctors for
whatever they may come across in their practice. This includes women
whose lives are in danger due to their pregnancy, for whom terminating
a pregnancy is the only way that woman will stay alive. Keeping future
providers from learning these procedures--and it is an option that they
may choose only if they choose to learn it--puts these women at risk.
Regardless of what one's views are on women's reproductive rights, I
think we can all agree that our future medical providers should be
trained and ready for any medical emergency that they might encounter.
To play politics with their education and the lives of women is an
embarrassment.
Madam Chair, it is time for this Congress to learn to trust the
American people, to trust our doctors, to trust our families, and to
trust women.
The American Congress of
Obstetricians and Gynecologists,
Washington, DC, May 24, 2011.
ACOG Opposes the Foxx Amendment to H.R. 1216
The American Congress of Obstetricians and Gynecologists
(ACOG), representing 55,000 ob-gyns and partners in women's
health, opposes the Foxx amendment to H.R. 1216, an amendment
to the Public Health Service Act.
The Foxx amendment would disallow GME funding for abortion
training, part of ob-gyn educational curricula in accredited
medical residency programs, and unnecessarily duplicate
already recognized protections for medical students and
teaching hospitals who choose to not participate in abortion
training.
Residency education standards are set by the universally
recognized Accreditation Council for Graduate Medical
Education (ACGME) whose Residency Review Committees (RRCs)
accredit residency programs. These standards, supported by
the American College of Obstetricians and Gynecologists,
require that ``experience with induced abortion must be part
of residency training.''
These standards already fully accommodate institutions,
programs, and individuals
[[Page H3374]]
who choose not to participate in abortions or abortion
training. Every ob-gyn residency program may opt out of
providing in-house training, and is required only to offer
their residents an opportunity for abortion training at an
outside facility. Similarly, residents with religious or
moral objections may opt out of receiving abortion training,
and are required only to be trained in management of abortion
complications--not the provision of abortion, but the care of
potential consequent medical complications.
Training in abortion, for those institutions, programs, and
individuals who choose to participate, is important to
women's health. Federal funds may be used for abortions in
cases of rape, incest, or when a woman's life is endangered.
Girls and women who are victims of rape or incest, or whose
lives are endangered by their pregnancies, must have
continued access to this surgical procedure, and this care
must be safely provided by trained medical specialists.
The Nation's women's health physicians urge a no-vote on
the Foxx amendment. Should you have any questions, please
contact Nevena Minor, ACOG Government Affairs Manager, at
[email protected] or 202-314-2322.
I yield back the balance of my time.
Mr. TONKO. Madam Chair, I move to strike the last word.
The Acting CHAIR. The gentleman from New York is recognized for 5
minutes.
Mr. TONKO. Madam Chair, I rise in opposition to H.R. 1216, the
underlying bill. As a resident of upstate New York, where much
attention has been given to today's special election for a
congressional seat, people are saying loud and clear, Hands off my
Medicare.
Republicans are determined again to put us on the road to ruin with
their plans to end Medicare. Despite outcries from their constituents,
they are pushing forward to end a program that 46 million seniors and
disabled individuals depend on for their health care. This gross
injustice is made immeasurably more egregious and offensive by the fact
that this is being done not to balance the budget, but to expand and
permanently guarantee even bigger tax cuts for millionaires and
billionaires, and to give new tax breaks to some of the world's most
profitable companies, including oil.
I have heard a lot of talk in the last few months about the need to
make tough choices these days. The average senior on Medicare earns
just over $19,000 a year. About one quarter of Medicare beneficiaries
suffer from a cognitive or mental impairment, and most have at least
one or more chronic medical conditions. So I ask my Republican
colleagues, what exactly is it about stripping these Americans bare of
their health and economic security that qualifies as tough? There is
nothing tough about stealing from the poor or the weak to give to the
rich.
Our seniors, on the other hand, know all about tough choices: Do I
buy groceries, or do I buy prescriptions? Do I pay rent, or do I pay
medical bills? It hurts, but how much will it cost? These are those
tough choices. These are life and death choices. With the passage of
Medicare in 1965, we entered into a covenant with each and every
American citizen.
The Republican voucher plan ends Medicare. Instead, seniors will be
on their own with a measly voucher and forced to buy insurance in the
private market, where all decisions will be profit-driven. More profits
for insurance companies on the backs of seniors. Sounds like a
Republican plan to me. This new voucher program amounts to a ration
card. The value of the voucher is not linked to increases in health
care costs in the private market, yet the costs of private health
insurance have risen over 5,000 percent since the creation of
Medicare--5,000 percent.
The analysis of the nonpartisan Congressional Budget Office has
estimated that in less than 20 years these vouchers would pay just 32
cents on every dollar that a senior would spend on health care
premiums. Now, the Republican leadership has repeatedly stated that
this budget gives seniors the same coverage as Members of Congress.
Well, as a Member of Congress myself, I know that our health plans pay
for about 72 cents on every dollar of health coverage, not 32 cents.
America knows that legislation in Congress carries a statement of
priorities and values, not purely dollars and cents. And what sense
does it make to cut funding for training primary care physicians who
are on the front lines not only of keeping our constituents and
communities healthy, but also of lowering health care costs with early,
simple treatments?
I urge my colleagues to stand with our seniors and stand up for
middle class priorities. Let's defend our middle class. Let's defend
our working families. I urge my colleagues to oppose this bill.
Madam Chair, I yield back the balance of my time.
Ms. TSONGAS. Madam Chair, I move to strike the last word.
The Acting CHAIR. The gentlewoman from Massachusetts is recognized
for 5 minutes.
Ms. TSONGAS. Madam Chair, I rise in opposition to the underlying
bill, H.R. 1216, and to the ongoing efforts by my colleagues across the
aisle to undermine our constituents' access to affordable health care.
I recently heard from my constituent from Haverhill, Massachusetts,
named Phil Gelinas, who relies on Medicare for his health coverage. His
wife's diabetes treatment and prescription drugs are also covered
through Medicare, and they have both paid into Medicare all their lives
through payroll deductions. He remarked to my office that there was no
way that they could meet the cost of health care today without
Medicare.
He and his wife are not alone. Each day, thousands of seniors like
the Gelinases use Medicare to cover the costs of doctors' appointments,
prescription drugs, as well as routine tests and treatments.
Under the budget that House Republicans passed in April and that the
Senate is set to consider this week, the Medicare program that seniors
have relied on for more than 50 years to meet their medical needs and
expenses would be eliminated. In its place would be a voucher system
that pays a small lump sum to private insurers to cover seniors. Any
costs not covered by that payment would fall to seniors to pay or
forego coverage.
My colleagues on the other side of the aisle argue that elimination
of Medicare is needed to help reduce the deficit, and that the same
benefits that seniors now enjoy under Medicare will be replicated in
the private insurance market. Not so. In reality, their plan will
result in a far lower standard of care for seniors, while trillions of
dollars continue to be added to the national debt. Rather than taking
steps to reduce the underlying increases in health care costs, which in
turn drive up the cost of Medicare, their plan simply shifts those
costs to seniors.
The value of the vouchers that would replace Medicare would not keep
pace with rising health care costs, so seniors will be increasingly
required to make up the difference. Just 8 years after the program
starts, a voucher will cover less than one-third of the cost of a
private health insurance package with the same benefits as Medicare
currently provides, leaving seniors to cover the rest.
{time} 1620
According to the nonpartisan Congressional Budget Office, the average
senior will end up spending nearly twice as much of their income on
health care than under the current Medicare system. That is why AARP
released a statement warning that the budget ``would result in a large
cost shift to future and current retirees. The Republican proposal,
rather than tackling skyrocketing health care costs, would simply shift
those costs onto the backs of people in Medicare.''
Instead of focusing on cost control measures that would bring down
the cost of Medicare, the budget claims cost savings but only by
passing those costs directly on to our seniors.
Furthermore, because costs have typically grown faster in the private
market than in Medicare, the costs faced by seniors under the
Republican plan will be much higher than the costs faced by the Federal
Government now.
My colleagues have argued that seniors won't be affected by these
costs for years to come, but this is simply not true. For example, the
House budget immediately reopens the prescription drug doughnut hole
for current seniors that was fixed with passage of last year's health
reform law. It also significantly increases costs for seniors now
residing in nursing homes and for their adult children who may not be
able to afford their parents' care.
Despite being presented as a solution for our deficits, the budget
proposal
[[Page H3375]]
would still add $8 trillion to the national debt over the next 10
years. These new debts are incurred in part because their budget
proposal also slashes taxes for the wealthiest Americans while
continuing to provide billions in tax breaks for oil companies and
other preferred industries.
Real deficit reduction will require a blend of spending reductions,
new revenue, and additional reforms to control rising health care
costs. But simply shifting those costs onto seniors by eliminating
Medicare will prove as unsustainable for our Nation's well-being as the
current budget crisis we face.
Mr. DAVIS of Illinois. Madam Chair, I move to strike the last word.
The Acting CHAIR. The gentleman is recognized for 5 minutes.
Mr. DAVIS of Illinois. Madam Chairman, I rise in opposition to the
Foxx amendment and to the underlying bill, H.R. 1216, to amend the
Public Health Service Act, to convert funding for graduate medical
education in qualified teaching health centers from direct
appropriations to an authorization of appropriations.
This bill would eliminate mandatory funding that establishes new or
expanding programs for medical residents in teaching health centers and
unobligated funds previously appropriated to the grant program.
Under policies currently being considered by some in the House
majority, academic medical centers and teaching hospitals face as much
as $60 billion in cuts over the next 10 years to Medicare funding for
indirect medical education and direct graduate medical education. These
cuts would reduce indirect medical education payments by 60 percent
from the current level of 5.5 percent to 2.2 percent, capping direct
graduate medical education payments at 120 percent of the national
average salary paid to residents.
It would reduce Federal funding for medical residency training, as
wrong public policy. Given our present situation with the shortage of
primary care and family practice physicians, and the expected future
growth of our population, it makes no sense for the Republicans to end
the present structure of Medicare. In 2010, 47.5 million people were
covered by Medicare. We have 39.6 million at the age of 65 and older
and 7.9 million disabled.
The Republican budget plan is a voucher plan that would raise health
care costs and would immediately create higher costs for prescription
drugs for our seniors and disabled. This plan would end Medicare's
entitlement of guaranteed benefits and promote rationing by private
insurance companies, who would make decisions on approving or
disapproving treatments for our seniors and the disabled.
The Medicare program is efficiently managed, devoting less than 2
percent of its funding to administrative expenses. Medicare has
dramatically improved the quality of life for seniors and the disabled.
It is the largest source of health coverage in the Nation. Democrats
are committed to strengthening Medicare, not tearing it down.
Under the guise of reform, Republicans desire to end Medicare as we
know it today.
Last year, the Republicans promised the American people that jobs
would be their number one priority. Well, I ask, where are the jobs?
But, instead, they want to make draconian cuts to programs to help
seniors and the disabled, the middle class, the poor and the needy, and
yet provide tax cuts of over $1 trillion to millionaires and
billionaires.
And so we ask, where are the jobs and where are the opportunities?
The estimated 1-year impact of anticipated graduate medical education
cuts for Illinois is $144 million for indirect medical education and
$39 million for graduate and medical education, which totals $183
million. If there are no doctors, there can be no medical care.
I urge that we vote against these measures.
Ms. WATERS. Madam Chair, I move to strike the last word.
The Acting CHAIR. The gentlewoman from California is recognized for 5
minutes.
Ms. WATERS. I rise in opposition to the underlying bill, H.R. 1216,
which would undermine the teaching health centers program, which trains
primary care physicians.
Madam Chairman and members, this is just one more trick by
Republicans to dismantle health care reform. They are going after the
training of primary doctors. We need more primary doctors, even if
there was no health care reform. There are many communities throughout
this country that have no primary health care physicians.
Our Nation is facing a serious shortage of primary care physicians.
Primary care physicians are an essential part of a successful health
care system. They are the first point of contact for people of all ages
who need basic health care services, whether they are working people
with the employer-provided health insurance, low-income children on
Medicaid, or seniors on Medicare.
The Republicans have made it clear that they are not concerned about
access to basic health care services. The Republican budget for fiscal
year 2012 turns Medicare into a voucher program, slashes Medicaid by
more than $700 billion over the next decade, and cancels the expansion
of health insurance coverage, which was included in the The Affordable
Care Act last year.
The Republican budget cuts to Medicare are especially detrimental to
current and future Medicare recipients. Under the Republican budget,
individuals who are 54 and younger will not get government-paid
Medicare benefits like their parents and grandparents. Instead, they
will receive a voucher-like payment to purchase health insurance from a
private insurance company.
There will be no oversight to these private programs. We will not be
able to contain the cost. We will not be able to mandate what the basic
services should be. As a matter of fact, we know the stories about the
HMOs and the fact that they had accountants who determined what care
you could get, not physicians who had the knowledge and the ability to
determine what you need.
When the first of these seniors retire in 2022, they will receive an
average of $8,000 to buy a private insurance plan. That is much less
than the amount of the subsidy Members of Congress receive for our
health plans today.
The coverage gap in the Medicare prescription drug program will
continue indefinitely. Under the Affordable Care Act, this so-called
doughnut hole is scheduled to be phased out. The Republican budget will
allow seniors to continue to pay exorbitant prices for their
prescriptions when they reach the doughnut hole. The Republican budget
also gradually increases the age of eligibility for Medicare from 65 to
67 years of age.
Madam Chairman, the Republican budget is also detrimental to
Americans who depend again on Medicaid, including low-income children,
disabled Americans, and seniors in nursing homes. The budget converts
Medicaid into a block grant program and allows States to reduce
benefits, cut payments to doctors, even freeze enrollment. Medicaid
funding is slashed by more than $700 billion over the next decade.
{time} 1630
That is over one-third of the program's funding.
Meanwhile, the Republican budget extends the Bush-era tax cuts beyond
their expiration in 2012 and cuts the top individual tax rate down to
25 percent from 35 percent. According to the Center for Tax Justice,
the Republican budget cuts taxes for the richest 1 percent of Americans
by 15 percent while raising taxes for the lowest income 20 percent of
Americans by 12 percent.
The national shortage of primary care doctors is not a problem for
multimillionaires. They will always be able to find a doctor who will
treat them and pay them whatever they ask for. But most American
seniors need well-trained primary care physicians and Medicare benefits
that they can rely on.
I urge my colleagues to oppose the underlying bill, oppose the
drastic cuts to Medicaid, and oppose the Republican plan to dismantle
Medicare. They're trying to dismantle health care reform piece by
piece, inch by inch. Today it's an attack on training needed by primary
care physicians. What is it tomorrow?
We know that they have a strategy that includes hundreds of bills
that would dismantle, again, piece by piece Medicare reform. It's not
fair, Madam Chair and Members. Health care reform
[[Page H3376]]
so that all Americans are covered is something that we should all
support.
Ms. WOOLSEY. Madam Chair, I move to strike the last word.
The Acting CHAIR. The gentlewoman from California is recognized for 5
minutes.
Ms. WOOLSEY. Madam Chair, I rise in opposition to this amendment and
the underlying bill, H.R. 1216.
This is just the last attempt, the latest and newest attempt, by the
majority to stall health care reform and undermine the health security
of the American people. We had barely taken our oaths in January when
they voted to repeal the Affordable Care Act; now trying to eliminate
title X funding that provides critical primary care for women, and last
month they went after the funding for the health care exchanges, and
they voted to cut grants for school-based health centers that served
young children.
But worst of all is the Republican budget resolution that was passed
last month. It rips the heart out of Medicare, eviscerates and
disfigures a program that would no longer be recognized. It's one of
the more radical proposals I've seen during 18 years in Congress. They
want to strip guaranteed benefits and break the Medicare promise that
has served our seniors so well for nearly half a century.
And what do they replace it with? A voucher. A voucher that won't be
able to keep up with soaring health care costs, a voucher that will
give seniors no leverage in the health care marketplace, a voucher that
will put older Americans at the mercy of the insurance companies.
Madam Chairwoman, the CBO has concluded that the Republican proposal
will double health care costs for seniors. So if you are 54 years old
today, you will need to save an additional $182,000 to make up for the
Medicare benefits you will lose under the Republican plan.
And they are not content to destroy Medicare. Medicaid comes in for
brutal treatment as well. By converting it to a block grant, they would
be throwing as many as 44 million Americans off the insurance rolls,
eliminating coverage for the poorest people, most nursing home
residents and people with disabilities.
My friends on the other side of the aisle who say we have to do this
to balance the budget, they know they're wrong. I say they're dead
wrong. We do not need to put seniors and low-income Americans on an
austerity program in order to rein in the deficit. We do not need to
shred the social safety net or to squeeze the middle class in order to
get our fiscal house in order. In fact, we can save taxpayers $68
billion over 7 years and expand the menu of health care choices by
instituting a public option. If you ask the American people, they would
rather see some shared sacrifice than cutting spending. They would
rather see us eliminate tax breaks for CEOs who have no idea what it's
like to choose between taking their medication or eating their next
meal.
Madam Chairwoman, I will vote ``no'' on H.R. 1216. It's just another
example of Republican negligence and callousness on health care. They
clearly prefer the broken system that leaves millions uninsured,
imposing crippling costs that bankrupt families and bankrupt small
businesses. The majority doesn't want to solve the health care crisis.
They want to exacerbate it.
Ms. RICHARDSON. Madam Chair, I move to strike the last word.
The Acting CHAIR. The gentlewoman from California is recognized for 5
minutes.
Ms. RICHARDSON. I rise to speak in opposition to H.R. 1216.
Under the guise of deficit reduction, Republicans, through H.R. 1216,
are attempting to attack our Nation's vital support system for our
seniors. The Republican budget would deny seniors, and those who are
coming forward after those that are currently taking advantage of these
benefits, health care, long-term care, and the Social Security benefits
that these seniors have earned.
Sunday evening, I just got back from my district where I had an
opportunity to have our annual senior briefing, and there were over 900
seniors who were there and they were concerned. I spoke with several of
my seniors in my district, and they're worried about how they and even
some of their parents who are in their nineties today will be able to
get by once RyanCare--which is what I'm going to call it, the attack on
Medicare--destroys something we all need. By following RyanCare and
turning Medicare into a voucher program, Republicans would gradually
eliminate the peace of mind that many of our seniors have grown to be
able to count on.
We don't want to go back to the old days of calling seniors ``poor''
and not having an opportunity to live in dignity in the last years.
These fixed value vouchers, which are being suggested in RyanCare,
would not only not keep up with the rising costs of health care, but it
would cost seniors an additional $7,000 more per year by 2020.
In California alone, which is where I'm from, under the Republican
budget, seniors would pay $214 million more on prescription drugs in
2012 alone. That's next year.
The Republican budget would return our country to a time when being
old was something that people would be afraid of, not look forward to.
The Republican budget would also turn Medicaid into a block grant
system. Haven't we seen what that's done with community development
block grants? It wouldn't work. Under a block grant system, Medicaid
would no longer be able to support the elderly. By converting the
current Medicaid system into a block grant index to inflation and
population growth, Congress would shift the burdens of rising health
care costs and aging populations to the States. All you have to do is
look at the Los Angeles Times to see what's happening to my State, and
I don't think we'd be able to help the seniors.
The deficit must be addressed. In fact, I've supported many bills and
amendments that have been brought forward on the other side. But it
should be done in a fair way. We should not balance the budget on the
backs of our Nation's seniors, not after Wall Street and our car
manufacturers got a bailout.
I will, and Democrats will, continue to work to protect, strengthen,
and save Social Security, Medicare, and Medicaid.
Ms. EDWARDS. Madam Chair, I move to strike the last word.
The Acting CHAIR. The gentlewoman from Maryland is recognized for 5
minutes.
Ms. EDWARDS. I rise in opposition to the underlying bill.
Madam Chair, Republicans have returned to the Hill after a hard week
at work in our districts really trying to explain away the plan to
dismantle Medicare to their constituents. But I want to tell it to you
really straight, Madam Chair, and that is that the reason that it's
hard to explain is because there really is no explanation. The plan
that Republicans have under consideration would indeed end Medicare as
we know it. It would end Medicare, and it's just that simple. The plan
would turn Medicare into a voucher system that would leave seniors
paying more and more out of their pockets for health care.
I was out at a town hall meeting at a senior center in my
congressional district. It's one where people have gone--they come from
every level of the private sector and business--to enjoy their
retirement. And they receive Medicare benefits. And I asked them, who
in this room, a room of about 100 or so seniors, how many of you would
like to go into negotiations with an insurance company about how much
you're going to pay for your health care? And no surprise, not a single
one of those seniors stood up. But that's exactly what the Ryan plan,
the Medicare dismantling plan, would do for seniors. It would say to
seniors, we want you to go on your own and negotiate with the big
insurance companies.
{time} 1640
Well, we know that that can happen for those of us who are younger,
but it certainly cannot happen for our seniors. It would shift the
burden on to retirees to make the system much less efficient and
increase administrative costs that are eventually passed on to all
consumers.
According to the Congressional Budget Office, the Republican plan
would raise the eligibility age for beneficiaries from 65 to 67. And it
repeals provisions of the Affordable Care Act that are actually
designed to make the system even more efficient. This just
[[Page H3377]]
doesn't make sense. I think seniors have caught on. In fact, I think
all Americans have caught on.
The thing about Medicare is it is not just about our seniors, Madam
Chair. It is also about the contract that each of us, one generation,
makes to the next generation. It is the contract that I have made with
my mother and my son makes with me, and it is to make sure that we are
taken care of in our old age because we have paid into it and we have
paid for it.
According to the Center for Economic and Policy Research, a 54-year-
old worker would need to save an additional $182,000 to pay for the
higher cost of private insurance with the government elimination of
Medicare; $182,000, let's just absorb that for all of those 54 year
olds. How long is it going to take you to get to age 65 and save
$182,000 to pay for your health care costs? Well, we know that that
would be an impossibility.
I want to tell you what is happening in Maryland because it will
happen all across this country. It is that our seniors are recognizing
that the GOP plan would require seniors to pay an additional $6,800 out
of their own pockets for expenses for health care, and that is not
including the fact that they will have to negotiate and probably pay
even more than that.
So at a time when our seniors are vulnerable and they are struggling
and they have seen a depletion in their savings, it is really not fair
to threaten them and to threaten their quality of life by ensuring that
they are going to have to pay these out-of-pocket costs.
So I would ask us, Madam Chair, to really examine what it is that we
are asking the American people to absorb.
I was up with a group of seniors in New Hampshire, and throughout my
congressional district; and our seniors are saying to us, It is not
just about us, and don't count on us supporting this plan just because
we happen to be over age 55. We support Medicare because we understand
what it means for future generations.
So this is a link, a bond between the young people in this country
who are working, our seniors and our retirees, to protect Medicare and
to protect the benefits that come with it.
I would ask us on this underlying bill--I think some of my colleagues
have spoken to this--we need more primary care. Already we are seeing
what is happening in our system where 26 year olds, up to 26 year olds,
can be covered on their parents' health insurance. Do you know what
that is doing? It is actually bringing down the cost. It is making sure
that we have more resources to absorb the care that people need as they
get older.
And so let's not stomach a dismantling of the Medicare protection
that we have known for 46 years in this country, this contract from one
generation to the next generation, to ensure that our seniors who have
worked so hard are able to enjoy their retirement without sacrificing
everything that they have to pay the cost for additional benefits while
health insurance companies walk away with record profits, and certainly
while oil and gas companies walk away with theirs.
Mr. GUTHRIE. Madam Chair, I move to strike the last word.
The Acting CHAIR. The gentleman from Kentucky is recognized for 5
minutes.
Mr. GUTHRIE. I rise in support of the Foxx amendment. We have been
debating the bill throughout the day, and I support the bill.
I just want to comment, I was also back home last week, and I went to
a 100th birthday party for a group of people in northern Kentucky in
the Louisville area and part of my district who were turning 100 years
old. There was a lady there who was 103. She was born during Teddy
Roosevelt's Presidency. I went there to thank them. I am one who is a
big believer in what the Greatest Generation has done for us. I am a
member of the baby boom generation. I was born in 1964. I am 47 years
old. From 1946 to 1964, if you were born in 1946, you are in Medicare
this year; you are 65 years old. I wanted to thank them and let them
know that what we are doing is making a sustained and secure Medicare
system for them.
We all know as of the end of last week that 2024 is the date put out
that Medicare goes bankrupt. So what we have put together is a real
proposal for 10 years to allow people the opportunity to adjust that
are 54 and younger because there is not a member of the Greatest
Generation--and if anybody says different they are wrong--there is not
a member of the Greatest Generation that is affected. As a matter of
fact, half the baby boomers are covered, are not affected by the
changes that we have to make to make a secure and better future.
I am 47 years old. This means a lot to me because my daughter is 17.
And you ask a lot of people my age: Do we have a better life-style than
our parents had? Well, the Greatest Generation gave us a better life-
style than they had because they wanted us to have a better life-style
than they had. You ask a lot of people my age: Do we think our children
will have a better life-style? It is amazing and it is disappointing to
think how many people think that our children are not going to have the
same quality of life that we had.
I didn't come to Washington, D.C. to be part of a government that
doesn't address the fact that we want our children to have a better
future than we had. In 30 years when my daughter is my age--she
graduates from high school in 2 weeks--we can pay off the national
debt.
So think about it. I am 47 years old. We have got a $14.3 trillion
debt. You ask a lot of people my age: Do you think our children will
have a better future? A lot of people say ``no'' because they say we
keep piling on debt and deficits as far as the eye can see.
Madam Chair, if you ask me now if I thought my daughter at 47 years
old is living in a country with zero national debt, do you think my
children, grandchildren and her grandchildren will have a better
future, they will. That is what we are talking about. We are talking
about saving and securing Medicare for the Greatest Generation. We are
talking about saving and securing it for people as they become older
and more mature.
So anybody that says the Greatest Generation is affected by this is
just not saying what was passed out of the House of Representatives. If
anybody is saying that seniors are affected by this, they are not
saying what was passed out of the House of Representatives. To say that
we have to reform the program to make it stronger and better for them,
that is accurate. And making it stronger and better for those who come
forward, that is what we are talking about doing. That is what the
facts are.
People deserve the facts. People are tired of hearing rhetoric. They
want facts. And the facts are that we are sustaining and securing it
for the Greatest Generation, and reforming it so it will be there as
our children mature. And if we pass the budget, if the Senate would
pass the budget that we passed out of the House, when my daughter is my
age, we will have zero national debt, and we will have a better future.
And then ask her if she thinks her children will have a better future
than she did, and I guarantee you that she will say that.
Mr. MILLER of North Carolina. Madam Chair, I move to strike the last
word.
The Acting CHAIR. The gentleman from North Carolina is recognized for
5 minutes.
Mr. MILLER of North Carolina. I rise to oppose the nonsensical
pending amendment and the underlying bill, although the underlying bill
doesn't really do all that, but most of all to disagree with the
remarks of the gentleman from Kentucky just now, and from other remarks
like that, that what the Republicans have done is not going to affect
the people on Medicare now or the people who are older than 55, 55 and
older.
What it does, in fact, is shift more and more of the cost of health
care to people who cannot afford it so that the richest Americans will
not have to pay taxes. They will cut taxes for the richest Americans by
even more, and they will protect insurance company profits and the
profits of everyone else in the health care field who are making vulgar
profits that are causing American health care to be twice as expensive
as health care anywhere else in the developed world.
The arguments and what the Republican Congress has done in these last
few months have made very clear how cynically dishonest everything
Republicans said about health care in the last 2 years really was,
especially about Medicare.
[[Page H3378]]
When Democrats really did find a way to get control of costs without
affecting the quality, the availability of care, the access to care,
the quality of care, all Republicans would say, even when it was
specifically and narrowly targeted at fraud, they said that we were
cutting Medicare. Now we see what they really think about Medicare. Now
we see how little they really do understand how important Medicare is
to the financial security of older Americans, of Americans in
retirement.
They say it will not affect you if you are over 55; if you are 55 or
older. Well, I just turned 58. It is nice to know that Republicans care
that much about me; but let me tell you, that is not the way it is
going to work.
{time} 1650
Well, when I turn 65, I'll qualify for Medicare. Presumably, I'll get
Medicare. My 96-year-old mother, who I also did visit this weekend,
will get Medicare. I feel pretty confident she'll get Medicare for the
rest of her life and that, when I turn 65, I'll get Medicare. For the
guy who is 53 now, which is just 5 years younger than I am, at 60 he'll
be paying taxes for my Medicare, and he won't be getting it. He'll
never get it. What he will get instead is a coupon, a voucher. He'll
get an allowance to go buy private insurance, and private insurance is
simply not going to pay for what Medicare pays for. It's going to be
far more expensive.
The Congressional Budget Office estimates that in just 10 years those
folks will have to pay 60 percent of their own health care costs if
this plan goes through, what they call a ``path to prosperity,'' which
should be called the ``path to insurance company profits.'' In 20
years, it will be two-thirds of their health care costs. They'll be
paying for it. They'll also be paying taxes. Working Americans, people
who are still in the workforce, will be paying taxes so that I get
Medicare, and they know that's not the deal they're getting. The deal
they'll be getting is that little voucher, that puny little voucher,
that puts them at the mercy of insurance companies.
Now, Republicans thrive on resentment. All of Republican politics
seems to be built around resentment. I don't want to have a Nation so
filled with resentment between generations. Ms. Edwards spoke just a
moment ago about the contract between generations, that just as our
parents took care of us in our childhoods, we will take care of our
parents and their generation when they retire. We'll take care of them
with our Social Security taxes and our Medicare taxes. They will get
those benefits. Yet under the Republican plan, the path to insurance
company profits, they won't get Medicare. They'll get that little
voucher.
How long is that going to go on before that resentment builds up? How
long is that going to go on before the people who are paying the taxes
for it and who know they'll never get it are going to say, No, no more
of this. We have got to change this?
Madam Chair, what we want is for all Americans to get the same deal.
We want the people who are 65 and the people who are 96 to get the same
deal, the people who are 70 to get the same deal, the people who are 58
to get the same deal, the people who are 50 and 30 to get the same
deal. If this Congress is willing to control costs, even though that
means limiting the profits of some of the people who are getting really
rich from our dysfunctional health care system, we can do that.
I yield back the balance of my time.
Mr. CICILLINE. I move to strike the last word.
The Acting CHAIR. The gentleman from Rhode Island is recognized for 5
minutes.
Mr. CICILLINE. I rise in opposition to the amendment and in defense
of our Nation's seniors, who are really under attack.
Why is that? Because the current Republican budget proposal passed by
this House and up for Senate consideration pulls the rug out from
underneath our seniors. It ends Medicare by making huge cuts in
benefits and by putting insurance companies in charge of our seniors'
health care, letting insurers decide what treatment and what tests our
seniors will receive.
Under the Republican plan, Medicare will end. It will not only impact
our seniors; it will impact the family members of our seniors, who will
now have those responsibilities. It will reopen the doughnut hole,
making it more expensive for our seniors to get their prescriptions,
the prescriptions they need to keep them healthy; and under their plan,
they will slash support for seniors in nursing homes while continuing
to give subsidies in the billions of dollars to big oil companies.
And what else? More than 170,000 Rhode Islanders, which is my home
State, rely on Medicare; and they will literally be paying to give
additional tax breaks to the wealthiest Americans in our country. To
make matters worse, the nonpartisan Congressional Budget Office
determined that this budget actually adds $8 trillion to the national
debt over the next decade because its cuts in spending are outpaced by
the gigantic tax cuts for the richest Americans.
Our seniors cannot afford this Republican budget. It would deny them
health care, long-term care, and the benefits that they have earned.
The Republicans' choice to end Medicare by cutting benefits and by
turning power over to the insurance companies for the important health
care decisions of our seniors will result in reduced coverage and an
exposure to greater financial risk for Medicare recipients, costing
seniors an estimated $6,000 more each year for their care.
The Congressional Budget Office determined that, under this
Republican budget, seniors' out-of-pocket expenses for health care
would more than double and could almost triple. They concluded: ``Most
elderly people would pay more for their health care under the
Republican plan than they would pay under the current Medicare
system.''
To put that into context, the CBO found that, in 2030, seniors would
pay 68 percent of premiums and out-of-pocket costs under the Republican
plan compared to only 25 percent under current law; and it found that
the Republican plan means seniors will pay more for their prescription
drugs because it reopens the doughnut hole, costing each of the 4
million seniors who fall into that coverage gap up to $9,300 by 2020.
The conservative Wall Street Journal concluded that this plan ``would
essentially end Medicare, which now pays for 48 million elderly and
disabled Americans, as a program that directly pays those bills.''
Under the guise of deficit reduction, this Republican plan is
recklessly attacking vital support systems for our seniors. We all
agree that we have to address the deficit. The issue isn't whether we
should reduce it but, rather, how we do it. Let's repeal subsidies to
Big Oil. Let's eliminate fraud and waste. Let's end the wars that are
costing us more than $2 billion a week. We should not be balancing the
budget on the backs of our Nation's seniors.
The Federal budget is about more than just dollars and cents. It is a
statement of our values and our priorities as a country. The Republican
budget reflects the wrong priorities. It would rather cut benefits to
our seniors than cut subsidies to Big Oil or corporations that ship our
jobs overseas.
By ending Medicare, this Republican budget breaks the promise we made
to our seniors to protect them in their golden years. We must do better
for our seniors. Medicare has met the health care needs of seniors
while providing them with financial stability for more than 40 years.
Ending Medicare would pull the rug out from underneath the feet of our
seniors during their golden years.
So I ask my colleagues, if we can't protect our Greatest Generation,
what's next?
I yield back the balance of my time.
Mr. McHENRY. I move to strike the last word.
The Acting CHAIR. The gentleman from North Carolina is recognized for
5 minutes.
Mr. McHENRY. Madam Chair, I've heard my colleagues give volumes of
words here today, but I've seen little action. In the 4 years they
controlled the U.S. House, they proposed nothing in the way of
meaningful entitlement reform: nothing to preserve Social Security,
nothing to preserve Medicare, nothing to improve Medicaid and ensure
that it's there.
Madam Chair, I ask, where is the plan of these House Democrats who
are speaking today? Where is their plan for entitlement reform?
[[Page H3379]]
Mr. ANDREWS. Will the gentleman yield?
Mr. McHENRY. I yield to the gentleman from New Jersey.
Madam Chair, I would ask my colleague, where is his plan on
entitlement reform?
Mr. ANDREWS. Does the gentleman favor permitting Medicare to
negotiate the price of prescription drugs, the way the VA does, and
save $25 billion a year?
Mr. McHENRY. In reclaiming my time, I would ask, does the gentleman
favor the Medicare part D prescription drug benefit, which has a lower
cost basis than what your colleagues proposed at the time of enactment?
Mr. ANDREWS. Will the gentleman yield?
Mr. McHENRY. I'm going to finish up here, my friend.
Madam Chair, in this discussion, there are lots of questions but
little substantive action--no policy proposals--to make sure that
Medicare is there for the next generation, much less for the end of the
Greatest Generation.
I would ask my colleagues to come forward with a substantive plan,
not just to take up time here on the U.S. House floor, not to take away
time from these important amendments that we have under this open rule
here on the House floor. I would ask my colleagues to do something real
and substantive rather than to push us to a debt crisis, which their
policies and their spending are pushing us towards.
I yield back the balance of my time.
Mr. ANDREWS. Madam Chair, I move to strike the last word.
The Acting CHAIR. The gentleman from New Jersey is recognized for 5
minutes.
(Mr. ANDREWS asked and was given permission to revise and extend his
remarks.)
Mr. ANDREWS. My friend who just spoke asked us where the plan is to
reduce the debt and deficit. If he is here, I would be happy to yield
to him, but I would ask him to consider these ideas.
{time} 1700
One, Medicare pays more than twice as much for a Coumadin pill than
the Veterans Administration does because we have a law that the
majority supported that says that Medicare can't negotiate prescription
drug prices. I favor repealing that law and saving at least $25 billion
a year. I would ask my friend if he supports that, and I would yield if
he would like to answer.
Mr. McHENRY. Will the gentleman yield?
Mr. ANDREWS. Does the gentleman support that idea?
I yield to the gentleman from North Carolina.
Mr. McHENRY. Why didn't the gentleman do it when he was in the
majority? And I would be happy to yield back the balance of my time.
Why is this not in ObamaCare? It's just everything else.
Mr. ANDREWS. Reclaiming my time, we did not do so because we couldn't
get two Republican Senators to support it on the other side. We would
have done it over here.
Second thing; does the gentleman support stopping the spending of
$110 billion a year to occupy Iraq and Afghanistan and instead spend
that money here in the United States? Does the gentleman support that?
I would ask him if he would like to answer that question.
Mr. McHENRY. I'm sorry, I didn't hear the question.
Mr. ANDREWS. I'll repeat it. We are spending about $110 billion a
year to help finance the Government of Iraq and Afghanistan. I would
rather see that $110 billion a year reduce our deficit. Would the
gentleman support that?
Mr. McHENRY. Does the gentleman support the President's war on Libya?
Mr. ANDREWS. I, frankly, do not. But reclaiming my time, I especially
don't support paying the bills for Baghdad and Kabul that we could be
using to reduce our deficit here at home.
Third, we're going to spend at least $60 billion over the next 10
years to give tax breaks to oil companies that made record profits--$44
billion last year alone--as our constituents are paying over $4 a
gallon at the pump. I support repealing those giveaways to the oil
industry and putting that money toward the deficit. I don't see the
gentleman anymore, I'm not sure how he stands on it, but we support
that.
Four, I support the idea that people who make more than $1 million a
year might be asked to contribute just a little more in taxes to help
reduce this deficit. Now I know the other side is going to say, well,
this will hurt the job creators in America. There is an echo in this
Chamber. In 1993, President Clinton proposed a modest increase on the
highest earning Americans to help reduce the deficit. The former
Speaker at the time, or Mr. Gingrich--he wasn't the Speaker at the
time, he became the Speaker--said this would cause the worst recession
in American history. He was wrong. The gentleman who became the
majority leader, Mr. Armey, said that this was a recipe for economic
collapse. He was wrong.
When we followed the supply-side trickle down the last 8 years under
George W. Bush, the economy created 1 million net new jobs. But when we
asked the wealthiest Americans to pay just a little more to reduce the
deficit in the 1990s, the economy created 23 million new jobs.
So when they ask, where is the plan, here is the plan: Don't abolish
Medicare the way they plan to; negotiate prescription drug prices; stop
paying the bills for Iraq and Afghanistan; stop the giveaways to oil
companies that make record profits; and ask the wealthiest in this
country to pay just a bit more to reduce our deficit. Let's put that
plan on the floor and reduce the deficit that way.
Madam Chair, I yield back the balance of my time.
Ms. LEE. Madam Chair, I move to strike the last word.
The Acting CHAIR. The gentlewoman from California is recognized for 5
minutes.
Ms. LEE. Madam Chair, I rise in strong opposition to the underlying,
very reckless bill, H.R. 1216.
Republicans, and we've heard this over and over again, want to
destroy and to deny seniors long-term affordable health care by
eliminating programs that are training the future health workforce of
our country.
This legislation is really part of an ongoing Republican attack on
Medicare under the guise of deficit reduction and fiscal
responsibility. It really is about privatizing Medicare, and of course
that means that there will be some winners and there will be some
losers. The Republican plan to end Medicare threatens the healthy and
secure retirement that we promised American seniors. In fact, an end to
Medicare is an end to a lifeline that millions of seniors rely on.
Medicare gives peace of mind to millions of Americans who pay into it
all their lives.
The Republicans want to give aging Americans a voucher, mind you,
that will not come close to covering the cost of health care instead of
maintaining and improving Medicare. Sure, waste, fraud and abuse must
be addressed wherever we find it, including the Pentagon, but we
disagree with the Republican agenda that the program must be killed.
The Republicans want to end this program when millions of Medicare
beneficiaries are struggling to make ends meet, and when we know that
Medicare-eligible beneficiaries will double over the next 20 years.
Republicans have the wrong priorities--focused on letting the rich
get richer on the backs of the middle class and the most vulnerable in
our Nation. Under the guise of reform, Republicans would increase costs
for seniors and cut benefits while giving tax cuts to millionaires,
subsidies to oil companies, and sending desperately needed jobs
overseas.
If the Republicans get their way, millions of seniors would
immediately begin paying higher costs for prescription drugs. The
impact of killing Medicare will be the most severe on vulnerable and
underserved populations, including our seniors of color, while
negatively impacting all seniors who rely on Medicare to protect their
health and economic security. An end to Medicare is really an end to a
lifeline that millions of seniors rely on.
If Republicans have their way, millionaires will continue to get big
bonuses while millions of Americans fall deeper into poverty. Madam
Chair, approximately 43.5 million Americans were living in poverty in
2009, but did you know that nearly 4 million of
[[Page H3380]]
those are seniors? Given our challenged economy, we can't expect these
numbers to have improved since 2009.
Medicare is part of a promise made to hardworking Americans to ensure
that they would not lack the security of having health care. And so
rather than stand silently while Republicans destroy a program that
protects vulnerable populations, we are here to speak up and stand up
for our mothers and our fathers, our grandmothers and our grandfathers,
our aunts and our uncles, and yes, our young people and our children,
to be their voice in the House of Representatives. We are here to
declare that Medicare should be protected and improved to protect our
Nation's seniors and most vulnerable populations, and we are here to
say that we want to secure it for future generations.
Ending Medicare really does end this promise and the security for
millions of Americans today and in the future. So we are here today to
defend Medicare and the support that it gives to our seniors. We must
ensure that those who have worked hard their entire lives strengthening
our Nation have the health security that they need and deserve in their
later years.
Mr. SESSIONS. Madam Chair, I move to strike the last word.
The Acting CHAIR. The gentleman from Texas is recognized for 5
minutes.
Mr. SESSIONS. Madam Chairman, I have seen shameless acts on this
floor before, and we are watching another one with the last few
speakers that we have seen here today.
The facts of the case are--and people know this--we passed a budget
resolution which is a construct to ask this House of Representatives to
consider a plan so that we do not bankrupt Medicare--which is exactly
what anyone who voted for the health care plan on March 21 or 22 1 year
ago did. The plan which President Obama and Speaker Pelosi at that time
supported took $500 billion out of Medicare to support a plan--which
could not be sustained either--which cost $2 trillion for health care.
So this year, Republicans have a plan to sustain Medicare that is a
market-based plan. It's not a voucher program. Not one person who is
presently on Medicare today nor anybody that is 55 years old or older
today would be impacted by this plan. It is a plan that says we should
challenge the Congress of the United States--including the
administration also--to come up with a plan about how we can sustain
Medicare, as we do see a doubling over the next 15 years of people who
will be expected to participate in that plan.
So that we get this right for once, let me say this: It is not a
voucher program. It does not impact anyone that is presently on
Medicare. So the shameless things we've heard today about everyone's
grandmother and everybody's grandfather and all these people that will
be thrown off Medicare, they will be unaffected.
Here's what the plan calls for: It calls for the United States
Congress to begin a process with hearings that would allow people who
would be on Medicare, instead of a one-size-fits-all plan of Medicare,
to have a plan that looks just like what government employees would
have, a realistic opportunity for them to choose among several plans,
whether they want a basic plan all the way up to a plan in which they
could fully participate themselves.
{time} 1710
Today, Medicare is a closed, one-size-fits-all process, just like we
heard Mr. Miller, ``We're going to treat everybody the same way.'' It
does not work, because not everybody has the same needs as each other.
We will have a plan which is market-based, which does not bankrupt this
country nor the system, which will allow the individual an opportunity
to come into a process and have their own health care just like
somebody who works for the Federal Government. It would allow people
who were in that program to take money out of their own pocket, to
choose their own doctor if they chose to, and to be allowed to
supplement those payments. We would probably set a mark, a bar, that
said if you make above a certain amount of money, that's not determined
yet, but if you had the ability to pay for yourself, you shouldn't rely
upon the government. That is another way to make sure that we support
the system, because if people have the ability to pay for their own
health care, we should allow them to do that and encourage them to do
that.
Then we look at how doctors are paid. Doctors today have not only
been mistreated by both sides, but in particular as we see doctors not
being compensated, they are not available, and it means seniors are
being denied coverage because physicians are not being reimbursed
properly. It allows us to have a great system, where doctors would want
to serve seniors, a great and better system that is market-based
whereby the ability that a person has to pay, if they do, then they
would pay their own physician and their own way with the minimum
support from the government.
The bottom line is, the gentleman from North Carolina asked a
relevant question, and the answer that came back was, when he said,
what is your plan, the answer that came back was, what about the war
and what about oil companies? Well, the facts of the case are, we're
talking about Medicare here today, a system that is draining this
country from not only its ability to provide outstanding and excellent
health care but also a system that takes away choices from seniors.
I yield back the balance of my time.
Announcement by the Acting Chair
The Acting CHAIR. Members are reminded not to traffic the well when
other Members are under recognition.
Mr. RYAN of Ohio. I move to strike the last word.
The Acting CHAIR. The gentleman is recognized for 5 minutes.
Mr. RYAN of Ohio. Madam Chair, I rise in opposition to the underlying
bill, and I think it's important for us to go back, as we hear about
market-based solutions, to why Medicare was started in the first place.
There is no market to provide health care for older people, because
there's no money to be made. Insurance companies can't make money off
of covering old people who get sick, really, really sick.
What this plan does, Madam Chair, and the analysis was, well, it's
just going to be like the Federal employee plan, where Members of
Congress and Federal employees get a premium support. Well, the premium
support that Federal employees get is about 70 some percent of the
health care costs, and that number goes up and down with inflation for
health care. So no matter what the health care costs are, the Federal
employee has 70 some percent of that covered.
The problem with the Republican plan is that the voucher, or the
premium support, is hooked to the CPI, the Consumer Price Index, which
is 2\1/2\ percent, maybe, so the voucher is going to go up at CPI, say,
2\1/2\ percent, while health care costs are usually a percent or two
above GDP growth, so say we have 4 percent growth, then health care
costs are going to go up at 5 percent, maybe 6 percent. So your premium
support, or your voucher, is going to increase every year by 2\1/2\
percent, while health care costs are going up at 5\1/2\ percent. It
doesn't take rocket science to figure out that over the course of
several years, that voucher becomes worthless, and it will only
probably cover 30 percent, maybe, of the cost of the health care that
these seniors are going to get.
So let's not sit here and pretend like the senior citizens in the
Medicare program are going to somehow be living large and getting some
kind of great health care. This dismantles the Medicare program.
Period. Done. At least have the courage to come out and say, we want to
dismantle the Medicare program.
If you want to look at how far to the right that the Republican Party
has gotten on this issue, I've never seen former Speaker Gingrich do a
faster or more complete Potomac two-step in my entire life than when he
even insinuated that this may not be good for seniors, because the goal
now of the Republican Party, Madam Chair, is to dismantle the Medicare
program.
They tried years ago to try to privatize Social Security. This is no
surprise. And so my question is, Madam Chair, if you're a 55-year-old
guy in Youngstown, Ohio, who statistically, over the last 30 years,
your wages have been stagnant with no increase in real wages over the
last 30 years, now you're saying to them that they've got to come up
with another $182,000 to be able to pay for their health care.
You can nod your head ``no'' all you want, Madam Chair. These are the
facts. The Congressional Budget Office
[[Page H3381]]
says, neutral third party, that the average person going into this
Medicare proposal will pay $6,000 more a year. That's not the
Democratic study committee or our policy wonk saying it, it's CBO. Six
thousand more a year. While the guy's wages have been stagnant for the
last 30 years?
And that's where the issue of the oil companies does come in, because
we're giving huge breaks to oil companies. We'll take more arrows to
protect, on the other side, to protect even thinking about possibly
asking the wealthiest 1 percent to pay just a little bit more to help
us address this issue. The sky is falling. The world's ending. It's so
bad that we can't even muster up the courage to ask Bill Gates and
Warren Buffett to just help us out a little bit while we have all these
problems and three wars going on at the same time? I mean, come on,
Madam Chair, this is not right. This is not right.
So, at the end of the day, the Democratic plan is for Medicare. We
keep it to cover senior citizens and their health care when they get
older, and if we've got to make adjustments, we make adjustments. But
you don't dismantle the entire plan, and you don't at the same time
give tax breaks to the oil companies.
The Acting CHAIR. The time of the gentleman has expired.
Mr. RYAN of Ohio. Don't dismantle Medicare, Madam Chair. Don't do it.
Mr. BURGESS. Madam Chairman, I move to strike the last year.
The Acting CHAIR. The gentleman from Texas is recognized for 5
minutes.
Mr. BURGESS. I thank the Chair for the recognition.
You know, if we're going to tell stories here, let's start out with
``once upon a time'' and maybe we can end with ``and they lived happily
ever after.''
Whose budgetary plan puts Medicare at the most risk? Is it the
responsible Republican plan that was debated on this floor for hours
over a month ago? This was a plan that for the first time we had laid
out for us a road map, a pathway, for how to save Medicare for people
who are going to enter into the program in 20 years', 30 years' time.
Now what is the plan on the other side? Well, there was no plan from
House Democrats. There is no plan from the Senate Democrats. There is a
plan from the President. The President laid out his aspirational
budget, just as the Republicans laid out their aspirational program
which was their budget, and the President's aspirational document laid
out a very clear path. The President believes in 15 people, not elected
by anyone but appointed by him, and their ability to control costs in
the Medicare system. It was written into a bill called the Patient
Protection and Affordable Care Act. You may remember it.
I have a great deal of sympathy with those on the other side who do
not like the Independent Payment Advisory Board. In fact, one of their
number wrote an editorial for USA Today yesterday decrying the nature
of the Independent Payment Advisory Board, but the sad fact of the
matter is, this is the Democratic alternative to the Republican plan to
save Medicare into the next 50 years.
{time} 1720
That plan, the Democrats' plan, the President's plan, with the
Independent Payment Advisory Board, says 15 people are going to be
picked, they will be paid well, they will then decide where are the
cuts going to occur in Medicare.
Now, true enough, Congress gets an opportunity. This 15-member board
will come back to the United States Congress and say, ``Here is the
menu of cuts that we believe are necessary to have this year in order
to keep Medicare solvent.'' By law, they have to come up with a certain
dollar number of cuts. But as the President himself said in his speech
to Georgetown here earlier this year, that's a floor, not a ceiling. If
we need to save more money, we can go back to the Independent Payment
Advisory Board and save more money.
Now, Congress looks at the cuts that are brought to them by this
unelected independent board and says, We don't like those cuts. Some of
those cuts are going to be very damaging to poor seniors on Medicare.
Do we have a choice? Yes. We can vote it up or down. If we vote it
down, we have to come up with our own menu of cuts to then deliver to
the Secretary of Health and Human Services. What if Congress can't
agree? I know. When has that ever happened before? But what if we can't
agree amongst ourselves? Do we get to do something like the doc fix
that we do every year? No, we do not. That's the whole purpose of the
Independent Payment Advisory Board. We cannot intervene on behalf of
America's patients because the President's board has spoken.
So Congress can't agree on what these cuts should be.
So what do we do? We continue to fight. But guess what happens? April
15 of the next year, the Secretary of Health and Human Services,
whoever he or she may be at that time, gets to institute those cuts
that were brought to you by the Independent Payment Advisory Board.
Now, is that a good idea?
And I've heard discussion here on the floor today about $6,000. You
know what? If you don't fix that sustainable growth rate formula, guess
what's going to happen to every senior, rich and poor, who is on the
Medicare program? Either they're not going to be able to find a doctor
to care for them when they require care, or they're going to have to
pay more money. How much money are they likely to pay? About $6,000 per
senior.
But look. The Independent Payment Advisory Board, something like that
has never happened in this country. In a free society, we've got now an
unelected board who is going to tell us what kind of medical care we
can get, when we can get it, where we can get it, and most importantly,
when you have had enough. And when they say you've had enough, that's
it. No more. Dialysis, insulin. It doesn't matter. You're full. You've
had your share. That is the problem with the Independent Payment
Advisory Board.
And Congress then becomes powerless because frequently we do disagree
with each other, and if we can't come to a consensus, the Secretary
makes that decision for us. And then the next year starts all over
again.
I've got a great deal of sympathy with my friends on the other side
of the aisle because they did not include this language in their bill.
And we all remember a year ago the very bad process that brought us the
Patient Protection Affordable Care Act. And what was that process? It
was the Senate on Christmas Eve that passed a House-passed bill that
then came back over to the United States House and will the House now
agree to the Senate amendment to H.R. 3590? You all remember 3590. It
was a housing bill when you passed it in the summer of 2009. It was a
health care bill when it came back to the House.
You did not include the Independent Payment Advisory Board in H.R.
3200 for a very good reason. The reason is it's un-American, and you
know it, but now you're left to defend it.
I yield back the balance of my time.
Mr. MARKEY. I move to strike the last word.
The Acting CHAIR. The gentleman from Massachusetts is recognized for
5 minutes.
Mr. MARKEY. You know, this is a crazy debate that we're having here
right now because the Republicans, they keep saying to the Democrats,
Well, what's the plan? So we say to the Republicans, Well, what's your
plan? Your plan just seems to be saying to Grandma and Grandpa that
they're taking too much. That they really--they're taking America for a
ride, and we have to cut Medicare. Their health care is too good. And
Grandma and Grandpa, they didn't do enough for America.
So the Democrats, we turn around and say, Hey, how about looking at
it this way: How about before you go after Grandma and her Medicare
card and how about you say to Warren Buffet, Hey, how about not taking
those extra tax breaks?
And the Republicans say, We can't take away any tax breaks from
Warren Buffet and all of the other multi-multimillionaires and
billionaires. Because they've contributed so much to America, we don't
want to touch their money, even though that would give us hundreds of
billions of dollars.
And then we say to them, Well, how about prescription drugs? How
about we negotiate the price for prescription drugs, for Medicare, the
way we do
[[Page H3382]]
with the VA? That would save about a quarter of a trillion dollars over
a 10-year period. They say, That would be unfair to the drug companies.
We can't touch them either.
Then we say to them, Well, you know, the war in Iraq, the war in
Afghanistan, it's winding down now. Maybe we could look into the
defense budget and save a few billion dollars there before we ask
Grandma to sacrifice on the health care that she gets from Medicare?
And the Republicans say, We can't do that either. We can't look at any
cuts in the defense budget. That would be much too hard on those
defense contractors.
So then we say to them, How about the oil industry? At least the oil
industry, the $40 billion in tax breaks which they're going to get over
the next 10 years? I mean, does anyone in America really believe that
they need tax breaks in order to have an incentive to go out and drill
for oil when people are paying $3, $3.50, $4 a gallon at the pump?
But the Republicans say, No. You can't touch the oil companies
either. You've got to give big tax breaks to the oil industry as well,
even as they're tipping Grandma and Grandpa upside down at the pump
when they're coming in to put in their unleaded $4 a gallon gasoline--
self-serve, by the way--at the pump.
So what do they do instead? What they do is they put an oil rig on
top of the Medicare card so that the oil industry can drill into
Grandma's Medicare and pull out the funding in order to provide the tax
breaks for Big Oil, for Warren Buffet, for the prescription drug
industry, for the wars in Iraq and Afghanistan. It's all off of
Grandma. She's the one. We've targeted the person responsible for all
of the wasteful spending in the United States. It's all Grandma's
fault. Let's cut Medicare. She didn't do enough to build our country
through the 1930s, the 1940s, the 1950s, and the 1960s. It's all on
Grandma.
So this drill rig that they are building into the pocketbooks of
Grandma in order to find that funding, that's what their plan is all
about. It's an oil pipeline into the pocketbooks of the seniors. They
want to cut checkups for Grandma while they cut checks for the oil
companies. They want to cut health care to Grandma and give wealth care
to big oil companies and to billionaires and to prescription drug
companies.
Their plan is big tax breaks for Big Oil and tough breaks for Grandma
and for the seniors in our country.
And the CEO of Chevron? He says it's un-American to think about
increasing taxes on the oil industry. You know what I say to him? It's
unbelievable that you could make that argument. But even more
unbelievable that the Republican Party would accept that argument and
cut Medicare for Grandma. To privatize it, to hand it over to the
insurance industry, to increase the cost by $6,000 per year for their
costs even as they say to Warren Buffet, the oil companies, the big
drug companies, the arms contractors, Don't worry. We're going to
protect your programs. It's just Grandma that's on the cutting block.
So, ladies and gentlemen, this is a debate of historical dimensions.
And until the Republicans come forward with a plan--which they don't
have in order to make Medicare solvent--by raising the revenues out of
these other areas from millionaires, from the oil industry, and from
others, do not expect us to say to Grandma it's her fault. It's not her
fault. She built this country. She deserves this benefit. And we should
not be cutting it.
This Republican plan to end Medicare is just something that wants to
turn it over to the insurance industry. Vote ``no'' on the Republican
plan.
Mr. COURTNEY. I move to strike the last word.
The Acting CHAIR. The gentleman from Connecticut is recognized for 5
minutes.
Mr. COURTNEY. I rise in opposition to the underlying bill, which, by
the way, is a bill that would repeal a provision of the Affordable Care
Act that was aimed at trying to strengthen the primary care
infrastructure of this country, which is in fact a huge challenge for
the Medicare program, but for some reason over the last couple of
months or so, Medicare just seems to be the target.
I think it's important for people to remember that in 1965 when
Medicare was passed and signed into law on Harry Truman's front porch,
only half of America's seniors had health insurance.
{time} 1730
Part of it was because of the cost, but part of it was because the
insurance companies would not insure that demographic. It was just
simply too high a risk to write insurance policies by individual
companies for people who, again, because of nature carried the highest
degree of risk in terms of illness and disease. Over time, the genius
of Medicare, which was to pool risk, to create a guaranteed benefit, to
fund it through payroll taxes, to fund it through Medicare part B
premiums, demonstrated that we could raise the dignity and quality of
life for people over age 65 and in fact extend life expectancy.
But the Republican Party has been targeting this program over and
over again. In the 1990s, they came out with Medicare part C, Medicare
Plus Choice, which was again giving insurance companies a set payment
who promised to provide a more efficient, lower cost product for
seniors. And what happened? Insurance companies enrolled millions of
seniors in Medicare Plus Choice products. And realizing in a short
space of time that they did not in fact have the funds to create a
sustainable product, they canceled coverage for seniors all across the
country.
I was at hearings in Norwich, Connecticut, in 1998, where seniors who
had signed up for these programs suddenly got notification in mid-
policy year that the insurance companies changed their minds, and they
dropped them like a hot potato. In many instances, seniors who were in
the middle of cancer treatments and chronic disease treatments were
left high and dry without coverage. So that program failed.
Later, we had Medicare Advantage. Medicare Advantage was sold on,
again, the premise that it would provide coverage for seniors cheaper
than regular Medicare. And what in fact happened? The Department of
Health and Human Services had to offer insurance companies 120 percent
of the baseline costs for Medicare in order to entice insurance
companies to participate in the Medicare Advantage program; a
ridiculous overpayment, treating unfairly seniors who were in
traditional Medicare and paying for Medicare supplemental insurance.
Last year we did something about that unfairness by equalizing the
payments to seniors on traditional Medicare and Medicare Advantage. And
today what we have is the Ryan Republican plan, which says you get an
$8,000 voucher if you are under age 55, and good luck in terms of
trying to find coverage, again, in a market that is going to be very,
very careful about not extending actual coverage because of the risk
that's attached to it.
Now, the rank unfairness of saying that we are going to create a two-
tiered system for people over the age of 55 and people under the age of
55 is obvious even in my own family. I am 58 years old. My wife Audrey,
who is a pediatric nurse practitioner, is 51. I get one version of
Medicare; she gets stuck with the loser version of Medicare under this
proposal. Again, the unfairness of it is so obvious to all families
across America. And again, it is one that is why I think the public is
turning so quickly against the Republican agenda.
And we are told and we are asked: What's your alternative? Well, look
at the trustees' report that came out last week. Look at it. What it
said was that the Affordable Care Act in fact extended solvency for the
Medicare program by 8 years. We did suffer some reductions, but that
was because of the economy. Read the trustees' language. The smart
efficiencies which were introduced into the Medicare program through
the Affordable Care Act in fact have made the Medicare program
healthier.
And if you look at the Ryan Republican budget plan, they took every
nickel of those savings from the Affordable Care Act. Even though that
caucus demagogued all across the country, campaigning about so-called
Medicare cuts in the Affordable Care Act, well, the Ryan Republican
plan incorporated every single one of those changes in the Affordable
Care Act.
[[Page H3383]]
But at the same time, it took away all the benefits of the Affordable
Care Act in terms of helping seniors with prescription drug coverage,
annual checkups, cancer screenings, smoking cessation, all of the smart
changes which the Affordable Care Act made to provide a better,
smarter, more efficient Medicare benefit for seniors.
The fact of the matter is that the Democrats do have an alternative.
We have a program which we passed last year which, for the first time
in decades, extended the solvency of the Medicare program.
Let's not abandon it. Let's preserve the guaranteed benefit for
seniors. Let's reject the Ryan Republican Medicare plan.
Mr. McDERMOTT. Madam Chairman, I move to strike the last word.
The Acting CHAIR. The gentleman from Washington is recognized for 5
minutes.
Mr. McDERMOTT. Madam Chairman, I rise in opposition to this
underlying bill.
It reminds me, as I listen to this debate, of debates around the
Vietnam War. I remember a village that was napalmed by a military unit,
and the officer who had them do it, he was asked why he did it. He
said, well, I destroyed it to save it. Now that's the argument we are
hearing today on Medicare. We have to destroy it to save it.
Now ask yourself--and there are a lot of people watching, Madam
Chairman. If I were sitting at home trying to figure out what's this
all about, well, why would Representative Ryan suggest that a voucher
system is the way to save Medicare because of the rising costs?
Everyone knows that the costs of Medicare and medication and health
care in this country are totally out of control.
Now, President Obama came up with a plan which he brought out here.
It wasn't like he created something that nobody had ever thought about
before in the whole United States. He looked at the State of
Massachusetts. It's been a place where a lot of great things have come
from. And he saw what Governor Romney, a Republican, a Republican
thought that we ought to have a universal plan for Massachusetts, and
so they passed the law and they covered everybody in Massachusetts.
Now, then came the question: Once you have got access for everybody,
how do you control the costs? Well, then the problems developed. And
the problem was they found in Massachusetts they didn't have enough
primary care physicians. Now, what does that have to do with it? That's
what this bill is about. This bill is about the training of primary
care physicians.
What everybody in this country needs is a physician that knows them
and is a medical home. When they get sick, they go to that person. The
doctor knows them. If they need some preventive care, the doctor takes
care of it. The doctor does it in a very cost efficient way, before the
catastrophes.
Now, for the many people in this country who don't have a primary
care physician, they sit at home and say, well, I've got to wait until
I am really, really sick, and then they go to the emergency room. Now,
if you have your blood pressure monitored and you take medication, you
can live a long life; but if you don't, you are very likely to wind up
with a stroke.
Now, we spend millions of dollars in hospitals on stroke victims that
could have been prevented by good primary care. And we say to
ourselves, well, why don't we have more primary care physicians? Well,
because the health care system is designed to take care of people after
the big event. After they have got the cancer, we will spend millions
of dollars on cancer treatment. We will spend millions of dollars on
heart problems, on all these things where prevention could have
prevented it all and cost less. That's what every industrialized
country in the world has done.
It's why the Swiss are able to provide universal coverage to
everybody in Switzerland for a little over one half of what we spend in
the United States. Because they provide good preventive care in the
form of general practice, general medicine. That's true in England, in
Norway, in Canada, in every other country except the United States,
where we are dominated by specialists.
Now, in this country, if you get sick or you have a pain, if you
don't have a primary care physician, a doctor who knows you, you call
up your friends and you say, I've got a pain in my leg. What should I
do? And they say, well, I saw an orthopedic surgeon, and his name is
such, and so you go to a specialist. And that specialist looks at your
leg. He doesn't look at all the rest of you. He doesn't know what's
going on with you. He doesn't know your whole history.
When I started in medical school, the maxim we were taught at the
very beginning was: Listen to the patient. He is telling you what's the
matter with him. And everybody knows that doctors are running on a
conveyor belt today, one right after another, no time to listen because
we have not invested in primary care physicians.
{time} 1740
Now, the average kid going to medical school would like to take care
of people; but when he comes out, or she comes out, they are $250,000
in debt. This bill is making that problem worse and, therefore, is bad
for Grandma and everybody else.
Mr. GINGREY of Georgia. Madam Chairman, I move to strike the last
word.
The Acting CHAIR. The gentleman is recognized for 5 minutes.
Mr. GINGREY of Georgia. Madam Chairman, sitting in my office and
listening to this debate, and I can't help but feel that this is
nothing but a bunch of demagoguery on the part of our colleagues on the
Democratic side of the aisle.
I take this opportunity to oppose the amendment, but, more
importantly, to ask my colleagues to stop this demagoguery in regard to
throwing Grandma under the bus in reference to the Medicare program and
what our side of the aisle has proposed in the Republican budget.
You know, the average age of this body is 58 years old. Almost all of
us are Grandma and Grandpa, and you are running these ads all across
the Nation, I guess, particularly in New York 26, showing a reasonable
facsimile of our fantastic chairman of the Budget Committee pushing
Grandma in a wheelchair off the cliff.
Look, New York 26 is over. You don't need any more votes. Stop all
this demagoguery.
You have done nothing in regard to the Medicare program. What is
there in the 2012 budget, in the Obama budget, that does anything
toward trying to solve the Medicare program, which will be bankrupt in
2024 if nothing is done? That is the total irresponsibility and the
hypocrisy of this side of the aisle, Madam Chairman.
And the responsible side of the aisle is the Republican side of the
aisle which says, look, let's save this program for our children and
our grandchildren, guarantee, protect and strengthen it for Grandma and
Grandpa, our current seniors, and not only the current seniors who are
65 and those who are disabled and already on the Medicare program, but
anybody who will come into the Medicare program within the next 10
years.
And, you know, Madam Chairman, at that point, in 2022, you will have
about 65 million people on the Medicare program as we know it,
traditional Medicare; and they will be on that program until their
natural death and many of them, thank God, because of our great health
care system in this country, will live to be 90 years old.
So this idea of killing Medicare is an absolute misinterpretation,
and you know it. You are misleading the American people.
This program that we are proposing, and it's a proposal, it's
something that we can work together on both sides of the aisle, we can
negotiate, you know, it's not set in stone--but what we say, what
Speaker Boehner says, what Chairman Ryan says is, look, let's try this
program in 2022 where people who are coming into Medicare at age 65,
many of whom are working and in excellent health, we will simply give
them a premium support, but not a voucher in their hands, but to send
to the insurance company of their choice. Let them get their medical
care where Members of Congress get their medical care. Let them have
the same options to choose from, Madam Chairman.
That's what's this is about. And the average, if it is $8,000, it
will be adjusted every year for inflation and that average 8,000 will
be higher for an individual who comes into the Medicare
[[Page H3384]]
program at age 65 that is already sick, that already has heart disease
or diabetes or is on dialysis. It's somebody, as they get older, that
premium support will increase.
This is the way we save the Medicare program; and, oh, yes, by the
way, folks like us, like members of the subcommittee, our premium
support will be significantly less because we are not Warren Buffett,
but we can afford to pay more, and we should pay more. If that's $4,000
a year more, so be it. We save the program for those who need it the
most, those who are middle- and low-income seniors, and that is the
compassionate thing to do.
So, colleagues, stop this demagoguery. Let's get together, let's work
together and solve this problem once and for all.
I yield back the balance of my time.
Announcement by the Acting Chair
The Acting CHAIR. Members are reminded to address their comments to
the Chair.
Ms. SCHAKOWSKY. I move to strike the last word.
The Acting CHAIR. The gentlewoman from Illinois is recognized for 5
minutes.
Ms. SCHAKOWSKY. I am getting a real kick out of this debate. I really
am. You know, we hear one after another of my Republican colleagues
coming up here and self-righteously talking about ending the
demagoguery and we should end the TV ads.
And I just want to remind you that through the 2010 elections, the
Republicans went on television and, yes, how about demagogued, the
issue of Medicare, saying that Democrats wanted to cut $500 billion
from Medicare.
Well, let's talk about the truth. We were challenged, just a little
while ago: What is your plan? Well, here was our plan to save Medicare
and that was to say in The Affordable Care Act, yes, we are going to
cut subsidies to the insurance companies that meant that we were
bilking the government and the taxpayers, and we were having to overpay
them, and, yes, we are going to cut waste and fraud from the Medicare
program.
And that's how we are going to save $500 billion. But not only would
we not cut a single penny from benefits, but we were actually able to
increase benefits while trimming Medicare.
We, you know--so you scared the heck out of seniors but never
mentioned, of course, at the same time we reduced the cost of Medicare.
We improved Medicare by adding to its solvency; we closed the
doughnut hole, making prescription drugs more affordable; and we
provided a wellness exam every year at no cost; and we provided
preventive services with no cost sharing. But nevertheless, on
television, those ads warned against those Democrats who didn't cut one
thing from Medicare and improve it. And now you are saying, well, we
are not going to do anything to people 55 and under. To me that sounds
like 55 and under, you better look out.
Now, the ads in New York are working because people love their
Medicare. And what they don't want to see, you know, all but four
Republicans voted to literally end Medicare.
You can call it something else, but you can't call it Medicare
because those guaranteed benefits are gone. It makes huge cuts in
Medicare benefits. Seniors that fall under the new plan would have to
pay about $6,000 more a year. That's what the Congressional Budget
Office says, $6,000 more a year out of pocket for their health care,
and it would put insurance company bureaucrats in charge of seniors'
health care, letting insurers decide what tests and what treatment that
seniors get, throwing seniors back into the arms of the insurance
companies who have shown no love to them.
And so let's look at what the American people think about Medicare.
Well, if you are 65 years and older, 93 percent of Americans say the
Medicare program as it is right now is very important or somewhat
important to them, actually 83 percent very important.
If they are 55 to 64, 91 percent say Medicare is very important; and
if you are 40 to 54, we have got 79 percent of Americans who say the
Medicare program is very or somewhat important; and if you are 18 to
39, 75 percent.
{time} 1750
People get it. Medicare works. Medicare is efficient. Medicare is
good for our country, for people with disabilities and for the seniors.
And if we are looking to save Medicare, we do have a plan. We know how
to make that more efficient. We have done it in the Affordable Care
Act. And we are willing to sit down and talk about how we make Medicare
more efficient, but not by ruining, destroying and getting rid of
Medicare to the point that you've got to find another name. It won't be
Medicare anymore.
And so they've admitted, it seems to me, that people 55 and younger,
you better look out. Because that program that will allow our seniors
to live perhaps to 90 years old, people who are going to be eligible
for Medicare as it is right now will no longer be in place. And we are
not talking about rich people----
The Acting CHAIR. The time of the gentlewoman has expired.
Ms. SCHAKOWSKY. We're talking about poor seniors and middle class
people.
Don't support this plan.
Announcement by the Acting Chair
The Acting CHAIR. Members are reminded to refrain from trafficking
the well while another Member is under recognition.
Mr. WOODALL. Madam Chair, I move to strike the last word.
The Acting CHAIR. The gentleman from Georgia is recognized for 5
minutes.
Mr. WOODALL. Madam Chair, like my colleague from Georgia, I too was
sitting back in my office. I saw the debate break out on the floor of
the House on the Medicare proposal, the proposal to rescue Medicare
from certain bankruptcy. And I wondered, because I sit on the Rules
Committee, and the Rules Committee has one of the great pleasures of
deciding what comes to the floor, how it comes to the floor and what
goes on, and I knew that this wasn't Medicare reform day. This was the
amendment by my colleague from North Carolina (Ms. Foxx) to protect
life. It was an amendment to a bill brought to the floor by my
colleague, Mr. Guthrie, which restores congressional oversight and
regular order through the appropriations process, those things that I
ran for Congress to do. And I rise in strong support both of the Foxx
amendment and of Mr. Guthrie's underlying bill.
But when I heard this talk about Medicare and all the games and what
has happened in the past, I have to say, I have only been here--this
is, what, month number 5 for me. I'm still brand new, and I'm still
optimistic enough to believe that it doesn't have to all be about sound
bites, that it really can be about solutions.
And I want to say to my colleagues on the Democratic side of the
aisle, when you say that you came up with a proposal in the President's
health care bill last year to deal with Medicare, I believe you. I take
you at your word. I read through that, too. I saw that Medicare
Advantage was removed as an option for seniors. That distressed me. I
saw that new benefits, as Ms. Castor just referenced, had been added,
Madam Chair, added to a program that's already going bankrupt. I saw
that that is one direction that you can take the Medicare program.
Now I'm a proud member of the House Budget Committee, the House
Budget Committee that worked hard and long to produce the Medicare
reform proposal that we're talking about, oddly enough, here today. And
it's a program that saves Medicare for everybody 55 years of age and
under and provides them with choice.
I just want to tell a personal story. I don't consume a lot of health
care. I've been very blessed in that regard. But I had to go in for a
chest CT the other day. I have a medical savings account, so I'm
responsible for the first couple of thousand dollars of my health care
bill. So the first health care I consumed was my chest CT. I got on the
Internet and started shopping around. It turns out that the difference
between the cheapest chest CT and the most expensive chest CT in my
part of Georgia is four times--four times. I got in the car. I drove
across town and spent my $4 a gallon for gas to go get the cheap one.
It turns out the really expensive one was right next door. I could have
walked right next door.
Folks, when we talk about how we, we the United States Congress, we
the U.S. House of Representatives voted to
[[Page H3385]]
save Medicare in the 2012 budget proposal, we talked about saving it by
providing choice. Again, my colleagues are exactly right. We did that
in 1997. That was the debate, can we save Medicare in 1997 by providing
more choice? Well, we succeeded with adding Medicare Advantage, but we
didn't get much further than that. This is that next step. This is that
next step because we know that choice matters. We know that choice
matters.
The gentleman who held my seat and has been retired used to tell the
story of his mother in upstate Minnesota, and every Tuesday she would
go to the doctor with a group of friends just to make sure everything
was okay, just to get checked out. She was on Medicare. One day, there
was a terrible snowstorm in Minnesota. The winds were blowing and the
snow was piling up. They all got together on Tuesday, and Edna wasn't
there, and they began to get worried. They called around and they asked
around. It turned out Edna just wasn't feeling well. She couldn't be
there that day.
You make different choices when you're not responsible for the bills.
And we do that over and over and over again. This isn't just a Medicare
issue. This is a philosophical difference between these two sides of
the aisle about what kind of an America we are going to live in going
forward. Are we going to live in one where folks take care of you but
they tell you the manner they're going to do it? Or do we live in one
where we help you along but you get to make those fundamental choices
for you?
It's clear to me why my constituents sent me to Washington as a
first-time elected official this year. It's clear to me where the 2012
budget proposal takes this House and takes this country.
I implore my colleagues, we can absolutely argue about your plan as
it was introduced in the President's health care bill and our plan as
it was introduced in the fiscal year 2012 budget proposal, but let's
not, let's not make it anything other than what it is. It's a
difference in two visions. Yours saves Medicare for 6 years. Ours saves
Medicare for a lifetime. And, Madam Chair, I think we owe the voters no
less.
Mr. PERLMUTTER. Madam Chair, I move to strike the last word.
The Acting CHAIR. The gentleman from Colorado is recognized for 5
minutes.
Mr. PERLMUTTER. I just say to my friend from Georgia, who really is
my friend, that this isn't about demagoguery, sir. And what I would
say, Madam Chair, the issue before us is: What got our country into a
financial pickle? The Republicans want to pick on Medicare, but
Americans know.
I had a Government in the Grocery this weekend, and an older
gentleman came up to me. He said, Why is there such a focus on
Medicare, something that has been working for 50 years? It's helping
seniors have healthier, longer lives. What's the big deal? He said that
10 years ago this country was running a surplus, running a surplus,
revenues exceeded expenses. Under Bill Clinton, revenues were exceeding
expenses. But then there was a decision under the Bush administration
to cut taxes. Okay. If revenues are exceeding expenses, then maybe
that's okay. That cost us $1 trillion over the next 10 years. Then came
the decision to prosecute two wars. He said to me that two wars cost us
about $1 trillion, too, didn't it, Mr. Congressman? I said, Yeah. He
said, Okay. Medicare 10 years ago was fine, revenues exceed expenses.
Now we've got tax cuts for millionaires and billionaires, $1 trillion
dollars; two wars, $1 trillion; and then there was this big crash on
Wall Street where we lost revenues and we had bigger expenses. That was
a couple trillion dollars, wasn't it, sir? I said, Yeah, that's about
right. And he said, So why--that turned our budget upside down. So now
why are we focusing on Medicare? Why blame Medicare for $4 trillion of
losses to the United States? It wasn't Medicare that is harming the
financial success of this country. So why all the blame when this
program really has been working for seniors for so long?
So I would say to my friends on the Republican side of the aisle,
this is a program that my friends haven't liked since its inception.
This is a program that Republicans haven't liked from its inception.
So to turn the target into Medicare and not say to have tax cuts for
millionaires and billionaires, that that should be part of the whole
equation of balancing our budget, or taking away the incentives and all
of the tax benefits for oil companies at $100 a barrel but say, no,
we're going to focus on Medicare, in my opinion, that's just wrong.
Mr. GINGREY of Georgia. Will the gentleman yield?
Mr. PERLMUTTER. I yield to the gentleman from Georgia.
Mr. GINGREY of Georgia. I appreciate the gentleman from Colorado, my
good friend, for yielding.
I would just rhetorically ask, and maybe he would like to
definitively answer, how much of the windfall profit taxes, if you
will, against Big Oil, Big Pharma, big anything, are you going to put
back into the Medicare program? And, by the way, how much of the
Medicare Advantage cuts that came from ObamaCare are actually going
back into the Medicare program as we know it?
Mr. PERLMUTTER. Reclaiming my time, I would say to my friend from
Georgia, do you know what? If those tax benefits are taken away at $100
a barrel, we can put them into Medicare. We can use them to balance the
budget. But I heard my other friend from Georgia say, well, this is
what's causing the bankruptcy.
{time} 1800
That is just not true. This country was running a surplus, for
goodness sake, and Americans understand that. They know what got us
into trouble financially, and it wasn't Medicare. So now to take it out
of Medicare and just take it out of our senior citizens where a program
is actually working, the goal of that program is so Americans could
live longer, healthier lives in their senior years. It's working. But
no, let's go blame that instead of the tax cuts for millionaires and
billionaires. Let's forget about those wars and the cost to the
country, and let's forget about the fact that we had a crash on Wall
Street.
My friends on the Republican side of the aisle say: Hey, this is a
perfect time to go after Medicare. We didn't like it before, we still
don't like it; let's get it.
With that, I yield back the balance of my time.
The Acting CHAIR. Pursuant to clause 6 of rule XVIII, proceedings
will now resume on those amendments----
Point of Order
Mr. WEINER. Madam Chair, I rise to a point of order.
The Acting CHAIR. The gentleman will state his point of order.
Mr. WEINER. Madam Chair, under the rule, Members are entitled to 5
minutes to speak to the matter at hand. Members are waiting;
principally among them is myself waiting at the microphone to be
recognized for that purpose. And now it sounds like you are proceeding
to shut down debate. I say that it is in violation of the order of the
House, as decided by the Rules Committee, to permit Members to speak
for 5 minutes on this matter. It is early in the evening, and many
Members are waiting to speak.
The Acting CHAIR. Pursuant to clause 6 of rule XVIII, the Chair may
resume proceedings on a postponed question at any time, even while
another amendment is pending.
Parliamentary Inquiry
Mr. WEINER. Madam Chair, point of parliamentary inquiry.
The Acting CHAIR. The gentleman will state his parliamentary inquiry.
Mr. WEINER. So the Chair is deciding, notwithstanding the fact that a
Member is standing here to speak about the plan to end Medicare, not to
mention Members are here seeking to be recognized, I believe of both
parties, the Chair is choosing at this moment that this is the
propitious moment to cut off debate, early in the evening when we have
plenty of work to do and Members seek to speak and offer amendments?
Is the Chair deciding arbitrarily, or was she given guidance to do
this by the Republican leadership who don't want to hear any more
critique of their plans to end Medicare?
The Acting CHAIR. The Chair is exercising her discretion to resume
proceedings on a postponed question at any time.
Pursuant to clause 6----
Mr. WEINER. * * *
The Acting CHAIR. The gentleman is not recognized.
[[Page H3386]]
Pursuant to clause 6 of rule XVIII, proceedings will now resume on
those amendments printed in the Congressional Record on which further
proceedings----
Motion to Rise
Mr. WEINER. Madam Chair, I move that the Committee do now rise.
The Acting CHAIR. The question is on the motion to rise.
The question was taken; and the Acting Chair announced that the noes
appeared to have it.
Recorded Vote
Mr. WEINER. Madam Chair, I demand a recorded vote.
A recorded vote was ordered.
The Acting CHAIR. Following this 15-minute vote, proceedings will
resume on those amendments printed in the Congressional Record on which
further proceedings were postponed, in the following order:
Amendment No. 2 by Mr. Tonko of New York.
Amendment No. 9 by Mr. Cardoza of California.
The Chair will reduce to 5 minutes the minimum time for any
electronic vote after the first vote in this series.
The vote was taken by electronic device, and there were--ayes 14,
noes 397, not voting 20, as follows:
[Roll No. 335]
AYES--14
Capuano
Cleaver
Conyers
Frank (MA)
Green, Gene
Johnson (IL)
Kucinich
Lee (CA)
Miller, George
Payne
Schakowsky
Watt
Waxman
Weiner
NOES--397
Ackerman
Adams
Aderholt
Akin
Alexander
Altmire
Amash
Andrews
Austria
Baca
Bachmann
Bachus
Baldwin
Barletta
Barrow
Bartlett
Barton (TX)
Bass (CA)
Bass (NH)
Becerra
Benishek
Berg
Berkley
Berman
Biggert
Bilbray
Bilirakis
Bishop (GA)
Bishop (NY)
Bishop (UT)
Black
Blackburn
Blumenauer
Bonner
Bono Mack
Boren
Boswell
Boustany
Brady (PA)
Brady (TX)
Brooks
Broun (GA)
Brown (FL)
Buchanan
Bucshon
Buerkle
Burgess
Burton (IN)
Butterfield
Calvert
Camp
Campbell
Canseco
Cantor
Capito
Capps
Cardoza
Carnahan
Carney
Carson (IN)
Carter
Cassidy
Castor (FL)
Chabot
Chaffetz
Chandler
Chu
Cicilline
Clarke (MI)
Clarke (NY)
Clay
Clyburn
Coble
Coffman (CO)
Cohen
Cole
Conaway
Connolly (VA)
Cooper
Costa
Costello
Courtney
Cravaack
Crawford
Crenshaw
Critz
Crowley
Cuellar
Culberson
Cummings
Davis (CA)
Davis (IL)
Davis (KY)
DeFazio
DeGette
DeLauro
Denham
Dent
DesJarlais
Deutch
Diaz-Balart
Dicks
Dingell
Doggett
Dold
Donnelly (IN)
Doyle
Dreier
Duffy
Duncan (SC)
Duncan (TN)
Edwards
Ellison
Ellmers
Emerson
Engel
Eshoo
Farenthold
Farr
Fattah
Fincher
Fitzpatrick
Flake
Fleischmann
Fleming
Flores
Forbes
Fortenberry
Foxx
Franks (AZ)
Fudge
Gallegly
Garamendi
Gardner
Garrett
Gerlach
Gibbs
Gibson
Gingrey (GA)
Gohmert
Gonzalez
Goodlatte
Gosar
Gowdy
Granger
Graves (GA)
Graves (MO)
Green, Al
Griffin (AR)
Griffith (VA)
Grijalva
Grimm
Guinta
Guthrie
Gutierrez
Hall
Hanna
Harper
Harris
Hartzler
Hastings (FL)
Hayworth
Heck
Heinrich
Hensarling
Herger
Herrera Beutler
Higgins
Himes
Hinchey
Hinojosa
Holden
Holt
Honda
Hoyer
Huelskamp
Huizenga (MI)
Hultgren
Hunter
Hurt
Inslee
Israel
Issa
Jackson Lee (TX)
Jenkins
Johnson (GA)
Johnson (OH)
Johnson, E. B.
Johnson, Sam
Jones
Jordan
Kaptur
Keating
Kelly
Kildee
Kind
King (IA)
King (NY)
Kingston
Kinzinger (IL)
Kissell
Kline
Labrador
Lamborn
Lance
Landry
Lankford
Larsen (WA)
Larson (CT)
Latham
LaTourette
Latta
Levin
Lewis (CA)
Lewis (GA)
Lipinski
LoBiondo
Loebsack
Lofgren, Zoe
Lowey
Lucas
Luetkemeyer
Lujan
Lummis
Lungren, Daniel E.
Lynch
Mack
Maloney
Manzullo
Marchant
Marino
Matheson
Matsui
McCarthy (CA)
McCaul
McClintock
McCollum
McCotter
McDermott
McGovern
McHenry
McIntyre
McKeon
McKinley
McNerney
Meehan
Meeks
Mica
Michaud
Miller (FL)
Miller (MI)
Miller (NC)
Miller, Gary
Moran
Mulvaney
Murphy (CT)
Murphy (PA)
Myrick
Nadler
Napolitano
Neal
Neugebauer
Noem
Nugent
Nunes
Nunnelee
Olver
Owens
Palazzo
Pallone
Pascrell
Paul
Paulsen
Pearce
Pelosi
Pence
Perlmutter
Peters
Peterson
Petri
Pitts
Platts
Poe (TX)
Polis
Pompeo
Posey
Price (GA)
Price (NC)
Quayle
Quigley
Rahall
Rangel
Reed
Rehberg
Reichert
Renacci
Reyes
Ribble
Richardson
Richmond
Rigell
Rivera
Roby
Roe (TN)
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Rokita
Rooney
Ros-Lehtinen
Roskam
Ross (AR)
Ross (FL)
Rothman (NJ)
Roybal-Allard
Royce
Runyan
Ruppersberger
Rush
Ryan (OH)
Ryan (WI)
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Scalise
Schiff
Schilling
Schmidt
Schock
Schrader
Schwartz
Schweikert
Scott (SC)
Scott (VA)
Scott, Austin
Scott, David
Sensenbrenner
Serrano
Sessions
Sherman
Shimkus
Shuler
Shuster
Simpson
Sires
Slaughter
Smith (NE)
Smith (NJ)
Smith (TX)
Smith (WA)
Southerland
Speier
Stark
Stearns
Stivers
Stutzman
Sullivan
Terry
Thompson (CA)
Thompson (MS)
Thompson (PA)
Thornberry
Tiberi
Tierney
Tipton
Tonko
Towns
Tsongas
Turner
Upton
Velazquez
Visclosky
Walberg
Walden
Walsh (IL)
Walz (MN)
Wasserman Schultz
Waters
Webster
Welch
West
Westmoreland
Whitfield
Wilson (FL)
Wilson (SC)
Wittman
Wolf
Womack
Woodall
Woolsey
Wu
Yarmuth
Yoder
Young (AK)
Young (FL)
Young (IN)
NOT VOTING--20
Braley (IA)
Filner
Frelinghuysen
Giffords
Hanabusa
Hastings (WA)
Hirono
Jackson (IL)
Langevin
Long
Markey
McCarthy (NY)
McMorris Rodgers
Moore
Olson
Pastor (AZ)
Pingree (ME)
Sewell
Sutton
Van Hollen
{time} 1830
Messrs. PERLMUTTER, GOHMERT, ACKERMAN and LEWIS of Georgia, Mrs.
HARTZLER, Ms. HERRERA BEUTLER, Ms. GRANGER and Ms. SLAUGHTER changed
their vote from ``aye'' to ``no.''
So the motion to rise was rejected.
The result of the vote was announced as above recorded.
Stated against:
Mr. FILNER. Madam Chair, on rollcall 335, I was away from the Capitol
region attendng the Civil Rights Freedom Riders' 50th Anniversary
Celebration. Had I been present, I would have voted ``no.''
Amendment No. 2 Offered by Mr. Tonko
The Acting CHAIR. The unfinished business is the demand for a
recorded vote on the amendment offered by the gentleman from New York
(Mr. Tonko) on which further proceedings were postponed and on which
the noes prevailed by voice vote.
The Clerk will redesignate the amendment.
The Clerk redesignated the amendment.
Recorded Vote
The Acting CHAIR. A recorded vote has been demanded.
A recorded vote was ordered.
The Acting CHAIR. This will be a 5-minute vote.
The vote was taken by electronic device, and there were--ayes 186,
noes 231, not voting 14, as follows:
[Roll No. 336]
AYES--186
Ackerman
Andrews
Baca
Baldwin
Barrow
Bass (CA)
Becerra
Berkley
Berman
Bishop (GA)
Bishop (NY)
Blumenauer
Boren
Boswell
Brady (PA)
Brown (FL)
Butterfield
Capps
Capuano
Cardoza
Carney
Carson (IN)
Castor (FL)
Chandler
Chu
Cicilline
Clarke (MI)
Clarke (NY)
Clay
Cleaver
Clyburn
Cohen
Connolly (VA)
Conyers
Costa
Costello
Courtney
Critz
Crowley
Cuellar
Cummings
Davis (CA)
Davis (IL)
DeFazio
DeGette
DeLauro
Deutch
Dicks
Dingell
Doggett
Donnelly (IN)
Doyle
Edwards
Ellison
Engel
Eshoo
Farr
Fattah
Frank (MA)
Fudge
Garamendi
Gibson
Gonzalez
Green, Al
Green, Gene
Grijalva
Gutierrez
Hanna
Harris
Hastings (FL)
Heinrich
Higgins
Himes
Hinchey
Hinojosa
Hirono
Holden
Holt
Honda
Hoyer
Inslee
Israel
Jackson Lee (TX)
Johnson (GA)
Johnson, E. B.
Jones
Kaptur
Keating
Kildee
Kind
Kissell
Kucinich
Langevin
Larsen (WA)
Larson (CT)
Lee (CA)
Levin
Lewis (GA)
Lipinski
Loebsack
Lofgren, Zoe
Lowey
Lujan
Lynch
Maloney
Markey
Matheson
Matsui
McCollum
McDermott
McGovern
McIntyre
McNerney
Meeks
Michaud
Miller (MI)
Miller (NC)
Miller, George
Moore
Moran
Murphy (CT)
Nadler
Napolitano
Neal
Olver
Owens
Pallone
Pascrell
Payne
Pelosi
Perlmutter
Peters
Peterson
Polis
Price (NC)
Quigley
Rahall
Rangel
Reyes
Richardson
[[Page H3387]]
Richmond
Ross (AR)
Rothman (NJ)
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Schakowsky
Schiff
Schrader
Schwartz
Scott (VA)
Scott, David
Serrano
Sewell
Sherman
Shuler
Sires
Slaughter
Smith (WA)
Speier
Stark
Sutton
Thompson (CA)
Thompson (MS)
Tierney
Tonko
Towns
Tsongas
Van Hollen
Velazquez
Visclosky
Walz (MN)
Wasserman Schultz
Waters
Watt
Waxman
Weiner
Welch
Wilson (FL)
Woolsey
Wu
Yarmuth
NOES--231
Adams
Aderholt
Akin
Alexander
Altmire
Amash
Austria
Bachmann
Bachus
Barletta
Bartlett
Barton (TX)
Bass (NH)
Benishek
Berg
Biggert
Bilbray
Bilirakis
Bishop (UT)
Black
Blackburn
Bonner
Bono Mack
Boustany
Brady (TX)
Brooks
Broun (GA)
Buchanan
Bucshon
Buerkle
Burgess
Burton (IN)
Calvert
Camp
Campbell
Canseco
Cantor
Capito
Carter
Cassidy
Chabot
Chaffetz
Coble
Coffman (CO)
Cole
Conaway
Cooper
Cravaack
Crawford
Crenshaw
Culberson
Davis (KY)
Denham
Dent
DesJarlais
Diaz-Balart
Dold
Dreier
Duffy
Duncan (SC)
Duncan (TN)
Ellmers
Emerson
Farenthold
Fincher
Fitzpatrick
Flake
Fleischmann
Fleming
Flores
Forbes
Fortenberry
Foxx
Franks (AZ)
Gallegly
Gardner
Garrett
Gerlach
Gibbs
Gingrey (GA)
Gohmert
Goodlatte
Gosar
Gowdy
Granger
Graves (GA)
Graves (MO)
Griffin (AR)
Griffith (VA)
Grimm
Guinta
Guthrie
Hall
Harper
Hartzler
Hayworth
Heck
Hensarling
Herger
Herrera Beutler
Huelskamp
Huizenga (MI)
Hultgren
Hunter
Hurt
Issa
Jenkins
Johnson (IL)
Johnson (OH)
Johnson, Sam
Jordan
Kelly
King (IA)
King (NY)
Kingston
Kinzinger (IL)
Kline
Labrador
Lamborn
Lance
Landry
Lankford
Latham
LaTourette
Latta
Lewis (CA)
LoBiondo
Lucas
Luetkemeyer
Lummis
Lungren, Daniel E.
Mack
Manzullo
Marchant
Marino
McCarthy (CA)
McCaul
McClintock
McCotter
McHenry
McKeon
McKinley
McMorris Rodgers
Meehan
Mica
Miller (FL)
Miller, Gary
Mulvaney
Murphy (PA)
Myrick
Neugebauer
Noem
Nugent
Nunes
Nunnelee
Olson
Palazzo
Paul
Paulsen
Pearce
Pence
Petri
Pitts
Platts
Poe (TX)
Pompeo
Posey
Price (GA)
Quayle
Reed
Rehberg
Reichert
Renacci
Ribble
Rigell
Rivera
Roby
Roe (TN)
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Rokita
Rooney
Ros-Lehtinen
Roskam
Ross (FL)
Royce
Runyan
Ryan (WI)
Scalise
Schilling
Schmidt
Schock
Schweikert
Scott (SC)
Scott, Austin
Sensenbrenner
Sessions
Shimkus
Shuster
Simpson
Smith (NE)
Smith (TX)
Southerland
Stearns
Stivers
Stutzman
Sullivan
Terry
Thompson (PA)
Thornberry
Tiberi
Tipton
Turner
Upton
Walberg
Walden
Walsh (IL)
West
Westmoreland
Whitfield
Wilson (SC)
Wittman
Wolf
Womack
Woodall
Yoder
Young (AK)
Young (FL)
Young (IN)
NOT VOTING--14
Braley (IA)
Carnahan
Filner
Frelinghuysen
Giffords
Hanabusa
Hastings (WA)
Jackson (IL)
Long
McCarthy (NY)
Pastor (AZ)
Pingree (ME)
Smith (NJ)
Webster
Announcement by the Acting Chair
The Acting CHAIR (during the vote). There are 2 minutes remaining in
this vote.
{time} 1838
So the amendment was rejected.
The result of the vote was announced as above recorded.
Stated for:
Mr. FILNER. Madam Chair, on rollcall 336, I was away from the Capitol
region attending the Civil Rights Freedom Riders' 50th Anniversary
Celebration. Had I been present, I would have voted ``aye.''
Amendment No. 9 Offered by Mr. Cardoza
The Acting CHAIR. The unfinished business is the demand for a
recorded vote on the amendment offered by the gentleman from California
(Mr. Cardoza) on which further proceedings were postponed and on which
the noes prevailed by voice vote.
The Clerk will redesignate the amendment.
The Clerk redesignated the amendment.
Recorded Vote
The Acting CHAIR. A recorded vote has been demanded.
A recorded vote was ordered.
The Acting CHAIR. This will be a 5-minute vote.
The vote was taken by electronic device, and there were--ayes 182,
noes 232, not voting 17, as follows:
[Roll No. 337]
AYES--182
Ackerman
Andrews
Baca
Baldwin
Barrow
Bass (CA)
Becerra
Berkley
Berman
Bishop (GA)
Bishop (NY)
Blumenauer
Boren
Boswell
Brady (PA)
Brown (FL)
Butterfield
Capps
Capuano
Cardoza
Carnahan
Carney
Carson (IN)
Castor (FL)
Chandler
Chu
Cicilline
Clarke (MI)
Clarke (NY)
Clay
Cleaver
Clyburn
Connolly (VA)
Conyers
Costa
Costello
Courtney
Critz
Crowley
Cuellar
Cummings
Davis (CA)
Davis (IL)
DeFazio
DeGette
DeLauro
Denham
Deutch
Dicks
Dingell
Doggett
Donnelly (IN)
Doyle
Edwards
Ellison
Engel
Eshoo
Farr
Fattah
Frank (MA)
Fudge
Garamendi
Gonzalez
Green, Al
Green, Gene
Grijalva
Gutierrez
Harris
Hastings (FL)
Heinrich
Higgins
Himes
Hinchey
Hinojosa
Hirono
Holden
Holt
Honda
Hoyer
Inslee
Jackson Lee (TX)
Johnson (GA)
Johnson, E. B.
Kaptur
Keating
Kildee
Kind
Kissell
Kucinich
Langevin
Larsen (WA)
Larson (CT)
Lee (CA)
Levin
Lewis (GA)
Lipinski
Loebsack
Lofgren, Zoe
Lowey
Lujan
Lynch
Maloney
Markey
Matheson
Matsui
McCollum
McDermott
McGovern
McIntyre
McNerney
Meeks
Michaud
Miller (NC)
Miller, George
Moore
Moran
Murphy (CT)
Nadler
Napolitano
Neal
Olver
Owens
Pallone
Pascrell
Payne
Pelosi
Perlmutter
Peters
Peterson
Polis
Price (NC)
Quigley
Rahall
Rangel
Reyes
Richardson
Richmond
Ross (AR)
Rothman (NJ)
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Schakowsky
Schiff
Schrader
Schwartz
Scott (VA)
Scott, David
Serrano
Sewell
Sherman
Shuler
Sires
Slaughter
Smith (WA)
Speier
Stark
Sutton
Thompson (CA)
Thompson (MS)
Tierney
Tonko
Towns
Tsongas
Van Hollen
Velazquez
Visclosky
Walz (MN)
Wasserman Schultz
Waters
Watt
Waxman
Weiner
Welch
Wilson (FL)
Woolsey
Wu
Yarmuth
NOES--232
Adams
Aderholt
Akin
Alexander
Altmire
Amash
Austria
Bachmann
Bachus
Barletta
Bartlett
Barton (TX)
Bass (NH)
Benishek
Berg
Biggert
Bilbray
Bilirakis
Bishop (UT)
Black
Blackburn
Bonner
Bono Mack
Boustany
Brady (TX)
Brooks
Broun (GA)
Buchanan
Bucshon
Buerkle
Burgess
Burton (IN)
Calvert
Camp
Campbell
Canseco
Cantor
Capito
Carter
Cassidy
Chabot
Chaffetz
Coble
Coffman (CO)
Cohen
Cole
Conaway
Cooper
Cravaack
Crawford
Crenshaw
Culberson
Davis (KY)
Dent
DesJarlais
Diaz-Balart
Dold
Dreier
Duffy
Duncan (SC)
Ellmers
Emerson
Farenthold
Fincher
Fitzpatrick
Flake
Fleischmann
Fleming
Flores
Forbes
Fortenberry
Foxx
Franks (AZ)
Gallegly
Gardner
Garrett
Gerlach
Gibbs
Gibson
Gingrey (GA)
Gohmert
Goodlatte
Gosar
Gowdy
Granger
Graves (GA)
Graves (MO)
Griffin (AR)
Griffith (VA)
Grimm
Guinta
Guthrie
Hall
Hanna
Harper
Hartzler
Hayworth
Heck
Hensarling
Herger
Herrera Beutler
Huelskamp
Huizenga (MI)
Hultgren
Hunter
Hurt
Issa
Jenkins
Johnson (IL)
Johnson (OH)
Jordan
Kelly
King (IA)
King (NY)
Kingston
Kinzinger (IL)
Kline
Labrador
Lamborn
Lance
Landry
Lankford
Latham
LaTourette
Latta
Lewis (CA)
LoBiondo
Lucas
Luetkemeyer
Lummis
Lungren, Daniel E.
Mack
Manzullo
Marchant
Marino
McCarthy (CA)
McCaul
McClintock
McCotter
McHenry
McKeon
McKinley
McMorris Rodgers
Meehan
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Mulvaney
Murphy (PA)
Myrick
Neugebauer
Noem
Nugent
Nunes
Nunnelee
Olson
Palazzo
Paul
Paulsen
Pearce
Pence
Petri
Pitts
Platts
Poe (TX)
Pompeo
Posey
Price (GA)
Quayle
Reed
Rehberg
Reichert
Renacci
Ribble
Rigell
Rivera
Roby
Roe (TN)
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Rokita
Rooney
Ros-Lehtinen
Roskam
Ross (FL)
Royce
Runyan
Ryan (WI)
Scalise
Schilling
Schmidt
Schock
Schweikert
Scott (SC)
Scott, Austin
Sensenbrenner
Sessions
Shimkus
Shuster
Simpson
Smith (NE)
Smith (NJ)
Smith (TX)
Southerland
Stearns
Stivers
Stutzman
Sullivan
Terry
Thompson (PA)
Thornberry
Tiberi
Tipton
Upton
Walberg
Walden
Walsh (IL)
Webster
West
Westmoreland
Wilson (SC)
Wittman
Wolf
Womack
Woodall
Yoder
Young (AK)
Young (FL)
Young (IN)
[[Page H3388]]
NOT VOTING--17
Braley (IA)
Duncan (TN)
Filner
Frelinghuysen
Giffords
Hanabusa
Hastings (WA)
Israel
Jackson (IL)
Johnson, Sam
Jones
Long
McCarthy (NY)
Pastor (AZ)
Pingree (ME)
Turner
Whitfield
Announcement by the Acting Chair
The Acting CHAIR (during the vote). There are 2 minutes remaining in
this vote.
{time} 1845
So the amendment was rejected.
The result of the vote was announced as above recorded.
Stated for:
Mr. FILNER. Madam Chair, on rollcall 337, I was away from the Capitol
region attending the Civil Rights Freedom Riders' 50th Anniversary
Celebration. Had I been present, I would have voted ``aye.''
Stated against:
Mr. TURNER. Madam Chair, on rollcall No. 337, I was unavoidably
detained and did not vote. Had I been present, I would have voted
``no.''
Mr. GUTHRIE. Madam Chairman, I move that the Committee do now rise.
The motion was agreed to.
Accordingly, the Committee rose; and the Speaker pro tempore (Mr.
Womack) having assumed the chair, Mrs. Capito, Acting Chair of the
Committee of the Whole House on the State of the Union, reported that
that Committee, having had under consideration the bill (H.R. 1216) to
amend the Public Health Service Act to convert funding for graduate
medical education in qualified teaching health centers from direct
appropriations to an authorization of appropriations, had come to no
resolution thereon.
____________________