Congressional Record, Volume 158 Issue 48 (Thursday, March 22, 2012)

[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.

____________________