[Congressional Record Volume 158, Number 85 (Thursday, June 7, 2012)]
[House]
[Pages H3589-H3599]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




PROVIDING FOR CONSIDERATION OF H.R. 436, HEALTH CARE COST REDUCTION ACT 
  OF 2012, AND PROVIDING FOR CONSIDERATION OF H.R. 5882, LEGISLATIVE 
                    BRANCH APPROPRIATIONS ACT, 2013

  Mr. SCOTT of South Carolina. Mr. Speaker, by direction of the 
Committee on Rules, I call up House Resolution 679 and ask for its 
immediate consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 679

       Resolved, That upon the adoption of this resolution it 
     shall be in order to consider in the House the bill (H.R. 
     436) to amend the Internal Revenue Code of 1986 to repeal the 
     excise tax on medical devices. All points of order against 
     consideration of the bill are waived. In lieu of the 
     amendment in the nature of a substitute recommended by the 
     Committee on Ways and Means now printed in the bill, an 
     amendment in the nature of a substitute consisting of the 
     text of Rules Committee Print 112-23, shall be considered as 
     adopted. The bill, as amended, shall be considered as read. 
     All points of order against provisions in the bill, as 
     amended, are waived. The previous question shall be 
     considered as ordered on the bill, as amended, and on any 
     further amendment thereto, to final passage without 
     intervening motion except: (1) 90 minutes of debate equally 
     divided and controlled by the chair and ranking minority 
     member of the Committee on Ways and Means; and (2) one motion 
     to recommit with or without instructions.
       Sec. 2.  At any time after the adoption of this resolution 
     the Speaker may, pursuant to clause 2(b) of rule XVIII, 
     declare the House resolved into the Committee of the Whole 
     House on the state of the Union for consideration of the bill 
     (H.R. 5882) making appropriations for the Legislative Branch 
     for the fiscal year ending September 30, 2013, and for other 
     purposes. The first reading of the bill shall be dispensed 
     with. All points of order against consideration of the bill 
     are waived. General debate shall be confined to the bill and 
     shall not exceed one hour equally divided and controlled by 
     the chair and ranking minority member of the Committee on 
     Appropriations. After general debate the bill shall be 
     considered for amendment under the five-minute rule. The bill 
     shall be considered as read. All points of order against 
     provisions in the bill for failure to comply with clause 2 of 
     rule XXI are waived. No amendment to the bill shall be in 
     order except those printed in the report of the Committee on 
     Rules accompanying this resolution and except pro forma 
     amendments offered at any time by the chair or ranking 
     minority member of the Committee on Appropriations or

[[Page H3590]]

     their respective designees for the purpose of debate. Each 
     such amendment may be offered only in the order printed in 
     the report, may be offered only by a Member designated in the 
     report, shall be considered as read, shall be debatable for 
     the time specified in the report equally divided and 
     controlled by the proponent and an opponent, shall not be 
     subject to amendment, and shall not be subject to a demand 
     for division of the question in the House or in the Committee 
     of the Whole. All points of order against such amendments are 
     waived. At the conclusion of consideration of the bill for 
     amendment the Committee shall rise and report the bill to the 
     House with such amendments as may have been adopted. The 
     previous question shall be considered as ordered on the bill 
     and amendments thereto to final passage without intervening 
     motion except one motion to recommit with or without 
     instructions.

  The SPEAKER pro tempore (Mr. Gardner). The gentleman from South 
Carolina is recognized for 1 hour.
  Mr. SCOTT of South Carolina. For the purpose of debate only, I yield 
the customary 30 minutes to the gentleman from Colorado (Mr. Polis), 
pending which I yield myself such time as I may consume. During 
consideration of this resolution, all time yielded is for the purpose 
of debate only.


                             General Leave

  Mr. SCOTT of South Carolina. Mr. Speaker, I ask unanimous consent 
that all Members have 5 legislative days to revise and extend their 
remarks.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from South Carolina?
  There was no objection.
  Mr. SCOTT of South Carolina. House Resolution 679 provides for 
consideration of H.R. 436, a bill to repeal the 2.3 percent excise tax 
on medical devices enacted as part of the President's health care law. 
It also provides for a structured rule for consideration of H.R. 5882, 
the Legislative Branch Appropriations Act. The legislative branch 
appropriations rule is typically the only structured rule in the 
appropriations process, and we are continuing that bipartisan tradition 
here today.
  We are voting here today to stand up for more than 423,000 American 
employees and the health of millions that their work protects. A new 
$29 billion tax on medical devices, passed as part of the President's 
health care package, threatens to stifle innovation in the health care 
industry. If medical device manufacturers are punished with this new 
tax, we are all punished. Our health is punished. Our parents' health 
is punished. Our kids' health is punished.
  Yesterday, I talked with one of my constituents, Dan Denson, who owns 
a medical device company in Summerville, South Carolina. He shared two 
concrete examples of how this new tax will hurt his company, the health 
care industry, and most importantly, it will hurt those in need of 
medical care.
  For Dan's home health company the profit margin is about 10 percent. 
That profit is used to pay their employees, improve technology, and 
expand when it's needed. So if you cut into it by 2.3 percent, you're 
cutting into their ability to create better devices that then provide 
better care for patients.
  As Dan put it, ``I can assure you that any additional impact to our 
cash flow will reduce the money available for innovation.
  Dan also talked to me about his fellow medical device companies who 
make the hoses for oxygen tanks and other devices which make life 
bearable for so many Americans. They are absolutely dependent on these 
devices. And what happens when we add a 2.3 percent tax to these 
smaller companies? Well, these companies work on a margin of around 3 
percent. So you don't have to be a math major to figure out that when 
you have a 3 percent profit margin and you have a new 2.3 percent tax, 
you are pretty close to zero.
  You simply cannot afford to run a business in this environment. You 
certainly cannot start a new business in this environment. We're not 
only hurting our medical device companies, we're also discouraging new 
entrepreneurs and innovators from being able to enter the ring.
  I felt it was so important to share Dan's thoughts today, as it shows 
in clear terms how this new tax will not only affect Americans' 
wallets, but it could impact the health of Americans in this country.

                              {time}  1240

  If our medical device manufacturers cannot continue to adapt and move 
forward with new and better technologies, our medical care system will 
slow down right alongside it.
  Because of innovation, life expectancy in the United States has 
increased by more than 3 years from 1986 to 2000, and the burden of 
chronic diseases representing more than 70 percent of the overall 
health care cost has been reduced. This tax affects devices ranging 
from cardiac defibrillators to artificial joints to MRI scanners, or, 
in plainer terms, the very devices that identify and treat patients in 
their time of need, and even those devices that could save lives. These 
days, technology is improving every single day.
  Why in the world would we want to put our innovators at a 
disadvantage? Why in the world would we want to take another $29 
billion worth of investments out of our future, out of our health care 
industry and put it in the hands of this government? There's no good 
answer to these questions, and there's no good reason for another new 
tax.
  Once again, Mr. Speaker, I rise in support of this rule and the 
underlying legislation. I encourage my colleagues to vote ``yes'' on 
the rule and ``yes'' on the underlying bill, and I reserve the balance 
of my time.
  Mr. POLIS. Mr. Speaker, I thank the gentleman for yielding me the 
customary 30 minutes, and I yield myself such time as I may consume.
  Mr. Speaker, I rise today in opposition to the rule for the 
underlying bills H.R. 436, the Protect Medical Innovation Act, and H.R. 
5882, the Legislative Branch Appropriations Act for Fiscal Year 2013. 
Frankly, I'm disappointed that the House Republicans continue to bring 
bills to the House under a closed process that restricts debate and 
discussion and doesn't allow amendments that could improve the 
underlying legislation and help forge a strong bipartisan majority.
  Mr. Speaker, the Republicans started this Congress with cries to 
repeal and replace the Affordable Care Act, and yet here we are a year 
and a half later, this body has voted several times to repeal the bill, 
but we've yet to see any plans to replace it. And here we are again 
with another bill to repeal the Affordable Care Act. As far as I can 
tell, my colleagues on the other side of the aisle have not presented a 
plan to reduce rising health care costs, to provide health care 
insurance to 30 million uninsured Americans.
  This body, and those who advocate repeal of the Affordable Care Act, 
it should be incumbent upon them to talk about what we should replace 
it with to prevent the rising cost of health care from being an 
increasing burden on American businesses and American families. The 
motivations for repealing the Affordable Care Act are weaker and more 
blatantly political than ever, especially after several votes of this 
body to repeal the Affordable Care Act.
  There are many provisions of the Affordable Care Act that the 
American people broadly support, including young adults staying on 
their parents' health insurance until they're 26, including creation of 
exchanges. Seniors throughout the United States are already benefiting 
from the Affordable Care Act's elimination of the Medicare prescription 
drug doughnut hole. In fact, in 2011, over 5.1 million Medicare 
beneficiaries saved over $3.2 billion on prescription drugs thanks to 
the Affordable Care Act.
  States across the country, including my home State of Colorado, are 
enthusiastically implementing health insurance exchanges in a 
bipartisan way that will help us reduce health care costs and expand 
access to high quality, affordable health care. So why are we still 
here talking about repealing the Affordable Care Act instead of 
focusing on areas where we share common ground?
  Unfortunately, the Protect Medical Innovation Act has been brought 
under a closed process which prohibits Members from being able to offer 
any amendments to this collection of four different bills. If my 
colleagues made an effort to compromise on health care proposals, there 
might actually be a chance to see legislation pass both Chambers with 
broad bipartisan support and signed by the President. This specific 
bill already has a veto threat from the President, and none of my 
colleagues on my side of the aisle were consulted with regard to a 
method of paying for this particular set of changes.

[[Page H3591]]

  Instead, the Republicans have chosen to cobble together three 
unrelated bills that do three totally different things, along with a 
very partisan offset with no opportunity to revise these bills; no 
opportunity for us to do our job as legislators, to amend these bills; 
no opportunity for us to work to forge a majority around commonsense 
proposals that can improve health care and create jobs.
  Let's take a look at what's in this diverse package of bills.
  Now, the original Protect Medical Innovation Act, that was the 
original bill before these three other bills were added and before this 
payment mechanism was added, would've repealed the excise tax on the 
manufacture or import of certain medical devices, one of the methods of 
funding the Affordable Care Act.
  Now a solid group of Members support repealing the tax. In fact, this 
tax impacts companies in my district like ZOLL Data Systems. And I hope 
we can have a straight up-or-down vote on this particular provision of 
this bill. But instead, it has been cobbled together with two unrelated 
bills and an unrelated method of paying for it.
  Similarly, there's solid support for two other pieces of legislation 
that are contained in this bill. One bill would have repealed the 
Affordable Care Act's prohibition on using HSAs and FSAs to purchase 
over-the-counter drugs, and another would have allowed individuals with 
FSAs to redeem money left in their accounts at the end of the year.
  Now, we all have our different opinions about these bills. I 
personally support allowing HSAs and FSAs to purchase over-the-counter 
drugs, and I personally oppose the FSA measure because I think that 
people should be able to spend the money that's left in their FSAs by 
the end of year; otherwise, what's the purpose of an FSA? It kind of 
ceases to exist and simply becomes a tax shelter if it's not dedicated 
to health.
  But the fact of the matter is, under this rule, no Members of this 
body will be able to express their support or opposition to any of 
these bills in particular because they've all been cobbled together 
into an incoherent mess of a bill which this rule is trying to jam down 
the throat of this body. We should have brought up these bills one at a 
time and found a reasonable offset. Instead, the Republicans have 
chosen to place the burden of paying for this cluster of bills on the 
backs of middle class American families.
  Now, there's a number of alternative ways that we could have paid for 
these bills. The most obvious one would have been repealing oil and gas 
subsidies. This was an offset that was included in the Democratic 
substitute which the majority failed to even allow to come up for a 
vote by this body. That offset would have provided $32 billion in 
reductions of oil and gas subsidies over 10 years, making sure that the 
government doesn't pick winners and losers in the energy space, 
allowing oil and gas to compete on a level playing field with all other 
energy resources instead of being designated as a recipient of taxpayer 
money and government subsidies. Now, that particular offset would have 
not only paid for eliminating the medical device tax, but also reduced 
our deficit by $3 billion.
  Today I introduced a bill, H.R. 5906, which would repeal the medical 
device tax and replace those lost revenues by eliminating tax loopholes 
and subsidies for oil and gas companies. Personally, I'm supportive of 
other ways of paying for the medical device tax as well. Let us work 
together to find a way to pay for any changes in the Affordable Care 
Act that don't fall squarely on the back of middle class American 
families.
  However, Mr. Speaker, instead of a thoughtful offset, the Republicans 
have chosen to dig into the pockets of low- and middle-income Americans 
to pay for this bill. So let's look at how this bill would affect 
American families.
  According to the Joint Committee on Taxation, this proposal would 
force 350,000 people to lose their health care insurance. Yes, that's 
350,000 people less that would have health care insurance.
  Now, how devastating and misguided is this? Let's take an example. 
Let's take a hypothetical family of four in Colorado, in Ohio, in 
Florida, in Pennsylvania. Let's say their household income is $36,000 a 
year. They're working hard to stay in that middle class. It's getting 
harder and harder. The family income, $36,000 a year; father and a 
mother. The mother has been out of work for 3 years. The total family 
cost of health care insurance is $12,000. Now, let's say the mother 
finds a job midway through the year. She's able to go back to work and 
she earns an additional $36,000 for her family, bringing that family of 
four's earnings to $72,000. They're fighting hard to stay in that 
middle class to afford their kids' college education. Now, under this 
bill, at the end of the year, that family is sent an additional health 
care bill for $5,160, a tax increase of over $5,000 for that middle 
class American family. Now, that's more likely to make it less of an 
incentive for that woman to get the extra job. What's the extra 
incentive to work if the government is going to stick you with a huge 
tax bill just for trying to support your family?
  Let's take another example. A family of four in Michigan, in Nevada, 
a father and mother with two young children. Let's say that the mother 
doesn't work outside the home. They're earning $36,000 a year and the 
family is struck with tragedy. The mother passes on early in the year 
leaving the father to support the kids. He takes a second job, as any 
good father would do, and is able to earn an additional $18,000 during 
the year working a 40-hour-a-week job and working a 20-hour-a-week job 
to put food on the table. Now, that increases that family's income to 
$54,000 from $36,000. And what does this Republican tax increase do? 
Well, it presents them at the end of the year with an additional $3,330 
tax increase, a $3,330 tax increase for a father who's just trying to 
put food on the table for his kids.

                              {time}  1250

  We can do better. The bill we are considering today would actually 
increase the tax hike on families by removing the restriction on the 
amount that families are required to pay. This has the perverse 
incentive of discouraging families from working and taking on 
additional jobs and working hard to get promoted. It takes away the 
incentive to perform well at your job and get a promotion or raise. 
Frankly, this payment mechanism encourages people to remain in poverty 
and on government assistance rather than striving to do better and earn 
more. This Republican bill punishes work, plain and simple, and is a 
huge tax increase on the middle class.
  Now, Mr. Speaker, if we want to repeal the medical device tax, let's 
discuss how to pay for it. If some people in this body think protecting 
subsidies for oil and gas companies is more important than getting rid 
of the medical device tax, well, fine, let's find another way to do it. 
But, unfortunately, this approach before us today isn't a serious 
approach to reducing the deficit. It's an approach that the President 
would veto, it's an approach that puts a huge tax burden squarely on 
the shoulders of working families in this country, and it doesn't help 
get Americans back to work.
  This proposal is based on politics, plain and simple, not on sound 
economic policies that are good for the middle class, good for the 
medical device industry, and good for America.
  This underlying rule also makes in order the Legislative Branch 
Appropriations Act for 2013. Now, that's an act that funds Congress 
itself and its supporting agencies. In these times of fiscal austerity, 
everyone--especially Members of Congress--should be tightening their 
belts.
  This bill provides a 1 percent reduction from last year's spending 
bill. Now, I am also heartened that it still ensures congressional 
support agencies have the sufficient funding they need to function so 
that we in this body can do our job.
  But even while the House's budget has been cut over 10 percent over 
the last 2 years, the House majority has chosen to spend scarce 
resources that the taxpayers have appropriated to us to defend the 
constitutionality of the Defense of Marriage Act, which bars gay and 
lesbian servicemembers, veterans and their spouses from securing the 
same benefits offered to straight military couples.
  As President Obama has determined, the law is simply indefensible 
constitutionally. And yet to date, this body, out of this bill, this 
Legislative appropriations bill, has spent three-quarters

[[Page H3592]]

of a million dollars of taxpayer money on fancy lawyers defending this 
discriminatory and offensive law. This waste of tax dollars is 
especially troubling given the recent First Circuit decision which 
found that DOMA is unconstitutional.
  Mr. Speaker, I can't support these underlying rules. It's beyond 
troubling to have a closed rule, not allowing amendments and thoughtful 
input from Members of both parties on four separate pieces of health 
care legislation that completely shuts out Republican ideas and 
Democratic ideas to improve the Affordable Care Act, improve job growth 
in this country, and help get our economy back on track.
  I reserve the balance of my time.
  Mr. SCOTT of South Carolina. Mr. Speaker, I find it quite interesting 
and almost hilarious that my friend to the left would talk about tax 
increases when in fact embedded in this health care bill is $123 
billion in new taxes on property owners. Really? $123 billion of new 
taxes on property owners in addition to the $29 billion new tax they 
were talking about today, in addition to eliminating $500 billion from 
Medicare in order to fund this health care plan.
  I think the conversation about tax increases is a conversation we 
could spend a day on, and we'd be happy to have that conversation. But 
today, I'm going to yield 2 minutes to the gentleman from Texas, 
Chairman Sessions.
  Mr. SESSIONS. Mr. Speaker, today, once again, we're on the floor of 
the House of Representatives with our friends on the other side of the 
aisle arguing about how we tax the American people, how if we're going 
to take this tax out we've got to replace it with another tax. Good 
gosh, aren't energy prices high enough already? Why do we want to pass 
that on to consumers and make gasoline more expensive? It does not make 
sense, and that's why we are here today to repeal a tax.
  Mr. Speaker, what is the tax we're talking about? It is a tax on 
business, on high tech. It is on medical devices that have allowed 
America to lead the world in solving problems, to give people medical 
devices, things that will make their lives even better.
  Mr. Speaker, I received a letter from Walter J. Humann, president and 
CEO, OsteoMed. He came and met with me at my office and then sent me a 
letter. Here's what Mr. Humann said--and I believe he represents not 
just the industry, but thousands of people, patients also who rely on 
high-tech and medical devices that would be without. He said:

       In addition to challenges with the FDA and reimbursement, 
     this 2.3 percent excise tax--which is on gross sales, whether 
     or not a business has any profits or not--will directly 
     impact our ability to create new jobs, invest in research and 
     development and effectively compete in a global marketplace.

  Further, he says:

       It should be noted that OsteoMed is also aggressively re-
     directing its business focus to international markets that 
     provide a less cumbersome and lengthy regulatory pathway with 
     revenue streams that are not subject to the medical device 
     tax . . . immediately saving 2.3 percent in the process. In 
     the past month, OsteoMed initiated the search for sales 
     managers in China and the Middle East to supplement recent 
     managers hired in Korea and Italy.

  Mr. Speaker, this is not just a tax. It is not just making it more 
difficult for employers to hire people. But it will stop America's 
innovative-ness to compete in the future.


                                                     OsteoMed,

                                        Addison, TX, June 5, 2012.
     Hon. Pete Sessions,
     U.S. House of Representatives,
     Washington, DC.
       Dear Representative Sessions: Thank you for taking time to 
     visit with me last week regarding OsteoMed and my concerns 
     about the significant ``headwinds'' we face, especially 
     related to the 2.3% medical device tax that is scheduled for 
     implementation in 2013. On behalf of OsteoMed's 400 
     employees, I thank you for your support of H.R. 436, which 
     would repeal this onerous provision that otherwise will 
     negatively impact innovation and job creation at a time when 
     we can least afford it.
       As president & CEO of OsteoMed, a dynamic, 20 year old 
     surgical device manufacturing company based in your district, 
     I confront the challenges that America's innovators face 
     every day. In addition to challenges with the FDA and 
     reimbursement, this 2.3% excise tax--which is on gross sales, 
     whether or not a business has any profits--will directly 
     impact our ability to create new jobs, invest in research and 
     development and effectively compete in the global market.
       OsteoMed formed a new subsidiary company a couple of years 
     ago to develop an innovative spine product that greatly 
     simplifies spine fusion surgery and improves patient 
     outcomes. OsteoMed launched this product last year which 
     quickly grew to almost $5MM in sales in 2011 and currently 
     employs a number of highly skilled, high paid individuals. 
     Due to the significant upfront investment and on-going 
     development costs, this new company is not projected to make 
     a profit in the near future but is nevertheless subject to 
     the device tax which will further delay this subsidiary's 
     success. As a result, OsteoMed has now delayed additional new 
     product developments and personnel in order to make ``ends 
     meet'' and achieve the returns initially envisioned when this 
     company was created.
       OsteoMed's core business manufactures surgical implant 
     systems for use in craniofacial, neurosurgical and small bone 
     orthopedic (upper and lower extremities) surgeries. These 
     systems require extensive, specialized instruments that are 
     typically not sold, but are used to implant the devices that 
     drive OsteoMed's revenue stream. The device tax will not only 
     tax gross product revenues, but my understanding is it will 
     also tax the instruments OsteoMed must invest in and place 
     into hospitals at no charge thereby further reducing my 
     company's profit opportunities and forcing expense reductions 
     in other areas in order to achieve our profit goals.
       OsteoMed's products are sold through a variety of sales 
     channels and will require a new level of administrative 
     burden in order to track the ``gross'' revenues defined by 
     this tax. This requirement, along with the recent challenges 
     imposed by the Physician Payment Sunshine Act, force 
     additional levels of administration and non value added 
     expenses that make OsteoMed less competitive and viable.
       The market in which OsteoMed competes is in turmoil and has 
     become increasingly competitive with many new offshore 
     competitors. As economics and recent government restrictions 
     have largely removed surgeons from the surgical device 
     purchase decision process, hospitals are now forcing 
     increasingly price concessions. Despite increased raw 
     material and labor costs, OsteoMed has been unable to raise 
     product prices over the past several years and is now equally 
     unlikely to simply pass along the device tax to our 
     customers.
       Like any other responsible business, OsteoMed must 
     carefully manage expenses in order to make profit and 
     continue to grow and succeed. In order to cover the shortfall 
     the new device tax will create, OsteoMed has already started 
     to implement cut backs in its operations including the delay/
     cancellation of new product development projects and the 
     hiring of additional personnel, including biomedical 
     engineering positions. It should be noted that OsteoMed is 
     also aggressively re-directing its business focus to 
     international markets that provide a less cumbersome and 
     lengthy regulatory pathway with revenue streams that are not 
     subject to the medical device tax. . . . immediately 
     ``saving'' 2.3% in the process. In the past month, OsteoMed 
     initiated the search for sales managers in China and the 
     Middle East to supplement recent managers hired in Korea and 
     Italy. Unfortunately, OsteoMed has already started to 
     effectively trade U.S. jobs for overseas positions as a 
     direct result of the medical device tax and other 
     governmental involvement.
       The medical device industry not only provides numerous 
     highly skilled and attractive jobs across the U.S., but it 
     also pays its workers on average 40% more than the typical 
     job. We are a vibrant sector of the economy and one of the 
     few remaining industries that produces a healthy export of 
     products. Tragically, this industry has now become the focus 
     of misguided and short-term government intervention and the 
     growth and continued prosperity of this proud American 
     industry now faces great hurdles.
       Again, I thank you for your service to our country and 
     specifically for your support of H.R. 436 to repeal this tax 
     and to help America's innovators continue to improve patient 
     care and drive job creation. I look forward to your ability 
     to visit OsteoMed when you are back in Dallas so you can see 
     firsthand our great employees and the innovative products 
     they produce to help people around the world. Please do not 
     hesitate to contact me to discuss this issue or any other 
     issues impacting the medical device industry.
           Sincerely,

                                             Walter J. Humann,

                                                  President & CEO,
                                                         OsteoMed.

  Mr. POLIS. Mr. Speaker, I yield 3 minutes to the gentleman from 
Pennsylvania (Mr. Altmire).
  Mr. ALTMIRE. Mr. Speaker, I rise in strong support of the legislation 
we will be voting on this afternoon to repeal the $30 billion excise 
tax on medical device companies, and I'm proud to join Mr. Paulsen in 
his effort to prevent this misguided tax from taking effect next year.
  The district I represent in western Pennsylvania is home to a number 
of medical device companies that have planted their roots in our 
region. They offer high-paying, quality jobs and are developing 
innovative devices that are saving lives.

[[Page H3593]]

  One example is Zoll Medical, which manufactures the LifeVest, a 
lightweight, wearable defibrillator that continuously monitors a 
patient's heart. The device allows patients with medical conditions to 
return to their daily lives with the peace of mind that they are 
protected from sudden cardiac arrest. This is the type of innovation 
that we should be encouraging in this country, not penalizing.
  The excise tax is simply misguided policy. The American medical 
device industry has proven that when given the chance to succeed, it 
has the ability to produce devices that can better the quality of life 
for Americans and even save lives.
  The industry is already facing challenges from foreign competitors 
that have an easier time getting their products to market. We must give 
the U.S. device manufacturers the opportunity to succeed, not punish 
them for being innovators and risk losing the incalculable 
contributions they provide to our economy, the delivery of health care 
and quality of life for every American.
  The rule that we are debating today provides us with the chance to 
vote to help ensure that the next great medical breakthrough is 
developed in this country right here in the United States and not 
overseas.
  I urge my colleagues to support its passage, and I thank Mr. Polis 
for yielding me the time.
  Mr. SCOTT of South Carolina. Mr. Speaker, I yield 2 minutes to the 
gentleman from Florida (Mr. Nugent).
  Mr. NUGENT. Mr. Speaker, I first want to thank my friend, Mr. Scott, 
and fellow Rules Committee member, for allowing me time to speak on 
this important issue.
  This rule brings to the floor a series of health issues that I hear 
about every day from constituents back home. About 46 million Americans 
have either a flexible spending account or a health savings account. 
These are hardworking American families that plan ahead for their 
health care. They're folks who don't want to be a drain on the health 
care system. But the Federal Government has the audacity to look at 
these funds from these families that have put aside for their health 
needs and see this as money for the government's taking. We need to be 
rewarding these people, not seeing them as a revenue source to pay for 
ObamaCare. But the government takeover of health care is going to 
punish them and encourage them to use more expensive treatment options.
  The bill we are considering today will undo ObamaCare's limitation on 
purchasing over-the-counter medications, freeing both health savings 
accounts and physicians' offices from these new, burdensome regulations 
that go into effect.

                              {time}  1300

  It will allow families to cash out up to $500 in their unused FSA 
balances at the end of the year as regular taxable income, and it will 
repeal a 2.3 percent tax imposed on the sale of medical devices. This 
tax will make health care more expensive. It will be passed down to the 
consumer, and it's already costing innovation and jobs in the medical 
device industry.
  I applaud the Ways and Means Committee for their work on this 
legislation and encourage my colleagues on both sides of the aisle to 
pass not only the rule, but support the underlying legislation.
  Mr. POLIS. Mr. Speaker, if we defeat the previous question, I'll 
offer an amendment to the rule to make in order the Connolly amendment, 
which proposes that Members who repeal Federal benefits for their 
constituents must forfeit such benefits themselves. Why should Members 
of Congress get special benefits that we deny to our own constituents?
  To discuss our proposal, I yield 3 minutes to the gentleman from New 
Jersey (Mr. Andrews).
  (Mr. ANDREWS asked and was given permission to revise and extend his 
remarks.)
  Mr. ANDREWS. I thank my friend for yielding.
  Chairman of the Federal Reserve Bernanke is on Capitol Hill today 
warning that if the Congress doesn't get the debt and deficit under 
control, we could be facing a fiscal collapse, a calamity. And he's 
right. And I think we all know that one of the ways to avoid a calamity 
is to move Americans from unemployment lines to payrolls.
  But this is another day when the House will not consider legislation 
that would cut taxes for small businesses that hire people. This is 
another day when the House will not consider legislation that would 
rehire police officers, firefighters, teachers. This is another day 
when the House will not consider legislation to rebuild our roads and 
our bridges and our electronic infrastructure.
  There is going to come a day when the House, I fear, will consider 
reductions in Medicare, Social Security, and Medicaid to deal with the 
deficit problem. Now, we need to consider these kinds of issues because 
they're an important part of the deficit. But when we do, I think most 
Members would agree with the proposition--I think all Members would 
probably agree with the proposition--that we should live under the laws 
that we write. If the Congress is going to consider a change to Social 
Security, we should live with that change. If the Congress is going to 
consider a change to Medicare, we should live with that change. We say 
this to our constituents when we go back to our districts.
  Let's vote for it today. We propose to put on the floor, as part of 
today's legislative agenda, legislation that would say, pure and 
simple, if there's a change to Social Security, Members of Congress 
will live under the same change. If there is a change to Medicare, 
Members of Congress will live under the same change. If there's a 
change to Medicaid, Members of Congress will live under the same 
change. I think we'd probably get a unanimous vote for that 
proposition.
  Let's put it on the floor and affirm to the people of this country 
who pay the bills and serve the country, we live under the same laws 
that we write.
  Mr. SCOTT of South Carolina. Mr. Speaker, I yield 3 minutes to the 
gentleman from Tennessee (Mr. Roe).
  Mr. ROE of Tennessee. I thank the gentleman for yielding.
  Mr. Speaker, I rise today in support of the rule and underlying H.R. 
436, the Protect Medical Innovation Act. This bill will make a positive 
impact in two critical areas: jobs and innovation.
  For 40 consecutive months now, unemployment has exceeded 8 percent. 
Just last week, we received the unwelcome news that unemployment had 
increased in May from the prior month. We're on the wrong track, and 
the medical device tax included in the Affordable Care Act will make a 
bad situation even worse.
  According to one industry study, the 2.3 percent medical device tax 
could result in the loss of 43,000 American jobs, and this is just 
outrageous. We should be taking steps to create good-paying American 
jobs, not preserving a tax hike that would ship these jobs overseas.
  Let me just put that in perspective, Mr. Speaker. I have a unique 
observation point as a physician in practice for over 30 years, and let 
me take you through some innovations that I've seen.
  In 1974, I learned how to do laparoscopy, which is where you place a 
scope inside the abdomen and look, just observe. And that's really 
about all we could do.
  I remember, 1986, my partner and I did the first ectopic pregnancy. 
That's a tubal pregnancy, where pregnancy has occurred in the fallopian 
tube, and we were in there trying to get this pregnancy out through a 
scope. We did not have the equipment to do it.
  Today you can take an ultrasound, diagnose this before rupture; and 
before, most of these were diagnosed after rupture, required blood 
transfusions, an open laparotomy, and days in the hospital. Today, I'm 
happy to report that we diagnose almost all of these before they 
rupture. We take a simple scope, with the new equipment and devices 
that have been discovered and utilized and developed, remove this, and 
send the patient home within hours.
  I've watched, now, this go from just a rudimentary observation to 
incredible surgery with the new Da Vinci device--we're able to do very 
complicated pelvic surgery, prostate cancer surgery, other abdominal 
surgeries, heart surgeries--that have done many things, have reduced 
suffering, lowered morbidity, mortality, and we certainly do not need 
to go in a different direction.
  Let me give you a very personal example that happened to me just 8 or 
9 months ago.

[[Page H3594]]

  In September of 2011, I was walking through the airport in Charlotte, 
North Carolina, when a gentleman arrested. If it had not been for an 
AED, a medical device, this gentleman would not be here with his family 
today. We were able to resuscitate him and send him successfully home 
to his family.
  We do not need to decrease this innovation. I've seen absolutely 
spectacular things that have occurred over the last 30 years.
  Also, this legislation is very simple. It does two other things. It 
allows an individual to use their HSA, which I have, to buy an across-
the-counter medication instead of coming to my office, the most 
expensive entry point into the health care system other than the 
emergency room, to get a prescription. It's counterproductive. It 
wastes time for the patient and their families.
  I also would certainly support the FSA agreement for letting someone 
keep $500 of their money.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. SCOTT of South Carolina. I yield the gentleman an additional 30 
seconds.
  Mr. ROE of Tennessee. And letting that individual and that family 
roll it over so they can use it the next year. Three very simple things 
and I will close.
  Regardless of what you believe in the Affordable Care Act, or how you 
believe, I urge my colleagues to support this. And I find it a little 
bit comical that we are fussing about a closed rule on these three 
simple items when we discussed a 2,700-page health care bill on a 
closed rule.
  Mr. POLIS. I yield myself such time as I may consume.
  In response to my colleague, Mr. Roe's discussion of very expensive 
medical devices and equipment, part of the justification for looking at 
revenues for medical devices is, through making sure that more 
Americans have access to insurance, we're able to increase demand and 
compensation for procedures that involve costly medical devices. This 
is a way that can actually drive business and job growth for the 
medical device industry by having more people covered by insurance. The 
Affordable Care Act will cover millions and millions of more Americans 
to ensure that they have access to medical devices, driving consumption 
and purchase of medical devices as well.
  Look, there's plenty of ways that we can talk about to pay for this 
bill. Unfortunately, this closed rule allows for no discussion, other 
than the extremely partisan, middle class tax increase, which the 
Republicans have proposed to pay for this bill.
  Personally, I've also supported and continue to support looking at a 
soda tax. Rather than tax something that makes people healthier and 
improves public health, like medical devices, why not tax something 
that makes people less healthy, like corn syrup with food coloring and 
water, a little bit of caffeine added, no nutritional content, 
increases diabetes, increases obesity, tooth decay, even been shown to 
hurt kids' performance in schools. And a study by Health Affairs, a 
nationwide tax of 1 percent on sugary drinks would actually go a long 
way towards being able to pay for repealing the medical device tax.
  So look, these are decisions that our constituents send us here to 
make. How do we want to pay for things? If we don't want to tax medical 
devices, are we going to tax the middle class instead, as this proposal 
will do?
  We talked about a family of four in Ohio, family of four in New York, 
that would pay over $5,000 a year in extra tax just because the mother 
went back to work, just because one member of the family might have 
passed away in a year, sticking them with an enormous tax bill? This 
tax-and-spend Republican majority continues to advocate tax after tax 
after tax increase directly targeted to middle class and working 
American families.

                              {time}  1310

  Look, let's evaluate how we want to pay for health care in this 
country. Health care is important. Health care is expensive. If you 
have better ideas than the Affordable Care Act--better ways to reduce 
health care costs for businesses, help families access health care--
let's get them on the table in an open process and talk about what we 
want to do to help drive down costs.
  But this cobbled-together set of bills will only decrease access to 
health care in this country. It will undermine the very demand for the 
medical devices that are so important to job growth and creation in 
this country. It will undermine the incentive of middle class families 
to try to improve their stations in life--to take on a second part-time 
job, to seek a promotion at work. It's very contrary to our American 
values that hard work gets you ahead in this country. If you work hard 
and if you play by the rules, you have a shot in this country, and this 
cobbled-together set of bills is an affront to that very concept that 
makes me so proud to be an American.
  I reserve the balance of my time.
  Mr. SCOTT of South Carolina. Mr. Speaker, I yield 1 minute to the 
gentleman from Pennsylvania (Mr. Dent).
  Mr. DENT. I just heard the previous speaker say that the Affordable 
Care Act is going to provide so much opportunity for medical device 
manufacturers that they will simply be able to eat this device tax. 
Well, that's not the case in my district, and there are three principal 
reasons why we must repeal this device tax:
  One, it increases health care costs for consumers on everything from 
wheelchairs, to bedpans, to prosthetics, to tongue depressors. Two, 
this is going to kill jobs. More than 400,000 jobs in the U.S. and 
22,000 in Pennsylvania are directly employed by the medical device 
industry. This tax will put up to 43,000 American jobs at risk. Three, 
this is going to stifle innovation by reducing investment in R&D, which 
leads to medical breakthroughs.
  By the way, this is a familiar health care law trifecta: higher 
costs, lost jobs, lost innovation.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. SCOTT of South Carolina. I yield the gentleman an additional 15 
seconds.
  Mr. DENT. This tax is going to have a profound impact in my 
congressional district on companies like Aesculap, Boas Surgical, 
BioMed, B. Braun, Olympus, OraSure, and Precision Medical Instruments.
  If you don't believe me, Chris Field of Boas Surgical in Allentown, a 
small business that manufactures custom orthotics and prosthetics, 
explained that the tax may ultimately force the employer out of 
business:

       The medical device tax would simply destroy what is left of 
     our company. After giving it our all, we would simply have to 
     turn out the lights, lock the doors and send 45 employees to 
     the unemployment lines; and our patients, including many of 
     our soldiers returning from combat, would no longer be able 
     to receive medical devices, such as their prostheses, from a 
     company which has faithfully served the Lehigh Valley for 
     over 90 years.

  Mr. POLIS. I yield myself such time as I may consume.
  An executive summary of a report by the Bloomberg Government is 
entitled ``Medical Device Industry Overstates Tax Impact,'' which was 
put together by health care policy analysts.
  This study calls into question the assumption that several of my 
colleagues on the other side have indicated that the medical device tax 
results in the loss of 43,000 jobs. After investigating, the Bloomberg 
Government officials found that this figure was based on the 
hypothetical assumptions of a 10 percent reduction in domestic 
employment resulting from manufacturing moving their operations 
offshore. So it was just based on guesswork. It was said, Well, how 
many jobs do we want to say this would cost? Let's just say 10 percent.
  Then they just put it down. There was no analysis. It was simply 
based on a guess, which I can just say with the same amount of backing 
that it will create 10,000 jobs or that it will eliminate 5,000 jobs or 
that it will create 20,000 jobs. You can say whatever you want, but 
there is no scientific analysis that leads to that conclusion.
  In fact, throwing 350,000 Americans into the ranks of the uninsured 
as this cobbled-together set of bills would do and reducing the number 
of insured Americans by 350,000 is certain to reduce the demand for 
medical devices. It is certain to reduce job growth and to hurt many of 
the companies that are complaining about the medical device tax.
  Again, if we can find a way to pay for it that doesn't throw over a 
quarter million Americans out of health care

[[Page H3595]]

insurance and that doesn't increase taxes for a family making $72,000 a 
year by over $5,000, let's do it. We can. We can look at taxing things 
that make people less healthy rather than taxing things that make 
people more healthy. We can eliminate tax loopholes and subsidies for 
the oil and gas industry. We can discuss eliminating agriculture 
subsidies.
  There are a lot of great ideas that Republicans and Democrats have to 
help replace the revenue that might be lost under this proposal; but 
under this closed rule, both Republicans and Democrats are prohibited 
from bringing any ideas forward about how to pay for this bill other 
than with an enormous tax increase on the middle class, throwing 
Americans off the insurance rolls, which actually reduces the demand 
for medical devices and will cost jobs in this country under this bill.
  I reserve the balance of my time.


                           EXECUTIVE SUMMARY

       An excise tax on medical devices imposed by the 2010 
     federal health-care overhaul isn't likely to reduce industry 
     revenue as much as the device manufacturers say. This 
     Bloomberg Government Study finds that while some reduction in 
     revenue is likely if the tax leads to higher prices, it won't 
     hit manufacturers on the magnitude forecast in 2011 by an 
     industry trade group.
       The price effect of the tax will be offset to some degree 
     by the expected increase in demand for medical devices as a 
     result of the estimated 32 million Americans who will obtain 
     health insurance under the law. The net impact on revenue 
     remains uncertain.
       The 2.3 percent tax on medical devices, which include 
     pacemakers, artificial joints, and magnetic resonance imaging 
     machines, takes effect in 2013. The tax may be passed along 
     to the buyers of most medical devices, which will increase 
     prices. A 2011 study commissioned by the Advanced Medical 
     Technology Association, or AdvaMal, an industry trade group, 
     estimates the resulting drop in revenue will be $1.3 
     billion--close to the median of 12 scenarios in its economic 
     model. That projection represents about 1.1 percent of the 
     industry's $116 billion in annual revenue. The group based 
     its estimates on expected reactions by suppliers and buyers 
     of medical devices to changes in price, a phenomenon that 
     economists call price elasticity.
       This study examines the economic assumptions underlying the 
     industry group's findings. Using relevant research, this 
     study finds that the price elasticity for medical devices is 
     likely to be weaker than the industry put forward; in other 
     words, an increase in price is not likely to lead to a severe 
     contraction in demand. Even the most modest scenario 
     considered by the AdvaMed study, projecting annual revenue 
     losses of $670 million, may be too high because it doesn't 
     account for the likelihood of an increase in demand for 
     medical devices by the newly insured.
       This study also calls into question the assumptions behind 
     another industry assertion that the medical-device tax will 
     result in a loss of 43,000 U.S. jobs. That figure, the 
     AdvaMed authors told Bloomberg Government, was based on a 
     ``hypothetical'' assumption of a 10 percent reduction in 
     domestic employment resulting from manufacturers moving their 
     operations offshore to avoid the tax.
       The study is AdvaMed's only quantitative analysis of the 
     impact of the tax supporting the group's assertion that the 
     medical-device tax will be harmful to manufacturers' revenue. 
     This Bloomberg Government review of those findings gives 
     lawmakers reason to be skeptical of its main findings.

  Mr. SCOTT of South Carolina. Mr. Speaker, I yield 2 minutes to the 
gentleman from Oklahoma (Mr. Lankford).
  Mr. LANKFORD. It is interesting to talk about an open or closed rule 
when we are discussing something with the Affordable Care Act. We all 
know what an open process that it was developed under and how wide open 
and inclusive that that was.
  Let's talk some basic economics with this.
  If you tax something more, you get less of it. That's simple 
economics. Apparently, somehow there is a desire to get less medical 
innovation. If we go to the medical innovators--the people with the 
latest devices, the newest devices, the best devices that are getting 
Americans healthier, that are providing a better quality of life for 
people from infants to senior adults--and then tax them more, we are 
discouraging them from future innovation and from creating the next 
products that create the next big medical wave on it.
  Currently, the best medical innovation in the world is happening in 
the United States of America. We want to keep it that way. We talk a 
lot about: Why are we losing manufacturing jobs? Why are manufacturing 
jobs going around the world? I'll tell you why we're losing 
manufacturing jobs. It's because, every time you turn around when 
you're in a manufacturing segment, you've got a Federal regulator in 
your building who is checking out something else. Whether it's your 
paperwork or your process or your people, they are constantly checking 
everything else. We also have this very high corporate tax structure. 
We have the highest in the industrial world. Now we're taking it to the 
medical device folks and making it even higher and making it even 
harder.
  What we need to do is have the best medical innovation in the world 
here, but we don't do that by punishing those companies for doing it 
here. If we want companies to go overseas and to do the best innovation 
in the world somewhere else, then we should continue to raise taxes on 
them. This solves that. This keeps it here. It keeps the companies here 
and keeps them from relocating and offshoring. It keeps premiums from 
going up. As the medical device cost goes up--guess what?--insurance 
premiums go up as well, as well as dental costs for dental devices.
  This is just another example of picking winners and losers and 
finding an industry that is successful and saying, Let's tax them more 
so we can move that money somewhere else. I'll tell you what. Let's 
just have the best medical innovation in the world continue to be here. 
Let's take care of that medical device tax and clear it out as of 
today.
  Mr. POLIS. My colleague from Oklahoma said, if you tax something, you 
get less of it. Under this bill, we tax work, and we tax middle class 
families taking a second job or getting a promotion at work. This bill 
will force families to stay on the government payroll. It will force 
people to continue to get their benefits because, if they try to work 
harder, you're increasing their taxes.
  Yes, if you tax something, you get less of it. This bill will result 
in people working less, having less of an incentive to work, less of an 
incentive to lift yourself up and to get off the government subsidies, 
less of an incentive to take a second job, less of an incentive to get 
a promotion. Why would we put squarely the burden of paying for this on 
people who just want to work harder to get ahead?
  If you tax something, you get less of it. This bill in its current 
form results in less work, fewer jobs, fewer chances for middle class 
families to stay in the middle class, fewer chances for aspiring middle 
class families to reach the middle class.
  I reserve the balance of my time.
  Mr. SCOTT of South Carolina. Mr. Speaker, we keep hearing 
consistently that somehow a tax that isn't a tax is now considered a 
tax, so the notion of recapturing overpayments from health care 
subsidies should not be considered a tax. It should be considered being 
honest and fair. So let me say it one more time: that requiring people 
to return money not correctly given to them is not a tax increase; it 
is a matter of honesty and integrity.
  Mr. Speaker, I yield 2 minutes to the gentleman from South Carolina 
(Mr. Mulvaney).
  Mr. MULVANEY. I thank my colleague.
  Mr. Speaker, I think something has gone overlooked here today, which 
is that this is a bill that has bipartisan support. So often back home, 
the folks want us to do things that have bipartisan support. We've seen 
several Members from across the aisle speak in favor of this bill and 
of this rule today; but I think something else is going overlooked, 
which is that the President should support this. This should be a bill 
that the President of the United States supports. After all, he was the 
one who said when he was campaigning--and I'm quoting now from 
candidate Barack Obama:

       I can make a firm pledge. Under my plan, no family making 
     less than $250,000 a year will see any form of tax increase--
     not your income tax, not your payroll tax, not your capital 
     gains taxes, not any of your taxes.

                              {time}  1320

  By the way, Mr. Chairman, it's very rare that we speak that boldly in 
politics. Oftentimes, we give ourselves space to walk things back. But 
that is about as unequivocal a statement as you can get.
  I imagine that since that statement was made in 2008, it's by 
accident that

[[Page H3596]]

we have, by my count, at least 13 taxes that violate that pledge. We 
have a new tax on cigarettes, a tax on non-qualified HSA distributions, 
a tax on insured and self-insured health plans, a tax on tanning 
services, a tax on brand name pharmaceuticals, and, of course, this tax 
on certain medical devices. My guess is that was done by mistake, and 
we need to fix that so that the President can keep his promises.
  So I encourage my friends across the aisle, as well as my own 
colleagues, to vote for the rule and to vote for the bill to help the 
President out, to help the President keep his promises so that we do 
not raise taxes on anybody in this country who makes less than 
$250,000.
  Mr. POLIS. Mr. Speaker, my colleague ended his remarks by saying 
don't raise taxes on people making under $250,000. This bill increases 
taxes on people making $40,000, $70,000, even as much as $90,000. 
That's what it is--it's a huge middle class tax increase.
  With that, I yield 2 minutes to the gentleman from New York (Mr. 
Crowley).
  Mr. CROWLEY. I thank my friend from Colorado.
  Mr. Speaker, I rise today to encourage my colleagues to vote ``no'' 
on ordering the previous question so we can consider Mr. Connolly's 
amendment that would give our constituents a chance to see whose side 
their representative is on.
  Since the Republican majority took office, they have repeatedly 
focused on chipping away at the protections afforded by Medicare, 
Medicaid, Social Security, and the Affordable Care Act. Yet many of 
these same Members are happy to claim these benefits for themselves and 
their families, even as they vote to deny access to these benefits for 
the very people who put them in office. The American people deserve 
better.
  We're saying to our colleagues on the other side of the aisle: if 
you're going to force your constituents to give up the right to access 
affordable insurance or retirement security, then you should do the 
same.
  Last year, I introduced a resolution that would require all Members 
of Congress to publicly disclose whether they participate in the 
Federal Employees Health Benefits program. The reasoning was simple: if 
Republicans wish to take away quality affordable health care from 
Americans, then they can no longer hide their benefits from the 
taxpayers that subsidize their own care.
  The taxpayers are our employers, and they deserve to know which 
Members are keeping taxpayer subsidized health benefits for themselves 
and their families while they vote to deny those same health care 
benefits and rights to all American families.
  For all their talk of transparency and accountability, my resolution 
was met with silence from the other side of the aisle. Today, they have 
a chance to try again and say to their constituents: I won't take away 
your benefits unless I'm willing to give up mine as well. How many will 
take that promise? Everyone should. But I fear that their party's 
political promises will trump the promises they should make to help 
their constituents.
  I will vote to stand on the side of the American people, and I 
encourage every one of my colleagues in this Chamber to join me and 
vote ``no'' on ordering the previous question.
  Mr. SCOTT of South Carolina. Mr. Speaker, I yield 2 minutes to the 
gentleman from Ohio (Mr. Renacci).

  Mr. RENACCI. Mr. Speaker, I rise today in support of H.R. 436, the 
Health Care Cost Reduction Act.
  Over the past 18 months, the House has been focused on legislation 
that will help set the table for job creation. This recession has 
proven more stubborn than previous ones in part because it hits solid, 
middle class jobs the hardest. The medical technology industry, 
however, is one area where America remains a global leader in 
manufacturing. There are more than 35,000 medical technology industry 
jobs in Ohio alone, well paying jobs too. Unfortunately, the 
President's health care law wants to punish this industry's success.
  His overhaul of the health care industry created a 2.3 percent tax on 
medical device sales in the U.S., which will be implemented just 6 
months from now. As a small business owner myself, I understand this 
tax will have a huge negative impact on this industry, killing American 
jobs, slowing medical innovation, and harming America's global 
competitiveness. That is because this tax is on revenues, not profits.
  Some in the Halls of Congress and in this administration who have 
never worked in the private sector may not realize it, but that is an 
important distinction. Placing the tax on the revenue side makes it 
much more costly for small device makers to pay for it because many of 
them have high revenue levels, but much smaller profit margins. You're 
taxing them based on how much business they do, not on how much money 
they make, an idea only career politicians could dream up and attempt 
to implement.
  Over 75 percent of medical device makers are small businesses with 
fewer than 50 employees. As such, it has been estimated that this tax 
will lead to somewhere between 15,000 and 50,000 lost jobs. I will not 
stand idly by while this tax threatens jobs across the country and my 
home State of Ohio. That is why I stand in strong support of the Health 
Care Cost Reduction Act, which would repeal this tax. And I thank 
Representative Paulsen for introducing it. We simply cannot be 
competitively global when we tax our manufacturers and our small 
businesses at a higher rate than our foreign competitors tax theirs.
  I call on my colleagues from both sides of the aisle to practice some 
economic common sense and join me in voting to repeal this tax.
  Mr. POLIS. Why should Members of Congress get special benefits 
because they're Members of Congress that they vote to deny to their 
constituents? Thankfully, if we defeat the previous question, Mr. 
Connolly will bring forward an amendment that will address this issue.
  With that, I am proud to yield 2 minutes to the gentleman from 
Virginia (Mr. Connolly).
  Mr. CONNOLLY of Virginia. I thank my colleague, Mr. Polis.
  Mr. Speaker, I rise to urge my colleagues to defeat the previous 
question.
  If we defeat the previous question, we will move immediately to 
consideration of an amendment that will ensure that Members of Congress 
do not shield themselves from changes in health care benefits that 
would reduce the level of care for our constituents. In fact, we might 
even call this the ``what's good for the goose'' amendment.
  In fact, the simple commonsense amendment would add a new section at 
the end of the Legislative Branch Appropriations Act to prohibit any 
proposed repeal of benefits in Social Security, Medicare, Medicaid, or 
the Affordable Care Act from taking effect until it has certified that 
a majority of Members in this body and the Senate are no longer 
eligible, whether through automatic or voluntary withdrawal, to receive 
the very same benefits being repealed.
  My colleagues will recall that during the health care reform debate, 
we responded to false claims about Members of Congress having gold-
plated health care by removing ourselves from the Federal Employees 
Health Benefits program. Members will soon use their own State-based 
exchanges to purchase insurance just like any other family in their 
community.
  We wanted our constituents to have as much confidence as we do that 
the exchanges will deliver the care that's promised. In keeping with 
that spirit, my simple amendment would ensure Members of Congress stand 
with their residents in living with any changes in benefits we might 
legislate.
  Mr. Speaker, we can offer our residents comfort of mind knowing that 
Members of Congress will share in those same benefits or reduced 
benefits by adopting this simple commonsense amendment, proving that 
what is good for the goose is also good for the gander.
  I urge defeat of the previous question.
  Mr. SCOTT of South Carolina. Mr. Speaker, I yield 1 minute to the 
gentleman from Indiana (Mr. Rokita).
  Mr. ROKITA. I thank the gentleman.
  Mr. Speaker, Indiana is a global leader in medical device innovation 
in the United States, providing tens of thousands of high-wage jobs to 
Hoosiers. There are over 300 medical device manufacturers in the State, 
many of them small businesses, all working on cutting-edge innovation.

[[Page H3597]]

  Mr. Speaker, we need to preserve what is working in America. The 
medical device industry is working. In fact, it's helping to save 
manufacturing in this country, period. One of the biggest threats to 
the medical device industry is the tax punishing policies put forth by 
the last Congress and the President of the United States, commonly 
known as ObamaCare. It will send these manufacturing jobs to other 
countries so the cost of the tax can be made up.

                              {time}  1330

  In addition to sending jobs out of the country, this tax, if not 
repealed, will only drive up the cost of health care by shifting the 
costs onto consumers.
  Medical device jobs provide an average of $60,000 in Indiana alone, 
which is 56 percent higher than the State average. The economic impact 
of Indiana's medical device industry eclipses $10 billion, and job 
growth has increased nearly 40 percent in the last few years. Similar 
numbers can be applied to the State and across this Nation.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. SCOTT of South Carolina. I yield the gentleman an additional 30 
seconds.
  Mr. ROKITA. Although the tax is not scheduled to take effect until 
next January, we are already feeling its choking boot on the necks of 
hardworking Americans and sick people. Indiana medical device companies 
have already laid off good Americans, thanks to this tax, which is just 
one more example of this failed Presidency.
  The national unemployment rate increased again last month. We cannot 
afford to move forward with this ill-conceived tax on American 
innovation, on American companies who add value to this Nation and its 
economy.
  I encourage all of my colleagues, Mr. Speaker, to vote ``yes'' on the 
rule and for final passage of H.R. 436.
  Mr. POLIS. I have no additional speakers on this huge Republican 
middle class tax increase. I would like to ask my colleague if he has 
any remaining speakers. I am prepared to close.
  I reserve the balance of my time.
  Mr. SCOTT of South Carolina. Mr. Speaker, I yield 1 minute to the 
gentleman from Illinois (Mr. Walsh).
  Mr. WALSH of Illinois. I thank the gentleman for yielding.
  Mr. Speaker, Illinois is hurting. Unemployment has been above 8 
percent for the past 3 years. The medical technology industry is one of 
the only success stories in the State, employing thousands and still 
growing.
  The district I represent is home to many of these medical technology 
companies. These are quality jobs with employees earning, on average, 
10 percent more than their counterparts in similar manufacturing 
fields.
  We must act now without hesitation. Illinois alone could lose 
anywhere from 1,200 to 1,300 good-paying jobs that support American 
families. That's why I cosponsored H.R. 436, rise in support now, and 
will continue to support all efforts to repeal the medical device tax.
  Mr. Speaker, the highest level of prosperity occurs when there is a 
free market economy and a minimum of government regulations. Illinois 
has suffered enough. We can't stand idly by and watch more burdensome 
taxes prevent honest, hardworking American from getting the quality 
jobs they deserve.
  Mr. POLIS. I would like to inquire if my colleague has any remaining 
speakers, and I would like to inquire of the Speaker how much time 
remains on both sides.
  The SPEAKER pro tempore. The gentleman from Colorado has 2\1/4\ 
minutes remaining, and the gentleman from South Carolina has 6\3/4\ 
minutes remaining.
  Mr. POLIS. I yield myself the remainder of the time.
  Mr. Speaker, at a time when millions of Americans are still out of 
work, here's yet another bill on the House floor that does nothing to 
create jobs or get our economy back on track.
  This House has already passed repeals of the Affordable Care Act 
several times, and here we have another bill that takes three bills and 
lumps them together with a controversial payment mechanism that's a 
huge tax increase on the middle class, and it drives Congress further 
from consensus and sound governance.
  Again, we're spending another legislative day repealing parts of the 
Affordable Care Act that the President has said he would veto with no 
opportunity for Members of either party to offer amendments or 
substitutes.
  Instead of seeking a bipartisan agreement on reducing health care 
costs or even doing anything to further the repeal of the medical 
device tax, the Republicans have made it impossible for many to support 
this bill by combining a number of unrelated bills with a huge middle 
class tax increase. This is not the transparent one-bill-at-a-time 
House that the American people deserve.
  My colleagues are once again passing on an opportunity for bipartisan 
reform in favor of simply scoring political points.
  Mr. Speaker, I ask unanimous consent to insert the text of the 
amendment into the Record, along with extraneous material, immediately 
prior to the vote on the previous question.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Colorado?
  There was no objection.
  Mr. POLIS. Mr. Speaker, I urge my colleagues to vote ``no'' and 
defeat the previous question so we can make sure that Members of 
Congress don't receive special benefits that we would deny to our 
constituents.
  I urge a ``no'' vote on the rule, so we can avoid this enormous 
Republican middle class tax increase, and I yield back the balance of 
my time.
  Mr. SCOTT of South Carolina. Mr. Speaker, I yield myself the 
remaining time.
  My assumption is my friends to the left truly believe if you say it 
often enough, it might become true. Even if it doesn't become true, if 
you say it often enough, perhaps someone watching will assume that the 
words being spoken are somehow true.
  We've heard it several times in the last hour, things that have been 
said over and over again because we are obviously once again in an 
election year. After hearing the arguments made by the other side 
regarding the previous question, there is no doubt that we are in an 
election year.
  To clarify, any future changes in benefits to Social Security or 
Medicare would also and always apply to Members of this body. There are 
no exceptions, Mr. Speaker, no, not one exception whatsoever. There are 
no carve-outs in the law giving special treatment to Members of 
Congress under Social Security or Medicare.
  But if you say it often enough, perhaps someone, somewhere watching 
somewhere in this Nation will come to the conclusion that it must be 
right. Let me say it one more time.
  Members of Congress will comply with the law as it is on Social 
Security and Medicare.
  Secondly, we have heard consistently over and over again--and this is 
another part of that alternate universe that doesn't exist unless you 
want someone to believe something that is simply not true--that somehow 
recapturing overpayments of health care subsidies is now considered a 
tax. I would say that at a time when we face a $16 trillion debt, we 
cannot afford to not recapture all the money owed to the Federal 
Government.
  My friends on the left want people to believe that if you recapture 
the dollars that were given inappropriately that somehow, some way this 
becomes a tax increase. Let me say it just in case folks listening 
didn't understand the words that I was speaking.
  Requiring people to return money not correctly given to them, this is 
not a tax, and it certainly is not a tax increase. It is simply a 
matter of honesty and integrity.
  Mr. Speaker, we're talking about the health care bill that took $500 
billion from Medicare. We're talking about the health care bill that 
takes $500 billion out of the pockets of everyday, average middle class 
Americans in the form of tax increases. There is one tax increase on 
those folks who own property, $123 billion through a new 3.8 percent 
tax. Today we find ourselves in the position of repealing a $29 billion 
medical device tax because the people who need the medical devices will 
end up paying that tax.
  I think we are in a position today, Mr. Speaker, to make sure that 
over 423,000 Americans who are employed in this country are able to 
continue to work. I believe that we are in a position, Mr. Speaker, to 
ensure that the

[[Page H3598]]

health care of millions of Americans continues to be a critical part of 
the discussion.
  Mr. Speaker, we are in a place to make sure that new taxes, $29 
billion of new taxes, don't continue to destroy American jobs.
  Mr. Speaker, I urge my colleagues not only to vote for the rule but 
to vote for the underlying legislation.
  The material previously referred to by Mr. Polis is as follows:

      An Amendment to H. Res. 679 Offered by Mr. Polis of Colorado

       At the end of section 2, add the following:
       Notwithstanding any other provision of this resolution, the 
     amendment printed in section 3 shall be in order as though 
     printed as the last amendment in the report of the Committee 
     on Rules if offered by Representative Connolly of Virginia or 
     a designee. That amendment shall be debatable for one hour 
     equally divided and controlled by the proponent and an 
     opponent.
       Sec. 3. The amendment referred to in section 2 is as 
     follows:
       At the end of the bill (before the short title), insert the 
     following:
       Members who repeal federal benefits for their constituents 
     must forfeit such benefits for themselves.
       Sec.__ (a) In General.--Any proposed repeal of benefits in 
     Social Security, Medicare, or Medicaid, or of any benefit 
     provided under the Patient Protection and Affordable Care Act 
     (Public Law 111 148), shall not take effect until the 
     Director of the Office of Personnel Management certifies to 
     the Congress that a majority of the Members of the House of 
     Representatives and a majority of Members of the Senate have, 
     as of the date that is 30 days after the date of the passage 
     of the repeal in the respective House, voluntarily and 
     permanently withdrawn from any participation, and waived all 
     rights to participate, as such a Member in that benefit. (b) 
     MEMBER DEFINED.--In this section, the term ``Member of the 
     House of Representatives'' means a Representative in, or a 
     Delegate or Resident Commissioner to, the Congress.
                                  ____

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

        The Vote on the Previous Question: What It Really Means

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

  Mr. SCOTT of South Carolina. Mr. Speaker, I yield back the balance of 
my time, and I move the previous question on the resolution.
  The SPEAKER pro tempore. The question is on ordering the previous 
question.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. POLIS. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  Pursuant to clause 9 of rule XX, the Chair will reduce to 5 minutes 
the minimum time for any electronic vote on the question of adoption.
  The vote was taken by electronic device, and there were--yeas 240, 
nays 179, not voting 12, as follows:

                             [Roll No. 358]

                               YEAS--240

     Adams
     Aderholt
     Akin
     Alexander
     Amash
     Amodei
     Austria
     Bachmann
     Bachus
     Barletta
     Bartlett
     Barton (TX)
     Bass (NH)
     Benishek
     Berg
     Biggert
     Bilbray
     Bishop (UT)
     Black
     Blackburn
     Bonner
     Bono Mack
     Boren
     Boustany
     Brady (TX)
     Brooks
     Broun (GA)
     Buchanan
     Bucshon
     Buerkle
     Burgess
     Burton (IN)
     Calvert
     Camp
     Campbell
     Canseco
     Cantor
     Capito
     Carter
     Cassidy
     Chabot
     Chaffetz
     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
     Jones
     Jordan
     Kelly
     King (NY)
     Kingston
     Kinzinger (IL)
     Kissell
     Kline
     Labrador
     Lamborn
     Lance
     Landry
     Lankford
     Latham
     LaTourette
     Latta
     LoBiondo
     Long
     Lucas
     Luetkemeyer
     Lummis
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     Matheson
     McCarthy (CA)
     McCaul
     McClintock
     McCotter
     McHenry
     McIntyre
     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
     Poe (TX)
     Pompeo
     Posey
     Price (GA)
     Quayle
     Reed
     Rehberg
     Reichert
     Renacci
     Ribble
     Rigell
     Rivera
     Roby
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Rokita
     Rooney
     Ros-Lehtinen
     Roskam
     Ross (FL)
     Royce
     Runyan
     Ryan (WI)
     Scalise
     Schilling
     Schmidt
     Schock
     Schweikert
     Scott (SC)
     Scott, Austin
     Sensenbrenner
     Sessions
     Shimkus
     Shuster
     Simpson
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Southerland
     Stearns
     Stivers
     Stutzman
     Sullivan
     Terry
     Thompson (PA)
     Thornberry
     Tiberi
     Tipton
     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)

                               NAYS--179

     Ackerman
     Altmire
     Andrews
     Baca
     Barrow
     Becerra
     Berkley
     Berman
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Bonamici
     Boswell
     Brady (PA)
     Braley (IA)
     Brown (FL)
     Butterfield
     Capps
     Capuano
     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)
     Davis (IL)
     DeFazio
     DeGette
     DeLauro
     Deutch
     Dicks
     Dingell
     Doggett
     Donnelly (IN)
     Doyle
     Edwards
     Ellison
     Engel
     Eshoo
     Farr
     Fattah
     Frank (MA)
     Fudge
     Garamendi
     Gonzalez
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hahn
     Hanabusa

[[Page H3599]]


     Hastings (FL)
     Heinrich
     Higgins
     Himes
     Hinchey
     Hinojosa
     Hirono
     Hochul
     Holden
     Holt
     Honda
     Hoyer
     Israel
     Jackson (IL)
     Jackson Lee (TX)
     Johnson (GA)
     Johnson, E. B.
     Kaptur
     Keating
     Kildee
     Kind
     King (IA)
     Langevin
     Larsen (WA)
     Larson (CT)
     Lee (CA)
     Levin
     Lewis (GA)
     Lipinski
     Loebsack
     Lofgren, Zoe
     Lowey
     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)
     Polis
     Price (NC)
     Quigley
     Rahall
     Rangel
     Reyes
     Richardson
     Richmond
     Ross (AR)
     Rothman (NJ)
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schiff
     Schrader
     Schwartz
     Scott (VA)
     Scott, David
     Serrano
     Sewell
     Sherman
     Sires
     Smith (WA)
     Speier
     Stark
     Sutton
     Thompson (CA)
     Thompson (MS)
     Tierney
     Tonko
     Towns
     Tsongas
     Van Hollen
     Velazquez
     Visclosky
     Walz (MN)
     Wasserman Schultz
     Waters
     Watt
     Waxman
     Welch
     Wilson (FL)
     Woolsey
     Yarmuth

                             NOT VOTING--12

     Baldwin
     Bass (CA)
     Bilirakis
     Cardoza
     Coble
     Filner
     Kucinich
     Lewis (CA)
     Marino
     Paul
     Shuler
     Slaughter

                              {time}  1404

  Messrs. COHEN, CICILLINE, DICKS and LYNCH changed their vote from 
``yea'' to ``nay.''
  Messrs. CRAWFORD and PETERSON changed their vote from ``nay'' to 
``yea.''
  So the previous question was ordered.
  The result of the vote was announced as above recorded.
  Stated against:
  Mr. FILNER. Mr. Speaker, on rollcall 359, I was away from the Capitol 
due to prior commitments to my constituents. Had I been present, I 
would have voted ``nay.''
  (By unanimous consent, Mr. Hoyer was allowed to speak out of order.)

                          ____________________