[Congressional Record Volume 158, Number 47 (Wednesday, March 21, 2012)]
[House]
[Pages H1443-H1450]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




PROVIDING FOR CONSIDERATION OF H.R. 5, PROTECTING ACCESS TO HEALTHCARE 
                                  ACT

  Mr. NUGENT. Madam Speaker, by direction of the Committee on Rules, I 
call up House Resolution 591 and ask for its immediate consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 591

       Resolved, That at any time after the adoption of this 
     resolution the Speaker may, pursuant to clause 2(b) of rule 
     XVIII, declare the House resolved into the Committee of the 
     Whole House on the state of the Union for consideration of 
     the bill (H.R. 5) to improve patient access to health care 
     services and provide improved medical care by reducing the 
     excessive burden the liability system places on the health 
     care delivery system. The first reading of the bill shall be 
     dispensed with. All points of order against consideration of 
     the bill are waived. General debate shall be confined to the 
     bill and amendments specified in this resolution and shall

[[Page H1444]]

     not exceed six hours equally divided among and controlled by 
     the respective chairs and ranking minority members of the 
     Committees on Energy and Commerce, the Judiciary, and Ways 
     and Means. After general debate the bill shall be considered 
     for amendment under the five-minute rule. In lieu of the 
     amendments recommended by the Committees on Energy and 
     Commerce and the Judiciary now printed in the bill, an 
     amendment in the nature of a substitute consisting of the 
     text of Rules Committee Print 112 18 shall be considered as 
     adopted in the House and in the Committee of the Whole. The 
     bill, as amended, shall be considered as the original bill 
     for the purpose of further amendment under the five-minute 
     rule and shall be considered as read. All points of order 
     against provisions in the bill, as amended, are waived. No 
     further amendment to the bill, as amended, shall be in order 
     except those printed in the report of the Committee on Rules 
     accompanying this resolution. Each such further amendment may 
     be offered only in the order printed in the report, may be 
     offered only by a Member designated in the report, shall be 
     considered as read, shall be debatable for the time specified 
     in the report equally divided and controlled by the proponent 
     and an opponent, shall not be subject to amendment, and shall 
     not be subject to a demand for division of the question in 
     the House or in the Committee of the Whole. All points of 
     order against such further amendments are waived. At the 
     conclusion of consideration of the bill for amendment the 
     Committee shall rise and report the bill, as amended, to the 
     House with such further amendments as may have been adopted. 
     The previous question shall be considered as ordered on the 
     bill, as amended, and any further amendment thereto to final 
     passage without intervening motion except one motion to 
     recommit with or without instructions.

  The SPEAKER pro tempore. The gentleman from Florida is recognized for 
1 hour.

                              {time}  1250

  Mr. NUGENT. Madam Speaker, for the purpose of debate only, I yield 
the customary 30 minutes to the gentleman from Florida (Mr. Hastings), 
pending which I yield myself as much time as I may consume. During 
consideration of this resolution, all time yielded is for the purpose 
of debate only.


                             General Leave

  Mr. NUGENT. Madam Speaker, I ask unanimous consent that all Members 
have 5 legislative days to revise and extend their remarks.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Florida?
  There was no objection.
  Mr. NUGENT. Madam Speaker, I rise today in support of this rule, 
House Resolution 591.
  H. Res. 591 provides a structured rule so that the House may consider 
H.R. 5, the Help Efficient, Accessible, Low-cost, Timely Healthcare Act 
of 2012. The rule provides for 6 hours of debate on this vital issue.
  In my opinion, the HEALTH Act is one of the most imperative pieces of 
legislation to come to the floor of the House in the 112th Congress 
thus far. The bill repeals a particularly egregious part of the 
government takeover of health care: the Independent Payment Advisory 
Board, or IPAB.
  In case you're not aware, IPAB is the 15-member panel created by 
ObamaCare to rein in Medicare costs. IPAB is made up of 15 unelected 
bureaucrats. The majority are not doctors, and their decisions will 
have the force of law and will go into effect automatically without the 
consent of Congress. We'll get back to IPAB in a moment.
  H.R. 5 also implements long-needed medical malpractice tort reform. I 
hear all the time that we need to bring down the cost of health care. 
My colleagues on the other side of the aisle claim that the government 
takeover of health care would do just that, reduce the cost of health 
care.
  In fact, President Obama claimed it would lower premiums by $2,500 
per family per year. We know that's just not the case. Since 
inauguration day in 2009, premiums have risen by $2,213, almost the 
same amount the President promised he was going to save us. The annual 
Kaiser Foundation survey of employer-provided insurance found that 
average family premiums totaled $12,860 in 2008 and are now $15,073 in 
2011. Moreover, the CBO, the Congressional Budget Office, projects the 
law's new benefit mandates will force premiums to rise on top of that 
$15,000 by $2,100 per year per family.
  Malpractice reform, on the other hand, will most definitely reduce 
the cost of health care. We've seen what defensive medicine is: CAT 
scans ordered, antibiotics prescribed, blood tests conducted--not 
because the doctor thought they were necessary, but because he or she 
was scared that if they didn't order them they would be sued for not 
prescribing them.
  A Department of Health and Human Services study said that defensive 
medicine costs between $70 billion to $126 billion a year. That's 
billions. The CBO estimate takes a little more moderate stance, putting 
that number around $54 billion. Let me tell you, $54 billion, $70 
billion, $126 billion, that's a lot of money in anybody's terms.
  I've heard from a lot of folks they are opposing the legislation 
because it defies States' rights. I have to say I'm particularly 
surprised to hear so many of my colleagues on the other side making 
this argument. I'm happy to see they've come to recognize the 
importance of States' rights and of State sovereignty. I hope that 
means that we can count on them for their support and efforts in moving 
forward to take Federal power away from Washington, D.C., and return 
that power back to the States, where it belongs and where our Founding 
Fathers envisioned it to be.
  I want to take a moment to make it clear to my colleagues on both 
sides of the aisle why this bill, H.R. 5, does not trample on the 
rights of our States.
  In the modern era, Congress has enacted many Federal tort reform 
statutes to supersede contrary State laws, including recent Federal 
tort reform protecting the vital domestic firearms industry, and 
judicial precedents leave little doubt as to their constitutionality. 
Even President Reagan, who was an unabashed champion for the States, 
established a special task force to study the need for tort reform, 
which concluded that the Federal Government should address tort reform 
across the board.
  I fear that the folks who are claiming the 10th Amendment and States' 
rights aren't looking at the entirety of H.R. 5. They aren't looking at 
all of the provisions that make it clear that the caps created in this 
bill only apply to States that don't already have their own caps.
  These provisions--``flexi-cap'' they are called--recognize that any 
State amount on caps takes precedence to this piece of legislation. 
That means if a State has a billion-dollar cap, good for them, let them 
keep it. It also means that if a State has a $100,000 cap, they can 
keep it, too. If a State decides to pass a law and establish a cap on 
their own to change their existing cap, they should go ahead and do it 
because H.R. 5 isn't going to do anything to stop them from doing that.
  H.R. 5 clearly ensures that it is a State's right to set its caps 
where it wants them. I understand that trial lawyers won't like the 
Federal limit. Luckily, I really worry about the American people as a 
whole, not just what trial lawyers have to say.
  I know this may be speculation, but I think that special interest 
groups and, perhaps, some of the new converts to the 10th Amendment are 
hiding behind the States' rights argument because, in fact, they just 
don't want to see their own profits go down. But I fear that the 
States' rights discussion is a red herring that only gets us off the 
most important issue, the issue that I started off with, the 
Independent Payment Advisory Board. Plain and simple, IPAB is going to 
cut the health care that our Nation's seniors can receive.
  This Medicare-rationing board, which is what this is, will decide the 
value of medical services and impose price controls that will slash 
senior access to doctors and other health care providers. We see this 
happening already.
  The Centers for Medicare & Medicaid Services actuary has confirmed 
that large reductions in Medicare payment rates to physicians would 
likely have serious implications for beneficiary access to care, 
utilization, intensity, and the quality of that care. As Donald 
Berwick, President Obama's appointee as the Medicare administrator, 
said:

       The decision is not whether or not we will ration care. The 
     decision is whether we will ration with our eyes open.

  H.R. 5 takes that choice away from Administrator Berwick, from IPAB, 
and from President Obama. H.R. 5 sets forth a new way forward, a way 
that says we don't need Washington bureaucrats, who haven't even 
practiced medicine, telling us what's best for us.
  We need to sit down with our doctors and come up with individual 
treatment

[[Page H1445]]

plans, a way that actually does something about health care costs by 
removing frivolous lawsuits from the equation, a way forward that means 
States' rights are still protected while also protecting seniors' 
rights to the best health care options available.

                              {time}  1300

  Madam Speaker, I support this rule, and I support the underlying 
legislation, and I encourage all of my colleagues to do the same.
  With that, I reserve the balance of my time.
  Mr. HASTINGS of Florida. Madam Speaker, I yield myself such time as I 
may consume.
  I rise in opposition to H.R. 5. Not only does this bill overlook the 
rights of injured patients, but it's also an attempt by the House 
Republican leadership to dismantle the Affordable Care Act.
  I would remind my friend from Florida that there is no example that 
allows for any of us to have it both ways. This matter violates the 
Constitution and, clearly, not just for those who argue the 10th 
Amendment from a conservative or a liberal perspective. It is all of us 
that feel very strongly that this measure usurps the power of States.
  I'm fond of saying what Randy Barnett, constitutional law professor 
at Georgetown, said, that people seem to be fair-weather federalists, 
and they abandon federalism whenever it is inconvenient to someone's 
policy preferences.
  H.R. 5 combines two completely unrelated measures. The first one is 
the reform of our Nation's medical malpractice system. The second one 
is the repeal of the Independent Payment Advisory Board, which was 
established by the Affordable Care Act. Please don't get me wrong; I'm 
fully aware of the challenges inherent to our medical liability system. 
The excessive cost of medical malpractice insurance faced by physicians 
seriously impairs our Nation's health care system by encouraging the 
practice of defensive medicine. This contributes to higher health care 
costs for both doctors and patients as well as diminished access to 
care for consumers.
  But while I agree that our medical liability system needs to be 
changed, I do not believe that it should be at the expense of the 
fundamental rights of patients, including their ability to seek 
compensation for wrongful injuries. Indeed, this bill imposes an 
arbitrary and unfair cap on noneconomic damages that injured patients 
can receive. Such limitations will extinguish our rights and have 
devastating consequences for individuals harmed by physicians and 
medical products.
  In addition, this bill seriously encroaches on the 10th Amendment of 
the Constitution by preempting State laws. And I'm not buying the 
confusion offered in the Rules Committee yesterday nor by my good 
friend from Florida. I know preemption when I see it. I know the 10th 
Amendment, and I know that people have stood for the 10th Amendment. I 
need not remind my colleagues that countless Republicans have made 
statements regarding this particular matter not fitting within the 
framework of the 10th Amendment's commerce provision.
  My Republican colleagues like to talk about frivolous lawsuits and 
unreasonably large jury awards. But I asked the question yesterday of 
the maker of this particular provision, what is his leg worth? It's 
easy for us here inside the beltway, and it's easy for us on the 
Republican or Democratic side, liberal or conservative, to be about the 
business of talking about somebody's harm. Then what happens is, all of 
the lawyers that are the bad people of the world, everybody wants the 
best lawyer when it is them and their problem that is a problem.
  I asked the maker of the bill, how much is his leg worth? When you 
cut off the wrong leg, who can stand among us and say that $250,000 is 
enough? So where did that cap come from? It came from a 1978 provision, 
$250,000. This is 2011, moving fast with costs rising.
  I ask anybody here or that is within the range of this particular 
measure at this time, please tell me, when did your health care 
insurance costs go down? I don't know of any example. I have been 
paying health care insurance for 49 years, and it's gone up repeatedly 
during that period of time. And I don't care whether there was a 
Republican President or a Democratic President, health care costs went 
up, and I don't think that this little measure here is going to bring 
it down.
  What do you think about the family in Chicago whose perfectly healthy 
baby was born lifeless because the hospital team failed to provide him 
with proper oxygenation during labor and to perform an emergency 
cesarean section on the mother? The boy is now 5 years old, suffers 
from permanent neurological damage, and is totally dependent on the 
care of his parents for all his daily activities. You ask his parents 
if $250,000 is enough for a lifetime of care. Oh, no.
  Then you say, well, thrust it on the States. Let Medicaid take care 
of it. And then what you do under the Ryan budget, my good friend, is 
you say block-grant Medicaid. I saw that movie in Florida when they 
block-granted Medicaid, and it was used for everything else other than 
for poor people. Something is wrong with that movie.
  What about the judge in Palm Beach County who had a surgical sponge 
left in his stomach after having abdominal surgery and had to wait 5 
months to have it removed? By then, the pus and bile-stained mass 
measured more than a foot long and a foot wide, and the rotted part of 
his intestine had to be removed. Ask him if a lawsuit was frivolous.
  Each case and each injury is different. It is not the role of 
Congress to decide the fate of these individuals and families 
devastated by malpractice by establishing arbitrary limits on the 
financial compensation that they are entitled to.
  As you all know, the medical malpractice portion of this bill is 
actually a pay-for, meant to offset the repeal of the Independent 
Payment Advisory Board, IPAB. IPAB is a board of 15 physicians and 
experts established by the Affordable Care Act to find ways to control 
health care costs associated with Medicare.
  Under the act, IPAB will make recommendations to slow the growth rate 
in Medicare spending if spending exceeds a certain target rate. The 
Congressional Budget Office estimates that the repeal of IPAB would 
increase direct spending by $3.1 billion over 10 years--$3.1 billion. 
Now is not the time to repeal measures that can save our Nation money 
and reduce our deficit without offering any substitute, and that's the 
take-away from this.
  My friends say don't do IPAB; and I say to my friends, well, what do 
you do? And you do nothing. That's what you do, and that's what you've 
been doing here in the Congress since we came here. We have given ``do-
nothing Congress'' a new meaning. Rather than dealing with jobs, the 
things that people are completely interested in, rather than passing 
the infrastructure measure that the Senate has passed that will deal 
immediately with jobs in America, we are here passing a measure--and it 
will pass the floor of the House of Representatives--that will go to 
the Senate and go nowhere. So then what did we do? We did nothing.
  The Congressional Budget Office also estimates that, thanks to the 
cost-saving mechanisms in place in the Affordable Care Act, IPAB will 
not likely be required to act for the next 10 years.
  I heard my colleague, just a minute ago, say that health care costs 
have gone up since President Obama has been in office. My mom is fond 
of saying that if we're going to keep pointing back to the other 
President--if Obama says Bush did it, and Bush says that Clinton did 
it, and then Clinton said that Bush did it, and Bush said that Nixon 
did it, and Nixon said that Carter did it--then we could just point 
back to George Washington and say George Washington did it then and get 
it all over with rather than continuing this charade before the people, 
making them think that somehow or another we have the solution here.

                              {time}  1310

  Health care costs have gone up, and they're going to continue to go 
up until we as men and women in the House of Representatives and in the 
United States Senate and as the American people sit down and decide 
that this is a solvable problem which will allow us to address those 
things that are vital in this country.
  The bill is a complete waste of time. It does nothing in addition to 
going nowhere. It does nothing to help the

[[Page H1446]]

American people. It contains nothing to improve the affordability and 
accessibility of health care. And repealing IPAB, if you want to talk 
about frivolous, that's what frivolous is. Let us give the American 
people what they really need right now--and that's jobs. How many times 
do we have to say that down here for people to finally get it?
  Frankly, I'm appalled by the hypocrisy of my Republican colleagues 
who keep stating that Federal spending needs to be kept under control. 
But at the first opportunity they wind up rejecting one of the most 
serious tools in place to actually tackle Medicare spending and find 
ways to make care more affordable.
  What are the Republicans offering to replace IPAB? Nothing. Since the 
beginning of the 112th Congress, the Republican majority has sought to 
repeal as many provisions of the Affordable Care Act as possible 
without providing any replacement and absolutely no long-term solution. 
If we do nothing, Medicare costs will continue to increase, thereby 
increasing the burden on millions of seniors, disabled individuals, and 
their families all across this country.
  What is the Republican plan? What is the plan? It is to replace 
Medicare with the new Ryan budget introduced yesterday. It is to 
replace it with some kind of premium that is nothing but a voucher 
system that would certainly result in increased costs for seniors and 
reduced benefits.
  The truth is that the Republicans have no plan to reduce Medicare, 
and I defy them to present it. If you look at the budget that was 
released yesterday, it's all filled with blank spaces--and I'll fill in 
the line--nothing, nothing, nothing. So, instead of just repealing 
IPAB, let us improve it, reform it or replace it. By doing nothing, 
it's surely not going to fix the problem.
  I reserve the balance of my time.
  Mr. NUGENT. Madam Speaker, I yield 3 minutes to my fellow member of 
the Rules Committee, a freshman, Rob Woodall from Georgia.
  Mr. WOODALL. Madam Speaker, I very much appreciate that. I thank my 
colleague on the Rules Committee for yielding.
  I wanted to come down here and talk about the rule. My colleague from 
Florida has just made a very impassioned case for why he is likely 
going to be voting ``no'' on the underlying legislation. If I 
understood his comments correctly, I'm guessing that it's going to be a 
``no'' vote after we have finished 6 hours of debate on this bill--6 
hours of debate--which is the kind of debate that a bill of this nature 
demands. And I'm very proud that the Rules Committee set aside that 
kind of time. I was fortunate enough to have one of my amendments made 
in order by the Rules Committee, as was my friend from Florida, but a 
lot of Members were not.
  I wanted to come down here, Madam Speaker, to speak to the 
authorizers, the chairmen out there who are sending this legislation to 
the floor. Because what we have in this House is called the CutGo rule, 
which says if you bring a bill to the floor that's actually going to do 
some reducing of the Federal deficit, if you're going to be bold enough 
in this House to send a bill to the floor that's going to reduce the 
burden that we're placing on our children and grandchildren everyday, 
then nothing that happens on the floor of the House as we try to amend 
that bill will be allowed to reduce that savings.
  So when a bill comes to the floor, as this bill has, H.R. 5, that has 
a very high CutGo number in it, we're in a box. It cannot be amended 
with different ideas because those ideas are either not germane--
germaneness means that it has to be relevant to the underlying 
legislation--or they can't cut any additional funds. So what we had to 
do in the Rules Committee yesterday was reject amendment after 
amendment after amendment that our colleagues offered that we would 
ordinarily have made in order here on the House floor in what has been 
the single most open Congress that I have seen in my lifetime. I'm a 
freshman on the floor of this House, but I've been watching this 
institution. This is the single most open Congress I've seen in my 
lifetime, but we were not able to make more amendments in order because 
they were not germane or they violated CutGo. To the Rules Committee's 
credit, we did not waive CutGo. We complied with the rules of this 
House.
  But I just say to my friends who are on those authorizing committees, 
if you want to take advantage of the Rules Committee in this Congress 
that is providing more opportunity for more debate and more amendment 
and more discussion than we have seen in decades, you need to be 
cognizant when you send those bills to the Rules Committee that we are 
not inclined to waive CutGo--and rightfully so--and we are not inclined 
to waive the germaneness rules--and rightfully so.
  What that means today is we're going to have the narrow discussion, 
that my friend from Florida has laid out, on the merits of this bill 
for over 6 hours today. I want to thank my friend on the Rules 
Committee for his leadership in bringing such an open rule to the 
floor, in bringing such an expansive rule to the floor and in genuinely 
providing the kind of opportunity for debate, even though I disagree 
with my friend from Florida on his underlying assertions, providing the 
opportunity for debate the likes of which America has not seen in 
decades.
  Mr. HASTINGS of Florida. Madam Speaker, my friend from Georgia--and 
he is my friend--pointed out that his amendment was made in order 
yesterday. I might add, in keeping with the notion if you can't have it 
both ways, he would strike all the findings. And it seems to me that 
that's admitting justification for the authority to pass Federal tort 
reform. But it directly contradicts the same constitutional arguments 
they will be making next week before the United States Supreme Court in 
their effort to repeal the Patient Protection and Affordable Care Act, 
a bill which many of the same conservative lawmakers argue that 
Congress did not have the constitutional authority to pass.
  I am very pleased to yield 3 minutes to my very good friend from New 
Jersey, a member of the Budget Committee, the distinguished gentleman 
(Mr. Andrews).
  (Mr. ANDREWS asked and was given permission to revise and extend his 
remarks.)
  Mr. ANDREWS. I thank my friend for yielding.
  Whether you're a Republican or a Democrat, a liberal or conservative, 
no matter where you live, I think most people agree that the number one 
issue confronting our country is the lack of jobs for the American 
people. It is the central issue of our times, central problem of our 
times. The American people want us to look forward and work together 
and solve that problem rather than looking backward and relitigating 
political debates.
  One hundred ninety-five days ago, the President of the United States 
came to this Chamber and set forth a series of specific ideas to put 
Americans back to work. One of those ideas was to put construction 
workers back to work in repairing and building our roads and bridges, 
building schools, wiring schools for the Internet, and in putting our 
construction industry and transportation industry back to work. We're 
going to spend 6 hours debating whether to repeal part of the health 
care bill--again. We're not going to spend 6 minutes debating a bill 
that would put our construction workers back to work fixing our roads 
and bridges.
  The Republican leadership of the House is kind of isolated on this 
because Democrats in the other body voted for a bill to put our 
construction workers back to work; and Republicans in the other body 
voted for the same bill. Three-quarters of the Senate voted for a bill 
to put our construction workers back to work.
  The Democrats are ready to vote for that bill. We introduced a 
version of that yesterday that says let's do that here, but the House 
Republican leadership won't put this bill on the floor. So instead what 
we're going to do is have what are recurring debates about whether to 
repeal the health care bill.
  People feel very strongly about the health care bill, pro and con; 
but I think most people feel even more strongly it's the wrong thing 
for us to be talking about right now. If there's a bill that three-
quarters of the Senate voted for to put Americans back to work, why 
don't we vote on that here today? Instead, what we're going to do is 
vote on repealing part of the bill that talks about a committee that 
might or might not take action 5 years

[[Page H1447]]

from now to do something about the way Medicare money is spent.

                              {time}  1320

  I think if you said to a Republican or a Democrat, a liberal or a 
conservative anywhere in this country, What would you like your House 
of Representatives to be voting on today: a bill that three-quarters of 
the Senate agreed to to put construction transportation workers back to 
work, or a bill that will decide whether a body will or won't act 5 
years from now on the way Medicare is going to be run? I think we all 
know the answer to that.
  The right thing to do is to oppose this rule and instead put on the 
floor the Senate transportation bill that three-quarters of the Senate 
voted for. Let's approve it, let's put it on the President's desk, and 
let's finally work together to put Americans back to work.
  Mr. NUGENT. Madam Speaker, I love the hyperbole. I love my friend 
from Florida's passionate discourse earlier in this conversation. But 
he was right. You can't have it both ways.
  Here's the problem. In their idea of having it both ways, they talk 
about medical malpractice as if, if we do nothing, things get better. 
If we ignore tort reform, things get better. If we ignore tort reform, 
costs of health care will stay the same. Well, in fact, it hasn't. It 
continues to rise.
  We talk about higher health care costs, but when we talk about that 
and we talk about IPAB in particular, 15--15--unelected bureaucrats. 
The maximum number that can be on that panel is seven physicians--
seven--so they're outvoted already. They're outvoted 8 7. No matter 
what they think is the proper care for a patient, they're going to be 
overridden by eight other bureaucrats that have nothing to do with 
providing health care to our seniors--not a thing.
  It's all going to be about costs. And they're right: that's how 
you're going to contain costs, by removing the options for seniors to 
get the medical care that they deserve and that they need.
  This independent panel is a rationing board. It's going to ration 
health care out because that's the only way that panel can save money 
for the Affordable Care Act. It was designed that way. It was designed 
to keep us--the American people that are going to use that service, 
that medical care--from getting it because physicians, when they get 
their payments cut, will no longer offer service. So where are we 
supposed to go? That is rationing. That's taking away service from 
people that need it the most, from those seniors that have paid into 
this system for their lifetimes and who are now depending on it to be 
there when they medically need it the most.
  This is about the seniors that are in my district. I have 250,000 
seniors, a quarter of a million, that rely upon Medicare. And if we're 
going to start rationing care to them, I think it's immoral, it's 
unethical, and it's not the way we should be doing it. We should be 
doing it by the free market. We should be talking about tort reform. 
Everybody agrees we need tort reform. Even the gentleman from Florida 
talked about the high cost of medical malpractice insurance. Well, 
where does that come from? It doesn't just spring up out of the Earth. 
It comes up because of a reason: because of the increased cost to 
provide medical malpractice. And, particularly for doctors, where it 
drives up the cost of medical care is that defensive medical care. 
That's what's driving up the cost along with the premiums that they 
have to pay because of the lack of tort reform.
  Madam Speaker, I reserve the balance of my time.
  Mr. HASTINGS of Florida. I yield myself such time as I may consume, 
and I will be very brief before yielding to my friend from the Rules 
Committee.
  My friend from Florida says that he appreciates the hyperbole. I 
hyperbole on occasion when I find that my friends who are taking 
positions that are going to hurt people require everything from 
hyperbole to passion to try to get the American people to readily 
understand. And to demonstrate what I'm talking about, my friend just 
stood and said that the IPAB board will be rationing. The statute, the 
provision giving rise to it, if it ever comes into existence in the 
future, specifically says that they cannot ration. I don't know whether 
my friend read that provision or not.
  But I am pleased to yield 1 minute to my friend on the Rules 
Committee, the gentleman from Colorado (Mr. Polis).
  Mr. POLIS. I thank the gentleman from Florida.
  We're in an unusual situation here where the same people on the other 
side of the aisle who decry the regulation of what insurance providers 
have to provide to those they insure across State borders and who want 
to interfere with our requirement that insurance companies not be 
allowed to discriminate based on preexisting conditions, on the other 
hand they say we need to replace the State tort systems, all 50 of 
them, with one overarching Federal approach with regard to malpractice.
  So whereas there is no Federal role in protecting patients from being 
dropped by their insurers, from preventing insurance companies from 
excluding individuals because they had childhood asthma, because 
they're a breast cancer survivor, and in many cases even because they 
have a child, while there is no Federal role for that, somehow there is 
a Federal role in micromanaging the way in which somebody who was 
wrongfully injured by a botched procedure can seek recourse.

  I ask my colleagues, not only where is the consistency, but how can 
we reconcile this with our values as Americans?
  Mr. NUGENT. Madam Speaker, I have to agree with my good friend from 
Florida on one issue, and that's in regard to rationing. You're right, 
it's not in the act. But if it walks like a duck, quacks like a duck, 
then it's a duck, because this board, this unelected board, is going to 
make decisions that Congress can't even touch. This board is going to 
say, this is the amount of money we will pay for this procedure. It 
doesn't matter if that's what the procedure costs. It doesn't matter 
that this doesn't cover the cost of the physician. It doesn't matter 
that what's going to happen is our physicians are going to refuse to 
see those patients.
  Madam Speaker, that is rationing. Call it what you want. That is 
rationing when you have an independent board that can make decisions in 
regard to the cost of services that you're going to make or decisions 
for you to have services by a particular doctor. We see it already 
today. In my physician's office it already says, ``We do not take new 
Medicare patients.''
  It's going to get worse. And this board, while it may not call it 
``rationing''--I give them great credit for not putting that in the 
terminology of the Affordable Care Act--it is rationing no matter what 
you call it.
  I reserve the balance of my time.
  Mr. HASTINGS of Florida. I yield myself such time as I may consume.
  I would be happy to yield to my friend just for a moment. So then 
what you're saying is, the IPAB board, which may bring down costs--and 
I might add you just said that Congress could not touch it, quoting 
you--that's not true. Congress could change it as long as it stays 
within the prescribed limits, and that is simply what the law, itself, 
says.
  But what is the Republican plan? As I understand it from Mr. Ryan's 
budget as offered yesterday, it would be a premium system for Medicare. 
Now you've just said that rationing by any other name or that you know 
it when it's a duck, and all of that kind of stuff. Well, a voucher by 
any other name is still a voucher, and you're going to tell me that 
that's a good system?
  I yield to my friend.
  Mr. NUGENT. If you look at what the Ryan plan said, it also talks 
about what we currently have today and that, if you want to keep what 
you have today in the way of Medicare, you keep it. But if you want to 
go out and buy your own insurance through a select group, you can do 
it, just as you can today, in regards to Medicare Advantage, but that's 
a choice that I can make.
  I thank you for giving me the time.
  Mr. HASTINGS of Florida. I reclaim my time only to say that you had 
it right, ``select.'' For example, our Governor in the State of Florida 
had one of those select provisions, and he's one of those people that 
wants us to turn everything over.
  I happened to have had the good fortune yesterday of having the 
chairman

[[Page H1448]]

of Blue Cross Blue Shield visit me, who thinks that this particular 
measure is something that would be helpful in his industry, but that's 
something for another day.
  Madam Speaker, if we defeat the previous question, I'm going to offer 
an amendment to the rule to provide that immediately after the House 
adopts this rule that it bring up H.R. 14, the House companion to the 
bipartisan Senate transportation bill.

                              {time}  1330

  I am pleased now to yield 3 minutes to my good friend, the 
distinguished gentleman from New York (Mr. Bishop).
  Mr. BISHOP of New York. I thank my friend from Florida for yielding.
  Time and time again over the last several months, we have heard from 
Republican leadership. We've heard their talk about the highway bill, 
H.R. 7, and they've talked about it as their principle jobs bill for 
the 112th Congress. Well, here we are, March 21, 10 days before the 
expiration of the current extension of the surface transportation bill, 
and where are we with respect to this incredibly important jobs 
legislation? We're nowhere. We're absolutely nowhere.
  As of today, House Republicans have yet to put forward a credible 
highway reauthorization that puts Americans back to work. Their only 
attempt, H.R. 7, the Boehner-Mica authorization, was passed on February 
14 in the Transportation Committee--passed on a party-line vote with, 
in fact, a couple of Republicans voting against it. Then something 
happened on the way to the floor. On the way to the floor, the 
Republican leadership realized that they didn't have the votes on their 
side of the aisle to pass it.
  And what about this bill? Well, Secretary Ray LaHood, a former 
distinguished Member of this body, Republican from Illinois, current 
Transportation Secretary, described it as the worst highway bill he's 
ever seen. He's been in public life for 35 years; he said it was the 
worst he's ever seen.
  The bill was drafted in the dark of night without any Democratic 
input. Remarkably, it removed transit from the highway trust fund--
removed the guaranteed Federal funding that's been in place on a 
bipartisan basis for 30 years, removed it. It couldn't attract, 
understandably, a single Democratic vote; but they found out on the way 
to the floor that they couldn't get enough Republican votes to pass it 
either.
  Now, I'm proud to be offering the Senate bill, MAP 21. We're calling 
it H.R. 14 here in the House. This bipartisan legislation should 
refocus the discussion on jobs and economic opportunities rather than 
the Republican message this week of tearing down Medicare and 
protecting the 1 percent at the expense of middle class families.
  MAP 21, or H.R. 14, represents a bipartisan path forward that makes 
meaningful reforms and provides certainty to States. MAP 21 passed 
overwhelmingly in the Senate with a bipartisan majority. As you heard 
Mr. Andrews say, three-quarters of the Senate voted for this bill. It's 
fully paid for--something that the House Republicans seem unable to 
come close to achieving--and the MAP 21, H.R. 14, pay-fors are less 
controversial than the pay-fors in the House Republican bill.
  It's been estimated that this bill will save 1.8 million jobs and 
create up to 1 million more jobs. During a weak economic recovery 
looking for a jump-start, why aren't we passing this bill? Why aren't 
we even debating this bill? Why are we 10 days away from the expiration 
of the current extension and there is no plan in this House to move 
forward?
  Is H.R. 14 the silver bullet to our surface transportation needs? No, 
it's not.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. HASTINGS of Florida. I yield the gentleman 1 additional minute.
  Mr. BISHOP of New York. I appreciate the gentleman for yielding.
  There is no silver bullet when it comes to our infrastructure needs. 
I, and a great many others, would prefer a 5-year bill; but given the 
hyper-partisan fashion in which the House Republicans have advanced 
H.R. 7 and some of the deeply flawed proposals included in their bill, 
H.R. 14 is the only proposal out there that currently Democrats and 
Republicans can stand behind. Democrats will not wait around for House 
Republicans to pander to their base and chase ideological extremes. 
Americans want jobs and safe roads and safe bridges.
  The Senate passed the biggest job-creating bill in this Congress by 
an overwhelming bipartisan margin. The House has done nothing. Let's 
get this country moving again by passing H.R. 14 so the President can 
sign it. Let's create jobs. Let's make it in America, and let's pass 
this bill.
  Mr. NUGENT. Madam Speaker, may I inquire of my good friend from 
Florida how many more speakers he may have.
  Mr. HASTINGS of Florida. I appreciate the gentleman for asking.
  Madam Speaker, would you advise both of us how much time each has.
  The SPEAKER pro tempore. The gentleman from Florida (Mr. Hastings) 
has 6 minutes remaining, and the gentleman from Florida (Mr. Nugent) 
has 14 minutes.
  Mr. HASTINGS of Florida. I have more speakers than I have time; but I 
know that during that period of time, I'm going to have at least two 
more speakers and possibly three.
  Mr. NUGENT. I continue to reserve the balance of my time.
  Mr. HASTINGS of Florida. Madam Speaker, I am very pleased to yield 2 
minutes to my good friend, the distinguished gentleman from Oregon (Mr. 
DeFazio).
  Mr. DeFAZIO. Repeal and replace, that's what the Republicans said 
they will do. Well, what's the replacement? Apparently, it's the Ryan 
voucher plan, which will stick it to seniors in the future--not too 
good of a replacement.
  But the other thing they're repealing that they don't want to talk 
about is they're repealing restrictions on age discrimination by the 
insurance industry. They would be repealing the restrictions on 
preexisting conditions to discriminate against people--redline them, 
essentially, by the insurance industry--and they would be repealing the 
provision of reviewing excessive rate increases which has been already 
successful in California this year.
  So the Republicans have come forward with this one part of the bill. 
They've already repealed all of ObamaCare, but now they're going to 
repeal it bit by bit because they don't want to do real things like 
deal with our transportation system and that.
  But there is one particularly objectionable part of this. They're 
going to pretend that they're taking away the antitrust protection of 
the insurance industry. Remember, this is an industry that can and does 
get together and collude to drive up our premiums. And after the 
Republicans do away with age discrimination, preexisting conditions, 
and rate increases, the industry is going to have a field day.
  So they're pretending that they're going to allow suits against the 
industry for antitrust violations. Unfortunately, not really. If 
someone wants to bring a suit, they can't do it as a class action. 
Well, more than 90 percent of antitrust suits are brought as class 
actions. Individuals do not have the resources to take on the insurance 
industry.
  So they're going to take something that in the last Congress was 
bipartisan--a bill I had to take away, really take away, the antitrust 
immunity in the insurance industry and give a benefit to all consumers 
in this country, passed this House by 406 19--and now they're going to 
fake out, they think, the American people by pretending they're taking 
on the insurance industry while they're filling their pockets with 
contributions from them.
  Good work, guys.
  Mr. NUGENT. Madam Speaker, I'm a little confused because I thought we 
were talking about other issues than what the gentleman was just 
speaking to, particularly as relates to IPAB and about tort reform.
  I'll be happy to reserve the balance of my time.
  Mr. HASTINGS of Florida. Madam Speaker, I am very pleased to yield 1 
minute to my good friend, the distinguished gentlewoman from California 
(Ms. Richardson).
  Ms. RICHARDSON. I thank the gentleman for yielding so that I might 
speak to the House companion bill to MAP 21, or H.R. 14, of which I'm a 
cosponsor.
  MAP 21, which we call H.R. 14 going forward, will generate jobs, 
repair roads and bridges, and invest in our infrastructure. This 
surface transportation authorization bill passed by the

[[Page H1449]]

Senate with a majority and with bipartisan support.
  I come before you today to urge my colleagues to bring this bill 
forward, H.R. 14, so that we might establish some consistency, unlike 
what we saw with the FAA reauthorization, consistency for States, for 
companies, for workers, for projects that need to get done. This bill 
will maintain current funding levels for highways and public 
transportation; it will consolidate and streamline highway programs; 
and will establish a much-needed national freight program, which is 
something I've been advocating for my entire time in Congress.
  This bill will authorize $1 billion for projects of national 
significance, which many of us feel in our own particular districts.
  H.R. 14 also improves safety, institutes performance measures, and 
improves accountability for transportation infrastructure investments.
  The SPEAKER pro tempore. The time of the gentlewoman has expired.
  Mr. HASTINGS of Florida. I yield the gentlelady an additional 30 
seconds.
  Ms. RICHARDSON. Now is the time for swift action by this House on a 
bipartisan Senate bill that will create and save at least 132,000 jobs 
in my area alone.
  Transportation has always been bipartisan. Let's keep it that way in 
this House. I urge the support of H.R. 14.
  Mr. NUGENT. Madam Speaker, I continue to reserve the balance of my 
time.

                              {time}  1340

  Mr. HASTINGS of Florida. Madam Speaker, would you tell me just how 
much time I do have.
  The SPEAKER pro tempore. The gentleman from Florida has 2\1/2\ 
minutes remaining.
  Mr. HASTINGS of Florida. Madam Speaker, I thank my friend for the 
debate and the time that he's allowed us. I thank all of our colleagues 
who came here.
  This H.R. 5 is going to be devastating to medical malpractice 
victims. Patients shouldn't have to pay the price for excessive 
malpractice insurance.
  If we want to reform the medical liability system, let us start with 
addressing insurance costs and physicians' premiums. Let us start with 
finding strategies to reduce and prevent mistakes and crack down on 
repeat offenders. Today, 5 percent of all doctors are responsible for 
54 percent of malpractice claims paid.
  Let's not start with penalizing patients for injuries due to no fault 
of their own. Let's not give the American people another reason to 
believe that Congress is out of touch. Thousands of people die each and 
every year due to medical malpractice. This is not frivolous.
  We had 16 of our Members come forward yesterday to offer amendments. 
We're going to have 6 hours of debate on six, ostensibly, because we, 
in the Rules Committee who have the power, refused to waive the power 
to allow those amendments to come in, some that included things such as 
not being able to allow a child 3 years old who may have a matter that 
doesn't manifest itself until he or she is 8 be barred because of time 
constraints, measures that deal with, like the pediatrician in Delaware 
who raped 100 or more children, babies, and that position would not be 
allowed for.
  I know that one would argue that some lawsuits are frivolous, and 
they are. I am a lawyer. I am a trial lawyer, and so I clearly support 
the trial lawyers, so as how that's understood with my bona fides. But 
when people are dying, that's not frivolous; and, as I said, people 
want the best lawyer that they can find.
  Madam Speaker, I ask unanimous consent to insert the text of the 
amendment in the Record, along with extraneous material, immediately 
prior to the vote on the previous question.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Florida?
  There was no objection.
  Mr. HASTINGS of Florida. I urge my colleagues to vote ``no'' and to 
defeat the previous question. I urge a ``no'' vote on the rule, and I 
do so for the reason that this measure does nothing, is going nowhere, 
will go to the Senate and will not pass, and everybody in this House 
knows it.
  We have to stop doing nothing and do something for the American 
people and jobs.
  I yield back the balance of my time.
  Mr. NUGENT. Madam Speaker, in closing, I appreciate my good friend's 
confession about being a trial lawyer. I'm not. I'm not an attorney. So 
what I'm worried about is not how attorneys enrich themselves; I'm 
worried about the people that I represent, the 250,000-plus that are on 
Medicare. I'm concerned about them.
  You hear from the other side, well, don't worry about it. It could be 
5, 10 years from now. Well, you know what? I'm concerned now because 
why would you have something put in place that's going to ration care 
to our seniors when they need it the most? That's when they need it the 
most. We should be advocating for them, not for trial lawyers. We 
should be here talking about tort reform to lower the cost. If you look 
at what California did, they're a model. They set up a model program. 
Their liability insurance for doctors is lower than the average across 
the board in the United States. This act, the HEALTH Act, is modeled 
after that.
  In regards to the noneconomic damages, limits on contingency fees for 
lawyers, big one there; about fair share, about proportional, whoever's 
at fault. It's a proportion of that reference to how the claim gets 
paid out. And I heard this talked about before: But will the health 
care act work to reduce health care costs and lower the deficit? 
According to the CBO, it will. It will be an average of 25 to 30 
percent below what it would be under current law, which is IPAB today, 
25 to 30 percent less than what the current law, IPAB, calls for.
  Is this important? I think the relationship between a patient and a 
doctor should be between a patient and a doctor and not have a 
middleman, called the United States Government, stepping in between you 
to say, ``You know what? We don't think that that service deserves a 
certain level of payment,'' and by reducing that payment we know that 
that service is not going to be provided. I truly don't believe that 
that's where we should be as a government, and I certainly don't 
believe that we should be in between the patients and their physicians.
  I also worry about--and I hear this from docs all the time back in my 
district--Rich, you know what's going to happen? We're just going to 
close our doors. Those that are entering the profession, there's less 
and less because they're concerned about how they're going to make a 
living, how they're going to pay back those student loans that they 
have, because they really want to pay it back. They want to do the 
right thing. But how are they going to do that if they can't open a 
practice and if they can't take Medicare patients because this board 
makes a decision to lower the cost of reimbursement?
  We've seen it already. Every time we do a doc fix, we have more and 
more doctors that are in trouble because of the fact they don't know 
what tomorrow's going to bring, and I don't want our seniors to worry 
about what tomorrow is going to bring. I don't want to balance the 
budget on the back of our seniors. That's not where we need to be.
  As we move along here, the reason I stand here today is that I 
support and I will defend our seniors, which is why I support H.R. 5, 
because it's common sense.
  Like I said, I'm not an attorney. I'm not a lawyer, so I have but one 
constituency that I worry about at this point on this particular issue, 
and it is this issue. You put all kinds of other stuff out there about 
transportation and all these things, but this is the pressing issue 
today in front of us. The issue is about tort reform. The issue is 
about IPAB and repealing IPAB so our seniors can have a direct 
relationship with a physician of their choice, and that's the important 
part.
  The material previously referred to by Mr. Hastings of Florida is as 
follows:

     An Amendment to H. Res. 591 Offered by Mr. Hastings of Florida

       At the end of the resolution, add the following new 
     sections:
       Sec. 2. Immediately upon adoption of this resolution the 
     Speaker shall, pursuant to clause 2(b) of rule XVIII, declare 
     the House resolved into the Committee of the Whole

[[Page H1450]]

     House on the state of the Union for consideration of a bill 
     consisting of the text of the bill (H.R. 14) to reauthorize 
     Federal-aid highway and highway safety construction programs, 
     and for other purposes. The first reading of the bill shall 
     be dispensed with. All points of order against consideration 
     of the bill are waived. General debate shall be confined to 
     the bill and shall not exceed one hour equally divided and 
     controlled by the chair and ranking minority member of , the 
     Committee on Transportation and Infrastructure. After general 
     debate the bill shall be considered for amendment under the 
     five-minute rule. All points of order against provisions in 
     the bill are waived. At the conclusion of consideration of 
     the bill for amendment the Committee shall rise and report 
     the bill to the House with such amendments as may have been 
     adopted. The previous question shall be considered as ordered 
     on the bill and amendments thereto to final passage without 
     intervening motion except one motion to recommit with or 
     without instructions. If the Committee of the Whole rises and 
     reports that it has come to no resolution on the bill, then 
     on the next legislative day the House shall, immediately 
     after the third daily order of business under clause 1 of 
     rule XIV, resolve into the Committee of the Whole for further 
     consideration of the bill.
       Sec. 3. Clause 1(c) of rule XIX shall not apply to the 
     consideration of the bill specified in section 2 of this 
     resolution.
                                  ____

       (The information contained herein was provided by the 
     Republican Minority on multiple occasions throughout the 
     110th and 111th Congresses.)

        The Vote on the Previous Question: What It Really Means

       This vote, the vote on whether to order the previous 
     question on a special rule, is not merely a procedural vote. 
     A vote against ordering the previous question is a vote 
     against the Republican majority agenda and a vote to allow 
     the opposition, at least for the moment, to offer an 
     alternative plan. It is a vote about what the House should be 
     debating.
       Mr. Clarence Cannon's Precedents of the House of 
     Representatives (VI, 308 311), describes the vote on the 
     previous question on the rule as ``a motion to direct or 
     control the consideration of the subject before the House 
     being made by the Member in charge.'' To defeat the previous 
     question is to give the opposition a chance to decide the 
     subject before the House. Cannon cites the Speaker's ruling 
     of January 13, 1920, to the effect that ``the refusal of the 
     House to sustain the demand for the previous question passes 
     the control of the resolution to the opposition'' in order to 
     offer an amendment. On March 15, 1909, a member of the 
     majority party offered a rule resolution. The House defeated 
     the previous question and a member of the opposition rose to 
     a parliamentary inquiry, asking who was entitled to 
     recognition. Speaker Joseph G. Cannon (R-Illinois) said: 
     ``The previous question having been refused, the gentleman 
     from New York, Mr. Fitzgerald, who had asked the gentleman to 
     yield to him for an amendment, is entitled to the first 
     recognition.''
       Because the vote today may look bad for the Republican 
     majority they will say ``the vote on the previous question is 
     simply a vote on whether to proceed to an immediate vote on 
     adopting the resolution . . . [and] has no substantive 
     legislative or policy implications whatsoever.'' But that is 
     not what they have always said. Listen to the Republican 
     Leadership Manual on the Legislative Process in the United 
     States House of Representatives, (6th edition, page 135). 
     Here's how the Republicans describe the previous question 
     vote in their own manual: ``Although it is generally not 
     possible to amend the rule because the majority Member 
     controlling the time will not yield for the purpose of 
     offering an amendment, the same result may be achieved by 
     voting down the previous question on the rule . . . When the 
     motion for the previous question is defeated, control of the 
     time passes to the Member who led the opposition to ordering 
     the previous question. That Member, because he then controls 
     the time, may offer an amendment to the rule, or yield for 
     the purpose of amendment.''
       In Deschler's Procedure in the U.S. House of 
     Representatives, the subchapter titled ``Amending Special 
     Rules'' states: ``a refusal to order the previous question on 
     such a rule [a special rule reported from the Committee on 
     Rules] opens the resolution to amendment and further 
     debate.'' (Chapter 21, section 21.2) Section 21.3 continues: 
     ``Upon rejection of the motion for the previous question on a 
     resolution reported from the Committee on Rules, control 
     shifts to the Member leading the opposition to the previous 
     question, who may offer a proper amendment or motion and who 
     controls the time for debate thereon.''
       Clearly, the vote on the previous question on a rule does 
     have substantive policy implications. It is one of the only 
     available tools for those who oppose the Republican 
     majority's agenda and allows those with alternative views the 
     opportunity to offer an alternative plan.

  Mr. NUGENT. Madam Speaker, I yield back the balance of my time, and I 
move the previous question on the resolution.
  The SPEAKER pro tempore. The question is on ordering the previous 
question.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. HASTINGS of Florida. Madam Speaker, on that I demand the yeas and 
nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this question will be postponed.

                          ____________________