[Congressional Record Volume 158, Number 102 (Tuesday, July 10, 2012)]
[House]
[Pages H4711-H4724]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   PROVIDING FOR CONSIDERATION OF H.R. 6079, REPEAL OF OBAMACARE ACT

  Mr. SESSIONS. Madam Speaker, by direction of the Committee on Rules, 
I call up House Resolution 724 and ask for its immediate consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 724

         Resolved, That upon adoption of this resolution it shall 
     be in order to consider in the House the bill (H.R. 6079) to 
     repeal the Patient Protection and Affordable Care Act and 
     health care-related provisions in the Health Care and 
     Education Reconciliation Act of 2010. All points of order 
     against consideration of the bill are waived. The bill shall 
     be considered as read. All points of order against provisions 
     in the bill are waived. The previous question shall be 
     considered as ordered on the bill and any amendment thereto 
     to final passage without intervening motion except: (1) five 
     hours of debate, with 30 minutes equally divided and 
     controlled by the Majority Leader and Minority Leader or 
     their respective designees, 60 minutes equally divided and 
     controlled by the chair and ranking minority member of the 
     Committee on Education and the Workforce, 60 minutes equally 
     divided and controlled by the chair and ranking minority 
     member of the Committee on Energy and Commerce, 60 minutes 
     equally divided and controlled by the chair and ranking 
     minority member of the Committee on Ways and Means, 30 
     minutes equally divided and controlled by the chair and 
     ranking minority member of the Committee on the Budget, 30 
     minutes equally divided and controlled by the chair and 
     ranking minority member of the Committee on the Judiciary, 
     and 30 minutes equally divided and controlled by the chair 
     and ranking minority member of the Committee on Small 
     Business; and (2) one motion to recommit.

  The SPEAKER pro tempore. The gentleman from Texas is recognized for 1 
hour.
  Mr. SESSIONS. For the purpose of debate only, I yield the customary 
30 minutes to my friend, the gentlewoman from Fairport, New York, and 
the ranking member of the Committee on Rules, Ms. Slaughter, 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. SESSIONS. Madam Speaker, I ask unanimous consent that all Members 
have 5 legislative days to revise and extend their remarks.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. SESSIONS. House Resolution 724 provides a closed rule for 
consideration of H.R. 6079.
  Madam Speaker, today I rise in support of this rule and the 
underlying bill. H.R. 6079, the Repeal of Obamacare Act of 2012, was 
introduced by the Republican majority leader, Eric Cantor, the 
gentleman from Virginia. The bill text has been online since last 
Thursday, giving Members more than the mandatory 3 days to read and to 
understand the language.

[[Page H4712]]

  Madam Speaker, on June 28, just 12 days ago, the United States 
Supreme Court upheld the individual mandate provisions contained in 
ObamaCare, thereby forcing every American to purchase health insurance. 
While I may disagree with how they ruled, I respect their decision and 
there is nothing we can do to change that. ObamaCare is now the 
official law of the land.
  However, there is something this body can do to reverse the course 
and to prevent the job-destroying aspects of this bill from taking 
effect: a complete repeal of the bill that the President asked this 
Congress to pass under Speaker Pelosi--and they did. We need to repeal 
ObamaCare today. In 2010, Republicans were elected all across this 
country because Americans understood the need to stop the tax-and-spend 
policies of the other party. H.R. 6079 will do exactly that.
  Last night in the Rules Committee, my colleague and friend, the 
gentleman from New Jersey (Mr. Andrews), urged us to ``dispassionately 
examine the facts.'' I agree with just that sentiment and would like to 
take a moment to do just that.
  Earlier this year, the Centers for Medicare and Medicaid Services, 
CMS, reported that health insurance premiums are expected to rise by 
over 44 percent over the next 9 years as a result of ObamaCare. And 
since ObamaCare was signed into law, there has been a steady decline in 
the number of Americans on private health insurance.
  A report from the McKinsey Group found that more than 50 percent of 
employers with a high awareness of the law say that they will stop 
offering health insurance, confirming what Republicans have been saying 
for 3 years, and that is, that ObamaCare is designed to force employers 
to drop coverage in an attempt to get Americans to enter the new health 
care exchanges.
  A Kaiser Family Foundation report found that health insurance 
premiums have increased by 9 percent, or $1,200, for the average 
American family following passage of the President's health care bill.
  According to the 2010 Medicare Trustees Report, as a direct result of 
ObamaCare, more than 90 percent of seniors will lose the retiree 
prescription drug coverage they have and will see nearly double-digit 
premium increases. Seniors will also see reduced access to doctors, as 
Medicare officials explained that physicians ``could find it difficult 
to remain profitable and might end their participation in the program, 
which possibly could jeopardize access to care for beneficiaries.''
  According to the President's own budget, the cost of ObamaCare 
subsidies have jumped $111 billion in just 1 year. Earlier this year, 
during a Ways and Means Committee hearing on February 28, 2012, when 
asked why this happened, Health and Human Services Secretary Sebelius 
said, ``I really don't know.''
  Finally, earlier this year, the nonpartisan Congressional Budget 
Office adjusted their long-term outlook of the impact of ObamaCare on 
our national debt. The revised figures show ObamaCare will cost 
taxpayers $1.8 trillion--twice as much as the President promised in 
2010 when the bill was passed.
  These are just a few of the facts that I believe should be considered 
dispassionately as we debate whether to repeal ObamaCare. If you think 
that the facts I just listed are what the country needs, vote to keep 
it. However, if you, like me, find these facts unacceptable for our 
future, then I urge you to join me in repealing ObamaCare so that we 
can focus on patient-centered health care solutions which do not 
increase dramatically insurance premiums, do not restrict access to 
physicians, and do not mount unsustainable debt onto our children and 
grandchildren, as well as harming employers who wish to employ more 
Americans.
  I urge my colleagues to vote for the rule and the underlying bill, 
and I reserve the balance of my time.

              [From the Wall Street Journal, June 8, 2011.

                    Study Sees Cuts to Health Plans

                            (By Janet Adamy)

       A report by McKinsey & Co. has found that 30% of employers 
     are likely to stop offering workers health insurance after 
     the bulk of the Obama administration's health overhaul takes 
     effect in 2014.
       The findings come as a growing number of employers are 
     seeking waivers from an early provision in the overhaul that 
     requires them to enrich their benefits this year. At the end 
     of April, the administration had granted 1,372 employers, 
     unions and insurance companies one-year exemptions from the 
     law's requirement that they not cap annual benefit payouts 
     below $750,000 per person a year.
       But the law doesn't allow for such waivers starting in 
     2014, leaving all those entities--and other employers whose 
     plans don't meet a slate of new requirements--to change their 
     offerings or drop coverage.
       Previous research has suggested the number of employers who 
     opt to drop coverage altogether in 2014 would be minimal.
       But the McKinsey study predicts a more dramatic shift from 
     employer-sponsored health plans once the new marketplace 
     takes effect. Starting in 2014, all but the smallest 
     employers will be required to provide insurance or pay a 
     fine, while most Americans will have to carry coverage or pay 
     a different fine. Lower earners will get subsidies to help 
     them pay for plans.
       In surveying 1,300 employers earlier this year, McKinsey 
     found that 30% said they would ``definitely or probably'' 
     stop offering employer coverage in the years after 2014. That 
     figure increased to more than 50% among employers with a high 
     awareness of the overhaul law.
       Behind the expected shift is the fact that the law will 
     give Americans new insurance options outside the workplace, 
     and carriers will no longer be allowed to deny people 
     coverage because they have been sick. McKinsey found that 
     reduced the moral obligation employers may feel to provide 
     coverage.
       The Obama administration says it is working to encourage 
     employers to retain coverage. An administration official, 
     Nick Papas, described the McKinsey report as an outlier amid 
     other research suggesting that employers overwhelmingly would 
     keep coverage.
       ``History has shown that reform motivates more businesses 
     to offer insurance,'' he said. ``When Massachusetts enacted 
     health reform, the number of individuals with employer-
     sponsored insurance increased.''
       The nonpartisan Congressional Budget Office, in a March 
     2010 report, found that by 2019, about six million to seven 
     million people who otherwise would have had access to 
     coverage through their job won't have it owing to the new 
     law. That estimate represents about 4% of the roughly 160 
     million people projected to have employment-based coverage in 
     2019.
       However, the CBO estimated that the overall number of 
     Americans with coverage will rise by 32 million because of 
     new subsidies and other steps.
       The law contains a disincentive for employers to drop 
     coverage. It requires all employers with more than 50 
     employees to offer health benefits to every full-time worker 
     or pay a penalty of $2,000 per worker, though it doesn't 
     apply to the first 30 workers. Health-policy experts have 
     questioned whether that is high enough to discourage 
     companies from health coverage.
       McKinsey found at least 30% of employers would gain 
     economically from dropping coverage even if they completely 
     compensated employees through other benefits or higher 
     salaries. The study suggests the fallout would be minimal, 
     with more than 85% of employees remaining in their jobs even 
     if their employer stopped coverage.
       Nearly half the employers said they would consider 
     alternatives to their current plan after 2014. Besides 
     dropping coverage, those included weighing a switch to a 
     defined-contribution model of insurance, in effect offering 
     coverage only to certain employees.
                                  ____


 [From the Kaiser Family Foundation and Health Research & Educational 
                                 Trust]

           Employer Health Benefits: 2011 Summary of Findings

       Employer-sponsored insurance is the leading source of 
     health insurance, covering about 150 million nonelderly 
     people in America. To provide current information about the 
     nature of employer-sponsored health benefits, the Kaiser 
     Family Foundation (Kaiser) and the Health Research & 
     Educational Trust (HRET) conduct an annual national survey of 
     nonfederal private and public employers with three or more 
     workers. This is the thirteenth Kaiser/HRET survey and 
     reflects health benefit information for 2011.
       The key findings from the 2011 survey, conducted from 
     January through May 2011, include increases in the average 
     single and family premiums, as well higher enrollment in high 
     deductible health plans with savings options (HDHP/S0s). The 
     2011 survey includes new questions on the percentage of firms 
     with grandfathered health plans, changes in benefits for 
     preventive care, enrollment of adult children due to the new 
     health reform law, and the use of stoploss coverage by firms 
     with self-funded plans.


           HEALTH INSURANCE PREMIUMS AND WORKER CONTRIBUTIONS

       The average annual premiums for employer-sponsored health 
     insurance in 2011 are $5,429 for single coverage and $15,073 
     for family coverage. Compared to 2010, premiums for single 
     coverage are 8% higher and premiums for family coverage are 
     9% higher. The 9% growth rate in family premiums for 2011 is 
     significantly higher than the 3% growth rate in 2010. Since 
     2001, average premiums for family coverage have increased 
     113%. Average premiums for family coverage are lower for 
     workers in small firms (3-199 workers) than for workers in 
     large firms (200 or more

[[Page H4713]]

     workers) ($14,098 vs. $15,520). Average premiums for high-
     deductible health plans with a savings option (HDHP/S0s) are 
     lower than the overall average for all plan types for both 
     single and family coverage.
       There is significant variation around the average annual 
     premiums as a result of factors such as benefits, cost 
     sharing, and geographic cost differences. Nineteen percent of 
     covered workers are in plans with an annual total premium for 
     family coverage of at least $18,087 (120% of the average 
     family premium), while 21% of covered workers are in plans 
     where the family premium is less than $12,058 (80% of the 
     average premium).
       Covered workers contribute on average 18% of the premium 
     for single coverage and 28% of the premium for family 
     coverage, similar to the percentages they contributed in 
     2010. Workers in small firms (3-199 workers) contribute a 
     significantly lower average percentage for single coverage 
     compared to workers in larger firms (15% vs. 19%), but a 
     higher average percentage for family coverage (36% vs. 25%). 
     As with total premiums, the share of the premium contributed 
     by workers varies considerably around these averages. For 
     single coverage, 59% of covered workers are in plans that 
     require them to pay more than 0% but less than or equal to 
     25% of the total premium, and 3% are in plans that require 
     more than 50% of the premium; 16% are in plans that require 
     them to make no contribution. For family coverage, 47% of 
     covered workers are in plans that require them to pay more 
     than 0% but less than or equal to 25% of the total premium, 
     and 15% are in plans that require more than 50% of the 
     premium; only 6% are in plans that require no contribution.
       Looking at the dollar amounts that workers contribute, the 
     average annual contributions in 2011 are $921 for single 
     coverage and $4,129 for family coverage. Neither amount is a 
     statistically significant increase over the 2010 values. 
     Workers in small firms (3-199 workers) have lower average 
     contributions for single coverage than workers in larger 
     firms ($762 vs, $996), and higher average contributions for 
     family coverage ($4,946 vs. $3,755). Compared to the overall 
     average contributions, workers in HDHP/S0s have lower average 
     contributions for single coverage ($723 vs. $921), while 
     workers in point of service (POS) plans have higher average 
     contributions for family coverage ($5,333 vs. $4,129).


                            PLAN ENROLLMENT

       Overall, PPOs are by far the most common plan type, 
     enrolling 55% of covered workers. Seventeen percent of 
     covered workers are enrolled in an HMO, 10% are enrolled in a 
     POS plan, and 1% are enrolled in a conventional plan. 
     Enrollment in HDHP/S0s continues to rise, with 17% of covered 
     workers in an HDHP/SO in 2011, up from 13% of covered workers 
     in 2010, and 8% in 2009. The enrollment distribution varies 
     by firm size, with PPOs and HMOs relatively more popular 
     among large firms (200 or more workers) and PPOs and HDHP/S0s 
     relatively more popular in smaller firms.


                         EMPLOYEE COST SHARING

       Most covered workers face additional costs when they use 
     health care services. A large share of workers in PPOs (81%) 
     and POS plans (69%) have a general annual deductible for 
     single coverage that must be met before all or most services 
     arc reimbursed by the plan. In contrast, only 29% of workers 
     in HMOs have a general annual deductible. Many workers with 
     no general annual deductible still face other types of cost 
     sharing when they use covered services.
       Among workers with a general annual deductible, the average 
     deductible amount for single coverage is $675 for workers in 
     PPOs, $911 for workers in HMOs, $928 for workers in POS 
     plans, and $1,908 for workers in HDHP/S0s (which by 
     definition have high deductibles). As in recent years. 
     workers with single coverage in small firms (3-199 workers) 
     have higher deductibles than workers in large firms (200 or 
     more workers); for example, the average deductibles for 
     single coverage in PPOs, the most common plan type, are 
     $1,202 for workers in small firms (3-199 workers) compared to 
     $505 for workers in larger firms. Overall, 31% of covered 
     workers are in a plan with a deductible of at least $1,000 
     for single coverage, similar to the 27% reported in 2010, but 
     significantly more than the 22% reported in 2009. Covered 
     workers in small firms (3-199 workers) remain more likely 
     than covered workers in larger firms (50% vs. 22%) to be in 
     plans with deductibles of at least $1,000.
       The majority of workers also have to pay a portion of the 
     cost of physician office visits. About three-in-four covered 
     workers pay a copayment (a fixed dollar amount) for office 
     visits with a primary care physician (74%) or a specialist 
     physician (73%), in addition to any general annual deductible 
     a plan may have. Smaller shares of workers pay coinsurance (a 
     percentage of the covered amount) for primary care office 
     visits (17%) or specialty care visits (18%). Most covered 
     workers in HMOs, PPOs, and POS plans face copayments, while 
     covered workers in HDHP/S0s are more likely to have 
     coinsurance requirements or no cost sharing after the 
     deductible is met. For in-network office visits, covered 
     workers with a copayment pay an average of $22 for primary 
     care and $32 for specialty care. For covered workers with 
     coinsurance, the average coinsurance is 18% for both primary 
     care and specialty care. While the survey collects 
     information on only in-network cost sharing, we note that 
     out-of-network cost sharing is often higher.
       Almost all covered workers (98%) have prescription drug 
     coverage, and nearly all face cost sharing for their 
     prescriptions. Over three-quarters (77%) of covered workers 
     are in plans with three or more tiers of cost sharing. 
     Copayments are more common than coinsurance for each tier of 
     cost sharing. Among workers with three- or four-tier plans, 
     the average copayments in these plans are $10 for first-tier 
     drugs, $29 for second-tier drugs, $49 for third-tier drugs, 
     and $91 for fourth-tier drugs. These amounts are not 
     significantly higher than the amounts reported last year. 
     HDHP/SOs have a somewhat different cost-sharing pattern for 
     prescription drugs than other plan types: 57% of covered 
     workers are enrolled a plan with three or more tiers of cost 
     sharing while 17% are in plans that pay 100% of prescription 
     costs once the plan deductible is met. Covered workers in 
     these plans are also more likely to pay coinsurance than 
     workers in other plan types.
       Most workers also face additional cost sharing for a 
     hospital admission or an outpatient surgery episode. After 
     any general annual deductible, 55% of covered workers have 
     coinsurance and 17% have copayment for hospital admissions.
       Lower percentages have per day (per diem) payments (6%), a 
     separate hospital deductible (3%), or both copayments and 
     coinsurance (9%). The average coinsurance rate for hospital 
     admissions is 17%, the average copayment is $246 per hospital 
     admission, the average per diem charge is $246, and the 
     average separate hospital deductible is $627. The cost-
     sharing provisions for outpatient surgery are similar to 
     those for hospital admissions, as most covered workers have 
     either coinsurance (57%) or copayments (18%). For covered 
     workers with cost sharing for each outpatient surgery 
     episode, the average coinsurance is 17% and the average 
     copayment is $145.
       Most plans limit the amount of cost sharing workers must 
     pay each year, generally referred to as an out-of-pocket 
     maximum. Eighty-three percent of covered workers have an out-
     of-pocket maximum for single coverage, but the limits differ 
     considerably. For example, among covered workers in plans 
     that have an out-of-pocket maximum for single coverage, 38% 
     are in plans with an annual out-of-pocket maximum of $3,000 
     or more, and 14% are in plans with an out-of-pocket maximum 
     of less than $1,500. Even in plans with a specified out-of-
     pocket limit, not all spending is counted towards meeting the 
     limit. For example, among workers in PPOs with an out-of-
     pocket maximum, 77% are in plans that do not count physician 
     office visit copayments, 35% are in plans that do not count 
     spending for the general annual deductible, and 84% are in 
     plans that do not count prescription drug spending when 
     determining if an enrollee has reached the out-of-pocket 
     limit.


              AVAILABILITY OF EMPLOYER-SPONSORED COVERAGE

       Sixty percent of firms offer health benefits to their 
     workers in 2011--a significant reduction from the 69% 
     reported in 2010, but much more in line with the levels for 
     years prior to 2010. The large increase in 2010 was primarily 
     driven by a significant (12 percentage points) increase in 
     offering among firms with 3 to 9 workers (from 47% in 2009 to 
     59% in 2010). This year, 48% of firms with 3 to 9 employees 
     offer health benefits. a level which is more consistent with 
     levels from recent years (2010 excluded). These figures 
     suggest that the 2010 results may be an aberration.
       Even in firms that offer health benefits, not all workers 
     are covered. Some workers are not eligible to enroll as a 
     result of waiting periods or minimum work-hour rules. Other 
     workers do not enroll in coverage offered to them because, 
     for example, of the cost of coverage or because they have 
     access to coverage through a spouse. Among firms that offer 
     coverage, an average of 79% of workers are eligible for the 
     health benefits offered by their employer. Of those eligible. 
     81% take up their employer's coverage, resulting in 65% of 
     workers in offering firms having coverage through their 
     employer. Among both firms that offer and do not offer health 
     benefits, 58% of workers are covered by health plans offered 
     by their employer, similar to the percentage in 2010.


            HIGH-DEDUCTIBLE HEALTH PLANS WITH SAVINGS OPTION

       HDHP/SOs include (1) health plans with a deductible of at 
     least $1,000 for single coverage and $2,000 for family 
     coverage offered with an Health Reimbursement Arrangement 
     (HRA), referred to as ``HDHP/HRAs,'' and (2) high-deductible 
     health plans that meet the federal legal requirements to 
     permit an enrollee to establish and contribute to a Health 
     Savings Account (HSA), referred to as ``HSA-qualified 
     HDHPs.''
       Twenty-three percent of firms offering health benefits 
     offer an HDHP/SO, up from 15% in 2010. Firms with 1,000 or 
     more workers are more likely to offer an HDHP/SO than smaller 
     firms (3-199 workers) (41% vs. 23%). Seventeen percent of 
     covered workers are enrolled in HDHP/SOs, up from 13% in 
     2010, and 8% in 2009. Eight percent of covered workers are 
     enrolled in HDHP/HRAs and 9% are enrolled in an HSA-qualified 
     HDHP. Twenty-three percent of covered workers in small firms 
     (3-199 workers) are enrolled in HDHP/SOs, compared to 15% of 
     workers in large firms (200 or more workers).
       The distinguishing aspect of these high deductible plans is 
     the savings feature available to employees. Workers enrolled 
     in an

[[Page H4714]]

     HDHP/HRA receive an average annual contribution from their 
     employer of $861 for single coverage and $1,539 for family 
     coverage. The average HSA annual contribution is $611 for 
     single coverage and $1,069 for family coverage. In contrast 
     to HRAs, not all firms contribute to HSAs. Sixty percent of 
     employers offering single coverage and 57% offering family 
     coverage through HSA-qualified HDHPs make contributions 
     towards the HSAs that their workers establish. The average 
     employer contributions to HSAs in these contributing firms 
     are $886 for single coverage and $1,559 for family coverage.
       The average premiums for single coverage for workers in 
     HSA-qualified HDHPs and HDHP/HRAs are lower than the average 
     premiums for workers in plans that are not HDHP/SOs. For 
     family coverage, the average premium for HSA-qualified HDHPs 
     is lower than the average family premium for workers in plans 
     that are not HDHP/SOs. For single and family coverage, the 
     average worker contributions to HSA-qualified HDHPs are also 
     lower than the average worker contributions to non-HDHP/SO 
     plans.


                            RETIREE COVERAGE

       Twenty-six percent of large firms (200 or more workers) 
     offer retiree health benefits in 2011, which is the same 
     percentage that offered retiree health benefits in 2010. The 
     offer rate has fallen slowly over time, with significantly 
     fewer large employers offering retiree health benefits in 
     2011 than in 2007 and years prior.
       Among large firms (200 or more workers) that offer retiree 
     health benefits, 91% offer health benefits to early retirees 
     (workers retiring before age 65) and 71% offer health 
     benefits to Medicare-age retirees.


                             HEALTH REFORM

       While many of the most significant provisions of the 
     Patient Protection and Affordable Care Act (ACA) will take 
     effect in 2014, important provisions became effective in 2010 
     and others will take effect over the next few years. The 2011 
     survey asked employers about some of these early provisions.
       Grandfathered Health Plans. The ACA exempts 
     ``grandfathered'' health plans from a number of its 
     provisions, such as the requirements to cover preventive 
     benefits without cost sharing or to have an external appeal 
     process. An employer-sponsored health plan can be 
     grandfathered if it covered a worker when the ACA became law 
     (March 23, 2010) and if the plan does not make significant 
     changes that reduce benefits or increase employee costs. 
     Seventy-two percent of firms had at least one grandfathered 
     health plan when they were surveyed (January through May of 
     2011). Small firms (3-199 workers) were more likely than 
     larger firms to have a grandfathered health plan (72% vs. 
     61%). Looking at enrollment, 56% of covered workers were in 
     grandfathered health plans when the survey was conducted. The 
     percentage of covered workers in grandfathered plans is 
     higher in small firms (3-199 workers) than in larger firms 
     (63% vs. 53%).
       Firms with plans that were not grandfathered were asked to 
     respond to a list of potential reasons why each plan is not a 
     grandfathered plan. Twenty-eight percent of covered workers 
     are in plans that were not in effect when the ACA was 
     enacted. Roughly similar percentages of workers are in plans 
     where the deductibles (37%), employee premium contributions 
     (35%), or plan benefits (29%) changed more than was permitted 
     for plans to maintain grandfathered status. The reasons plans 
     were not grandfathered varied by firm size, with workers in 
     small firms (3-199 workers) much more likely than workers in 
     large firms to be in a new plan that was not in effect when 
     the ACA was enacted (63% vs. 18%) and generally less likely 
     to be affected by plan changes.
       Preventive Benefits. The ACA requires non-grandfathered 
     plans to provide certain preventive benefits without cost 
     sharing. Firms were asked whether changes were made to their 
     cost sharing for preventive services or the services that 
     were classified as preventive because of health reform. 
     Twenty-three percent of covered workers are in a plan where 
     the employer reported changing the cost-sharing requirements 
     because of health reform. Workers in large firms (200 or more 
     employees) are more likely than workers in smaller firms to 
     be in such a plan (28% vs. 13%). Thirty-one percent of 
     covered workers are in a plan where the employer reported 
     changing the services that are considered preventive services 
     because of health reform.
       Coverage for Adult Children to Age 26. The ACA requires 
     firms offering health coverage to extend benefits to children 
     of covered workers until the child reaches age 26. The child 
     does not need to be a legal dependent, but until 2014, 
     grandfathered plans do not have to enroll children of 
     employees if those children are offered employer-sponsored 
     health coverage at their own job. The survey asked firms 
     whether any adult children who would not have been eligible 
     for the plan prior to the change in law had enrolled in 
     health coverage under this provision. Nineteen percent of 
     small firms (3-199 workers) and 70% of larger firms enrolled 
     at least one adult child under this provision.
       The numbers of children who enroll under this provision are 
     closely related to the number of workers in the firm. Smaller 
     firms (3-24 workers) on average enroll two adult children due 
     to the provision, while the largest firms (5,000 or more 
     workers) enroll an average of 492 adult children. In total, 
     an estimated 2.3 million adult children were enrolled in 
     their parent's employer sponsored health plan due to the 
     Affordable Care Act.
       Small Employer Tax Credit. The ACA provides a temporary tax 
     credit for small employers that offer insurance, have fewer 
     than 25 full-time equivalent employees, and have average 
     annual wages of less than $50,000. The survey included 
     several questions for both offering and non-offering 
     employers about their awareness of the tax credit and whether 
     they considered claiming it.
       Because our survey gathers information on the total number 
     of full-time and part-time employees in a firm, we cannot 
     calculate the number of full-time equivalent employees and 
     therefore could not limit survey responses only to firms 
     within the size range eligible for the credit. To ensure that 
     we included employers that may have a number of part-time or 
     temporary employees but could still qualify for the tax 
     credit, we directed these questions to employers with fewer 
     than 50 total employees. This approach allowed us to capture 
     some employers with more than 25 employees who would 
     nonetheless be eligible for the tax credit, but this also 
     means some employers who are unlikely to be eligible for the 
     tax credit (because they have more than 25 full-time 
     equivalent employees) were asked these questions.
       Among firms with fewer than 50 employees that offer 
     coverage, 29% said they have made an attempt to determine if 
     the firm is eligible for the small employer tax credit. Of 
     the firms which attempted to determine eligibility, 30% said 
     that they intend to claim the credit for both 2010 and 2011, 
     21% said they do not intend to claim the credit for either 
     year, 41% are not sure, and small percentages said they do 
     not know if they will claim the credit or they intend to 
     claim it for only one of the two years. The vast majority of 
     those saying they do not intend to claim the tax credit 
     indicated they were not eligible to receive it.
       Firms with fewer than 50 workers that do not offer health 
     insurance were asked if they were aware of the small business 
     tax credit. One-half (50%) of these firms said they were 
     aware of the credit, and of those aware, 15% are considering 
     offering coverage as a result of the credit.


                              OTHER TOPICS

       Stoploss Coverage. Many firms that have self-funded health 
     plans purchase insurance, often called ``stoploss'' coverage, 
     to limit the amount they may have to pay in claims either 
     overall, or for any particular plan enrollee. Fifty-eight 
     percent of workers in self-funded health plans are enrolled 
     in plans covered by stoploss insurance. Workers in self-
     funded plans in small firms (3-199 workers) are more likely 
     than workers in self-funded plans in larger firms to be in a 
     plan with stoploss protection (72% vs. 57%). About four in 
     five (81%) workers in self-funded plans that have stoploss 
     protection are in plans where the stoploss insurance limits 
     the amount the plan spends on each employee. The average per 
     employee claims cost at which stoploss insurance begins 
     paying benefits is $78,321 for workers in small firms (3-199 
     workers) with self-funded plans, and $208,280 for workers in 
     larger firms with self-funded plans.
       High-Performance Networks. Some plans offer tiered or high-
     performance networks, which group providers in the network 
     based on quality, cost, and/or efficiency of the care they 
     deliver. Plans encourage patients to visit higher performing 
     providers either by restricting networks to efficient 
     providers, or by having different copayments or coinsurance 
     for providers in different tiers in the network. Twenty 
     percent of firms offering coverage in 2011 include a high-
     performance or tiered provider network in their health plan 
     with the largest enrollment. Small firms (3-199 workers) and 
     larger firms are equally likely to offer a plan that includes 
     a high-performance or tiered network.


                               CONCLUSION

       The 2011 survey saw an upturn in premium growth, as the 
     average premiums for family coverage increased 9% between 
     2010 and 2011, significantly higher than the 3% increase 
     between 2009 and 2010. The percentage of workers in HDHP/SOs 
     continues to rise as employers seek more affordable coverage 
     options and are potentially seeking to shift increased costs 
     to workers. In 2011, 17% of covered workers were enrolled in 
     an HDHP/SO, compared to 13% in 2010 and 8% in 2009.
       Changes from the new health reform law are beginning to 
     have an impact on the marketplace. Significant percentages of 
     firms made changes in their preventive care benefits and 
     enrolled adult children in their benefits plans in response 
     to provisions in the new health reform law. Most employees 
     with employment-sponsored insurance are in grandfathered 
     plans that are exempt from some of the law's new provisions, 
     but this may change over time as firms adjust benefits and 
     cost sharing or change plan design to incorporate new 
     features. The survey will continue to monitor employer 
     responses to health reform as firms adapt to early provisions 
     in the law and as new provisions take effect.


                              METHODOLOGY

       The Kaiser Family Foundation/Health Research & Educational 
     Trust 2011 Annual Employer Health Benefits Survey (Kaiser/
     HRET) reports findings from a telephone survey of 2,088 
     randomly selected public and private employers with three or 
     more workers. Researchers at the Health Research & 
     Educational Trust, NORC at the University of Chicago, and the 
     Kaiser Family Foundation designed and analyzed the survey. 
     National Research, LLC conducted the fieldwork between 
     January and May 2011. In 2011 our

[[Page H4715]]

     overall response rate is 47%, which includes firms that offer 
     and do not offer health benefits. Among firms that offer 
     health benefits, the survey's response rate is 47%.
       From previous years' experience, we learned that firms that 
     decline to participate in the study are less likely to offer 
     health coverage. Therefore, we asked one question to all 
     firms with which we made phone contact, but the firm declined 
     to participate. The question was, ``Does your company offer a 
     health insurance program as a benefit to any of your 
     employees?'' A total of 3,184 firms responded to this 
     question (including 2,088 who responded to the full survey 
     and 1,096 who responded to this one question). Their 
     responses are included in our estimates of the percentage of 
     firms offering health coverage. The response rate for this 
     question was 71%. Since firms are selected randomly, it is 
     possible to extrapolate from the sample to national, 
     regional, industry, and firm size estimates using statistical 
     weights. In calculating weights, we first determined the 
     basic weight, then applied a nonresponse adjustment, and 
     finally applied a post-stratification adjustment. We used the 
     U.S. Census Bureau's Statistics of U.S. Businesses as the 
     basis for the stratification and the post-stratification 
     adjustment for firms in the private sector, and we used the 
     Census of Governments as the basis for post-stratification 
     for firms in the public sector. This year, we modified the 
     method used to calculate firm-based weights resulting in 
     small changes to some current and past results. For more 
     information on the change consult the Survey Design and 
     Methods section of the 2011 report. Some exhibits in the 
     report do not sum up to totals due to rounding effects and, 
     in a few cases, numbers from distribution exhibits referenced 
     in the text may not add due to rounding effects. Unless 
     otherwise noted, differences referred to in the text use the 
     0.05 confidence level as the threshold for significance.
                                  ____


 2010 Annual Report of the Boards of Trustees of the Federal Hospital 
   Insurance and Federal Supplementary Medical Insurance Trust Funds

       Each drug plan receives direct subsidies (calculated as the 
     risk-adjusted plan bid amount minus the plan premium), 
     prospective reinsurance payments, and low-income cost-sharing 
     subsidies from Medicare, as well as premiums from the 
     beneficiaries. At the end of the year, the prospective 
     reinsurance and low-income cost-subsidy payments are 
     reconciled to match the plan's actual experience. In 
     addition, if actual experience differs from the plan's bid 
     beyond specified risk corridors, Medicare shares in the 
     plan's experience gain or loss.
       Expenditures for this voluntary prescription drug benefit, 
     which started on January 1, 2006, were determined by 
     combining estimated Part D enrollment with projections of per 
     capita spending. Actual Part D spending information for 2009 
     was used as the projection base.
       a. Participation Rates
       All individuals enrolled in Medicare Part A or Part B are 
     eligible to enroll in the voluntary prescription drug 
     benefit.
       (1) Employer-Sponsored Plans
       There are several options for employer-sponsored retiree 
     health plans to benefit from the Part D program. One option 
     is the retiree drug subsidy (RDS), in which Medicare 
     subsidizes qualifying employer-sponsored plans a portion of 
     their qualifying retiree drug expenses (which are determined 
     without regard to plan reimbursement). About 20 percent of 
     beneficiaries participating in Part D were covered by this 
     subsidy in 2009. Effective with 2013 under the Affordable 
     Care Act, employers will no longer be able to deduct retiree 
     health plan costs that are reimbursed by the RDS. In 
     addition, retiree drug claims in the coverage gap will not be 
     eligible for the 50-percent brand-name drug discount, and the 
     28-percent RDS subsidy rate will remain constant even though 
     the coverage gap will be closing over time for other Part D 
     drug plan participants. As a result of these changes, RDS 
     program participation is assumed to decline quickly to about 
     2 percent in 2016 and beyond. It is expected that the 
     retirees losing drug coverage through qualifying employer 
     plans will participate in other Part D plans.

                              {time}  1310

  Ms. SLAUGHTER. Madam Speaker, I thank the gentleman for yielding me 
the customary 30 minutes and yield myself such time as I may consume.
  Madam Speaker, I guess I'd better start by saying that one man's 
facts are another woman's folly. I want everybody who is listening 
today to clear their minds of what they just heard and also to remind 
them that when Medicare and Social Security were also before the 
Congress of the United States, Republicans didn't like them either, and 
almost all of them voted against it. So to hear people whose plan for 
Medicare is to simply do away with it and give vouchers to the Medicare 
recipients no matter what their physical condition or their mental 
condition to go into the private market and try to buy insurance if 
they can with the amount of money that may not even cover it, this 
crying about Medicare in this bill, which really strengthens it, is 
hard to take.
  This is an incredible milestone today, and those of you in the 
gallery are here on a very important day. Over the last 2 years, over 
30 votes have been taken on this health care bill alone. Today is the 
31st. They want to defund or dismantle or do whatever to it. Never in 
the history of this Congress, and I feel perfectly secure in saying 
this, has anybody voted this many times on a single issue. Why? Because 
we don't have anything else to do.
  We are here simply killing time because everybody knows the Senate 
has already done away with this bill, so we know it's never going to 
become law. What it's going to do is, as I said yesterday at the Rules 
Committee, we're not trying to make law here, we're making political 
points. And that is a shame, because it's not that the country doesn't 
need our attention. It isn't as though the unemployment rate isn't so 
high and that people's futures are not so grim that they are crying out 
for us to get something done, but it has been said that this is the 
least productive Congress since the beginning of Congresses, apart from 
the Continental Congress.
  So here today, no jobs bill has been passed here, and over that time 
while everybody is clamoring for it, we do the 31st vote on this 
measure which, again, everybody knows is going nowhere. So we have just 
months left in the 112th Congress, and yet we vote again on this. We 
voted at least nine times on women's reproductive health, which shows 
you what are the real issues here that people care about.
  Sadly, we're not going to be able to vote this year, the rest of this 
term, on creating jobs or rebuilding the infrastructure or even ending 
the war in Afghanistan, but we vote for the 31st time on dismantling 
historic health care concerns.
  I am sure that while time runs out on this Congress to tackle the 
major issues that face us, to create jobs and to rebuild our country, 
we have failed to answer the call. I shouldn't say ``we'' because 
that's the polite way to do it on the floor of the House. But everybody 
knows who is wasting time.
  This year, thanks to the Affordable Care Act, already more than 
360,000 small businesses are expected to receive tax credits that 
reduce the cost of health care for their employees. And meanwhile, the 
new guarantees, one that ensures that the insurance companies will 
spend 85 percent of the cost on health care, of your premium dollar for 
the first time in history, 85 cents of that dollar is going to go to 
health care, not administrative costs, not being put away to something 
or building buildings or whatever else. It will go to health care. That 
in itself is going to reduce the cost. This increased efficiency is 
very good news not only for small business owners but all the rest of 
us who bear the burden of inefficient care.
  In addition, more than 3 million young adults are already insured on 
their parents' health care, and more than 5 million seniors have 
cheaper prescription drugs simply thanks to this health care reform, 
and we have not even started. It is not going to go into full effect 
until 2014, which I deplore, but nonetheless that's where we are.
  Despite these benefits for millions of Americans, the majority wants 
to take it all away. Now they talk about repeal and replace. With what? 
We've had no plan of replacement. There is no answer to what's going to 
happen to the seniors and others who are already benefiting from this 
plan. They have offered no solution of their own; and 537 days ago, the 
majority passed legislation requiring this Congress to craft a proposal 
that would keep popular provisions of the Affordable Care Act, such as 
health care for people with preexisting conditions.
  I hope everybody understands that your health care, as it is written 
now, has a yearly limit and a lifetime limit. If you exceed the 
lifetime limit, you are not insurable again in the United States. And 
you can do that very easily with, let's say, a serious head wound or 
other trauma. But we have waited for a year for this bill that was 
promised 537 days ago. I really believe, and I don't want to be 
cynical, but I certainly do believe, because I must, that no such bill 
will ever come.

  So what's going to happen if this bill passes and the Affordable Care 
Act is

[[Page H4716]]

repealed? What's going to happen to the millions of women who will, 
once again, be charged more money than men for the same health 
insurance coverage? Do you know women pay 40 percent more? What will 
happen to the millions of seniors who will, once again, face the 
financial threat of the doughnut hole? What's going to happen to the 
thousands of children who will, once again, be denied health insurance 
coverage because they were born with a preexisting condition? And what 
will happen to the young people on their parents' health care unable to 
find work because Congress is not involved with that--or at least the 
majority is not? What will happen to them?
  Today's vote will take away health care from women like Nancy 
O'Donnell, who is 60 years old and lives in my district in Rochester, 
New York. She works four jobs to make ends meet, and not a single one 
of them offers health care. Her life changed when she was diagnosed 
with cancer and told she would need a mastectomy. With no insurance to 
help cover the cost of major surgery, she faced the very real prospect 
of suffering with cancer and having no hope of being cured. And if 
anybody out there believes that you can be diagnosed with cancer and 
not be able to get treatment for it because you have no insurance, 
you've got another think coming.
  Prior to the Affordable Care Act, there would have been no recourse 
for a woman like Nancy. For years, millions of women and men in America 
were denied health insurance because cancer was a ``preexisting 
condition'' or if they had ever had it and they changed jobs and they 
had to get new health care, they probably would not be able to because 
they had had cancer. Even patients like Nancy who had insurance--and 
she did not, remember--would face lifetime and yearly limits on their 
health care, meaning that they would stop providing treatment because 
they didn't want her high-cost disease affliction.
  Thanks to the Affordable Care Act, these tragic stories are no more. 
Thanks to the Affordable Care Act, Nancy was able to access health 
insurance at a price she could afford. And with that health insurance 
in hand, she was able to access treatment and found out that a 
mastectomy was no longer needed. She has now had four clean CAT scans 
and no sign of cancer, and we are all delighted for her.
  Women like Nancy are the reason I brought the Affordable Care Act 
through the Rules Committee to the House floor. Women like Nancy are 
the reason I stood up to those who threw a brick through one of my 
district office windows and who threatened my family because I wanted 
to provide affordable, lifesaving health care to Americans in need. 
Health care was costing us 17, going on 18, percent of GDP, and we 
could not afford it unless we wanted to become the one industrial 
Nation on Earth that was only able to provide health care and do war.
  Surely to goodness, we would like to join the community of other 
nations. And in addition to that, we have put the burden on our 
employers to provide the health care for their employees that none of 
their competitors from overseas or Canada have to put up with. This has 
been really sad and really the start of the debate for Clinton health 
care which came from Lee Iacocca, who said that the cost of health care 
forced him to put about $2,000 more for the cost of each automobile he 
sold. It was unsupportable. But we're still at it here.
  The United States, as I said, is the only one that does not provide 
its citizens with safe, secure, and affordable health care. They do it 
much cheaper than we do with much better outcomes. Instead, we put the 
burden back on the employers. That puts us at a disadvantage with 
competitors all around the world. Despite not providing reliable health 
care to millions of our citizens, the cost of health care rises. Prior 
to the Affordable Care Act, we were on a trajectory to soon be bankrupt 
simply through the skyrocketing cost of care.

                              {time}  1320

  Since the Presidency of President Roosevelt--and I'm talking about 
Teddy here, we're going way back beyond, ahead of Franklin--numerous 
Presidents have tried to provide health care--President Nixon, 
President Truman, President Clinton--to the millions of the uninsured 
to lower the cost of care.
  We, each of us, when we talk about having other people buy health 
insurance if they can afford it, and if they can't, we help them, each 
family is expected, and has been for some time, paying what is 
estimated to be between $1,000 and $1,500 more on your own health care 
to cover for the uncompensated cost of people who don't have it.
  So why don't we deal with this in a mature and grown-up way? Because 
somehow or other we can't. But the reason could be this: yesterday 
morning, Politico, one of the newspapers that we have here on the Hill, 
reported on the plans of the majority over the next 4 weeks. They had 
been talking to members of the majority. In part, they wrote: ``House 
Republicans have planned a series of hot-button votes over the next 4 
weeks to contrast the party's agenda with that of Democrats and put 
President Barack Obama and Democratic candidates on the defensive,'' as 
though we are not capable of standing up and defending the votes that 
we take. ``The main goal is to boost the party's prospects on Election 
Day.''
  Madam Speaker, the record is clear: today's vote is nothing more than 
a show. It is political theater. It puts political games ahead of the 
health of the Nation's citizens.
  So, on behalf of the millions of Americans who are already benefiting 
from affordable care, I urge my colleagues to change course and 
reconsider the legislation before us today. Frankly, we should drop it. 
There's no point in taking this vote at all. Too much needs to be done, 
from creating jobs to investing in schools, rebuilding our broken 
highways and bridges. And we have only been able, in the United States, 
to build one airport from the ground up since 1972, in Denver. That 
tells you how modernized we are. But we are playing politics with 
health care reform instead, and health care is already saving lives.
  So I urge my colleagues to oppose today's rule, the underlying 
legislation, and I reserve the balance of my time.
  Mr. SESSIONS. Madam Speaker, at this time I'd like to yield 3 minutes 
to the gentleman from Spring Hill, Florida (Mr. Nugent), the gentleman 
from the Rules Committee.
  Mr. NUGENT. Madam Speaker, I want to thank the gentleman from Dallas, 
my Rules Committee colleague, Pete Sessions, for yielding me the time.
  Over the past couple of years, I've met with thousands of people in 
Florida's Fifth Congressional District, whether it's businessmen, 
people on Medicare, veterans, and they all have the same appeal to me: 
Please, please repeal ObamaCare.
  It's clear the American people know what our Democratic leaders 
still, to this day, don't want to admit: ObamaCare eliminates millions 
of American jobs, it cuts hundreds of billions of dollars from 
Medicare, and it puts in place 21 tax hikes that are going to cost the 
American people more than $800 billion over the next 10 years. And 
guess what. It only pays for 6 years of coverage. What a scam.
  Everybody knows the health care system is broken and reform is 
needed, but ObamaCare is not the answer. Madam Speaker, I think a 
number of my colleagues forget that although the Supreme Court upheld 
the individual mandate--because it's a tax--it did declare parts of the 
bill unconstitutional. The Court explicitly stated the Affordable Care 
Act is constitutional in part and unconstitutional in part. And 
expansion, they said, of ObamaCare unconstitutionally forces States to 
expand Medicaid.
  So the vote we take on this rule, H.R. 6097, gives Members of this 
body two things: repeal a law that is in part unconstitutional, and 
repeal an $800 billion tax increase on the American middle class. I 
have to think that if the other side knew that this was a tax increase 
back when they first implemented it, that--you know what?--they 
probably would rethink their thought on it.
  Last night, my colleagues on the other side said that ObamaCare 
reduces the deficit, but it's also a tax cut. Only in Washington does 
that work--creating a new trillion-dollar health care program means 
reducing government spending. Only in Washington is $800 billion in new 
taxes a cut. These are numbers I know my colleagues on the

[[Page H4717]]

other side of the aisle know, and, more importantly, the American 
people know it.
  For all these reasons, I'm grateful to Leader Cantor for introducing 
the Repeal of Obamacare Act, and I'm proud to be a cosponsor of this 
legislation. I support the rule, I support the underlying legislation, 
and I encourage all of my colleagues who want real health care reform 
to do the same.
  Ms. SLAUGHTER. Madam Speaker, I am pleased to yield 3 minutes to the 
gentleman from New Jersey (Mr. Andrews), the ranking member of the 
Education and the Workforce Subcommittee on Health.
  (Mr. ANDREWS asked and was given permission to revise and extend his 
remarks.)
  Mr. ANDREWS. I thank my friend from New York. It's great to be with 
her on the floor today, and my colleagues on the Republican side as 
well.
  Today we could be voting on a bill where we work together to cut 
taxes for small businesses that put Americans back to work, but we are 
not. Today we could be voting on a bill that would help cities and 
counties and States around the country rehire police officers and 
firefighters and teachers they've had to lay off--over 600,000 of them 
the last few years--but we are not. Today we could be voting on a bill 
that would say that, if an American company brings jobs back from 
overseas, we'll cut their taxes and we'll pay for it by eliminating tax 
giveaways and loopholes for companies that outsource their jobs outside 
of the United States and take them overseas, but we're not voting on 
that. For the 31st time in the last 18 months, we're voting on a bill 
to repeal the health care law.
  Now, I know there are Americans who feel strongly for and against the 
health care law, but almost every person I listen to feels very 
strongly we should be working together to help create an environment 
where businesses can create jobs for the American people, not voting 
for the 31st time on essentially a political argument.
  Now, I do agree with my friend from Texas--and I thank him for 
mentioning my name; I respect him very much--about the need for facts 
in this debate. There is one fact that I think we've got to get to 
right away, which is whether or not the law that they are trying to 
repeal for the 31st time increases or decreases the Federal deficit.
  The Congressional Budget Office, which is our neutral, nonpartisan 
auditor, said in January 2011--the first time of the 31 when the other 
side tried to repeal this law--that repeal of the law would add $220 
billion to the deficit. In other words, if you write the law off the 
books, the deficit goes up because of the spending restraints and the 
new revenues that are in the bill.
  I would want to ask my friend from Texas if he can tell us what the 
effect of the repeal of this bill--in other words, if this bill passes, 
what will this bill do to the deficit, according to the Congressional 
Budget Office?

  I yield to the gentleman from Texas.
  Mr. SESSIONS. I appreciate the gentleman asking the question.
  The gentleman also understands that the Congressional Budget Office 
has not, as a result of the Supreme Court, been able to render that 
decision.
  Mr. ANDREWS. Reclaiming my time, I would then respectfully ask my 
friend: Why don't we wait and see what the auditor says the bill will 
cost before we vote on it? My understanding is that they're going to do 
that probably by the end of this month. Why don't we wait and see what 
the auditor says it's going to cost before we vote on this bill?
  And I would yield to the gentleman.
  Mr. SESSIONS. I appreciate the gentleman engaging me. This really is 
of substance to the American people.
  The cost of the bill is twice now--we found out a year after it was 
passed--twice as expensive as it was originally started.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. SESSIONS. Madam Speaker, at this time, I'd like to yield 2 
minutes to the gentleman from San Antonio, Texas (Mr. Canseco), from 
the Financial Services Committee.
  Mr. CANSECO. I thank the gentleman from Texas for yielding this time, 
and I rise in support of the rule and the underlying bill to completely 
repeal ObamaCare.
  Though ObamaCare has been found to be constitutional, it doesn't mean 
it is good for our health care nor good for our economy. ObamaCare is 
still a government takeover of health care, putting Federal bureaucrats 
in charge of decisions that should be made by you and your doctor by 
creating 159 different boards, bureaucracies, and programs that will 
increase Washington's control over health care, like the Independent 
Payment Advisory Board, which is compromised of 15 unelected 
bureaucrats that will be empowered to decide what treatments Medicare 
will and will not cover.

                              {time}  1330

  ObamaCare also could lead to less access to care and lower quality 
health care. I recently visited with several physicians last week in my 
district, and they told me that ObamaCare could lead to a large exodus 
of physicians from active practice, leaving many Americans with health 
care coverage but without health care access.
  ObamaCare also cuts over half a trillion dollars from Medicare to pay 
for other spending, which could lead physicians to cut back on the 
number of American seniors that they will see, negatively impacting 
their care by leaving seniors with health care coverage but without 
access to care.
  Besides being bad for health care, ObamaCare is bad for our economy. 
I've visited with numerous small businesses throughout the 23rd 
Congressional District of Texas, and almost every one of them has told 
me that the biggest factor keeping them from expanding their businesses 
and hiring more employees is the uncertainty about health care costs 
due to various taxes and mandates contained in ObamaCare.
  Given the Supreme Court's ruling, it's now up to the people's elected 
representatives in the Congress to provide American families and small 
businesses with much-needed relief from the burdens of ObamaCare by 
repealing it completely. Only after ObamaCare is repealed can we then 
work to implement commonsense reforms to make health care more 
affordable and accessible.
  Ms. SLAUGHTER. Madam Speaker, I yield 3 minutes to the gentlewoman 
from California (Ms. Matsui), a member of the Committee on Energy and 
Commerce.
  Ms. MATSUI. I thank the gentlelady from New York for yielding me 
time.
  Madam Speaker, I rise today in strong opposition to this rule and the 
underlying legislation. This bill marks the 31st time that the 
Republicans attempted to repeal the Affordable Care Act, even though 
the Supreme Court of the United States has ruled it constitutional.
  Unfortunately, instead of focusing on job creation, here we are 
again. The underlying legislation exemplifies the majority's continuous 
drumbeat to abolish the ACA, fearful that Americans may have a chance 
to fully realize its tremendous benefits.
  Instead, the majority has only offered vague phrases and empty 
rhetoric, such as ``patient-centered health care,'' while repeatedly 
attempting to repeal legislation that will expand access to care for 
millions of Americans. Clearly, their idea of ``patient-centered health 
care'' refers only to those patients who can afford skyrocketing health 
insurance rates and do not have any preexisting conditions. What is the 
point of ``patient-centered health care'' when only a small portion of 
the public can access the care?
  The underlying legislation before us today would deny my constituents 
and the American people the consumer protections for which they've been 
asking for for years. This legislation would increase costs to 
families, small business owners, and seniors across the board. It would 
allow insurance companies to deny coverage to Americans with 
preexisting conditions, drop coverage when people get sick, re-
institute lifetime limits on coverage, and charge people more based 
merely on gender.
  The ACA has already created long-lasting benefits for many of my 
constituents, including Paula, who, in March of 2010, was diagnosed 
with Ewing's sarcoma, a rare children's bone cancer, and given a 15 
percent chance of survival. Initially, she was lucky to have health 
insurance. But at an average of $60,000 per chemotherapy treatment, she 
quickly approached her lifetime benefits cap. These are not burdens 
anyone can or should have to bear.

[[Page H4718]]

  Because of the ACA, she remained covered and was able to complete her 
full treatment plan. And in the future, because of the law, Paula will 
not have to fear being denied coverage due to this preexisting 
condition.
  It is time that we move forward and focus our efforts on job 
creation. I urge my colleagues to vote down this rule and vote against 
this underlying legislation.
  Mr. SESSIONS. Madam Speaker, at this time I yield 1 minute to the 
gentlewoman from Dunn, North Carolina (Mrs. Ellmers), a nurse, a health 
care professional prior to her service in the United States Congress.
  Mrs. ELLMERS. I thank my colleague from Texas for acknowledging me.
  Madam Speaker, I'm here today to join my colleagues and call for the 
immediate repeal of ObamaCare, with its massive tax increases.
  Last month, as we know, the Supreme Court verified that ObamaCare is, 
in fact, a tax, one that has increased financial burdens of every 
American by over $500 billion, and will go down in history as the most 
significant expansion of the Federal Government and its power. This law 
has and continues to be bad policy for all Americans and future 
generations.
  The Supreme Court's decision has sent a direct message to Congress 
and policymakers that we have to get back to work to repeal this law 
and replace it with effective, efficient reforms. I have begun 
circulating a letter that will be sent to Senator Harry Reid, calling 
on him to allow for his colleagues in the Senate to have an up-or-down 
vote on the repeal. Every American needs to know how his senator feels 
about this as well.
  We each have an obligation to vote our conscience and carry out the 
business of the American people. I am encouraging all of my colleagues 
here in the House to sign on to this letter so that each Member of 
Congress can decide whether or not they are in favor of raising taxes 
on millions of hardworking American taxpayers.
  Ms. SLAUGHTER. Madam Speaker, I am pleased to yield 2 minutes to the 
gentlewoman from Maryland (Ms. Edwards).
  Ms. EDWARDS. Madam Speaker, I thank the gentlelady from New York, and 
join her in opposing the rule and the underlying bill.
  This is the way it's supposed to work. Passed by the House, passed by 
the Senate, signed into law by the President, and upheld by the United 
States Supreme Court.
  The ruling provided certainty for Americans and businesses all across 
the country, knowing that the popular provisions they've already 
enjoyed are going to remain in place, and we can continue to implement 
the law of the land.
  So America, here's what Republicans want to take away from you today. 
They want to take away covering 7 million children, young adults who 
can remain on their parents health insurance plans until they're 26. 
They want to ban insurance companies from denying coverage to 17 
million children with preexisting conditions. They want to end tax cuts 
that benefit 360,000 businesses that employ 2 million workers, all 
provisions that have popular and bipartisan support.
  But rather than building on and moving forward from last month's 
ruling, nope, the Republicans, not surprisingly, decided to spend yet 
another day in Congress considering the repeal of the Affordable Care 
Act; 31 times that the House will vote on repeal. What a waste of 
America's time.
  Thirty times that we haven't voted on jobs bills. Thirty times we 
haven't focused on extending tax cuts for the middle class.
  For the American people in congressional districts all across the 
country, this is also the 31st time that the Republicans have put in 
jeopardy their access to quality, affordable, and comprehensive care. 
And so 250 million Americans could lose their benefits and protections 
with the vote today.

  It's a step backward for Marylanders like Doug Masiuk, who watched 
the Affordable Care Act because he couldn't afford to keep paying a 
third of his income for health care and had started using bags of coins 
to pay for his medicines. The Affordable Care Act saves Americans like 
him $4 billion.
  Families like the Mosbys in my county, in Prince Georges County, who 
suffered three traumatic health events and fell behind on their 
mortgage, almost lost their home. But the Affordable Care Act saves 105 
million Americans who would reach lifetime limits but for the 
Affordable Care Act that the Republicans today want to repeal.
  It's time to get on with it. It's enough. It's time for Republicans 
to move on, approve the settled law of the land, and start to implement 
the law.
  I urge my colleagues to vote down the rule and to vote against this 
repeal.
  Mr. SESSIONS. Madam Speaker, at this time I yield 2 minutes to the 
gentleman from Brigham City, Utah (Mr. Bishop), a member of the Rules 
Committee.
  Mr. BISHOP of Utah. Madam Speaker, if, indeed this will be the 31st 
time we will vote to repeal what is commonly called ObamaCare, that 
number signifies also the number of job-creating bills this House has 
passed and sent over to the Senate. It would be nice if the Senate 
would actually deal on any of those issues to move us forward on all of 
these concerns.
  I do want to speak for just 1 minute here, though, about the concept 
of the 10th amendment, one of the task forces on which I serve. 
Everything that we are talking about, there's nothing wrong with 
helping people provide for themselves. The issue always is where should 
that decision be made. There's nothing wrong about that at all, but 
where should it be made.
  The brilliance of our Founding Fathers in coming up with federalism 
was simply the idea of choices should be made by people in the areas in 
which they can affect themselves.
  Massachusetts appears to have a health care system they imposed upon 
themselves. They like it. That's fine.

                              {time}  1340

  It won't work in the State of Utah because we are different. We have 
far more kids than Massachusetts has. We have a higher percentage of 
small business. Our solution is not their solution.
  The brilliance of federalism is that the people who live in the 
States and the leaders of the States, they care as much as we do. They 
also can decide for themselves as much as we do. The other brilliance 
of federalism is that States can decide to be wrong if they want to 
without impacting the entire Nation. There are some States that may 
want to have a robust government involvement and tax themselves to do 
it. Allow them to do so. There are other areas that want to have a less 
robust government and tax themselves less. Allow them to do it. Only 
the States have the ability of becoming efficient, creating justice and 
creativity in their approaches.
  My State of Utah came up with a legislative exchange program that 
better meets the needs of my State, of the demographics of my State. It 
is, in my opinion, still a better way of going, but unfortunately, it 
is stopped by ObamaCare. That is not what we should be doing. Not all 
great decisions have to emanate from this particular body.

  Now, the Supreme Court has said this is a tax. Fine. It must be 
enforced by the Internal Revenue Service, and we need to realize that 
there will be 12,000 to 17,000 new employees of the Internal Revenue 
Service to enforce this provision. Will they be outsourced, as the IRS 
has done in the past--and does that present problems for it--or will 
they be funded in-house, which will cost us again?
  Ms. SLAUGHTER. Madam Speaker, I am pleased to yield 3 minutes to the 
gentleman from Massachusetts, who knows health care, the distinguished 
ranking member of the Committee on Natural Resources, Mr. Markey.
  Mr. MARKEY. The Affordable Care Act is now part of our Nation's 
fabric of health care laws. Right alongside Social Security and 
Medicare now stands the Affordable Care Act. Yet the Republicans keep 
trying to take away or to take apart the benefits included in this law 
for the 31st time since they took over the House of Representatives. 
What we have here, Madam Speaker, is a severe case of Republican 
reflux.
  Again and again, the Republicans keep coming up with harmful attempts 
to destroy all of the protections Americans have gained under this 
law--a Groundhog Day Republican reflux attempt to repeal this historic 
piece of

[[Page H4719]]

legislation that helps every family in our country. Again and again, 
the Republicans keep choosing corporations over consumers. The side 
effects of this Republican reflux are serious.
  If the Republicans succeed, insurance companies could, once again, 
deny coverage because of preexisting conditions. Kids with asthma, 
women with breast cancer, all of these protections would just go away, 
and the Republicans will replace it with nothing. Americans could, once 
again, be forced into bankruptcy just because they got sick. Just 
because they got sick, they could go bankrupt if the Republicans' 
repeal attempt is successful this afternoon on the House floor. And 
what are they going to put in place of that protection against going 
bankrupt just because you are sick? Nothing. They have no proposal to 
have something replace those protections for American families.
  Women could, once again, be discriminated against with higher 
insurance premiums. Just being a woman, unfortunately, under existing 
law is a condition which has women paying more. What are the 
Republicans going to replace this protection for women with, a 
protection that is now in the law? Nothing. They have no proposal 
they're bringing out here today onto the House floor.
  With this Republican reflux, it's the American people who get burned. 
All they are doing is bringing out a proposal to repeal protections 
that ensure for every American family all of these extra protections 
which the Republicans have always denied them. They keep saying: Oh, 
no. We care about preexisting conditions. Oh, no. We care about people 
going bankrupt. Oh, no. We care about women being discriminated 
against. Then you say to them: Well, where is your proposal? Bring it 
out here. Let's have a vote on it.
  But do you know what? This is about insurance companies over the 
consumers of our country. Vote ``no'' on this Republican reflux bill.
  Mr. SESSIONS. Madam Speaker, I would like to yield 2 minutes to the 
gentleman from Knoxville, Tennessee (Mr. Duncan).
  Mr. DUNCAN of Tennessee. I thank the gentleman for yielding.
  Madam Speaker, I rise in support of the rule and of the underlying 
legislation, the so-called Affordable Care Act, which should be called 
the ``Unaffordable Care Act.'' Even if the President's plan were the 
best thing since sliced bread, we simply cannot afford it.
  Both Medicare and Medicaid now cost many times more than what was 
estimated when they were first passed. Already, the estimate for the 
President's plan is double what it was just 1 year ago, and most of it 
will not be fully implemented until 2014 and some parts until 2016. And 
much of it is ``paid for'' by placing millions more onto the Medicaid 
rolls. This will cost all the States many billions they do not have.
  The nonpartisan Congressional Quarterly estimated these additional 
Medicaid costs at $627 billion over the next 10 years. In addition, in 
June, the Joint Committee on Taxation estimated that increased taxes 
over the next 10 years just to cover the plan would be from $675 
billion up to possibly as much as $804 billion. If these are lowball 
front-end estimates, as is typical, the health care plan will not work 
unless medical care is limited or restricted more and more each year.
  In considering their votes on this legislation, on this so-called 
Affordable Care Act, I hope that my colleagues will consider these 
strong words by Dr. Milton R. Wolf, President Obama's cousin. He wrote 
this:

       For the first time in the history of our Republic, our 
     government has demanded that every American, upon the 
     condition of breathing, be forced to enter a legal contract 
     with government-approved corporations. Not even King George 
     III dared impose such control. In truth, if a government can 
     force you to patronize companies of its choosing, the 
     fundamental relationship between the government and the 
     individual is irrevocably changed. If it is allowed to stand, 
     there will be no part of your life the government cannot 
     control, and no crony it cannot enrich with your money.

  I urge the support for this rule and this underlying legislation.
  Ms. SLAUGHTER. Madam Speaker, I yield 2 minutes to my colleague, the 
gentlewoman from New York (Mrs. Maloney).
  Mrs. MALONEY. I thank the gentlelady for yielding and for her 
leadership.
  Madam Speaker, today Congress must, once again, spend time in an 
empty gesture even as this country waits for real solutions to serious 
problems.
  Instead of dealing with ways to speed up and expand the creation of 
jobs, once again, our colleagues on the other side of the aisle insist 
that we pretend like we are going to repeal the Affordable Care Act--
even though that could drop over 6.6 million young adults under the age 
of 26 off their parents' health care policies; even though that could 
throw 17 million children with preexisting conditions to the mercy of 
the marketplace; even though that would drop 5.3 million seniors down 
the doughnut hole of Medicare; even though it would just create new 
uncertainties for small businesses.
  Even though all of this is true and more, you make Congress, once 
again, engage in this crude Kabuki, which is totally without meaning 
because, if by some dark miracle you are able to pass the bill in the 
House and the Senate, do you believe for one second that the President 
would sign it? So what are we doing today? We are taking a vote on 
repealing the Affordable Care Act for the 31st time. It was a waste of 
time the first time, the second time, the third time, and so on and so 
on, and it's a waste of time today.
  So I would say let's just hurry up. Vote ``no'' on the rule and on 
the underlying bill, and let's get back to the business of working to 
create jobs for the American people.

                              {time}  1350

  Mr. SESSIONS. At this time, I yield 1\1/2\ minutes to the gentleman 
from Savannah, Georgia (Mr. Kingston).
  Mr. KINGSTON. Madam Speaker, there are five quick reasons why I think 
this bill should be repealed:
  Number one, it does not decrease the cost of health care. In fact, it 
is estimated that it will increase costs by 13 percent per family and 
is already moving toward a $2,100 increase.
  Number two, the loss of health care. The nonpartisan Congressional 
Budget Office estimates that 20 million people will lose their 
employer-based health insurance because of the mandates in ObamaCare.
  Number three, it interferes with the patient-doctor relationship. The 
law creates 159 new boards, offices, and panels within the Federal 
Government to be in charge of people's health care decisions.
  Number four, increased government spending at a time where we borrow 
40 cents on every dollar we spend and our national debt is 100 percent 
of the GDP. ObamaCare is expected to cost over $1.8 trillion over the 
next decade. We don't have the money.
  Number five, loss of jobs. The nonpartisan Congressional Budget 
Office estimates that nearly 800,000 jobs will be lost because of 
ObamaCare.
  Madam Speaker, we need to repeal ObamaCare and replace it with the 
best ideas of Republicans and Democrats, which should include expanded 
health savings accounts, ending frivolous lawsuits, association health 
plans, across-State-line health care purchases, and State-run high-risk 
pools. These ideas will bring America together rather than divide us as 
a country over this very important issue.
  Madam Speaker, following are my remarks in their entirety:
  Rising Health Care Costs--Under the Patient Protection and Affordable 
Care Act (PPACA), CBO projects health insurance premiums will increase 
by $2,100 per family.
  By 2016, health insurance premiums for individuals and families will 
increase by 13%.
  Loss of Health Care Coverage--CBO estimates 20 million people could 
lose their employer-based health insurance because of the mandates 
imposed by PPACA.
  According to HHS's own assumptions, as high as 80% of small 
businesses and 64% of large businesses will discontinue offering health 
insurance to its employees.
  According to a survey by House Ways and Means, 71 of the nation's 
largest employers could save more than $28 billion in 2014 alone and 
$422.4 billion over a decade, by deciding to drop health insurance 
coverage for their 10.2 million employees and dependents and paying the 
$2,000 per-employee penalty instead.
  Some colleges have already begun dropping student health insurance 
plans for the coming academic year and others are warning students of 
premium increases because of a provision in the Obamacare requiring 
plans to expand their coverage benefits.

[[Page H4720]]

  For example, Bethany College in Kansas is cancelling its health 
insurance plan for students rather than face a premium increase of over 
350 percent, causing the plans to increase from $445 per year to more 
than $2,000 per year.
  A mandate in Obamacare requires all child-only health insurance 
carriers to guaranty issue plans, which allows individuals to purchase 
health insurance on the way to the emergency room. As a result, 17 
states including Georgia no longer offer new child-only health 
insurance policies.
  Interference with Patient-Doctor Relationship--PPACA creates the 
Independent Payment Advisory Board (IPAB) consisting of 15 bureaucrats 
responsible for making spending and coverage decisions for Medicare.
  CBO projects IPAB will have a marginal effect on reducing Medicare 
spending.
  The law does create 159 new boards, offices and panels within the 
federal government in charge of making decisions for people's health 
care.
  Increased Government Spending--PPACA is expected to cost $1.8 
trillion over the next decade, which is nearly double the original 
estimate.
  Total federal spending on health care will increase from 5.4 percent 
of GDP this year to 10.7 percent of GDP in 2037 and 18.3% by 2087.
  Loss of Jobs--The CBO estimates nearly 800,000 jobs will be lost 
because of passages of PPACA. This is because of the law's misguided 
incentives that increase the marginal tax rates discouraging work and 
labor supply.
  According to a survey by the U.S. Chamber of Commerce, 74 percent of 
small businesses stated PPACA makes it harder for firms to hire new 
workers.
  The same survey found 30% of the businesses surveyed are not hiring 
at all thanks to PPACA.
  Ms. SLAUGHTER. Madam Speaker, I yield 2 minutes to the gentleman from 
Texas, a member of the Committee on Ways and Means, Mr. Doggett, who 
also served on the Subcommittee on Health during the health care 
debate.
  Mr. DOGGETT. ``I have lived through a terminal illness while 
struggling to get well and struggling to get and keep my insurance. I 
have been denied insurance because of a preexisting condition. I have 
lived this. It is very real for me. Today I breathe a little better. 
Life is good because now I have hope.''
  That was the reaction of my constituent, Erin Foster, to the approval 
of the Affordable Health Care Act by the Supreme Court. And today's 
legislation ought to be called the Take Away Erin Foster Hope Act, 
because that's what it is, replacing the Affordable Health Care Act 
with only tax breaks for Tylenol.
  In a few days, thousands of Texans will be receiving checks of almost 
$200 each, of almost $200 million in rebates from private insurance 
companies that overcharged and abused them. This bill should be called 
the Return to Sender Act, because it says those abusive health 
insurance companies get their money back if this act became law.
  There are seniors today who are trying to make use of the flawed 
Republican prescription drug act that is now law. They left a giant 
gap--sometimes referred to as a ``doughnut hole''--in the coverage of 
that act.
  Our seniors, as a result of the Affordable Health Care Act, have seen 
their prescription costs go down, some of that doughnut hole plugged, 
eventually to fill it all, and provide them the protection that they 
have earned.
  This bill, if enacted, would double the cost of prescription drugs 
for those in the doughnut hole. About 2,250,000 Texas seniors would 
also no longer receive free preventive services. This act should be 
called the Charge Seniors More for Their Prescription Act, because 
that's what it does.
  You see, the problem is that in their near fanatic determination to 
see that President Obama fails on everything, Erin Foster and that 
senior and that individual that is counting on one of those rebate 
checks, they are just collateral damage to these Republicans.
  Mr. SESSIONS. Madam Speaker, at this time, I yield 1 minute to the 
gentleman from Laurens, South Carolina (Mr. Duncan), from the Foreign 
Affairs Committee, one of the most influential committees we have here 
in the House of Representatives.
  Mr. DUNCAN of South Carolina. Madam Speaker, Americans know that the 
government takeover of health care is wrong. They spoke very loudly 
when the other side of the aisle forced this on America in the last 
Congress. It was bad policy before the Supreme Court ruled, and it was 
bad policy in January when we first passed the repeal bill. It's bad 
policy today, and it will be bad policy tomorrow. It takes $500 billion 
away from Medicare. It puts government bureaucrats between Americans 
and their doctors. It rations care for American seniors. It adds 
exponentially to the Nation's debt. It grows government. Specifically, 
it grows the Internal Revenue Service to collect the tax, which the 
Supreme Court so evidently pointed out that it is a tax that will be 
assessed if you fail to meet government's requirement to buy something.
  Socialized medicine is wrong for America, and it is time to repeal 
the bill.
  Ms. SLAUGHTER. I am pleased to yield 2\1/2\ minutes to the gentleman 
from New Jersey (Mr. Pascrell).
  Mr. PASCRELL. Madam Speaker, Albert Einstein once said the definition 
of ``insanity''--and you've heard this before, Madam Speaker--is doing 
the same thing over and over and expecting different results. Well, 
we've already voted over 30 times to repeal or restrict the Affordable 
Care Act, and here we are again, wasting time with politics instead of 
putting people back to work.
  We're offering you the opportunity to help your constituents right 
now, Madam Speaker. You can defeat the previous question and take up 
the Bring the Jobs Home Act, which, for the first time, makes sure we 
promote insourcing of jobs and stops the corporate welfare for 
outsourcing jobs.
  In the last decade, we have lost 5.5 million manufacturing jobs and 
1.3 million back-office jobs. However, we have seen that the light of 
our economic recovery is powered by domestic production, not the 
outsourcing of jobs, and we've added over half a million manufacturing 
jobs in just the last 2 years.
  There are some who think outsourcing is a good policy. In fact, they 
have made hundreds of millions doing just that.
  I believe that the American Dream starts by creating good jobs right 
here in the United States, and that we should not outsource the 
American Dream to China or any other country.
  This bill is very simple here. We're going to end the tax breaks that 
encourage companies to shift their jobs overseas, and use that to pay 
for tax credits for patriotic companies that want to bring jobs back 
home. That's pretty simple.
  With all due respect, Madam Speaker, why are we wasting our time? The 
Supreme Court has ruled. The Affordable Care Act is the law of the 
land. If the law is repealed, according to a report by the New Jersey 
Public Interest Research Group, employers would see health care costs 
grow by more than $3,000 a year, and premiums would be increased from 
14 percent to 18 percent per year higher to those who want to buy 
insurance, and my home State of New Jersey would have 10,000 fewer jobs 
by the end of the decade.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Ms. SLAUGHTER. I yield an additional 10 seconds to the gentleman from 
New Jersey.
  Mr. PASCRELL. Despite the rhetoric, the majority is yet to propose a 
replacement that will cover all of the people they want to throw off 
the health care rolls. And they continue to ignore the number one 
priority of the American people: creating jobs.
  A week after the Fourth of July, Madam Speaker, I urge my colleagues 
to defeat this motion and let the House vote on a patriotic American 
bill that will create jobs right here.
  Mr. SESSIONS. Madam Speaker, at this time, I yield 2 minutes to the 
gentleman who, before he came to Congress, was on the front line of 
health care as an anesthesiologist on the eastern shore of Maryland, 
Congressman Harris.
  Mr. HARRIS. Thank you very much, Mr. Chairman, for yielding the time.
  Madam Speaker, my, my, my. Former Speaker Pelosi was so right when 
she said Congress had to pass this bill so Americans could just find 
out what's in it.

                              {time}  1400

  Well, Americans have learned a lot since we first tried to repeal the 
President's health care act last January. We learned that it still 
continues to stifle job growth as we learn more and more about it, and 
that's why we have to attempt to repeal it once again.

[[Page H4721]]

  Earlier this year, Americans discovered that the law creates a new 
nationwide mandate for coverage that doesn't allow people to opt out 
when they have a religious or moral objection to those covered 
services, a violation of the Religious Freedom Restoration Act duly 
passed by this Congress and, more importantly, a violation of their 
First Amendment rights. These inflexible mandates jeopardize the 
ability of institutions and individuals to exercise their rights of 
conscience, one of the most basic rights, and, yes, we discovered this 
since we voted on the repeal last January.
  Mr. Speaker, by now Americans have learned enough about this bill. 
They want it repealed, and we should listen to them. We should pass the 
rule and pass the bill.
  Ms. SLAUGHTER. I reserve the balance of my time.
  Mr. SESSIONS. Mr. Speaker, I yield 3 minutes to the Rules Committee 
chairman, the gentleman from California (Mr. Dreier).
  (Mr. DREIER asked and was given permission to revise and extend his 
remarks.)
  Mr. DREIER. Mr. Speaker, I would like to express my appreciation to 
the distinguished vice chairman of the Committee on Rules, our friend 
from Dallas, Mr. Sessions, for his superb management of this rule.
  I would like to say that as we look at where we're going, contrary to 
arguments that have been propounded here on the floor, it's important 
to note that everybody wants to do everything we possibly can to ensure 
that our fellow Americans have access to the best quality, affordable 
health care in the world. We have the best health care system in the 
world; we all know that. We want to make sure that we continue to see 
that health care system improve, and we have just come to the 
conclusion that the massive expansion of government is not the answer 
to the goal of ensuring that people have access to quality health care.
  The Supreme Court made their decision. We know what the Supreme 
Court's decision was. I think that that decision pointed out a few 
things. It's a tax. We were told consistently it wasn't a tax, and, 
frankly, if we had known what the Supreme Court told us about it being 
a tax, I don't believe that we would have had the passage of that 
measure from the House.
  That decision has been made, and also the Supreme Court, by virtue of 
determining what is constitutional, does not mean that it's good public 
policy. In fact, the Chief Justice has made it clear that they are not 
casting an opinion as to whether or not this is a right measure.
  I think that most of us have come down on the side of saying that we 
should have taken an incremental approach in dealing with this. There 
are a number of things that if we had done that would have, I believe, 
immediately reduced the cost of health insurance and direct health care 
costs, Mr. Speaker.
  They include things like allowing for the purchase of insurance 
across State lines, things like saying that there should be association 
health plans, which interestingly enough passed the House and died 
because of Democrats blocking it in the Senate when my party was last 
in the majority here. Also, things like allowing for real meaningful 
lawsuit abuse reform, which the President of the United States said he 
advocated when he was here, and I acknowledge pooling to deal with pre-
existing conditions is something that needs to be done.
  The fifth point is expanded medical savings accounts, which encourage 
people to put some dollars aside with a tax incentive plan for their 
health care needs.

  If we had done these five things, Mr. Speaker, and these are things 
that we as Republicans have put forward and again--as I said when we 
were last in the majority, when people on the other side often said 
that we did nothing--we passed association health plans, which, again, 
allow small business to pool together, come together and work to get 
lower rates as large corporations do.
  It seems to me, Mr. Speaker, that as we look at the challenges that 
we have, we can make this happen. The reason that we are casting the 
vote, as we will today to repeal, is that we need to do that so that we 
can do this in an open way.
  Now, I have got to say some would say this is a closed rule. This is 
simply an up-or-down vote on whether or not we should repeal this. When 
we last considered this measure that we are voting to repeal today, Mr. 
Speaker, I have got to tell you it was done under the most closed 
process we have ever had.
  The SPEAKER pro tempore (Mr. Poe of Texas). The time of the gentleman 
has expired.
  Mr. SESSIONS. I yield the gentleman an additional 2 minutes.
  Mr. DREIER. Let me just say that when we did this, when we did this 
here, it was done under a process that was unprecedented for an issue 
of this magnitude.
  That closed process, Mr. Speaker, is one of the things that I believe 
played a role in seeing the Speaker of the House of Representatives, 
then Nancy Pelosi, have to hand the gavel to John Boehner.
  The American people understood the fact that things were so closed 
around here, and I am very proud and happy that since we have been in 
the majority our Rules Committee has reported out bills that have 
allowed for a structure that has made more amendments considered in the 
first several months of this Congress than have been considered in the 
entire last Congress.
  So we have tried to work for more openness and, again, a real example 
of that closed process was what took place in the last Congress.
  Well, we need to take this measure, we need to repeal it. I hope very 
much that some of our colleagues in the other body will agree to that. 
People always say it's a foregone conclusion what's going to happen. 
Well, you know what? I never come to an absolute foregone conclusion.
  We have our responsibility, as Members of the House of 
Representatives, to step up to the plate and do what we as a body think 
is the right thing for us to do, and that's exactly what is going to 
take place today.
  So if it doesn't happen, I think that there might be a chance for us 
next year to do this. Again, Republicans, contrary to what is often 
said, do want to take steps to ensure that all of our fellow 
Americans--and we listen to these horror stories, and they are terrible 
stories of the way people have been treated.
  That's why I am a proponent of a structure that will allow for ways 
to deal with pre-existing conditions. I believe that we can in a 
bipartisan way, since the President advocated it, deal with meaningful 
lawsuit abuse reform.
  Again, we need to remember that if we want to keep our Nation on the 
cutting edge of technological development to find a cure for cancer, 
Alzheimer's and these other ailments, we need to make sure that there's 
still an incentive for that to take place.
  Mr. Speaker, I support the rule, and I support our underlying 
measure.
  Ms. SLAUGHTER. I continue to reserve the balance of my time.
  Mr. SESSIONS. Mr. Speaker, the Republicans today have brought forth 
the ideas about why we are repealing the ObamaCare health care bill. 
The process that was gone through has been under wide debate, but the 
results are factually known and understood.
  Mr. Speaker, our economy is in shambles. Our economy is in shambles 
because of uncertainty, uncertainty in the marketplace about the rules 
and regulations, not just of health care, but about the impact of Big 
Government, and this is the big daddy of all of them. The health care 
bill is the big daddy that invades every single piece, part of not just 
this country and our society, but because of the way it reaches into 
individuals and to families, it is very disruptive.
  The IRS will be empowered to hire up to 17,000 new IRS agents to make 
sure that not only are taxes being paid, but to make sure that the 
government has its way with people who, even though they may or may not 
choose to get health care, will be required to by this government. We 
well understand what the results are of this bill; and as a result of 
that, that's why Republicans are on the floor of the House of 
Representatives today.
  Ms. SLAUGHTER. I continue to reserve the balance of my time.
  Mr. SESSIONS. Mr. Speaker, I yield 2 minutes to the gentleman from 
New Jersey (Mr. LoBiondo).
  Mr. LoBIONDO. I appreciate the chairman for yielding.

[[Page H4722]]

  Mr. Speaker, I would like to reemphasize some points that I think 
probably have already been made, that health care is not a partisan 
issue. Whether we're Republicans or Democrats or Independents, we want 
to see health care more affordable and more accessible. Unfortunately, 
President Obama's health care bill does not do the job.
  The Supreme Court made it completely clear that this is a new tax.

                              {time}  1410

  With a very fragile economy, the last thing we need to do is impose a 
new tax on our businesses. In my district, the average unemployment 
rate is hovering around 13 percent. I've talked to many of the 
businesses. The uncertainty of this legislation is killing their 
incentive to hire new people. It's something that we really shouldn't 
let happen. And maybe more important, I believe that the sacrosanct 
doctor-patient relationship is jeopardized by the 111 new boards and 
commissions that will put cost before care.
  This is something that we cannot allow to happen. The best way to do 
it is for a total repeal, to start over with the points that will make 
sense, that most of America can get their arms around, that the medical 
community will say will help the doctor-patient relationship and 
businesses will have a clear understanding.
  Ms. SLAUGHTER. May I inquire of my colleague if he has further 
speakers?
  Mr. SESSIONS. At this time, I'd inquire of the Speaker how much time 
remains on both sides.
  The SPEAKER pro tempore. The gentlewoman from New York has 1 minute 
50 seconds remaining, and the gentleman from Texas has 3 minutes 
remaining.
  Mr. SESSIONS. Thank you very much, Mr. Speaker.
  I have no further requests for time, and I reserve the balance of my 
time.
  Ms. SLAUGHTER. Mr. Speaker, Presidents from both sides of the aisle 
have tried to do health care in the United States for a hundred years. 
Finally, 2 years ago, we were able to achieve the goal. Today, we vote 
on a bill that would dismantle that achievement for political points 
only, because the 31st time is not going to be the charm here.
  We have heard, again, the dire straits of this country. Please ask 
your Member of Congress why it is that we're voting on this for the 
31st time instead of doing something about jobs, for heaven's sake.
  I've not heard anything in that bill or anyplace else that 17,000 IRS 
agents are going to be hired. I think that's, again, something that we 
really don't know about.
  Mr. Speaker, I ask unanimous consent to insert the text of the 
amendment Mr. Pascrell talked about, along with the extraneous 
material, in the Record immediately prior to the vote on the previous 
question.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from New York?
  There was no objection.
  Ms. SLAUGHTER. I urge my colleagues to vote ``no'' and defeat the 
previous question.
  I urge a ``no'' vote on the rule, and I yield back the balance of my 
time.
  Mr. SESSIONS. I appreciate the gentlewoman from New York not only for 
her indulgence of this issue the past few days but also for her 
professional nature today.
  Mr. Speaker, we're on the floor because the health care bill that the 
President and House Democrats and Senate Democrats supported costs 
twice as much 1 year later as was guesstimated the year before.
  The United States is suffering economically, people are suffering 
economically, and we are losing our competitiveness with the world. We 
are here because the biggest driver of what I would consider to be not 
just lack of jobs in this country but also continued uncertainty for 
the business community. Someone called them corporations. They're 
really employers. Employers across this country are saying to Members 
of Congress not just in sworn testimony but in media after media, 
newspaper after newspaper, that it is uncertainty related to the health 
care bill that is causing them not to move forward on their plans to 
grow their business.
  We are here today because we need to make sure that we also 
understand the cost--the cost that is twice as much in 1 year as was 
guesstimated to be in the year before. This cost in doubling, this 
would mean that this body either needs to come up with a way to pay for 
it, which would mean, following the Democrats' proposal, instead of 
taking $500 billion out of Medicare, we would take $1 trillion out of 
Medicare. Instead of raising taxes $570 billion, we would have to raise 
taxes $1 trillion. Instead of all these things that the bill does that 
taxes people, instead of it being exactly the way they said it would 
be, including $70 billion for a plan for long-term care that now they 
cannot sustain, it would have to be $140 billion.
  Mr. Speaker, the American people do understand that health care is 
important, and Republicans would insist upon us following, just as we 
have in the past, health care bills which would better the marketplace, 
and people would have the ability to purchase health care at an 
affordable amount and to make sure that we have physicians and patients 
that have a close relationship. Please make no mistake: tort reform 
would be at the top of our order.
  Secondly, buying insurance across State lines would include a healthy 
marketplace. Third, 26-year-olds being on their parents' insurance, 
that's a bipartisan idea. High-risk pools to help spread out the cost 
would become available. We're for those, too. And certainly associated 
health care plans that are able to pool their resources so that they 
can have a bigger team size in which to purchase health care would be 
important. But more importantly, we need to make sure that every single 
American gets health care on a pretax basis.
  We've made our case today, Mr. Speaker. I am very proud of what we're 
doing. I urge my colleagues to vote for the rule and the underlying 
bill.
  The material previously referred to by Ms. Slaughter is as follows:

    An Amendment to H. Res. 724 Offered by Ms. Slaughter of New York

       Amendment in nature of substitute:
       Strike all after the resolved clause and insert:
       That immediately upon adoption of this resolution the 
     Speaker shall, pursuant to clause 2(b) of rule XVIII, declare 
     the House resolved into the Committee of the Whole House on 
     the state of the Union for consideration of the bill (H.R. 
     5542) to amend the Internal Revenue Code of 1986 to encourage 
     domestic insourcing and discourage foreign outsourcing. 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 among and controlled by the 
     chair and ranking minority member of the Committee on Ways 
     and Means. After general debate the bill shall be considered 
     for amendment under the five-minute rule. All points of order 
     against provisions in the bill are waived. At the conclusion 
     of consideration of the bill for amendment the Committee 
     shall rise and report the bill to the House with such 
     amendments as may have been adopted. The previous question 
     shall be considered as ordered on the bill and amendments 
     thereto to final passage without intervening motion except 
     one motion to recommit with or without instructions. If the 
     Committee of the Whole rises and reports that it has come to 
     no resolution on the bill, then on the next legislative day 
     the House shall, immediately after the third daily order of 
     business under clause 1 of rule XIV, resolve into the 
     Committee of the Whole for further consideration of the bill.
       Sec. 2. Clause 1(c) of rule XIX shall not apply to the 
     consideration of the bill specified in the first section of 
     this resolution.
                                  ____

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

        The Vote on the Previous Question: What It Really Means

       This vote, the vote on whether to order the previous 
     question on a special rule, is not merely a procedural vote. 
     A vote against ordering the previous question is a vote 
     against the Republican majority agenda and a vote to allow 
     the opposition, at least for the moment, to offer an 
     alternative plan. It is a vote about what the House should be 
     debating.
       Mr. Clarence Cannon's Precedents of the House of 
     Representatives (VI, 308-311), describes the vote on the 
     previous question on the rule as ``a motion to direct or 
     control the consideration of the subject before the House 
     being made by the Member in charge.'' To defeat the previous 
     question is to give the opposition a chance to decide the 
     subject before the House. Cannon cites the Speaker's ruling 
     of January 13, 1920, to the effect that ``the refusal of the 
     House to sustain the demand for the previous question passes 
     the

[[Page H4723]]

     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. SESSIONS. 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.
  Ms. SLAUGHTER. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 and clause 9 of rule 
XX, this 15-minute vote on ordering the previous question will be 
followed by 5-minutes votes on adopting the resolution, if ordered; and 
agreeing to the Speaker's approval of the Journal.
  The vote was taken by electronic device, and there were--yeas 238, 
nays 184, not voting 9, as follows:

                             [Roll No. 456]

                               YEAS--238

     Adams
     Aderholt
     Alexander
     Amash
     Amodei
     Austria
     Bachmann
     Bachus
     Barletta
     Bartlett
     Barton (TX)
     Bass (NH)
     Benishek
     Berg
     Biggert
     Bilbray
     Bilirakis
     Bishop (UT)
     Black
     Blackburn
     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
     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
     Jones
     Jordan
     Kelly
     King (NY)
     Kingston
     Kinzinger (IL)
     Kline
     Labrador
     Lamborn
     Lance
     Landry
     Lankford
     Latham
     LaTourette
     Latta
     Lewis (CA)
     LoBiondo
     Long
     Lucas
     Luetkemeyer
     Lummis
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     Marino
     McCarthy (CA)
     McCaul
     McClintock
     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
     Paul
     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 (FL)
     Royce
     Runyan
     Ryan (WI)
     Scalise
     Schilling
     Schmidt
     Schock
     Schweikert
     Scott (SC)
     Scott, Austin
     Sensenbrenner
     Sessions
     Shimkus
     Shuler
     Shuster
     Simpson
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Southerland
     Stearns
     Stivers
     Stutzman
     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--184

     Ackerman
     Altmire
     Andrews
     Baca
     Baldwin
     Barber
     Barrow
     Bass (CA)
     Becerra
     Berkley
     Berman
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Bonamici
     Boswell
     Brady (PA)
     Braley (IA)
     Brown (FL)
     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)
     Davis (IL)
     DeFazio
     DeGette
     DeLauro
     Deutch
     Dicks
     Dingell
     Doggett
     Donnelly (IN)
     Doyle
     Edwards
     Ellison
     Engel
     Eshoo
     Farr
     Fattah
     Filner
     Frank (MA)
     Fudge
     Garamendi
     Gonzalez
     Green, Al
     Green, Gene
     Grijalva
     Hahn
     Hanabusa
     Hastings (FL)
     Heinrich
     Higgins
     Himes
     Hinchey
     Hinojosa
     Hochul
     Holden
     Holt
     Honda
     Hoyer
     Israel
     Jackson Lee (TX)
     Johnson (GA)
     Johnson, E. B.
     Kaptur
     Keating
     Kildee
     Kind
     Kissell
     Kucinich
     Langevin
     Larsen (WA)
     Larson (CT)
     Lee (CA)
     Levin
     Lewis (GA)
     Lipinski
     Loebsack
     Lofgren, Zoe
     Lowey
     Lujan
     Lynch
     Maloney
     Markey
     Matheson
     Matsui
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McNerney
     Meeks
     Michaud
     Miller (NC)
     Moore
     Moran
     Murphy (CT)
     Nadler
     Napolitano
     Neal
     Olver
     Owens
     Pallone
     Pascrell
     Pastor (AZ)
     Pelosi
     Perlmutter
     Peters
     Peterson
     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
     Slaughter
     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--9

     Akin
     Bonner
     Gutierrez
     Hirono
     Jackson (IL)
     King (IA)
     Miller, George
     Platts
     Sullivan

                              {time}  1440

  Messrs. HASTINGS of Florida, BUTTERFIELD, and KUCINICH, Ms. LORETTA 
SANCHEZ of California and Ms. JACKSON LEE of Texas changed their vote 
from ``yea'' to ``nay.''
  Mr. POSEY changed his vote from ``nay'' to ``yea.''
  So the previous question was ordered.
  The result of the vote was announced as above recorded.
  The SPEAKER pro tempore. The question is on the resolution.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Ms. SLAUGHTER. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. This is a 5-minute vote.
  The vote was taken by electronic device, and there were--yeas 240, 
nays 182, not voting 9, as follows:

                             [Roll No. 457]

                               YEAS--240

     Adams
     Aderholt
     Alexander
     Amash
     Amodei
     Austria
     Bachmann
     Bachus
     Barletta
     Bartlett
     Barton (TX)
     Bass (NH)
     Benishek
     Berg
     Biggert
     Bilbray
     Bilirakis
     Bishop (UT)
     Black
     Blackburn
     Bono Mack
     Boren
     Boustany
     Brady (TX)
     Brooks
     Broun (GA)
     Buchanan
     Bucshon
     Buerkle
     Burgess

[[Page H4724]]


     Burton (IN)
     Calvert
     Camp
     Campbell
     Canseco
     Cantor
     Capito
     Carter
     Cassidy
     Chabot
     Chaffetz
     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
     Jones
     Jordan
     Kelly
     King (NY)
     Kingston
     Kinzinger (IL)
     Kissell
     Kline
     Labrador
     Lamborn
     Lance
     Landry
     Lankford
     Latham
     LaTourette
     Latta
     Lewis (CA)
     LoBiondo
     Long
     Lucas
     Luetkemeyer
     Lummis
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     Marino
     McCarthy (CA)
     McCaul
     McClintock
     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
     Paul
     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 (AR)
     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
     Yoder
     Young (AK)
     Young (FL)
     Young (IN)

                               NAYS--182

     Ackerman
     Altmire
     Andrews
     Baca
     Baldwin
     Barber
     Barrow
     Bass (CA)
     Becerra
     Berkley
     Berman
     Bishop (GA)
     Blumenauer
     Bonamici
     Boswell
     Brady (PA)
     Braley (IA)
     Brown (FL)
     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)
     Davis (IL)
     DeFazio
     DeGette
     DeLauro
     Deutch
     Dicks
     Dingell
     Doggett
     Donnelly (IN)
     Doyle
     Edwards
     Ellison
     Engel
     Eshoo
     Farr
     Fattah
     Filner
     Frank (MA)
     Fudge
     Garamendi
     Gonzalez
     Green, Al
     Green, Gene
     Grijalva
     Hahn
     Hanabusa
     Hastings (FL)
     Heinrich
     Higgins
     Himes
     Hinchey
     Hinojosa
     Hochul
     Holden
     Holt
     Honda
     Hoyer
     Israel
     Jackson Lee (TX)
     Johnson (GA)
     Johnson, E. B.
     Kaptur
     Keating
     Kildee
     Kind
     Kucinich
     Langevin
     Larsen (WA)
     Larson (CT)
     Lee (CA)
     Levin
     Lewis (GA)
     Lipinski
     Loebsack
     Lofgren, Zoe
     Lowey
     Lujan
     Lynch
     Maloney
     Markey
     Matheson
     Matsui
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McNerney
     Meeks
     Michaud
     Miller (NC)
     Moore
     Moran
     Murphy (CT)
     Nadler
     Napolitano
     Neal
     Olver
     Owens
     Pallone
     Pascrell
     Pastor (AZ)
     Pelosi
     Perlmutter
     Peters
     Peterson
     Pingree (ME)
     Polis
     Price (NC)
     Quigley
     Rahall
     Rangel
     Reyes
     Richardson
     Richmond
     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)
     Thompson (MS)
     Tierney
     Tonko
     Towns
     Tsongas
     Van Hollen
     Velazquez
     Visclosky
     Walz (MN)
     Wasserman Schultz
     Waters
     Watt
     Waxman
     Welch
     Wilson (FL)
     Woolsey
     Yarmuth

                             NOT VOTING--9

     Akin
     Bishop (NY)
     Bonner
     Gutierrez
     Hirono
     Jackson (IL)
     King (IA)
     Miller, George
     Woodall


                Announcement by the Speaker Pro Tempore

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

                              {time}  1446

  So the resolution was agreed to.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.

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