[Congressional Record Volume 158, Number 48 (Thursday, March 22, 2012)]
[House]
[Pages H1501-H1519]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  PROTECTING ACCESS TO HEALTHCARE ACT

  Mr. GINGREY of Georgia. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days in which to revise and extend their 
remarks and include 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 further consideration of the bill, 
H.R. 5.

                              {time}  1019


                     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 further 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 Mrs. 
Miller of Michigan (Acting Chair) in the chair.
  The Clerk read the title of the bill.
  The Acting CHAIR. When the Committee of the Whole rose on Wednesday, 
March 21, 2012, all time for general debate had expired.
  Pursuant to the rule, the bill shall be considered for amendment 
under the 5-minute rule.
  In lieu of the amendments recommended by the Committees on Energy and 
Commerce and the Judiciary printed in the bill, an amendment in the 
nature of a substitute consisting of the text of Rules Committee Print 
112 18 is adopted and the bill, as amended, shall be considered as an 
original bill for the purpose of further amendment under the 5-minute 
rule and shall be considered as read.
  The text of the bill, as amended, is as follows:

                                 H.R. 5

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Protecting Access to 
     Healthcare Act''.

                          TITLE I--HEALTH ACT

     SEC. 101. SHORT TITLE.

       This title may be cited as the ``Help Efficient, 
     Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 
     2012''.

     SEC. 102. FINDINGS AND PURPOSE.

       (a) Findings.--
       (1) Effect on health care access and costs.--Congress finds 
     that our current civil justice system is adversely affecting 
     patient access to health care services, better patient care, 
     and cost-efficient health care, in that the health care 
     liability system is a costly and ineffective mechanism for 
     resolving claims of health care liability and compensating 
     injured patients, and is a deterrent to the sharing of 
     information among health care professionals which impedes 
     efforts to improve patient safety and quality of care.
       (2) Effect on interstate commerce.--Congress finds that the 
     health care and insurance industries are industries affecting 
     interstate commerce and the health care liability litigation 
     systems existing throughout the United States are activities 
     that affect interstate commerce by contributing to the high 
     costs of health care and premiums for health care liability 
     insurance purchased by health care system providers.
       (3) Effect on federal spending.--Congress finds that the 
     health care liability litigation systems existing throughout 
     the United States have a significant effect on the amount, 
     distribution, and use of Federal funds because of--
       (A) the large number of individuals who receive health care 
     benefits under programs operated or financed by the Federal 
     Government;
       (B) the large number of individuals who benefit because of 
     the exclusion from Federal taxes of the amounts spent to 
     provide them with health insurance benefits; and
       (C) the large number of health care providers who provide 
     items or services for which the Federal Government makes 
     payments.
       (b) Purpose.--It is the purpose of this title to implement 
     reasonable, comprehensive, and effective health care 
     liability reforms designed to--
       (1) improve the availability of health care services in 
     cases in which health care liability actions have been shown 
     to be a factor in the decreased availability of services;
       (2) reduce the incidence of ``defensive medicine'' and 
     lower the cost of health care liability insurance, all of 
     which contribute to the escalation of health care costs;
       (3) ensure that persons with meritorious health care injury 
     claims receive fair and adequate compensation, including 
     reasonable noneconomic damages;
       (4) improve the fairness and cost-effectiveness of our 
     current health care liability system to resolve disputes 
     over, and provide compensation for, health care liability by 
     reducing uncertainty in the amount of compensation provided 
     to injured individuals; and
       (5) provide an increased sharing of information in the 
     health care system which will reduce unintended injury and 
     improve patient care.

     SEC. 103. ENCOURAGING SPEEDY RESOLUTION OF CLAIMS.

       The time for the commencement of a health care lawsuit 
     shall be 3 years after the date of manifestation of injury or 
     1 year after the claimant discovers, or through the use of 
     reasonable diligence should have discovered, the injury, 
     whichever occurs first. In no event shall the time for 
     commencement of a health care lawsuit exceed 3 years after 
     the date of manifestation of injury unless tolled for any of 
     the following--
       (1) upon proof of fraud;
       (2) intentional concealment; or
       (3) the presence of a foreign body, which has no 
     therapeutic or diagnostic purpose or effect, in the person of 
     the injured person.

     Actions by a minor shall be commenced within 3 years from the 
     date of the alleged manifestation of injury except that 
     actions by a minor under the full age of 6 years shall be 
     commenced within 3 years of manifestation of injury or prior 
     to the minor's 8th birthday, whichever provides a longer 
     period. Such time limitation shall be tolled for minors for 
     any period during which a parent or guardian and a health 
     care provider or health care organization have committed 
     fraud or collusion in the failure to bring an action on 
     behalf of the injured minor.

     SEC. 104. COMPENSATING PATIENT INJURY.

       (a) Unlimited Amount of Damages for Actual Economic Losses 
     in Health Care Lawsuits.--In any health care lawsuit, nothing 
     in this title shall limit a claimant's recovery of the full 
     amount of the available economic damages, notwithstanding the 
     limitation in subsection (b).
       (b) Additional Noneconomic Damages.--In any health care 
     lawsuit, the amount of noneconomic damages, if available, may 
     be as much

[[Page H1502]]

     as $250,000, regardless of the number of parties against whom 
     the action is brought or the number of separate claims or 
     actions brought with respect to the same injury.
       (c) No Discount of Award for Noneconomic Damages.--For 
     purposes of applying the limitation in subsection (b), future 
     noneconomic damages shall not be discounted to present value. 
     The jury shall not be informed about the maximum award for 
     noneconomic damages. An award for noneconomic damages in 
     excess of $250,000 shall be reduced either before the entry 
     of judgment, or by amendment of the judgment after entry of 
     judgment, and such reduction shall be made before accounting 
     for any other reduction in damages required by law. If 
     separate awards are rendered for past and future noneconomic 
     damages and the combined awards exceed $250,000, the future 
     noneconomic damages shall be reduced first.
       (d) Fair Share Rule.--In any health care lawsuit, each 
     party shall be liable for that party's several share of any 
     damages only and not for the share of any other person. Each 
     party shall be liable only for the amount of damages 
     allocated to such party in direct proportion to such party's 
     percentage of responsibility. Whenever a judgment of 
     liability is rendered as to any party, a separate judgment 
     shall be rendered against each such party for the amount 
     allocated to such party. For purposes of this section, the 
     trier of fact shall determine the proportion of 
     responsibility of each party for the claimant's harm.

     SEC. 105. MAXIMIZING PATIENT RECOVERY.

       (a) Court Supervision of Share of Damages Actually Paid to 
     Claimants.--In any health care lawsuit, the court shall 
     supervise the arrangements for payment of damages to protect 
     against conflicts of interest that may have the effect of 
     reducing the amount of damages awarded that are actually paid 
     to claimants. In particular, in any health care lawsuit in 
     which the attorney for a party claims a financial stake in 
     the outcome by virtue of a contingent fee, the court shall 
     have the power to restrict the payment of a claimant's damage 
     recovery to such attorney, and to redirect such damages to 
     the claimant based upon the interests of justice and 
     principles of equity. In no event shall the total of all 
     contingent fees for representing all claimants in a health 
     care lawsuit exceed the following limits:
       (1) Forty percent of the first $50,000 recovered by the 
     claimant(s).
       (2) Thirty-three and one-third percent of the next $50,000 
     recovered by the claimant(s).
       (3) Twenty-five percent of the next $500,000 recovered by 
     the claimant(s).
       (4) Fifteen percent of any amount by which the recovery by 
     the claimant(s) is in excess of $600,000.
       (b) Applicability.--The limitations in this section shall 
     apply whether the recovery is by judgment, settlement, 
     mediation, arbitration, or any other form of alternative 
     dispute resolution. In a health care lawsuit involving a 
     minor or incompetent person, a court retains the authority to 
     authorize or approve a fee that is less than the maximum 
     permitted under this section. The requirement for court 
     supervision in the first two sentences of subsection (a) 
     applies only in civil actions.

     SEC. 106. PUNITIVE DAMAGES.

       (a) In General.--Punitive damages may, if otherwise 
     permitted by applicable State or Federal law, be awarded 
     against any person in a health care lawsuit only if it is 
     proven by clear and convincing evidence that such person 
     acted with malicious intent to injure the claimant, or that 
     such person deliberately failed to avoid unnecessary injury 
     that such person knew the claimant was substantially certain 
     to suffer. In any health care lawsuit where no judgment for 
     compensatory damages is rendered against such person, no 
     punitive damages may be awarded with respect to the claim in 
     such lawsuit. No demand for punitive damages shall be 
     included in a health care lawsuit as initially filed. A court 
     may allow a claimant to file an amended pleading for punitive 
     damages only upon a motion by the claimant and after a 
     finding by the court, upon review of supporting and opposing 
     affidavits or after a hearing, after weighing the evidence, 
     that the claimant has established by a substantial 
     probability that the claimant will prevail on the claim for 
     punitive damages. At the request of any party in a health 
     care lawsuit, the trier of fact shall consider in a separate 
     proceeding--
       (1) whether punitive damages are to be awarded and the 
     amount of such award; and
       (2) the amount of punitive damages following a 
     determination of punitive liability.
     If a separate proceeding is requested, evidence relevant only 
     to the claim for punitive damages, as determined by 
     applicable State law, shall be inadmissible in any proceeding 
     to determine whether compensatory damages are to be awarded.
       (b) Determining Amount of Punitive Damages.--
       (1) Factors considered.--In determining the amount of 
     punitive damages, if awarded, in a health care lawsuit, the 
     trier of fact shall consider only the following--
       (A) the severity of the harm caused by the conduct of such 
     party;
       (B) the duration of the conduct or any concealment of it by 
     such party;
       (C) the profitability of the conduct to such party;
       (D) the number of products sold or medical procedures 
     rendered for compensation, as the case may be, by such party, 
     of the kind causing the harm complained of by the claimant;
       (E) any criminal penalties imposed on such party, as a 
     result of the conduct complained of by the claimant; and
       (F) the amount of any civil fines assessed against such 
     party as a result of the conduct complained of by the 
     claimant.
       (2) Maximum award.--The amount of punitive damages, if 
     awarded, in a health care lawsuit may be as much as $250,000 
     or as much as two times the amount of economic damages 
     awarded, whichever is greater. The jury shall not be informed 
     of this limitation.
       (c) No Punitive Damages for Products That Comply With FDA 
     Standards.--
       (1) In general.--
       (A) No punitive damages may be awarded against the 
     manufacturer or distributor of a medical product, or a 
     supplier of any component or raw material of such medical 
     product, based on a claim that such product caused the 
     claimant's harm where--
       (i)(I) such medical product was subject to premarket 
     approval, clearance, or licensure by the Food and Drug 
     Administration with respect to the safety of the formulation 
     or performance of the aspect of such medical product which 
     caused the claimant's harm or the adequacy of the packaging 
     or labeling of such medical product; and
       (II) such medical product was so approved, cleared, or 
     licensed; or
       (ii) such medical product is generally recognized among 
     qualified experts as safe and effective pursuant to 
     conditions established by the Food and Drug Administration 
     and applicable Food and Drug Administration regulations, 
     including without limitation those related to packaging and 
     labeling, unless the Food and Drug Administration has 
     determined that such medical product was not manufactured or 
     distributed in substantial compliance with applicable Food 
     and Drug Administration statutes and regulations.
       (B) Rule of construction.--Subparagraph (A) may not be 
     construed as establishing the obligation of the Food and Drug 
     Administration to demonstrate affirmatively that a 
     manufacturer, distributor, or supplier referred to in such 
     subparagraph meets any of the conditions described in such 
     subparagraph.
       (2) Liability of health care providers.--A health care 
     provider who prescribes, or who dispenses pursuant to a 
     prescription, a medical product approved, licensed, or 
     cleared by the Food and Drug Administration shall not be 
     named as a party to a product liability lawsuit involving 
     such product and shall not be liable to a claimant in a class 
     action lawsuit against the manufacturer, distributor, or 
     seller of such product. Nothing in this paragraph prevents a 
     court from consolidating cases involving health care 
     providers and cases involving products liability claims 
     against the manufacturer, distributor, or product seller of 
     such medical product.
       (3) Packaging.--In a health care lawsuit for harm which is 
     alleged to relate to the adequacy of the packaging or 
     labeling of a drug which is required to have tamper-resistant 
     packaging under regulations of the Secretary of Health and 
     Human Services (including labeling regulations related to 
     such packaging), the manufacturer or product seller of the 
     drug shall not be held liable for punitive damages unless 
     such packaging or labeling is found by the trier of fact by 
     clear and convincing evidence to be substantially out of 
     compliance with such regulations.
       (4) Exception.--Paragraph (1) shall not apply in any health 
     care lawsuit in which--
       (A) a person, before or after premarket approval, 
     clearance, or licensure of such medical product, knowingly 
     misrepresented to or withheld from the Food and Drug 
     Administration information that is required to be submitted 
     under the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 
     et seq.) or section 351 of the Public Health Service Act (42 
     U.S.C. 262) that is material and is causally related to the 
     harm which the claimant allegedly suffered
       (B) a person made an illegal payment to an official of the 
     Food and Drug Administration for the purpose of either 
     securing or maintaining approval, clearance, or licensure of 
     such medical product; or
       (C) the defendant caused the medical product which caused 
     the claimant's harm to be misbranded or adulterated (as such 
     terms are used in chapter V of the Federal Food, Drug, and 
     Cosmetic Act (21 U.S.C 351 et seq.)).

     SEC. 107. AUTHORIZATION OF PAYMENT OF FUTURE DAMAGES TO 
                   CLAIMANTS IN HEALTH CARE LAWSUITS.

       (a) In General.--In any health care lawsuit, if an award of 
     future damages, without reduction to present value, equaling 
     or exceeding $50,000 is made against a party with sufficient 
     insurance or other assets to fund a periodic payment of such 
     a judgment, the court shall, at the request of any party, 
     enter a judgment ordering that the future damages be paid by 
     periodic payments, in accordance with the Uniform Periodic 
     Payment of Judgments Act promulgated by the National 
     Conference of Commissioners on Uniform State Laws.
       (b) Applicability.--This section applies to all actions 
     which have not been first set for trial or retrial before the 
     effective date of this title.

     SEC. 108. DEFINITIONS.

       In this title:
       (1) Alternative dispute resolution system; adr.--The term 
     ``alternative dispute resolution system'' or ``ADR'' means a 
     system that provides for the resolution of health care 
     lawsuits in a manner other than through a civil action 
     brought in a State or Federal court.
       (2) Claimant.--The term ``claimant'' means any person who 
     brings a health care lawsuit, including a person who asserts 
     or claims a right to legal or equitable contribution, 
     indemnity, or subrogation, arising out of a health care 
     liability claim or action, and any person on whose behalf 
     such a claim is asserted or such an action is brought, 
     whether deceased, incompetent, or a minor.
       (3) Compensatory damages.--The term ``compensatory 
     damages'' means objectively verifiable

[[Page H1503]]

     monetary losses incurred as a result of the provision of, use 
     of, or payment for (or failure to provide, use, or pay for) 
     health care services or medical products, such as past and 
     future medical expenses, loss of past and future earnings, 
     cost of obtaining domestic services, loss of employment, and 
     loss of business or employment opportunities, damages for 
     physical and emotional pain, suffering, inconvenience, 
     physical impairment, mental anguish, disfigurement, loss of 
     enjoyment of life, loss of society and companionship, loss of 
     consortium (other than loss of domestic service), hedonic 
     damages, injury to reputation, and all other nonpecuniary 
     losses of any kind or nature. The term ``compensatory 
     damages'' includes economic damages and noneconomic damages, 
     as such terms are defined in this section.
       (4) Contingent fee.--The term ``contingent fee'' includes 
     all compensation to any person or persons which is payable 
     only if a recovery is effected on behalf of one or more 
     claimants.
       (5) Economic damages.--The term ``economic damages'' means 
     objectively verifiable monetary losses incurred as a result 
     of the provision of, use of, or payment for (or failure to 
     provide, use, or pay for) health care services or medical 
     products, such as past and future medical expenses, loss of 
     past and future earnings, cost of obtaining domestic 
     services, loss of employment, and loss of business or 
     employment opportunities.
       (6) Health care lawsuit.--The term ``health care lawsuit'' 
     means any health care liability claim concerning the 
     provision of health care goods or services or any medical 
     product affecting interstate commerce, or any health care 
     liability action concerning the provision of health care 
     goods or services or any medical product affecting interstate 
     commerce, brought in a State or Federal court or pursuant to 
     an alternative dispute resolution system, against a health 
     care provider, a health care organization, or the 
     manufacturer, distributor, supplier, marketer, promoter, or 
     seller of a medical product, regardless of the theory of 
     liability on which the claim is based, or the number of 
     claimants, plaintiffs, defendants, or other parties, or the 
     number of claims or causes of action, in which the claimant 
     alleges a health care liability claim. Such term does not 
     include a claim or action which is based on criminal 
     liability; which seeks civil fines or penalties paid to 
     Federal, State, or local government; or which is grounded in 
     antitrust.
       (7) Health care liability action.--The term ``health care 
     liability action'' means a civil action brought in a State or 
     Federal court or pursuant to an alternative dispute 
     resolution system, against a health care provider, a health 
     care organization, or the manufacturer, distributor, 
     supplier, marketer, promoter, or seller of a medical product, 
     regardless of the theory of liability on which the claim is 
     based, or the number of plaintiffs, defendants, or other 
     parties, or the number of causes of action, in which the 
     claimant alleges a health care liability claim.
       (8) Health care liability claim.--The term ``health care 
     liability claim'' means a demand by any person, whether or 
     not pursuant to ADR, against a health care provider, health 
     care organization, or the manufacturer, distributor, 
     supplier, marketer, promoter, or seller of a medical product, 
     including, but not limited to, third-party claims, cross-
     claims, counter-claims, or contribution claims, which are 
     based upon the provision of, use of, or payment for (or the 
     failure to provide, use, or pay for) health care services or 
     medical products, regardless of the theory of liability on 
     which the claim is based, or the number of plaintiffs, 
     defendants, or other parties, or the number of causes of 
     action.
       (9) Health care organization.--The term ``health care 
     organization'' means any person or entity which is obligated 
     to provide or pay for health benefits under any health plan, 
     including any person or entity acting under a contract or 
     arrangement with a health care organization to provide or 
     administer any health benefit.
       (10) Health care provider.--The term ``health care 
     provider'' means any person or entity required by State or 
     Federal laws or regulations to be licensed, registered, or 
     certified to provide health care services, and being either 
     so licensed, registered, or certified, or exempted from such 
     requirement by other statute or regulation.
       (11) Health care goods or services.--The term ``health care 
     goods or services'' means any goods or services provided by a 
     health care organization, provider, or by any individual 
     working under the supervision of a health care provider, that 
     relates to the diagnosis, prevention, or treatment of any 
     human disease or impairment, or the assessment or care of the 
     health of human beings.
       (12) Malicious intent to injure.--The term ``malicious 
     intent to injure'' means intentionally causing or attempting 
     to cause physical injury other than providing health care 
     goods or services.
       (13) Medical product.--The term ``medical product'' means a 
     drug, device, or biological product intended for humans, and 
     the terms ``drug'', ``device'', and ``biological product'' 
     have the meanings given such terms in sections 201(g)(1) and 
     201(h) of the Federal Food, Drug and Cosmetic Act (21 U.S.C. 
     321(g)(1) and (h)) and section 351(a) of the Public Health 
     Service Act (42 U.S.C. 262(a)), respectively, including any 
     component or raw material used therein, but excluding health 
     care services.
       (14) Noneconomic damages.--The term ``noneconomic damages'' 
     means damages for physical and emotional pain, suffering, 
     inconvenience, physical impairment, mental anguish, 
     disfigurement, loss of enjoyment of life, loss of society and 
     companionship, loss of consortium (other than loss of 
     domestic service), hedonic damages, injury to reputation, and 
     all other nonpecuniary losses of any kind or nature.
       (15) Punitive damages.--The term ``punitive damages'' means 
     damages awarded, for the purpose of punishment or deterrence, 
     and not solely for compensatory purposes, against a health 
     care provider, health care organization, or a manufacturer, 
     distributor, or supplier of a medical product. Punitive 
     damages are neither economic nor noneconomic damages.
       (16) Recovery.--The term ``recovery'' means the net sum 
     recovered after deducting any disbursements or costs incurred 
     in connection with prosecution or settlement of the claim, 
     including all costs paid or advanced by any person. Costs of 
     health care incurred by the plaintiff and the attorneys' 
     office overhead costs or charges for legal services are not 
     deductible disbursements or costs for such purpose.
       (17) State.--The term ``State'' means each of the several 
     States, the District of Columbia, the Commonwealth of Puerto 
     Rico, the Virgin Islands, Guam, American Samoa, the Northern 
     Mariana Islands, the Trust Territory of the Pacific Islands, 
     and any other territory or possession of the United States, 
     or any political subdivision thereof.

     SEC. 109. EFFECT ON OTHER LAWS.

       (a) Vaccine Injury.--
       (1) To the extent that title XXI of the Public Health 
     Service Act establishes a Federal rule of law applicable to a 
     civil action brought for a vaccine-related injury or death--
       (A) this title does not affect the application of the rule 
     of law to such an action; and
       (B) any rule of law prescribed by this title in conflict 
     with a rule of law of such title XXI shall not apply to such 
     action.
       (2) If there is an aspect of a civil action brought for a 
     vaccine-related injury or death to which a Federal rule of 
     law under title XXI of the Public Health Service Act does not 
     apply, then this title or otherwise applicable law (as 
     determined under this title) will apply to such aspect of 
     such action.
       (b) Other Federal Law.--Except as provided in this section, 
     nothing in this title shall be deemed to affect any defense 
     available to a defendant in a health care lawsuit or action 
     under any other provision of Federal law.

     SEC. 110. STATE FLEXIBILITY AND PROTECTION OF STATES' RIGHTS.

       (a) Health Care Lawsuits.--The provisions governing health 
     care lawsuits set forth in this title 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 title. The provisions governing 
     health care lawsuits set forth in this title supersede 
     chapter 171 of title 28, United States Code, to the extent 
     that such chapter--
       (1) provides for a greater amount of damages or contingent 
     fees, a longer period in which a health care lawsuit may be 
     commenced, or a reduced applicability or scope of periodic 
     payment of future damages, than provided in this title; or
       (2) prohibits the introduction of evidence regarding 
     collateral source benefits, or mandates or permits 
     subrogation or a lien on collateral source benefits.
       (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 
     provided by this title or create a cause of action.
       (c) State Flexibility.--No provision of this title shall be 
     construed to preempt--
       (1) any State law (whether effective before, on, or after 
     the date of the enactment of this title) that specifies a 
     particular monetary amount of compensatory or punitive 
     damages (or the total amount of damages) that may be awarded 
     in a health care lawsuit, regardless of whether such monetary 
     amount is greater or lesser than is provided for under this 
     title, notwithstanding section 4(a); or
       (2) any defense available to a party in a health care 
     lawsuit under any other provision of State or Federal law.

     SEC. 111. APPLICABILITY; EFFECTIVE DATE.

       This title shall apply to any health care lawsuit brought 
     in a Federal or State court, or subject to an alternative 
     dispute resolution system, that is initiated on or after the 
     date of the enactment of this title, except that any health 
     care lawsuit arising from an injury occurring prior to the 
     date of the enactment of this title shall be governed by the 
     applicable statute of limitations provisions in effect at the 
     time the injury occurred.

          TITLE II--REPEAL OF INDEPDENT PAYMENT ADVISORY BOARD

     SEC. 201. SHORT TITLE.

       This title may be cited as the ``Medicare Decisions 
     Accountability Act of 2012''.

     SEC. 202. REPEAL OF THE INDEPENDENT PAYMENT ADVISORY BOARD.

       Effective as of the enactment of the Patient Protection and 
     Affordable Care Act (Public Law 111 148), sections 3403 and 
     10320 of such Act (including the amendments made by such 
     sections, but excluding subsection (d) of section 1899A of 
     the Social Security Act, as added and amended by such 
     sections) are repealed, and any provision of law amended by 
     such sections is hereby restored as if such sections had not 
     been enacted into law.

  The Acting CHAIR. No further amendment to the bill, as amended, shall 
be in order except those printed in House Report 112 416. Each such 
further amendment may be offered only in the order printed in the 
report, by a Member designated in the report, shall

[[Page H1504]]

be considered read, shall be debatable for the time specified in the 
report, equally divided and controlled by the proponent and an 
opponent, shall not be subject to amendment, and shall not be subject 
to a demand for division of the question.

                              {time}  1020


                 Amendment No. 1 Offered by Mr. Woodall

  The Acting CHAIR. It is now in order to consider amendment No. 1 
printed in House Report 112 416.
  Mr. WOODALL. Madam Chairman, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

      Page 1, strike line 9 through page 3, line 8 and insert the 
     following:

     SEC. 102. PURPOSE.

       It is the purpose of this title to implement reasonable, 
     comprehensive, and effective health care liability reforms 
     designed to--

  The Acting CHAIR. Pursuant to House Resolution 591, the gentleman 
from Georgia (Mr. Woodall) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Georgia.
  Mr. WOODALL. Madam Chairman, my amendment is a very straightforward 
amendment. But before I actually talk about the text of it, I want to 
speak about the real accomplishment of my friend from Georgia, who is 
the sponsor of the underlying legislation, H.R. 5.
  The Washington Times did an article on this Congress and called it 
one of the most ineffective Congresses in history because they looked 
at how many laws we passed. But then they went on, and they looked at 
how many days of debate we'd had, how many votes we'd had, how many 
issues that were important to the American people have we been able to 
expose in this Congress that we have not been able to expose in 
Congress before Congress before Congress before Congress in the past, 
and, Madam Chair, that's what we have today.
  This bill, introduced by my good friend from Georgia, gives the 
American people an opportunity to discuss something that is on every 
single family's mind in this country when it comes to health care, and 
that is controlling the cost of medical malpractice litigation.
  Now, in this body, I'm sure we could disagree about the myriad ways 
there are to control it, but we can agree, I suspect--man and woman, 
Democrat and Republican--that it has to be controlled. And I thank my 
colleague from Georgia for having the courage and the stick-to-itness 
to bring this bill to the floor after so many years of silence on this 
issue.
  Madam Chair, my amendment simply strikes the findings section of the 
bill. As you know, findings are nonbinding parts of the legislation 
that speak to the intent of Congress. And this issue is, again, such a 
passionate one, not just for the 435 Members of this House, but for the 
300 million Americans across this country. I choose to let the 
legislation speak for itself.
  This legislation has been carved out with states' rights provisions 
in it, to make sure the States have the flexibility that they need. It 
has been carved out with input from physicians, from attorneys, from 
families, from providers all across the board.
  So my amendment, Madam Chair, would not change the substance of the 
bill but would simply eliminate the findings section to allow the 
substance of the bill to speak for itself.
  And with that, I reserve the balance of my time.
  Mr. CONYERS. I rise in opposition to the Woodall amendment.
  The Acting CHAIR. The gentleman from Michigan is recognized for 5 
minutes.
  Mr. CONYERS. Madam Chair, we're striking the findings. By striking 
statements of constitutional authority for the bill, the amendment 
recognizes that many Members of the House question Congress' 
constitutional authority to pass H.R. 5. So for that reason, my 
colleagues, the findings are all important. Supporters of states' 
rights ought to take the next step and eliminate the section of the 
bill that preempts State law. Indeed, many supporters of the underlying 
bill have spent years arguing that decisions about health care are 
fundamentally prerogatives of the State.
  So I have only 18 conservative or Republican scholars and leaders 
that agree with me, including the Heritage Foundation; the Virginia 
attorney general, Mr. Cuccinelli; the constitutional law professor at 
Georgetown Law Center; the distinguished Senator from Oklahoma, Mr. 
Coburn; some of our colleagues, including Judge Ted Poe of Texas, our 
colleague from Nebraska, Lee Terry, former judge Louie Gohmert, in 
particular, Ron Paul; the founder of the Tea Party Nation, Judson 
Phillips.
  It goes on and on, where we are all in agreement that the findings 
are, indeed, critical and ought to be left in the bill. To take the 
findings out is incredible because we say that the Federal Government 
shouldn't be involved, that it's a State matter, and tort law, itself, 
is a State matter.
  So for those reasons, Madam Chair, I am pleased to represent a 
bipartisan group of Members and scholars that very strenuously object 
to the findings being removed in this Woodall amendment.

       Here's what conservative scholars and leaders have to say 
     about this hypocrisy:
       Heritage Foundation: Despite H.R. 5's reliance on the 
     Commerce Clause, Congress has no business (and no authority 
     under the Constitution) telling states what the rules should 
     be governing medical malpractice claims.
       Ken Cuccinelli, Virginia Attorney General: Senate Bill 197 
     takes an approach that implies ``Washington knows best'' 
     while trampling states'' authority and the 10th Amendment. 
     The legislation is breathtakingly broad in its assumptions 
     about federal power, particularly the same 1 power to 
     regulate commerce that lies at the heart of all the lawsuits 
     (including Virginia's) against the individual mandate of the 
     2010 federal health-care law. I have little doubt that the 
     senators who brought us S. 197 oppose the use of the commerce 
     clause to compel individuals to buy health insurance. Yet 
     they have no qualms about dictating to state court judges how 
     they are to conduct trials in state lawsuits. How does this 
     sort of constitutional disconnect happen?
       And if [S. 197, a medical malpractice bill] it were ever 
     signed into law--by a Republican or Democratic president--
     would file suit against it just as fast as I filed suit when 
     the federal health-care bill was signed into law in March 
     2010.
       Randy Barnett, Constitution law professor at Georgetown Law 
     Center and senior fellow at the Cato Institute: This bill 
     [H.R. 5] alters state medical malpractice rules by, for 
     example, placing caps on noneconomic damages. But tort law--
     the body of rules by which persons seek damages for injuries 
     to their person and property--have always been regulated by 
     states, not the federal government. Tort law is at the heart 
     of what is called the `police power' of states. What 
     constitutional authority did the supporters of the bill rely 
     upon to justify interfering with state authority in this way?
       Constitutional law professors have long cynically ridiculed 
     a `fair-weather federalism' that is abandoned whenever it is 
     inconvenient to someone's policy preferences. If House 
     Republicans ignore their Pledge to America to assess the 
     Constitution themselves, and invade the powers `reserved to 
     the states' as affirmed by the Tenth Amendment, they will 
     prove my colleagues right.
       Senator Tom Coburn (R OK): What I worry about as a fiscal 
     conservative and also as a constitutionalist, is that the 
     first time we put our nose under the tent to start telling 
     Oklahoma or Ohio or Michigan what their tort law will be, 
     where will it stop? In other words, if we can expand the 
     commerce clause enough to mandate that you have to buy health 
     insurance, then I'm sure nobody would object to saying we can 
     extend it enough to say what your tort law is going to be. 
     Then we are going to have the federal government telling us 
     what our tort laws are going to be in healthcare, and what 
     about our tort laws in everything else? Where does it stop?
       One of the things our founders believed was that our 13 
     separate states could actually have some unique identity 
     under this constitution and maybe do things differently, and 
     I think we ought to allow that process to continue as long as 
     we are protecting human and civil rights.
       Congressman Lee Terry (R NE): If you're a true believer in 
     the 10th Amendment, then why are we not allowing the states 
     to continue to create their own laws and decide what's in 
     their best interest for their residents?
       Congressman Ted Poe (R TX): The question is: does the 
     federal government have the authority under the Commerce 
     Clause to override state law on liability caps? 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. . . . but 
     I have concerns with the current bill as written.
       Congressman Louie Gohmert (R TX): The right of the states 
     for self-determination is enshrined in the 10th Amendment . . 
     . I am reticent to support Congress imposing its

[[Page H1505]]

     will on the states by dictating new state law in their own 
     state courts.
       Congressman Ron Paul (R TX): The federal government 
     shouldn't be involved. It's a state matter; tort law is a 
     state matter.
       Congressman John Duncan (R TN): I have faith in the 
     people--I have faith in the jury system. It's one of the most 
     important elements of our freedom, and it was so recognized 
     in the Constitution, was felt to be so important, it was 
     specifically put into the Constitution in the Seventh 
     Amendment. And I'll tell you, it's a very dangerous thing to 
     take away rights like that from the people.
       Senator Mike Lee (R UT) on tort reform: Congress needs to 
     be very careful when it enters into a uniquely state law area 
     like tort. So tort reform needs to be undertaken very 
     carefully insofar as it done at the federal leve1.
       Judson Phillips, founder of Tea Party Nation: Some 
     conservatives complain opposing unconstitutional tort reform 
     rewards the trial lawyers. The trial lawyers may benefit from 
     stopping unconstitutional tort reform, but we fight to 
     protect the Constitution. In this case, the trial lawyers are 
     with us supporting the 10th Amendment.
       Robert Natelson, senior fellow at the Independence 
     Institute: To be blunt: H.R. 5 flagrantly contravenes the 
     limitations the Constitution places upon Congress, and 
     therefore violates both the Ninth and Tenth Amendments. . . . 
     During the debate over ratification of the Constitution, 
     leading Founders specifically represented that the subject-
     matter of H.R. 5 was outside federal enumerated powers and 
     reserved to the states.
       John Baker, Catholic University law professor: House 
     Republicans hope to nationalize medical malpractice law, 
     which is traditionally a matter of state tort law, by passing 
     H.R. 5, a bill that would wipe out all state medical 
     malpractice laws and complete the nationalization of 
     healthcare. Passage of H.R. 5 would undercut arguments that 
     Obamacare is unconstitutional.
       Carrie Severino, chief counsel and policy director at the 
     Judicial Crisis Network: Among other things, S. 197 sets a 
     statute of limitations for claims, caps damages and creates 
     standards for expert witnesses . . . but they are not within 
     the constitutional powers granted to the federal government 
     for the very same reasons Obamacare is not.
       The law's own justification for its constitutional 
     authority should be chilling to anyone committed to limited 
     federal power. The bill's findings state that health care and 
     health insurance are industries that `affect interstate 
     commerce,' and conclude that Congress therefore has Commerce 
     Clause power to regulate them--even when it involves an in-
     state transaction between a doctor and patient, governed by 
     in-state medical malpractice laws.

  I yield back the balance of my time.
  Mr. WOODALL. Madam Chair, I yield myself such time as I may consume 
to say that, as a freshman in this body, I've had to learn a few things 
over the last 15 months here serving in this body, and what I have 
learned is that I haven't been able to get every bill that I want out 
of this House the exact way I want it when it leaves here. It has been 
much to my chagrin. I thought I was going to be able to come here and 
make every bill perfect before it leaves here. But not only can I not 
make it perfect before it goes, but then I have to deal with that 
United States Senate, and that has proved to be the most complicated 
part of this process.
  There are absolutely, as the gentleman has listed, folks who have 
concerns about the underlying nature of this bill. But if not for this 
Gingrey bill, we wouldn't be able to have this conversation at all. If 
not for the courage of folks to step out on the ledge and begin this 
conversation, we wouldn't be able to have it at all.
  If we are to advance the cause of litigation reform in this country, 
if we are to control the inaccessibility of health care that comes from 
rising costs, then we have to be willing to come to the floor of this 
House and have the kinds of debates that my friend from Georgia has 
made possible today. That's true.
  I may disagree with some of the ways that we've gotten here--and by 
striking the findings, we make no conclusions today about why we're 
here--but we make the certain conclusion today that if we don't begin 
this process, we will never bring it to conclusion. If we don't have 
this discussion today, Madam Chair, we will never solve these issues.
  Mr. CONYERS. Would the gentleman yield?
  Mr. WOODALL. I would be happy to yield to the ranking member.
  Mr. CONYERS. I thank the gentleman for his courtesy. But why, as a 
new Member--and we welcome you to this body--why would we strike all 
the findings from H.R. 5?
  Mr. WOODALL. Reclaiming my time, and I thank the ranking member for 
his question. And that's a good way to conclude, Madam Chair.
  The reason is because the language of the bill speaks for itself. The 
language of the bill speaks for itself. When this bill passes the House 
today, Madam Chair, we will have the U.S. House of Representatives on 
record about solutions to the malpractice challenges that face this 
Nation. But there is no need to be on the record today, Madam Chair, 
about all of the different ways that we got here. Because I might 
disagree with my friend from Georgia about how we got here. I would 
certainly disagree with my friend from Michigan about how we got here.
  But what is important is that we begin to take those steps forward. 
And with the removal of these findings, we are going to be able to let 
that language stand on its face for this House to have the free and 
open debate that I'm looking forward to today.
  I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from Georgia (Mr. Woodall).
  The question was taken; and the Acting Chair announced that the ayes 
appeared to have it.
  Mr. CONYERS. Madam Chair, I demand a recorded vote.
  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further 
proceedings on the amendment offered by the gentleman from Georgia will 
be postponed.

                              {time}  1030


                Amendment No. 2 Offered by Ms. Bonamici

  The Acting CHAIR. It is now in order to consider amendment No. 2 
printed in House Report 112 416.
  Ms. BONAMICI. Madam Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 23, line 22, strike ``date of enactment'' and insert 
     ``effective date''.
       Page 23, line 24, strike ``date of enactment'' and insert 
     ``effective date''.
       Page 24, line 2, insert after ``the injury occurred'' the 
     following: ``This title shall take effect only on the date 
     the Secretary of Health and Human Services submits to 
     Congress a report on the potential effect of this title on 
     health care premium reductions.''.

  The Acting CHAIR. Pursuant to House Resolution 591, the gentlewoman 
from Oregon (Ms. Bonamici) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Oregon.
  Ms. BONAMICI. My amendment to H.R. 5 simply requires the Secretary of 
Health and Human Services to submit a report to Congress detailing the 
effect that the tort reform provisions in this bill would have on 
health care premiums and delays the effective date of title I of the 
bill until that report is submitted.
  For years, proponents of tort reform have tried to convince Americans 
that skyrocketing health care costs are entirely attributable to greedy 
plaintiffs and runaway jury awards. They recite anecdotes about doctors 
closing their practices, refusing to deliver babies or perform 
surgeries, for fear of being sued. But, Madam Chair, we should not be 
making Federal policy based on anecdotes.
  If recent independent research is any indication, the report that the 
Secretary submits to Congress under this amendment is unlikely to find 
that the bill will have any meaningful effect on health care premiums. 
Recent analysis in States adopting restrictions similar to those in 
this bill has found no substantial impact on the consumer cost of 
health care, nor has access to health providers improved as a result.
  Proponents of tort reform claim that capping damages will drive down 
the cost of medical malpractice insurance and that doctors will pass 
this savings along to patients. But 2 years ago, CBO found that 
malpractice insurance premiums, settlements, and awards account for 
just a tiny fraction of total health care expenditures. In 27 States 
where damages have been capped, the medical malpractice premiums are 
not lower on average than in States without caps.
  My amendment asks for data on how this bill will affect the cost of 
health care for all Americans. Now, I want to be very clear--no one 
should be compensated for a frivolous lawsuit. But there are ways to 
address frivolous

[[Page H1506]]

lawsuits without infringing on the rights of those who truly have been 
injured by medical mistakes.
  What this bill does accomplish ought to frighten anyone who believes 
in the rights of States to govern themselves and the rights of 
individuals to be compensated for loss. This bill tramples over the 
rights of States to enact laws governing their own tort systems, and it 
severely restricts individuals' rights to be compensated for all the 
losses caused by health care providers.
  In my home State of Oregon, for example, our supreme court has held 
that most statutory caps on noneconomic damages are unconstitutional. 
And Oregon is not alone. At least 12 other States have some 
constitutional prohibition against these types of restrictions. This 
bill not only overrides State laws and constitutions governing punitive 
and noneconomic damage awards; it also addresses States' statutes of 
limitations, pleading standards, attorney-fee provisions, and joint 
liability. But it does not stop there.
  Although this bill is being presented as medical malpractice reform, 
it reaches far beyond professional malpractice against doctors to 
include product liability cases against drug and device manufacturers, 
bad-faith claims against HMOs and insurance companies, and negligence 
suits against nursing homes. And it would take away all of the State 
and individual rights in far-reaching areas of the health care industry 
without evidence that doing so will lower the premiums for Americans. 
This is an unwarranted intrusion in personal liberty and a giveaway to 
insurance companies. So we should know if it's going to lower health 
care premiums.
  If this Congress is going to enact a sweeping bill nullifying 
longstanding State law and trampling on State constitutional rights, 
it's not too much to ask that we arm ourselves with the knowledge of 
how this will actually affect American families. This amendment simply 
requires the Secretary of Health and Human Services to submit a report 
to Congress with that information before title I of this bill takes 
effect--a reasonable requirement.
  I reserve the balance of my time.
  Mr. GINGREY of Georgia. Madam Chair, I rise in opposition to the 
Bonamaci amendment.
  The Acting CHAIR. The gentleman is recognized for 5 minutes.
  Mr. GINGREY of Georgia. I rise in opposition to the Bonamici 
amendment because it would indefinitely delay critical medical 
liability reforms that will save American taxpayers tens of billions of 
dollars and save our health care system upwards of $200 billion a year 
in unnecessary spending.
  The amendment before us would delay enactment of the tort reforms 
outlined in H.R. 5 until the Secretary of Health and Human Services 
submits a report to Congress on the potential effects of medical 
liability reform on health care premiums. However, the amendment does 
not require the Secretary to produce a report by a date certain. In 
fact, the Secretary could simply choose to never issue a report and 
forever delay the reforms at the heart of this underlying bill.
  Regardless of what one thinks about H.R. 5, I do not believe it is 
appropriate to vest the Secretary of Health and Human Services with the 
authority to permanently block enactment of a law based on the 
inability to produce a report. I realize that there are some who might 
disagree because they would like to provide the Secretary with the 
authority under IPAB to unilaterally dictate the medical choices of 
seniors. Given the track record of this administration on liability 
reform and their failure to address the issues in ObamaCare, HHS should 
not be given the power to bob and weave on this issue once again.
  I do find the amendment somewhat ironic, and I actually wish the 
author of the amendment was in Congress during debate over PPACA. Maybe 
if we had this type of amendment then, we would not be saddled with a 
law that has taken away people's health care choices and raised their 
health care premiums. We were promised that the law would reduce health 
care premiums by $2,500 a year. During debate on PPACA we knew that 
that was not true, and the CBO told Congress that it was not true. What 
was common sense is coming to fruition now. The law has given us a 
billion-dollar new bureaucracy, and it's fueling ever-increasing health 
care and premium costs.
  In this case, Madam Chairman, this amendment is not needed because we 
have seen that real medical liability reform can and will reduce costs. 
It will stop the vicious cycle of frivolous lawsuits and defensive 
medicine. It will make our health care system more efficient and 
actually reduce unnecessary spending in the health care system, another 
thing the health care law failed to do. We do not need this amendment.
  With that, Madam Chairman, I yield 1 minute to the distinguished 
majority leader, the gentleman from Virginia (Mr. Cantor).
  Mr. CANTOR. I thank the gentleman.
  Madam Chair, I rise in opposition to this amendment, which would 
simply delay the implementation of what we know is a cost-savings 
measure to so many millions of seniors--and so many millions of 
Americans, not just seniors.
  Madam Chair, today we will vote to repeal one of PPACA's most harmful 
provisions, the Independent Payment Advisory Board. IPAB is emblematic 
of the two very different visions held by Republicans and Democrats 
about the path to quality care and how to control costs in our health 
care system.
  Madam Chair, the President and his party want a centralized board of 
bureaucrats to control decisions about how health care is allocated to 
our Nation's seniors. He proposes to restrict health care choices in 
order to lower cost. Our American system of free enterprise, 
innovation, and ingenuity has made our health care centers the best in 
the world. Our doctors transform dire health care conditions into 
promising outcomes and healthy lives. We produce the world's lifesaving 
drugs, disease-prevention regimens, biologics, and devices. But IPAB 
hamstrings the best available care for our seniors by imposing 
artificial and arbitrary constraints on cost.
  Neither the President nor congressional Democrats have proposed a 
solution to strengthen Medicare. Instead, the President gives 15 
bureaucrats the power to make fundamental decisions about the care that 
seniors will have access to. Not to be deterred, the President has 
proposed expanding this board numerous times over the past year, vastly 
growing the board's scope and ability to fix prices and ultimately 
ration care for our Nation's seniors.
  Madam Chair, the President and I do agree on this: the current 
Medicare reimbursement system is broken. But we don't need a board of 
unelected bureaucrats to control costs. As we have proposed today, 
there is a better path forward.
  During the health care debate, the President agreed with our Nation's 
doctors that defensive medicine practices are driving up costs. Yet 
meaningful medical liability reform was not included in the 2,000-page 
health care law.
  Madam Chair, as my colleagues have proposed today, we can model 
medical liability reforms on State-based laws. California, Texas, and 
Virginia have all implemented working solutions that drive down the 
cost of care. We can even propose more creative medical liability 
reform solutions. We're always open to new ideas and suggestions. But 
not delay. Moving forward with commonsense medical liability reforms 
will mean that doctors can continue serving patients.

                              {time}  1040

  It means that injured patients will be compensated more quickly and 
fairly. It means health care costs will go down.
  Madam Chair, you don't need a new rationing board to save $3 billion. 
You simply need to enact liability reform policies that are so 
commonsense even States like California and others have had them on the 
books for decades.
  When the entire medical community stands opposed to an idea, I would 
hope that our colleagues on the other side of the aisle and the 
President would listen. ObamaCare's IPAB is not the solution our 
seniors are expecting us to deliver. Our seniors deserve better.
  Madam Chair, I thank Dr. Phil Roe, the gentleman from Tennessee, and 
Dr. Phil Gingrey, the gentlemen from Georgia, for sponsoring the PATH 
Act. I'd also like to recognize Chairman Fred Upton, Chairman Dave 
Camp, and Chairman Lamar Smith for working to strengthen Medicare for 
our seniors. Under their leadership, our House

[[Page H1507]]

committees are advancing policies that will deliver the quality of 
health care the American people deserve.
  Ms. BONAMICI. Madam Chair, I yield 15 seconds to my colleague from 
Michigan (Mr. Conyers).
  Mr. CONYERS. Just to get the facts into this debate, I rise in strong 
support of the Bonamici amendment. I include for the Record the 
Congressional Budget Office letter to Chairman Dreier on March 19 in 
which the CBO estimates that enacting the provision will increase the 
deficits, if you use IPAB, by $3.1 billion.

                                      Congressional Budget Office,


                                                U.S. Congress,

                                   Washington, DC, March 19, 2012.
     Hon. David Dreier,
     Chairman, Committee on the Rules, House of Representatives, 
         Washington, DC.
       Dear Mr. Chairman: The Congressional Budget Office has 
     reviewed H.R. 5, the Help Efficient, Accessible, Low-cost, 
     Timely Healthcare (HEALTH) Act of 2011, as posted on the Web 
     site of the House Committee on Rules on March 12, 2012. CBO 
     estimates that enacting the bill would reduce direct spending 
     and increase revenues; therefore, pay-as-you-go procedures 
     apply. Together, the changes to direct spending and revenues 
     would reduce future deficits by $13.7 billion over the 2013 
     2017 period and by $45.5 billion over the 2013 2022 period.
       Federal spending for active workers participating in the 
     Federal Employees Health Benefits program is included in the 
     appropriations for federal agencies, and is therefore 
     discretionary. H.R. 5 would also affect discretionary 
     spending for health care services paid by the Departments of 
     Defense and Veterans Affairs. CBO estimates that implementing 
     H.R. 5 would reduce discretionary spending by $1.1 billion, 
     assuming appropriations actions consistent with the 
     legislation.
       H.R. 5 would impose limits on medical malpractice 
     litigation in state and federal courts by capping awards and 
     attorney fees, modifying the statute of limitations, and 
     eliminating joint and several liability. It also would repeal 
     the provisions of the Affordable Care Act (ACA) that 
     established the Independent Payment Advisory Board (IPAB) and 
     created a process by which that Board (or the Secretary of 
     the Department of Health and Human Services) would be 
     required under certain circumstances to modify the Medicare 
     program to achieve certain specified savings.
       CBO estimates that the changes in direct spending and 
     revenues resulting from enactment of the limitations on 
     medical malpractice litigation would reduce deficits by $48.6 
     billion over the 2013 2022 period. CBO also estimates that 
     implementing those provisions would reduce discretionary 
     spending by $1.1 billion, assuming appropriations actions 
     consistent with the legislation. The basis for that estimate 
     is described in the cost estimate CBO transmitted on March 
     10, 2011, for the HEALTH Act as ordered reported by the House 
     Committee on the Judiciary on February 16, 2011. The 
     estimated budgetary effects have been updated to assume 
     enactment near the end of fiscal year 2012 and to reflect 
     CBO's current budgetary and economic projections.
       CBO estimates that enacting the provision that would repeal 
     the Independent Payment Advisory Board would increase 
     deficits by $3.1 billion over the 2013 2022 period. The basis 
     for that estimate is described in the cost estimates CBO 
     transmitted on March 7 and March 8, 2012, for H.R. 452 as 
     ordered reported by the House Committee on Energy and 
     Commerce and by the House Committee on Ways and Means, 
     respectively.
       H.R. 5 contains an intergovernmental mandate as defined in 
     the Unfunded Mandates Reform Act (UMRA) because it would 
     preempt state laws that provide less protection for health 
     care providers and organizations from liability, loss, or 
     damages (other than caps on awards for damages). CBO 
     estimates the cost of complying with the mandate would be 
     small and would fall well below the threshold established in 
     UMRA for intergovernmental mandates ($73 million in 2012, 
     adjusted annually for inflation).
       H.R. 5 contains several mandates on the private sector, 
     including caps on damages and on attorney fees, the statute 
     of limitations, and the fair share rule. The cost of those 
     mandates would exceed the threshold established in UMRA for 
     private-sector mandates ($146 million in 2012, adjusted 
     annually for inflation) in four of the first five years in 
     which the mandates were effective.

  Mr. GINGREY of Georgia. Madam Chair, I respect my colleague from 
Oregon, and I know she is well meaning and very thoughtful, but I must 
oppose her amendment. At this time, I urge my colleagues to vote 
against the amendment, and I reserve the balance of my time.
  Ms. BONAMICI. Madam Chairman, this is a reasonable amendment. It 
simply asks that before we make sweeping Federal policy that overrides 
State and individual rights we know what we're getting in return.
  I urge my colleagues to support this very reasonable amendment. I 
yield back the balance of my time.
  Mr. GINGREY of Georgia. Madam Chair, I yield back the balance of my 
time as well.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from Oregon (Ms. Bonamici).
  The question was taken; and the Acting Chair announced that the noes 
appeared to have it.
  Ms. BONAMICI. Madam Chair, I demand a recorded vote.
  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further 
proceedings on the amendment offered by the gentlewoman from Oregon 
will be postponed.
  The Chair understands that amendment No. 3 will not be offered.


                  Amendment No. 4 Offered by Mr. Dent

  The Acting CHAIR. It is now in order to consider amendment No. 4 
printed in House Report 112 416.
  Mr. DENT. Madam Chair, I rise for the purpose of offering an 
amendment.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       At the end of the bill, insert the following:

              TITLE III--HEALTH CARE SAFETY NET ENHANCMENT

     SEC. 301. SHORT TITLE.

       This title may be cited as the ``Health Care Safety Net 
     Enhancement Act of 2012''.

     SEC. 302. PROTECTION FOR EMERGENCY AND RELATED SERVICES 
                   FURNISHED PURSUANT TO EMTALA.

       Section 224(g) of the Public Health Service Act (42 U.S.C. 
     233(g)) is amended--
       (1) in paragraph (4), by striking ``An entity'' and 
     inserting ``Subject to paragraph (6), an entity''; and
       (2) by adding at the end the following:
       ``(6)(A) For purposes of this section--
       ``(i) an entity described in subparagraph (B) shall be 
     considered to be an entity described in paragraph (4); and
       ``(ii) the provisions of this section shall apply to an 
     entity described in subparagraph (B) in the same manner as 
     such provisions apply to an entity described in paragraph 
     (4), except that--
       ``(I) notwithstanding paragraph (1)(B), the deeming of any 
     entity described in subparagraph (B), or of an officer, 
     governing board member, employee, contractor, or on-call 
     provider of such an entity, to be an employee of the Public 
     Health Service for purposes of this section shall apply only 
     with respect to items and services that are furnished to an 
     individual pursuant to section 1867 of the Social Security 
     Act and to post stabilization services (as defined in 
     subparagraph (D)) furnished to such an individual;
       ``(II) nothing in paragraph (1)(D) shall be construed as 
     preventing a physician or physician group described in 
     subparagraph (B)(ii) from making the application referred to 
     in such paragraph or as conditioning the deeming of a 
     physician or physician group that makes such an application 
     upon receipt by the Secretary of an application from the 
     hospital or emergency department that employs or contracts 
     with the physician or group, or enlists the physician or 
     physician group as an on-call provider;
       ``(III) notwithstanding paragraph (3), this paragraph shall 
     apply only with respect to causes of action arising from acts 
     or omissions that occur on or after January 1, 2012;
       ``(IV) paragraph (5) shall not apply to a physician or 
     physician group described in subparagraph (B)(ii);
       ``(V) the Attorney General, in consultation with the 
     Secretary, shall make separate estimates under subsection 
     (k)(1) with respect to entities described in subparagraph (B) 
     and entities described in paragraph (4) (other than those 
     described in subparagraph (B)), and the Secretary shall 
     establish separate funds under subsection (k)(2) with respect 
     to such groups of entities, and any appropriations under this 
     subsection for entities described in subparagraph (B) shall 
     be separate from the amounts authorized by subsection (k)(2);
       ``(VI) notwithstanding subsection (k)(2), the amount of the 
     fund established by the Secretary under such subsection with 
     respect to entities described in subparagraph (B) may exceed 
     a total of $10,000,000 for a fiscal year; and
       ``(VII) subsection (m) shall not apply to entities 
     described in subparagraph (B).
       ``(B) An entity described in this subparagraph is--
       ``(i) a hospital or an emergency department to which 
     section 1867 of the Social Security Act applies; and
       ``(ii) a physician or physician group that is employed by, 
     is under contract with, or is an on-call provider of such 
     hospital or emergency department, to furnish items and 
     services to individuals under such section.
       ``(C) For purposes of this paragraph, the term `on-call 
     provider' means a physician or physician group that--
       ``(i) has full, temporary, or locum tenens staff privileges 
     at a hospital or emergency department to which section 1867 
     of the Social Security Act applies; and
       ``(ii) is not employed by or under contract with such 
     hospital or emergency department, but agrees to be ready and 
     available to provide services pursuant to section 1867 of the 
     Social Security Act or post-stabilization services to 
     individuals being treated in the hospital or emergency 
     department with or without compensation from the hospital or 
     emergency department.

[[Page H1508]]

       ``(D) For purposes of this paragraph, the term `post 
     stabilization services' means, with respect to an individual 
     who has been treated by an entity described in subparagraph 
     (B) for purposes of complying with section 1867 of the Social 
     Security Act, services that are--
       ``(i) related to the condition that was so treated; and
       ``(ii) provided after the individual is stabilized in order 
     to maintain the stabilized condition or to improve or resolve 
     the condition of the individual.
       ``(E)(i) Nothing in this paragraph (or in any other 
     provision of this section as such provision applies to 
     entities described in subparagraph (B) by operation of 
     subparagraph (A)) shall be construed as authorizing or 
     requiring the Secretary to make payments to such entities, 
     the budget authority for which is not provided in advance by 
     appropriation Acts.
       ``(ii) The Secretary shall limit the total amount of 
     payments under this paragraph for a fiscal year to the total 
     amount appropriated in advance by appropriation Acts for such 
     purpose for such fiscal year. If the total amount of payments 
     that would otherwise be made under this paragraph for a 
     fiscal year exceeds such total amount appropriated, the 
     Secretary shall take such steps as may be necessary to ensure 
     that the total amount of payments under this paragraph for 
     such fiscal year does not exceed such total amount 
     appropriated.''.

     SEC. 303. CONSTITUTIONAL AUTHORITY.

       The constitutional authority upon which this title rests is 
     the power of the Congress to provide for the general welfare, 
     to regulate commerce, and to make all laws which shall be 
     necessary and proper for carrying into execution Federal 
     powers, as enumerated in section 8 of article I of the 
     Constitution of the United States.

  The Acting CHAIR. Pursuant to House Resolution 591, the gentleman 
from Pennsylvania (Mr. Dent) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Pennsylvania.
  Mr. DENT. Madam Chair, I'm pleased to join my colleague, Pete 
Sessions from Texas, on the floor this morning to support a very 
important amendment that we've introduced that would address the crisis 
in access to emergency care by extending liability coverage to on-call 
and emergency room physicians.
  The underlying bill we're debating here today is about patient access 
to care. Now I recognize that ideology may divide the House on the 
underlying bill. But common sense should unite the House on this 
particular amendment. Our former colleague, Bart Gordon of Tennessee, 
had introduced this legislation with me last year. In this session, we 
have bipartisan support for this concept. Mr. Matheson, Mr. Langevin, 
and Mr. Ruppersberger all have cosponsored this legislation that I am 
offering as an amendment. They cosponsored the original bill.
  There's a growing shortage of physicians and specialists willing to 
work in emergency rooms. We've seen it all over the country. A 2006 
Institute of Medicine report, ``The Future of Emergency Care,'' noted 
that the availability of on-call specialists is an acute problem in 
emergency departments and trauma centers. Emergency and trauma care is 
delivered in an inherently challenging environment. Every day, 
physicians providing emergency care make life-and-death decisions with 
little information or time about the patients they're treating.
  I've spoken with surgeons who've told me they dread a Code Blue out 
of fear of a lawsuit. They want to serve these people who are coming 
into these emergency centers but are fearful for their families of a 
lawsuit. That's what medicine has become, unfortunately, because of 
this out-of-control litigation system.
  As a result, these physicians providing emergency and trauma care 
face extraordinary exposure to medical liability claims. Forty percent 
of hospitals say the liability situation has resulted in less physician 
coverage for their emergency departments. According to a report from 
the GAO, soaring medical liability premiums have led specialists to 
reduce or stop on-call services to emergency departments. This trend 
threatens patients' access to emergency surgical services. 
Neurosurgery, orthopedics, and general surgery are the most impacted. 
They also are the services that emergency departments most frequently 
require. Trauma centers across the country have closed. In my home 
State of Pennsylvania, this has been a very serious problem.
  This is an urgent issue that needs to be addressed. This amendment 
would protect access to emergency room care and reduce health care 
costs by allowing emergency and on-call physicians who deliver EMTALA-
related services medical liability protections. EMTALA, the Emergency 
Medical Treatment and Active Labor Act, ensures that any person who 
seeks emergency medical care at a covered facility is guaranteed an 
appropriate screening exam and stabilization treatment before transfer 
or discharge, regardless of their ability to pay. EMTALA is a Federal 
mandate that protects all our citizens, the insured and the uninsured 
alike. This amendment will provide a backstop for the doctors who 
provide these critical services.
  Specifically, the amendment would ensure medical services furnished 
by a hospital, emergency department, or a physician or on-call provider 
under contract with a hospital or emergency department pursuant to the 
EMTALA mandate are provided the same liability coverage currently 
extended to community health centers and health professionals who 
provide Medicaid services at free clinics.
  This amendment will not impact the rights of individuals who have 
been harmed to seek redress. What this amendment will do is ensure 
medical professionals are available to provide critical, timely, 
lifesaving emergency and trauma medical care to all Americans when and 
where it is needed.
  Please join me and Representative Sessions in supporting this 
amendment. If an accident ever happened to any of us, Heaven forbid, we 
want to make sure that there are people in these trauma centers and 
those emergency rooms ready to deal with us and who have nothing on 
their mind but saving our lives, not worrying about lawsuits. So I urge 
adoption of this amendment.
  At this time, I reserve the balance of my time.
  Mr. CONYERS. Madam Chairman, I rise in opposition to this amendment.
  The Acting CHAIR. The gentleman from Michigan is recognized for 5 
minutes.
  Mr. CONYERS. To my colleague, Mr. Dent, hold up. You're giving 
complete immunity to hospitals, physicians, and providers for any 
emergency activity. Do you want to do away with all liability 
whatsoever because it's in an emergency room? Of course, you don't. But 
this amendment requires the Federal Government to pay for the medical 
errors committed and denies our government any ability to address or 
reprimand those who commit medical errors. You don't want to do that. 
You don't want to go that far.
  The Federal Government would be responsible for all occurrences of 
negligence in an emergency room. Please. Ninety-eight thousand patients 
die every year due to preventable medical errors.
  I reserve the balance of my time.


                    Announcement by the Acting Chair

  The Acting CHAIR. Members are advised to address their remarks to the 
Chair.
  Mr. DENT. Madam Chair, just very briefly in answer to my colleague's 
comments, I want to say very briefly that this does not waive 
liability. It simply says that when care is federally mandated under 
EMTALA that there will be Federal liability protection provided to 
those who are providing the care. That's only fair. People still can 
bring action, but there will be Federal liability protection, as there 
should be, because this care is being required under Federal law. I 
think it's completely reasonable.
  At this time, I reserve the balance of my time.
  Mr. CONYERS. But what we're doing in the amendment is to provide 
immunity to all hospitals and physicians and require the Federal 
Government to pay for medical errors committed by them.
  Look, we have 98,000 patients dying every year due to preventable 
medical errors. I'm not slamming the docs and the hospitals. I'm saying 
that we don't want to provide complete immunity.

                              {time}  1050

  This Dent amendment, Madam Chairman, does just that: it provides 
complete immunity.
  So I'm asking my colleagues to please slow down and realize that 
irreparable harm due to negligence in the emergency room--and we've got 
pages

[[Page H1509]]

and pages of examples--would be not subject to adjudication because of 
this amendment. It's a very dangerous amendment. It goes way too far. 
It's overbroad. And I urge my colleagues to carefully examine the 
consequences of this provision.
  I reserve the balance of my time.
  The Acting CHAIR. The gentleman from Pennsylvania has 30 seconds 
remaining.
  Mr. DENT. The only thing I would like to say in response, once again, 
is this immunity protection only applies to care provided under EMPALA, 
and that's federally mandated care. Other activities going on in that 
emergency room or trauma center would not be given this exemption from 
liability, only federally mandated care. It can't be any more clear.
  I reserve the balance of my time.
  The Acting CHAIR. The gentleman from Michigan has 2 minutes 
remaining.
  Mr. CONYERS. Madam Chairman, this amendment would actually lower the 
incentive to practice safe medicine, and I say this on careful 
examination.
  I'm surprised that my colleague, the leader on the other side, 
himself a distinguished doctor, would be silent on this provision 
because it shields hospitals, employed physicians, even physicians who 
are already covered by private insurance; and physicians working in an 
emergency room setting will never be held accountable when they 
wrongfully injure their patient. That is my only reservation and 
objection to what is otherwise an honorably intended revision of this 
measure.
  When hospitals and emergency room departments are not held 
accountable for medical errors and for negligence, then they have no 
incentive to offer quality care or hire competent physicians. Please, I 
beg you to carefully examine the dangers implicit in the Dent-Sessions 
amendment.
  I yield back the balance of my time.
  The Acting CHAIR. The gentleman from Pennsylvania has 15 seconds 
remaining.
  Mr. DENT. In conclusion, this amendment has bipartisan support. As I 
said, our former colleague, Bart Gordon, who was a cosponsor, 
introduced this bill along with me last session. Mr. Langevin is a 
cosponsor of the bill, Mr. Matheson, Mr. Ruppersberger. It makes sense. 
This is important to make sure our citizens have access to emergency 
care should they ever need it.
  At this time, I urge support of the amendment, and I yield back the 
balance of my time.
  Mr. SESSIONS. Madam Chair, I rise to support the amendment to H.R. 5 
that I have co-sponsored with my good friend Congressman Charlie Dent 
of Pennsylvania. The amendment extends critical liability coverage to 
emergency room and on-call physicians and physician groups.
  Madam Chair, we are at a crisis point in this country. In these 
difficult economic times, our emergency rooms have become a source of 
primary care to many of our fellow citizens. At the time that we need 
them the most, nearly half of all emergency rooms in medical liability 
crisis states are under staffed. We face this shortage not because of a 
lack of trained specialists, but because liability coverage costs too 
much due to the unique set of medical challenges that are seen in 
emergency situations.
  By law, emergency rooms must treat anyone who needs care regardless 
of if they have insurance or can afford it. Over the past several 
years, emergency rooms have seen an increase in patients due to the 
number of unemployed and/or uninsured people needing care. We have 
found that our emergency room cases are becoming more complicated and 
frequent, and our doctors do not have the luxury of a complete patient 
history.
  Our emergency physicians are the first line of defense for the health 
care community. As such, we must provide basic liability protections to 
these emergency and on-call physicians. This liability protection is 
critical to maintaining the state of the art emergency facilities that 
we have at our disposal today.
  The Dent-Sessions amendment would deem hospitals, emergency rooms, 
physicians and physicians groups that provide emergency care to 
individuals to be employees of the Public Health Service for purposes 
of any civil action that may arise due to health care items and 
services provided under the Public Health Service Act.
  I commend Congressman Dent for his leadership on this issue and would 
ask my colleagues to support this amendment which is critical for 
patient care.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from Pennsylvania (Mr. Dent).
  The amendment was agreed to.


                  Amendment No. 5 Offered by Mr. Gosar

  The Acting CHAIR. It is now in order to consider amendment No. 5 
printed in House Report 112 416.
  Mr. GOSAR. Madam Chairman, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       At the end of the bill, add the following (and make such 
     technical and conforming changes as may be appropriate):

TITLE III--RESTORING THE APPLICATION OF ANTITRUST LAWS TO HEALTH SECTOR 
                                INSURERS

     SEC. 301. SHORT TITLE.

       This title may be cited as the ``Health Insurance Industry 
     Fair Competition Act of 2012''.

     SEC. 302. APPLICATION OF THE ANTITRUST LAWS TO THE BUSINESS 
                   OF HEALTH INSURANCE.

       (a) Amendment to McCarran-Ferguson Act.--Section 3 of the 
     Act of March 9, 1945 (15 U.S.C. 1013), commonly known as the 
     McCarran-Ferguson Act, is amended by adding at the end the 
     following:
       ``(c) Nothing contained in this Act shall modify, impair, 
     or supersede the operation of any of the antitrust laws with 
     respect to the business of health insurance. For purposes of 
     the preceding sentence, the term `antitrust laws' has the 
     meaning given it in subsection (a) of the first section of 
     the Clayton Act, except that such term includes section 5 of 
     the Federal Trade Commission Act to the extent that such 
     section 5 applies to unfair methods of competition. For the 
     purposes of this subsection, the term `business of health 
     insurance' shall--
       ``(1) mean `health insurance coverage' offered by a `health 
     insurance issuer' as those terms are defined in section 9001 
     of the Patient Protection and Affordable Care Act, which 
     incorporates by reference and utilizes the definitions 
     included in section 9832 of the Internal Revenue Code (26 
     U.S.C. 9832); and
       ``(2) not include--
       ``(A) life insurance and annuities;
       ``(B) property or casualty insurance, including but not 
     limited to, automobile, medical malpractice or workers' 
     compensation insurance; or
       ``(C) any insurance or benefits defined as `excepted 
     benefits' under section 9832(c) of the Internal Revenue Code 
     (26 U.S.C. 9832(c)), whether offered separately or in 
     combination with products described in subparagraph (A).''.
       (b) Related Provision.--For purposes of section 5 of the 
     Federal Trade Commission Act (15 U.S.C. 45) to the extent 
     such section applies to unfair methods of competition, 
     section 3(c) of the McCarran-Ferguson Act shall apply with 
     respect to the business of health insurance without regard to 
     whether such business is carried on for profit, 
     notwithstanding the definition of ``Corporation'' contained 
     in section 4 of the Federal Trade Commission Act.
       (c) Limitation on Class Actions.--
       (1) Limitation.--No class action may be heard in a Federal 
     or State court on a claim against a person engaged in the 
     business of health insurance for a violation of any of the 
     antitrust laws (as defined in section 3(c) of the Act of 
     March 9, 1945 (15 U.S.C. 1013), commonly known as the 
     McCarran-Ferguson Act).
       (2) Exemption.--Paragraph (1) shall not apply with respect 
     to any action commenced--
       (A) by the United States or any State; or
       (B) by a named claimant for an injury only to itself.

  The Acting CHAIR. Pursuant to House Resolution 591, the gentleman 
from Arizona (Mr. Gosar) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Arizona.
  Mr. GOSAR. Madam Chair, I rise to address the House today in support 
of my amendment to H.R. 5 to amend the McCarran-Ferguson Act. This act 
exempts the business of insurance from many Federal antitrust laws. In 
this modern day and age, it is hard to see why this exemption still 
persists.
  One of the original reasons to carve this exemption for the industry, 
which dates all the way back to 1945, was that insurance companies 
needed to share actuarial information in order to balance risk when 
setting premiums. However, since 1945, our Federal law has evolved to 
include safe harbors to permit companies to share this data as needed. 
I believe that violations of antitrust law cannot always be dealt with 
on the State level anymore as cash-strapped States lack the resources 
to enforce the law against these large, multi-state insurance 
companies. Therefore, it is time for this exemption to be repealed so 
that we can empower health insurance companies to compete more 
aggressively for the consumer dollar, increase competition, increase

[[Page H1510]]

insurance options, empower patients to a patient-centered system, and 
they decrease premiums. Therefore, we all win.
  Lowering the cost of health insurance is a goal we should all share. 
That is why the House passed a very similar measure, H.R. 4626, with 
over 400 votes in 2010.
  There is one key difference between H.R. 4626 and this amendment, a 
difference of which I am proud. My amendment includes a prohibition on 
class action lawsuits in Federal court against these health insurance 
companies.
  The FTC should have the power to investigate bad actors in the health 
insurance industry, but it helps no one if these companies--or for that 
matter, any American businesses--get mired in lawsuits that will cost 
millions. Class action lawsuits often result in big bucks in attorney 
fees for greedy trial attorneys, while leaving only pennies in the 
hands of plaintiffs who are allegedly wronged in the first place.
  For example, let's take the Cobell settlement. Fifteen years ago, a 
group of Native Americans sued the Federal Government and Secretary of 
the Interior, Bruce Babbitt, for mismanagement of their funds and won a 
$3.4 billion settlement only to find out that their attorneys were 
petitioning the judge for over $200 million in fees. This is 
outrageous.
  When the poorest of poor are wronged in this country and are awarded 
a settlement in court, they shouldn't have to split pennies amongst 
themselves as their lawyers walk away with a big fat check. That is the 
spirit behind the tort reform piece of my amendment. I am pleased to 
see this House ready to pass significant tort reform today and 
encourage all my colleagues to support my amendment as well as the 
underlying bill.
  I reserve the balance of my time.
  Mr. CONYERS. Madam Chairman, I rise in strong opposition to this 
amendment.
  The Acting CHAIR. The gentleman from Michigan is recognized for 5 
minutes.
  Mr. CONYERS. It is my position that within the good that this does is 
a poison pill. The good is that consumers would also benefit from a 
repeal of McCarran-Ferguson. We salute you. But the poison pill is that 
this measure would ban class actions on a claim for violation of 
antitrust law, which is the cleverest way of ending antitrust law. 
Unless you have a class action--well, my doctor-Congressman is not a 
lawyer, but without class actions, you can't bring a claim because 
nobody's going to file a suit on a $30 issue, 1 million people suing 
for $30 each. So it's a poison pill.
  I'd like to yield such time as he may consume to the gentleman from 
Oregon (Mr. DeFazio), who had an amendment that had huge bipartisan 
support.
  Mr. DeFAZIO. I thank the gentleman for yielding.
  We had, at the end of last Congress, a tremendous bipartisan vote--
406 19--on repealing straight up the antitrust immunity of the 
insurance industry.
  The American people, no matter where they are on the Affordable Care 
Act, agree on one thing: insurance companies should not be able to get 
together and collude to either exclude people from coverage or drive up 
prices. Yet they do. They have an exemption under a law from the 1940s.
  Now, what the gentleman is offering sounds pretty good, but it won't 
get us there because 90 percent of the antitrust cases are private, and 
almost every single one of those cases is a class action. So if you 
preclude class actions, you can pretend you're being tough with the 
insurance industry while you can wink and nod and say, hey, don't worry 
about it because there really won't be any litigation under this; and 
you're still going to be able to skate, and you're still going to be 
able to collude, and you're still going to be able to drive up prices.
  Think of the context in what we're doing. We're talking about IPAB 
today, but they've already voted to repeal the entire Affordable Care 
Act. That means no more restrictions on rescissions--the dirty little 
practice where you've been paying your premium for years and you get 
sick and the insurance company says, sorry, we're not going to renew 
your policy. That's been outlawed.

                              {time}  1100

  They're going to do away with the prohibitions on age discrimination. 
They're going to do away with the prohibitions on preexisting 
conditions. So now we're going to have an insurance industry that is, 
essentially, free from antitrust law, that can take away your policy 
when you get sick, that can discriminate against you because you're 
old, can discriminate against you because you're sick or you have been 
sick, and it would take away the protections and the review of 
excessive rate increases.
  So if we were doing a straight-up, take away their antitrust 
immunity, make them play by the same rules as every other business in 
America, except for professional sports, who are exempt from antitrust 
law, that would be fine. But let's not have this phony fig leaf so you 
can wink and nod to the insurance industry and say, ``Hey, don't worry 
about it; it won't have any impact,'' but we can say to consumers we're 
with them.
  Mr. GOSAR. We failed to realize that what we did here in repeal of 
McCarran-Ferguson is the FTC. It is the FTC. It is the FTC and the 
Department of Justice.
  Right now, privately, yes, you're right. Without the repeal of 
McCarran-Ferguson, there is more coming from the private aspect, but 
that's because we have limited the Federal oversight in the FTC and the 
Department of Justice.
  This compromise is weighted very carefully to make sure that we get 
back to a balance, both Federal and State, and does not oversee the 
states' rights as well.
  I reserve the balance of my time.
  Mr. CONYERS. Madam Chairman, I yield myself the balance of my time.
  We are here debating an overwhelming proposition offered by the 
gentleman from Oregon (Mr. DeFazio), which would have corrected this 
problem so beautifully. But now comes the poison pill, which says no 
more class actions. If you can't bring class actions in this matter, 
then there's no way people with small, valid claims can go into court 
and sue for 30 bucks.
  Now, I think most people understand this without going to law school. 
If you eliminate class actions, you have effectively destroyed the 
McCarran-Ferguson repeal that we are bragging about. So it's a kind of 
undercover scheme. We pretend we're doing something good. We ignore 
DeFazio's overwhelmingly bipartisan supported provision, and we let the 
insurance company through, and they live to continue the vile practices 
that have been revealed and discussed in this debate.
  I yield back the balance of my time.
  Mr. GOSAR. Once again, I want to make sure that everybody understands 
that you're giving Federal oversight of collusion and monopoly. In 
class action lawsuits, what you're doing is not giving it all away, but 
you're limiting the vast improprieties that occur right now with class 
action.
  This is carefully manipulated so that we're moving the balance down 
the field and it balances it out with competition and having some 
oversight over our jurisdiction of judgements that are impugned with 
class action. Class action has gotten way out of line, and most 
American people do understand that classification.
  I yield back the balance of my time.
  Mr. SMITH of Texas. Madam Chair, 2 years ago, during the debate over 
the Obama administration's unconstitutional health care bill, this 
House considered a measure similar to this amendment.
  During that debate, I argued that the repeal of the McCarran-Ferguson 
antitrust exemption for health insurers had ``all the substance of a 
soup made by boiling the shadow of a chicken.'' However, I reluctantly 
supported that bill because I believed that it would have no meaningful 
effect. Compared to the administration's health care bill, a bill that 
does nothing looked like a great idea.
  As I noted during the debate 2 years ago, the repeal of the McCarran-
Ferguson exemption for health insurers will not bring down premiums.
  The Congressional Budget Office (CBO) says that ``whether premiums 
would increase or decrease as a result of this legislation is difficult 
to determine, but in either case the magnitude of the effect is likely 
to be quite small.''
  The effects of the repeal of this exemption will be small. The CBO 
says, ``State laws already bar the activities that would be prohibited 
under Federal law if this bill was enacted.'' Every State's insurance 
regulations

[[Page H1511]]

ban anticompetitive activities like bid rigging, price fixing and 
market allocation. Every State has insurance regulators who already 
actively enforce these prohibitions.
  This amendment, like the bill we considered 2 years ago, will have no 
meaningful impact and may have minor negative unintended consequences.
  But I will once again reluctantly support this measure because this 
amendment takes important steps to limit its unintended consequences 
and to reaffirm the McCarran-Ferguson exemption for non-health lines of 
insurance.
  This amendment contains language that clearly limits its application 
to the business of health insurance. While the repeal of the McCarran-
Ferguson exemption for health insurance does essentially nothing, 
repealing it for other types of insurance could be disastrous.
  One of the main benefits of the McCarran-Ferguson exemption is that 
it allows insurance companies, subject to state regulation, to share 
historical and actuarial data.
  The antitrust laws generally frown on competitors that share data. 
But in the insurance market, sharing data improves competition. This is 
because a shared pool of data about the risks and loss rates of various 
kinds of insurance allows small and medium-sized insurers to enter the 
market and compete.
  If insurance companies did not pool data, only the largest insurers 
would have access to enough data to account for risk and price their 
policies.
  For a number of reasons, which include the size of most health plans, 
the availability of health care data from various public and private 
sources, and the relative predictability of health care costs, health 
insurers rely much less on sharing data than other insurers.
  This amendment contains a clear definition that limits its 
application to the business of health insurance. It clarifies that the 
McCarran-Ferguson exemption continues to apply to life insurance, 
annuities, property and casualty insurance, and other non-health types 
of insurance. It is an improvement over other proposals that are not so 
limited, defined and clear about their intent.
  This amendment also prevents private class action antitrust lawsuits 
against health insurers. This limits the possible unintended negative 
effects.
  Because this amendment is much improved in ways that will limit its 
unintended consequences, and because it reaffirms the importance of the 
McCarran-Ferguson exemption to non-health lines of insurance, I support 
the amendment.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from Arizona (Mr. Gosar).
  The amendment was agreed to.


                 Amendment No. 6 Offered by Mr. Stearns

  The Acting CHAIR. It is now in order to consider amendment No. 6 
printed in House Report 112 416.
  Mr. STEARNS. Madam Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       At the end of the bill, add the following:

     TITLE III--PROTECTIONS FOR GOOD SAMARITAN HEALTH PROFESSIONALS

     SEC. 301. SHORT TITLE.

       This title may be cited as the ``Good Samaritan Health 
     Professionals Act of 2012''.

     SEC. 302. LIMITATION ON LIABILITY FOR VOLUNTEER HEALTH CARE 
                   PROFESSIONALS.

       (a) In General.--Title II of the Public Health Service Act 
     (42 U.S.C. 202 et seq.) is amended by inserting after section 
     224 the following:

     ``SEC. 224A. LIMITATION ON LIABILITY FOR VOLUNTEER HEALTH 
                   CARE PROFESSIONALS.

       ``(a) Limitation on Liability.--Except as provided in 
     subsection (b), a health care professional shall not be 
     liable under Federal or State law for any harm caused by an 
     act or omission of the professional if--
       ``(1) the professional is serving as a volunteer for 
     purposes of responding to a disaster; and
       ``(2) the act or omission occurs--
       ``(A) during the period of the disaster, as determined 
     under the laws listed in subsection (e)(1);
       ``(B) in the health care professional's capacity as such a 
     volunteer; and
       ``(C) in a good faith belief that the individual being 
     treated is in need of health care services.
       ``(b) Exceptions.--Subsection (a) does not apply if--
       ``(1) the harm was caused by an act or omission 
     constituting willful or criminal misconduct, gross 
     negligence, reckless misconduct, or a conscious flagrant 
     indifference to the rights or safety of the individual harmed 
     by the health care professional; or
       ``(2) the health care professional rendered the health care 
     services under the influence (as determined pursuant to 
     applicable State law) of intoxicating alcohol or an 
     intoxicating drug.
       ``(c) Standard of Proof.--In any civil action or proceeding 
     against a health care professional claiming that the 
     limitation in subsection (a) applies, the plaintiff shall 
     have the burden of proving by clear and convincing evidence 
     the extent to which limitation does not apply.
       ``(d) Preemption.--
       ``(1) In general.--This section preempts the laws of a 
     State or any political subdivision of a State to the extent 
     that such laws are inconsistent with this section, unless 
     such laws provide greater protection from liability.
       ``(2) Volunteer protection act.--Protections afforded by 
     this section are in addition to those provided by the 
     Volunteer Protection Act of 1997.
       ``(e) Definitions.--In this section:
       ``(1) The term `disaster' means--
       ``(A) a national emergency declared by the President under 
     the National Emergencies Act;
       ``(B) an emergency or major disaster declared by the 
     President under the Robert T. Stafford Disaster Relief and 
     Emergency Assistance Act; or
       ``(C) a public health emergency determined by the Secretary 
     under section 319 of this Act.
       ``(2) The term `harm' includes physical, nonphysical, 
     economic, and noneconomic losses.
       ``(3) The term `health care professional' means an 
     individual who is licensed, certified, or authorized in one 
     or more States to practice a health care profession.
       ``(4) The term `State' includes each of the several States, 
     the District of Columbia, the Commonwealth of Puerto Rico, 
     the Virgin Islands, Guam, American Samoa, the Northern 
     Mariana Islands, and any other territory or possession of the 
     United States.
       ``(5)(A) The term `volunteer' means a health care 
     professional who, with respect to the health care services 
     rendered, does not receive--
       ``(i) compensation; or
       ``(ii) any other thing of value in lieu of compensation, in 
     excess of $500 per year.
       ``(B) For purposes of subparagraph (A), the term 
     `compensation'--
       ``(i) includes payment under any insurance policy or health 
     plan, or under any Federal or State health benefits program; 
     and
       ``(ii) excludes--
       ``(I) reasonable reimbursement or allowance for expenses 
     actually incurred;
       ``(II) receipt of paid leave; and
       ``(III) receipt of items to be used exclusively for 
     rendering the health services in the health care 
     professional's capacity as a volunteer described in 
     subsection (a)(1).''.
       (b) Effective Date.--
       (1) In general.--This title and the amendment made by 
     subsection (a) shall take effect 90 days after the date of 
     the enactment of this title
       (2) Application.--This title applies to any claim for harm 
     caused by an act or omission of a health care professional 
     where the claim is filed on or after the effective date of 
     this title, but only if the harm that is the subject of the 
     claim or the conduct that caused such harm occurred on or 
     after such effective date.

  The Acting CHAIR. Pursuant to House Resolution 591, the gentleman 
from Florida (Mr. Stearns) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Florida.
  Mr. STEARNS. I yield myself such time as I may consume.
  I have a very simple amendment today. It's the Good Samaritan Health 
Professionals Amendment. This amendment would allow trained medical 
professionals to volunteer across State lines to assist in 
Presidentially declared Federal disaster sites.
  My colleagues, in the aftermath of Hurricane Katrina, we saw 
firsthand how much of a demand there is for trained professionals at 
disaster sites and how there is a need to provide liability protection 
for these very experienced individuals.
  According to the Council of State Governments, the most pressing need 
immediately after Katrina was the availability of medical volunteers. 
However, out-of-state practitioners providing medical treatment face 
the real possibility of noncoverage under their medical malpractice 
policies. Those that volunteer and treat the sick are at risk of 
violating existing statutes and potentially facing criminal or 
administrative penalties or civil liabilities.
  A Baton Rouge newspaper, The Advocate, ran a story in September 2005 
that talked about Dr. Mark Perlmutter, who was in the midst of giving a 
woman chest compressions when FEMA asked him to stop because of issues 
of liability protection.
  CNN ran a story about a doctor who was evacuated to the New Orleans' 
airport. The doctor was amazed to see hundreds of sick people and 
wanted to help them. He wanted to ply his professional talents and heal 
the sick, but

[[Page H1512]]

was prevented from doing so because of legal liability. ``They told us, 
you know, you could help us by mopping the floor,'' and that's what he 
was forced to do. And so he mopped the floor while people died all 
around him.
  What was the cost of inaction because of the litigious society that 
we have? It's incidents like these, my colleagues, that's why I 
introduced the Good Samaritan Health Professionals Act, H.R. 3586. It's 
a very simple bill, and its the foundation for this amendment to the 
PATH Act.
  This amendment would allow medical professionals to volunteer at 
disaster sites. It would provide limited civil liability protection to 
medical volunteers who act on a good faith effort.
  This is limited protection. It still allows victims to sue for 
serious acts such as criminal misconduct, reckless misconduct, or gross 
negligence. It does not cover criminal acts by health volunteers.
  You shouldn't have someone that spent years in college, years in 
medical school, through residency, spent years as a practicing 
physician, push a mop when there's clear need for their services. This 
is wrong, and my amendment will correct that.
  My colleague from Utah Mr. Matheson and myself have a very simple 
amendment today. It is the Good Samaritan Health Professional 
Amendment. This amendment would allow trained medical professionals to 
volunteer across State lines to assist at presidentially declared 
disaster sites.
  In the aftermath of Hurricane Katrina, we saw first hand how much of 
a demand there is for trained professionals at disaster sites and how 
there is a need to provide liability protection.
  According to the Council of State Governments, the most pressing need 
immediately after Katrina was the availability of medical volunteers.
  However, out-of-State practitioners providing medical treatment face 
the real possibility of non-coverage under their medical malpractice 
policies. Those that volunteer and treat the sick are at risk of 
violating existing statues and potentially facing criminal or 
administrative penalties or civil liability.
  A Baton Rouge newspaper, The Advocate, ran a story in September 2005 
that talked about Dr. Mark Perlmutter, who was in the midst of giving a 
woman chest compressions when FEMA asked him to stop because of issues 
of liability protection.
  CNN ran a story about a doctor who was evacuated to the New Orleans 
airport. The doctor was amazed to see hundreds of sick people and 
wanted to help. He wanted to ply his profession and heal the sick, but 
was prevented from doing so because of legal liability. ``They told us, 
you know, you could help us by mopping the floor.'' And so he mopped 
the floors while people died around him.
  What was the cost of inaction because of our litigious society?
  Its incidents like this, that's why I introduced the Good Samaritan 
Health Professional Act, H.R. 3586. It's a very simple bill, and it's 
the foundation for this amendment to the PATH Act.
  This amendment would allow medical professionals to volunteer at 
disaster sites. It would provide limited civil liability protection to 
medical volunteers who act on a good faith effort.
  This is limited protection. It still allows victims to sue for 
serious acts such, as criminal misconduct, reckless misconduct or gross 
negligence. It does not cover criminal acts by health volunteers.
  But for everyone working in good faith and doing the right thing, it 
will provide this basic protection to any trained medical volunteer. It 
will protect:
  Doctors, nurses or physician assistants that treat the injured;
  The psychiatrist, psychologist or therapist that provide emotional 
assistance to those grieving, and;
  The pharmacists or respiratory therapists that helps treat chronic 
conditions like diabetes or COPD.
  You shouldn't have someone that spent years in college, years in 
medical school, been through residency, and spent years as a practicing 
physician, push a mop when there is a clear need for their services.
  This is wrong, and my amendment will correct this.
  The Good Samaritan Health Professional Amendment has a broad 
coalition of supporters. They include:
  The American College of Surgeons
  The American Medical Association
  The American Hospital Association
  The College of Emergency Physicians
  The Neurologists
  The Physician Insurers Association
  The Roundtable of Critical Care
  These are just a sample; there are more medical groups that support 
this amendment. I also would like to submit these letters of support 
into the Record.
  This is a good amendment. It will save lives.

                                 American College of Surgeons,

                                                   March 21, 2012.
     Hon. John Boehner,
     Speaker of the House of Representatives,
     Washington, DC.
       Dear Mr. Speaker: On behalf of the more than 78,000 members 
     of the American College of Surgeons (ACS), I would like to 
     express our support for amending H.R. 5, the Protecting 
     Access to Healthcare (PATH) Act of 2011 to include H.R. 3586, 
     the Good Samaritan Health Professionals Act of 2011 (Stearns/
     Matheson Amendment). The ACS supports this amendment which 
     would ensure disaster victims' access to medically necessary 
     care in a declared emergency.
       Rapid medical response in a disaster can greatly decrease 
     loss of life and improve outcomes for patients who 
     desperately need assistance. Surgeons in particular, with 
     their training in trauma and critical care, play a major role 
     in the health care community's response to most disaster 
     situations. Properly trained volunteers are critical in such 
     circumstances.
       However, due to inconsistent state laws and lack of federal 
     policy, it is often unclear whether protections against 
     unnecessary lawsuits exist for medical volunteers who cross 
     state lines. Sadly, this lack of uniformity has greatly 
     hindered the ability of volunteer health professionals to 
     provide care; in some cases, volunteer health professionals 
     have even been turned away due to uncertainty about potential 
     liability.
       Enactment of the Stearns/Matheson amendment would provide 
     volunteer health professionals with the same level of civil 
     immunity that they have in their home state when they provide 
     urgently needed care in a declared emergency. Removing 
     barriers that prohibit licensed surgeons and other qualified 
     health care professionals from voluntarily administering 
     medically necessary care during disasters will ensure 
     citizens access to high-quality surgical services in the 
     event of a crisis.
       Again, we strongly support the Stearns/Matheson amendment 
     to H.R. 5 and look forward to working with you to ensure its 
     enactment.
           Sincerely,
                                          David B. Hoyt, MD, FACS,
     Executive Director.
                                  ____

                                                   March 21, 2012.
       Dear Member of Congress: The undersigned organizations 
     strongly support the Stearns/Matheson amendment to the 
     Protecting Access to Healthcare Act (H.R. 5) and urge you to 
     vote for the amendment when it is considered on the House 
     floor.
       The Stearns/Matheson amendment will provide liability 
     protections to health professionals, including physicians, 
     who volunteer to help victims of federally-declared 
     disasters. The medical profession has a long history of 
     stepping forward to assist disaster victims. Rapid medical 
     response in a disaster can greatly decrease loss of life and 
     improve outcomes for patients who desperately need care.
       Thousands of health professionals volunteered in the 
     aftermath of Hurricanes Katrina and Rita to help the 
     hurricane victims with their medical needs. Unfortunately, 
     much needed medical volunteers were turned away due to 
     inconsistent Good Samaritan laws as well as confusion and 
     uncertainty about the application of these laws. Sadly, this 
     lack of uniformity has greatly hindered the ability of 
     volunteer health professionals to provide care; and in many 
     cases, health care providers could not provide these critical 
     services, even if they wanted to, due to lack of liability 
     protections.
       The Stearns/Matheson amendment will help ensure that health 
     professionals who volunteer their services in future 
     disasters will not face similar uncertainties, thereby 
     allowing them to focus on providing aid to victims. We urge a 
     ``Yes'' vote on the Stearns/Matheson amendment.
           Sincerely,
         Advocates for EMS, American Association of Neurological 
           Surgeons, American Association of Orthopaedic Surgeons, 
           American College of Emergency Physicians, American 
           College of Surgeons, American Medical Association, 
           American Trauma Society, Congress of Neurological 
           Surgeons, Orthopaedic Trauma Association, Physician 
           Insurers Association of America, The Roundtable on 
           Critical Care Policy, Trauma Center Association of 
           America.

  I reserve the balance of my time.
  Mr. CONYERS. I rise in opposition to the Stearns amendment.
  The Acting CHAIR. The gentleman from Michigan is recognized for 5 
minutes.
  Mr. CONYERS. Madam Chairman, the problem here is we don't have a 
problem. The 1997 law, which is called the Volunteer Protection Act, 
which I don't recall being mentioned, already provides immunity to all 
volunteers, not just doctors, to everybody, all volunteers, and has 
worked very effectively to ensure that nonprofit or government entities 
remain responsible for background checks.

[[Page H1513]]

  I remind my colleagues of the Tenth Amendment to the Constitution, 
which is violated in H.R. 5, which preserves our system of federalism 
that allows States to legislate their own State tort laws and the 
qualifications of health care professions. What could be more simple 
than that?
  This is one of the least debated provisions of our great 
Constitution. And so amendments that limit liability of health care 
professionals by our Congress and provide a virtual blanket immunity to 
any individual for any harm while acting in a volunteer capacity during 
a disaster violates the Tenth Amendment to the Constitution.
  Madam Chairman, I reserve the balance of my time.
  Mr. STEARNS. Madam Chairman, how much time do I have left on my side?
  The Acting CHAIR. The gentleman from Florida has 2 minutes and 15 
seconds remaining, and the gentleman from Michigan has 3 minutes 
remaining.

                              {time}  1110

  Mr. STEARNS. The one thing I would say to the gentleman, this is not 
unlimited. As I pointed out, there are provisions to allow for 
stipulations.
  I yield 1 minute to the cosponsor on the Democrat side, Mr. Matheson 
from Utah.
  Mr. MATHESON. Madam Chair, I stand in strong support of this 
amendment, as I do to the underlying bill.
  The amendment before us will provide much-needed liability 
protections to medical professionals to ensure that they are able to do 
what they are trained to do, which is save lives.
  As Mr. Stearns indicated, in the aftermath of Hurricane Katrina, it 
became clear that a uniformity of Good Samaritan laws is needed in this 
country. In several instances, qualified and certified physicians and 
other medical professionals from across the country were turned away 
from providing much-needed and critical care to victims of this 
disaster even when it was plainly apparent that the medical resources 
in the communities that were affected by the disaster were far beyond 
the capacity to provide adequate emergency care.
  Yet doctors from Utah who volunteered to provide emergency care in 
situations such as this shouldn't fear unnecessary lawsuits and, above 
all else, should not be turned away due to uncertainty about liability 
protections.
  I want to thank my friend and colleague, Mr. Stearns, for his work 
and his partnership on this amendment. This commonsense measure to 
provide sensible protections to those Good Samaritans who volunteer 
their medical services to help those struck by disaster is an amendment 
we should all support. I urge colleagues on both sides of the aisle to 
support this bipartisan amendment.
  Mr. CONYERS. Madam Chair, I raise a question to my good friend from 
Florida.
  If you feel strongly about this, why don't we modify the Volunteer 
Protection Act of 1997 rather than go into the business of a 
constitutional violation by changing all of the State laws with this 
wholesale limitation of liability? Why not do it in a more appropriate 
way, which we would be bound to consider with you?
  I yield to the gentleman if he cares to make a comment on that.
  Mr. STEARNS. Mr. Conyers, the point is this is a Federal disaster, 
and a Federal disaster like Katrina, in which the Federal Government is 
involved, you want to have a bill that's a Federal bill.
  Mr. CONYERS. The Volunteer Protection Act, I say to my colleague from 
Florida, is a Federal bill enacted in 1997, and that's the one that I 
would urge you to want to join with me and others to modify if there is 
a problem.
  What you're doing by Stearns-Matheson is that you are now changing 
the law in all 50 States without going through the Volunteer Protection 
Act over which we have jurisdiction. That's the reason that I urge my 
colleagues that there is no need to upend existing State laws to 
provide unnecessary immunity.
  I reserve the balance of my time.
  Mr. STEARNS. Madam Chairman, I'd just say that the 50 State laws are 
not allowing a physician to help. He has to mop the floors.
  I yield 45 seconds to Mr. Franks from Arizona. He's chairman of the 
Constitution Subcommittee of the House Judiciary Committee.
  Mr. FRANKS of Arizona. Madam Chair, I just rise in strong support of 
this very commonsense amendment by my friend, Mr. Stearns from Florida.
  This amendment is to provide liability protection to health care 
workers who volunteer to help in disaster response for their fellow 
human beings.
  Madam Chair, rescue efforts often can be chaotic; and without the 
help of volunteers, government Agencies cannot always help everyone 
effectively. Many State tort laws, including those of Louisiana, the 
State hardest hit by Hurricane Katrina, are unclear in regards to who 
is covered under State Good Samaritan protections.
  Madam Chair, this is a country of Good Samaritans. We should 
encourage our fellow human beings to help their fellow human beings and 
not offer impediments to them. I think this amendment does that, and I 
support it with the strongest conviction.
  Mr. CONYERS. Madam Chair, that's what we're doing under the Volunteer 
Protection Act is protecting our volunteers, our good citizens that 
come forward.
  Please, I would like to focus on the amendment here that provides a 
lesser degree of liability protection while allowing weaker State 
standards to remain in place.
  What we need to do is to preserve our system of federalism and 
support the Volunteer Protection Act which is constitutional, which 
does not violate the prerogative of the States to manage and legislate 
on their own tort laws and determine the qualifications of health care 
professionals.
  The Acting CHAIR. All time for debate has expired.
  The question is on the amendment offered by the gentleman from 
Florida (Mr. Stearns).
  The question was taken; and the Acting Chair announced that the ayes 
appeared to have it.
  Mr. STEARNS. Madam Chair, I demand a recorded vote.
  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further 
proceedings on the amendment offered by the gentleman from Florida will 
be postponed.


                    Announcement by the Acting Chair

  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, proceedings 
will now resume on those amendments printed in House Report 112 416 on 
which further proceedings were postponed, in the following order:
  Amendment No. 1 by Mr. Woodall of Georgia.
  Amendment No. 2 by Ms. Bonamici of Oregon.
  Amendment No. 6 by Mr. Stearns of Florida.
  The Chair will reduce to 2 minutes the minimum time for any 
electronic vote after the first vote in this series.


                 Amendment No. 1 Offered by Mr. Woodall

  The Acting CHAIR. The unfinished business is the demand for a 
recorded vote on the amendment offered by the gentleman from Georgia 
(Mr. Woodall) on which further proceedings were postponed and on which 
the ayes prevailed by voice vote.
  The Clerk will redesignate the amendment.
  The Clerk redesignated the amendment.


                             Recorded Vote

  The Acting CHAIR. A recorded vote has been demanded.
  A recorded vote was ordered.
  The vote was taken by electronic device, and there were--ayes 234, 
noes 173, answered ``present'' 2, not voting 22, as follows:

                             [Roll No. 122]
                                     

                               AYES--234

     Adams
     Aderholt
     Akin
     Alexander
     Amash
     Amodei
     Bachmann
     Barletta
     Bartlett
     Barton (TX)
     Bass (NH)
     Benishek
     Berg
     Biggert
     Bilirakis
     Black
     Blackburn
     Blumenauer
     Bonner
     Boustany
     Brady (TX)
     Braley (IA)
     Brooks
     Broun (GA)
     Buchanan
     Bucshon
     Buerkle
     Burgess
     Burton (IN)
     Calvert
     Camp
     Canseco
     Cantor
     Capito
     Carter
     Cassidy
     Chabot
     Coble
     Coffman (CO)
     Cole
     Conaway
     Costa
     Cravaack
     Crawford
     Crenshaw
     Cuellar
     Culberson
     Davis (KY)
     Denham
     Dent
     DesJarlais
     Diaz-Balart
     Doggett
     Dreier
     Duffy
     Duncan (SC)
     Duncan (TN)
     Ellmers
     Emerson
     Farenthold
     Fincher
     Fitzpatrick
     Flake
     Fleischmann
     Fleming
     Flores
     Forbes
     Fortenberry
     Foxx

[[Page H1514]]


     Franks (AZ)
     Frelinghuysen
     Gallegly
     Gardner
     Garrett
     Gerlach
     Gibbs
     Gibson
     Gingrey (GA)
     Gohmert
     Goodlatte
     Gosar
     Gowdy
     Granger
     Graves (GA)
     Graves (MO)
     Griffin (AR)
     Grimm
     Guinta
     Guthrie
     Hall
     Hanna
     Harper
     Harris
     Hartzler
     Hastings (WA)
     Hayworth
     Heck
     Hensarling
     Herger
     Herrera Beutler
     Huelskamp
     Huizenga (MI)
     Hultgren
     Hunter
     Hurt
     Issa
     Jenkins
     Johnson (IL)
     Johnson (OH)
     Johnson, Sam
     Jones
     Jordan
     Kelly
     King (IA)
     King (NY)
     Kingston
     Kissell
     Kline
     Labrador
     Lamborn
     Lance
     Landry
     Lankford
     Latham
     LaTourette
     Latta
     Lewis (CA)
     Lipinski
     LoBiondo
     Long
     Lucas
     Luetkemeyer
     Lummis
     Lungren, Daniel E.
     Mack
     Matheson
     McCarthy (CA)
     McCaul
     McClintock
     McCotter
     McHenry
     McKeon
     McKinley
     McMorris Rodgers
     Meehan
     Mica
     Miller (FL)
     Miller (MI)
     Miller, Gary
     Mulvaney
     Murphy (PA)
     Myrick
     Neugebauer
     Noem
     Nugent
     Nunes
     Nunnelee
     Olson
     Palazzo
     Paulsen
     Pearce
     Pence
     Petri
     Pitts
     Poe (TX)
     Pompeo
     Posey
     Price (GA)
     Quayle
     Reed
     Rehberg
     Reichert
     Renacci
     Ribble
     Rigell
     Rivera
     Roby
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Rokita
     Rooney
     Ros-Lehtinen
     Roskam
     Ross (AR)
     Ross (FL)
     Royce
     Runyan
     Ruppersberger
     Ryan (WI)
     Scalise
     Schilling
     Schmidt
     Schweikert
     Scott (SC)
     Scott, Austin
     Sessions
     Shimkus
     Shuler
     Shuster
     Simpson
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Southerland
     Stearns
     Stivers
     Stutzman
     Sullivan
     Thompson (PA)
     Thornberry
     Tiberi
     Tipton
     Turner (NY)
     Turner (OH)
     Upton
     Walberg
     Walden
     Walsh (IL)
     Webster
     West
     Westmoreland
     Whitfield
     Wilson (SC)
     Wittman
     Wolf
     Womack
     Woodall
     Yoder
     Young (AK)
     Young (FL)
     Young (IN)

                               NOES--173

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

                        ANSWERED ``PRESENT''--2

     Griffith (VA)
     Sensenbrenner
       

                             NOT VOTING--22

     Ackerman
     Austria
     Bachus
     Bishop (UT)
     Bono Mack
     Brown (FL)
     Chaffetz
     Davis (IL)
     Engel
     Gonzalez
     Jackson (IL)
     Kinzinger (IL)
     Lee (CA)
     Lowey
     Manzullo
     Marchant
     Marino
     McIntyre
     Paul
     Platts
     Rangel
     Thompson (MS)

                              {time}  1145

  Messrs. BRADY of Pennsylvania, BARROW, GEORGE MILLER of California, 
BERMAN, KEATING, BUTTERFIELD, NADLER, and TONKO changed their vote from 
``aye'' to ``no.''
  Mr. PETRI, Mrs. CAPITO, Messrs. HUELSKAMP, HERGER, Mrs. LUMMIS, and 
Mr. YODER changed their vote from ``no'' to ``aye.''
  So the amendment was agreed to.
  The result of the vote was announced as above recorded.


                Amendment No. 2 Offered by Ms. Bonamici

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


                             Recorded Vote

  The Acting CHAIR. A recorded vote has been demanded.
  A recorded vote was ordered.
  The Acting CHAIR. This will be a 2-minute vote.
  The vote was taken by electronic device, and there were--ayes 179, 
noes 228, answered ``present'' 1, not voting 23, as follows:

                             [Roll No. 123]

                               AYES--179

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

                               NOES--228

     Adams
     Aderholt
     Akin
     Alexander
     Amash
     Amodei
     Bachmann
     Barletta
     Bartlett
     Barton (TX)
     Bass (NH)
     Benishek
     Berg
     Biggert
     Bilbray
     Bilirakis
     Black
     Blackburn
     Bonner
     Boren
     Boustany
     Brady (TX)
     Brooks
     Broun (GA)
     Buchanan
     Bucshon
     Buerkle
     Burgess
     Burton (IN)
     Calvert
     Camp
     Campbell
     Canseco
     Cantor
     Capito
     Carter
     Cassidy
     Chabot
     Coble
     Coffman (CO)
     Cole
     Conaway
     Cravaack
     Crawford
     Crenshaw
     Culberson
     Davis (KY)
     Denham
     Dent
     DesJarlais
     Diaz-Balart
     Dold
     Dreier
     Duffy
     Duncan (SC)
     Duncan (TN)
     Ellmers
     Emerson
     Farenthold
     Fincher
     Fitzpatrick
     Flake
     Fleischmann
     Fleming
     Flores
     Forbes
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Gardner
     Garrett
     Gerlach
     Gibbs
     Gingrey (GA)
     Gohmert
     Goodlatte
     Gosar
     Gowdy
     Granger
     Graves (GA)
     Graves (MO)
     Griffin (AR)
     Griffith (VA)
     Grimm
     Guinta
     Guthrie
     Hall
     Hanna
     Harris
     Hartzler
     Hastings (WA)
     Hayworth
     Heck
     Hensarling
     Herger
     Herrera Beutler
     Huelskamp
     Huizenga (MI)
     Hultgren
     Hunter
     Hurt
     Issa
     Jenkins
     Johnson (OH)
     Johnson, Sam
     Jones
     Jordan
     Kelly
     King (IA)
     King (NY)
     Kingston
     Kissell
     Kline
     Labrador
     Lamborn
     Lance
     Landry
     Lankford
     Latham
     LaTourette
     Latta
     Lewis (CA)
     LoBiondo
     Long
     Lucas
     Luetkemeyer
     Lummis
     Lungren, Daniel E.
     Mack
     Matheson
     McCarthy (CA)
     McCaul
     McClintock
     McCotter
     McKeon
     McKinley
     McMorris Rodgers
     Meehan
     Mica
     Miller (FL)
     Miller (MI)
     Miller, Gary
     Mulvaney
     Murphy (PA)
     Myrick
     Neugebauer
     Noem
     Nugent
     Nunes
     Nunnelee
     Olson
     Palazzo
     Paulsen
     Pearce
     Pence
     Peterson
     Petri
     Pitts

[[Page H1515]]


     Poe (TX)
     Pompeo
     Posey
     Price (GA)
     Quayle
     Reed
     Rehberg
     Reichert
     Renacci
     Ribble
     Rigell
     Rivera
     Roby
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Rokita
     Rooney
     Ros-Lehtinen
     Roskam
     Ross (FL)
     Royce
     Runyan
     Ryan (WI)
     Scalise
     Schilling
     Schmidt
     Schock
     Schweikert
     Scott (SC)
     Scott, Austin
     Sessions
     Shimkus
     Shuster
     Simpson
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Southerland
     Stearns
     Stivers
     Stutzman
     Sullivan
     Thompson (PA)
     Thornberry
     Tiberi
     Tipton
     Turner (NY)
     Turner (OH)
     Upton
     Walberg
     Walden
     Walsh (IL)
     Webster
     West
     Westmoreland
     Whitfield
     Wilson (SC)
     Wittman
     Wolf
     Womack
     Woodall
     Yoder
     Young (AK)
     Young (FL)
     Young (IN)

                        ANSWERED ``PRESENT''--1

       
     Sensenbrenner
       

                             NOT VOTING--23

     Ackerman
     Austria
     Bachus
     Bishop (UT)
     Bono Mack
     Brown (FL)
     Chaffetz
     Davis (IL)
     Frank (MA)
     Gonzalez
     Jackson (IL)
     Kinzinger (IL)
     Lee (CA)
     Lowey
     Manzullo
     Marchant
     Marino
     McIntyre
     Paul
     Platts
     Rangel
     Terry
     Thompson (MS)


                    Announcement by the Acting Chair

  The Acting CHAIR (during the vote). There is 1 minute remaining.

                              {time}  1150

  Messrs. JOHNSON of Georgia and WALZ of Minnesota changed their vote 
from ``no'' to ``aye.''
  So the amendment was rejected.
  The result of the vote was announced as above recorded.


                 Amendment No. 6 Offered by Mr. Stearns

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


                             Recorded Vote

  The Acting CHAIR. A recorded vote has been demanded.
  A recorded vote was ordered.
  The Acting CHAIR. This will be a 2-minute vote.
  The vote was taken by electronic device, and there were--ayes 251, 
noes 157, answered ``present'' 1, not voting 22, as follows:

                             [Roll No. 124]

                               AYES--251

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

                               NOES--157

     Altmire
     Amash
     Andrews
     Baca
     Baldwin
     Barrow
     Bass (CA)
     Becerra
     Berman
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Bonamici
     Boswell
     Brady (PA)
     Braley (IA)
     Broun (GA)
     Capps
     Capuano
     Carnahan
     Carney
     Castor (FL)
     Chandler
     Chu
     Cicilline
     Clarke (MI)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Conyers
     Cooper
     Costello
     Courtney
     Critz
     Crowley
     Cummings
     Davis (CA)
     DeGette
     DeLauro
     Deutch
     Dicks
     Dingell
     Doggett
     Donnelly (IN)
     Doyle
     Edwards
     Ellison
     Engel
     Eshoo
     Farr
     Filner
     Fudge
     Green, Al
     Grijalva
     Gutierrez
     Hahn
     Hanabusa
     Hastings (FL)
     Heinrich
     Higgins
     Himes
     Hinchey
     Hinojosa
     Hirono
     Holden
     Holt
     Honda
     Hoyer
     Israel
     Jackson Lee (TX)
     Johnson (GA)
     Johnson (IL)
     Johnson, E. B.
     Kaptur
     Keating
     Kildee
     Kind
     Kucinich
     Langevin
     Larson (CT)
     Levin
     Lewis (GA)
     Lipinski
     Loebsack
     Lofgren, Zoe
     Lujan
     Maloney
     Markey
     Matsui
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McNerney
     Meeks
     Michaud
     Miller (NC)
     Miller, George
     Moore
     Murphy (CT)
     Nadler
     Napolitano
     Neal
     Olver
     Owens
     Pallone
     Pascrell
     Pastor (AZ)
     Pelosi
     Peters
     Peterson
     Pingree (ME)
     Poe (TX)
     Price (NC)
     Quigley
     Rahall
     Richardson
     Richmond
     Rothman (NJ)
     Roybal-Allard
     Rush
     Ryan (OH)
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schiff
     Schwartz
     Scott (VA)
     Scott, David
     Serrano
     Sewell
     Sherman
     Sires
     Smith (WA)
     Speier
     Stark
     Sutton
     Thompson (CA)
     Tierney
     Tonko
     Towns
     Tsongas
     Van Hollen
     Velazquez
     Visclosky
     Walz (MN)
     Wasserman Schultz
     Waters
     Watt
     Waxman
     Welch
     Wilson (FL)
     Woolsey
     Yarmuth

                        ANSWERED ``PRESENT''--1

       
     Sensenbrenner
       

                             NOT VOTING--22

     Ackerman
     Austria
     Bachus
     Bishop (UT)
     Bono Mack
     Brown (FL)
     Chaffetz
     Davis (IL)
     Gohmert
     Gonzalez
     Jackson (IL)
     Kinzinger (IL)
     Lee (CA)
     Lowey
     Manzullo
     Marchant
     Marino
     McIntyre
     Paul
     Rangel
     Terry
     Thompson (MS)

                              {time}  1156


                    Announcement by the Acting Chair

  The Acting CHAIR (during the vote). There is 1 minute remaining.
  So the amendment was agreed to.
  The result of the vote was announced as above recorded.


                          Personal Explanation

  Mr. KINZINGER of Illinois. Madam Chair, on March 22, 2012, I was 
unavoidably detained because fog delayed my return flight from Illinois 
and I was unable to cast a vote on H.R. 5, the Protecting Access to 
Healthcare Act. Had I been able to I would have cast an ``aye'' vote in 
favor of final passage of this legislation. I would also have cast an 
``aye'' vote in favor of Amendment No. 1 by Representative Woodall; a 
``no'' vote against Amendment No. 2 by Representative Bonamici; and an 
``aye'' vote in favor of Amendment No. 6 by Representative Stearns.
  The Acting CHAIR. There being no further amendments, under the rule, 
the Committee rises.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Yoder) having assumed the chair, Mrs. Miller of Michigan, 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, and, pursuant to House 
Resolution 591, she reported the bill, as amended by that resolution, 
back to the House with sundry further amendments adopted in the 
Committee of the Whole.
  The SPEAKER pro tempore. Under the rule, the previous question is 
ordered.
  Is a separate vote demanded on any further amendment reported from 
the

[[Page H1516]]

Committee of the Whole? If not, the Chair will put them en gros.
  The amendments were agreed to.
  The SPEAKER pro tempore. The question is on the engrossment and third 
reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.


                           Motion To Recommit

  Mr. LOEBSACK. Mr. Speaker, I have a motion to recommit at the desk.
  The SPEAKER pro tempore. Is the gentleman opposed to the bill?
  Mr. LOEBSACK. I am opposed, in its current form.
  The SPEAKER pro tempore. The Clerk will designate the motion to 
recommit.
  The Clerk read as follows:

       Mr. Loebsack moves to recommit the bill H.R. 5 to the 
     Committees on Ways and Means and Energy and Commerce with 
     instructions to report the same to the House forthwith with 
     the following amendment:
       Add at the end the following new section:

     SEC. 203. PROHIBITING ELIMINATION OF MEDICARE PROGRAM AND 
                   INCREASED COSTS OR REDUCED BENEFITS TO SENIORS 
                   AND PEOPLE WITH DISABILITIES.

       (a) The repeal of section 1899A of the Social Security (42 
     U.S.C. 1395kkk) pursuant to section 202 of this Act shall 
     not, with respect to the Medicare program under title XVIII 
     of the Social Security Act, be construed as furthering or 
     promoting any of the following:
       (1) Eliminating guaranteed health insurance benefits for 
     seniors or people with disabilities under such program.
       (2) Establishing a Medicare voucher plan that provides 
     limited payments to seniors or people with disabilities to 
     purchase health care in the private health insurance market 
     or otherwise increasing Medicare beneficiary costs.
       (b) The repeal of section 1899A(c)(2)(A)(ii) of the Social 
     Security Act (42 U.S.C. 1395kkk(c)(2)(A)(ii)) pursuant to 
     section 202 of this Act shall not, with respect to seniors or 
     people with disabilities, be construed as providing for or 
     promoting any of the following:
       (1) Rationing health care.
       (2) Raising revenues or premiums for seniors or people with 
     disabilities under section 1818 of the Social Security Act, 
     section 1818A of such Act, or section 1839A of such Act.
       (3) Increasing cost-sharing (including deductibles, 
     coinsurance, and copayments) under the Medicare program for 
     seniors or people with disabilities.
       (4) Otherwise restricting benefits or modifying eligibility 
     criteria under such program for seniors or people with 
     disabilities.

  Mr. ROE of Tennessee (during the reading). Mr. Speaker, I ask 
unanimous consent to dispense with the reading of the motion.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Tennessee?
  There was no objection.
  The SPEAKER pro tempore. The gentleman from Iowa is recognized for 5 
minutes.
  Mr. LOEBSACK. Mr. Speaker, while I oppose the underlying bill, I'm 
offering this final amendment on a topic that I know is important to 
all of us here in this Chamber: our Nation's seniors. I grew up in 
poverty, and my grandmother took care of my siblings and me during my 
childhood. She relied on Social Security survivor benefits to put food 
on the table, and because of her, I know firsthand how important 
programs like Social Security and Medicare are to our seniors. In my 
grandmother's case, it meant the difference between putting food on the 
table and my family going hungry.

                              {time}  1200

  Before these historic programs were enacted, far too many seniors 
struggled just to meet their basic needs, let alone access the 
appropriate medical care to keep them safe and healthy. These important 
safety net programs have been incredibly successful as well in lowering 
senior poverty rates in America.
  Just like my grandmother, today's seniors made sacrifices big and 
small to pave the way for a better life for future generations. Our 
country is what it is today because of them. That is why I believe that 
seniors who worked hard all of their lives should have access to the 
best medical care available. We need to care for them just like they 
cared for us.
  If my colleagues join me in passing this amendment, it will be 
incorporated into the bill and the bill will be immediately voted on. 
It would ensure that the underlying bill does not eliminate guaranteed 
health insurance benefits for seniors or people with disabilities on 
Medicare. It would also ensure that the underlying bill does not lead 
to a voucher system, ration health care, raise premiums and copayments, 
or otherwise restrict Medicare benefits.
  I recently held senior listening sessions around my district in Iowa. 
When I talk to Iowa seniors, I hear far too often that many of them are 
struggling just to make ends meet. That is unacceptable. No hardworking 
American should ever have to retire into poverty, and they certainly 
shouldn't see their hard-earned savings wiped out because of medical 
bills.
  During my listening sessions, I heard time and again from seniors 
about how much they rely on Medicare in order to stay healthy and stay 
afloat financially. Seniors' medical and prescription drug costs 
already eat up a growing portion of their income, and many of them are 
stretched thin even without rising gas prices, utility costs, and an 
economic downturn that has hit savings hard. They pay attention to what 
is happening here in Washington--we should all be reminded of that--and 
they're upset about proposals to cut and weaken Medicare.
  Our seniors did not get us into the fiscal mess that we're in today 
in the first place, and I think it's unfair to punish them for 
Washington's irresponsible behavior. They cannot and they should not 
bear more of this burden. Unfortunately, the Republican plan for 
Medicare would force seniors to do just that. It would end the Medicare 
guarantee, replacing it with a voucher system. The voucher would not 
keep up with health care inflation, and it would force seniors to pay 
more and more of their health care costs out of pocket.
  In these tough economic times, we need to find ways to be more 
efficient while maintaining quality of care. There are ways to do that, 
such as moving Medicare from a fee-based to a value-based payment 
system, something that I have supported all along since I've been in 
this Congress. However, the Republican plan for Medicare ignores these 
options and, instead, undermines traditional Medicare while doing 
nothing to reduce health care costs. This would shift costs to 
beneficiaries.
  For low-income seniors like my grandmother was, enacting this plan 
could be disastrous. That is why my final amendment would ask the 
Members of this Chamber simply to uphold their commitment to America's 
seniors.
  From my listening sessions, I know that seniors don't want a voucher 
that forces them to buy insurance in the private market. They don't 
want higher costs or reduced benefits, and they don't want some 
newfangled program. They want to keep Medicare the way it is: a 
guaranteed benefit they can count on when they need it.
  Seniors in my district and across the country know we have big 
problems, but we can strengthen and preserve Medicare without ending 
the guarantee--a guarantee, by the way, that is neither Republican nor 
Democratic, but it's an American guarantee. I think we all need to keep 
that in mind and remember that.
  Mr. Speaker, I urge all of my colleagues in the House to join me in 
voting for this final amendment to preserve and to strengthen the most 
successful health insurance program our Nation has ever created, 
namely, Medicare.
  Our grandparents have stood by us, folks; I think it's time that we 
stand by them.
  I yield back the balance of my time.
  Mr. ROE of Tennessee. Mr. Speaker, I rise in opposition to the motion 
to recommit and strongly support H.R. 5.
  The SPEAKER pro tempore. The gentleman is recognized for 5 minutes.
  Mr. ROE of Tennessee. Mr. Speaker, 2\1/2\ years ago in this body, we 
debated the Affordable Care Act, and I remember being part of that 
debate here on the House floor. Part of that debate was to increase 
access for American citizens and to maintain the physician-patient 
relationship.
  I have a letter here that was signed by 75 of us, both Democrats and 
Republicans, opposing, in part, because in the House version of the 
Affordable Care Act the Independent Payment Advisory Board was not 
there.

  This bill is very simple. H.R. 5 is to repeal the Independent Payment 
Advisory Board and to vote for malpractice reform, a very simple bill, 
one that should be easy to support. Let's just discuss and see what 
occurred.
  Based on the Independent Payment Advisory Board--most seniors don't

[[Page H1517]]

know about this--after the $500 billion has been taken out to pay for a 
new benefit. The Independent Payment Advisory Board are 15 unelected 
bureaucrats, appointed by the President and approved by the Senate to 
oversee Medicare spending.
  Why does this bring angst to a physician? I practiced medicine for 31 
years in Tennessee. My concern is I've already seen two examples of 
this, and this will be the third.
  The first is a sustainable growth rate, a formula based on how to pay 
doctors in Medicare. This was established in 1997. Each year--almost 
every year since then--the Congress has had the ability to change this 
because, why? We were afraid if reimbursements to physicians were cut, 
access to our patients would be denied.
  Let's look at what's going on right now.
  Two weeks ago in this body, we extended the SGR for 10 months, 
preventing a 27 percent cut to physicians. Well, as a doctor, what 
would this mean for me in providing care for my patients? Well, what 
this would mean is you couldn't afford to see the patients. With IPAB, 
a formula based on spending, not quality or access, what would happen, 
I believe, is that this would occur, this 27 percent--at the end of 
this year, a 31 percent cut, which would be catastrophic for our 
Medicare patients.
  So it's a very simple bill. We don't want Washington-based 
bureaucrats getting in between the physician-patient relationship. 
Medical decisions should be made between not an insurance company, and 
certainly not 15 unelected bureaucrats in Washington. It should be made 
between a patient, the doctor, and that family.
  The second part of this bill, very simply, is medical-legal 
malpractice reform.
  When I began my medical practice in Tennessee, my malpractice 
premiums were $4,000 a year. When I left 4 years ago to come to 
Congress, $74,000 a year. During that time, from 1975 until I left to 
come here, there's basically one insurance company in Tennessee, and 
over half the premium dollars that were paid during that time went to 
attorneys, not to the injured party. Less than 40 cents of the 
malpractice premium dollar in that State have gone to people who have 
actually been injured. It's a very bad system.
  The tort system we have for medical liability now is a very bad 
system. It needs to be reformed. No one has ever argued about paying 
actual damages. No one has ever argued about paying medical bills. It's 
the unintended consequences of this bill that have run the cost up at 
no value to patients.
  I strongly encourage my colleagues to support this bipartisan bill, 
and I yield back the balance of my time.

                                Congress of the United States,

                                Washington, DC, December 17, 2009.
     Hon. Nancy Pelosi,
     Speaker, House of Representatives, Capitol Building, 
         Washington, DC.
       Dear Madam Speaker: In July, 75 members of the U.S. House 
     of Representatives wrote to express strong opposition to 
     proposals, such as the ``Independent Medicare Advisory 
     Council (IMAC) Act of 2009'' and the ``Medicare Payment 
     Advisory Commission (MedPAC) Reform Act of 2009'' (H.R. 2718, 
     S. 1110, S. 1380), that would divest Congress of its 
     authority for Medicare payment policy and place this 
     responsibility in an executive branch commission or board. 
     This letter clearly stated opposition to the inclusion of 
     these or any other similar proposals in health reform or any 
     other legislation, but with recent developments, we, the 
     undersigned members, believe it is imperative to restate our 
     strong opposition to any proposal or legislation that would 
     place authority for Medicare payment policy in an unelected, 
     executive branch commission or board.
       Consistent with the July letter, on November 7, 2009, the 
     House passed the ``Affordable Health Care for America Act'' 
     (H.R. 3962) did not include provisions to create an unelected 
     Medicare board. Yet, at present, the Senate is considering 
     the ``Patient Protection and Affordable Care Act of 2009,'' 
     which includes provisions to create an ``Independent Medicare 
     Advisory Board'' (IMAB) that would effectively end Congress's 
     authority over Medicare payment policy.
       To create an unelected, unaccountable Medicare commission 
     as envisioned in the Senate's IMAB proposal would end 
     Congress's ability to shape Medicare to provide the best 
     policies for beneficiaries in our communities around the 
     country. Through the legislative process, and from Medicare's 
     beginning, Members have been able to represent the needs of 
     their communities by improving benefits for seniors and the 
     disabled, affecting policies that fill the health care 
     workforce pipeline, and ensuring that hospitals are equipped 
     to care for diverse populations across our individual 
     districts. Such a responsibility is one that is not taken, 
     nor should be given away, lightly.
       These proposals would severely limit Congressional 
     oversight of the Medicare program, and to place this 
     authority within the executive branch, without Congressional 
     oversight or judicial review, would eliminate the 
     transparency of Congressional hearings and debate. Without 
     the open and transparent legislative process, Medicare 
     beneficiaries and the range of providers who care for them 
     would be greatly limited in their ability to help develop and 
     implement new policies that improve the health care of our 
     nation's seniors. An executive branch Medicare board would 
     also effectively eliminate Congress's ability to work with 
     the Centers for Medicare and Medicaid Services to create and 
     implement demonstration and pilot projects designed to 
     evaluate new and advanced policies such as home care for the 
     elderly, the patient-centered medical home, new less invasive 
     surgical procedures, collaborative efforts between hospitals 
     and physicians, and programs designed to eliminate fraud and 
     abuse.
       The creation of a Medicare board would also effectively 
     eliminate state and community input into the Medicare 
     program, removing the ability to develop and implement 
     policies expressly applicable to different patient 
     populations. Instead, national policies that would flow from 
     such a board would ignore the significant differences and 
     health care needs of states and communities. Geographic and 
     demographic variances that exist in our nation's health care 
     system and patient populations would be dangerously 
     disregarded. Furthermore, all providers in all states would 
     be required to comply even if these policies were detrimental 
     to the patients they serve. Such a commission could not only 
     threaten the ability of Medicare beneficiaries, but of all 
     Americans, to access the care they need.
       Finally, as the people's elected representatives, we much 
     oppose any proposal to create a board that would surrender 
     our legislative authority and responsibility for the Medicare 
     program to unelected, unaccountable officials within the very 
     same branch of government that is charged with implementing 
     the Medicare policies that affect so many Americans. 
     Therefore, we must strongly oppose the creation of IMAB, 
     IMAC, a reconstituted MedPac or any Medicare board or 
     commission that would undermine our ability to represent the 
     needs of the seniors and disabled in our own communities. 
     Again, we urge you to reject the inclusion of these or any 
     like proposal in health reform or any other legislation.
           Sincerely,
         Richard E. Neal; Mary Bono Mack; Patrick J. Tiberi; Phil 
           Gingrey; Marsha Blackburn; Joe Courtney; Stephen F. 
           Lynch; Michael C. Burgess; John Lewis; Jerry McNerney; 
           James P. McGovern; G. K. Butterfield; Bill Cassidy; Jim 
           McDermott; John W. Olver; Doris O. Matsui; Fortney Pete 
           Stark; Timothy H. Bishop; Allyson Y. Schwartz; Shelley 
           Berkley.
         David P. Roe; Brett Guthrie; Mike Rogers; Henry C. 
           ``Hank'' Johnson, Jr.; Linda T. Sanchez; Eric J. J. 
           Massa; Michael E. Capuano; Donna M. Christensen; Susan 
           A. Davis; Daniel Maffei; Michael M. Honda; Laura 
           Richardson; John Hall; Sam Farr; John Fleming; Yvette 
           D. Clarke; Kendrick B. Meek; Alan Grayson; Mike 
           Thompson; Edward J. Markey.
         Eliot L. Engel; Gary L. Ackerman; John F. Tierney; 
           Edolphus Towns; Carolyn B. Maloney; Nita M. Lowey; 
           Donald M. Payne; Gregory W. Meeks; Lynn C. Woolsey; Ken 
           Calvert; Bob Filner; Pete Sessions; Steve Buyer; 
           Jerrold Nadler; Dana Rohrabacher; Brian P. Bilbray; 
           Gene Green; Barney Frank; Wm. Lacy Clay; Maurice D. 
           Hinchey.
         William D. Delahunt; Bill Pascrell, Jr.; Steve Kagen; 
           Steve Israel; Joseph Crowley; Ginny Brown-Waite.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered on the motion to recommit.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.


                             Recorded Vote

  Mr. LOEBSACK. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 and clause 9 of rule 
XX, this 15-minute vote on the motion to recommit will be followed by 
5-minute votes on passage of the bill, if ordered, and approval of the 
Journal, if ordered.
  The vote was taken by electronic device, and there were--ayes 180, 
noes 229, answered ``present'' 2, not voting 20, as follows:

[[Page H1518]]

                             [Roll No. 125]

                               AYES--180

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

                               NOES--229

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

                        ANSWERED ``PRESENT''--2

     Bartlett
     Sensenbrenner
       

                             NOT VOTING--20

     Ackerman
     Austria
     Bachus
     Bishop (UT)
     Bono Mack
     Brown (FL)
     Chaffetz
     Davis (IL)
     Gonzalez
     Jackson (IL)
     Kinzinger (IL)
     Lee (CA)
     Lowey
     Manzullo
     Marchant
     Marino
     McIntyre
     Paul
     Rangel
     Thompson (MS)


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore (during the vote). There are 2 minutes 
remaining.

                              {time}  1229

  Messrs. CARNEY and BECERRA changed their vote from ``no'' to ``aye.''
  So the motion to recommit was rejected.
  The result of the vote was announced as above recorded.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.


                             Recorded Vote

  Mr. CONYERS. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The SPEAKER pro tempore. This will be a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 223, 
noes 181, answered ``present'' 4, not voting 23, as follows:

                             [Roll No. 126]

                               AYES--223

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

                               NOES--181

     Altmire
     Amash
     Andrews
     Baca
     Baldwin
     Barrow
     Bass (CA)
     Becerra
     Berkley
     Berman
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Bonamici
     Boswell
     Brady (PA)
     Braley (IA)
     Butterfield
     Capps
     Capuano
     Carnahan
     Carney
     Carson (IN)
     Chandler
     Chu
     Cicilline
     Clarke (MI)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly (VA)
     Conyers
     Cooper
     Costa
     Costello
     Courtney
     Critz
     Crowley
     Cuellar
     Cummings
     Davis (CA)
     DeFazio
     DeGette
     DeLauro
     Deutch
     Dicks
     Dingell
     Doggett
     Donnelly (IN)
     Doyle
     Duncan (TN)
     Edwards
     Ellison
     Engel
     Eshoo
     Farr
     Fattah
     Filner
     Frank (MA)
     Fudge
     Garamendi
     Garrett
     Gohmert
     Green, Al
     Green, Gene
     Griffith (VA)
     Grijalva
     Hahn
     Hanabusa
     Hastings (FL)
     Heinrich
     Higgins
     Himes
     Hinchey
     Hinojosa
     Hirono

[[Page H1519]]


     Holden
     Holt
     Honda
     Hoyer
     Israel
     Jackson Lee (TX)
     Johnson (GA)
     Johnson (IL)
     Johnson, E. B.
     Kaptur
     Keating
     Kildee
     Kind
     Kucinich
     Langevin
     Larsen (WA)
     Larson (CT)
     Levin
     Lewis (GA)
     Lipinski
     Loebsack
     Lofgren, Zoe
     Lujan
     Lynch
     Maloney
     Markey
     Matsui
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McNerney
     Meeks
     Michaud
     Miller (NC)
     Miller, George
     Moore
     Moran
     Murphy (CT)
     Nadler
     Napolitano
     Neal
     Olver
     Owens
     Pallone
     Pascrell
     Pastor (AZ)
     Pelosi
     Perlmutter
     Peters
     Pingree (ME)
     Poe (TX)
     Polis
     Posey
     Price (NC)
     Quigley
     Rahall
     Reyes
     Richardson
     Richmond
     Ross (AR)
     Rothman (NJ)
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schiff
     Schrader
     Schwartz
     Scott (VA)
     Serrano
     Sewell
     Sherman
     Shuler
     Sires
     Slaughter
     Smith (WA)
     Speier
     Stark
     Sutton
     Terry
     Thompson (CA)
     Tierney
     Tonko
     Towns
     Tsongas
     Van Hollen
     Velazquez
     Visclosky
     Walz (MN)
     Wasserman Schultz
     Waters
     Watt
     Waxman
     Webster
     Welch
     Wilson (FL)
     Woolsey
     Yarmuth

                        ANSWERED ``PRESENT''--4

     Broun (GA)
     King (IA)
     Sensenbrenner
     Woodall

                             NOT VOTING--23

     Ackerman
     Austria
     Bachus
     Bishop (UT)
     Bono Mack
     Brown (FL)
     Castor (FL)
     Chaffetz
     Davis (IL)
     Duffy
     Gonzalez
     Gutierrez
     Jackson (IL)
     Kinzinger (IL)
     Lee (CA)
     Lowey
     Manzullo
     Marchant
     Marino
     McIntyre
     Paul
     Rangel
     Thompson (MS)


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore (during the vote). There are 2 minutes 
remaining.

                              {time}  1236

  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.
  Stated for:
  Mr. DUFFY. Mr. Speaker, on rollcall No. 126, I was unavoidably 
detained. Had I been present, I would have voted ``aye.''


                          personal explanation

  Ms. LEE of California. Mr. Speaker, I was not present for rollcall 
votes 122 126. Had I been present, I would have voted ``no'' on No. 
122, ``yes'' on No. 123, ``no'' on No. 124, ``yes'' on No. 125, and 
``no'' on No. 126.

                          ____________________