[Congressional Record Volume 158, Number 47 (Wednesday, March 21, 2012)]
[House]
[Pages H1453-H1490]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  PROTECTING ACCESS TO HEALTHCARE ACT

  Mr. UPTON. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days to revise and extend their remarks on the 
legislation and to insert extraneous material on H.R. 5.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Michigan?
  There was no objection.
  The SPEAKER pro tempore. Pursuant to House Resolution 591 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. 5.

                              {time}  1505


                     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. 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, with Mr. Westmoreland 
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.
  General debate shall be confined to the bill and amendments specified 
in House Resolution 591 and shall not exceed 6 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.
  The Chair recognizes the gentleman from Michigan (Mr. Upton).
  Mr. UPTON. Mr. Chairman, I yield myself such time as I might consume.
  I rise today in support of the PATH Act, which addresses two of the 
most glaring deficiencies in the President's overhaul of the health 
care system.
  By what it does and also by what it fails to do, the health care law 
threatens access to quality health care for literally millions of 
Americans.
  Section 3403 of the Affordable Care Act established the Independent 
Payment Advisory Board, or IPAB. A panel of 15 unelected, unaccountable 
bureaucrats will be given the power to make major decisions regarding 
what goods and services are valuable. These decisions will then be 
fast-tracked, essentially bypassing the legislative process, with 
almost no opportunity for discussion or review. The PATH Act prevents 
this by repealing IPAB.
  I suspect that most Americans still believe that patients and their 
doctors should have a voice and should be able to decide what health 
care services that they find valuable. I think that they still believe 
that major policy decisions affecting the Medicare program and the 
health care system in general need to go through the regular 
legislative process and be subject to the normal system of checks and 
balances according to the Constitution.
  It is encouraging that the cosponsors of legislation to repeal IPAB 
include 20 Democrats and that the bill was favorably reported out of 
the Energy and Commerce Committee earlier this month without any 
recorded opposition--a voice vote.
  I encourage my colleagues on both sides of the aisle to support 
repealing IPAB and not to block its passage at the expense of our 
seniors in a blind effort to defend the President's signature 
legislation.
  The legislation today also includes reforms that will actually lower 
the

[[Page H1454]]

cost of health care, a glaring omission in the President's health care 
law. The health care law failed to provide any meaningful reform to the 
broken and costly medical liability system, which is currently one of 
the largest cost drivers of our health care system.
  The current system is responsible for as much as $200 billion a year 
in unnecessary spending on defensive medicine. It fails to compensate 
injured patients in a fair and timely matter, and it threatens access 
to quality health care by driving good doctors out of high-risk 
specialties such as obstetrics and neurosurgery.

                              {time}  1510

  According to the CBO, these commonsense reforms will reduce the 
Federal deficit by $48.6 billion over the next 10 years.
  How have opponents proposed to fix this present system? They want to 
spend more; $50 million in grants for State demonstrations, as called 
for in the health care law, is not a solution. It's an abdication of 
responsibility. The President promised to look at Republican ideas for 
medical liability reform. Passing this legislation is the very first 
step towards allowing the President to make good on that promise.
  Health care decisions should be made between a doctor and a patient. 
That relationship doesn't work when bureaucrats and trial lawyers come 
between them. So I urge my colleagues to vote in support of this 
legislation.
  Mr. Chairman, I reserve the balance of my time.
  Mr. WAXMAN. Mr. Chairman, I yield myself such time as I may consume.
  I rise in opposition to H.R. 5. It combines two very bad ideas into 
one terrible bill that is anti-senior, anti-consumer, and anti-health.
  It's no accident that we're considering the legislation during the 
second anniversary of the Affordable Care Act, because this is a thinly 
veiled, partisan attempt to confuse the public and obscure the law's 
success in covering young people, reducing costs for seniors, and 
providing improved health benefits.
  Title I of the bill before us, the medical malpractice provisions, 
have been around for over a decade. They have not been enacted under 
Democratic or Republican Congresses and Presidents because they are an 
extreme intrusion on the authority of the States to set their own 
liability rules and would shield bad actors from accountability when 
they cause injury and death.
  Let's be clear: this bill is much broader than traditional medical 
malpractice legislation. It protects manufacturers, distributors, 
suppliers, marketers, even promoters of health care products. And it 
gives them protection even if they intentionally cause harm. Insurance 
companies and HMOs are protected as well. The bill shields drug and 
device manufacturers with complete immunity from punitive damages, no 
matter how reckless their conduct, so long as their products were at 
one time approved by the FDA.
  This bill preempts State action in an area that has traditionally 
been left to the States. To the extent that we do have a medical 
malpractice problem in this country, it should be addressed at the 
State level. But this bill not only strips away State law; it puts in 
place a Federal scheme that will not reduce medical errors, will not 
award appropriate and adequate compensation when an injury occurs, and 
will not lower health care costs.
  The second part of the bill would repeal the Independent Payment 
Advisory Board, which helps keep Medicare costs under control if they 
rise more than anticipated. IPAB's role is to recommend evidence-based 
policies to improve Medicare without harming patients.
  Repealing IPAB is the height of hypocrisy. The main Republican attack 
on Medicare and the Affordable Care Act is that we cannot afford them. 
House Republicans are proposing changes that would destroy Medicare 
because they say taking care of our seniors just costs too much. Yet 
today they will vote for a bill that eliminates one of Medicare's cost-
saving innovations and saddles Medicare with over $3 billion in 
unnecessary costs. It's no wonder that the public holds Congress in so 
little regard.
  The Republican master plan for Medicare is to end the guarantee 
coverage and shift more costs on to seniors and people with 
disabilities. They don't hold down the costs; they simply shift them on 
to seniors and disabled people. Under Medicare, they pay more for it 
out of their own pockets. This is part of the Republican assault on 
Medicare. It would repeal the backstop in Medicare that keeps Medicare 
affordable for seniors.
  I want to be clear about what the IPAB is and what it isn't. The 
board is explicitly in statute prohibited from rationing. It also is 
prohibited from making recommendations that increase costs to seniors 
or cut benefits. IPAB also doesn't take away the role of Congress. IPAB 
makes recommendations, but Congress can and should act on those 
recommendations.
  We hear a lot about these unelected bureaucrats. Let me tell you 
that, around this place, there are a lot of elected bureaucrats. Here 
is the fundamental difference between the Democratic approach to 
Medicare and the Republican approach: Democrats in Congress are 
committed to preserving Medicare and protecting seniors' benefits; 
Republicans have proposed ending Medicare's guarantee of coverage so 
they can pay for tax breaks for oil companies and millionaires. Let me 
underscore that. They want to take money out of Medicare so they can 
give more tax breaks to billionaires and oil companies.
  Like some of my colleagues, I have concerns about some aspects of the 
IPAB. I don't agree with the premise that we need IPAB to make Congress 
do its job. But no one should think that the hyperbole of IPAB's 
Republican critics--rationing, death panels, and faceless bureaucrats 
pulling the plug on sick patients--represents reality. That came from 
their propaganda word masters.
  House Republicans are voting to repeal the Independent Payment 
Advisory Board because they simply want to eliminate Medicare. They 
want to provide vouchers instead of benefits. They want to shift costs 
to the beneficiaries. They want to put Medicare into a death spiral and 
leave insurance companies in charge of seniors' care. Then it would be 
the insurance companies that could then ration care, cut benefits and, 
according to the Congressional Budget Office, likely increase out-of-
pocket costs by $6,000.
  Does anybody doubt insurance companies ration care? Try to get an 
insurance policy if you have a previous medical condition. They won't 
even cover you, or they will charge you so much you can't afford it. Is 
that what we want, to let the insurance companies make these decisions 
for our seniors and disabled people?
  H.R. 5 is a partisan assault on Medicare and an assault on patients 
who are injured by careless doctors and drug companies and an assault 
on States' rights.
  I urge my colleagues to vote ``no'' on H.R. 5.
  Mr. Chairman, I reserve the balance of my time.
  Mr. UPTON. Mr. Chairman, I yield 2 minutes to the chairman emeritus 
of the Energy and Commerce Committee, Mr. Barton, the gentleman from 
Texas.
  (Mr. BARTON of Texas asked and was given permission to revise and 
extend his remarks.)
  Mr. BARTON of Texas. I thank the distinguished chairman.
  We have just heard an argument from one of the authors, if not the 
chief author, of the new health care law. So it's understandable that 
former Chairman Waxman would rise in indignant defense of his product 
and opposed to this bill.
  H.R. 5, the PATH bill, is in actuality a reasoned response to an 
irrational attempt to socialize health care in the United States of 
America. The Independent Payment Advisory Board, which this legislation 
repeals, is an independent 15-member panel appointed by the President, 
unless the President doesn't appoint it, in which case three of the 
President's chief advisers become the board. And if they don't decide 
to do it, then one person, the Secretary of Health and Human Services, 
has the authority when this kicks in in 2014 to make all kinds of 
decisions that directly impact health care in America.
  I don't think, and a majority of my colleagues don't think, that 
that's the way it should be done. So this bill in one paragraph--I 
think on page 24--repeals that section. That is a good start.

[[Page H1455]]

It is not the end-all be-all, but it is a good start to regaining 
control of health care by individuals and the marketplace.

                              {time}  1520

  The other thing this bill does is it puts in a medical malpractice 
reform that has been long overdue. The President, in his State of the 
Union, said he was for medical malpractice reform, but I am told that 
he has said he is not for this medical malpractice reform, just like he 
is not against the Keystone pipeline, but he called Senators to oppose 
it when it came up in the other body.
  We need medical malpractice reform. Independent observers have said 
that this bill, which Congressman Gingrey of Georgia is the original 
sponsor of, would save $48 billion over, I think, a 10-year period if 
enacted--$48 billion. That's real reform. It does not preempt States. 
It allows the States to continue their medical malpractice laws that 
they've already enacted.
  So I ask that we vote for this piece of legislation.
  And I thank the chairman and the subcommittee chairman and all of the 
Members who have made it possible.
  Mr. WAXMAN. Mr. Chairman, I am pleased at this time to yield 3 
minutes to the distinguished ranking member and soon-to-be chairman of 
the Health Subcommittee, the gentleman from New Jersey (Mr. Pallone).
  Mr. PALLONE. I thank the gentleman from California.
  I have a great deal of respect for my former chairman and colleague 
from Texas, but as I listen to him, the problem is that it's always the 
same: It's my way or the highway. And it's just very unfortunate, 
because there have been many opportunities in the committee where we 
could have worked together to come up with legislation on things like 
malpractice reform and IPAB, but that's not what we get from the 
Republican side of the aisle. They just constantly want to do their own 
thing.
  And as he said, the President may be for malpractice reform, but if 
he's not for this malpractice reform, then he's a bad guy. And that's 
the point: We need to get together. If we're ever going to accomplish 
anything, we need to work together; and I don't see that happening on 
the Republican side of the aisle today.
  I am very disappointed in the process of considering H.R. 5. I am 
disappointed and frustrated that my Republican colleagues had an 
opportunity to bring to the floor a bill that I and some of my 
Democratic colleagues supported, but what they decided to do instead is 
to simply play political games, political games over and over again.
  All sectors of the health care industry agree that the Independent 
Payment Advisory Board, IPAB, should be repealed. I am the first one to 
tell you how much I am opposed to IPAB. In fact, during the Energy and 
Commerce Committee's Subcommittee on Health markup, I voted in favor of 
its repeal. But, unfortunately, my Republican colleagues have no 
interest in truly repealing IPAB. They only care about defacing the 
Affordable Care Act and continuing their political game of repealing 
the law piece by piece. How do I know that? Because they've decided to 
pay for the IPAB repeal with H.R. 5, one of the most controversial and 
historically partisan bills of the past decade.
  We've been through this same debate. Every time, every year, H.R. 5, 
on the floor again. Each year the Republicans have been in charge, 
we're forced to consider identical legislation that contains the exact 
same areas over which we remain divided. In fact, the Republicans 
weren't even able to enact this bill into law when they had the 
majorities in the House and Senate and the Presidency, and the reason 
is because they have zero desire to solve the problems of this country. 
All they are interested in accomplishing is a political message to take 
home to their districts.
  I have said again and again that I would work with my colleagues on 
truly addressing malpractice reform, but those calls have gone 
unanswered. Over the years, there has been little effort on the part of 
Republicans to reach across the aisle and to work with Democrats on a 
satisfactory solution to medical liability reform.
  I do understand that medical malpractice and liability is a very real 
problem for doctors in my home State and in the country, but H.R. 5 is 
not the answer. Any true reform must take a balanced approach and 
include protections for the legal rights of patients and be limited to 
medical malpractice.
  Today my vote on this package is a ``no'' vote on H.R. 5 alone. As I 
have stated, it's too controversial and extreme in its current form. 
Although it's described as a medical malpractice measure, H.R. 5 
extends far beyond the field of malpractice liability.
  I am just extremely disappointed. I am being honest in saying this. I 
am very disappointed that the Republican leadership has robbed many 
Democrats of their ability to vote cleanly on IPAB repeal and have, 
instead, yet again, politicized this body.
  When will you learn?
  Mr. UPTON. Mr. Chairman, I yield 2 minutes to the gentlelady from 
North Carolina, the vice chairwoman of the Energy and Commerce 
Committee, Mrs. Myrick.
  Mrs. MYRICK. I thank the chairman.
  Mr. Chairman, this is Washington, so we have to have an acronym for 
everything up here. The IPAB isn't a new techie device but is an 
example of one of the many misguided parts of the budget-busting health 
care reform law.
  What is this debate really about? We all know that Medicare is headed 
toward financial catastrophe, and the health reform law only succeeded 
in putting the program in a more precarious position. There is no easy 
solution to this problem, but Republicans have put forward a plan that 
would actually set the program on a healthy fiscal path again, without 
hurting those who are already on the program.
  Of course, because this is Washington, rather than having a hearty 
debate, this proposal continues to be demagogued and derided. Instead, 
the health reform bill gave us IPAB, an unaccountable board tasked with 
limiting procedures and treatments in order to control costs. It's a 
top-down, unconstitutional, ineffective, and inefficient way to solve 
Medicare's fiscal problems. And if you think that this board won't make 
recommendations to limit the use of expensive but life-sustaining 
treatments, you haven't been paying attention.
  But here's something that gets lost in this debate: IPAB doesn't just 
apply to Medicare benefits for seniors who are on a government program.
  First off, those of us who have been here for a while know that 
private insurers tend to follow Medicare. We see it all the time. Once 
Medicare changes coverage for a treatment, those decisions push private 
payers to also move in that direction, because so much of our health 
care system relies on Medicare's policies. The government already 
controls so much of our health care sphere that inefficiencies abound.
  If that weren't enough, starting in 2015, the IPAB can make decisions 
about what private plans will cover. Yes, 15 people will be deciding 
what private companies will be covering. That's what is fundamentally 
wrong with the health care reform law, and we should repeal the whole 
thing. But in the meantime, let's repeal this ill-conceived board and 
address this country's medical malpractice problems while we're at it.
  Mr. WAXMAN. Mr. Chairman, I am pleased to yield to an important 
member of our committee, the gentleman from Texas (Mr. Green) for 2 
minutes.
  Mr. GENE GREEN of Texas. I thank my colleague, the ranking member on 
our Energy and Commerce Committee.
  I rise in opposition to this bill. I am not opposed to all of it; in 
fact, I am a strong supporter of the repeal of the IPAB provisions. 
However, we can't undermine Americans' rights in court through placing 
arbitrary limits on malpractice cases. That's what this bill before us 
does. We shouldn't solve a bad policy problem by implementing more bad 
policy. We should be passing good legislation, not trying to pass 
something that has no chance of becoming law, and that's what this bill 
does.
  The Affordable Care Act, the underlying statute that this bill is 
amending, has had an enormous positive impact on the constituents I 
represent, and the law hasn't totally taken effect yet. But it's 
getting better. I was proud to support this landmark legislation as 
part of the Energy and Commerce Committee and on the Health 
Subcommittee.

[[Page H1456]]

  Before the passage of the Affordable Care Act, my congressional 
district had the largest percentage of uninsured of any district in our 
country. We still have a lot of work to do, but things are getting 
better. For the last 2 years, 53,000 children in my district can't lose 
the security offered by health insurance due to preexisting conditions; 
3,400 seniors have saved an average of $540 on prescription drugs; 
9,000 young people now have health insurance that they didn't have 
before the Affordable Care Act.
  The Affordable Care Act is not perfect, but no bill is perfect. The 
bill before us today is far from perfect. I support the repeal of IPAB. 
I opposed IPAB in 2009 when it came up in our committee markup of the 
Affordable Care Act. I do not believe a panel of outsiders appointed by 
the President should take responsibility for what Congress needs to do 
in making decisions on Medicare payment rates. That's part of our job 
as Members of Congress. However, this bill has stepped too far; and I 
want to the opportunity to vote on a freestanding IPAB repeal, but I 
cannot support H.R. 5 because it's a bridge too far.

                              {time}  1530

  Mr. UPTON. Mr. Chairman, I yield 2 minutes to the gentleman from 
Florida (Mr. Stearns).
  Mr. STEARNS. I thank the distinguished chairman.
  This bill, contrary to what the gentleman from Texas said, is an 
opportunity for him to vote to not let bureaucrats make the decision. 
He has a chance to do this. I'm a little surprised why he's saying he's 
against the bill. Of course, I think many of us are going to repeat the 
same arguments.
  The fundamental point is that this bill will save almost $50 billion 
over 10 years. How many people on this side don't want to save money? I 
think everybody on both sides of the aisle would like to save money. So 
this is stopping defensive medicine and untold amount of litigation by 
passing this bill. This could effectively create lower premiums for 
everybody and lower the cost of health care.
  This bill would eliminate, as pointed out even by the gentleman from 
Texas, the Independent Payment Advisory Board, given the colloquial 
name of IPAB. Just this morning, as chairman of the Oversight and 
Investigation Committee, we held a hearing on the President's failed 
health care law. It's clear that countless pages of regulation, rules, 
and requirements for ObamaCare have been incredibly confusing. When we 
had this hearing, it was brought up clearly that this bill, over 2 
years old, has given almost 1,700 waivers to entities who cannot comply 
with this health care bill.
  So my constituents and individuals throughout this country view these 
massive new rules and regulations as increasing interference by the 
Federal Government into their lives. And, obviously, business 
communities are seeking waivers. Seventeen hundred entities are asking 
for waivers because they can't comply. It creates uncertainty in the 
marketplace.
  So for all these reasons we must pass this bill. In fact, IPAB is SGR 
on steroids. Rather than fixing the SGR problem in the health care law, 
Democrats are happy to allow continued cuts to physician payments and 
then double down on further cuts through IPAB. This is a group of 15 
unelected bureaucrats who would save Medicare by making draconian cuts 
to provider payments. Democrats wanted to control the future cost of 
Medicare by giving unelected, bureaucrats the power to cut payments to 
hospitals and to our doctors.
  If Democrats were serious, they would support this bill. Nancy 
Pelosi, the former Speaker and minority leader said, ``We have to pass 
this bill so you can find out what's in it.'' Remember that quote?
  I am determined to make sure we don't have to fully implement the 
bill so we can see what it costs.
  Mr. WAXMAN. Mr. Chairman, I'm always amused when I hear people talk 
about government interference in our lives. If people think Medicare is 
an unjust government interference in their lives, they can forgo their 
Medicare, but I don't know too many people who would like to do that. 
What the Republicans are proposing is to take that Medicare away from 
them and turn it over to private insurance. Put that to a vote. I don't 
think the American people would support that either.
  I am pleased to yield 2 minutes to a very important member on our 
committee, especially the Health Committee, the Representative from the 
Virgin Islands (Mrs. Christensen).
  Mrs. CHRISTENSEN. I thank you for yielding.
  Mr. Chair, I rise today during a time when we should all be 
celebrating the many great successes of the Affordable Care Act on its 
second-year anniversary. Democrats have rightly been applauding the 
health and economic benefits of affordable, reliable access to high-
quality health care services brought about by that landmark law. Not so 
with our Republican colleagues, who choose to ignore or misrepresent 
the many benefits millions of people have been enjoying because of the 
Affordable Care Act.
  Then comes this disastrous marriage between two bills--one that will 
repeal the Independent Payment Advisory Board--which some Democrats 
like myself support--and the other malpractice bill, which I strongly 
oppose because it will trample States' rights, providing extraordinary 
protections for drug and medical device and health insurance companies, 
making it nearly impossible for those harmed to seek and achieve 
justice.
  I support the IPAB repeal because in its current form it will not 
achieve significant savings or ensure quality access to health care 
under Medicare. Additionally, as a physician who practiced for more 
than two decades, I'm opposed to its broad authority to make 
recommendations that would detrimentally affect health care providers 
and eventually Medicare beneficiaries. However, attaching at the very 
last minute a medical malpractice bill that provides protection to 
every entity involved in medical malpractice and health care lawsuits 
except the victim is just plain wrong.
  And, no pun intended, but adding insult to injury is the fact that 
their medical malpractice bill is completely outdated. The bill was 
designed more than two decades ago. Back then we did have challenges 
with malpractice insurance, but today those challenges have been 
addressed. Today, we do not have a malpractice insurance crisis in this 
country.
  I strongly oppose H.R. 5, and encourage my friends on the other side 
of the aisle in the future, if it's more than just political rhetoric, 
to quit while they're ahead.
  Mr. PITTS. Mr. Chair, at this time I yield 2 minutes to the 
distinguished vice chairman of the Health Subcommittee, the gentleman 
from Texas, Dr. Burgess.
  Mr. BURGESS. I thank the chairman for the recognition.
  Mr. Chairman, I will focus my remarks on the Independent Payment 
Advisory Board because it encompasses all that is wrong with the 
Affordable Care Act. The health law itself contains policies that will 
disrupt the practice of medicine. Along with the many excesses and 
constrictions within the law, the Independent Payment Advisory Board 
represents the very worst of the worst of what will happen.
  As a physician, as a Member of Congress, as a father, as a husband, 
as a patient in his sixties, I am offended by the Independent Payment 
Advisory Board. This board is not accountable to any constituency, and 
it exists only to cut provider payments to fit a mathematically created 
target. The board throws the government into the middle of what should 
be a sacred relationship between the doctor and the patient. The doctor 
and the patient should have the power to influence prices and guide 
care, not this board.
  Beyond controlling Medicare, the Independent Payment Advisory Board's 
rationing edicts will serve as a benchmark for private insurance 
carriers' own payment changes. Although Mr. Waxman bemoaned the fact 
that private insurance would be part of Medicare, this thing will 
actually dictate the behavior of private insurances in this country.
  The board will have far-reaching implications beyond Medicare for our 
Nation's doctors. Because of the limitations on what the control board 
can cut, the majority of spending reductions will come from cuts to 
part B, the doctors' fees. Doctors will become increasingly unable to 
provide the

[[Page H1457]]

services that the board has decided are not valuable.
  Is the answer to squeeze out doctors? Sounds like rationing to me.
  So which sounds like the better--Medicare bankruptcy and an unelected 
board deciding the care of Medicare beneficiaries or doctors and 
patients deciding and defending the right of the care that they 
receive?
  The future of American health care should not be left up to this 
board, to this panel. It's an aloof arbiter of health care for seniors 
who depend on Medicare. I support the repeal of the Independent Payment 
Advisory Board.
  I'll just leave you with a quote from the American Medical 
Association:

       It puts our health policy and payment decisions in the 
     hands of an independent body with no accountability. Major 
     changes in the Medicare program should be decided by elected 
     officials.

  The American Medical Association.
  Mr. WAXMAN. Mr. Chairman, I am pleased to yield 3 minutes to my 
colleague from California, one of the key people in the authorship of 
the Affordable Care Act, George Miller.
  Mr. GEORGE MILLER of California. I thank the gentleman for yielding.
  Mr. Chair, I came to Congress in 1975. Since that time, I've been 
involved in the debate over national health reform proposals. 
Throughout these debates, lawmakers struggled with how to control costs 
without sacrificing quality care. Unfortunately, for decades, Congress 
chose to kick the can down the road while costs continue to climb and 
to soar. This trend ended with Affordable Care Act.
  For the first time, Congress put in place specific and identifiable 
measures that will make our health care system more transparent and 
efficient. This includes the creation of the Independent Payment 
Advisory Board. This board will be a backstop to ensure that Federal 
health programs operate efficiently and effectively for both seniors 
and taxpayers. We need to give these innovations a chance to work. 
Because without these innovations, there's little hope to get health 
care costs under control.
  Five hundred thirty-five Members of Congress cannot be nor should 
they be the doctors who think they know best of the practice of every 
medical field. Five hundred thirty-five Members of Congress are not 
immune to special interests that have a financial stake in the 
decisions that are made--not necessarily in the best interest of the 
seniors, the taxpayers, or the delivery of medicine in this country, 
but perhaps in the best interest of their companies. That's why the 
Affordable Act created an independent board of health experts to make 
the recommendations to improve the system. It does not usurp the role 
of Congress. It simply acts as a fail-safe in case government spending 
exceeds benchmarks. Under the law, doctors will retain full authority 
to recommend the treatments they think are best for patients. The law 
also prohibits recommendations that would ration care, change premiums, 
or reduce Medicare benefits.
  In short, this independent board is about strengthening Medicare with 
evidence-based decisionmaking. Without innovative reforms like the 
board, Medicare's future will be put in jeopardy. Kicking this can down 
the road any further will only bolster those who seek to kill Medicare. 
We must strengthen Medicare, not end the Medicare guarantee.
  The Affordable Care Act strengthened Medicare. It extended the life 
of the trust fund and has already lowered costs for millions of 
seniors. However, without innovation, our current system will be 
unsustainable for our Nation's families, businesses, and taxpayers.
  The Republican plan to end the Medicare guarantee is no alternative. 
Innovation is the alternative. I urge my colleagues to support the 
Independent Payment Advisory Board and reject this legislation.

                              {time}  1540

  Mr. PITTS. Mr. Chairman, I would much rather hear from some of our 
doctor friends who are speaking so eloquently. I have another doctor, a 
member of the Health Subcommittee, from Pennsylvania. I yield 2 minutes 
to the distinguished gentleman, Dr. Tim Murphy.
  Mr. MURPHY of Pennsylvania. I thank the gentleman.
  Last decade, when I was a State senator of Pennsylvania, I took on 
HMOs and plans that made decisions by accountants and MBAs and not MDs. 
It was important to do that because we found that doctors could not 
make decisions even though they were supposedly empowered to do that. 
Instead, there were boards that would make decisions for them.
  And now here we are with deja vu all over again. We're about to have 
15 Presidential appointees--even under the advice of both Chambers of 
Congress--none of whom are involved with medicine, making decisions 
with regard to who makes decisions for you in terms of what gets paid 
and how much gets paid to doctors and hospitals. But as it goes 
through, what happens if there's a decision that says it's not going to 
be covered? Can you call the board, itself? No. Can your doctor call 
the board? No. Can your hospital call the board? No. Can your Member of 
Congress call the board? No. But, in fact, it would take an act of 
Congress passed by the House and Senate and signed by the President to 
override them.
  So who is this panel, and what decisions can they make? By law, it's 
people who are involved with finance, economics, hospital 
administration, reimbursements, some physicians, health professionals, 
pharmacy benefit managers, employers, people involved with outcome 
research and medical health services and economics.
  What's missing from that is any requirement that it might be people 
who have knowledge of such things as oncology, endocrinology, 
pediatrics, obstetrics, geriatric medicine, family medicine and 
surgery, and the list goes on and on. So, in other words, what's going 
to happen here is not only if you like your doctor you may not be able 
to keep him or her, but if your doctor doesn't like what's going to be 
covered, there is nothing he or she can do about that. This is not the 
practice of medicine; this is the practice of government overtaking 
medicine.
  While Americans were begging for us to fix a broken system, what they 
got was half a trillion in new taxes, half a trillion in Medicare cuts, 
trillions in new costs, and massive mandates--1,978 new 
responsibilities of the Secretary of Health and 150 boards, panels, and 
commissions yet to be appointed. And we don't know what's going to 
happen. We need to return health care to where it really is going to be 
fixed.
  Mr. WAXMAN. Mr. Chairman, I yield myself 1 minute.
  We're talking about the Independent Payment Advisory Board--advisory 
board.

       The appointed membership of the Board shall include 
     physicians and other health professionals, experts in the 
     area of pharmaco-economics or prescription drug benefit 
     programs, employers, third-party payers, individuals skilled 
     in the conduct and interpretation of biomedical, health 
     services.

  Dot, dot, dot. These are people who will give us some 
recommendations, but they can't give us recommendations to take away 
services. They can't give us a recommendation to impose more costs on 
the Medicare beneficiaries. And when they give us their 
recommendations, Congress can act on it. And if we don't like it, we 
can change them.
  I think we have the Republicans trying to scare people. They come in 
and say ``Medicare costs too much.'' Well, if it costs too much, that's 
why we need this backup, to be sure that we're holding down costs. They 
say, ``it costs too much and therefore let's ends it.'' That doesn't 
make any sense. I think Americans should not be fooled.
  Mr. Chairman, I would like to now yield 3 minutes to my colleague 
from California, the ranking member of the Subcommittee on Health of 
the Ways and Means Committee, Mr. Stark.
  (Mr. STARK asked and was given permission to revise and extend his 
remarks.)
  Mr. STARK. I want to thank Mr. Waxman for yielding to me at this 
time.
  I rise in opposition to H.R. 5, brought to the floor by my Republican 
colleagues. It does two things. It repeals IPAB as created in the 
Affordable Care Act, and it enacts a medical malpractice reform long 
sought by my Republican friends as a way to protect pharmaceutical 
companies, medical device companies, and health care providers from any 
liability or full liability when they cause harm or death.

[[Page H1458]]

  The medical malpractice part of this bill is so bad that the 
California Medical Association rejects the bill and says to vote ``no'' 
unless they had a decent medical malpractice reform part in it. And 
when the doctors will reject medical malpractice reform issues, you 
know it's got to be bad.
  This extreme proposal is really not needed. I happen to agree with 
the part of the bill that repeals IPAB. We refused to include it in the 
House version of health reform. And Congress has always stepped in in 
its congressional manner to strengthen Medicare's finances when needed, 
and I see no need for us to relinquish that duty. We only have to look 
at the health reform law. It has extended solvency; it has slowed 
spending growth; it has lowered beneficiary costs; it has improved 
benefits, modernized the delivery system, created new fraud-fighting 
tools. We've done a good job. In fact, the CBO projects that IPAB won't 
even be triggered until the next 10 years, proving we've already done 
our job here in Congress of strengthening Medicare's finances.
  Today's Republican support to repeal IPAB isn't a sincere interest in 
providing Medicare for all. They still want to give us an unfunded or 
underfunded voucher, slash and burn funding. And despite my opposition 
to IPAB, it's far less dangerous to Medicare than the Republican 
voucher plan put forth in the House Republican budget this week. IPAB 
doesn't undermine Medicare's guaranteed benefits and its ability to 
reduce Medicare spending. It has guardrails to prevent it. It doesn't 
permit costs to come from reducing Medicare and increasing costs on 
beneficiaries. It prohibits rationing, and it has annual limits on the 
cuts. The Republican voucher plan has none of these protections.
  The Republicans are continuing their march begun by Newt Gingrich to 
have Medicare ``wither on the vine.'' I urge my colleagues to vote 
``no'' on yet another political stunt, which really, thankfully, is not 
destined to become law at this time.

                                    Sacramento, CA, Mar. 15, 2012.
     RE. H.R. 5 Protecting Access to Healthcare Act.
     CMA Position. Oppose Unless Amended.

     Hon. John Boehner,
     Speaker, House of Representatives,
     Washington, DC
     Hon. Nancy Pelosi,
     Minority Leader, House of Representatives,
     Washington, DC.
       Dear Speaker Boehner and Leader Pelosi: The California 
     Medical Association has adopted a position of Oppose Unless 
     Amended on H.R. 5 the ``Protecting Access to Healthcare 
     Act.'' While we strongly support the repeal of the Medicare 
     Independent Payment Advisory Board (IPAB) and appreciate the 
     state preemption of medical liability laws that will preserve 
     California's successful MICRA law, we have serious concerns 
     with two additional medical liability provisions that will 
     expose California physicians to even greater liability 
     despite the bill's stated legislative intent to reduce health 
     care costs and insurance premiums.


   Support Repeal of the Medicare Independent Payment Advisory Board 
                                 (IPAB)

       CMA strongly opposes the Medicare Independent Payment 
     Advisory Board (IPAB) which thwarts Congress' stewardship of 
     the Medicare program and gives fifteen unaccountable 
     individuals the power to make significant cuts to Medicare. 
     We believe it is Congress' responsibility to ensure the 
     Medicare program meets the needs of their communities. The 
     IPAB is mandated to make draconian cuts if Medicare spending 
     exceeds unrealistic budget targets in 2014. While we 
     appreciate the necessity to control the growth in health care 
     spending, the IPAB mandate does not leave room to actually 
     reform the program, particularly because hospitals and other 
     providers are exempt from the cuts until 2020. It 
     disproportionately harms physicians who are already 
     challenged to provide care to Medicare patients with limited 
     resources. As you know, physicians are facing large Medicare 
     SGR payment cuts over the next decade as well.
       These measures are already forcing more California 
     physicians to limit the number of Medicare patients they can 
     accept. If additional cuts take effect, physicians will be 
     forced to leave the program--harming timely access to quality 
     care for California's seniors and military families.
       The IPAB was not part of the House Health Care Reform bill 
     because most of the leaders in the California delegation 
     opposed it. Please continue to stand against an IPAB that 
     takes important decisions out of your hands.


                Medical Liability: Oppose Unless Amended

       For the last several decades, California's medical 
     liability law--MICRA--has successfully protected patients and 
     physicians. It has kept medical liability insurance 
     affordable and thus, protected access to care for California 
     patients while reducing health care costs. CMA appreciates 
     the provisions in H.R. 5 that allow state preemption and the 
     preservation of California's important MICRA law. While we 
     agree with the intent of H.R. 5--to provide MICRA-like 
     protections for physicians in other states--we have serious 
     concerns with two provisions that will increase physician 
     liability costs not only in California but across the 
     country. We believe these provisions are inconsistent with 
     the stated intent of the legislation to reduce insurance 
     premiums and overall health care costs.
       1. Fair Share Rule
       California has a joint and several liability law that 
     governs economic damages and allows claimants to recover the 
     full amount of economic damages from any defendant. The Fair 
     Share Rule in H.R. 5 will preempt California's law and put 
     full recovery by injured patients at risk. As written, the 
     Fair Share Rule will dramatically increase the potential for 
     physicians to face enforcement proceedings against their 
     personal assets. This will force physicians to purchase 
     increased medical professional liability insurance coverage, 
     which will significantly increase liability premiums in 
     California for physicians.
       Therefore, CMA requests the following amendment that would 
     allow states with joint and several liability laws to 
     maintain those important laws.
       Page 23, line 4 Add: (b) Protection of States' Rights and 
     Other Laws.
       (1) Any issue that is not governed by any provision of law 
     established by or under this title (including State standards 
     of negligence) shall be governed by otherwise applicable 
     State or Federal law.
       (2) This title shall not preempt or supersede any State or 
     Federal law that imposes greater procedural or substantive 
     protections for health care providers and health care 
     organizations from liability, loss, or damages than those 
     provide by this title or create a cause of action or any 
     State law that governs the allocation or recovery of damages 
     among joint tort feasors. 
       2. No Punitive Damages for Medical Products and Devices 
     that Comply with FDA Standards
       The CMA has serious concerns with granting complete 
     immunity from punitive damages to medical product and device 
     manufacturers, distributors and suppliers. We believe this 
     will force plaintiffs to look only to physicians and other 
     providers to seek relief and will significantly increase 
     physician exposure and liability costs. CMA believes that the 
     United States Supreme Court decision on this issue in Levine 
     v Wyeth was correct and should remain the law because the 
     alleged benefits of providing immunity to pharmaceuticals 
     companies through preemption are far outweighed by the harm 
     to patient care and physicians.
       Therefore. CMA urges that subdivision (c) of Section 106 of 
     Title I of the Protecting Access to Healthcare Act be 
     stricken in its entirety.
       At the very least, if Title I, Section 106(c) remains in 
     the bill, the CMA requests the following amendments to 
     protect physicians from punitive damages liability that would 
     otherwise be that of the manufacturers and suppliers of 
     medical products and devices.
       Page 10, line 14: (c) No punitive damages for products that 
     comply with FDA standards
       (1) In General (A) No punitive damages may be awarded 
     against the manufacturer, distributor, or prescriber of a 
     medical product, or a supplier of any component or raw 
     material of such medical products, based on a claim that such 
     product caused the claimant's harm where--
       Page 16. Lines 24 25: ``. . . or the manufacturer, 
     distributor supplier, marketer, promoter, [or] seller, or 
     prescriber of a medical product, . . .''
       Page 17, Lines 15 16: ``. . . or the manufacturer, 
     distributor supplier, marketer, promoter, [or] seller, or 
     prescriber of a medical product, . . .''
       Page 17, Line 25: ``44. . . or the manufacturer, 
     distributor supplier, marketer, promoter, [or] seller, or 
     prescriber of a medical product, . . .''
       The CMA urges you to accept these important amendments. We 
     appreciate the efforts to repeal the IPAB, to protect 
     California's MICRA law with a state preemption, and to bring 
     liability relief and lower health care costs to the rest of 
     the nation.
       Thank you for this important work.
           Sincerely,
                                                 James T. Hay, MD,
                                                        President.

  Mr. PITTS. Mr. Chairman, I'd just like to take 30 seconds to respond 
to the distinguished ranking member before I yield to Mr. Bass.
  He mentioned that this so-called expert panel could have physicians 
and health care professionals. I refer him to section 3403(g) of PPACA 
on page 423, specifically on the majority for the panel. There's a 
specific prohibition that you can't have a majority of health care 
providers or physicians on IPAB. And as far as these being 
recommendations, you can't appeal; you can't sue this board. Only with 
three-fifths vote in both Chambers with commensurate cuts can you 
overturn their recommendation.
  I yield 1 minute to the gentleman from New Hampshire (Mr. Bass).

[[Page H1459]]

  Mr. BASS of New Hampshire. I thank my friend from Pennsylvania for 
yielding to me.
  Mr. Chairman, I rise in support of the bill consisting of two 
previous bills--tort law reform and a repeal of the Independent Payment 
Advisory Board.
  I wasn't here when the Obama health care, the Affordable Care Act 
law, was passed. In listening to the debate over the last half hour, 
you would have thought that nobody supported this bill. Of all the 
speakers we've had, I think three have admitted they supported it then, 
and now you'd think that it never existed. Well, any agency that's 
scored by CBO to save $3.1 billion is not going to do it by providing 
more services for seniors or innovation or preservation. It's going to 
do it by cutting payments to providers or by cutting services to 
beneficiaries. It's as simple as that.
  This is the beginning of, perhaps, the core of what represents a 
Federal Government takeover of health care services in this country. 
Sure, there may be a process whereby recommendations could go to the 
Congress; but instead of the relationship being between a patient and a 
doctor, it is going to be governed more by a Federal bureaucracy that 
will make these decisions.
  I urge support of the pending bill, H.R. 5.

                              {time}  1550

  Mr. WAXMAN. Mr. Chairman, I yield myself 1 minute.
  We hear these things now, but we heard them in 1965 when Medicare was 
being proposed--socialized medicine, an unfair government intrusion 
into our lives.
  Medicare is a popular, successful program. I support it. But the 
Republicans didn't support it then, and they don't support it now.
  The Affordable Care Act is an excellent bill. I proudly voted for it 
because as a result of that legislation we're already seeing young 
people being able to get insurance up to 26 years of age on their 
parents' policies. We're already seeing seniors getting help to pay for 
their prescription drugs. We are seeing insurance companies prohibited 
from the abuses where they put lifetime limits, and they're going to be 
stopped from denying people health insurance because of preexisting 
medical conditions. This is good, and we're going to get even more 
benefits for over 30 million Americans when the bill is fully in place.
  It's a good bill. The Republicans would like to repeal it. But let's 
not forget, they didn't want Medicare in the first place.
  Mr. Chairman, now that I've used my minute, I would like to yield 3 
minutes to a member of our committee from the State of Illinois (Ms. 
Schakowsky), who has been very involved in helping seniors on all of 
these programs, whether it's Social Security or Medicare or Medicaid. 
She is very knowledgeable and highly respected--a little shorter than 
the podium, but I'm pleased to yield to her.
  (Ms. SCHAKOWSKY asked and was given permission to revise and extend 
her remarks.)
  Ms. SCHAKOWSKY. I thank the gentleman very much for yielding to me.
  I hope the American people understand what's going on here today. 
H.R. 5 represents another in a long line of partisan political attacks 
on the Affordable Care Act.
  Since its passage 2 years ago, this historic law has been under 
attack. Today's bill would repeal the Independent Payment Advisory 
Board. The Affordable Care Act is replete with provisions to lower 
Medicare costs, from unprecedented tools to fight fraud to efficiency 
reforms. The IPAB is a backstop to those provisions.
  What the Affordable Care Act does not do--and what the IPAB is 
prohibited from doing--is increase costs to seniors and people with 
disabilities or cut benefits. That may be why my Republican colleagues 
don't like it. If you look at their proposal to take away the Medicare 
guarantee and turn it into a voucher program, you can see why. Instead 
of lowering costs for everyone as the Affordable Care Act does, the 
Republican plan just shifts costs onto the backs of those who can least 
afford it--seniors, disabled people, and their families. These are the 
same people who are harmed by the tort-reform provisions of H.R. 5--
Federal intrusion coupled with disregard for injured consumers.
  Instead of working to improve health care quality, as the Affordable 
Care Act does, H.R. 5 simply restricts the rights of patients harmed by 
dangerous drug companies, nursing homes, medical device manufacturers, 
doctors, and hospitals.
  I am especially opposed to arbitrary caps on noneconomic damages. 
Economic damages provide compensation for lost wages. Noneconomic 
damages provide compensation for injuries that are just as real and 
damaging, injuries liking excruciating pain, disfigurement, loss of a 
spouse or a grandparent, inability to bear children. These arbitrary 
caps are particularly discriminatory for seniors and children who don't 
have lost wages and are not worth much.
  H.R. 5--higher costs to seniors and disabled people and fewer legal 
rights for injured consumers. It's a bad deal on both counts.
  I hope the American people understand what is going on here today. 
H.R. 5 represents another in a long line of partisan political attacks 
on the Affordable Care Act.
  Yesterday, my colleagues on the other side of the aisle released 
their FY 2013 budget proposal. Once again they propose to repeal the 
Affordable Care Act and once again they propose to end the Medicare 
guarantee.
  I find it ironic that my colleagues on the other side of the aisle 
criticize the Medicare program because they claim cost growth is out of 
control and the program is going bankrupt.
  The Medicare provisions of the Affordable Care Act are replete with 
provisions from cutting fraud to improving the efficiency of health 
care delivery that will lower costs--without shifting costs to seniors 
and people with disabilities or cutting the Medicare guarantee. The 
Independent Payment Advisory Board is designed as a backstop to those 
provisions--which CB0 tells us will be effective enough that we will 
not even need IPAB for the next decade.
  And, here we are today set to consider legislation to repeal the 
Independent Payment Advisory Board not because my colleagues on the 
other side of the aisle have a better idea but because they want to get 
rid of the entire Affordable Care Act and eliminate Medicare.
  If IPAB has to act, the Affordable Care Act explicitly states that it 
can only make recommendations regarding Medicare and cannot make 
recommendations that would ration care, raise premiums, increase cost-
sharing, restrict benefits or modify eligibility. IPAB is also supposed 
to consider the effect of its recommendations on Medicare solvency, 
quality and access to care, the effect on changes in payments to 
providers, and the impact on those dually eligible for Medicare and 
Medicaid.
  There are certainly ways to improve IPAB and the Affordable Care 
Act--but the bill before us doesn't make improvements--it just repeals. 
I wish my colleagues on the other side of the aisle would be honest 
with seniors, people with disabilities and the American public about 
their replacement plan.
  What exactly is the Republican alternative? My colleagues on the 
other side of the aisle have talked a lot about Medicare costs and 
sustainability, but what is their plan? If the alternative is anything 
like the proposals included in the Republican budget--which shifts 
costs to seniors and empowers insurance companies--then I choose IPAB.
  My colleagues on the other side of the aisle have strategically 
paired IPAB repeal with medical malpractice reform.
  We do have a medical malpractice crisis in this country--but it is 
not that injured consumers are suing too much--in fact, the number of 
suits has declined. It is not that injured consumers are receiving 
exorbitant compensation--in fact, the size of settlements and awards 
have been stable--tracking the rate of medical inflation.
  The crisis we are facing in America is that too many patients are the 
victims of medical errors and too many good doctors are being 
overcharged by private insurers. We cannot make this a fight between 
doctors and trial lawyers and lose sight of the fact that too many 
Americans will be affected by malpractice. Their lives and the lives of 
their families will never be the same. It is their interests that we 
must protect.
  One in three patients admitted to a hospital experiences an ``adverse 
event''--they get the wrong prescription, receive the wrong surgical 
procedure, acquire an infection. But this goes far beyond preventable 
medical injuries in hospitals. This legislation is so broadly drafted 
that it will apply to medical devices, pharmaceutical products, nursing 
homes and for-profit health insurers.
  We haven't any assurance that this bill will reduce the incidence of 
medical malpractice--nor has anyone given us any assurance that it will 
lower medical liability premiums. But one thing is certain--it will 
trample on states' rights and take away long-standing civil justice

[[Page H1460]]

rights. Taking away patient rights does not improve the quality of our 
health care system--it just leaves injured consumers without recourse.
  I especially oppose arbitrary caps on non-economic damages and other 
restrictions on the rights of medical malpractice victims to seek 
accountability and compensation for their injuries. We are going to 
hear from proponents of H.R. 5 that these caps are not harmful because 
economic costs--medical bills and lost wages--are left uncapped.
  But what about injuries that are just as painful but less 
quantifiable--the inability to bear children, the loss of a spouse or 
child or grandparent, excruciating pain, permanent and severe 
disfigurement.
  Non-economic damages compensate injured victims for very real 
injuries--and those who suffer those injuries deserve their full and 
fair day in court.
  H.R. 5 is an attack on victims who, for the rest of their lives, will 
suffer as a result of negligence and malpractice. We should not add to 
their pain by denying them their legal rights.
  I urge my colleagues to reject H.R. 50.
  Mr. PITTS. Mr. Chairman, at this time I yield 1 minute to another 
distinguished member of the Health Subcommittee, the gentleman from 
Kentucky (Mr. Guthrie).
  Mr. GUTHRIE. I thank the gentleman for yielding.
  I rise today in support of H.R. 5, legislation to repeal the IPAB and 
make critical reforms to our medical liability system.
  The IPAB was created in the health care law as a way to contain 
growing costs, but the reality is those savings will likely be found by 
removing health care decisions from patients and doctors and placing 
them in the hands of unelected and unaccountable bureaucrats.
  H.R. 5 also addresses the critical issue of medical liability reform. 
Our current tort system is driving doctors out of the practice of 
medicine. Those who remain are forced to practice defensive medicine, 
further increasing health care costs.
  The Congressional Budget Office has estimated that medical-liability 
reform will save hardworking taxpayers over $40 billion. H.R. 5 makes 
two commonsense reforms to protect doctors and patients. I urge my 
colleagues to support the bill.
  Mr. WAXMAN. Mr. Chairman, may I inquire how much time each side has.
  The Acting CHAIR (Mr. Hastings of Washington). The gentleman from 
California has 36 minutes remaining, and the gentleman from 
Pennsylvania has 44 minutes remaining.
  Mr. WAXMAN. Mr. Chairman, at this time I'd yield 5 of our 36 minutes 
to the gentleman from Iowa (Mr. Braley).
  Mr. BRALEY of Iowa. I thank the gentleman for yielding.
  Mr. Chairman, here we go again. My conservative friends are once more 
trying to take away rights of American citizens that are as old as the 
Declaration of Independence and the Bill of Rights. They're doing it by 
talking about taking away the rights of patients without ever 
mentioning the words ``patient safety.''
  This issue has been with us for a long time. In fact, about 10 years 
ago, the highly regarded Institutes of Medicine did three studies on 
the issue of patient safety and the alarming cost it adds to our 
overall health care delivery system.
  The first of their studies was called ``To Err is Human: Building a 
Safer Health System.'' On this cover it says: ``First, Do No Harm.'' 
The study concluded that every year up to 98,000 people die in this 
country due to preventable medical errors. It also talked in this study 
about the cost of those medical errors. It estimated that the cost of 
failing to stop these preventable medical errors is between $17 billion 
and $29 billion a year. Now, if you multiply that over the 10 years of 
the Affordable Care Act, that means if we eliminated those errors, we 
would save $170 to $290 billion a year.
  So do we focus on patient safety and preventing medical errors? No, 
we focus on taking away the rights of the most severely injured. 
Because it's what caps on damages do, they penalize those with the most 
egregious injuries and those who have no earning capacity. So who are 
those people? They're seniors, they're children, and they are stay-at-
home mothers. They're the ones most severely penalized when you take 
away rights guaranteed in the Bill of Rights and the Declaration of 
Independence. So I oppose this bill in the name of the Tea Party, not 
just the current Tea Party, but the original Tea Party, which was 
founded in opposition to taxation without representation.
  If you go to Thomas Jefferson's Declaration of Independence, you will 
see that grievance against King George listed. Right below it in the 
Declaration of Independence is this grievance, that he has taken away 
the right to trial by jury. That right was so important, ladies and 
gentlemen, that it was embedded in the Seventh Amendment to the Bill of 
Rights. It says very clearly that in suits at common law, which is what 
a medical negligence claim is, the jury gets to decide all questions of 
fact and no one else. Well, one of the most important questions of fact 
in a jury trial is the issue of damages. My friends are trying to take 
away that right from the jury--the very same people who elected us to 
Congress--because they apparently think that Congress knows more than 
the people who sent us here, those who go into jury boxes all over this 
country in your State and listen to the actual facts of the case before 
deciding what's fair, including the all-important issue of what are 
fair and reasonable damages.
  So they're talking a lot today about defensive medicine. I want to 
tell you about the myth of defensive medicine. Every time a health care 
provider submits a fee-for-services, they represent that that medical 
procedure or that medical test was medically necessary. If they don't 
make that representation, they don't get paid. Well, guess what, folks? 
If something is performed and billed as ``medically necessary,'' that, 
by definition, is not defensive medicine, because defensive medicine is 
when you're doing something that's not medically necessary to protect 
yourself from litigation. So you can't have it both ways. You can't 
take the money and claim you are practicing defensive medicine.

                              {time}  1600

  We also heard about the myth of setting these caps 30 years ago and 
never adjusting them for inflation. They always want to talk about the 
California bill that was passed in the mid-seventies and impose the 
very same cap in this bill, $250,000.
  What they don't tell you is, if you adjust that cap based on the rate 
of medical inflation over that same period of time, the cap would now 
be worth almost $2 million and that, if you reduce that $250,000 cap to 
present value, those people in today's dollars are only getting the 
equivalent of $64,000, no matter how serious their injury is.
  That's why I oppose this legislation, and that's why people who 
believe in the Constitution and in the States' rights, under the 10th 
Amendment, to decide what their citizens will receive as justice should 
be outraged that this bill is on the floor today.
  Mr. PITTS. Mr. Chairman, at this time I yield 2 minutes to the 
gentleman from New Jersey (Mr. Lance), another valued member of the 
Health Subcommittee.
  Mr. LANCE. Mr. Chairman, I rise today in support of H.R. 5 that 
combines the repeal of the Independent Payment Advisory Board with 
significant medical malpractice reforms that will help reduce health 
care costs and preserve patients' access to medical care.
  Today marks the 2-year anniversary of the House passage of the 
President's health care law. During that debate 2 years ago, I joined 
Members from both sides of the aisle in calling on the President to 
address one of the drivers of the high cost of health care by reforming 
the current medical liability system. Unfortunately, the President's 
health care bill passed the House on March 21, 2010, absent any real or 
meaningful medical liability reform.
  The new law did include the Independent Payment Advisory Board, or 
IPAB, and this cost-control board, made up of 15 unelected and, might I 
add, unconfirmed officials, has the power to make major cost-cutting 
decisions about Medicare, with little oversight or accountability.
  The IPAB has been criticized by both Republicans and Democrats, and 
its repeal is supported by nearly 400 groups representing patients, 
doctors, and employers.
  Today, on the 2-year anniversary of the House passage of the health 
care law, we have an opportunity to move to the future and enact real 
health care

[[Page H1461]]

reform that will help bring down health care costs that are escalating 
at unsustainable rates while, at the same time, protecting needed care 
for our senior citizens.
  As a member of the House Energy and Commerce Committee, I am pleased 
to have the opportunity to work on this important legislation, and I 
urge all of my colleagues to support H.R. 5.
  Mr. WAXMAN. Mr. Chairman, I continue to reserve the balance of my 
time.
  Mr. PITTS. Mr. Chairman, at this time I yield 2 minutes to the 
gentleman from Georgia, Dr. Gingrey, another distinguished member of 
the Health Subcommittee.
  Mr. GINGREY of Georgia. Mr. Chairman, I thank the gentleman for 
yielding. And, of course, I stand in strong support of H.R. 5, the PATH 
Act, having authored half of the legislation, that is, the HEALTH Act, 
the medical liability reform act.
  But I'm also strongly in favor of repeal of IPAB, the Independent 
Payment Advisory Board created under ObamaCare. We know and our 
colleagues on the other side of the aisle, many of them, know that this 
is the most egregious part of this 2,700-page piece of legislation, 
which is now the law of the land. But what it is, Mr. Chairman, IPAB, 
is their way of saving Medicare.
  I'll ask them time after time: What is your plan to save Medicare? 
They have no answers. All they want to do is continue to criticize our 
side of the aisle when we have meaningful, thoughtful plans to save and 
protect and strengthen, not just for these current recipients under the 
Medicare program, those who are seniors, those who are disabled, but 
also our children and our grandchildren.
  What do we get from this side of the aisle, from the Democratic side? 
We get IPAB.
  The language says no rationing, yet the provisions call for cutting 
reimbursements to providers; and eventually, without question, just as 
it has in Canada and the UK, Mr. Chairman, that leads to the denial of 
care. If that's not rationing, I don't know what it is.
  Let me, in the remaining part of my time, speak a little bit in 
regard to H.R. 5, the HEALTH Act, the medical liability reform act.
  The gentleman from Iowa, the trial attorney, was just up here trying 
to imply that we would take away a person's right to a redress of their 
grievances if they had been injured by a medical provider or a health 
care facility because of practice below the standard of care.
  The Acting CHAIR. The time of the gentleman has expired.
  Mr. PITTS. I yield the gentleman another 1 minute.
  Mr. GINGREY of Georgia. And I thank the gentleman.
  The gentleman from Iowa knows, in fact, that that is absolutely not 
true.
  What we do in this HEALTH Act is limit the awards for so-called pain 
and suffering at $250,000. And, Mr. Chairman, indeed, a number of 
States, after California enacted this law 35 years ago--Texas, Florida, 
my own State of Georgia--have enacted caps higher than that, and, no 
doubt, other States will do so in the future, because this bill 
specifically says--and it's called the flex caps--that if a State wants 
to enact a limit on noneconomics of $1 million and have it applicable 
to multiple defendants, they can do that. They have the right to do 
that. And in regard to the injury to a patient, there are no caps 
whatsoever. There are still suits that are awarded to injured patients 
that are in the millions of dollars.
  So the gentleman from Iowa was totally disingenuous in what he was 
trying to explain--a very smooth talking, very convincing lawyer. 
That's what we expect.
  But we want to end frivolous lawsuits so that those who are truly 
injured get their day in court, and that's what this bill does.
  Mr. WAXMAN. Mr. Chairman, I yield myself 1 minute.
  I thank the gentleman, who is a physician, for his comments.
  He said he wants to save Medicare. He said the Republicans want to 
save Medicare. They want to save Medicare, but their budget proposal 
would end Medicare.
  Let's just understand, those who are on Medicare know they can go to 
the doctor or the hospital or other health care provider and Medicare 
will pay. Under the Republican proposal, they'd be given a voucher and 
told to go buy a private insurance policy, as much as they could afford 
by adding additional money. To save it, they want to end it.
  And we hear the statement, so-called pain and suffering. For people 
who are living their lives with constant pain and suffering from a 
medical malpractice problem, it's not so-called to them. It's a real, 
terrible situation that they have to live with.
  I think that, because one of our speakers happens to be a trial 
lawyer, I want to point out that the past speaker is a medical 
physician, as if that should make a difference. Let's base our 
arguments on the points that are made.
  I, at this point, want to yield 3 minutes to the gentleman from 
Vermont (Mr. Welch), an important Member whom we hope will come back to 
our committee in the very near future.
  Mr. WELCH. I thank the gentleman.
  In Vermont, we faced the challenge that we face in this Nation: We 
want to have access to health care, and we want it to be affordable.
  When we had legislation, the Democrats were pushing access. The 
Republican Governor was concerned about cost. We sat down and realized 
we're both right. If Democrats want to achieve the goal of access to 
health care for everybody, we have to control cost. Our Republican 
Governor was right. We worked to do that. This Congress has failed to 
do that.
  Health care costs are rising beyond our ability to pay. Whether it's 
the taxpayer, whether it's the business that's paying the premiums, 
whether it's an individual who is self-pay, you cannot have health care 
costs rising at 6.5 percent a year, as they have for the past 10 years, 
higher than the rate of inflation, profits, or the economic growth. It 
can't be sustained. IPAB is a tool to help us control health care 
costs. We have to do that for our taxpayers, for our employers and for 
our citizens.

                              {time}  1610

  It's advisory. These 15 people who have experience in economics and 
in medicine will look at data, will look at information. What's there 
to fear in their doing that? They'll make recommendations to Congress. 
Congress will retain the right to have the final say as to whether 
these recommendations will work or not or if we want to substitute 
something else. That makes sense.
  The alternative is what has been put forward to essentially shift the 
burden of rising health care costs onto seniors and citizens by turning 
Medicare into a voucher. It would cap what the taxpayer would pay by 
exempting this Congress from making reforms in how we deliver care that 
could result in costs coming down and simply saying to seniors on 
Medicare that if costs go up 6.5 percent a year, another 6.5 percent--
you know what, folks?--you are on your own. Figure out how to pay for 
it. Congress is AWOL on this.
  So to the extent that we claim we want access but we won't control 
costs and take steps that are required to make health care spending 
sustainable, we're shirking our responsibility. IPAB is not the answer, 
but it's a good tool.
  To reject it and instead replace it with a voucher system where the 
full burden of runaway health care costs are simply imposed on seniors 
is the wrong way to go in a continuation of Congress ducking its 
responsibility for the reforms in the health care system that our 
citizens need and deserve.
  Mr. PITTS. Mr. Chairman, I am pleased at this time to yield 3 minutes 
to one of our leaders, the distinguished gentleman from Texas (Mr. 
Hensarling).
  Mr. HENSARLING. Mr. Chairman, regrettably the President's policies 
have failed and continue to harm our economy.
  We were told if we would pass the stimulus plan, unemployment would 
never exceed 8 percent, and instead it's exceeded 8 percent for 37 
straight months. We were told that the President would cut the deficit 
in half, and instead we have the worst debt in our Nation's history. We 
were told he would take steps to reduce the price of oil, and instead 
gas prices have doubled at the pump. One more of his policies

[[Page H1462]]

that has failed is clearly his health care plan.
  We were told that it would create jobs, but instead every day I hear 
from job creators in the Fifth District of Texas who write me things 
like:

       ObamaCare will put a tremendous burden on my company. I 
     can't put a 5-year plan in place. I therefore have to 
     withhold cash for expansion.

  I also hear things like:

       I could start two companies and hire multiple people, but 
     based on this administration and the lack of facts with 
     ObamaCare, I will continue to sit and wait.

  We know now that the Congressional Budget Office says that the health 
care plan will cost us almost a million jobs from this economy.
  We were also told that if we pass this that health care would be more 
affordable and lower premiums, but instead the Congressional Budget 
Office now tells us that the new benefit mandates will force premiums 
to rise in the individual market by $2,100 per family.
  Any way you look at it, the President's health care law is harming 
job growth; it's harming our economy. But perhaps even more ominously, 
it's the infamous Independent Payment Advisory Board, section 3403 of 
the act, that will harm our seniors.
  The IPAB is going to be comprised of 15 unelected, unaccountable 
bureaucrats handpicked by the President. Their sole job is going to be 
to ration health care to our seniors and impose Federal price controls. 
This will undoubtedly slash senior access to doctors and to other 
providers. They literally will be making decisions about the health of 
our loved ones, our parents, and our grandparents.
  The Centers for Medicare and 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 quality of services.
  Mr. Chairman, when it comes to my parents, both of whom are on 
Medicare, no government acronym, no government bureaucrat, no 
government board can ever substitute for the good judgment of their 
chosen family doctor. That's why today I'm proud to stand with my 
colleagues here to vote to repeal the IPAB.
  Once again, we need to repeal the President's health care plan and do 
it today.
  Mr. WAXMAN. Mr. Chairman, I am pleased at this time to yield 4 
minutes to the distinguished Democratic whip, Mr. Hoyer, from the State 
of Maryland.
  Mr. HOYER. I want to speak about this bill, but I also want to 
respond to the chairman of the Republican Conference, who apparently 
fails to realize that we've created 4 million jobs, 3.96 million to be 
exact, over the last 24 months. We've had 10 quarters of growth in 
America. As opposed to losing 786,000 jobs the last month of President 
Bush's term, we added 257,000 last month in the private sector.
  So to say that the President's program is not working is simply 
inaccurate.
  Now, ladies and gentlemen, this is a wolf in sheep's clothing. They 
don't like the health care bill. That's what the chairman of the 
conference just said. He wants to vote to repeal that. We understand 
that. They want to pick it apart piece by piece.
  Let me talk about it. Two years ago, we passed a comprehensive health 
care reform package that is already lowering costs, expanding access, 
and contributing to deficit reduction. The Affordable Care Act was a 
significant moment when Congress once again took bold action to 
constrain the growth in health care spending and make insurance more 
accessible and affordable for all Americans. As the wealthiest country 
on the face of the Earth, we ought to make sure that people can get 
insurance and have affordable, accessible health care.
  Insurance companies can no longer deny coverage to children with 
preexisting conditions. I bet they think that's a benefit, a protection 
that will be extended to all Americans by 2014. I've had a lot of 
people talk to me about that provision. They like it.
  Insurance companies can no longer drop Americans from their policies 
when they get sick or impose arbitrary and unfair caps on coverage. You 
buy insurance to make sure when you get sick you have coverage. If you 
get very sick and need more coverage, it says you can't cancel because 
you're really sick. I think Americans like that.
  Since the Affordable Care Act was signed into law, over 32 million 
seniors on Medicare have access to free preventative services. The 
Medicare part D doughnut hole is on the path to close completely by 
2020. Seniors who fall into this coverage gap are right now getting a 
50 percent discount on their brand drugs. They like that.
  Now 360,000 small businesses have already taken advantage of tax 
credits that are helping them provide more affordable coverage to over 
2 million workers. Lifetime limits on over 105 million Americans with 
private insurance have been eliminated. Over 2,800 employers have 
already received financial assistance that helps them provide 
affordable insurance to 13 million retirees who are not yet eligible 
for Medicare.
  The CBO continues to project that the Affordable Care Act will reduce 
the deficits by tens of billions of dollars by the end of this decade.
  Despite all of these benefits, today Republicans will take yet 
another vote to repeal part of the Affordable Care Act. But what they 
want to do is repeal the act. That's what the chairman said of the 
conference. I take him at his word. I appreciate his honesty.
  Today their focus is on the Independent Payment Advisory Board, or 
IPAB, which couldn't be a less timely issue. IPAB is a backstop 
mechanism to ensure that the Affordable Care Act's savings and cost-
containment provisions will be achieved. But CBO has already said they 
don't expect it to be triggered at all over the next decade. That's 
because the Affordable Care Act's cost-containment provisions are 
already having a significant impact on slowing the growth of health 
care and Medicare spending.
  This proves that the Medicare spending can be constrained without 
turning Medicare into a voucher program as the chairman has said. That 
forces seniors to spend more and ends the Medicare guarantee. Americans 
don't want that.
  The Republican plan does exactly that and tries to mask the end of 
Medicare as we know it by talking about choices and competition.
  The Acting CHAIR. The time of the gentleman has expired.
  Mr. WAXMAN. I yield the gentleman an additional minute.
  Mr. HOYER. But both competition and choice already exist in the 
Medicare program.

                              {time}  1620

  Of beneficiaries, 99.7 percent have access to at least one Medicare 
Advantage plan, and in the majority of counties, they have an average 
of 26 private plans to choose from. In spite of all these choices, 
about 75 percent of all seniors still choose to remain in traditional 
Medicare.
  The Republican budget, released just yesterday, paints a clear 
picture of their priorities, showing once again they stand for ending 
the Medicare guarantee, shifting ever-increasing costs on to our 
seniors and repealing all of the Affordable Care Act's patient 
protections.
  I stand behind the cost-containment provisions, the delivery-system 
reforms, the improvement to Medicare, and the new benefits and 
protections that were enacted under health reform. And I stand with my 
fellow Democrats and America's seniors in support of preserving the 
Medicare guarantee and ensuring that Medicare remains available and 
affordable for generations to come.
  I appreciate the ranking member's leadership on this issue and all of 
those who were critically responsible in ensuring that Americans have 
access to affordable quality health care.
  Mr. PITTS. Mr. Chairman, 2 years ago, they said PPACA would cost less 
than $1 trillion. The CBO's new estimate says it's going to cost over 
$1.7 trillion. Stay tuned.
  I now yield 2 minutes to the author of the IPAB repeal, the gentleman 
from Tennessee, Dr. Roe.
  Mr. ROE of Tennessee. I thank the chairman for yielding.
  I guess, if the Affordable Care Act is so popular with the American 
people, that's why 60 percent want it overturned. I'll start by saying 
that. That's the latest that I've seen.
  Let me just go over briefly what the IPAB is and why I'm so 
vehemently opposed to it.

[[Page H1463]]

  As an over-30-year practicing physician, I've looked at this, and 
I've seen two examples already of why I know and what I know is going 
to happen here.
  We have the model in the SGR, the sustainable growth rate, which is 
what we pay Medicare physicians today. As has been stated multiple 
times, we have a board with 15 appointed people to it. Over half of 
them cannot be health care providers or cannot be health care-related 
folks that are going to make decisions based on a formula for Medicare 
spending. We're going to set limits. If you exceed those limits, then 
cuts will come to providers. We've done that with SGR. And guess what 
the Congress has had the ability to do during that time? To override 
those cuts, because everybody in here, both Republicans and Democrats, 
understand if we cut our providers, we're going to decrease access for 
those patients.
  What has happened with SGR? Just 2 weeks ago, we passed an SGR 
temporary fix to the end of this year to avoid a 27 percent cut in 
physician payments. Guess what would happen with IPAB? Mr. Chairman, 
there would be a 27 percent cut to Medicare providers and in 5 years--
also, the hospitals are included. I can tell you our rural hospitals 
where I live will not survive those cuts. Those cuts will occur with 
minimal overlook from this U.S. Congress and no judicial review.
  Let me read this right here: IPAB is the single biggest yielding of 
power to an independent entity since the creation of the Federal 
Reserve. This is not me. This is Peter Orszag, the former budget 
director for President Obama.
  My concern as a practicing physician is that if we cut physician 
payments so far, our patients will not have access to us. Right now, 
Mr. Chairman, in the primary care group I'm in, that access is already 
being limited, and we see it around the country.
  One final thing. I started practicing as an obstetrician in 1977. 
I've delivered almost 5,000 babies. I paid $4,000 a year for 
malpractice coverage. When I left, the young physician who replaced me 
was paying $74,000 a year. The patient has got no more value.
  In 1975, when I got back home from the Army, every single malpractice 
carrier had left the State of Tennessee. Almost all 10,000 physicians 
in Tennessee get their insurance from a mutual company. Since 1975, 
over half the premium dollars that every doctor has paid into the State 
of Tennessee has gone to attorneys, not to the injured party. Less than 
40 cents of every dollar has gone to the people who have actually been 
injured.
  We have a terrible system of paying people who have been injured, 
compensating them. This will allow us to do that and will allow us to 
get some certainty so that those costs don't keep rising beyond 
anybody's ability to pay. What has happened in a lot of places, Mr. 
Chairman, is access to OB doctors and high-risk doctors has been 
limited because of the liability.
  I strongly support H.R. 5, and urge my colleagues to do the same.
  Mr. WAXMAN. Mr. Chairman, nobody is going to deny that there is a 
problem with medical malpractice. The issue is whether the State of 
Tennessee can adopt a law to solve its own problem the way the State of 
California has done, the way the other States have acted. Let the 
States operate in this area which has been traditionally reserved for 
them. Washington does not have all the answers. Imposing one system on 
the whole country is not the way to go.
  I would like to at this point yield 3 minutes to the gentleman from 
the State of Washington (Mr. McDermott).
  (Mr. McDERMOTT asked and was given permission to revise and extend 
his remarks.)
  Mr. McDERMOTT. Mr. Chairman, you might ask why we're having this 
debate. Well, the Republicans have never wanted to solve the Americans' 
problem with health care access and cost; and the Congress passed, with 
the President's help, a bill that gave access to many millions of 
people and put in place some mechanisms to control costs.
  The Republicans have tried to repeal it again and again, Mr. 
Chairman; and they know next Wednesday it's going to be in the Supreme 
Court. So today is press release time, and they have a formula for 
press releases in this House. The Members are going home to their 
districts, so they select a straw man and they put him up here. The 
straw man in this case is the IPAB. Then they scare seniors. They say: 
this IPAB is going to take away your health care. Then all the seniors 
are supposed to crawl under the chair or under the bed because the 
Republicans are out scaring people again. They do it by telling half 
truths.
  This commission will make recommendations that the Congress can 
adopt, change, or if they don't want to do it, they can let them go 
into play. They have three choices, and the Congress can do either to 
change them or adopt them. We're not to giving away our power. That is 
a half truth to say that we are.
  Secondly, as you heard from the whip, it's 10 years before this 
happens. Folks, if you're sitting at home watching this--Mr. Chairman, 
they are probably all scared and have quit eating their dinner because 
they're worried about what's going to happen. We're talking about 
something that's going to happen in 10 years. This is simply a scare 
tactic, and it is directly related to the attempt to derail the 
President's reelection. If they can take down this health care bill, 
they will have him. They will have shown he hasn't done anything. But 
the fact is he got it through here, and it's going to be implemented in 
2013.
  You can spend all the time you want passing bills in here that are 
absolutely kabuki theater, because this bill is going to go over to the 
Senate. You all know it has to pass both the Senate and the House. The 
Senate put this in. Does anybody think that the United States Senate is 
going to take away seniors' rights to health care? I mean, does anyone 
think that? You're accusing the United States Senate of putting this in 
the bill, setting it up to take away health care benefits from seniors. 
That is nonsense. If you think the Senate is going to walk away from 
this provision, well, more kabuki theater. We will be back on another 
day.
  The Acting CHAIR. The time of the gentleman has expired.
  Mr. WAXMAN. I yield the gentleman 1 additional minute.
  Will the gentleman yield?
  Mr. McDERMOTT. I yield to the gentleman from California.

                              {time}  1630

  Mr. WAXMAN. We want to hold down the costs in health care for 
Medicare, itself. The cost of health care is going up for all health 
care coverage; but Medicare, if it goes up too much, it's a real 
problem. So in the Affordable Care Act, we try to put in place ways to 
hold down costs by reorganizing the delivery of care. We have some 
other strategies. We hope it will work. But for a backstop, if it 
doesn't work, there is this Independent Payment Advisory Board, and 
they will give us some idea as to how to hold down health care costs.
  Now, it seems to me, the biggest objection is, once they give their 
recommendations, we can accept them, we can change them, or we can let 
them go into effect. I think the biggest problem is that if nothing 
happens, those health care costs go up; and that's what preserves the 
right of Congress, is to let nothing happen. And this is not how to 
hold down costs. This is to let the costs go up.
  I thank the gentleman for yielding.
  Mr. PITTS. Mr. Chairman, at this time, I yield 3 minutes to another 
doctor, Dr. Harris, from the State of Maryland.
  Mr. HARRIS. Mr. Chairman, I think the gentleman from California just 
said what this is all about: The IPAB is about cutting expenditures for 
our seniors on Medicare when they need their health care.
  The IPAB is no straw man. It's a health care policy bureaucrat's 
dream and a Medicare patient's nightmare. It's 15 bureaucrats--and the 
gentleman from California called it right--insurance company 
representatives, pharmacy company representatives, benefit managers, 
employers, all those people who really have the care of an individual 
patient in mind.
  In fact, that rationing board limits the number of health care 
professionals who can serve to a minority, a minority of people, and 
then goes further and says, And, oh, by the way, they have to actually 
stop practicing health care for the 6 years they sit on the board. How

[[Page H1464]]

close are they going to be to knowing what's going on in the care of a 
patient?
  The gentleman from Iowa talked about the myth of defensive medicine. 
I want to ask anyone who cares to go in a labor and delivery suite and 
look what's happened to obstetric care, to our women in America over 
the past 40 years because we don't have effective tort reform.
  I'm an obstetric anesthesiologist. I spent 30 years in a labor and 
delivery suite. In 1970, the cesarean section rate in this country was 
5 percent. One in 20 women going to a hospital to have a baby would 
have a cesarean section. Last year it was 33 percent. I will tell you, 
not much has changed about childbirth in that time, but now a woman 
going into the hospital to have a baby has a one in three chance of 
having a cesarean section. Not only that, but 40 years ago--those of 
you who want to, ask people you know who delivered 40 years ago. Most 
obstetrics was delivered by a one- or two-person group where a woman 
got to know the obstetrician who was going to deliver her baby.
  Go ask the folks in your district now what happens. You go into a 
group of about 10 or 12 people because they can't afford the 
malpractice insurance. They have to go into a big group so someone else 
can pay it. It's impersonal service. Go and try to find an obstetrician 
who is in their fifties or sixties and practicing obstetrics. They gave 
it up long ago because they can't afford the premiums. The most 
experienced obstetricians are no longer delivering care to American 
women.
  The C-section rate is one in three, and a woman can't even expect to 
see her obstetrician every time she goes to those prenatal visits 
because there are eight or 10 in the group, and they all have to have a 
chance to see that patient. That's what the lack of tort reform has 
done to the delivery of care to women in this country.
  We need to pass this bill and pass it now.
  Mr. WAXMAN. Mr. Chairman, may I inquire how much time each side has 
remaining in the general debate.
  The Acting CHAIR. The gentleman from California has 17\1/2\ minutes 
remaining, and the gentleman from Pennsylvania has 29\3/4\ minutes 
remaining.
  Mr. WAXMAN. I will reserve the balance of my time.
  Mr. PITTS. Mr. Chairman, at this time, I yield 2 minutes to another 
doctor, the gentleman from Indiana, Dr. Bucshon.
  Mr. BUCSHON. Mr. Chairman, I rise today in support of repealing the 
Independent Payment Advisory Board, or the so-called IPAB; and I urge 
President Obama and our colleagues in the U.S. Senate to join us, the 
House Republicans, in saving access to quality care for America's 
seniors.
  I've been a practicing physician for over 15 years, and I don't think 
I have seen anything potentially more detrimental to seniors' health 
care than the Independent Payment Advisory Board created under the 
Affordable Care Act. As has already been said, this group of 15 
unelected Washington, DC, bureaucrats, appointed by the President, will 
be making decisions on the funding of Medicare with little oversight 
from your elected officials. This is not a partisan issue. Whether it's 
this President, the next President, or a President 20 years from now, 
no President should have the power to create a board with this much 
control over health care.
  Doctors provide critical care to our Nation's seniors, but they also 
run a business. They have to receive proper reimbursement to keep their 
doors open or they will lose their ability to provide care for 
America's seniors.
  The Affordable Care Act has already cut over $500 billion from the 
Medicare program, and then the President doubled down by proposing over 
$300 billion more in his budget. Medicare cannot sustain further cuts 
if we are to keep access for America's seniors.
  Without any chance of judicial or congressional oversight, IPAB will 
become one of the most powerful agencies within our government.
  I ask the American people: What part of the government operates this 
way? When people in Washington, DC, make decisions you don't agree 
with, you can vote them out of office, but when IPAB makes a decision, 
the American people most likely will have no recourse.
  If the President and the U.S. Senate really are concerned about 
saving Medicare, which they claim to be, I urge them to get serious and 
work with us, because according to CBO, Medicare may be insolvent as 
early as 2016. We need to reform Medicare in order to strengthen and 
preserve it for future generations, and true reform is not continuing 
to cut funding of the program.
  Again, I urge the President and the Senate to join us in eliminating 
IPAB.
  Mr. WAXMAN. I continue to reserve the balance of my time.
  Mr. PITTS. Mr. Chairman, at this time I yield 2 minutes to another 
doctor, the gentleman from Michigan, Dr. Benishek.
  Mr. BENISHEK. I thank the chairman for yielding.
  Mr. Chairman, as my good friend, the chairman, knows, before I came 
to this House, I served as a general surgeon for three decades. So 2 
years ago this week, while President Obama was pitching his 2,000-page 
health care overhaul, I was back home in Michigan, taking care of 
patients and wondering how this law was going to change the 
relationship between a physician and his patients.

  Now the President's broken promises have shown us: Instead of 
providing real solutions to strengthen the doctor-patient relationship 
or improving the way we deliver health care to patients, the President 
gave us the Independent Payment Advisory Board. IPAB is a 15-member 
commission of unelected bureaucrats charged with cutting Medicare 
spending, specifically reimbursement for physicians. It's a very 
Washington-type solution to take something as personal as a doctor 
seeing a patient in his office and creating a panel of Washington 
bureaucrats to determine how that's going to be paid for.
  As a physician, I can tell you that when you set up an unelected 
board and give them unprecedented power and little government 
oversight, the results will be clear. This will lead to arbitrary cuts 
to the Medicare program, less access to care, and rationing. Today we 
are voting to stop that from happening.
  Mr. Chairman, we've already heard the other side of the aisle 
accusing the majority of pushing Grandma off a cliff. But instead of 
scare tactics and hyperbole, I ask Members on both sides of the aisle 
to support this effort to repeal the IPAB. Support this effort to 
eliminate what seniors are really concerned about: a group of unelected 
bureaucrats making health care decisions for them.
  As a physician, I am proud to support the repeal of this ill-
conceived rationing board on behalf of all my patients and constituents 
in northern Michigan.

                              {time}  1640

  Mr. WAXMAN. Mr. Chairman, I continue to reserve the balance of my 
time.
  Mr. PITTS. Mr. Chairman, at this time I yield 2 minutes to another 
health care professional--a nurse--the gentlelady from North Carolina, 
Renee Ellmers.
  Mrs. ELLMERS. I thank the chairman for this opportunity to speak with 
my colleagues as a nurse and a wife of a general surgeon.
  Mr. Chairman, IPAB was created under ObamaCare to slash Medicare 
spending by restricting health care services for seniors in need. 
Repealing IPAB will restore the doctor-patient relationship.
  Mr. Chairman, when someone goes to the doctor, they reveal the most 
personal experiences of their lives and engage in a relationship with a 
dedicated health care professional who puts his or her career on the 
line for the purpose of making that individual whole again. Left alone, 
President Obama's government-knows-best mentality will force our 
seniors to cede this relationship to a board of unelected and 
unaccountable bureaucrats who will have the power over the health and 
the lives of millions of other Americans. Each patient is unique, and 
their care rests on the doctor's ability to provide the best treatments 
available, regardless of the cost of their liability.
  One of the greatest challenges facing our Nation's health care 
system, including Medicare, is the rapidly rising costs. This 
legislation recognizes that. This legislation repairs and repeals the 
IPAB with commonsense medical liability reform that will save billions 
of dollars.

[[Page H1465]]

  I have sat and listened to the debate today, and I have listened 
intently over the 2 years since ObamaCare went into effect, and I still 
have one question to my Democrat colleagues across the aisle: What is 
your solution for Medicare? We know it is not sustainable as it is now. 
What is your solution?
  Mr. Chairman, Federal bureaucrats should not dictate to doctors how 
to provide care, force them to provide medication regardless of their 
known complications, and make them liable with no limits or 
protections.
  The Acting CHAIR. The time of the gentlewoman has expired.
  Mr. PITTS. I yield the gentlelady an additional 30 seconds.
  Mrs. ELLMERS. We have got to move forward on malpractice reform. Our 
colleagues ask the question, How can malpractice be put in place at the 
Federal level? And yet they have put Federal health care as an issue 
and put control as an issue.
  We must provide patients and medical professionals with the security 
and the safety net.
  Mr. WAXMAN. I yield myself such time as I may consume.
  Mr. Chairman, our idea for Medicare for the future is to make it 
better, not to eliminate it. In the Affordable Care Act, we provide 
help for seniors to pay for their prescription drugs, especially when 
they're in the doughnut hole. We provide money so they will be sure to 
have preventive services without having to pay for them so that we know 
we can prevent diseases that we otherwise have to pay to treat. We have 
extended the life of the Medicare trust fund. We're always looking for 
ways to hold down costs in a reasonable, rational way.
  One of the reasons we have very high costs in Medicare is, when a 
doctor and a patient get together, the doctor decides on how many 
services are going to be paid for, especially when that doctor gets 
paid more money for more services. Therefore, we've got to look for 
alternatives to that. Now I have a feeling the doctors like the idea of 
deciding how many services are going to be paid for, but we just can't 
afford that.
  So we have ways to hold down health care costs by trying to bring 
people together in affordable care organizations, ways for doctors to 
manage the care from physician to physician in a more efficient way, 
and we have a backup if these other things don't work--to have an 
advisory committee to give us their ideas; but their ideas cannot lead 
to rationing health care or making people have to pay more money for 
their insurance or to restrict benefits or modify eligibility. That's 
what we propose to do.
  The Republicans propose to take away the assured guarantee of 
services under Medicare and require people to go find a private 
insurance plan, if they can afford it, over and above the voucher, 
which would never keep pace with the increase of health care costs.
  At this time, I yield 2 minutes to my California colleague (Mr. 
Thompson).
  Mr. THOMPSON of California. I thank the gentleman for yielding.
  I rise today in opposition to this legislation. Whether or not you're 
a fan of the IPAB, I strongly urge you to oppose the bill. This bill is 
not about IPAB. This bill is nothing more than a political maneuver to 
attack the Affordable Care Act on the 2-year anniversary of its 
enactment.

  I challenge anyone to talk to one of the over 7,000 young adults in 
my district who now have health care insurance coverage and ask them if 
the Affordable Care Act should be repealed. Or maybe the 6,000 seniors 
in my district who have saved over $3 million on the cost of 
prescription drugs. Or the 30,000 children and 120,000 adults who now 
have health care insurance that actually covers preventive services 
without burdensome copayments. Or the thousands of children with 
preexisting health conditions who will no longer be denied coverage by 
health insurers or told they've hit their lifetime cap for services 
because of a disease with which they were born. Ask them if they'd like 
to repeal the Affordable Health Care Act.
  No one has ever suggested that this bill was the perfect solution to 
health care, but we should be working together to fix it, not trying to 
repeal it for cheap political points. And to add the medical 
malpractice provision that they added in this bill, that is so wrong-
headed that the doctors in California have come out in opposition to 
this bill. Any doctor will tell you there's work that needs to be done 
in regard to medical malpractice, but the way this was done has even 
brought the doctors to the table in opposition.
  So, on behalf of the millions of Americans who are already benefiting 
from the Affordable Care Act, I ask you to join with me and with the 
California doctors in opposition to this legislation that does no one 
any good at all.
  Mr. PITTS. I yield myself such time as I may consume.
  Mr. Chairman, I find it interesting that the gentleman who just spoke 
signed a letter to former Speaker Pelosi on December 17, 2009, that 
says the IPAB provisions severely limit the congressional oversight of 
the Medicare program and eliminate the transparency of congressional 
hearings and debate. Moreover, the creation of a Medicare board would 
effectively eliminate State community input in the Medicare program, 
removing the ability to develop and implement policies expressly 
applicable to different patient populations. So IPAB or an equivalent 
commission, they said, could not only threaten the ability of Medicare 
beneficiaries but of all Americans to access the care they need.
  I yield 2 minutes to the gentleman from New Mexico (Mr. Pearce).
  Mr. PEARCE. Mr. Chairman, I appreciate the opportunity to speak on 
this legislation, H.R. 5.
  One of the most trusted sources of information in my Mom's life--
she's in her eighties--is her physician. We just got a history lesson, 
a civics lesson, from our friends across the aisle just a moment ago 
expressing how the Democrat Congress passed, the Democrat Senate 
passed, and a Democrat President signed into law a bill that puts into 
place ways to control the costs. It took $500 billion from Medicare in 
order to pay for the bill that they passed. Then in addition to the 
civics lesson, we were given a political reality that the Senate is not 
going to take the bill up--therefore, we should not be discussing it.
  I think, for the peace of mind of people like my mom who are going to 
have the IPAB, this independent board, inserted between them and their 
doctors--Mom won't even get to talk to her doctor if this board decides 
she can't. The scheduler will simply say you have to come back next 
month or next year, and we're told we shouldn't bring that up because 
it might scare seniors. Seniors have a right to be scared. They have a 
right to wonder.

                              {time}  1650

  If some board does not even answer to Congress, it can change laws 
without coming to us, and it can write its own rules; and we're to be 
told that we should not be discussing this issue because it might 
frighten seniors. It just might, and they very well should be told.
  The Obama health care legislation did not bring one new doctor into 
service, but it brought millions of new patients in. The real truth is 
that we have increasing demand for doctor services because of these new 
patients and no new supply. You're going to have to limit it somewhere. 
They wanted to hide this limitation under the IPAB. We're simply 
saying, let's restore the relationship between 86-year-old moms and the 
doctors. Let's get rid of the IPAB. This bill would do it.
  Mr. WAXMAN. I yield myself such time as I may consume.
  Mr. Chairman, if you listen to the comments that were just made on 
the House floor, it would be better to leave over 30 million people 
without health insurance because they want to see doctors when they get 
sick.
  The legislation, the Affordable Care Act, provides more training for 
doctors and higher reimbursement for primary care doctors, and it 
provides for the opportunity to get a medical education with a payback 
in underserved areas. We're going to get more doctors, but we shouldn't 
say that those who have health insurance should turn their backs as the 
Republicans, I feel, are doing to all of those who have no insurance 
whatsoever.
  I want to yield, at this point, 5 minutes to the distinguished 
gentleman from the State of Virginia (Mr. Scott) so he can further 
speak on this legislation.
  Mr. SCOTT of Virginia. Mr. Chairman, I rise today in opposition to 
H.R.

[[Page H1466]]

5. There are several troublesome provisions with the bill.
  For example, it sets an arbitrary and discriminatory $250,000 cap on 
noneconomic damages; it reduces the amount of time an injured patient 
has to file a lawsuit; and it also repeals IPAB, the board created by 
the Affordable Care Act to control Medicare costs while preserving 
access to care.
  Although there are many troublesome provisions in the bill, I'd like 
to speak at length about one provision, the so-called fair share 
provision.
  The fair share provision would repeal the general rule of joint and 
several liability. Joint and several liability is a common law 
principle that enables an injured patient to seek compensation from any 
or all of the parties responsible for the patient's injuries. Joint and 
several liability provides that each of the guilty defendants are 
jointly responsible and individually responsible for the total damages, 
and, if they want, they can agree in advance on how to apportion fault 
among themselves; thus they can purchase and share the cost of 
insurance and charge their fees for services based on that agreement.
  The general rule of joint and several liability does not burden the 
injured patient with the requirement of assigning proportional fault. 
This PATH Act creates a bizarre and impossible standard for the patient 
by eliminating joint and several liability. It requires that the 
plaintiff, who is the patient, demonstrate each negligent party's 
proportional responsibility. This is often impossible for the plaintiff 
because frequently all the patient knows is he woke up as the victim of 
malpractice. Why should he then be required to find out what each and 
everybody did? And how does he do that when everybody is denying any 
liability?
  Unfortunately, this bill essentially requires the plaintiff to 
conduct a separate case against each defendant, each case requiring a 
finding of duty of care, a breach of that duty, a proximate cause, a 
finding of damages, and then a determination of what part of the 
damages are attributable to what malpractice.
  Each of those cases requires an expensive expert witness, 
depositions, and the full expense of complicated litigation. It also 
complicates any settlement that might take place because a patient 
can't take a chance of settling with one defendant without knowing 
what, ultimately, the other defendants might have to pay.
  What's most disturbing about this bill is it eliminates joint and 
several liability for all kinds of damages, including economic damages. 
In doing so, H.R. 5 is more extreme than most States' laws. Economic 
loss compensates injured parties for their out-of-pocket expenses, such 
as the hospital bills, the doctor bills, and lost wages. Even though 
the proponents of H.R. 5 claim to use California's Medical Injury 
Compensation Reform Act as a model, not even California eliminates 
joint and several liability for economic damages.
  Mr. Chairman, over centuries, each State has balanced judicial 
procedures between defendants and plaintiffs. Some provide longer and 
some shorter statutes of limitations. Some have large, some have small, 
and some have no caps at all on damages. Some deny recovery in cases of 
contributory negligence. Others allow recovery based on comparative 
negligence. Most have joint and several liability--a few do not--but 
the interests of plaintiffs and defendants have been balanced over the 
years in each State. We should not override centuries of the State-
level balancing of these interests by preempting some parts of tort law 
with this Federal bill.
  Mr. Chairman, we usually hear that tort reform is necessary to 
address three problems: defensive medicine, high malpractice premiums, 
and frivolous lawsuits.
  This bill will not prevent, will not do anything to deal with 
defensive medicine, because the lawsuits are not eliminated. There will 
still be defensive medicine, and because it increases expenses for 
defendants, it may actually increase total malpractice premiums.
  Finally, the bill does not target frivolous lawsuits. The Institute 
of Medicine estimates that approximately up to 100,000 patients die 
every year due to medical mistakes, and yet there are only about 15,000 
medical malpractice payments each year, so there's a question of 
whether or not frivolous lawsuits are even a problem. But to the extent 
that it is a problem, this bill will not target frivolous lawsuits; it 
will increase the cost of litigation and may reduce all lawsuits, but 
it will not target frivolous lawsuits.
  So, Mr. Chairman, I would hope that we will not pass a Federal law to 
abolish joint and several liability at the State level, and I would 
urge my colleagues to oppose this legislation.
  Mr. PITTS. Mr. Chairman, at this time, I yield 2 minutes to the 
gentleman from Illinois (Mr. Hultgren).
  Mr. HULTGREN. Mr. Chairman, I rise today in support of this bill.
  The unelected and unaccountable bureaucrats of the Independent 
Payment Advisory Board pose a threat to the ability of seniors in my 
district and around this country to get the health care they need.
  Across my district, I hear from doctors who are deeply concerned 
about their ability to accept more Medicare recipients because 
reimbursement rates are already too low; but if the IPAB bureaucrats 
are allowed to ration care, rates will be driven even lower. Fewer 
doctors will be able to afford to treat Medicare patients. It's cruel 
to tell our seniors that they have Medicare but refuse to tell them 
that there will be no doctors who will be able to treat them.
  IPAB will be the end of Medicare as we know it and the end of 
seniors' ability to get treatment from their preferred doctors. That's 
why we must act now to repeal IPAB--to protect seniors and to protect 
Medicare.

  I hope my colleagues on both sides of the aisle will join me in 
supporting this bill.
  Mr. PITTS. May I ask the gentleman how many speakers he has 
remaining?
  Mr. WAXMAN. We have one.
  Mr. PITTS. I'll yield to myself at this time, then, such time as I 
may consume.
  Mr. Chairman, H.R. 5, the Protecting Access to Healthcare Act, the 
PATH Act, not only fixes our broken medical liability system; it also 
repeals the Independent Payment Advisory Board, one of the most ominous 
provisions in the President's sweeping overhaul of health care.
  Medical liability reform will preserve access to quality health care 
in States like Pennsylvania by allowing doctors in high-risk 
specialties, such as obstetrics and neurosurgery, to practice without 
the fear of frivolous lawsuits and, according to the Congressional 
Budget Office, to reduce the Federal deficit by $48.6 billion over the 
next 10 years.
  According to the President's health care law, the purpose of IPAB is 
to reduce Medicare's per capita growth rate. The board is made up, as 
we've heard, of 15 unelected, unaccountable bureaucrats who will be 
paid $165,300 a year to serve 6-year terms on the board. If Medicare 
growth goes over an arbitrary target, the board is required to submit a 
proposal to Congress that would reduce Medicare's growth rate.

                              {time}  1700

  These recommendations will automatically go into effect unless 
Congress passes legislation that would achieve the same amount of 
savings. In order to do so, Congress must meet an almost impossible 
deadline and clear an almost insurmountable legislative hurdle.
  The board has the power to make binding decisions about Medicare 
policy with no requirement for public comment prior to issuing their 
recommendations. Individuals and providers will have no recourse 
against the board because its decisions cannot be appealed or reviewed. 
In other words, the board will make major health care legislation 
essentially outside the usual legislative process.
  The board is also limited to how it can achieve the required savings. 
Therefore, IPAB's recommendations will be restricted to cutting 
provider reimbursements. In many cases, Medicare already reimburses 
below the cost of providing services, and we're already seeing doctors 
refusing to take new Medicare patients--or Medicare patients at all--
because they cannot afford to absorb the losses.
  Any additional provider cuts will lead to fewer Medicare providers. 
That means that beneficiary access will suffer. Seniors will be forced 
to wait in

[[Page H1467]]

longer and longer lines to be seen by an ever-shrinking pool of 
providers or will have to travel longer and longer distances to find a 
provider willing to see them. Clearly, Medicare growth is on an out-of-
control trajectory that endangers the solvency and continued existence 
of the program. IPAB, however, is not the solution.
  I urge my colleagues to support H.R. 5.
  With that, I reserve the balance of my time.
  Mr. WAXMAN. Mr. Chairman, I am pleased at this time to yield 2 
minutes to the gentleman from New Jersey (Mr. Holt).
  Mr. HOLT. I thank my friend from California.
  Mr. Chairman, I rise in opposition to H.R. 5, which would repeal the 
Independent Payment Advisory Board, which I think is one of the good 
features of the health reform law.
  I have real concerns about H.R. 5. We're talking about undoing work 
instead of doing the work that this Congress should do--repealing IPAB 
in the pretext of protecting Medicare just one day after the Republican 
budget was released that would end Medicare and shift the costs of 
health care to our seniors while giving tax breaks to millionaires. 
There's just no logic to this.
  The bill would also make significant changes to the Federal health 
care liability system, making it difficult for legitimately injured 
patients to hold health care providers accountable, including even 
limiting the ability of victims of sexual abuse from getting justice 
from the institutions and providers who had harmed them.
  The health reform law, which the Republicans want to repeal, included 
malpractice reforms, like grant programs for States. While I support 
improvements to the medical malpractice process, it's important to note 
that malpractice is not the primary--not even really a significant 
reason--for the escalating health care costs. States that have passed 
stringent limits on medical malpractice claims like the ones in H.R. 5 
have in fact some of the most expensive health care in the country.
  This bill is irresponsible and unnecessary. Where is the 
transportation bill? Where are the jobs bills? Why are we on the floor 
talking about undoing good work instead of doing the work that this 
Congress should be doing? This bill is irresponsible and unnecessary. I 
urge my colleagues to vote ``no'' on this political theater.
  The Acting CHAIR (Mr. Womack). The time of the gentleman has expired.
  Mr. WAXMAN. I'd like to yield 1 additional minute to the gentleman 
and ask him to yield to me.
  Mr. HOLT. I am pleased to yield to my friend from California.
  Mr. WAXMAN. The problem that we keep facing is rapidly rising health 
care costs. It's not just for Medicare; it's for private insurance. 
It's for anybody who has health coverage that costs of health care are 
going up rapidly. The approach of Medicare has always been to look for 
ways to hold down the cost.
  There was a time when ophthalmologists would charge a fee for 
removing the cataract and then ask for another fee for inserting the 
lens. Well, that made sense when that surgery was brand new, but they 
didn't want to give up the two fees that they were receiving because it 
would be a reduction in their reimbursement. But Medicare said no, that 
really doesn't make sense. Medicare does a lot of things to hold down 
cost, and then private insurance picks them up because so often they 
make sense.
  The Acting CHAIR. The time of the gentleman has expired.
  Mr. WAXMAN. I yield the gentleman another 30 seconds.
  Mr. HOLT. And I yield that to the gentleman.
  Mr. WAXMAN. The way to hold down cost is to try to reform the way 
health care is delivered. Medicare tries to do that. If we don't do it 
that way, the Republicans would say that private insurance will be able 
to control it because that's all people are going to be able to get. No 
more Medicare. They will have to buy private insurance and let the 
insurance company tell the doctor and the patient what they will be 
able to do with their trying to hold down cost, without regard to the 
Medicare patient.
  I thank the gentleman for yielding to me.
  Mr. Chairman, I yield back the balance of my time.
  Mr. PITTS. Mr. Chairman, before I yield to the gentleman from 
Georgia, Dr. Gingrey, for our close, I just want to remind him of a 
statement by the chairman. Representative Stark of the Ways and Means 
Subcommittee on Health, during the debate and passage of PPACA, he 
called the establishment of the board ``a dangerous provision that sets 
Medicare up for unsustainable cuts.'' We should be reminded of that.
  At this time, I yield the balance of my time to one of the authors of 
the legislation, a distinguished member of the Health Subcommittee and 
a doctor, the gentleman from Georgia, Dr. Gingrey.
  Mr. GINGREY of Georgia. Madam Chairman, as a physician Member and 
coauthor of the bill, I am truly honored that Chairman Pitts is 
allowing me to close the debate on H.R. 5, the PATH Act--appropriately 
named. For meaningful medical liability reform and the elimination of 
IPAB together will put Medicare in specific, and health care in 
general, back on the right path: a path to fiscal solvency for one-
sixth of our economy; a path to compassionate, cost effective, 
efficient, and timely health care for all who call this great country 
home; a path to fairness in our court systems so that those injured by 
malpractice get their day before a jury of their peers and they are 
justly compensated, not crowded out by the growing problem of frivolous 
claims and out-of-control legal fees; a path to a bipartisan and a 
bicameral solution to one of the most pressing issues that this Nation 
will ever again face, that is, to save Medicare for our current seniors 
and strengthen it for all future generations.
  Let's get started right now. Our country cannot wait any longer. Vote 
``yes'' on H.R. 5, the right PATH Act.

                              {time}  1710

  Mr. CAMP. Madam Chairman, I yield myself such time as I may consume.
  Today I come to the floor to speak in support of H.R. 5, the 
Protecting Access to Healthcare Act, which, among other things, will 
repeal yet another poorly designed provision from the Democrats' health 
care law.
  Specifically, this legislation would repeal the Independent Payment 
Advisory Board. IPAB, as it's commonly known, is a dangerous new 
government agency made up of unelected bureaucrats who can meet in 
total secrecy to decide what seniors will pay and what health care 
services will be available to seniors. This unaccountable board has but 
one objective: to save money by restricting access to health care for 
Medicare beneficiaries.
  Nearly 2 years since its passage, the Democrats' health care law 
remains deeply unpopular, with an Associated Press poll recently 
revealing that nearly half of the American people oppose the law. IPAB, 
which is a critical component of the law, illustrates why those 
concerns are still so strong.
  A separate poll confirms that opposition far outweighs support with 
73 percent expressing concern that Medicare cuts recommended by IPAB 
could go into effect without congressional approval. Even IPAB's 
recommendations overturn a law previously passed by Congress. Seventy-
one percent expressed concern that changes made to Medicare based on 
IPAB's recommendations cannot be challenged in court, and 67 percent 
worry that IPAB could choose to limit which specific health services 
are covered by Medicare.
  The American people have every reason to be worried. We should be 
protecting and empowering our seniors, not jeopardizing their access to 
health care. Yet IPAB removes seniors, physicians, and families from 
the decision-making process about how best to meet their health care 
needs. Instead of giving seniors more choices, these unelected 
bureaucrats will take away choices from patients, from doctors, and 
from families. This government-knows-best approach is why Americans 
across the country support repeal, and it's also why there's strong 
bipartisan support here in Congress to repeal IPAB.
  When the Ways and Means Committee considered this legislation, we 
received numerous letters from groups across the Nation representing 
employers, patients, doctors, and health care professionals who voiced 
strong support for IPAB repeal. The groups span

[[Page H1468]]

across the political spectrum and include the Easter Seals, the 
Alliance of Specialty Medicine, the Veterans Health Council, 
FreedomWorks, and Americans for Tax Reform. In total, over 390 groups 
have signed letters asking that Congress repeal IPAB, and I will insert 
these letters into the Record.
  America's seniors deserve better. Without reform, the Medicare 
trustees have said that Medicare will soon go broke and not be able to 
provide the benefits seniors rely on. With more and more Americans 
becoming eligible for Medicare each day, no time is more urgent than 
now to secure the future of beneficiaries' access to care. IPAB does 
just the opposite. It threatens seniors' access to health care, and 
that is why it must be repealed.
  Madam Chairman, the Democrats got it right when they named the IPAB. 
It truly is the Independent Payment Advisory Board. It's independent 
from seniors, independent from people with disabilities, independent 
from the voters, independent from legal challenges and appeals, and 
independent from any accountability.
  It's time to give that independence back to doctors, to patients, and 
to Congress by voting to repeal this Washington power grab. I urge my 
colleagues to join me in supporting repeal of the Independent Payment 
Advisory Board and to vote ``yes'' on this legislation.

                                                    March 7, 2012.
       Dear Member of Congress: The organizations listed below 
     represent a breadth of entities including all sectors of the 
     healthcare industry, employers of different sizes and 
     geographic locations, as well as purchasers of care, 
     consumers and patients. We all share the conviction that the 
     Independent Payment Advisory Board (IPAB) will not only 
     severely limit Medicare beneficiaries' access to care but 
     also increase healthcare costs that are shifted onto the 
     private sector. While we all recognize the need for more 
     sustainable healthcare costs, we do not believe the IPAB is 
     the way to, or will, accomplish this goal.
       As you know, the Patient Protection and Affordable Care Act 
     (PPACA [P.L. 111 148]) created the IPAB, a board appointed by 
     the President and empowered to make recommendations to cut 
     spending in Medicare if its spending growth reaches certain 
     measures. The IPAB will have unprecedented power with little 
     oversight, even though it has the power to literally change 
     laws previously enacted by Congress. Further, the law 
     specifically prohibits administrative or judicial review of 
     the Secretary's implementation of a recommendation contained 
     in an IPAB proposal.
       We are deeply concerned about the impact the IPAB will have 
     on patient access to quality healthcare. The bulk of any 
     recommended spending reductions will almost certainly come in 
     the form of payment cuts to Medicare providers. This will 
     affect patient access to care and innovative therapies. In 
     the past five years for which data is available, the number 
     of physicians unable to accept new Medicare patients because 
     of low reimbursement rates has more than doubled. According 
     to an American Medical Association survey, current 
     reimbursement rates have already led 17 percent of all 
     doctors, including 31 percent of primary care physicians, to 
     restrict the number of Medicare patients in their practices. 
     In all likelihood, the IPAB will only exacerbate this 
     problem.
       While we are all supportive of improving the quality of 
     care in this country, we are concerned that the IPAB will not 
     be able to focus on improving healthcare and delivery system 
     reforms, as some of its proponents have suggested. Requiring 
     the IPAB to achieve scoreable savings in a one-year time 
     period is not conducive to generating savings through long-
     term delivery system reforms. According to a recent Kaiser 
     Family Foundation issue brief, ``[w]hile the requirement to 
     achieve Medicare savings for the implementation year provides 
     a clear direction and target for the Board, it may discourage 
     the type of longer-term policy change that could be most 
     important for Medicare and the underlying growth in health 
     care costs, including delivery system reforms that MedPAC and 
     others have recommended which are included in the ACA--and 
     which generally require several years to achieve savings. If 
     these delivery system reforms are not `scoreable' for the 
     first year of implementation, the IPAB may be more likely to 
     consider more predictable, short-term scoreable savings, such 
     as reductions in payment updates for certain providers.'' The 
     Congressional Budget Office (CBO) has in fact stated that the 
     Board is likely to focus its recommendations on changes to 
     payment rates or methodologies for services in the fee-for-
     service sector by non-exempt providers. Again, this will have 
     a severe, negative impact on Medicare beneficiaries.
       Last, we believe that the IPAB sets a dangerous precedent 
     for overriding the normal legislative process. Congress is a 
     representative body that has a duty to legislate on issues of 
     public policy. Abdicating this responsibility to an unelected 
     and unaccountable board removes our elected officials from 
     the decision-making process for a program that millions of 
     our nation's seniors and disabled individuals rely upon, 
     endangering the important dialogue that takes place between 
     elected officials and their constituents.
       We do not believe the IPAB is the right way to achieve 
     savings in Medicare and strongly urge Congress to eliminate 
     this provision.
           Sincerely,
       Abigail Alliance, Action CF AdvaMed, Advocates for 
     Responsible Care, AIDS Delaware, AIDS Drug Assistance 
     Programs Advocacy Association, AIDS Housing Association of 
     Tacoma, AIDS Institute, Alabama Orthopaedic Society, Alabama 
     Podiatric Medical Association, Alaska State Chamber of 
     Commerce, Alaska State Grange, Alder Health Services, Inc., 
     Alliance for Aging Research, Alliance of Specialty Medicine, 
     ALung Technologies, Inc., Alzheimer's & Dementia Resource 
     Center, Alzheimer's Arkansas, American Academy of Facial 
     Plastic & Reconstructive Surgery, American Academy of 
     Neurology.
       American Academy of Otolaryngology--Head and Neck Surgery, 
     American Academy of Physical Medicine and Rehabilitation, 
     American Association for the Study of Liver Diseases, 
     American Association of Clinical Endocrinologists, American 
     Association of Clinical Urologists, American Association for 
     Homecare, American Association for Marriage and Family 
     Therapy, American Association of Neurological Surgeons, 
     American Association of Orthopaedic Executives, American 
     Association of Orthopaedic Surgeons, American Autoimmune 
     Related Diseases Association, American College of Emergency 
     Physicians, American College of Emergency Physicians--Indiana 
     Chapter, American College of Mohs Surgery, American College 
     of Osteopathic Surgeons, American College of 
     Radiology, American College of Surgeons--Missouri Chapter, 
     American Congress of Obstetricians and Gynecologists, 
     American Gastroenterological Association, American Liver 
     Foundation--Allegheny Division.
       American Osteopathic Academy of Orthopedics, American 
     Physical Therapy Association, American Podiatric Medical 
     Association, American Society of Anesthesiologists, American 
     Society of Breast Surgeons, American Society of Cataract and 
     Refractive Surgery, American Society of General Surgeons, 
     American Society of Plastic Surgeons, American Society of 
     Radiation Oncology, American Urological Association, 
     Americans for Prosperity, Amigos por la Salud, Arizona 
     BioIndustry Association, Arizona Medical Association, Arizona 
     Podiatric Medical Association, Arizona Urological Society, 
     Arkansas Medical Society, Arkansas Orthopaedic Society, 
     Arkansas Podiatric Medical Association, Associated Industries 
     of Florida.
       Association for Behavioral Healthcare, Association of 
     Nurses in AIDS Care, Asthma & Allergy Foundation of America--
     California Chapter, Asthma & Allergy Foundation of America--
     New England Chapter, Bay Bio, BEACON (Biomedical Engineering 
     Alliance & Consortium), Connecticut, BIOCOM, BioNJ, BioOhio, 
     Biotechnology Industry Organization (BIO), Bismarck-Mandan 
     Chamber of Commerce, California Healthcare Institute, 
     California Hispanic Chambers of Commerce, California Medical 
     Association, California Orthopaedic Association, California 
     Podiatric Medical Association, California Rheumatology 
     Alliance, California Urological Association, Capital Region 
     Action Against Breast Cancer!, Center of the American 
     Experiment.
       Children's Rare Disease Network, Coalition for Affordable 
     Health Coverage, Coalition of State Rheumatology, Council of 
     University Chairs of Obstetrics & Gynecology Organizations, 
     Colorado Academy of Family Physicians, Colorado BioScience 
     Association, Colorado Cross-Disability Association, Colorado 
     Gerontological Society, Colorado Podiatric Medical 
     Association, Colorado Retail Council, Colorado Springs Health 
     Partners, Community Health Charities of Florida, Community 
     Health Charities of Nebraska, Congress of Neurological 
     Surgeons, Community Oncology Alliance, Connecticut 
     Orthopaedic Society, Connecticut Podiatric Medical 
     Association, Connecticut State Urology Society, Delaware 
     Academy of Medicine, Delaware Ecumenical Council on Children 
     and Families.
       Delaware HIV Consortium, Delaware Podiatric Medical 
     Association, Delaware State Orthopaedic Society, Docs 4 
     Patient Care, Easter Seals, Easter Seals Crossroads, Easter 
     Seals Iowa, Easter Seals of Arkansas, Easter Seals of Maine, 
     Easter Seals of Massachusetts, Easter Seals of New Jersey, 
     Easter Seals of Southeastern PA, Easter Seals of South 
     Florida, Easter Seals UCP North Carolina, Elder Care Advocacy 
     of Florida, Florida Chamber of Commerce, Florida Medical 
     Association, Florida Podiatric Medical Association, Florida 
     Society of Neurology, Florida Society of Rheumatology.
       Florida Society of Thoracic & Cardiovascular Surgeons, 
     Florida State Hispanic Chamber of Commerce, Florida 
     Transplant Survivor's Coalition, Florida Urological Society, 
     Georgia Association for Home Health Agencies, Georgia Bio, 
     Georgia Orthopaedic Society, Georgia Podiatric Medical 
     Association, Global Genes, Global Healthy Living Foundation, 
     Grand Rapids Area Chamber of Commerce, HEALS of the South, 
     Healthcare Institute of New Jersey, Healthcare Leadership 
     Council, HealthHIV, Hemophilia Foundation of Maryland, Heart 
     Rhythm Society,

[[Page H1469]]

     Hoosier Owners and Providers for the Elderly, Idaho Medical 
     Association, Idaho Podiatric Medical Association.
       Illinois Association of Orthopaedic Surgeons, Illinois 
     Biotechnology Industry, Organization--iBIO', 
     Illinois Chamber of Commerce, Indiana Association of Cities 
     and Towns, Indiana Health Care Association, Indiana Health 
     Industry Forum, Indiana Medical Device Manufacturers Council, 
     Inc., Indiana Neurological Society, Indiana Podiatric Medical 
     Association, Indiana State Medical Association, 
     InterAmerican College of Physicians & Surgeons, 
     International Franchise Association, International 
     Institute for Human Empowerment, International Society for 
     the Advancement of Spine Surgery, Iowa Orthopaedic 
     Society, Iowa Podiatric Medical Association, Kansas 
     Medical Society, Kansas Podiatric Medical Association, 
     Kansas Urological Association.
       Kentucky BioAlliance, Kentucky Medical Association, 
     Kentucky Podiatric Medical Association, Kidney Cancer 
     Association of Illinois, Large Urology Group Practice 
     Association, Latino Diabetes Association, Licensed 
     Professional Counselors Association of Georgia, Louisiana 
     State Medical Society, Lupus Alliance of America--Hudson 
     Valley Affiliate, Lupus Alliance of America--Queens and Long 
     Island Affiliate, Lupus Alliance of America--Southern Tier 
     Affiliate, Lupus Alliance of America--Upstate New York 
     Affiliate, Lupus Foundation of Arkansas, Lupus Foundation of 
     America, DC/MD/VA Chapter, Lupus Foundation of Florida, Lupus 
     Foundation of Mid and Northern New York, Lupus Foundation of 
     the Genesee Valley, Lupus Foundation of Pennsylvania, Mabel 
     Wadsworth Women's Health Center, Maine Health Care 
     Association.
       Maine Osteopathic Association, Maine Podiatric Medical 
     Association, Maine State Council of Vietnam Veterans of 
     America, Maryland Orthopaedic Association, Maryland State 
     Medical Society, Massachusetts Association for Behavioral 
     Health Systems, Massachusetts Association for Mental Health, 
     Massachusetts Biomedical Initiatives, Massachusetts Medical 
     Device Industry Council, Massachusetts Orthopaedic 
     Association, Massachusetts Podiatric Medical Society, Medical 
     Association of Georgia, Medical Association of the State of 
     Alabama, Medical Society of Delaware, Medical Society of the 
     District of Columbia, Medical Society of the State of New 
     York, Medical Society of New Jersey, Men's Health Network, 
     Mental Health America of Indiana, Mental Health America of 
     Greater Houston.
       MichBio, Michigan Chamber of Commerce, Michigan College of 
     Emergency Physicians, Michigan Podiatric Medical Association, 
     Michigan Orthopaedic Society, Michigan Society of 
     Anesthesiologists, Minnesota Podiatric Medical Association, 
     Minnesota State Grange, Mississippi Arthritis and Rheumatism 
     Society, Mississippi Orthopaedic Society, Mississippi 
     Podiatric Medical Association, Missouri State Medical 
     Association, Missouri Urological Association, Montana 
     Orthopaedic Society, National Alliance on Mental Illness, 
     National Alliance on Mental Illness Colorado, National 
     Alliance on Mental Illness Florida, National Alliance on 
     Mental Illness Georgia, National Alliance on Mental Illness 
     Indiana, National Alliance on Mental Illness Maine.
       National Alliance on Mental Illness Michigan, National 
     Alliance on Mental Illness NC, National Alliance on Mental 
     Illness Texas, National Association for Home Care & Hospice, 
     National Association for Home Care & Hospice--Indiana 
     Chapter, National Association for Home Care & Hospice--Ohio 
     Chapter, National Association for Uniformed Services, 
     National Association of Manufacturers, National Association 
     of Nutrition and Aging Services Programs, National 
     Association of People with AIDS, National Association of 
     Social Workers NC, National Association of Spine Specialists, 
     National Council of Negro Women, National Council of Negro 
     Women--Los Angeles View Park Section, National Council for 
     Community Behavioral Healthcare, National Health Foundation, 
     National Hemophilia Foundation--Delaware Valley Chapter, 
     National Kidney Foundation--Ohio Chapter, National Medical 
     Association, National Minority Quality Forum.
       National Retail Federation, NCBIO, Nebraska Academy of 
     Physician Assistants, Nebraska Medical Association, Nebraska 
     Orthopaedic Society, Nebraska Urological Association, 
     Neurofibromatosis Mid-Atlantic, Nevada Orthopaedic Society, 
     Nevada Podiatric Medical Association, Nevada State Medical 
     Association, New Hampshire State Grange, New Horizons Home 
     Health Services, New Jersey Academy of Ophthalmology, New 
     Jersey Mayors Committee of Life Science, New Jersey Podiatric 
     Medical Society, New Mexico Podiatric Medical Association, 
     New York Podiatric Medical Association, New York State 
     Rheumatologists Society, New York State Urological 
     Society, North Carolina Association on Aging.
       North Carolina Psychological Association, North Carolina 
     Rheumatology Association, North Carolina Urological 
     Association, North Dakota Chamber of Commerce, North Dakota 
     Medical Association, North Dakota Policy Council, Northwest 
     Urological Society, Ohio Association of Ambulatory Surgery 
     Centers, Ohio Association of County Behavioral Health 
     Authorities, Ohio Association of Medical Equipment Services, 
     Ohio Hospital Association, Ohio Orthopaedic Society, Ohio 
     State Grange, Ohio State Medical Association, Ohio Urological 
     Society, Ohio Veterans United, Oklahoma Podiatric Medical 
     Association, Oklahoma State Medical Association, Oklahoma 
     State Orthopaedic Society, Oklahoma State Urologic 
     Association.
       Old North State Medical Society, Oregon Medical 
     Association, Oregon Podiatric Medical Association, Partners 
     in Care Foundation, Partnership for Drug Free North Carolina, 
     Pennsylvania BIO, Pennsylvania Chamber of Business & 
     Industry, Pennsylvania Medical Society, Pennsylvania 
     Orthopaedic Society, Personal Coaching & Psychotherapy for 
     Women, PhRMA, Premier healthcare alliance, RARE Project, 
     RetireSafe, Rhode Island Medical Society, Rio Grande 
     Foundation, New Mexico, Rocky Mountain Stroke Center, Rural 
     Health IT, Sanfilippo Foundation for Children, Society for 
     Cardiovascular Angiography and Interventions.
       Society for Vascular Surgery, Society of Gynecologic 
     Oncology, Society of Urologic Oncology, South Carolina BIO, 
     South Carolina HIV/AIDS Care Crisis Task Force, South 
     Carolina Medical Association, South Carolina Orthopaedic 
     Association, South Carolina Podiatric Medical Association, 
     South Carolina Urological Association, South Dakota Podiatric 
     Medical Association, South Dakota State Orthopaedic Society, 
     South Jersey Geriatric Care PC, South Jersey Senior 
     Networking Group, Southeastern Medical Device Association 
     (SEMDA), Southwest Michigan Pharmacist Association, Stockton 
     Center on Successful Aging, Syndicus Scientific Services, 
     Team Sanfilippo Foundation, Tennessee Medical Association, 
     Tennessee Orthopaedic Society.
       Tennessee Podiatric Medical Association, Texas Healthcare & 
     Bioscience Institute, Texas Podiatric Medical Association, 
     Texas Urological Society, The Center for Health Care 
     Services, The G.R.E.E.N. Foundation, The National Grange, 
     U.S. Chamber of Commerce, U.S. Pain Foundation, Urology 
     Society of New Jersey, Utah Medical Association, Utah 
     Podiatric Medical Association, Utah State Orthopaedic 
     Society, Vascular Society of New Jersey, Vermont Medical 
     Society, Vermont Podiatric Medical Association, Veterans 
     Health Council, VHA Inc., Vietnam Veterans of America, 
     Virginia Biotechnology Association.
       Virginia Podiatric Medical Association, Visiting Nurse 
     Association of Ohio, Washington Biotechnology & Biomedical 
     Association, Washington Free Clinic Association, Washington 
     Osteopathic Medical Association, Washington State Podiatric 
     Medical Association, Washington Rheumatology Association, 
     Washington State Medical Association, Washington State 
     Urology Society, WERAK Foundation, West Virginia Academy of 
     Otolaryngology, West Virginia Chapter of the American College 
     of Cardiology, West Virginia Manufacturer's Association, West 
     Virginia Orthopaedic Society, West Virginia State Medical 
     Association, William ``Hicks'' Anderson Community Center, 
     Wisconsin Hospital Association, Wisconsin Urological Society, 
     Wyoming State Grange, Women Against Prostate Cancer.
                                  ____



                                Health Care Freedom Coalition,

                                                   March 19, 2012.
       Dear Member of Congress: On behalf of the 26 undersigned 
     members of the Health Care Freedom Coalition and our ally 
     organizations, representing industry, policy, taxpayer, and 
     medical professional groups, and their millions of patients 
     and members, we are writing to express our concerns regarding 
     the Independent Payment Advisory Board provision of the 
     Patient Protection and Affordable Care Act and the disastrous 
     impact of its implementation on both patient care as well as 
     Congressional authority.
       Section 3403 of the Patient Protection and Affordable Care 
     Act (PPACA) established the Independent Payment Advisory 
     Board (IPAB) to reduce Medicare spending. But ultimately this 
     panel of 15 independent, unelected bureaucrats with 
     unilateral authority and whose decisions are freed from 
     judicial and administrative review will most certainly cut 
     payments to physicians under Medicare, will limit patient 
     access to, and quality of, medical care.


       Independent, Unelected, Politically-Appointed Bureaucrats

       Of the 15 members, twelve will be appointed by the 
     President, and the law actually prevents practicing medical 
     professionals--like doctors--from membership. The rules 
     almost guarantee that the members will be academics. The 
     highly-paid bureaucrats will likely be paid more than many of 
     the doctors they are second-guessing. These six-year terms 
     come with an anticipated paycheck of $165,300--more than the 
     average family practice physician earns in many cities in 
     Ohio, Pennsylvania and Florida.


    Undemocratic, Unilateral Authority and Lack of Redress or Review

       The decisions cannot be challenged in the courts and are 
     freed from the normal administrative rules process--require 
     no public notice, public comment or public review. IPAB 
     ``recommendations'' carry the full force of the law, unless 
     2/3 of the House and Senate vote to override. In essence, 
     Congress has given this Board the authority to legislate.


              Decisions Will Impact Physicians & Patients

       The board is specifically forbidden from ``any 
     recommendations to ration health care'', but PPACA fails to 
     define the word ``ration.'' Instead, it allows IPAB to pay 
     doctors reimbursement rates below costs, which in essence 
     would constrict a physician's ability to treat patients. 
     Longitudinal studies already show that about one-fourth of 
     doctors already refuse new Medicare patients,

[[Page H1470]]

     and as many as 50% restrict the services they are willing to 
     perform for their current patients. And this is expected to 
     worsen, as even more doctors will be unable to afford to take 
     Medicare patients.


           Absolves Congress from Oversight & Decision-Making

       IPAB is intended to take tough decisions about Medicare 
     spending out of the purview of Congress, in effect, 
     delegating away its legislative responsibilities under the 
     Constitution to either a 15 member Board, or by default, the 
     Secretary of Health and Human Services. IPAB was simply 
     created to absolve Congress of having to make decisions that 
     directly impact the quality and access of care for Seniors, 
     and also insulate them from having to make tough decisions.
       The ill-advised quest for ``cost effectiveness'' is doomed 
     to failure. As we have seen in Great Britain, any de facto 
     price controls are likely to do nothing to control the growth 
     of spending. Further, this one-size-fits-all approach to 
     dictating medical care in a country of more than 300 million 
     is ill-advised.
       If Congress believes that these decisions handed over to 
     IPAB are too much of a hot political potato for it to decide, 
     then perhaps it is a clear indication that this is the wrong 
     course of action.
           Sincerely,
         Kathryn Serkes, CEO & Chairman Doctor Patient Medical 
           Association; Grover Norquist, President Americans for 
           Tax Reform; Dean Clancy Legislative Counsel & VP, 
           Health Care Policy Freedom Works; Jim Martin, Chairman 
           60 Plus Association; Heather Higgins, President & CEO 
           Independent Women's Voice; Colin A. Hanna, President 
           Let Freedom Ring; Ken Hoagland, Chairman Restore 
           America's Voice Foundation; Christopher M. Jaarda, 
           President American Healthcare Education Coalition; HSA 
           Coalition; Tim Phillips, President Americans For 
           Prosperity; Amy Ridenour, Chairman The National Center 
           for Public Policy Research; Mario H. Lopez, President 
           Hispanic Leadership Fund; David Williams, President 
           Taxpayers Protection Alliance; Andrew Langer, President 
           Institute for Liberty; Jane Orient, MD, Executive 
           Director Association of American Physicians & Surgeons; 
           Eric Novak, MD US Health Freedom Coalition; Andrew F. 
           Quinlan, President Center for Freedom and Prosperity; 
           Grace-Marie Turner, President Galen Institute; Hal C. 
           Scherz, MD, FACS, FAAP President & CEO Docs 4 Patient 
           Care; Amy Kremer, Chairman Tea Party Express; Penny 
           Nance, CEO and President Concerned Women for America; 
           Dr. Joseph L. Bridges, President & CEO The Seniors 
           Coalition; Pete Sepp, Executive Vice President National 
           Taxpayers Union; Judson Phillips Tea Party Nation; 
           Stephani Scruggs, President Unite In Action, Inc; Ana 
           Puig, Co-Founder Kitchen Table Patriots.

  I reserve the balance of my time.
  Mr. LEVIN. Madam Chairman, I yield myself such time as I may consume.
  I hope everybody's been listening to this. What has become clear is 
this: the Republicans have a 3-act play. First, repeal IPAB; next, 
repeal the rest of health care reform; and, finally, repeal Medicare.
  It is so hypocritical to come forth and say that the efforts of 
Republicans is to protect Medicare when the purpose of it is to destroy 
it. That's what would happen if they had prevailed before. That's what 
would happen if they prevail today with their voucher plan.
  So the third act really came forth before the first act. They rolled 
out, yesterday, their budget plan that essentially would repeal 
Medicare, would destroy it. There would be a voucher and, over time, 
the end of Medicare.
  It's an essential commitment to the seniors of this country, and we 
Democrats are determined to thwart every effort to destroy it.
  Now, as to the first act, repeal IPAB. You know, it's interesting 
that Medicare is a major instrumentality for ensuring that over time 
the costs of Medicare are brought under control, protecting the health 
care opportunities of seniors. Indeed, there have been efforts already 
under the Affordable Care Act to bring under control the costs of 
Medicare, to make sure it survives.
  So being an essential part of controlling health care costs over the 
long term, the Republican proposal, essentially, would go in the 
opposite direction. And that's why the CBO, last year projected--and I 
want everybody to listen to this--that health care costs would jump by 
39 percent under the Republican plan to end the Medicare guarantee. 
That's why 300 economists have said that health reform puts into place, 
essentially, every cost-containment provision policy that analysts have 
considered. It's because of those policies that CBO has given this 
estimate that IPAB isn't going to be triggered until some time after 
2022.
  So what happens is, the Republicans come forth with the repeal of 
IPAB as a first step towards repealing Medicare when they have never 
presented an alternative in terms of the Affordable Care Act. So, 
today, we hear all the scare tactics about a board whose operation 
effectively won't be triggered for a decade. That's a scare tactic that 
is not worthy of this floor, so I urge very much that we oppose.
  It's interesting that the Republican budget has a cap that is more 
severe, if you want to put it that way, more strenuous than the 
provision that relates to IPAB. And so they come forth, and they say 
that IPAB, which won't be triggered until 2022, is something that they 
should oppose, while they want to put in place a budget this year that 
would have a more severe cap than is in IPAB. Let me also say the 
notion that there is some agency here that could act without any role 
for Congress is simply untrue. It's not true. You shouldn't say it.
  We have an opportunity, once IPAB goes into operation, to review any 
recommendation that comes forth, and to replace it, as long as the 
various targets are met. So I urge very much that we reject this 
proposal in part because the repeal, in and of itself, I think, is a 
mistake but mainly because of what the aim is here, and that has been 
so clear from the debate, because people who come here on the 
Republican side, some of them talk about IPAB; some don't even discuss 
IPAB. They talk about the Affordable Care Act.

                              {time}  1720

  The polling data we have is essentially relating to the Affordable 
Care Act as well as to IPAB. I think the more people understand what 
has been going on, the more they see the benefits of health care 
reform, the more they will be supportive of it. We're going to take 
that case to the American people.
  Let me just give you a few numbers that everyone should know about 
ACA.
  It's been only 2 years since it was signed into law, but Americans 
are already receiving the benefits of lower costs and better coverage.
  Let me give you a few facts:
  86 million Americans have received one or more free preventative 
services such as checkups and cancer screenings;
  105 million Americans no longer have a lifetime limit on their 
coverage;
  Up to 17 million children with preexisting conditions can no longer 
be denied coverage by insurers. Up to 17 million kids. You repeal this 
Act, you put them into total jeopardy;
  2\1/2\ million additional young adults up to 26 now have health 
insurance through their parents' plan. If you had succeeded in past 
efforts of repealing health care reform, those 2\1/2\ million people 
would have been out in the cold;
  Also, 5.1 million seniors in the doughnut hole have saved $3.2 
billion on their prescription drugs, an average of $635 per senior. If 
you had succeeded with repeal, over 5 million seniors would have been 
essentially with increased costs;
  Over 2 million seniors have had a free annual wellness visit under 
Medicare;
  Already under the small business health care tax credit, over 350,000 
small employers have used it to help provide health insurance for 2 
million workers.
  Republicans come here using scare tactics about IPAB, 10 years away 
from being triggered according to CBO. You essentially say repeal 
health care reform though you've never had a comprehensive plan to 
replace it. That's been the bankruptcy of your position.
  I finish, reminding everybody that we're the only industrial nation 
on the globe which has tens of millions of people who go to bed every 
day without a stitch of health insurance coverage.
  The administration's brief before the Supreme Court has illustrated 
what the result is in terms of the added costs of the uninsured who go 
to emergency rooms. Billions and billions of dollars that are 
essentially shifted to people who have insurance and shifted to 
taxpayers who have to cover the costs of emergency coverage.
  So we come here with a passion. We worked hard to support and to pass 
this act. We worked hard to put it together. A major piece of 
legislation like that always needs continued work, but not

[[Page H1471]]

its repeal. That would be a grave, grave, grave mistake.
  So I think it's time to pull down the curtain on this three-act play 
of the House Republicans trying first to repeal IPAB, then to repeal 
the rest of health care reform, and then to repeal Medicare. 
Fortunately, if we're mistaken and the majority passes it here, it will 
deserve a death in the Senate of the United States.
  I reserve the balance of my time.
  Mr. CAMP. Madam Chairman, I yield myself 15 seconds just to say that 
our Republican alternative, our Republican health care bill, prevented 
unlawful recisions, had no lifetime caps on coverage, did not deny 
coverage to those with preexisting conditions, and was the only bill 
that was scored by CBO as lowering premiums. Also, we did it without 
spending $2 trillion and 2,400 pages and did not create a board of 15 
unelected bureaucrats.
  With that, I yield 2 minutes to the distinguished chairman of the 
Health Subcommittee, the gentleman from California (Mr. Herger).
  Mr. HERGER. Madam Chairman, I rise in strong support of H.R. 5.
  Today's debate goes to the heart of the question of what kind of 
health care system we want to have. House Republicans believe the 
solution to making health care more affordable and strengthening the 
Medicare program is more freedom, empowering innovation and competition 
to reduce costs and improve quality, giving seniors the opportunity to 
choose the health care that's best for them.
  The Independent Payment Advisory Board, IPAB, represents a very 
different approach to controlling health care costs, a one-size-fits-
all plan in which unelected and unaccountable bureaucrats decide what 
kind of health care you should get. Physicians, patient advocates, and 
respected scholars, Democrats and Republicans alike, have warned that 
the IPAB threatens access to care for seniors and people with 
disabilities. The board has the authority to meet and make decisions in 
secret without considering the perspective of patients and their 
doctors and without judicial review. Madam Chairman, this is the wrong 
approach. IPAB must be repealed.
  H.R. 5 also includes important reforms to reduce the cost of 
frivolous medical lawsuits. The President's health care overhaul has 
not fulfilled his promise to reduce health insurance premiums by 
$2,500, but commonsense medical liability reforms will truly bring down 
health costs both for American families and the Medicare program.
  I urge the passage of this legislation.
  Mr. LEVIN. I now yield 3 minutes to the distinguished member of our 
committee, Mr. Blumenauer, from the proud State of Oregon.
  Mr. BLUMENAUER. Madam Chairman, I come to the floor coming from the 
Budget Committee, where my Republican colleagues are busy at work 
breaking the commitment that we all made to one another establishing a 
path forward on deficit reduction. It wasn't just a commitment that was 
made amongst legislative leaders; we wrote it into law. Now they're 
breaking that commitment.
  They are involved with the budgets that are going to actually reduce 
health care in this country, and yet they would come to the floor and 
ask us to get exorcised about something that may happen 10 years from 
now.
  I find the language curious. You could just as easily say, instead of 
the Supreme Court, you could talk about nine unelected judicial hacks 
meeting in secret that have no judicial review. They're a power unto 
themselves.
  Get a grip, people.
  IPAB comes into play only if we are unable to deal with controlling 
costs. Remember, our Republican friends--I voted against it--set up the 
SGR so that we have to have a doc fix every year, putting cost control 
on automatic pilot, because they didn't have the gumption year after 
year to deal with the policy changes to make a difference.
  We have MedPAC for Medicare that gives us recommendations, but 
Congress blinks.

                              {time}  1730

  What's going to happen maybe 10 years from now, if costs are not 
under control, then there will be 15 people who are experts, who are 
recommended by congressional leaders, nominated by the President, 
confirmed by the Senate, who will make recommendations if Congress 
doesn't do its job. Then Congress will be able to take those 
recommendations and put in place alternatives. Nothing is going to 
happen here without Congress having the ability to match and do better.
  But because Congress historically hasn't had a backbone and has 
failed miserably in areas of cost control and reform, we put into the 
health care reform act a fail-safe, not unlike what we've had to do to 
take base closing out of the hands of the logrolling in Congress and 
have a streamlined procedure. This is a fail-safe. This makes sense. 
It's not going to happen unless Congress fails in its task.
  I strongly suggest that what we ought to do--rather than trying to 
unravel health care reform on this floor and in the Budget Committee--
is accelerate it.
  The Acting CHAIR (Ms. Herrera Beutler). The time of the gentleman has 
expired.
  Mr. LEVIN. I yield the gentleman an additional 2 minutes.
  Mr. BLUMENAUER. Remember, the elements in the health care reform, 
when you unwind them, virtually without exception, have their roots in 
a bipartisan consensus of what needs to happen to make our health care 
system more efficient.
  Many of these pilot projects, these demonstrations have actually 
already been at work in States across the country, including some that 
have Republican Governors. We're doing some of it in the State of 
Oregon. It has the dreaded mandate, which was a Republican think tank 
option that was an alternative to HillaryCare 20 years ago, and, in 
fact, was put in place by Governor Romney, who is going to be, by all 
accounts, the Republican standard bearer for President.
  This is an example of Congress at its worst, making up a problem, 
attacking something that would help us do our job better. They are 
trying to demonize it in a way that you could do with virtually any 
other board or commission, ignoring the safeguards, ignoring the fact 
that the statute says specifically that it shall not ration. Instead, 
they are willing to allow insurance companies to ration and ignore the 
need for reform.
  I strongly urge rejection of this misguided proposal. Let's get back 
to work. Let's do our job. It will never come into play if Congress 
does its job, and Congress will always have the last say.
  Mr. CAMP. Madam Chairman, I yield 2 minutes to a distinguished member 
of the Ways and Means Committee, the gentlewoman from Kansas (Ms. 
Jenkins).
  Ms. JENKINS. I thank the chairman for yielding.
  The President's health care law is chock full of pitfalls, tax 
increases, government overreaches, and newly created bureaucracies. But 
perhaps the most outrageous and dangerous manifestation is the 
Independent Payment Advisory Board.
  This board of 15 arbitrarily appointed bureaucrats is charged with 
slashing Medicare reimbursement rates, which will drastically impact 
the medicine and procedures available to our seniors.
  The IPAB has no mandate to improve patient care. Its mandate is to 
meet a budget, and it may ultimately lead to the rationing of care for 
our senior citizens. The IPAB gives these bureaucrats unprecedented 
power with no accountability, no judicial review, and no requirement 
for transparency. The simple fact is that the American people don't 
want and certainly don't need bureaucrats coming between us and our 
doctors.
  Today we ask for the repeal of the IPAB, but we will also make up for 
any amount of lost savings this absurd board would have been able to 
find by strengthening our health care system with honest and 
straightforward medical liability reform.
  Frivolous lawsuits have caused malpractice insurance rates to 
skyrocket. As a result, the price of health care for patients has 
followed the same trajectory, and we've seen dramatic health care 
access issues for our rural communities.
  If we repeal the IPAB and enact these commonsense medical liability 
reforms, this legislation will reduce the

[[Page H1472]]

deficit by over $45 billion, according to the CBO. These are 
commonsense, bipartisan, fiscally responsible reforms that strengthen 
the doctor-patient relationship and put the American people back in 
charge of their health care decisions.
  I urge all of my colleagues to support this.
  Mr. LEVIN. I yield 4 minutes to a member of our Ways and Means 
Committee, the gentleman from Wisconsin (Mr. Kind).
  Mr. KIND. I thank the gentleman from Michigan for yielding me this 
time.
  Madam Chair, I rise in opposition to H.R. 5.
  Two years ago, the Affordable Care Act was passed, and I was a proud 
supporter of that legislation. Not because I thought it was the perfect 
bill, but because I thought it gave us the tools and the potential to 
reform a health care system that was in desperate need of reform, of 
putting things in place that could deliver better quality of care that 
is given for a better price, and also increasing access to health 
insurance throughout the country, and to finally address the 52 million 
uninsured Americans that we have living in our own communities.
  Yet the ultimate verdict on whether health care reform works or fails 
for everyone in this country is whether we can figure out creative ways 
of bringing down those costs in health care.
  One thing I do know under the health care reform bill that has been 
enacted is that in my congressional district in western Wisconsin, this 
year alone 4,200 young adults are able to stay on their parents' health 
care plan; whereas, before they couldn't. What a relief that has been 
to those families, making sure that those kids, many of whom are in 
school, can stay on the family plan.
  Of the 5,800 seniors this year who have fallen into the doughnut 
hole, they are seeing a cost savings of roughly $610 apiece because of 
the 50 percent price discount they now get under this legislation. 
That's not peanuts in western Wisconsin. There are 86,000 seniors now 
that are able to go and get preventive care services without copays, 
without deductibles, without out-of-pocket expenses. We want them to go 
in and get those tests so something worse doesn't happen to them, which 
will inevitably drive up the cost for everyone in the Medicare system.
  There are 15,000 small businesses in western Wisconsin that now 
qualify for tax credits for providing health care to their employees to 
make it more economically feasible for them to do what they want to do, 
and that is provide health care coverage for their workers. That 35 
percent tax credit goes up to 50 percent in 2014, when we're able to 
move forward on the creation of the health insurance exchanges. And 
39,000 children in western Wisconsin who have a preexisting condition 
can no longer be denied healthcare coverage in their lives.
  This is the right thing to do, and yet we have to figure out some 
cost-containment measures to make sure that it's sustainable and 
affordable in the future.
  The Independent Payment Advisory Board is a backstop in that effort. 
It's not the first thing we go to in order to find cost savings, but if 
costs do exceed target growth rates, the Independent Payment Advisory 
Board is able to come forward--with Congress--with recommended cost 
savings that will be implemented only if Congress refuses to act 
ourselves. And that has been the problem around here for too long. We 
get recommendations from MedPAC and other entities on where we can find 
cost savings, but because of the inability of Congress to stand up to 
some powerful special interests, quite frankly, it's very difficult for 
this institution to act by itself in order to implement those cost 
savings.
  I find it a little bit humorous that my colleagues on the other side 
are so fearful of this payment advisory board making some decisions 
when it comes to the rising health care costs when they feel perfectly 
comfortable turning these decisions over to private insurance companies 
who are motivated by profit and trying to maximize their margin of gain 
by providing health care coverage. I think that's nonsensical.
  Ultimately, if health care reform is going to work, we have to change 
the way health care is delivered in this country so that it is more 
economical in how we pay for it, so that it is value- and not volume-
based anymore.
  I come from an area of the country with health care providers that 
have models of care that are highly integrated, they are very 
coordinated, they are patient-focused, and they are producing some of 
the best results in the Nation. Yet a Medicare recipient in La Crosse, 
Wisconsin, receives on average about $5,000 a year compared to $17,000 
in Miami. Yet the results in La Crosse are much better than the results 
in Miami, and there are studies out there showing there is over-
utilization in the delivery of health care, which is driving up costs 
for everyone.
  The Acting CHAIR (Ms. Herrera Beutler). The time of the gentleman has 
expired.
  Mr. LEVIN. I yield to the gentleman 2 additional minutes.

                              {time}  1740

  Mr. KIND. I thank the gentleman.
  The studies show that one out of every three health care dollars is 
going to tests, they are going to procedures, they are going to things 
that don't work. They're not improving health care. And oftentimes, 
because of the over-utilization that patients are receiving, many of 
these patients are being left worse off rather than better off. So 
we've got to reform the delivery system, which the Affordable Care Act 
puts in place. But ultimately, we have to change the way we pay for 
health care. We need to end and destroy the fee-for-service system, 
which is all volume-based payments, and move to a value-based 
reimbursement system. The IPAB commission can help us get to that 
promised land.
  And this has been a bipartisan issue for a long time. Dr. Frist has 
been talking about payment reform that's value-based for as long as I 
can remember. My own former Governor, former HHS Secretary Tommy 
Thompson, has said repeatedly that if we do anything, make sure that we 
change the payment system so it is value- and not volume-based anymore. 
Mark McClellan, President Bush's CMS Director, the same thing. So 
there's been bipartisan recognition that we have to do it. IPAB gives 
us an opportunity to do that, but it's not the final say. They merely 
come forward with their recommended cost savings and challenges the 
Congress to come up with an alternative cost savings.
  So, folks, this is gut-check time. This is whether we are serious 
about trying to bend the cost curve. Their plan would get rid of 
Medicare. It turns it into a private voucher and a voucher that's 
inadequate to address the costs that seniors face. They don't reform 
the way health care is delivered. They're not reforming how we pay for 
health care. They're merely changing who pays for health care under 
Medicare, and those costs are going to be shifted on the backs of our 
seniors. That's no way of reforming a health care system that's in need 
of reform, that only address the Medicare portion within our budget.
  What we need to be working on and what the Affordable Care Act gives 
us the tools to do is to reform the entire health care system, both 
public programs and private programs. And that's something that we 
fundamentally have to do to get our economy back on track, creating 
good-paying jobs. Because if you just repeal it now, we go back to the 
status quo, which means more uninsured, higher costs, and our 
businesses are less able to compete globally. I encourage my colleagues 
to reject H.R. 5.
  Mr. CAMP. I yield myself 15 seconds.
  I would just say that with regard to IPAB, the 15 unelected people 
appointed by the President, Congress can't simply reject the IPAB 
findings. Congress has to reject and find those savings somewhere else 
within the program, unlike the Base Closure Commission, which some 
Members have cited. And these are all people appointed by the 
President.
  So with that, I would yield 2 minutes to a distinguished member of 
the Ways and Means Committee, the gentleman from Minnesota (Mr. 
Paulsen).
  Mr. PAULSEN. I thank the gentleman for yielding.
  Madam Chair, the very foundation of our health care system is that 
relationship between a patient and their doctor. But the President's 
new health care law inserts government bureaucracy in the middle of 
that longstanding

[[Page H1473]]

relationship. One clear example of this is the establishment of the 
Independent Payment Advisory Board, this 15-member board of unelected, 
unaccountable bureaucrats who will soon have the authority to dictate 
our Nation's Medicare policy by effectively deciding what health care 
seniors can receive. And since its inception, IPAB has been the focus 
of vocal and sustained opposition from doctors, physicians, and 
patients because it does threaten to reduce beneficiaries' access to 
treatments and services that are included in the Medicare program.
  Madam Chair, the repeal of IPAB has strong bipartisan support. Given 
the widespread concern about the impact that IPAB will have to deny 
quality health care services, it's no wonder that about 350 
organizations that represent veterans, seniors, employers small and 
large, as well as doctors and physicians and consumers in all 50 
States, support its repeal. Although a majority of us here in Congress 
have registered our concerns about IPAB and support its repeal, it is 
the American public, including many folks from my community, who remain 
the most vocal about ending this program before it is implemented.
  The American people have every reason to be worried about this IPAB 
board. The unchecked powers of IPAB have been explained by my 
colleagues already at length. Simply put, IPAB is a dangerous new 
government agency that will be made up of unelected bureaucrats with no 
oversight, no accountability, and no recourse for seniors to appeal any 
of IPAB's decisions. The decision-making, the deliberations, the 
meetings that IPAB hold do not have to be held in public.
  Madam Chair, rather than endangering Medicare beneficiaries, we 
should be empowering them. Rather than making decisions behind closed 
doors, we should be having these discussions in public in our hearing 
rooms between doctors, patients, and consumers. Let's do the right 
thing and protect American seniors by repealing this overreaching 
provision.
  Mr. LEVIN. I now yield 4 minutes to the gentleman from Texas, a 
member of our committee, Mr. Doggett.
  Mr. DOGGETT. I thank the gentleman.
  Many an American family has been wrecked by soaring health care 
costs. We know it's been a leading cause of personal bankruptcy. We 
know that spiraling health care costs have been a leading cause of 
credit card debt, and now Republicans have continued their sustained 
effort to wreck the Affordable Care Act.
  As we have been witnessing at the same time that this debate is going 
on within the Budget Committee, on which I also serve, the Republican 
plan to end the guaranteed benefits of Medicare, they think that our 
seniors pay too little, so they offer a voucher plan that would result 
in our seniors having to pay much more for their health care. They 
would tell the senior or the individual with disabilities, Go out and 
fish for insurance with this voucher. But they won't find any fish 
biting, though they will continue to be bitten with rising health care 
costs. That's why President Lyndon Johnson created Medicare in the 
first place, because private insurance companies weren't interested in 
covering the old and the infirm.
  Today's approach is the same approach that Republicans took last year 
when they had their signature accomplishment. Right in the first month 
of their takeover of this Congress, they came out here with this page-
and-a-half bill that I call the ``12 platitudes.'' They repealed what 
they said they didn't like, and they came forward with 12 lines of what 
they said they would replace the Affordable Care Act with. But all 
we've gotten since then are bills that began after they did the total 
repeal--repealing individual sections, like school health care clinics, 
like this proposal dealing with the question of health care costs.
  We know they don't like it. We know they don't like President Obama 
and anything that he is for. They tell us everything that is wrong with 
the Affordable Care Act, but they sure can't come up with a better idea 
that they have the courage to bring to a vote in the Ways and Means 
Committee or bring to a vote on the floor of this House. It's all about 
what they're against, but they haven't brought any of the 12 platitudes 
that they approved last year into a legislative form to deal with this 
issue of spiraling cost for our government and families or to deal with 
any other aspect in the Affordable Care Act.
  Now, I have to say, quite frankly, that I wish the Affordable Care 
Act were as good as they think it is bad. It's not. It is a compromise 
of a compromise--it has many inadequacies--but compared to the 
Republican alternative of doing nothing and compared to the broken 
health care system that has wrecked so many American families who are 
faced with a health care crisis, this approach is far superior.
  This board's opponents tell us that Congress should be able to make 
all these decisions. Well, I've served on the Ways and Means Committee 
and on the Health Subcommittee previously for a number of years. I wish 
it could be so, and I think we could play a more constructive role. 
But, frankly, the history is that Congress hasn't done a very good job 
of controlling costs. When we have taken steps to control costs, as we 
did with the $500 billion in cost control that we put into the 
Affordable Care Act that increases the solvency, extends the solvency 
of the Medicare trust fund by 12 years, all we've gotten is attack and 
criticism from them for the steps that we took that did limit cost.
  So I don't view this aspect of the Affordable Care Act as necessarily 
the best way to do it or the only way to do it. But when all they offer 
us is nothing except vouchering Medicare for our seniors and similar, I 
think we should stick with the reform that we have until a better 
alternative is presented, and that alternative is not being presented 
tonight.
  Republicans don't have a plan to make the hard decisions to lower 
health care costs. They just want our seniors, individuals with 
disabilities, and families across America to pay more so that they can 
preserve all these tax breaks for the wealthiest and most economically 
successful people in our society and, for all of those corporations 
that export jobs abroad, to continue to provide them incentives to do 
just that.

                              {time}  1750

  I believe that this bill should be rejected just like their other 
repeal efforts until they come up and present on the floor a better 
idea, and I don't think they have one. They just have all the retreads 
of the Bush-Cheney years. Until then, I say stick with the Affordable 
Care Act.
  Mr. CAMP. I yield 2 minutes to a distinguished member of the Ways and 
Means Committee, the gentleman from Illinois (Mr. Roskam).
  Mr. ROSKAM. Mr. Chairman, thank you for yielding.
  Madam Chairman, did you notice something? The gentleman from Oregon--
and I took a note and I'm kind of paraphrasing, but he basically was 
arguing from the other side of the aisle that IPAB, this cost control 
board, will basically never come into play as long as Congress does its 
job. During the health care hearing that we had in the Ways and Means 
Committee, the gentleman from Wisconsin on the other side of the aisle 
characterized IPAB as a leap of faith, and now we just heard from the 
gentleman from Texas who acknowledged it's not the best solution, but 
let's stick with it.
  Here's the problem with sticking with this failed solution, Madam 
Chairman. They're asking seniors to bear the brunt of this.
  We had an expert witness, Madam Chairman, who came into the Ways and 
Means Committee, and I posed this question to him. I said: There's no 
rationing per se. It's defined out of the bill, although it's not 
defined in the bill. But the bill says there can't be rationing, but 
can there be per se rationing? In other words, if coverage is denied 
based on cost, is that rationing?
  And he said: Absolutely, Congressman.
  So think about what the other side of the aisle is asking. Take a 
leap of faith, a leap of blind faith, that somehow Congress is going to 
come up with the remedy and that seniors are not going to be held at 
risk.
  The gentleman from Texas said that we're only here criticizing 
things. Let me tell him, Madam Chairman, what we are for.
  We're for the repeal of IPAB. We're for the repeal of something that 
is

[[Page H1474]]

going to put such downward pressures on seniors, it will make people's 
heads spin. What we've got to do is make sure that we put remedies in 
place that empower seniors, that create patient-centered health care 
and don't deny care and put more out-of-pocket costs on the backs of 
seniors.
  We can't repeal this thing fast enough. We need to vote ``aye'' and 
get this done.
  Mr. LEVIN. It's curious. You're talking about, according to CBO, a 
board whose operation would be triggered in 2022. You come here and 
scare people. It doesn't work. You talk about rationing. You're talking 
about an operation 10 years from now.
  Right now, health care is being rationed. You have 50-plus million 
people who have no insurance, 50-plus million people who have no 
insurance at all, and you haven't come up with a bill that would 
address that.
  I am proud to yield 4 minutes to the gentleman from New Jersey (Mr. 
Andrews), who has been so key in the health care debates.
  (Mr. ANDREWS asked and was given permission to revise and extend his 
remarks.)
  Mr. ANDREWS. I thank my friend for yielding and for his compliment.
  When our mothers and fathers go to the doctor or the hospital, we 
want to be sure they get the best health care that can possibly be 
delivered and that their doctor and their family think they ought to 
get; and that health care should never be subject to the strategic plan 
of any insurance company or the whims of the marketplace.
  Because it is not profitable, as a general rule, to take care of the 
aged and the infirm, President Johnson and this Congress, in 1965, 
created the Medicare guarantee, and they guaranteed that our seniors 
and people with disability would get the care they need irrespective of 
the whims of the marketplace. The majority brings this bill to the 
floor today because they raise fears about what might happen to the 
Medicare guarantee 10 years from now.
  There is a very important question about Medicare before this 
Congress, but it's coming about 8 days from now, not 10 years from now, 
when the majority will bring yet another budget that systematically 
unravels and ends the Medicare guarantee.
  Call it what they will, when you have a system where the healthiest 
and the most prosperous and, in some cases, the youngest retirees can 
opt into a private insurance system, those that will be left in regular 
Medicare will be the aged and the infirm and the poor. Medicare will 
then go the way of Medicaid, which their budget cuts by nearly 40 
percent, according to some estimates.
  Frankly, as a diversion from the real threat to Medicare, which is 
yet another Republican budget coming to this floor 8 days from now that 
will end the Medicare guarantee, we now have a series of wild 
accusations about the Independent Payment Advisory Board, which the 
Congressional Budget Office says, based on current cost performance, 
would have no role for at least 10 years.
  So we hear all these things about these unelected bureaucrats making 
decisions. I would say, Madam Chair and fellow House Members, consider 
the source.
  Two years ago, we heard that everyone in America would be in a 
government-run health plan if the Affordable Care Act passed. It hasn't 
happened.
  Two years ago, we heard that every small business in America would be 
forced to buy unaffordable health insurance for their employees. It 
hasn't happened.
  Two years ago, we heard that every American family would have to bear 
a crushing tax increase because of the Affordable Care Act. It hasn't 
happened.
  Two years ago, we heard there would be drastic cuts in benefits to 
Medicare beneficiaries because of the Affordable Care Act. Not only has 
it not happened, benefits have increased. Seniors pay a lower share of 
their prescription drug costs and Medicare pays more. Seniors have 
access to annual preventive checkups without copays and deductibles. It 
hasn't happened.
  Finally, lest we forget, those who say the IPAB is such a virulent 
threat to Medicare and said there were death panels in the Affordable 
Care Act, where are they? Can anyone on the other side point to one 
person who has gone before a government committee and been denied 
health care since the Affordable Care Act and as a result of that act?
  The Acting CHAIR. The time of the gentleman has expired.
  Mr. LEVIN. I yield the gentleman 2 additional minutes.
  Mr. ANDREWS. It is a fiction--it is a distortion--and here we are at 
it again.
  Now, in the first 2 weeks of their majority, the majority came here 
and made a promise to the American people. They said: Yes, we're going 
to try to repeal the Affordable Care Act, but then we're going to 
replace the Affordable Care Act. It was repeal and replace.
  We've had the repeal as a recurring scenario on the floor. This is 
just another chapter in it. Where's the replace?
  For the provision that says that people 26 and under can stay on 
their parents' plans, if you repeal the Affordable Care Act, where is 
your bill to replace it?
  For the provision that says that no person can be denied health 
insurance or charged more for it if they're diabetic or if they have 
breast cancer or asthma, where is their replacement?
  For the provision that says that seniors who fall into the doughnut 
hole get significantly greater help in paying for their prescription 
drugs, where is their replacement?
  For the provision that says that small business people who 
voluntarily provide health insurance to their employees get a 
significant tax cut, where is their replacement?
  There's a saying that our friend from Texas says about being all hat 
and no horse. The majority is all repeal and no replace.
  So this is yet another example of a debate that's tired, worn out, 
and seen its day. The Affordable Care Act is helping improve the lives 
of Americans. An empty political debate like this one isn't, and 
certainly ending the Medicare guarantee, as the Republicans will try to 
do in 8 days, is the wrong way to go, and so is this bill.

                              {time}  1800

  Mr. CAMP. I yield myself 30 seconds.
  I would just say to my friend from New Jersey who says ``consider the 
source''--and the source is the American people--73 percent have 
expressed concern that the Medicare cuts recommended by IPAB would not 
only go into effect without congressional approval, but would also hurt 
their ability to get the Medicare services they need.
  Let me just say I hear from my friends on the other side how 
important IPAB is to the integrity of Medicare. It is not effective 
until 2022. And let me just say with regard to the Medicare cuts that 
are in your health care bill, most of them don't take place until 2014. 
And I would just say that our health care bill included provisions that 
covered preexisting conditions, included many of the provisions the 
gentleman mentioned, and we did it without a tax increase, and we did 
it as the only health care bill that was scored by the Congressional 
Budget Office as decreasing premiums for American citizens.
  With that, I yield 2 minutes to a distinguished member of the Ways 
and Means Committee, the gentlewoman from Tennessee (Mrs. Black).
  Mrs. BLACK. Let's, first of all, start with the simple fact that no 
one in this room can deny, and that is there are 10,000 baby boomers 
that are added to the rolls each day. Medicare's exponential growth 
will cause the program to go bankrupt in 10 years. The Congressional 
Budget Office and the Medicare and Medicaid trustees have been ringing 
these alarm bells about Medicare's dwindling finances, and we must act 
now.
  Over 46 million Americans rely on Medicare for their health care, and 
something must be done soon to save this program for future 
generations. Unfortunately, the President's budget proposal failed to 
address Medicare's grim future. Instead, what we have on the law books 
now is a 15-member board that is charged with cutting costs and denying 
care to our seniors. The Independent Payment Advisory Board established 
in the health care law would cut physician payment rates, forcing many 
doctors to stop seeing Medicare patients. This board makes senior care 
harder to access and

[[Page H1475]]

puts bureaucrats between the patients and their doctors.
  Now, it's been said here today there's not another plan. Let me 
correct that. There is another way. As a matter of fact, there is a 
bipartisan way. The plan for Medicare that is a bipartisan proposal 
does three things. It does not make any changes for those at or near 
retirement, it offers guaranteed coverage options to seniors regardless 
of their preexisting conditions or health history, and it is financed 
by a premium-support payment that's adjusted to provide additional 
financial assistance to those who are low-income and less-healthy 
seniors, and more wealthy seniors will pay.
  So the choice is clear: we can continue to stick our heads in the 
sand and go on with a program that takes away choice for our seniors, 
limits their care and supports the status quo, or we can improve a plan 
to save Medicare and provide more choice. For me, the choice is clear.
  Mr. LEVIN. Let me just say it is strange to say you save something by 
destroying it. That is 1984 in 2012.
  I now yield 2 minutes to the gentleman from New Jersey.
  (Mr. ANDREWS asked and was given permission to revise and extend his 
remarks.)
  Mr. ANDREWS. I thank my friend from Michigan for yielding, and I want 
to comment on something, Madam Chair, that my dear friend from 
Michigan, the chair of the Ways and Means Committee, said. As has 
become part of the Republican catechism, he talked about the so-called 
Medicare cuts that were in the Affordable Care Act. It is correct that 
in the Affordable Care Act we reduced Medicare spending by $495 billion 
by cutting corporate welfare to insurance companies, by cutting 
overpayments to medical equipment suppliers, and cracking down on fraud 
and abuse of the Medicare program. The majority must agree with these 
ideas because in the budget they are marking up today in the Budget 
Committee, every penny of that $495 billion in savings is included in 
the majority's budget. The majority must agree with these savings, and 
I commend them for it, because the budget resolution that passed here 
last year that essentially every member of the majority voted for 
included every penny of that $495 billion in savings.
  So I would ask my friends on the other side that if they're so in 
objection to those cuts, why did you vote for them last year? And why 
are they in your budget this year? I would be happy to yield.
  Mr. CAMP. Since the gentleman has asked, we are using those dollars 
to protect the Medicare program. You used those dollars to create a new 
entitlement which we can't afford.
  Mr. ANDREWS. Reclaiming my time.
  Mr. CAMP. Certainly you would reclaim your time.
  Mr. ANDREWS. Because the gentleman's point was there was something 
wrong with the cuts. Obviously, he would contradict that point. Every 
dollar of the cuts in the Affordable Care Act have been embraced, 
supported and voted for by the Republican majority for which you 
deserve credit.
  Mr. CAMP. I yield 2 minutes to a distinguished Member from 
Mississippi (Mr. Nunnelee).
  Mr. NUNNELEE. Madam Chair, I thank the chairman for his leadership in 
this area. I thank you for yielding.
  I find it fascinating as I listen to the debate that even while 
discussion is going on on the budget, we're hearing accusations that 
say Republicans want to end Medicare. In reality, 2 years ago when the 
national health care bill passed, that ended Medicare as we know it. 
That cut half a trillion dollars out of Medicare spending. That put in 
place this unelected group of bureaucrats that will make health care 
decisions for seniors.
  And I hear this afternoon suggestions that say, well, it may not even 
go in effect for 10 years; let's wait and see. Well, we have a saying 
in Mississippi: Do you know when is the best time to kill a snake? 
That's the first time you see it. This IPAB is a snake, and the best 
time to kill it is today. The club and the vehicle by which we'll kill 
it is this bill, and that's why I'm going to vote for it, and I urge 
all of my colleagues to do the same.
  Mr. LEVIN. It is now my privilege to yield 3 minutes to the 
distinguished gentleman from Missouri (Mr. Clay).
  Mr. CLAY. I thank the gentleman from Michigan for yielding.
  Madam Chair, my friends on the other side of the aisle want to repeal 
the Affordable Care Act. Since straight-out repeal didn't work, they 
are trying to dismantle it bit by bit. I'd like to focus on the effects 
of the ACA, or the Affordable Care Act, on women's health.
  The ACA is the greatest improvement for women's health in decades. 
The health care needs of women are greater. Historically, women have 
played a central role in coordinating health care for family members. 
Here are just some of the ways that the ACA, a bill that I am proud to 
have helped pass, will improve women's health:
  Women will not have to pay more than men for the same insurance 
policies. Imagine that. Women will not be denied coverage because they 
are sick or have preexisting conditions. Oh, that's an improvement. 
Women will be guaranteed preventive services with no deductibles or co-
pays. More low-income women will have timely access to family-planning 
services. Wow, miracle of miracles. Nursing mothers will have the right 
to a reasonable break time and a place to express breast milk at work. 
Pregnant and parenting women on Medicaid will get access to needed 
services. That would be an improvement. Senior women will save 
thousands of dollars as reform closes the Medicare prescription drug 
coverage gap. And women will be able to comparison shop when choosing 
health plans for their families. Family caregivers, who are typically 
women, will benefit from new supports that help them care for their 
loved ones while also taking care of themselves.
  Madam Chair, as a son, as a father, and as an American, I strongly 
support the ACA and its improvements to health care for everyone, 
especially women. Dismantling the act, whether through immediate 
repeal, lawsuits, or piece by piece, means losing those improvements, 
and that is unacceptable.

                              {time}  1810

  Mr. CAMP. Madam Chairman, I yield 2\1/2\ minutes to a distinguished 
member of the Ways and Means Committee, the gentleman from Washington 
State (Mr. Reichert).
  Mr. REICHERT. Madam Chair, 2 years ago, the President's massive 
health care plan came before us, and then-Speaker Pelosi said we had to 
pass this bill to find out what was in it. Well, you know what? We're 
finding out what's in this bill.
  In the last 2 years, we've had 47 committee hearings in six different 
committees. We've taken 25 floor votes to repeal, defund, or dismantle 
harmful elements of this massive $1 trillion, 2,000-page government 
takeover of our Nation's health care system. We're finding out what's 
in this bill.
  We've already repealed the 1099 requirement with bipartisan support. 
We've already repealed the CLASS Act with bipartisan support. Now we're 
awaiting the Supreme Court's decision on whether the individual mandate 
is constitutional.
  I think the public is now beginning to learn a little bit about this 
bill themselves. I think they know there is a 3.8 percent tax on small 
businesses, our job creators. There's another 2.3 percent tax on 
medical devices--wheelchairs for our seniors, hearing aids for our 
disabled folks. These are things that are in this bill. There's a 40 
percent tax on your health care plans.
  Now they keep telling us, too, that if you like your health care 
plan, you can keep it. Well, President Obama, himself, said, you know, 
there may have been some language snuck into this bill that runs 
contrary to that premise. Who do we believe here? What do we believe?
  Here we are again. One more thing to add to the list of what we're 
finding out, IPAB, the Independent Payment Advisory Board. This 
unelected board makes decisions and gives recommendations to Congress 
for cutting Medicare payments. So this panel of unelected bureaucrats 
unilaterally decides what kind of care is now available and allowable 
to our seniors, to our veterans, and to our Americans with 
disabilities--not doctors, not nurses, not anybody who has medical or 
scientific training. These are bureaucrats.
  Just what we need, more bureaucrats.

[[Page H1476]]

  If we don't vote to repeal this provision, a gang of 15 unelected 
bureaucrats will have the ability to cause cuts to Medicare payments 
without anyone else's input.
  The Acting CHAIR. The time of the gentleman has expired.
  Mr. CAMP. I yield the gentleman an additional 30 seconds.
  Mr. REICHERT. So this rationing board will threaten seniors' access 
to care in secret. There is absolutely no requirement for openness or 
transparency or for those bureaucrats to hold public meetings or 
consider input on its proposals. The IPAB, this board of bureaucrats, 
is unaccountable; it's secretive and threatens patients' care.
  Mr. LEVIN. I yield myself such time as I may consume.
  We're talking about a board whose operations trigger, according to 
CBO, 10 years from now.
  I just want to say to those who say it's unaccountable: Every one of 
their recommendations will come before the Congress of the United 
States, every single one. What's unaccountable are the statements that 
are made on this floor that are not true.
  I reserve the balance of my time.
  Mr. CAMP. Madam Chairman, I yield 2 minutes to a distinguished member 
of the Ways and Means Committee, the gentleman from Texas (Mr. Brady).
  Mr. BRADY of Texas. Madam Chairman, many Members of Congress didn't 
have the time or the choice to read this new health care law before it 
became law. After it was passed, I asked our economists of the Joint 
Economic Committee--they spent 4 months going through every page and 
provision of this new law--to show the American public just what this 
new health care takeover looked like. They went through all 2,300 pages 
of the bill, and this is what the new health care law in America looks 
like--well, actually, not completely. We could only fit one-third of 
all that new bureaucracy on one page.
  Here are the physicians, over in that corner are the patients, and in 
between are 159 new Federal agencies and bureaucrats in between you and 
your doctor.
  We can do better for the American public than this horrible health 
care law, and we're doing that today.
  Today, we're going to take on--this chart, the way it works, 
everything in dark blue is a new expansion of government; everything in 
orange, potential rationing boards; everything in green is $1 trillion 
of new tax increases or slashing cuts to Medicare. All the light blue 
provisions deal with expansion of government into the free market.
  But today, we're going to act. We're not going to wait. We're going 
to act to repeal one of the key rationing boards. This Independent 
Payment Advisory Board, you've heard today, 15 unelected bureaucrats, 
will make life-or-death decisions about treatment in the future.
  My mom is one of those Medicare seniors who I have no doubt, if this 
is not repealed, will someday see her treatments limited by these 
unelected bureaucrats. Our Democratic friends say, We're not rationing, 
because the government will not actually say ``no'' to a senior who 
needs care. They just won't reimburse the doctor or the local hospital 
or the local hospice care to take care of them.
  I don't know what you call that, but I call that rationing.
  The Acting CHAIR. The time of the gentleman has expired.
  Mr. CAMP. I yield the gentleman an additional 30 seconds.
  Mr. BRADY of Texas. I thank the chairman. I will be very brief.
  This board has unlimited power to slash even more than that, and 
Congress is virtually powerless to stop it.
  This is America. We don't allow these bureaucrats to make these life-
or-death decisions. Republicans in this House are going to repeal this 
dangerous bureaucracy, and we are, when we get a chance, replacing it 
with affordable health care for America.
  Mr. LEVIN. No. What the Republicans would do would be to send the 
decisions already there in large measure to insurance companies.
  I reserve the balance of my time.
  Mr. CAMP. Madam Chairman, I yield 2 minutes to the distinguished 
gentleman from Pennsylvania (Mr. Dent).
  Mr. DENT. Madam Chairman, the bill we're considering today, H.R. 5, 
the Protecting Access to Healthcare Act, or PATH, is about patient 
access to care, plain and simple.
  In the months leading up to the passage of the health care law and 
since the law was enacted, Congress has spent countless hours talking 
about the need to increase access to health care. The health care law 
signed nearly 2 years ago was the wrong direction for our country and 
for our citizens, and it will negatively impact access to care.
  The two issues that we're going to address here today in this 
legislation--repealing the Independent Payment Advisory Board, or IPAB, 
and enacting meaningful medical liability reforms--are key to ensuring 
that all Americans have access to quality care.
  Now, as to the first piece of this legislation, the IPAB, the 
Independent Payment Advisory Board, let's be very clear: nothing about 
these advisory rulings are advisory. Good luck to anybody; good luck if 
you try to ignore the advice of the IPAB. It's going to be more like a 
medical IRS than an advisory panel.
  Let's be clear: the very purpose of this IPAB is to save money by 
restricting access to health care for Medicare beneficiaries. It will 
achieve these savings by ratcheting down payments to providers who are 
already underpaid by Medicare. This will lead to fewer doctors who are 
willing to see Medicare beneficiaries, and, undeniably, this will lead 
to delays and denials of care.
  This board, as has been said many times, is made up of 15 unelected 
bureaucrats--and unaccountable ones at that--that will wield enormous 
power, and there are no checks and balances in place to ensure that 
authority is being used appropriately. This abdicates Congress' 
responsibility, and it threatens care for our Nation's seniors.
  Make no mistake that IPAB must be repealed. We don't need a medical 
IRS.
  The second part of this legislation is going to reform our medical 
liability system. Across our country, our medical profession has 
practiced defensive medicine out of fear of frivolous lawsuits. This 
not only drives up health care costs, but it creates serious doctor 
recruitment and retention problems, especially in the so-called ``high-
risk'' disciplines such as orthopedics, neurosurgery, emergency 
medicine, and obstetrics.
  The Acting CHAIR. The time of the gentleman has expired.
  Mr. CAMP. I yield the gentleman an additional 15 seconds.
  Mr. DENT. This medical liability crisis has had serious implications 
in my State of Pennsylvania. It's time we act on this issue.
  I live in a State where we train a lot of doctors, but we can't 
retain them and we can't recruit them. It's a very serious problem for 
us.
  It's time we pass this legislation. We'll say more about medical 
liability tomorrow in the amendment process.
  Support the legislation.
  Mr. LEVIN. I reserve the balance of my time.
  Mr. CAMP. Madam Chairman, I yield 2 minutes to a distinguished member 
of the Ways and Means Committee, the gentleman from Louisiana, Dr. 
Boustany.

                              {time}  1820

  Mr. BOUSTANY. I thank the chairman of the full committee for yielding 
time to me.
  I had a great career as a cardiac surgeon in treating thousands of 
Medicare patients in my career. And my career ended prematurely because 
of a disability.
  But I learned something a long time ago from my father, who's a 
family doctor, who went before me, who taught me about the art of 
medicine. And the most important thing he taught me, despite all the 
technology we have, is that trust in the doctor-patient relationship is 
the most important thing, the most important foundation of good health 
care, high quality health care.
  Look at this chart. What's wrong with this?
  Clearly, you could see all the bureaucratic entities. But where's the 
doctor, and where's the patient?
  The doctor is down here in the corner, and I think way off in the 
other corner are the patients. So all this stuff in the middle is what 
undermines the trust in the doctor-patient relationship.
  Now, we had Health and Human Services Secretary Kathleen Sebelius in 
front of our committee recently, and

[[Page H1477]]

we were asking about this Independent Payment Advisory Board. We asked 
the question about rationing, and what came out was, number one, 
there's no definition of rationing in the statute, so the Department 
will have to write rules. And she admitted in committee--very tacitly 
but effectively admitted--that they're not going to be able to write 
rules that can actually protect seniors from IPAB.
  Even the left-leaning Kaiser Family Foundation admits, IPAB must 
issue cuts to meet spending targets ``even if evidence of access or 
quality concerns surfaced.'' AARP warns IPAB's Medicare cuts ``could 
have a negative impact on access to care.''
  Both of those are really understatements. According to Medicare's own 
actuaries, Medicare physician payments could fall to less than half of 
projected Medicaid rates under current law.
  The Acting CHAIR. The time of the gentleman has expired.
  Mr. CAMP. I yield the gentleman an additional 15 seconds.
  Mr. BOUSTANY. We won't control costs by cutting Medicare provider 
reimbursements below the cost of providing care. And if left on the 
books, IPAB will endanger the lives of seniors and delay access to 
providers. It's very clear.
  This undermines the doctor-patient relationship. It undermines trust 
in our health care system. It undermines quality, and we will not 
control costs with IPAB. That's why we must repeal it.
  Mr. LEVIN. I yield myself 1 minute.
  The present system doesn't have enough primary care. I know from my 
own experience that there's a lack of family physicians and primary 
care physicians. The Affordable Care Act strengthens that program, will 
strengthen the relationship between the physician and the patient. And 
for anybody to come here and scare patients and seniors into thinking 
that there is some kind of a wall that will be replaced is really not 
true.
  Mr. BOUSTANY. Will the gentleman yield?
  Mr. LEVIN. I yield to the gentleman.
  Mr. BOUSTANY. We have a severe shortage of physicians in this country 
today, and it's getting worse, worse by the month and by the year. And 
as a physician who stays close to the physician community around this 
country, I am hearing all kinds of stories about physicians nearing 
retirement moving up that retirement date. We're seeing fewer people 
going to medical school. All of this is creating a major disruption in 
our health care system.
  The Acting CHAIR. The time of the gentleman has expired.
  Mr. LEVIN. I yield myself an additional 1 minute.
  Look, I respect that. But the primary fact, the basic fact is that 
the Affordable Care Act addresses this issue more effectively than has 
been addressed before. There is more money for primary care physicians, 
for family physicians. That's what we need. That's what we need.
  And to come here and raise the specter that this bill is going to 
diminish it, when its major purpose, among others, is to increase the 
availability, to have a linkage between the patient and the specialty 
care--
  Mr. BOUSTANY. Will the gentleman yield for one more point?
  Mr. LEVIN. I yield to the gentleman.
  Mr. BOUSTANY. We have a severe shortage in cardiothoracic surgeons, 
in neurosurgeons, other key specialists that are very essential for the 
care of Medicare patients, and it's getting worse. We need both primary 
care and specialty physicians to deal with this patient population. 
It's getting worse.
  The Acting CHAIR. The time of the gentleman has again expired.
  Mr. LEVIN. I yield myself an additional 30 seconds.
  Look, we need to address it, but destroying Medicare is not the way 
to address it. That's what you do. You destroy it. You destroy it when 
you say you're saving it.
  I reserve the balance of my time.
  Mr. CAMP. I yield 2 minutes to the distinguished gentleman from 
Indiana (Mr. Pence).
  (Mr. PENCE asked and was given permission to revise and extend his 
remarks.)
  Mr. PENCE. I thank the chairman for yielding.
  I rise today in support of the Protecting Access to Healthcare Act. 
This bill will take an important step forward in dismantling the 
government takeover of health care that was passed by this body some 2 
years ago.
  The PATH Act essentially would repeal the Independent Payment 
Advisory Board included in ObamaCare, and I strongly support it.
  Now, quite frankly, the IPAB that is the acronym that's been used 
often on the floor in this debate is probably something that most 
Americans are unfamiliar with. But they deserve to know that buried in 
section 3403 of ObamaCare, there's a powerful board of unelected 
bureaucrats, this so-called Independent Payment Advisory Board, whose 
sole job will be to save money by restricting access to health care for 
Medicare beneficiaries. That's the purpose of IPAB.
  IPAB is required to achieve specific savings in years where Medicare 
spending is deemed to be too high. It will lead, inexorably, to 
rationing. It will take medical decisions out of the hands of doctors 
and patients, and it will reduce patient choice, unambiguously.
  Furthermore, ObamaCare doesn't even require that IPAB do all of this 
in the public domain. There's no requirement that IPAB hold public 
meetings or hearings, consider public input on its proposal, or make 
its deliberations open to the public.
  Unaccountable Washington bureaucrats meeting behind closed doors to 
make unilateral decisions that should be made by patients and doctors 
is unacceptable, and this IPAB must be repealed.
  It was 2 years ago that we passed this government takeover of health 
care into law. It's important to note that the first act of this 
Congress in January 2011 was a full repeal of ObamaCare.
  The Acting CHAIR. The time of the gentleman has expired.
  Mr. CAMP. I yield the gentleman an additional 30 seconds.
  Mr. PENCE. I thank the gentleman.
  You'll never convince me that the Federal Government, under the 
Constitution, has the authority to order the American people to buy 
health insurance whether they want it or need it, or not. My hope is 
that in the days ahead, the Supreme Court will come to that conclusion.
  I believe we must not rest, we must not relent until we repeal 
ObamaCare, lock, stock and barrel. But, for now, let's take the path 
that is before us. Let's pass the Protecting Access to Healthcare Act, 
and let's repeal this onerous Independent Payment Advisory Board once 
and for all.
  Mr. LEVIN. I yield myself the balance of my time.
  Look, the Supreme Court will be hearing the case about the individual 
mandate next week, and I don't think we want to argue this now. We 
don't have any judges here.
  But let me say, on the individual mandate, it really is ironical that 
the more conservative, apparently, you are, the more you dislike the 
individual mandate, when the individual mandate was the central point 
within the health care reform proposal of conservatives in this country 
several decades ago. It was their central point in the eighties and in 
the nineties. And now they've reversed course and claim, I guess, what 
they proposed in the seventies and eighties was constitutional then is 
unconstitutional today. Talk about a flip-flop. That is, I think, maybe 
an unconstitutional flip-flop, but the Court will decide that.

                              {time}  1830

  Let me just say a word about cost containment and the importance of 
our addressing that and the importance of our reforming the present 
system, how we reimburse the fee-for-service system. I don't think it's 
been noticed that, in addition to IPAB, ACA has a number of provisions 
that will go into effect long before IPAB could become operational. 
Those systems are beginning to work.
  For conservatives who talk about the importance of cost containment, 
they want to repeal an act that has within it not only the seeds of 
cost containment, but the instrumentalities of it. In fact, they're 
beginning to work well enough. That's why CBO says that it's going to 
be 10 years before IPAB is triggered.
  So, those who come here who claim to be concerned about cost 
containment essentially are undermining their own position.

[[Page H1478]]

  Well, this is act one of the Republican three-act play.
  The second is to eliminate health care reform altogether, and the 
third is to take away Medicare.
  I want to close reporting the views of AARP in terms of the Ryan 
budget proposal. It says:

       It lacks balance, jeopardizes the health and economic 
     security of older Americans. A number of proposals in this 
     budget put at risk millions of individuals by prioritizing 
     budget caps and cuts over the impact on people.

  Those who talk about the cap that would essentially be within the 
structure of IPAB's operation, that proposed cut is less than in the 
Ryan budget, which would be more severe, and essentially the 
implementation would be by insurance companies who are nameless, who 
are unaccountable.
  So let me continue with another quote from the AARP:

       By creating the premium support system for Medicare 
     beneficiaries, the proposal is likely to simply increase 
     costs for beneficiaries while removing Medicare's promise of 
     secure health coverage--a guarantee the future seniors have 
     contributed to through a lifetime of hard work.
       The premium support method described in the proposal, 
     unlike private plan options that currently exist in Medicare, 
     would likely `price out' traditional Medicare as a viable 
     option, thus rendering the choice of traditional Medicare as 
     a false promise.

  So this is what I think we should do in terms of this three-act play 
of the House Republicans. That is to start by rejecting act one, this 
repeal of IPAB.
  This may be a vote, but it's not going to be an act.
  I finish with this. In a sense, you are acting because this isn't 
going to become law. You have not come up in all of these months with a 
comprehensive alternative to the Affordable Care Act. There's not been 
a comprehensive bill put forth. We haven't voted on a comprehensive 
bill in these days on the Ways and Means Committee. Instead, there has 
a piece-by-piece effort to dismantle what was health care reform to 
address a serious situation, including over 50 million people who go to 
sleep every night without health care coverage in the United States of 
America.
  We should be ashamed of that. We should be ashamed. A couple years 
ago, we acted to lift that shame off of the shoulders of all of us in 
the United States of America.
  I urge we vote ``no'' on this bill.
  I yield back the balance of my time.
  Mr. CAMP. Madam Chairman, I yield myself the balance of my time.
  Nearly 70 percent of seniors are worried that IPAB will limit their 
Medicare choices and the coverage that's available to them under 
Medicare. I think this is the most troubling part of the health care 
law that the Democrats rammed through the Congress, and that is because 
this secret rationing board is given enormous power with no 
accountability.
  The 15 unelected board members of IPAB are free to cut reimbursement 
rates for certain procedures or for services that they deem 
unnecessary. They can cut those rates so low that physicians will no 
longer be able to offer those services. That's pretty clearly the 
ability to ration.
  We have had countless physician groups warn us about the IPAB. 
They're warning us that these cuts will force them to stop seeing 
Medicare patients, and the real problem is, because TRICARE 
reimbursement rates are tied directly to Medicare, that will have 
health care for our military personnel negatively impacted by the IPAB 
as well.
  The Democrats gave IPAB blanket authority to operate in secret. There 
is no requirement that their deliberations, their reasonings for their 
conclusions must be made public. Also, the health care bill states 
directly that IPAB, and I'm quoting here, ``may accept, use, and 
dispose of gifts or donations of services or property.'' That's not a 
very subtle invitation for lobbyists and others with interests in 
issues before the Congress to impact these unelected and unaccountable 
IPAB members with cash, with gifts, with other items.
  So not only do they have enormous power that if the Congress can't 
override automatically becomes law. But they have the ability to do it 
in secret, and the legislation states directly that they can accept 
gifts and donations.
  So this is a troubling piece of ObamaCare that we need to repeal, and 
I urge my members to vote for repeal of this.
  I yield back the balance of my time.
  Mr. SMITH of Texas. Madam Chairwoman, I yield myself such time as I 
may consume.
  Madam Chairwoman, America's medical liability system is broken and in 
desperate need of reform.

                              {time}  1840

  Frivolous lawsuits drive physicians out of the practice of medicine. 
Limitless liability discourages others from high-risk medical 
specialties and substantially increases the cost of health care.
  The solutions to this crisis are both well known and time tested, but 
the President's recent health care legislation did nothing to address 
the problems in our medical liability system.
  We cannot wait any longer to fix the problem. We should pass this 
bipartisan medical liability reform legislation to cut health care 
costs, spur medical investment, create jobs, and increase access to 
health care for all Americans.
  H.R. 5, the HEALTH Act, is modeled after California's decades-old and 
highly successful health care litigation reform. According to the 
National Association of Insurance Commissioners, the rate of increase 
in medical professional liability premiums in California since 1976 has 
been nearly three times lower than the rate of increase experienced in 
other States.
  By incorporating California's time-tested reforms at the Federal 
level, the HEALTH Act saves taxpayers billions of dollars, encourages 
health care providers to maintain their practices, and reduces health 
care costs for patients. It especially helps traditionally underserved 
rural and inner-city communities and women who seek obstetrics care.
  The reforms in H.R. 5 include a $250,000 cap on noneconomic damages 
and limits on the contingency fees lawyers can charge, and it allows 
courts to require periodic payments for future damages in order to 
ensure that injured patients receive all of the damages they are 
awarded without bankrupting the defendant.
  The HEALTH Act also includes provisions that create a fair share rule 
by which damages are allocated fairly in direct proportion to fault, 
and it provides reasonable guidelines on the award of punitive damages.
  The HEALTH Act allows for the payment of 100 percent of plaintiffs' 
economic losses. These unlimited economic damages include all their 
medical costs, their lost wages, their future lost wages, 
rehabilitation costs, and any other economic out-of-pocket loss 
suffered as a result of a health care injury.
  The HEALTH Act also does not preempt any State law that otherwise 
caps damages.
  This bill is a commonsense and constitutional approach to reducing 
the cost of health care.
  Whereas, the HEALTH Act allows doctors to freely practice nationwide, 
the ObamaCare individual mandate dictates that all people buy a 
particular product, whether they want it or not.
  Unlike ObamaCare, the HEALTH Act saves the American taxpayers money. 
The Congressional Budget Office recently determined that the 
President's health care law will cost almost double its original $900 
billion price tag. Another CBO report estimates that premiums for 
medical malpractice insurance ultimately would be an average of 25 
percent to 30 percent below what they would be under current law. These 
are just a few reasons why organizations like Americans for Tax Reform 
support this legislation.
  The HEALTH Act also reduces the cost of health care as it decreases 
the waste in our system caused by defensive medicine. This practice 
occurs when doctors are forced by the threat of lawsuits to conduct 
tests and prescribe drugs that are not medically required.
  According to a Harvard University study, 40 percent of medical 
malpractice lawsuits filed in the United States lack evidence of 
medical error or any actual patient injury. That's 40 percent. Many of 
these suits amount to legalized extortion of doctors and hospitals. But 
because there are so many lawsuits, doctors are forced to conduct 
medical tests simply to avoid a lawsuit

[[Page H1479]]

in which lawyers claim not everything possible was done for the 
patient. This wasteful defensive medicine adds to our health care costs 
without improving the quality of patient care.
  In his 2011 State of the Union address, President Obama said:

       I'm willing to look at other ideas to bring down costs, 
     including one that Republicans suggested last year: medical 
     malpractice reform to rein in frivolous lawsuits.

  Let's help the President keep his word and put this legislation on 
his desk.
  Madam Chairwoman, I reserve the balance of my time.
  Mr. CONYERS. Madam Chair, I yield myself such time as I may consume.
  Ladies and gentlemen of the House, when we passed the landmark 
Affordable Care Act, some derisively termed it ``ObamaCare.'' I believe 
that some day this bill will be famous because it is named after the 
President.
  We were proud to have taken up an important step in realizing a goal 
that we've been striving for for quite a long time. But today, we're 
confronted with a leader in the House, himself a medical doctor, who is 
urging that we take a step backward and roll back our progress.
  The measure before us will repeal the Independent Payment Advisory 
Board, which would save us millions of dollars and pay for itself by 
pushing through malpractice legislation that undermines State 
sovereignty and enriches corporations that surely don't need it.
  Congress established the advisory board to slow Medicare's growth 
costs. The Independent Payment Advisory Board does not undermine our 
role in Medicare policy nor does it cut access to care. Its repeal, 
however, removes critical oversight and efficiency and paves the way 
for the majority's plans to replace guaranteed health care for seniors 
with corporate voucher systems.
  How many of us have constituencies that you could go back home and 
tell your constituents that you're going to replace this health care 
bill that is praised from one end of the country to the other, that has 
taken decades to enact, that we're now going to use vouchers for health 
care?
  When we passed President Obama's landmark Affordable Care Act, we 
were proud to have taken an important step in realizing that ideal.
  But today, the Majority takes a step backwards. They seek to roll 
back our progress. H.R. 5, the so-called ``Help Efficient, Accessible, 
Low-cost, Timely Healthcare Act,'' will repeal the Independent Payment 
Advisory Board, IPAB, which saves us millions, and pay for it by 
pushing through malpractice legislation that undermines State 
sovereignty and enriches insurance companies.
  Congress established the IPAB to slow Medicare's growth costs. The 
IPAB does not undermine our role in Medicare policy or cut access to 
care. Its repeal, however, removes critical oversight and efficiency, 
and paves the way for the Majority's plans to replace guaranteed 
healthcare for seniors with corporate voucher systems.
  Rolling back these cost-cutting measures will cost the Federal 
Government money, and so to pay for this costly repeal, the Majority 
has offered up the same tired old medical malpractice proposals they 
have been pushing for the last two decades. In fact, this is the 
fourteenth time that the full House will have considered this measure 
since 1995. It wasn't a good idea 20 years ago, and it isn't a good 
idea today.
  Rather than helping doctors and victims, the bill before us 
represents a windfall for the health care business. It pads the pockets 
of insurance companies, HMOs, and the manufacturers and distributors of 
defective medical products and pharmaceuticals. And it does so at the 
expense of innocent victims--particularly women, children, the elderly, 
and the poor.
  The malpractice liability provisions before us today would supersede 
the law in all 50 states to cap non-economic damages, cap and limit 
punitive damages, limit access to the courts for poorer victims of 
medical malpractice, shorten the statute of limitations for claims, 
eliminate protections for children, and eliminate joint and several 
liability.
  We need to cut the charades and get to the heart of the problem.
  The malpractice insurance industry is plagued by collusion, price 
fixing, and other anticompetitive activities. Yet this bill does 
nothing to respond to this problem.
  It is also clear that a legislative solution largely focused on 
limiting victims rights available under our state tort system will do 
little other than increase the incidence of medical malpractice--
already the sixth leading cause of preventable death in our nation.
  Under the proposed caps on damages, Congress would be saying to the 
American people that we don't care if you lose your ability to bear 
children, we don't care if you are forced to bear excruciating pain for 
the remainder of your life, we don't care if you are permanently 
disfigured or crippled.
  The proposed new statute of limitations takes absolutely no account 
of the fact that many injuries caused by malpractice or faulty drugs 
take years or even decades to manifest themselves and trace the root 
cause.
  The bill would allow insurance companies teetering on the verge of 
bankruptcy to delay and then completely avoid future financial 
obligations. And they would have no obligation to pay interest on 
amounts they owe their victims.
  And guess who else gets a sweetheart deal under this legislation? 
Drug companies--most of which are foreign. This bill makes drug and 
device manufacturers immune from punitive damages, so long as the FDA 
has approved their products or their products are generally considered 
``safe,'' no matter how egregious their behavior.
  The bottom line is that this legislation doesn't prevent terrible 
things from happening in hospitals. The bill's takeover of state courts 
won't help judges throw out frivolous lawsuits, and a ceiling of a 
quarter of a million dollars won't stop bad actors from looking for a 
payout.
  Instead, this legislation lifts legal and financial risk from 
hospitals, drug manufacturers, and insurance companies, and drops that 
burden onto real people, the victims of medical malpractice.
  This bill helps the powerful at the expense of the injured, the 
elderly, and the very young. It raises serious federalism concerns and 
overturns the law in all 50 states. And it huts real people with real 
injuries, blocks them from the courts and limits their rights to legal 
redress, all in the name of a dangerous, unnecessary, and unfair theory 
about malpractice liability.
  I urge my colleagues to reject this anti-patient, anti-victim 
legislation.
  Madam Chair, I reserve the balance of my time.
  Mr. SMITH of Texas. Madam Chairwoman, I yield such time as he may 
consume to the gentleman from California (Mr. Lungren), who is the 
chairman of the House Administration Committee and a senior member of 
the Judiciary Committee.
  Mr. DANIEL E. LUNGREN of California. I thank the gentleman for 
yielding.
  The idea that 15 unelected individuals on the Independent Payment 
Advisory Board have been empowered by the so-called Patient Protection 
and Affordable Care Act to ration health care for seniors--and that's 
for all seniors--is as Orwellian as these titles crafted by the 
previous Congress to divert attention from what's really being done 
here.
  Delegating such authority to a government board to make such 
decisions with such a dramatic impact on the health care alternatives 
available to Medicare recipients raises the most serious ethical 
concerns about respect for the dignity of our seniors. This is the 
unfortunate consequence of a world view which favors the notion of 
bureaucratic expertise and efficiency as a solution to the challenges 
facing our health care system today. The purpose of providing quality 
health care to our Nation's seniors is simply incompatible with the 
idea that the delivery of health care services can be achieved through 
some sort of algorithm contrived by a panel of experts.
  Rather than empowering seniors to play a more active role in their 
own health care decisions, the IPAB moves in the opposite direction by 
empowering an unaccountable government panel to make these decisions. 
In this regard, the inclusion of legislative language to repeal IPAB 
could not be better placed than with a medical liability reform bill, 
for IPAB is itself, per se, malpractice.

                              {time}  1850

  Now, H.R. 5 contains many important reforms concerning our health 
care litigation system. These health care reforms are modeled after my 
own State of California's Medical Injury Compensation Reform Act, 
better known as MICRA. This important initiative was signed into law 
over three decades ago by then- and now, again, California Governor 
Jerry Brown.
  I practiced under this law for several years. I practiced under the 
law that preceded MICRA. I did a good deal of medical malpractice 
defense in the courtroom. I appeared before juries, before judges. I 
settled cases. I had the

[[Page H1480]]

opportunity to defend doctors and hospitals. About 90 percent of the 
cases I did were on the defense side, about 10 percent on the 
plaintiff's side. I believe I had the first successful medical 
malpractice suit against an HMO in the State of California. I had an 
opportunity to view the system close up.
  And the fact of the matter is, without the MICRA reforms, the 
California medical system, the health care system would have collapsed. 
We had doctors leaving the State of California--particularly in 
specialties such as obstetrics and gynecology, neurosurgery, 
anesthesiology--moving to other States because the premiums that were 
required to be paid by our doctors had become so exorbitant that they 
either had to leave the State or no longer be able to practice 
medicine.
  Information received by our Judiciary Committee from the National 
Association of State Insurance Commissioners indicates that since 1976, 
when it was adopted, California's medical professional liability 
premiums have risen at less than half the pace of the rest of the 
country. While I would caution that MICRA must not be perceived as a 
silver bullet, it was, nonetheless, an important step forward taken by 
our State and a sound model for reform. This is, once again, evidence 
that as laboratories of democracy, our States more often than not serve 
as incubators of reform.
  At the same time, I do believe that it is important to recognize that 
the American legal system and our civil justice system, in particular, 
contains vagaries unique to each of the States which operate within the 
context of a system of federalism. In this regard, we need to be 
cautious on the Federal level in making assumptions about the impact of 
our actions. Even in California, itself, the effort to adopt a Federal 
medical liability reform statute has raised some questions about 
possible unintended consequences.
  Even though one aspect of the impetus behind H.R. 5 is to bring 
relief to medical practitioners from the trap of defensive medicine, as 
suggested by the chairman of our committee--and I do believe that is 
true--physicians are, unfortunately, expressing some concerns over some 
of the provisions contained in H.R. 5.
  Specifically, the California Medical Association, while they support 
getting rid of the board as we previously discussed, have expressed 
some opposition to the fair-share rule contained in section 4(d) of the 
HEALTH Act. They have expressed that the fair-share rule in H.R. 5 will 
preempt California's law and put full recovery by injured patients at 
risk. They inform us, ``As written, the fair share rule will 
dramatically increase the potential for physicians to face enforcement 
proceedings against their personal assets. This would force physicians 
to purchase increased medical professional liability insurance 
coverage, which will significantly increase liability premiums in 
California for physicians.''
  Secondly, the California Medical Association has expressed ``serious 
concerns with granting complete immunity from punitive damages to 
medical produce and device manufacturers, distributors, and 
suppliers.'' They state, ``We believe this will force plaintiffs to 
look only to physicians and other providers to seek relief and will 
significantly increase physician exposure and liability costs.''
  So I'm somewhat on the horns of a dilemma here. I do believe that we 
absolutely, as the physicians of the California Medical Association 
believe, ought to rid ourselves of the Independent Payment Advisory 
Board for fear that its implementation will, in fact, interfere with 
the doctor-patient relationship, interfere with the availability of 
medical care, interfere with the availability of physicians to seniors 
and others. But they have expressed some concerns that we have to give 
other States the benefit of MICRA. And I understand some of their 
concerns. I think we may be very well able to address that in further 
language.
  Although it is my intention to vote for passage of H.R. 5, my hope is 
that before it would return to us from the Senate, we would 
specifically address the concerns raised by the physicians from my 
State. The necessary repeal of IPAB is an important reform. Some of 
these others contained in the further section of the health care act 
warrant support. But I do believe we need to have some changes, and I 
would look forward to those changes in a conference report or any bill 
which is returned to the body by the Senate.
  I would like to say this, that for someone who practiced law for a 
number of years in the area of medical malpractice, with doctors and 
hospitals, and saw what a failure to limit noneconomic damages was 
doing to the availability of health care--not just the cost of health 
care, but the availability of health care in my home State--I do 
believe MICRA is a model that ought to be replicated by other States in 
the Union.
  I do believe that the facts are in. Over 30 years, we've been able to 
see that it has improved access to health care, improved the number of 
physicians, particularly in difficult specialties, and it has brought 
down the overall cost of premiums and, therefore, the cost of medical 
care in my State.
  The idea that somehow medical malpractice premiums have no effect 
either on the cost of care or the accessibility of care flies in the 
face of the experience of 30 years in my home State of California.
  Mr. CONYERS. Madam Chair, I am pleased now to yield 1 minute to the 
former Speaker of the House of Representatives, our leader, the 
gentlewoman from California, Nancy Pelosi.
  Ms. PELOSI. I thank the gentleman for yielding. I appreciate his 
leadership for helping us honor what our Founders put forth in our 
founding documents, which is life, liberty, and the pursuit of 
happiness. And that is exactly what the Affordable Care Act helps to 
guarantee: a healthier life, the liberty to pursue happiness free of 
the constraints that the lack of health care might provide to a family. 
If you want to be a photographer, a writer, an artist, a musician, you 
can do so. If you want to start a business, if you want to change jobs, 
under the Affordable Care Act, you have that liberty to pursue your 
happiness.
  So that is why I am so pleased that this week we can celebrate the 2-
year anniversary of the Affordable Care Act; and I want to mention some 
of the provisions that are in it but not before mentioning that the 
legislation on the floor today is a feeble attempt to unravel 
legislation that makes a big difference in the lives of America's 
families.
  You be the judge: if you are a family with a child with asthma, 
diabetes, is bipolar, has a preexisting medical condition, up until 
this bill, your child could be discriminated against for life of ever 
receiving affordable health insurance and, therefore, care. The full 
thrust of the law does not take place until 2014; but already, for 
months now, no child in America can be denied health coverage because 
of a preexisting condition, and soon all Americans will have that same 
protection.
  For the first time in American history, millions of American women 
and seniors have access to free preventive health services, services 
that prevent, that are better early intervention to detect a possible 
illness in a person.

                              {time}  1900

  Eighty-six million Americans have already received key preventive 
health benefits under the law, and more than 5 million seniors have 
saved over $3.2 billion in prescription drug expenses. Already, $3.2 
billion in prescription drug benefits because of provisions of the law 
that are already in effect.
  So if you're a senior and you're caught in the doughnut hole, or you 
would have been, you are already benefiting from this law. And that's 
what the Republicans are trying to take away from you, from your 
family, from your life, from your liberty, from your pursuit of 
happiness.
  The last point about seniors and prescription drugs is particularly 
important because it fits in with our consistent commitment from day 
one as authors of Medicare in the sixties, fits with our consistent 
commitment to always strengthen Medicare for American seniors, never 
weaken it. Indeed, as I mentioned, Democrats created Medicare, 
sustained Medicare, and Democrats will always protect Medicare even 
from language that is so misleading as to make one wonder.
  Republicans, on the other hand, have voted to end Medicare. End the 
Medicare guarantee. They have said that their goal for Medicare is for 
it to wither on the vine. And tonight's legislation is a part of the 
withering on the

[[Page H1481]]

vine. It's important for you to know that if you care about Medicare, 
if you depend on Medicare, this is the wither-on-the-vine scenario.
  In fact, just yesterday, the Republicans released their budget, which 
would end the Medicare guarantee and shift cost to seniors. End the 
guarantee. What does that mean? Shift cost to seniors--perhaps up to 
$6,400 for most seniors a year--and, again, let Medicare wither on the 
vine. That's why today's legislation is such a cynical political ploy. 
And I know that American seniors will not be fooled by it.
  Today brought legislation to repeal what is known as IPAB, the 
Independent Payment Advisory Board. Independent. Independent of 
political influence over decisions that are made. This piece of the 
legislation was a bend-the-curve to reduce the cost of health care in 
America.
  Republicans are desperate to distract seniors from their real record 
on Medicare, and that's what they're trying to do today. I say that 
without any fear of contradiction and without any hesitation because 
nothing less is at stake than the well-being of our seniors, their 
personal health, and their economic health. And that means their 
security.
  Further, in this bill Republicans have recycled their old medical 
malpractice liability legislation that undermines states' rights and 
hurts the rights of injured patients to obtain just compensation.
  Because of the impact on American States of what they're trying to do 
in this bill, the bipartisan National Conference of State Legislatures 
has strongly opposed this bill. That bipartisan group says that after a 
careful review it had reached ``the resounding bipartisan conclusion 
that Federal medical malpractice legislation is unnecessary.''
  Again, Madam Speaker, this week we celebrate the 2-year anniversary 
of the Affordable Care Act for what it embodies. It's about innovation. 
It's about not just health care in America but a healthier America. 
It's about prevention and innovation. It's about customized, 
personalized care. It's about electronic medical records. It's about 
lowering costs, expanding access, and improving quality.
  So much misleading information is put out there about it that it's 
important to keep repeating the difference, the transformative nature 
of the legislation. In fact, it has already begun to transform the 
lives of America's children by saying no longer will they be denied 
coverage because they have a preexisting medical condition. And soon we 
can fully say that no longer being a woman is a preexisting medical 
condition, where women are discriminated against to the tune of a 
billion dollars a year, and cost of premiums, not to mention exclusion 
from obtaining coverage.
  And so I proudly celebrate the 2-year anniversary, and I emphatically 
oppose the legislation on the floor. If you want to unravel Medicare, 
vote ``aye.'' If you want to support Medicare, if you think health care 
is a right for the many, not just a privilege for the few, vote ``no.''
  Mr. SMITH of Texas. I yield myself such time as I may consume.
  Mr. Chairman, most Americans still oppose ObamaCare yet support 
medical liability reform of the kind that we are considering tonight. A 
recent survey found that 83 percent of Americans believe that reforming 
the legal system needs to be part of any health care reform plan.
  As the Associated Press recently reported, most Americans want 
Congress to deal with malpractice lawsuits driving up the cost of 
medical care, says an Associated Press poll. Yet Democrats are 
reluctant to press forward on an issue that would upset a valuable 
political constituency--trial lawyers--even if President Barack Obama 
says he's open to changes.
  The AP poll found that support for limits on malpractice lawsuits 
cuts across political lines, with 58 percent of independents and 61 
percent of Republicans in favor. Democrats were more divided. But 
still, 47 percent said they favor making it harder to sue while 37 
percent are opposed. The survey was conducted by Stanford University 
with the nonprofit Robert Wood Johnson Foundation. In the poll, 59 
percent said they thought at least half the tests doctors order are 
unnecessary--ordered only because of fear of lawsuits.
  In a poll done by the Health Coalition on Liability and Access in 
October, 2009, 69 percent of Americans said they wanted medical 
liability reform included in health care reform legislation. Seventy-
two percent said their access to quality medical care is at risk 
because lawsuit abuse forces good doctors out of the practice of 
medicine.
  Mr. Chairman, let's support a bill that is so strongly endorsed by 
the American people.
  I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I am pleased to yield such time as he may 
consume to a member of the House Judiciary Committee, Jerrold Nadler, 
who has worked on this subject matter for quite a long time.
  Mr. NADLER. I thank the gentleman for yielding, and I rise in 
opposition to this deeply flawed and deceptively named legislation.
  Contrary to the bill's title, this bill will not promote access to 
better health care nor will it make health care more affordable. If the 
wishes of many of the proponents of this legislation come true and the 
Affordable Care Act is repealed and Medicare and Medicaid as we know 
them are curtailed or eliminated, then decent, affordable health care 
will remain out of reach for millions of Americans, including many who 
now have access to health care services.
  I urge all Members to keep one fact in mind as we debate the medical 
malpractice aspects of this bill. These provisions would apply only to 
people who had meritorious claims of malpractice against them. You 
don't have to limit people's recoveries or attorneys fees for people 
without meritorious claims. So whatever we're doing here today will be 
done only to those who have been injured, whose injuries have been 
inflicted by someone else's wrongdoing, and who need and should be 
entitled to compensation.
  The argument we hear, which is not a new one, is that if we allow the 
players in the health care industry, including Big Pharma, the 
manufacturers of defective medical devices, and even big insurance 
companies and HMOs that routinely pay for health care services, to 
escape the consequences of the harm they inflict, then somehow we'll 
all be better off.

                              {time}  1910

  This is not true, has never been true, and, despite the extravagant 
claims of the proponents of this bill and the industries lobbying for 
it, that will not be true if this multibillion dollar gift to bad 
actors in the health care industry were to become law.
  Just how pricey a gift to industry are we talking about here? 
According to the Congressional Budget Office, $45.5 billion over the 
next decade. Now, anyone who believes that those savings will be passed 
along directly to consumers, health care providers, and victims of 
medical malpractice is living in a dream world. Some of us will 
remember the debates we had in this House for the 8 years preceding 
enactment of the 2005 Bankruptcy Code rewrite. We will no doubt 
remember the argument that abuse of the bankruptcy system was a hidden 
tax of $400 a year for every American and that tightening the rules 
would be of interest to all consumers. Well, we passed that huge 
giveaway to the big banks. Consumers have not seen a nickel of that 
$400. The banks pocketed all the money. If you think that this bill 
will lower costs for consumers, that the big insurance companies will 
not simply pocket the money, there's a famous bridge in my district 
that I might be willing to sell to you.
  So keep in mind just who will be bearing the burden of this 
legislation: people who are subject to limitations on damages and on 
their ability to obtain competent counsel--something not imposed on 
insurance companies, drug companies, or HMOs. That may be good for the 
insurance companies, for the manufacturers of defective drugs and 
medical devices and all the other wrongdoers walking these Halls with 
open checkbooks, but it will come at the expense of their victims.
  Nowhere does CBO, or their sponsors, explain why their belief that 
insurance companies, Big Pharma and medical device manufacturers will 
pass any savings along, nor do they account for the cost of the care 
needed by people who have been injured and who will be unable to 
receive adequate compensation.

[[Page H1482]]

  This bill is not limited to suits against individual health care 
service providers, doctors and other licensed health care 
professionals. It would provide protection against malpractice claims 
for large corporations, insurance companies, health maintenance 
organizations, and pharmaceutical giants when they deal in defective 
products or when someone else's health is destroyed because an 
insurance company refused to pay for necessary care.
  Mr. Chairman, we heard the gentleman from California refer to the 
California legislation that is the model for this legislation passed in 
1976, 36 years ago. That legislation enacted a limit and said for 
noneconomic damages you can only get a recovery of $250,000 because you 
lost a leg when they removed the wrong leg. They felt in 1976 that 
$250,000 was an appropriate amount to limit it to. In today's dollars, 
that's $38,000.
  But there's no inflator in that legislation, and there's no inflator 
in this legislation. That $250,000 in 1976 today is $1.4 million. So if 
we were modeling this on that, we should say the limit is $1.4 million, 
but we're not doing that. We're saying 250, and we're not putting an 
inflation adjustment in here, so it will be $250,000 this year, and 5 
years from now it will be the equivalent of $100,000, and 10 years from 
now $35,000 and eventually zero.
  I submit that it is very wrong. It may be that if malpractice causes 
a woman to lose her fertility, causes her to lose the ability to bear 
children, the medical costs to her may be minor, the lost wages, the 
economic damages may be minor. But the inability to bear a child should 
be limited to $250,000 and eventually to almost nothing because there's 
no inflation in this? If someone is put in a wheelchair for life, the 
pain and suffering is worth almost nothing? That's what is wrong with 
this legislation, and that's what's immoral about this legislation. 
That's why we ought to vote against this legislation.
  Mr. SMITH of Texas. Mr. Chairman, I yield 5 minutes to the gentleman 
from Illinois (Mr. Johnson).
  Mr. JOHNSON of Illinois. Mr. Chairman and Members of the House, first 
of all, let me thank the chairman for his willingness to allow me to 
speak on an issue on which we do not agree. I appreciate the courtesy; 
I appreciate the lively debate that has preceded me in, I think, 
probably a far more articulate way than I'm going to be able to 
articulate. But let me just, Mr. Chairman and Members of the House, 
address this in a bigger sense and then maybe in a specific sense from 
the standpoint of a Republican Member of the United States Congress.
  To begin with, I believe that this addition is largely unrelated and 
almost entirely disconnected from the underlying bill. I believe it 
demonstrates some concern--or I believe it reveals some lack of 
concern--for sensitivity, and I think in a lot of ways reveals the 
duplicitousness that I think is inherent in a discussion of this issue. 
I think it is statist and antithetical to our beliefs, at least my 
beliefs and I think most of the Members' on this side of the aisle, 
with respect to what America is all about.
  I look at this from the standpoint of a Republican Member in a 
Republican Party who has been a forerunner and who has dealt with the 
issue of states' rights and, quite frankly, has attacked this health 
care bill--and the Attorneys General--on a states' rights and 
interstate commerce basis. It is a classic example, Mr. Chairman and 
Members of the House, of what has historically been an area for states' 
rights. Whether it's the criminal justice or domestic law or civil 
justice, our Founding Fathers set in place a Federal level and a State 
level of government, and this strikes at the core of states' rights.
  In addition to that, Mr. Chairman and Members of the House, 
separation of powers. We have been critical--and I think legitimately--
from this side of the aisle with respect to HHS waivers that have been 
granted. We've been critical of the EPA and the U.S. DOT and so forth 
for their administration and their promulgation of rules without 
legislative authorization. And yet this entirely desecrates, in some 
ways, our whole judicial function, our whole judicial function 
regarding liability and damages. It is an intrusion into the judicial 
arena, which is something that is sacrosanct, and I think that's 
essential to our viewpoint of what the Constitution is all about.
  It also strikes at the core of our free market system. I have been 
involved from a number of standpoints in the law practice; and I see a 
system that, in an overwhelming number of cases, works to effect 
justice. Two attorneys or more, witnesses, jurors, a judge, and the 
common law of 200 or 250 years almost inevitably results in just 
results. And now we have a situation, despite that commitment to free 
market that we have, where we're now proposing that the Federal 
Government dictate an imprimatur to override this whole system that's 
already in place and I think infringes on our constitutional right to a 
trial by jury.
  It also strikes, I think, Mr. Chairman and Members of the House, what 
we Republicans say we believe in in terms of individual worth. One of 
our attacks, quite frankly, on the passage of this bill, which I 
largely subscribe to the attacks, is one that deals with the deep 
personalization of the individual inherent in President Obama's health 
care approach. This bill is a collectivist attack on personal realities 
and is a disregard for age, circumstances, State or community of 
residence; and I think that addresses in a very serious way the concept 
that we have constitutional worth of the individual.
  In conclusion, this bill has essentially nothing to do with revenue 
production. We all know that. It obfuscates the underlying purpose of 
the bill, which is, quite frankly, to dismantle the inherent 
bureaucracy in the health care bill, which I largely subscribe to. It 
injects politics into a legitimate debate on a substantive public 
policy and prevents Republican and Democrat Members from an up-or-down 
vote and strikes, I think, at our fundamental beliefs of states' 
rights, of individualism and on constitutional premise.
  In summary, I believe that a ``no'' vote is a vote to preserve 
individual dignity. Our ``no'' vote is one to maintain constitutional 
values, and it is to safeguard states' rights and the separation of 
powers. I know this is well intended, but this is not the vehicle to do 
it in. The vehicle is Austin, Texas, or Albany, New York, or 
Springfield, Illinois. I have some serious concerns about State 
legislation that would also interfere with separation of powers, but 
this is not the arena to do it in; it is not the bill to do it in; and 
I think, quite frankly, it is one that, unfortunately for me, strikes 
at the core of why I'm here. I'm not here to dismantle our common law 
system; I'm not here to dismantle the free market system; and I'm not 
here to dismantle states' rights. I'm here to stand up for what I think 
the American people sent us here for.
  I don't think the health care bill was well considered. I think it 
should be substantially addressed in terms of this and other 
legislation. But this bill doesn't do it, ladies and gentlemen; and I, 
with all due respect, ask my colleagues on both sides of the aisle to 
join with me in a ``no'' vote on what I think may be a well intended, 
but certainly misdirected, effort. And I join with my colleagues over 
here and some over here in urging a ``no'' vote.
  Mr. CONYERS. Mr. Chairman, I ask if the distinguished gentleman from 
Illinois (Mr. Johnson) would like additional time. If he requires any, 
I would be glad to arrange to yield him further time.
  If you require more time, I would be delighted to yield it to you.
  Mr. JOHNSON of Illinois. You are very kind to do that, Mr. Conyers.

                              {time}  1920

  I think I probably pretty well addressed it. I think between myself 
and my inarticulate comments and your opposition and some opposition 
over here, I think the debate has been very good and good for the 
process. And this is one I'm with you on, sir.
  Mr. CONYERS. I thank you, Mr. Johnson.
  Mr. Chairman, I am pleased now to yield 4 minutes to the Judiciary 
Committee member from Florida (Mr. Deutch), who has worked very 
carefully with us on this subject matter.
  Mr. DEUTCH. Mr. Chairman, it's no surprise that I am disappointed 
with the content of this bill before us today. I join with my 
colleagues who have expressed their disappointment, but I'm also 
disappointed with the process behind it.

[[Page H1483]]

  Yesterday, for a totally bogus reason, the Rules Committee declared 
an amendment I offered out of order. They claimed it would add to the 
cost of the bill despite having no numbers. The amendment did not 
create some new regulation. It did not create new judicial proceedings. 
It did not set aside money for a new program.
  Let me tell you what it did do, Mr. Chairman. It would have made a 
terrible bill slightly better. It's simple.
  My amendment ensured that doctors who intentionally--not 
accidentally, but intentionally--harm their patients are not exempt 
from medical malpractice liability. If this Congress wishes to tell a 
child made blind by the negligence of his doctor that those in this 
Chamber know better than a jury, if my colleagues wish to pretend that 
the Seventh Amendment of the United States Constitution, guaranteeing a 
trial by jury, was somehow omitted from the Bill of Rights, I disagree, 
but so be it. The very least we can do is ensure that if a doctor 
intentionally abuses his patients that he will not evade justice.
  Surely, the sponsors of this bill did not intend to extend liability 
caps to a pediatrician who sexually abused a child or a dentist who 
raped his patients under sedation. I'm disgusted to say that those are 
both real examples of the kind of abhorrent behavior H.R. 5 may 
mistakenly immunize without clarification.
  Is it too much to ask that we simply think this through? Can someone 
explain to me how this amendment costs a penny? Better yet, will 
someone explain to the 103 children who were molested by a Delaware 
pediatrician that Washington wants to make it easier for sexual 
predators to evade justice?
  My friends, differentiating between medical errors and intentional 
harm is not some wild and crazy new idea being pedaled by the left. 
Many States--blue States, red States, and in between--limit malpractice 
awards but make distinctions for intentional torts.
  The majority could have considered my small change and protected the 
commonsense State laws that are already on the books. Instead, under 
the 112th Congress, relentless partisanship has poisoned this well and 
impeded our ability to write good laws. Perhaps, Mr. Chairman, perhaps 
the reason Americans are so disenchanted with Congress is because they 
know that it doesn't have to be this way.
  I urge my colleagues to vote ``no'' on this legislation.
  Mr. SMITH of Texas. Mr. Chairman, I yield myself such time as I may 
consume.
  Mr. Chairman, lawsuit abuse drives doctors out of their practices. 
There's a well-documented record of doctors leaving the practice of 
medicine and of hospitals shutting down, particularly practices that 
have high liability exposure. This problem has been particularly acute 
in the fields of OB/GYN and trauma care as well as in rural areas.
  The absence of doctors in vital practice areas is, at best, an 
inconvenience; at worst, it can have deadly consequences. Hundreds or 
even thousands of patients may die annually due to a lack of doctors.
  According to one State study, 38 percent of physicians have reduced 
the number of higher-risk procedures they provide, and 28 percent have 
reduced the number of higher-risk patients they serve, all out of fear 
of liability.
  The American College of Obstetricians and Gynecologists has concluded 
that:

       The current legal environment continues to deprive women of 
     all ages, especially pregnant women, of their most educated 
     and experienced women's health care providers.

  A study from Northwestern University School of Medicine polled 
residents and found that many wished to leave the State to avoid its 
hostile malpractice environment. The study concluded that:

       Approximately one-half of graduating Illinois residents and 
     fellows are leaving the State to practice. The medical 
     malpractice liability environment is a major consideration 
     for those that plan to leave Illinois to practice.

  Without a uniform law to control health care costs, many States will 
continue to suffer under doctor shortages.
  Mr. Chairman, I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I am pleased now to yield as much time as 
he may consume to the distinguished gentleman from Georgia (Mr. 
Johnson), a member of the House Judiciary Committee.
  Mr. JOHNSON of Georgia. Today, Mr. Chairman, I rise in opposition to 
this harmful bill, H.R. 5, the so-called Protecting Access to 
Healthcare Act.
  Now, this bill is premised upon what I would call a story, because 
that's what my mamma used to tell me. My mamma and my grandmamma, as I 
was growing up, used to say that's wrong to say that someone is lying. 
Don't say that. You say that they're telling a story. So I grew up 
plagued with the guilt that comes from calling somebody a liar. I still 
have that sense of shame associated with that word ``liar.''
  I'm not here to accuse anybody of lying, but I will say that H.R. 5, 
the so-called Protecting Access to Healthcare Act, is a story, is 
premised on the story that runaway frivolous lawsuits, medical 
malpractice lawsuits are a major cause of driving the cost of medical 
care through the roof. That's not true.
  This bill restricts a patient's ability to recover compensation for 
damages caused by medical negligence, defective products, and 
irresponsible insurance companies. It also sets a cap of $250,000 for 
noneconomic compensatory damages which are awarded to victims for 
emotional pain and suffering, physical impairment and disfigurement.
  I'm so sorry to have not had this photograph blown up. It's a photo 
of Caroline Palmer of Marietta, Georgia. Ms. Palmer was in an 
automobile accident back on March 23, 2007. She sustained two broken 
legs, a broken shoulder, abrasions on her arms, and a collapsed lung. 
While she was at the hospital, recuperating, they noticed that her left 
hand was swollen, dusky blue, and cool to the touch. But after so 
noting on her medical record, the doctor left work that day, and no 
further action was taken about that. That was a clear sign that blood 
was not flowing to that limb and that something was wrong.

                              {time}  1930

  Nothing was done. No followup. The next day they found that the IV 
line had been misplaced in her arm, and they referred her in for some 
treatments to try to reinvigorate the circulation in that arm, and 
there was nothing they could do.
  They tried everything. They even subjected Caroline to a procedure on 
both arms to relieve the pressure and treat the loss of circulation by 
producing a large gaping hole in both arms, and that procedure failed. 
Whereupon, she then was subjected to the cutting off of her left arm 
and the cutting off of her right arm.
  Now, we've talked a lot about, well, how much is a leg worth? How 
much is a leg worth when you lose a leg? Well, how much are two legs 
worth? How much are two arms worth?
  This picture shows Caroline Palmer in this horrendous state; and 
under this amendment, under this bill, H.R. 5, this woman, this victim, 
would be limited to $250,000 for her pain and suffering and 
disfigurement, and that's not right.
  How do you put a cap on someone's pain and suffering? How heartless 
is it to cap noneconomic damages when one has lost a limb? becomes 
blind?
  How much is vision worth? How much is the ability to see? How much is 
that worth? $250,000, under this legislation.
  If you become paralyzed at the hands of a negligent health care 
provider, can no longer walk, how much is that worth? $250,000.
  These caps hurt the most vulnerable among us: children, senior 
citizens, and working poor. They can't even recover for economic losses 
such as lost wages. They may not be working. A child doesn't work. A 
child left with no arms is limited in noneconomic damages to $250,000. 
He's got to roll with that for the rest of his life--$250,000. It's not 
right.
  Medical malpractice is about real people with real injuries. The 
Institute of Medicine estimates that 98,000 people die each year in the 
United States from preventable medical errors. Tort reform proposals, 
such as H.R. 5, fail to address the deaths and injuries associated with 
preventable medical errors every year.
  Now, this, H.R. 5, is an unholy alliance between two stories: the one 
story which I just outlined to you and the

[[Page H1484]]

other story being the repeal of the 15-person Independent Payment 
Advisory Board, also known as IPAB, which was created under RomneyCare. 
Oops, I mean ObamaCare. Oops, I mean, the Affordable Care Act.
  Now, while I do believe that there are some good reasons to be 
opposed to the IPAB and to vote to abolish it--I believe there are some 
good reasons for that--the rationing of medical care is not one of 
them. Anyone who says that this IPAB board has the power to cut the 
benefits paid to Medicare recipients has either not read the bill or is 
telling you a story.
  Just for the record, I want to read 42 U.S.C. section G, 1395kkk. I'm 
not going to comment on the kkk right now, but that's the subsection of 
the subsection of 42 U.S.C. where the law that was passed, RomneyCare--
I mean ObamaCare, I mean Affordable Health Care Act--is stated, the 
law, 42 U.S.C., and it says:

       The proposal shall not include any recommendation to ration 
     health care, raise revenues or Medicare beneficiary premiums 
     under section 1818, 1818A, or 1839, increase Medicare 
     beneficiary cost-sharing (including deductibles, coinsurance, 
     and copayments), or otherwise restrict benefits or modify 
     eligibility criteria.

  That is what ObamaCare, RomneyCare--I mean the Affordable Health Care 
Act--provides for. That's the law. Anybody who tells you otherwise is 
telling you a story.
  Going back to the first story, I really oppose it for the reasons 
that I've previously stated. This bill is another example of the 
Republican majority bringing a partisan bill to the House floor that 
has virtually no chance of becoming a law. H.R. 5 does not create any 
jobs or grow the economy. It's a slap in the face, also, of states' 
rights--something we've heard--that the other side has depended on for 
a long time, states' rights, the 10th Amendment.
  H.R. 5, ladies and gentlemen, denies States their right to have their 
own tort laws. The State of Georgia, for instance, in its constitution, 
says that all citizens are entitled to a jury trial. The legislature 
imposed a $350,000 cap on noneconomic damages in medical malpractice 
and other cases. The case went up to the Georgia Supreme Court, which 
ruled that to limit noneconomic damages deprives one of their 
constitutional right to a jury trial. This bill, H.R. 5, would do away 
with what the Georgia Supreme Court has ruled insofar as Georgia law is 
concerned. It's a gross overstepping of Federal legislation into the 
affairs of the State, and I oppose it.
  I understand that there was a meeting yesterday, a specially called 
meeting that Majority Leader Eric Cantor called of the Tea Party 
Republican Caucus to kind of tighten some screws and twist some arms to 
get the caucus to go along with H.R. 5 so that no one would get 
embarrassed. Now, we've yet to see what will happen, but I believe that 
all of the Tea Party Republicans will fall into line and vote in favor 
of H.R. 5, which has absolutely no chance of passing once it goes to 
the other body.

                              {time}  1940

  I want to thank the ranking member of the Judiciary Committee, John 
Conyers, for giving me this time.
  Mr. SMITH of Texas. Mr. Chairman, I am pleased to yield such time as 
he may require to the gentleman from Georgia, Dr. Gingrey, who happens 
to be the sponsor of the legislation we're considering tonight, the 
HEALTH Act.
  Mr. GINGREY of Georgia. Mr. Chairman, I thank the chairman of the 
Judiciary Committee for yielding to me and the opportunity to follow 
directly my colleague from Georgia on the other side of the aisle.
  A number of things were said. I feel grateful to have the opportunity 
to address those.
  One of the comments that the gentleman made, the gentleman is my good 
friend, and he would agree with that. But in regard to this emergency 
caucus meeting with the Tea Party Caucus on the Republican side with 
our majority leader, Eric Cantor, I am an original member of the Tea 
Party Caucus in the House of Representatives. If there had been any 
emergency-called meeting, Mr. Chairman, I can assure you that I would 
have been right there with Michele Bachmann and Steve King and others, 
the 20 of us that were original members of the House GOP Tea Party 
Caucus. There was no such meeting.
  Let me refute that statement, although I greatly respect my friend 
from Georgia, from DeKalb.
  Mr. JOHNSON of Georgia. Will the gentleman yield?
  Mr. GINGREY of Georgia. I will be glad to yield to my friend.
  Mr. JOHNSON of Georgia. I certainly don't want to misstate what 
actually happened, and I think I said that it's my understanding that 
that meeting was held. That's the information that I received.
  Mr. GINGREY of Georgia. Reclaiming my time, and he did say that. He 
said it was his understanding. He didn't say it was a matter of fact. I 
appreciate that comment.
  But another thing, Mr. Chairman, that I want to address, he named 
names. I think the lady's name was Ms. Palmer of Marietta, Georgia. I 
live in Marietta, Georgia, and have for the last 36 years. I represent 
Marietta, Georgia, in the 11th Congressional District and have for the 
last 9\1/2\ years.
  The description of this unfortunate soul's injuries and the things 
that happened to her, the broken bones, the collapsed lung, the lack of 
blood flow to the extremities because of an improper placement of an 
intravenous line, maybe instead of in a vein in an artery, that 
resulted in amputations of her upper extremities. When the general 
public hears stuff like that, Mr. Chairman, they're horrified.
  To think that we on this side of the aisle with H.R. 5, the HEALTH 
Act, which is part of the PATH Act that we are discussing on the floor 
today, to suggest that a person that suffers like that could only 
recover $250,000 in non-compensatory pain and suffering is absolutely 
untrue.
  The gentleman, my friend from DeKalb, is an attorney. He knows the 
legal system. He's been in the courtroom. I'm not sure whether he's 
tried on the side of the plaintiff or the defense in regard to medical 
malpractice cases, but he clearly knows the difference in noneconomic 
pain and suffering in regard to this particular bill, and, on the other 
hand, recovery for severe losses, medical compensation, loss of wages, 
loss of extremities, what this poor soul suffered.
  Let me just read, Mr. Chairman, this comment: Nothing in the HEALTH 
Act denies injured plaintiffs the ability to obtain adequate redress, 
including compensation for 100 percent of their economic loss. 
Essentially, anything to which a receipt can be attached. Believe me, 
the plaintiff's attorney will attach every receipt, including the 
medical costs, the cost of pain relief medication, their loss of wages, 
their future lost wages, rehabilitation costs, and any other economic 
out-of-pocket loss suffered as a result of a health care injury.
  Economic damages include anything whose value can be quantified, 
including lost wages, home services, au pair, companion to go shopping, 
medical costs, rehabilitation of a home, access for someone who has an 
incapacity, an inability to access a normal home.
  So, the gentleman, just like the gentleman from Iowa, the plaintiff's 
attorney that spoke on the floor earlier in regard to misleading 
statements, to suggest that in this legislation we would take away the 
ability of a person like Ms. Palmer of Marietta, Georgia, for a full 
and complete redress of grievances if a medical practitioner or a 
facility has performed below the standard of care for that local 
community--my colleague, the chairman of the Judiciary Committee, the 
distinguished chairman, gave me some statistics in regard to some of 
the economic losses that people have incurred and judgments that have 
been awarded by a jury of their peers.
  Listen to this, Mr. Chairman. In August of 2010, Contra Costa County, 
a judgment for $5,500,000. These are California cases, by the way, Mr. 
Chairman. It's California law that H.R. 5 is based on. MICRA passed 
back in 1975.
  But these are cases in 2010. This one in February 2010, Riverside 
County, $16,500,000; November, 2009, Los Angeles County, $5 million; 
October, 2009, Sacramento County, $5,750,000. I will go down to the 
last one, although there are several others on the list. July, 2007, 
Los Angeles County, an award of $96,400,000. This, Mr. Chairman, is in 
2007. MICRA was passed in 1975.

[[Page H1485]]

  This case in 2007, this plaintiff may have been awarded $250,000 
noneconomic because there was a cap. But the cap is there not to deny 
them their day in court, their ability to be judged by a jury of their 
peers and a decision made in regard to just compensation.
  There are 21 members of the House GOP Doctors Caucus. It includes 16 
physicians, a psychologist, several dentists, several registered 
nurses. I'll guarantee you, Mr. Chairman, in every one of these cases I 
mentioned coming out of California, we would be sitting there fighting 
for those plaintiffs. Maybe even a witness for the plaintiff, for Mrs. 
Palmer, to say the sky is the limit, and, Mr. Plaintiff's Attorney, you 
tack on every economic cost that you can dream up, and we'll vote in 
favor of it.
  But what we are opposed to, Mr. Chairman, is this opportunity for 
people to come in to court and clog up the court system and crowd out 
Mrs. Palmer and maybe many of these cases from California with 
frivolous lawsuits where there is no justification for the claim, where 
people are just hoping with a lottery mentality that some sympathetic 
jury will just simply say, Oh, gosh, we know there's no damage here. 
But after all, the doctor has $10 million worth of insurance. It's not 
coming out of his pocket. Let's award the plaintiff $6 million or $8 
million worth of noneconomic pain and suffering--if you want to call it 
that--in damages.

                              {time}  1950

  That's the thing that's got to stop. That's what's causing the price 
of health care to rise astronomically. That's why doctors are ordering 
all of these unnecessary tests and practicing defensive medicine. Every 
time a patient comes to the emergency room with a headache, even though 
the doctor is skilled in physical diagnosis, in taking a history, and 
can examine that patient and look in their eyes, making sure there is 
no bulge of the pupils or the optic discs, they know that patient has a 
tension headache. They know it's perfectly safe to send him or her home 
with a prescription to return in 24 hours. But, no, because of these 
frivolous lawsuits, they're going to order a CAT scan that costs 
$1,500. You multiple that time and time and time again, that's what 
this is all about. That's the problem we're trying to solve.
  For my friend from DeKalb--and he is my great friend--or my friend 
from Iowa or, indeed, the former Speaker, the minority leader, Ms. 
Pelosi, to come to the floor and very eloquently--and she is eloquent 
and speaks with a lot of passion, great ability, a great communicator--
but to mislead is downright wrong.
  The truth needs no adjectives, Mr. Chairman. The truth is what is in 
the PATH Act, H.R. 5. And I say to my colleagues: We need to pass this 
and do this in a bipartisan way and not worry here about what's going 
to happen in the Senate. Let's do the right thing in the House of 
Representatives, and let's do the people's work.
  Mr. CONYERS. Mr. Chairman, I yield myself 1 minute to ask my friend 
and distinguished medical practicer and Member of Congress, Mr. 
Gingrey, is he aware that his bill, H.R. 5, eliminates joint and 
several liability for both economic and noneconomic damages?
  I yield to the gentleman for that purpose.
  Mr. GINGREY of Georgia. I thank the gentleman for yielding. This is 
his time, and I appreciate him yielding. It gives me an opportunity to 
explain in regard to joint and several liability.
  Mr. Chairman, it's important for our colleagues on the House floor 
and anyone within shouting distance to understand what we're talking 
about in regard to joint and several liability.
  Under current law, anyone who is named as a defendant in a medical 
malpractice suit is liable for whatever judgment is rendered. It 
matters not how much they participate in the case.
  Let me give my good friend from Michigan, the ranking member of the 
Judiciary Committee, an example. Of course he knows this. Let's say 
it's an OB/GYN case and the surgeon who has done a hysterectomy on 
Friday is going to church on Sunday morning and asks his colleague to 
stop by and see the patient and to tell her that he'll be around that 
afternoon to check on her. The doctor says, sure, I'll be glad to.
  He peeks his head in the door and Mrs. Jones said, I'm fine.
  Okay. Your doctor will be around this afternoon to check on you.
  Things go to heck in a hand basket. The operating physician maybe has 
practiced below the standard of care. But that doctor that covered, 
that peeked in the door, that really had nothing to do with the case, 
surely, as Mr. Conyers knows, will be named in the lawsuit. And if he 
or she happens to have the deepest pockets under the current law, they 
could be liable for the entire judgment; whereas the doctor who 
practiced below the standard of care, who has a shallow pocket, would 
get off scot-free.
  I yield back to my friend, and I thank you for the opportunity.
  The Acting CHAIR (Mr. Nugent). The time of the gentleman from 
Michigan has expired.
  Mr. CONYERS. I yield myself an additional minute, and I thank Dr. 
Gingrey for his response.
  I ask the author of this bill, H.R. 5, if the answer to my question 
of whether H.R. 5 eliminates joint and several liability for both 
economic and noneconomic damages is ``yes''?
  Mr. GINGREY of Georgia. The answer is ``yes.''
  Mr. CONYERS. I thank the gentleman very much.
  Mr. Chairman, I am now pleased to yield as much time as she may 
consume to the gentlewoman from Houston, Texas, Ms. Sheila Jackson Lee.
  Ms. JACKSON LEE of Texas. Let me thank the ranking member and also 
the chairman of the Judiciary Committee and the leadership for giving 
us the opportunity to celebrate, as we debate H.R. 5, the Affordable 
Care Act, which is 2 years in the making.
  Clearly, it speaks to where we are today. So in celebration of the 
Affordable Care Act, let me first of all wish it a happy anniversary.
  Before I start on the Affordable Care Act, let me indicate to my good 
friend from Georgia and the Physicians Caucus that many of us do not 
take a back seat to our support for physicians. How can I help myself, 
coming from a community where the Texas Medical Center is fighting for 
a permanent doctor fix, which we've not been able to secure from this 
Congress, and as well, being a champion of physician-owned hospitals. 
Because I do believe that physicians have a high level, an acuteness of 
their concern for their patient. Maybe it is also because in the last 
decade I've had to tend to ailing parents, both of whom I lost, and 
have seen doctors up close and personal dealing with one of the most 
difficult times in any child's life.
  This is not about a fight of one side or another regarding doctors, 
and my constituents have been kind enough to give me time here to have 
gone through these debates over and over again. Let me just say very 
quickly: I am glad the Affordable Care Act is in place, because what 
we're celebrating today, as we talk about H.R. 5, is that women will 
not be dropped from insurance when they get sick or pregnant; insurance 
companies will not require women to obtain preauthorization for 
referral for access to an OB/GYN; millions of older women with chronic 
conditions will not be banned from care; 279,000 constituents in the 
18th Congressional District will have improved employee health care; 
187,000 uninsured in the 18th Congressional District will now have 
access to health care; and my hospitals, my public hospitals, my Texas 
Children's Hospital, St. Luke's, Methodist, Ben Taub, M.D. Anderson 
will be able to secure compensation in uncompensated care. I celebrate 
the Affordable Care Act.
  But today we're discussing legislation that has already received a 
veto notice from the President, but we're here on the floor of the 
House discussing H.R. 5 and ignoring the fact that the Affordable Care 
Act has already confirmed health care is vital to America, and we in 
the Congress must protect it.
  By the way, the Affordable Care Act is a preserver of Medicare and 
strengthens Medicare.

                              {time}  2000

  But let me tell you what we are facing with this legislation that is 
anchored with the component dealing with medical malpractice. We have

[[Page H1486]]

seen documentation across States that, in fact, medical malpractice is 
an insurance issue. And even when there is an attempt to, in essence, 
dumb down the recovery, we have seen that the insurance companies do 
not, in essence, reward the physicians. Insurance premiums are still 
high, high, high, high, high. How do I know? You can go to the State of 
Texas and ask physicians are their insurance premiums such that they're 
celebrating today. Yes, there were some measured declines, but they are 
paying high insurance premiums.
  Now, in the findings of H.R. 5, our friends cite the Commerce Clause 
and indicate that Congress has a right to write this bill on health 
care because of the Commerce Clause. As I understand it, many are 
pursuing the challenge of the Affordable Care Act, suggesting we had no 
authority. But in their own bill, the findings cite interstate commerce 
as the basis of writing this bill. But there are some friends over 
there that just caught it, and one of the amendments from another 
gentleman from Georgia strikes the findings. This is a case of ``have 
your cake and eat it too'' because they know that tort law has, for a 
long time, been the prerogative of States.
  So to cite President Reagan when he gave this seminal talk on tort 
law in 1986, his words:

       So over the years, tort law has helped us drive the 
     negligent out of the marketplace. This, in turn, has 
     permitted legitimate economic innovation to take its course 
     and raise living standards throughout the Nation.

  So the President agrees that tort law drives the negligent out of the 
arena. He then goes on to say, as he put together this task force:

       To be sure, much tort law would remain to be reformed by 
     the 50 States, not the Federal Government. And in our Federal 
     system of government, this is only right.

  So my friends cannot deny that H.R. 5 implodes State law. It takes 
away the authority of States. And removing it by some late amendment is 
not going to make it right. You are going to violate the rights of 
Colorado, Florida, Illinois, Maryland, Michigan, Texas, and West 
Virginia that have enacted their own medical malpractice damage caps. 
You are going to implode the rights of Connecticut, Iowa, New York, 
Oregon, and Tennessee that have expressly chosen not to limit. And in 
this bill, if you have not limited it, then you are capped. In this 
bill, you rid the rights of those States that have not capped, and the 
flexibility only comes if you have capped and it is higher than what we 
have, and you obliterate constitutional State law that has its own 
caps.
  So this is not as black-and-white as my good friends would like to 
make it. We are riding in on the high horse, and we are not?
  For example, in my State of Texas, on May 29, 2010, Connie Spears 
went to a hospital reporting excruciating leg pain. This was all too 
familiar due to her previous blood clots. The emergency room doctor ran 
tests and discharged her with a bilateral leg pain. But what really 
happened is that she had blood clots around a vein filter. She got 
kidney failure. She went unconscious. To save her life, two legs were 
amputated. There was definitive negligence. And it is important to note 
that she sits today with no legs.
  What we are suggesting is that we are now intruding into State law, 
that this individual now, under Federal law, loses noneconomic damages 
for pain and suffering and the extent of the negligence that was 
promoted and, as well, faces a Federal hard hat to prevent her from 
having relief. Now, this is in the State of Texas, and we have tort law 
reform that many oppose, but it is a State decision.
  I offered an amendment that would have carved out an exemption for 
health care lawsuits for serious and irreversible injury, supported by 
two of my colleagues, Congressman Hank Johnson and Mr. Quigley. It 
exempted victims of malpractice that resulted in irreversible injury, 
including loss of limbs and loss of reproductive ability, from the 
$250,000 cap. This was not accepted.
  What we say today is people like Connie Spears, children, seniors who 
are limited in their noneconomic damages, now have no basis for 
punishing those who were blatant in their negligence, no way of dealing 
in a punitive manner to prevent these kinds of acts from happening and 
recognizing the loss of limbs of someone who may have been unemployed.
  My friends cannot have it both ways, that is, challenging the 
Affordable Care Act because they say that interstate commerce does not 
allow us to do good, but yet coming back in their findings to suggest 
they have the upper hand.
  Well, I'm going to join my friend on the other side of the aisle, Mr. 
Johnson, on states' rights. Today, on H.R. 5, you literally quash and 
extinguish states' rights; and in the course of doing so, you quash the 
rights of injured patients, for those that Ronald Reagan said to get 
negligence out of the marketplace, out of the way of those who need 
care so that the good can rise up.
  So I would make the argument that we're now debating in a conflicted 
manner. I don't know what the positions of Republicans are. They want 
to get rid of the Affordable Care Act, which was premised on interstate 
commerce, the authority of Congress. They come right back at our 2-year 
anniversary, celebrating people who are living because of the 
Affordable Care Act, and now want to place their hat on doing this on 
interstate commerce. I want to know where all the states' rights 
advocates are and why you are abolishing and eliminating constitutional 
State law, why you are eliminating statutory law where individual 
States have expressed their will.
  I believe this bill, along with the component that wants to dash the 
Affordable Care Act, is a bill destined for the President's veto. But 
more importantly, let me try to understand how we can have our good 
friends on the other side of the aisle have their cake and eat it too.
  I'm celebrating with the celebratory cake of the Affordable Care Act. 
I don't mind celebrating this Congress' right to help save lives.
  How do you put a bill on the floor of the House where you have argued 
that there is no right for us to be involved in health care, and now 
you want to dash the rights of those who have been injured through 
interstate commerce and the Congress of the United States of America? 
Frankly, the complexity of your argument is such that it makes no 
sense; and, frankly, I hope that my colleagues will join me and applaud 
the Affordable Care Act, celebrate the expanded life that we have 
provided, and also recognize that those individuals who seek remedy in 
the marketplace, who have been injured by negligence and acts that have 
been dastardly, are compensated in a fair and just manner. That is all 
we ask under the Constitution: due process and the rights of all 
Americans.
  Mr. SMITH of Texas. Mr. Chairman, I yield 2 minutes to the gentleman 
from Georgia (Mr. Gingrey).
  Mr. GINGREY of Georgia. Mr. Chairman, I appreciate Chairman Smith 
yielding to me. And, of course, with great hesitation do I rise, 
because the gentlewoman who just spoke was recently rated one of the 
most eloquent, if not the most eloquent, Members of this body.
  But even though she is eloquent, with all due respect, I think she is 
wrong. And with regard to the issue of the Commerce Clause and the 
issue of the Affordable Care Act, PPACA, and as is sometimes referred 
to, and not really pejoratively--if successful, it will be his legacy--
ObamaCare.

                              {time}  2010

  This bill, Mr. Chairman, was created by forcing individuals to engage 
in commerce; that is, to purchase health insurance, under the penalty 
or a tax--I'm not sure from day to day how they're going to describe 
it, but without question that's not constitutional. And I expect maybe 
it will be a 5 4 decision in June of the Supreme Court, but maybe 9 0, 
because that is clearly unconstitutional. It is not applicable under 
the Commerce Clause to force people to engage in commerce. The 
Constitution says to regulate interstate commerce.
  Of course, that is very much applicable in H.R. 5, in the Medical 
Liability Reform Act. Because when you have a situation in health care 
where there is no provision for certain medical specialties in a high-
risk area like neurosurgery, obstetrics and gynecology, cardiovascular 
surgery, where babies have to be delivered beside the road.
  The Acting CHAIR. The time of the gentleman has expired.

[[Page H1487]]

  Mr. SMITH of Texas. I yield the gentleman 2 additional minutes.
  Mr. GINGREY of Georgia. I thank the gentleman for yielding.
  But clearly the gentlelady from Texas--and I think she knows this. 
Texas has enacted tort reform. They have caps that are different in 
fact than originally existed in California 35 years ago. The result in 
Texas, if all of my colleagues from Texas on this side of the aisle are 
truthful with me, is that the problem in Texas has stabilized. 
Physicians are coming back to Texas. There's no shortage of specialists 
because of the law that was passed in Texas.
  And I want to point out to the gentlewoman, too, that in this bill 
there is a provision called flexi-caps that basically says whatever a 
State does preempts Federal law in regard to caps on noneconomic, as 
well as contingency fees for plaintiffs' attorneys, or any other 
provision of the law. State law prevails if they address that either 
before this bill is passed or after the bill is passed.
  Ms. JACKSON LEE of Texas. Will the gentleman yield?
  Mr. GINGREY. The gentlelady is eloquent but she's wrong on this 
issue, and I will yield to her.
  Ms. JACKSON LEE of Texas. Dr. Gingrey, thank you for your kindness 
and your kind words. I would say that rather than being wrong, we 
disagree.
  But what I would say is, if you do not have a cap, then this bill 
will supersede the laws in States that say they have no caps. And the 
only thing I would conclude on is that your bill is premised, even 
though you're citing the individual mandate--and we can quarrel about 
that as to whether or not it is a forced-upon mandate or whether there 
are options of that individual having employer-based insurance, et 
cetera--but it is premised on interstate commerce. And therefore you 
have an amendment being offered by one of your members to strike that.
  The Acting CHAIR. The time of the gentleman has expired.
  Mr. CONYERS. Mr. Chair, I yield the gentlelady 1 additional minute.
  Ms. JACKSON LEE of Texas. I thank the gentleman.
  The premise of this bill is interstate commerce, which in the initial 
arguments being made by my friends on the other side of the aisle, they 
argued vigorously that we couldn't even do health care under this 
premise, even though we have Medicare. The premise you have in this 
bill is under interstate commerce. But you have an amendment that is 
seeking to strike your findings because you were caught with a conflict 
between dealing with this question congressionally, which we're saying 
is legitimate from the perspective of the Affordable Care Act--you're 
trying to use it now--but you realize that there are Members who are 
now arguing the question of states' rights.
  We have existing State law on tort reform--hundreds of years of tort 
reform--and you're trying to abolish it, and with this added 
legislation on medical malpractice you're now trying to supersede 
existing State law.
  The Acting CHAIR. The time of the gentlewoman has expired.
  Mr. CONYERS. I yield the gentlelady 1 additional minute.
  Ms. JACKSON LEE of Texas. Where the amounts of moneys are not capped, 
where there are no caps, this bill places the $250,000 in. If there are 
no caps. That is an overriding of State law. No matter how you cut it, 
it's an overriding of State law enforcement. And you can't have your 
cake and eat it, too. I'm willing to celebrate the Affordable Care Act 
and eat the cake because it saves lives. But what you're doing here now 
is not. You're overriding State laws. Many States.
  Mr. SMITH of Texas. Mr. Chairman, I yield 4 minutes to the gentleman 
from Arizona (Mr. Quayle), who is an active member of the Judiciary 
Committee.
  Mr. QUAYLE. I thank the gentleman for yielding and for his work on 
this important piece of legislation.
  Mr. Chairman, I rise in support of H.R. 5, the PATH Act, because our 
country is in urgent need of medical malpractice reform. Currently, we 
have a jackpot justice system that is not based in reality, and it's 
badly damaging our country's health care system. Profiteering attorneys 
know this. And that's why the number of malpractice suits has been 
precipitously rising year after year.
  Back in the 1960s, one out of seven physicians would have had a 
malpractice claim over their entire lifetime. Today, it's one in seven 
physicians are sued each year. That is an astronomical jump in the 
number of claims that are being put on doctors. And the doctors are now 
being forced out of the profession even when they haven't done anything 
wrong. The practice of defensive medicine is harming the quality of 
care and pushing up costs. The enormous expense of ensuring a doctor 
against liability is making health care inflation much worse, not to 
mention the fact that the current system is damaging the doctor-patient 
relationship. It damages it in a way because every doctor has to see 
every interaction with the patient as a potential lawsuit. That is not 
what the doctor-patient relationship should be built on. It should be 
built on mutual respect and trust. And until we have something that 
actually addresses the medical malpractice problems that we have and we 
get the reforms that are much needed, that actual relationship is never 
going to improve.
  So I urge the House to pass the PATH Act because it will do two vital 
things to get health care costs under control: First, it would 
eliminate ObamaCare's Independent Payment Advisory Board and thereby 
keep a board of unelected, unaccountable bureaucrats from restricting 
senior access to health care. It also brings medical malpractice 
lawsuits under control by capping noneconomic damages and limiting 
attorneys' fees so more money will actually go to the victims rather 
than overzealous trial lawyers.
  These reforms will save taxpayers over $40 billion over the next 
decade. Everyone knows that we need to do something about rising health 
care costs, and this bill and taking care of the medical malpractice 
problems that we have will go a long way in getting those costs under 
control. This bill will give every Member of this House the opportunity 
to be part of the solution.
  I urge my colleagues to vote ``yes'' on H.R. 5.
  Mr. CONYERS. I yield such time as she may consume to a senior member 
of the Judiciary Committee, Maxine Waters of California.
  Ms. WATERS. Thank you very much, Mr. Conyers, former chair of the 
Judiciary Committee, ranking member, and a gentleman who has provided 
superb leadership in opposition to H.R. 5.
  Mr. Chairman, I rise in strong opposition to H.R. 5, poorly titled 
Protecting Access to Healthcare, the so-called PATH Act, an 
unconstitutional, Big Government bill that violates the 10th Amendment 
and states' rights.

                              {time}  2020

  At the very start of the 112th Congress, my colleagues on the 
opposite side of the aisle declared that all business conducted in the 
House would be consistent with the Constitution. Yet if you read the 
constitutional authority statement attached to H.R. 5, the Republican 
sponsors seem to believe that the Commerce Clause magically creates a 
path for Congress to mandate nationwide caps on punitive damages in all 
medical malpractice lawsuits. The Republicans are telling all 
Americans, no matter how severe the injury or egregious the mistake by 
the doctor, hospital or drug manufacturer, that their losses are going 
to be capped at $250,000.
  And with all due respect to the gentleman from Georgia, 
Representative Gingrey, who introduced H.R. 5, even his own State 
supreme court has found caps on punitive damages to be 
unconstitutional. In 2010, the Georgia supreme court unanimously struck 
down limits on jury awards in medical malpractice cases. The Georgia 
court determined that a $350,000 cap on noneconomic damages violates 
the right to a jury trial as guaranteed under the Georgia Constitution.
  Section 110(a) of H.R. 5 would impose an even lower cap on damages in 
Georgia, effectively overturning the court's decision by an act of 
Congress. The section reads:

       The provisions governing health care lawsuits set forth in 
     this Act preempt, subject to subsections (b) and (c), State 
     law to the extent that State law prevents the application of 
     any provisions of law established by or under this Act.

  In addition to Georgia, other States like Arizona, Pennsylvania, 
Wyoming

[[Page H1488]]

and Kentucky whose State constitutions specifically prohibit damage 
limitations will have their constitutions overruled by Congress.
  For Members who have for years now questioned the constitutionality 
of the Affordable Care Act, you need but take a look at H.R. 5. H.R. 5 
goes far beyond anything passed by the Democratic majority. If you 
don't believe me, just listen to Tea Party Nation founder Judson 
Phillips. In slamming H.R. 5 he wrote:

       Whether you think tort reform is a good idea or not, it is 
     an issue that belongs to the States, not to the Federal 
     Government. Tort law has always been governed by the States.

  Now, I didn't say that, Mr. Conyers didn't say that, and Ms. Jackson 
Lee didn't say that. None of those who have been over here this evening 
opposing H.R. 5 and laying out the facts and the consequences of H.R. 5 
said this. Let me repeat. I am quoting Tea Party Nation founder Judson 
Phillips:

       Whether you think tort reform is a good idea or not, it is 
     an issue that belongs to the States, not to the Federal 
     Government. Tort law has always been governed by the States.

  Even some of my Republican colleagues on the Judiciary Committee have 
expressed concerns. Congressman Poe, Republican from Texas said:

       I believe that each individual State should allow the 
     people of that State to decide--not the Federal Government. 
     If the people of a particular State don't want liability 
     caps, that's their prerogative under the 10th Amendment.

  Well, let's listen to what Congressman Louie Gohmert, Republican of 
Texas, said:

       The right of the States for self-determination is enshrined 
     in the 10th Amendment. I am reticent to support Congress 
     imposing its will on the States by dictating new State law in 
     their own State courts.

  To my conservative colleagues in this Chamber, don't be tricked. 
Don't be fooled. H.R. 5, simply and clearly put, violates states' 
rights. Reject this unconstitutional piece of legislation, protect 
States' constitutional rights to set tort law and just vote ``no'' on 
H.R. 5.
  Now, let me just wrap this up by saying that the gentleman from 
Georgia referred over and over again, constantly, this evening about 
frivolous Californians. And he talked about these juries who didn't 
take into consideration the facts on these negligence cases, but rather 
looked at the insurance and said, oh, just give them whatever, they 
didn't care. Well, I came to defend California and to tell you the 
difference between what happened in tort reform in California and what 
you have been told by the gentleman from Georgia.
  Supporters of H.R. 5 claim that it is the same as MICRA, a medical 
malpractice liability law passed in California in 1975. H.R. 5 is far 
different from MICRA, except that neither law delivered on lower 
insurance premiums. The differences are clear:
  H.R. 5 applies damage caps in all ``health care lawsuits,'' including 
cases against drug companies, nursing homes, insurance companies and 
HMOs. MICRA only applies to malpractice cases against a doctor or a 
hospital.
  Punitive damages are reserved for only the most egregious medical 
malpractice; they are meant to deter future dangerous conduct. H.R. 5 
limits punitive damages. MICRA does not cap punitive damages.
  H.R. 5 gives total immunity from punitive damages to drug and device 
manufacturers if their products have been approved by the FDA or are 
``generally recognized as safe and effective.'' MICRA does not provide 
this kind of sweeping immunity for the drug industry.
  H.R. 5 caps noneconomic damages at $250,000 in the aggregate, no 
matter how many parties have been damaged by medical malpractice, even 
when an injury results in loss of a marital relationship. California 
law recognizes a separate claim for loss of consortium--claims brought 
by the spouse of an injured patient. MICRA does not limit these claims.
  Joint and several liability, which my leader asked you about, Mr. 
Gingrey, enables an individual to bring one claim against any of the 
parties involved in a medical malpractice injury and ensures that 
injured victims are fully compensated. H.R. 5 completely eliminates 
joint liability for both economic and noneconomic losses. California 
law only limits joint liability for noneconomic damages.
  H.R. 5 and MICRA are alike in one main respect--by themselves, 
neither law can deliver on lower medical malpractice insurance 
premiums.
  H.R. 5 includes unprecedented legal protections for the insurance 
industry, but no guarantee that any future savings will be passed onto 
doctors or patients.
  Following the passage of MICRA, insurance premiums for doctors 
increased in California by 450 percent over the next 13 years. Premiums 
only decreased after California enacted Proposition 103, a ballot 
initiative that mandated a 20 percent rollback in premium rates. I was 
in the California legislature when that happened.
  H.R. 5 does not guarantee lower premium rates for doctors. In fact, 
the bill only mentions insurance companies when giving them protection 
from liability.
  So, again, I say, don't be fooled, don't be tricked. I don't really 
mean to imply, Mr. Gingrey, that you are trying to fool or trick 
anybody, but you're simply wrong. We have given our opposition in more 
ways than one this evening to H.R. 5. But since you alluded to or 
talked about or pointed directly to California and all of these people 
who simply have frivolous lawsuits and these poor juries who sit and 
don't take into consideration the facts and simply look at how much 
insurance is available and just award these tremendous amounts, I had 
to add to my testimony this evening a defense and an explanation and 
show the difference between MICRA and H.R. 5.
  I think I have done that, and I think I have done that with the facts 
that exist. I am very pleased that I have been able to join with my 
colleagues this evening to not only reveal what H.R. 5 is and is not, 
but I think we have made the case. I think that we have put the facts 
forward in such a way that we're going to win on this issue. I ask you 
to oppose H.R. 5.
  Mr. SMITH of Texas. Mr. Chairman, I yield such time as he may consume 
to the gentleman from Georgia, Dr. Gingrey.

                              {time}  2030

  Mr. GINGREY of Georgia. Mr. Chairman, I thank Chairman Smith for 
yielding to me.
  As good a communicator as the gentlewoman from California is, I would 
be quick to state that she is not the Great Communicator. The Great 
Communicator, of course, was President Ronald Reagan.
  The gentlewoman from California talked about comments that were made 
on my side of the aisle, members of the Judiciary Committee, and named 
a couple of Members on my side of the aisle that were concerned about 
federalism and the 10th Amendment and states' rights. I just want to 
remind her that, at least from our perspective--and the gentlewoman may 
not agree with this at all--but from our perspective on this side of 
the aisle, the Great Communicator was President Ronald Reagan.
  In a speech in 1986 to the U.S. Chamber of Commerce, after a 
commission had reported to him on this issue of medical liability 
reform and the need for same, the President very clearly outlined 
almost the identical provisions that are part of MICRA, the Medical 
Injury Compensation Reform Act, that was passed in his State that he 
governed for 8 years, the great State of California. So, again, the 
gentlelady makes her points well; but, quite honestly, I think there's 
a bit of embellishment on their side of the aisle.
  Who do you trust? The gentleman from Arizona (Mr. Quayle) just spoke 
moments ago, Mr. Chairman, about who do we trust. Well, right above 
you, as you sit there, first of all, ``In God We Trust.'' In mom and 
dad we trust. In Dr. Bailey, Augusta, Georgia, we trust. In uncle we 
trust, but that's way down the line, way down the line.
  I think our colleagues on the other side of the aisle think that Big 
Government should control everything, that they should make the 
decisions. That's where ObamaCare came from. To do it, they had to 
proffer a 2,800-page bill that is clearly unconstitutional.
  H.R. 5 is not unconstitutional. You look at article I, section 8, 
clause 3, the Commerce Clause, and clearly it's constitutional. 
Requiring someone, forcing someone to engage in commerce, indeed, to 
purchase health insurance

[[Page H1489]]

under the penalty of a tax is unconstitutional, and that will be 
determined by the Supreme Court.
  Mr. CONYERS. Mr. Chairman, we have no further requests for time. With 
the agreement of the chairman of the committee, I would like to close 
at this point.
  Mr. SMITH of Texas. Mr. Chairman, we have no other speakers as well, 
and I am prepared to close on this side.
  The Acting CHAIR. The Chair recognizes the gentleman from Michigan.
  Mr. CONYERS. I'd like to thank all of the Members on both sides of 
the aisle that have participated in this important debate. There has 
been a lot of clarity, even though there has been a great difference in 
opinion.
  I return the balance of my time with this thought in mind, that even 
though the author of this bill is a well-regarded medical practitioner 
and a distinguished Member of the body, he is a doctor, but he is not a 
lawyer.
  I commend him on the fact that he agreed with the statement that to 
me determines a lot of people's point of view about this very 
controversial bill that is now before the floor, H.R. 5. That is, he 
agreed and answered in the affirmative that H.R. 5 eliminates joint and 
several liability for economic, noneconomic, and punitive damages. To 
me, with all the cases that have been of human suffering, of injury to 
women and children, of how wrong it would be to limit all of these 
kinds of damages to $250,000 in this 21st century is an insult to 
common sense and fair play.
  Mr. GINGREY of Georgia. Will the ranking member yield?
  Mr. CONYERS. I will yield to the gentleman.
  Mr. GINGREY of Georgia. I appreciate very much you yielding to me for 
that, because clarification needs to be made.
  You're suggesting that what I said was there would be a limitation of 
$250,000 because of the elimination of joint and several liability. 
That's not true at all. Whatever the judgment is, the $250,000 in 
noneconomic, the $10 million in economic, would be apportioned to the 
defendants in proportion to their liability. That's what the 
elimination of joint and several liability means, eliminating this 
deep-pocket mentality of plaintiff's attorneys.
  Mr. CONYERS. Well, through the Chairman, I accept the comments of the 
gentleman from Georgia. I assume that his response to my question 
earlier is still ``yes.'' If that is the case, then all I can say is 
that I think there are very few people in the Federal legislature or 
among our citizenry who would say that there should not be an unlimited 
amount of recovery. The gentleman must have some feeling for the fact 
that $250,000 for the rest of the person's life, if they lose arms or 
legs, eyes, it's just unacceptable. I won't say that it's immoral, but 
it's unfair.
  It's my hope that most of our colleagues, as we continue this debate 
tomorrow, will realize that that is the fatal flaw in a bill that may 
have some justification in other parts of it, but that limitation of 
damages cannot be rationalized nor justified by the collective body of 
this legislature. For that reason, sir, I am urging all of our 
colleagues to consider this one point that I make tonight, as I close, 
as to be controlling in their decision that they will make as we vote 
tomorrow on this bill.
  I thank all of the Members that have joined in this debate this 
evening.
  Mr. Chairman, I yield back the balance of my time.
  Mr. SMITH of Texas. Mr. Chairman, I yield myself the balance of my 
time.
  Mr. Chairman, I just want to reemphasize again that, under this bill, 
awards are possible that far exceed the $250,000 cap in noneconomic 
damages. That's because under the economic damages provision, there is 
simply no cap. As a result of that, States like California and Texas, 
which have adopted reforms very similar to the reforms in this 
particular piece of legislation, there have been numerous awards of 
multimillion dollars awarded to individuals who have been injured.

                              {time}  2040

  So even though we had that $250,000 noneconomic cap, that is not an 
absolute cap on the awards that have been made.
  A minute ago, Dr. Gingrey mentioned that in California, for example, 
several years ago, I believe it was 2007, there was a $96 million 
award. And in the last year for which we have records, in 2010, there 
were awards, I think, for over $6 million, over $10 million, over $14 
million. So an individual is able to be reimbursed for the costs and 
the injuries that that individual may have incurred.
  Mr. Chairman, I also want to say that America's medical liability 
system increases the cost of health care and decreases access to care 
as doctors abandon their practices and avoid high-risk specialties out 
of fear of being sued. Medical liability reform, this bill tonight will 
solve this problem.
  According to the Journal of the American College of Surgeons, 5 years 
after tort reform legislation passed in my home State of Texas, the 
number of physicians in the State increased by 24 percent. That is 
twice the rate of growth in population over the same period of time. 
Other States have seen similar results.
  But most States have not enacted meaningful reforms and, as a result, 
frivolous lawsuits have created a medical liability crisis. This crisis 
has forced women to drive great distances to deliver their babies 
because their local hospital doesn't have an OB GYN.
  It has resulted in those who need complicated procedures being placed 
on waiting lists for months because the only available specialist has 
too many patients who seek care, and it has caused accident victims to 
lose their lives because their local emergency room no longer has a 
trauma center. America's broken medical liability system has caused 
patients to lose access to high-quality health services.
  The liability reforms contained in the HEALTH Act will do these 
things: lead to a significant savings in health care expenses, reduce 
the practice of defensive medicine, halt the departure of doctors from 
high-litigation States and medical specialties, improve access to 
health care, and increase the affordability of health insurance. Also, 
according to the Congressional Budget Office, this legislation will 
reduce the Federal deficit by more than $45 billion over the next 10 
years. This is a significant savings in a time of escalating deficits 
and debt.
  We've seen the positive effects that similar medical liability 
reforms have had at the State level. Reforms in States like California 
and Texas have enhanced patient care, reduced doctor shortages, and 
decreased cost. It's time for Congress to enact these reforms for the 
benefit of all Americans.
  Mr. Chairman, before I yield back the balance of my time, I'd like to 
thank the gentleman from Georgia, Dr. Gingrey, who has spoken so well 
so many times tonight, for introducing this piece of legislation that 
is going to help so many people across America.
  With that, I yield back the balance of my time.
  Ms. SCHWARTZ. Mr. Chair, I rise in opposition to the bill before us.
  H.R. 452, the Medicare Decisions Accountability Act, had clear 
bipartisan support.
  As a co-sponsor, I am deeply disappointed by Republicans' decision to 
link this legislation to an unrelated and partisan issue. This rule 
ensured that repealing IPAB would not be given serious consideration in 
the House.
  My support for IPAB repeal reflects my confidence in and commitment 
to Medicare payment and delivery system reforms in the Affordable Care 
Act that will improve quality, increase efficiency and care 
coordination, and not only save lives but reduce costs.
  IPAB is not a ``death panel'' or a ``rationing board.'' IPAB is 
simply the wrong approach to the right goal.
  Abdicating responsibility for legislating sound health care policy, 
whether to an unelected commission or private insurers, undermines our 
ability to represent the needs of our constituents.
  Republicans have once again demonstrated that political showmanship 
trumps legitimate concerns expressed by seniors and the medical 
community.
  Linking IPAB repeal to tort reform--an unrelated, divisive, and 
polarizing issue--has brought what was once a bipartisan effort to a 
screeching halt.
  I urge my colleagues to vote against this partisan stunt and put our 
Nation's seniors first.
  Mr. FITZPATRICK. Mr. Chair, over the course of the last 2 years since 
the President signed the so called Affordable Care Act into law, 
bipartisan opposition to many portions of this legislation has steadily 
grown in this Chamber.
  I have called for a full repeal of the law, however, it is vital that 
the most damaging sections be repealed here and now. One of

[[Page H1490]]

the most clearly flawed aspects of the Affordable Care Act is the 
creation of the Independent Payment Advisory Board.
  As the House puts forward ideas to protect and save Medicare, the 
Administration has decided it can better serve seniors by cutting 
Medicare by more than $575 billion to create a panel of unelected, 
unaccountable Washington bureaucrats tasked with cutting Medicare even 
further.
  More than 230 of my colleagues in the House and over 380 groups 
representing doctors, patients and employers have joined us in 
opposition to the IPAB. I urge the Senate and President to stand with 
us against this overreach of government power and pass the Protecting 
Access to Healthcare Act.
  The Acting CHAIR. All time for general debate has expired.
  Mr. SMITH of Texas. Mr. Chairman, I move that the Committee do now 
rise.
  The motion was agreed to.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Griffith of Virginia) having assumed the chair, Mr. Nugent, 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. 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, had come to no 
resolution thereon.

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