Congressional Record, Volume 160 Issue 42 (Thursday, March 13, 2014)

[Congressional Record Volume 160, Number 42 (Thursday, March 13, 2014)]
[House]
[Pages H2374-H2383]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

PROVIDING FOR CONSIDERATION OF H.R. 3189, WATER RIGHTS PROTECTION ACT;
PROVIDING FOR CONSIDERATION OF H.R. 4015, SGR REPEAL AND MEDICARE
PROVIDER PAYMENT MODERNIZATION ACT Of 2014; AND PROVIDING FOR
PROCEEDINGS DURING THE PERIOD FROM MARCH 17, 2014, THROUGH MARCH 21,
2014

Mr. BURGESS. Mr. Speaker, by direction of the Committee on Rules, I
call up House Resolution 515 and ask for its immediate consideration.
The Clerk read the resolution, as follows:

H. Res. 515

Resolved, That at any time after adoption of this
resolution the Speaker may, pursuant to clause 2(b) of rule
XVIII, declare the House resolved into the Committee of the
Whole House on the state of the Union for consideration of
the bill (H.R. 3189) to prohibit the conditioning of any
permit, lease, or other use agreement on the transfer,
relinquishment, or other impairment of any water right to the
United States by the Secretaries of the Interior and
Agriculture. The first reading of the bill shall be dispensed
with. All points of order against consideration of the bill
are waived. General debate shall be confined to the bill and
shall not exceed one hour equally divided and controlled by
the chair and ranking minority member of the Committee on
Natural Resources. After general debate the bill shall be
considered for amendment under the five-minute rule. It shall
be in order to consider as an original bill for the purpose
of amendment under the five-minute rule the amendment in the
nature of a substitute recommended by the Committee on
Natural Resources now printed in the bill. The committee
amendment in the nature of a substitute shall be considered
as read. All points of order against the committee amendment
in the nature of a substitute are waived. No amendment to the
committee amendment in the nature of a substitute shall be in
order except those printed in part A of the report of the
Committee on Rules accompanying this resolution. Each such
amendment may be offered only in the order printed in the
report, may be offered only by a Member designated in the
report, shall be considered as read, shall be debatable for
the time specified in the report equally divided and
controlled by the proponent and an opponent, shall not be
subject to amendment, and shall not be subject to a demand
for division of the question in the House or in the Committee
of the Whole. All points of order against such

[[Page H2375]]

amendments are waived. At the conclusion of consideration of
the bill for amendment the Committee shall rise and report
the bill to the House with such amendments as may have been
adopted. Any Member may demand a separate vote in the House
on any amendment adopted in the Committee of the Whole to the
bill or to the committee amendment in the nature of a
substitute. 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.
Sec. 2. Upon adoption of this resolution it shall be in
order to consider in the House the bill (H.R. 4015) to amend
title XVIII of the Social Security Act to repeal the Medicare
sustainable growth rate and improve Medicare payments for
physicians and other professionals, and for other purposes.
All points of order against consideration of the bill are
waived. The amendment printed in part B of the report of the
Committee on Rules accompanying this resolution shall be
considered as adopted. The bill, as amended, shall be
considered as read. All points of order against provisions in
the bill, as amended, are waived. The previous question shall
be considered as ordered on the bill, as amended, and on any
amendment thereto to final passage without intervening motion
except: (1) one hour of debate equally divided among and
controlled by the chair and ranking minority member of the
Committee on Energy and Commerce and the chair and ranking
minority member of the Committee on Ways and Means; and (2)
one motion to recommit with or without instructions.
Sec. 3. On any legislative day during the period from
March 17, 2014, through March 21, 2014--
(a) the Journal of the proceedings of the previous day
shall be considered as approved; and
(b) the Chair may at any time declare the House adjourned
to meet at a date and time, within the limits of clause 4,
section 5, article I of the Constitution, to be announced by
the Chair in declaring the adjournment.
Sec. 4. The Speaker may appoint Members to perform the
duties of the Chair for the duration of the period addressed
by section 3 of this resolution as though under clause 8(a)
of rule I.

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

General Leave

Mr. BURGESS. Mr. Speaker, I ask unanimous consent that all Members
have 5 legislative days to revise and extend their remarks.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
There was no objection.
Mr. BURGESS. Mr. Speaker, House Resolution 515 provides for
consideration of H.R. 3189, the Water Rights Protection Act, under a
structured amendment process, making in order three amendments and
providing for extra time for debate for the substitute amendment, which
will be offered by Mr. Polis.
The rule also provides for the consideration of H.R. 4015, the SGR
Repeal and Medicare Provider Payment Modernization Act of 2014 with one
amendment, offered by Chairman Camp from the Ways and Means Committee,
being self-executed in order to ensure that the legislation has a valid
pay-for.
This is necessary so that the bill before us does not run afoul with
the majority's rule on CutGo. As is customary, the rule allows the
minority to offer a motion to recommit on each bill. Finally, the rule
provides for the customary district work period authority.
H.R. 3189, the Water Rights Protection Act, addresses a concern of a
number of our Western State colleagues who have experienced the Federal
Government threatening to take over the private water rights of
businesses and private citizens held on public lands.
The bill, sponsored by Representative Scott Tipton from Colorado, is
a bipartisan effort to protect water supplies and property rights
designated for recreation, agriculture, local conservation, and
municipal use from Federal Government overreach.
The bill protects water users and upholds State water laws by
prohibiting Federal agencies from extorting water rights through their
use of permits, leases, and other land management arrangements.
If the floor debate on this bill is anything like the debate which
members of the Rules Committee observed last night, this discussion
will be spirited, as this issue deeply affects Western States, where so
much of their land is controlled by the Federal Government.
The second bill, H.R. 4015, the SGR repeal legislation, is an issue
that I have worked on my entire congressional career. It reflects years
of bipartisan, multicommittee, bicameral discussions and negotiations,
bringing together Members of all ideological stripes, as well as those
from the outside, to coalesce around a policy to help patients and to
help their care providers get out from under the constant threat of
payment cuts under the current sustainable growth rate structure for
Medicare payments.
Everyone agrees, Mr. Speaker, that the Medicare sustainable growth
rate has got to go; but today, we are considering an actual framework
to realistically accomplish that goal.
This formula--the sustainable growth rate formula--was enacted as
part of the Balanced Budget Act of 1997 in an ultimately misguided
means by which to restrain Federal spending in Medicare Part B.
The formula consists of expenditure targets, which are established by
applying a growth rate, which is designed to bring spending in line
with the expenditure targets over time.
Since 2002, this formula has called for a reduction to physician
reimbursement rates. However, every Congress has consistently passed
legislation to override this formula. This has led this body to find
over $150 billion with no solution out of this annual mess.
If Congress were to let the SGR go into effect, physicians would face
a 24 percent reduction in reimbursement rates in just a few weeks'
time. This unrealistic assumption of spending and efficiency have
plagued the health care profession and our Nation's seniors.
The bill before us repeals the SGR--let me repeat that because it is
so important--this bill repeals the sustainable growth rate formula,
avoiding potentially devastating across-the-board cuts slated for 2014
and does so at a cost far lower than what Congress has already spent or
would likely spend over the next 10 years' time.
The bill provides for 5 years of payment transition, essential to
allow us to ensure continued beneficiary access, to allow medicine to
concentrate on moving to a broad adoption of quality reporting, and
allow Congress to move past the distraction of this formula to identify
Medicare reforms that can further benefit beneficiaries.
This bill will also allow providers the time to develop and the time
to test quality measures and clinical practice improvement activities,
which will be used for performance assessment during other phases of
this bill. During the 5-year stability period, physicians will receive
annual increases of \1/2\ of 1 percent.
I know, I can hear it already. That is not very much. Correct, it is
not; but it is more in aggregate than what has been provided over the
last several years. More importantly, it provides that stability so
physician offices can plan and plan ahead on how to take care of their
patients.

{time} 1245

The quality measures implemented in what is called the Merit-Based
Incentive Payment System will be evidence-based and developed through a
transparent process that will seek input from provider groups, from
patient groups, and from other stakeholders.
Quality reporting will involve a provider's being judged against its
practice rather than a one-size-fits-all, generic standard of care that
does not take into account the unique practices of various specialty
providers.
Providers will also self-determine their measures. We consolidate
three reporting programs into the Merit-Based Incentive Payment System,
easing the administrative burden on doctors while retaining the
congressionally established goals of quality, resource use, and
meaningful use.
The new reimbursement structure ensures continued access to high-
quality care while providing physicians with certainty and security in
their reimbursements. Physicians will be aware of the benchmarks they
are competing against, and unlike current law, all penalties assessed
from those not meeting the benchmarks will go to those who are. This
keeps the dollars

[[Page H2376]]

in the Medicare system, and that, ultimately, drives the quality, which
benefits Medicare patients.
Standards against which providers will be measured will be developed
by professional organizations in conjunction with existing programs and
will incorporate ongoing feedback to doctors, thus further ensuring
that optimal care is ultimately provided to the patient.
Realtime feedback will be gained through registries and performance
data, and doctors are encouraged to participate in the process through
data reporting. For eligible professionals who choose to opt out of the
fee-for-service program, alternative payment models will be available.
These alternative models may include patient-centered medical homes,
whether they are primary or specialty models, and bundles or episodes
of care. By encouraging alternative payment models, care coordination,
and disease management, our proposed solution will inspire innovation.
Qualifying practices that move a significant number of their patients
into one of these alternative payment methods will see a 5 percent
quality bonus. The bill will also take affirmative steps to improve the
accuracy of relative values and misvalued services.
But even though we are taking these important steps toward ensuring
quality care, the bill specifically states that these quality measures
are not creating a Federal right of action or a legal standard of care
or a duty of care owed by the health care provider to the patient.
Mr. Speaker, we have had a lot of discussion. I know my friends on
the other side of the dais may disagree with having to pay for new
spending, but this is an important reform that Republicans put in place
when they reclaimed the majority after the 2010 elections. If you want
to increase mandatory spending, you should reduce mandatory spending
elsewhere. This is a simple concept, and I know that my constituents
and many Americans agree with this.
The Democrats' substitute highlights the difference between the
parties on this issue. Democrats have embraced a budget gimmick to
offset their bill, a gimmick that even the nonpartisan Congressional
Budget Office has said is not scorable. There is no way that it will
pay for anything, because the score is zero.
Republicans want to reform Medicare and the payment system in a
responsible way and do so in a way that is paid for. If my colleagues
on the other side can find a legitimate offset, I am happy to review
it. In fact, this is exactly what we are asking of the United States
Senate. You don't like our offset. Offer one of your own, and let's
work together to pass these much-needed reforms.
This bill is consistent in its themes throughout. We provide payment
stability, reduce and streamline the administrative burden, increase
predictability in doctors' interactions with the Centers for Medicare
and Medicaid Services, build transparency into systems, encourage
innovation and the delivery of services, and keep providers in the
driver's seat.
I encourage my colleagues to vote ``yes'' on the rule and ``yes'' on
the underlying bills.
I reserve the balance of my time.
Mr. POLIS. I thank the gentleman for yielding me the customary 30
minutes, and I yield myself such time as I may consume.
Mr. Speaker, we have two bills before us under this rule, which I
will briefly discuss before getting into the more important topic of
what bills are not being considered on the floor of the House this
week.
Notably, despite comprehensive immigration reform's having passed the
Senate with more than two-thirds support, despite the fact that there
are more than 10 million people here in this country illegally, despite
the fact that our borders are porous and that people are sneaking
across, as well as illicit goods, despite the fact that we have no
meaningful workplace enforcement, despite the fact that farmers and the
faith-based community are crying out for reform--the business
community, the tech community, labor--there is no immigration bill on
the floor of the House today. Instead, we are discussing two bills.
We are discussing one SGR fix. Now, that sounds obscure to people,
``SGR fix.'' What is that? This is the reimbursement rate for doctors
under Medicare, and there is a budgetary fiction that long predates me
in this place. I assume that, at the time, Republicans and Democrats
created this elaborate budgetary fiction together as this degree of
budgetary fiction requires both parties' most creative thoughts to
possibly put it together. So we pretend every year that there are going
to be large cuts to Medicare. I think Republicans and Democrats know
that that is not likely to happen. Those cuts would completely gut
Medicare. Doctors would drop Medicare patients if those cuts were to
occur.
So each year and sometimes shorter than a year--sometimes 6 months,
sometimes 3 months, sometimes 2 years--Democrats and Republicans have
to come together to figure out how to avoid those automatic cuts that
otherwise occur. That discussion is about how to pay for avoiding those
cuts each time.
Democrats have suggestions to pay for it--let's eliminate oil and gas
loopholes; let's use the overseas contingency fund. Republicans have
ideas about how they want to pay for it--in this case, the 52nd repeal
of ObamaCare. By the way, they want to keep all of the taxes from
ObamaCare; they just want to get rid of some of the benefits. So they
are going to keep all of the taxes from ObamaCare--those Republicans
love those taxes--but they are getting rid of some of the benefits.
That is the secret of what they are using to pay for it, just so you
know.
The real discussion is how to do it, but in this case, the
Republicans are presumably so embarrassed about their pay-for--the fact
that they are using the ObamaCare taxes to pay for Medicare--that they
are slipping it into the rule in what is called the ``deem and pass''
language, or what is characterized by some as the ``demon pass''
language.
This rule says:

The amendment printed in part B of the report of
the Committee on Rules accompanying this resolution shall
be considered as adopted.

That means there is not even going to be a vote on the actual way to
pay for avoiding the Medicare cuts. It is in the rule, itself. This is
the most costly rule I have ever seen. This rule costs $138 billion of
ObamaCare taxes that the Republicans want to use. This is an expensive
rule, Mr. Speaker. If there is a real desire to talk with Democrats
about ways to pay for the Medicare SGR fix, also called the ``doc
fix,'' we are happy to do it. We were hoping that you would allow a
Democratic pay-for sponsored by Mr. Tierney, who will talk about the
previous question. Our idea is to use the Overseas Contingency Fund to
avoid any cut to Medicare beneficiaries, but this rule does not allow
us to do that. This rule doesn't even allow the House to vote on using
ObamaCare taxes to pay for SGR. It includes the ``deem and pass''
language in the rule, itself--a rule, itself, that includes self-
executing language that costs $138 billion. That is one expensive rule,
Mr. Speaker, and I certainly hope my colleagues vote ``no.''
This rule also includes H.R. 3189, the Water Rights Protection Act.
As my colleague said, those of us in the West feel that whiskey is for
drinking and water is for fighting about. I think the debate on the
Rules Committee last night and the upcoming debate here on the floor
will probably reflect that old adage. The genesis of this particular
bill is something that Mr. Tipton and I and, I think, many Members of
this body agree on. We wanted to address a narrow dispute between the
U.S. Forest Service and ski permit holders that directly impacts my
district and impacts Mr. Tipton's district.
I support Mr. Tipton's efforts in that regard, and I was hoping we
could have gotten the bill to a point where it would have passed near
unanimously or unanimously. Instead, this bill has become a job-killing
Republican water grab that even the counties that it was designed to
help oppose. The counties in my district that have ski resorts--Eagle,
Rand, Summit County, famous resorts like Winter Park, Vail, Arapahoe
Basin, Breckenridge, among others--now oppose this bill because it will
destroy jobs in their counties by destroying recreational opportunities
like white-water rafting, fishing, year-round tourism opportunities,
which are

[[Page H2377]]

critical to the economic success of my district.
These changes to this job-killing Republican water grab have caused
this bill to snowball into an effort that will hurt our rivers' health,
destroy recreational opportunities, and the underlying bill jeopardizes
the agreements that leave waters in streams and rivers, which allow our
tourism industry to be so vibrant. Even some of the counties, as we
mentioned in the Rules Committee yesterday--certainly not all of those
counties--like Pitkin County and the home of Aspen and Mr. Tipton's
district, also oppose this bill. Again, there was an overreaching
decision by the U.S. Forest Service that required ski area permittees
to transfer the ownership of water rights to the Federal Government. In
2012, that water directive was overturned by a U.S. District Court
judge.
It is important to note that I believe in the purpose of this bill,
and I hope that we can address it through the amendment that I have
offered, which allows for 20 minutes of floor debate under this bill.
This bill can still be saved by this body's endorsing the amendment
that I have offered as part of this bill, which is also supported by
ski area representatives from across the Mountain West, along with my
colleagues from Colorado Ms. DeGette and Mr. Perlmutter.
Unfortunately, this job-killing Republican water grab bill uses the
ski area directive as a pretense for making wholesale job-killing
changes. Look, ski areas have been a punching bag for U.S. Forest
Service's misguided policies for the last decade. I think we can find
common cause around a narrow solution. In that time, the Forest Service
has changed the ski area water policies four times. It has
inconsistently enforced others' water clauses. It has left ski areas
subject to the agency's whim. They are very capital-intense ski areas.
They are the major economic driver of the mountain areas of my
district, but they have been at the whim of sometimes arbitrary Federal
actions. Ski areas collectively hold water rights worth hundreds of
millions of dollars that are critical for their businesses.
Now, my colleagues might wonder what kind of improvements a ski area
might want to make. In 2011, this body unanimously voted to support the
Ski Area Recreational Opportunity Enhancement Act, which allowed ski
areas to expand summertime activities, like zip lines and mountain
biking. Amongst some of those other summertime activities that ski
resorts benefit from are white-water rafting, fishing--the very kinds
of recreational opportunities that will be impacted by this job-killing
Republican water grab.
I entered several pieces of testimony into the record in the Rules
Committee yesterday--statements from water districts and from
counties--with regard to how this bill will impact recreational
opportunities in Colorado. Along with Ms. DeGette, Mr. Perlmutter, Ms.
DelBene, Ms. Kuster, Mr. Cartwright, and Mr. Huffman, I was proud to
offer an amendment that would fix and address the issues in H.R. 3189
and return the bill to its original purpose.
The amendment ensures that any U.S. Forest Service directive will not
condition ski area permits on the transfer title of any water right or
require any ski area permittee to acquire a water right in the name of
the United States. The amendment ensures the long-term viability of ski
areas, and it makes sure that this bill is not the job-killing
Republican water grab that it has become.
It is important to note that the narrow dispute that was the genesis
of this bill could have been solved with a suspension measure. We have
offered language repeatedly to Mr. Tipton and his staff, to the
committee and its staff, but we were not taken up on that offer, sadly.
Instead, we have before us a job-killing Republican water grab bill
that would devastate my district.

{time} 1300

Instead, the manager's amendment was offered, as well as additional
language in committee.
This bill is riddled with problems that are not addressed. The bypass
flows issue is not solved in the manager's amendment, which does
address the Endangered Species Act component but does nothing to
address the issues around the Forest Service, BLM, Interior, and
Agriculture agencies that also have relevant authority under a number
of statutes, including the Federal Land Policy and Management Act,
Forest Service and Park Service Organic Act, and Wild and Scenic Rivers
Act, to impose bypass flows.
Simply put, the manager's amendment doesn't make the necessary
improvements to make this a bipartisan measure--they are simply window
dressing for a job-killing Republican water grab.
Let's talk about some of the issues in the underlying legislation.
In the West, water rights are State-based, and any challenge to a
right or to the system itself is a very delicate proposition to years
of precedence and claims, subordinate and senior, with regard to water.
As a result, this legislation only serves to cast doubt on the
complicated laws and authorities that make up our Nation's and State
water laws, and that companies, individuals, and counties have made
decisions on and already have economic investments in.
In addition, this bill, absent my amendment, muddles the message of
disapproval over the 2011 decision.
What exactly are we saying with regard to this bill? A bill that was
meant to address the needs of ski areas because of the 2011 directive
instead has become an all-encompassing, job-killing Republican water
grab, which is not even a clear signal of our unhappiness with the
original directive.
I think not only would there be a much cleaner path to actually
become the law of the land if we were to consider a targeted approach
encompassed by the amendment that I have offered, but it also, even
absent becoming law, would send a clear and unambiguous message to the
U.S. Forest Service of congressional disapproval of the directive.
Instead, I think they will just shrug their shoulders and say, That
is that crazy House of Representatives.
This bill is not going to become law. This bill will not have any
impact--and the message is lost with regard to the 2011 directive.
If they think this is the House's reaction--muddled, job-killing,
water-grabbing--to this sort of thing, what is to stop them from doing
this again? What is to stop them from targeting ranchers? What is to
stop them from targeting recreation areas?
When this kind of thing occurs, we need a targeted reaction that can
become law or a clear and unambiguous message that the House will not
stand for it.
In summary, this rule contains $183 billion in ObamaCare taxes that
are spent for another purpose and allows two bills to come to the
floor, both of which could be negotiated in good faith with the
Democrats, and both of which have not.
I reserve the balance of my time.
Mr. BURGESS. Mr. Speaker, I yield myself 1 minute to respond to some
of this, just to put things in context on a timeline.
H.R. 4015 was introduced on February 6, 2014. The bill has been
available to all Members and the public for more than a month. The bill
is cosponsored by the bipartisan chairs and ranking members of the
Committees on Energy and Commerce, Ways and Means, and the Senate
Finance Committee.
We are recommending no changes to the underlying substance of H.R.
4015, which has been negotiated on a bipartisan basis.
I do believe that providing offsets for new spending is an
appropriate course of action. Therefore, the Camp amendment saves
almost $170 billion over the next 10 years, and this rule ensures that
we aren't making future generations foot the bill.
I yield 4 minutes to the gentleman from Colorado (Mr. Tipton).
Mr. TIPTON. I thank the gentleman for yielding.
Mr. Speaker, it is with some dismay that I have to address some of
the comments that have been made by my good friend and colleague from
Colorado.
Unfortunately, through their own words, they are willing to throw
farmers and ranchers--hardworking Americans--under the bus, for an
ideological cause, something that we simply cannot accept in the West.
In the Western United States, water is the lifeblood of our
communities. H.R. 3189 codifies that existing right.
The water grab that is taking place is not by this legislation but by
the

[[Page H2378]]

very Federal Government that our opponents seem to want to be able to
protect and put in a position of authority over State rights and the
Fifth Amendment of the Constitution.
As a sponsor of this bipartisan legislation, I support the rule on
H.R. 3189, and I encourage an open debate because I believe the merits
of this bill will truly speak for themselves.
Federal attempts to be able to manipulate Federal permit, lease, and
land management processes to circumvent long-established State water
law and hijack privately held water rights have sounded the alarm bell
for all non-Federal water users that rely on these water rights for
their livelihood.
The most recent case of the Federal Government's overreach and
infringement on private property rights involves a U.S. Forest Service
attempt to require the transfer of privately held water rights to the
Federal Government as a permit condition on National Forest System
lands. There is no just compensation for the transfer of these
privately held rights, despite the facts that many stakeholders have
invested millions of their own capital in developing them and, in many
cases, rely on them for their livelihoods.
This Forest Service permit condition has hurt a number of
stakeholders in my home State of Colorado, including the Powderhorn ski
area near Grand Junction. The Aspen ski area in my district, which he
cited, supports this legislation.
Despite having been excellent stewards of the environment and their
water rights, the Forest Service has demanded the relinquishment of
State-granted water rights from these ski areas in order to continue
their operations.
The same tactics have been used in Utah, Nevada, and other Western
States where agencies have required the surrender of possession of
water rights in exchange for approving the conditional use of grazing
allotments.
This water grab has broad implications that have begun to extend
beyond the recreation and farming and ranching community, and are now
threatening municipalities and other businesses.
As a result of efforts that began in 2011 and encompass testimony
from several hearings by the Natural Resources Committee, conversations
with numerous stakeholders across Colorado and the West, and close
collaboration with my friends on the committee, I introduced this
bipartisan Water Rights Protection Act.
This legislation provides critical protection for water rights
holders from Federal takings by ensuring that Federal agencies cannot
extort private property rights through uneven-handed negotiations. The
Water Rights Protection Act offers a sensible approach that preserves
water rights and the ability to develop water requisite to living in
the arid West without interfering with water allocations for non-
Federal parties or allocations that protect the environment that is
cherished by all Westerners.

To this end, the bill prohibits Federal agencies from pilfering water
rights through the use of permits, lease, and other land management
arrangements for which it would otherwise have to pay just compensation
under the Fifth Amendment of the Constitution. The bill also prohibits
Federal land management agencies from forcing water users to apply for
or acquire water rights from the United States rather than for the
water users themselves.
Finally, this commonsense legislation provides certainty by upholding
longstanding Federal deference to State water law in which countless
water users rely.
As the American Farm Bureau states in their letter of support:

H.R. 3189 grants no new rights to any party, nor does it in
any way infringe on existing rights of individuals, States,
or the Federal Government. This legislation simply reaffirms
what has been existing law for generations in the West.

I am proud that this important piece of legislation that is supported
by a broad coalition of stakeholders is now present. Water is our most
precious resource in the West, and long-held private property rights to
it must be protected from uncompensated Federal takings.
I urge adoption of the rule.
Mr. POLIS. Mr. Speaker, I yield 3 minutes to the gentlewoman from
Texas (Ms. Jackson Lee), to further discuss the rule that allows for
the debate of the job-killing Republican water grab and the bill to
keep ObamaCare taxes and remove the benefits.
Ms. JACKSON LEE. I thank the gentleman very much.
Might I make a March plea in this March madness?
Can't we all get along and work together on important items such as
water rights and the SGR?
I rise, first of all, to make it very clear that I am a strong
supporter of providing adequate compensation to our physicians who
serve Medicare patients. It is important for our seniors to know that
Medicare will be there when they need it. But it is equally important
that there are physicians who are willing to attend to them without
going broke.
Let it be very clear that I believe my record has been extremely
strong on the idea of making sure the benefits for seniors are not cut.
The misrepresentation that the Affordable Care Act cuts Medicare
benefits is not true. Now we have the sustainable growth rate, which we
had bipartisan support for, and all of a sudden we have a poison pill
of a self-executing rule, which was challenged in the Rules Committee,
to take money from the Affordable Care Act to allegedly help the
doctors.
Every doctor I speak to wants a permanent fix for the SGR. There are
a number of suggestions made in the other body, somewhat unpleasant,
but we were willing to look at those particular suggestions.
As with any business, medical clinics and physician offices have
payrolls to meet, bills to pay, and expenses to meet as they become
due. Why are we playing with them when, in essence, we know that this
is not going anywhere? Why are we not taking care of these physicians
who spend 8 years and hundreds of thousands of dollars to work to gain
a degree because they are healers, they believe in it, they want to
serve the public. Now, rather than have a bipartisan bill--in the
spirit of St. Patrick's Day--and be able to come together and work
together, no, we have a bill that poses a serious problem.
I oppose the rule because it corrupts what would otherwise be a
strongly supported bipartisan bill to sustain physician reimbursement
rates, and it is another attempt, again by our friends on the other
side, to disregard and mislead the public about the Affordable Care
Act.
Let me clearly say that 11 groups representing the Nation's seniors--
doctors and advocates--sent a letter to congressional leaders urging
the House to reject the Republicans' toxic doc fix, the GOP's 51st vote
to repeal.
From the letter:

The undersigned organizations representing Medicare
beneficiaries and providers appreciate the bipartisan,
bicameral work done to repeal the Sustainable Growth Rate,
SGR, and reform the Medicare reimbursement system. The
current effort to link, however, SGR reform with changes to
the Affordable Care Act injects partisan politics in
bipartisan legislation.

Access to health care for more than 50 million Americans with
Medicare is a serious matter. We should not schedule a vote that does
not take seriously the idea of making sure our doctors get sufficient
compensation.
The other wrongheaded approach to this is there are no amendments
being allowed. No amendments, Mr. Speaker. A closed rule. I just saw
some documentation of how many closed rules we have had in this House.
The SPEAKER pro tempore (Mr. Womack). The time of the gentlewoman has
expired.
Mr. POLIS. I yield the gentlewoman an additional 30 seconds.
Ms. JACKSON LEE. I thank the gentleman.
The Jackson Lee amendment that was not allowed would have ensured
that, notwithstanding any provision of this act, no delay in the
application of any provision of the Affordable Care Act would have
occurred. It would have called for some studies about Medicare
providers. It would have given us real information.
Jackson Lee amendment No. 2 would have required the Secretary to
submit a report on cost savings.
The real point is, between skewing the water rights of people and the
SGR, this rule should be opposed. We should get back to the drawing
board.

[[Page H2379]]

Can't we all get along and work together on the right kind of
legislation for water rights? More importantly, Mr. Speaker, our
doctors deserve better, and I will say to them, you will get better
from us.
Mr. Speaker, I rise to speak in strong opposition to the Rule for
H.R. 4015, the SGR Repeal and Medicare Provider Payment Modernization
Act of 2014.
Let me say first that I am a strong supporter of providing adequate
compensation to our physicians who serve Medicare patients. It is
important for our seniors to know that Medicare will be there when they
need it. But it is equally important that there are physicians who are
willing to attend to them without going broke.
That is why we have a Sustainable Growth Rate or ``SGR.'' Medicare
reimbursement enables rural physicians and hospitals to remain open for
business.
As with any business, medical clinics and physician offices have
payrolls to meet, bills to pay, and expenses to meet as they become
due. If revenues are not sufficient to cover costs, the business will
not long survive.
Thus, it is critical that we not disrupt timely and adequate payment
to Medicare providers.
The problem with H.R. 4015 is what happened in the Rules Committee.
The Rules Committee, on a party line vote, added language to the Rule
for H.R. 4015 that would delay the Affordable Care Act's implementation
of the individual mandate.
I oppose the Rule for two reasons:
It corrupts what would otherwise be a strongly supported bipartisan
bill to sustain physician reimbursement rates for medical services
approved under Medicare, and
It is another attempt by the Republicans to mislead the public
regarding the Affordable Care Act.
The Jackson Lee Amendments offered to the Rules Committee for H.R.
4015 would have improved the bill by removing the uncertainty that
physicians would not keep the reimbursement rates they now have for
treating patients under Medicare.
Jackson Lee Amendment #1 would have ensured that notwithstanding any
provision of this Act, no delay in the application of any provisions of
the Affordable Care Act's individual mandate can take effect before
January 21, 2017.
Jackson Lee Amendment #2 would have required the Secretary of Health
and Human Services to submit a report to Congress on the impact of the
Medicare provider payments on the diversity and availability of
physicians and hospitals to underserved rural and urban communities.
Jackson Lee Amendment #3 would have required the Secretary of Health
and Human Services to submit a report to Congress on the cost savings
associated with people no longer using emergency rooms or acute care
facilities as their primary means of obtaining health care.
Jackson Lee Amendment #4 would ensure that the bill cannot be
construed or interpreted to permit or require a delay in the
application of the Affordable Care Act's individual mandate.
I know that many predicted that the Affordable Care Act would cause
havoc on the nation's health care system. But it is not the ACA that is
causing havoc--it is the 50 desperate but futile attempts by the Tea
Party to scuttle a law that has been passed by Congress, signed by the
President, upheld by the Supreme Court.
The most threatening actions to our nation's healthcare system by Tea
Party Republicans are their attacks on Medicare.
In 2014, according to the Kaiser Foundation 16% of the nation's
people have medical insurance under Medicare:
Texas has 12% of its residents insured under Medicare;
Arkansas, Florida and Vermont have 19% of their residents insured
under Medicare; and
West Virginia and Main have 21% of their residents insured under
Medicare.
Kentucky; Mississippi, Missouri, Ohio, Oklahoma, Oregon, South
Dakota, Tennessee, Wisconsin, Ohio, Oklahoma, and Oregon have 18% of
their residents insured under Medicare.
Every state has more than 10% of their residents insured by Medicare.
The uncertainly created by the majority regarding Medicare
reimbursement over the last several years has forced physicians to
reevaluate continuing their medical practice and frustrated hospitals
working to make budget projections over several years into the future--
this is critical to business decision making.
Because of uncertainty created by Medicare physician reimbursement--
physicians and hospitals have been forced to close their offices,
reduce services, or merge.
When patients find they cannot keep their physician or that their
options for health care are being affected--it is not because of the
Affordable Care Act.
Our nation has taken a momentous step in creating a mindset that good
health is a personal responsibility with the enactment of the
Affordable Care Act. The health care law did not automatically enroll
all citizens into the program; it was specifically designed to be an
opt-in process.
There are tens of thousands of visitors each day to the website and
despite problems with the initial rollout of the online health
insurance registration process, millions have enrolled and experience
the peace of mind that comes from having affordable, high quality
health insurance that is there when you need it.
I have held many events in my District to inform and connect people
with Navigators and Community Health Centers and send a strong message
to my constituents encouraging them that now is the time for them to
obtain affordable, accessible, and high quality health insurance for
themselves and their families.
So it is puzzling that with less than 70 legislative days remaining
in the Second Session of the 113th Congress, we are still seeing
attempts to end the Affordable Care Act.
The fact that a bill that is critical to the provision of payments to
physicians that treat Medicare patients is not safe from the politics
of the moment is troubling.
I ask my colleagues to support Medicare patients and their physicians
by rejecting this Rule.
Mr. BURGESS. Mr. Speaker, may I inquire as to the amount of time that
remains.
The SPEAKER pro tempore. The gentleman from Texas has 15\1/2\ minutes
remaining. The gentleman from Colorado has 12 minutes remaining.
Mr. BURGESS. Thank you, Mr. Speaker.
I yield myself 2 minutes.
I wanted to just list some of the exemptions from the individual
mandate--those passed in a bipartisan manner by the House of
Representatives and those instituted by executive action by the
President:
July 17, we delayed the individual mandate until 2015. Twenty-two
Democrats voted in favor of that.
March 10, 2014, delayed the individual penalty for individuals who
fail to have health care coverage. Twenty-seven Democrats voted in
favor.
March 11, H.R. 1814, exempted individuals with certain religious
beliefs. Passed by a voice vote. Not a single dissenting vote.
March 11, we exempted volunteer firefighters and emergency responders
from the individual mandate. The vote was 410-0. 186 Democrats voted in
favor.
March 11, we exempted individuals who receive health coverage under
TRICARE, VA, from being counted towards the employer mandate under the
ACA. 183 Democrats voted in favor of that exemption.
This is not something that is exclusive to the House of
Representatives.

{time} 1315

Just last week, the administration quietly excused millions of people
from the requirement to purchase health insurance or else pay the tax.
Now all you need to do is fill out a form attesting that your plan was
canceled and you believe that the plan options available in the
marketplace in your area are more expensive than your canceled
insurance policy. You believe that to be true. You don't have to prove
it. You believe it to be true. It is self-attestation. So the President
has already delayed the individual mandate for another 2 years' time.
This is a reasonable proposal, what is out there today. Yes, doctors
do need relief, but we need to pay for that. I believe the proposal
before the Congress today will do just that.
Mr. Speaker, I reserve the balance of my time.
Mr. POLIS. Mr. Speaker, I yield myself such time as I may consume.
The Republicans are getting worse and worse on these ObamaCare votes.
You would think that you would get better with practice, after 52 times
they would be better at repealing ObamaCare. That is because this body,
the House of Representatives, has voted to repeal ObamaCare, in whole
or in part, 52 times.
Those votes started out where it was very simple. The votes were to
repeal everything that was in the Affordable Care Act. That is how
those votes started. Now they have gotten to the point where the
Republicans want to keep the taxes from ObamaCare and get rid of the
benefits. I don't think anybody wants that.
I mean, if you are talking about repealing the Affordable Care Act,
you still have people that are split on that. You might have a few more
people that

[[Page H2380]]

agree with you or a few more that agree with us, but the American
people have different opinions about that. But if you offered any of
them keep all the taxes and get rid of the benefits, I can't imagine
anybody wants that.
I would hope that, after so much practice, the Republicans would be
quite good at this. It seems to be the core competency they are
developing. Almost every week, in fact, this body repeals ObamaCare,
but now they are repealing it in a way that keeps all the taxes and
gets rid of the benefits; so I am quite surprised that the old adage of
``practice makes perfect'' is far from true with regard to the
Republican approach to this bill.
Mr. Speaker, I yield 3 minutes to the gentleman from Wisconsin (Mr.
Kind).
Mr. KIND. Mr. Speaker, I thank my good friend from Colorado for
yielding me this time.
Mr. Speaker, we have an opportunity in this session of Congress of
getting rid of an onerous policy that has affected the delivery of
health care throughout our country since 1997, the so-called
sustainable growth rate. That is the reimbursement that our doctors,
our physicians receive in Medicare.
We have been working hard at this for a number of years. I commend my
good friend and colleague from Texas for the leadership that he has
shown on this issue.
The policy behind the SGR repeal that is going to be before this
Congress tomorrow has been bipartisan in support. It moves the health
care system in the direction where it needs to go, with an emphasis on
quality and value, as opposed to the volume of services and moving away
from the so-called fee-for-service reimbursement schedule that we have
right now.
I believe that if we continue to drive the health care system in that
direction, we can get much better quality of care for all Americans,
but at a much better price. There are a lot of tools under the
Affordable Care Act that are moving us in that direction now to a more
integrated, coordinated, patient-centered health care delivery system,
but also a reimbursement system that finally is based on the value or
the quality of care that is given and no longer the volume of services
that are rendered.
In fact, just recently, the Institute of Medicine at the National
Academy of Sciences came out with their analysis of the health care
system, and found that we are spending close to $750 billion every year
on things that don't work. They don't improve patient care. It is the
overutilization that is costing us so much and, most of the time,
leading to worse outcomes rather than better outcomes; yet the bill
with the SGR before us would correct a lot of this with different
payment models, with the emphasis on quality and value, with value
incentives built into it.
The problem that we have before us tomorrow is how they are going to
pay for it. It is this itch that they have to scratch over and over
again called the Affordable Care Act, or so-called ObamaCare. They
can't help themselves but to keep going back to that well in order to
find offsets and pay-fors for other measures where there is bipartisan
support and agreement on.
So we will go through this ruse yet again tomorrow. We will have this
debate. The vote will probably be along partisan-lines, knowing that it
is not going to advance anywhere in the Senate, nor would the President
embrace this type of pay-for eliminating the individual responsibility
component of the Affordable Care Act. And then we will be right back to
where we are today, and that is having to sit down, talk to one
another, find some reasonable offsets in order to finally repeal the
SGR.
Repeal of SGR is on sale right now. The Congressional Budget Office
has been very kind in their score on what repeal would look like--
roughly $138 billion. Still a lot of money. In fact, where current per
capita health care spending is going right now, it keeps getting better
month after month. We are at the lowest per capita health care spending
in the last 50 years, certainly lower than anything that we have ever
seen under Medicare and Medicaid.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. POLIS. Mr. Speaker, I yield the gentleman an additional 45
seconds.
Mr. KIND. So there are some powerful trends that are leading to a
reduction in overall health care spending, things that we should study
and explore and try to sustain.
But moving forward with an SGR repeal based on pay-fors that are
being offered is just a dead-end road, it is not going to advance, and
this is too important of a topic, too serious of an issue throughout
our health care system to play these partisan, political games all over
again.
So let's scratch this itch once again, and then, next week, let's
come back together and see if we can, in a bipartisan fashion, find
some commonsense, reasonable offsets that both parties can agree to,
that the Senate can work on, that the President will sign, so we can
finally get rid of this SGR onus that has been hanging over us.
Mr. BURGESS. Mr. Speaker, I yield myself 2 minutes.
Mr. Speaker, again I remind the body that this language, this
compromise, this bipartisan, bicameral compromise has been available
for all to see since February 6. During that time, what response have
we gotten from the United States Senate as the responsible way to pay
for this legislation? Crickets. Zero. Nothing.
We are offering this bill today with the pay-for that has been
embraced by both sides in a bipartisan fashion, as I have demonstrated
to you already. This would not be necessary if the Senate had provided
us feedback on what their approach to a method of paying for this
legislation would be, but they did not.
We know the chairman of the Senate Finance Committee, the Finance
Committee in the other body, the chairwoman has now gone to a different
occupation, so there is a new chairperson in the other body on the
Finance Committee, but that shouldn't have been an obstacle. There was
a way forward to provide the discussion, a preconference conference, if
you will, because we had all agreed on the policy. This was not a
mystery. This was not something that one body had done in secret. This
had all been done out in the open for the past 2 years. So that pathway
was available.
But for whatever reason, the other body said no deal. We don't want
to deal with the House. We want to jam the House at the last minute and
get them to accept something. Or better yet, let's just do another
patch and get us past our Election Day. That is a very cynical
approach.
Mr. Speaker, today before us on the floor we are taking a responsible
approach. And guess what. Because we have taken this approach, the
Senate is now talking once again about their way forward, which,
ultimately, I think is a good thing.
Mr. Speaker, I reserve the balance of my time.
Mr. POLIS. Mr. Speaker, I would like to inquire of the gentleman if
he has any remaining speakers.
Mr. BURGESS. As the gentleman from Colorado knows, I am capable of
filling whatever volume of time remains on my own, but, no, I don't see
other speakers seeking recognition.
I would inquire of the gentleman from Colorado his status of
additional speakers.
Mr. POLIS. I am prepared to close. I have 6 minutes, and I wanted to
yield to the gentleman if he has remaining speakers who wanted to speak
before I close.
Mr. BURGESS. I am prepared to close.
Mr. POLIS. Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, sadly, with these two bills, while the Republican job-
killing water grab bill and the ObamaCare tax bill are both not going
to become law, they both have a genesis in a real issue, one that calls
for bipartisan cooperation, one that affects the water rights of ski
areas that we have offered language in an amendment that would address,
the other, my colleague, Mr. Kind, addressed.
This body has a long tradition of coming together around figuring how
to pay for SGR. Now, the gentleman mentioned February 6 the language
was available. The language regarding the SGR fix is not what is in
dispute. The way of paying for the SGR fix is what is the topic of
debate between Democrats and Republicans. That language was not seen
February 6. That language is not even going to be voted upon under this
rule. It is contained in the rule itself.

[[Page H2381]]

Sadly, while we take up our time on these bills that are not going to
become law, we continue to avoid action on the pressing issue of
reforming our immigration system. In August, a number of us sent a
letter to Speaker Boehner saying that he should introduce comprehensive
immigration reform legislation. If he failed to do so, we would work
with a diverse group of our colleagues to introduce a bill for
comprehensive immigration reform in the House. There were crickets, and
so my colleagues and I, in October, introduced H.R. 15, comprehensive
immigration reform, a bill that has bipartisan cosponsors, over 200
sponsors from both sides of the aisle.
Immigration reform is supported by an unprecedented coalition,
including business and tech companies, faith leaders from across the
country, police, security specialists, but most importantly, the
American people, who are sick and tired of having over 10 million
people in our country illegally.
We need to restore the rule of law. We need to allow American
families to succeed in our country and to live their dreams. We need to
have control of our border. We need to implement mandatory workplace
authentication to ensure that people who are here illegally cannot
work. Every day that passes is a failure of this body to address these
issues, and the solution to all of these issues, workplace
authentication, securing our border, uniting families, those are all in
H.R. 15.
Look, we are ready to talk. If you don't want to bring H.R. 15 to a
vote, Mr. Speaker, what are your immigration bills? What is the package
of bills that will address these? Because we know it will take a
multifaceted approach. A wall alone on the southern border doesn't
solve this issue. The day after that wall is erected, there are still
10 million people here illegally, and the fact that half the people who
are here illegally don't sneak across that border, they come here
legally and then they outstay their welcome and work illegally. So this
requires a solution that I think this Congress is capable of. I think
we can work together.
Rather than consider divisive, job-killing water grab bills, rather
than consider divisive ObamaCare tax bills that the Republicans want to
use ObamaCare taxes, rather than repeal them, let's come together
around immigration reform. House Republicans need to reject offensive
and unproductive rhetoric and show real leadership that the business
community in our country is calling out for.
A few weeks ago, a Wall Street Journal op-ed criticized Republicans'
failure to act on commonsense reform. The Wall Street Journal said:
``Republicans have killed immigration reform for now, but the Farm
Bureau study shows that in the real economy it's still needed.''
We could increase GDP by 3.3 percent. We can raise American wages by
$470 billion with immigration reform. We can create 121,000 jobs for
Americans each year by bringing comprehensive immigration reform to the
floor.
Over 70 percent of the American people support immigration reform. It
is time to act.
Mr. Speaker, if we defeat the previous question, I will offer an
amendment to the rule to bring up the reasonable solution that would
permanently fix the SGR and is offset by capping spending on the
Overseas Contingency Fund.
Mr. Speaker, I ask unanimous consent to insert the text of the
amendment in the Record along with extraneous material immediately
prior to the vote on the previous question.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Colorado?
There was no objection.
Mr. POLIS. Mr. Speaker, unfortunately, but I regret to say
unsurprisingly, the Republicans continue to play politics with
Medicare, politics with water that is the lifeblood of the American
West and the economic lifeblood of the counties that I represent in
Eagle and Summit County. And all we have here to vote on today is, once
again, an attempt to undermine the Affordable Care Act, to keep the
taxes and remove the benefits, and an attempt to grab the water from
those who would use it for fishing and recreation in the Mountain West.

{time} 1330

I hope that we can do better.
If we can reject this $183 billion rule, I think it will send a
message to the Speaker that we are ready for immigration reform.
We are ready to reach out our hand on the SGR, on the doc fix, and
figure out the best way to pay for it, taking the best ideas that
Republicans and Democrats have to offer, working with the gentleman
from Wisconsin (Mr. Kind) and others to bend the cost curve, so that we
can deliver a better quality of services to American seniors and
contain costs more effectively.
I urge my colleagues to vote ``no'' and defeat the previous question
and vote ``no'' on the underlying bills.
I yield back the balance of my time.
Mr. BURGESS. Mr. Speaker, I yield myself the balance of the time.
Mr. Speaker, I do want to direct Members' attention to yesterday's
Wall Street Journal, the article entitled ``ObamaCare's Secret Mandate
Exemption,'' which goes into some detail about the self-attestation for
the so-called hardship exemption, which the administration included as
part of an unrelated rule last week.
As a consequence, there is an exemption from the individual mandate
for the next 2 years for anyone who simply wants to go and say: I am
sorry; this is too tough for me to do.
Mr. Speaker, today's rule provides for the consideration of two
important bills, one dealing with critical water rights and the other
addressing the serious problem in the Medicare Sustainable Growth Rate.
I certainly want to thank the gentleman from Colorado (Mr. Tipton) on
H.R. 3189, as well as thank the chairmen and the ranking members of the
House Committees on Energy and Commerce and Ways and Means, as well as
the Senate Finance Committee, for coming together for our Nation's
doctors and seniors.
As I close, I would like to note that each committee's work is
represented in H.R. 4015. H.R. 4015's base policy has the backing of
the House and Senate negotiators and all three committees of
jurisdiction. The original cosponsors of the bill include the chairmen
and the ranking members of the full committees of jurisdiction, as well
as their health subcommittees.
The bill has gained support from the GOP Doctors Caucus, as well as
many physicians on the other side of the aisle. We have over 100
bipartisan cosponsors. The bill's policy has been embraced by organized
medicine, with well over 700 State and national groups in support of
the bill.
From primary care to specialists to surgeons to organized nursing and
everyone in-between, we have support for this policy. We will not be
able to accomplish this goal without substantive and immediate
bipartisan dialogue seeking agreement on reforms to offset the costs
associated with the policies in H.R. 4015.
While the delay of the mandate has received bipartisan support, I
understand the problems that arise and the opposition that arises.
These reforms must receive the necessary majority support, not only
of the House and Senate, but also be agreed to by the White House.
However, no one Chamber can negotiate on such an important task in a
vacuum.
This action by the House is a means of clearly demonstrating that the
legislative policies contained within H.R. 4015 and S. 2000 not only
have the support of the committees of jurisdiction and organized
medicine, but can gain the necessary support to pass the House.
Mr. Speaker, this is clearly not the end of this conversation. It is
another step--another step of many that have been taken in
demonstrating to both sides of the Capitol that the committees of
jurisdiction have produced significant policy that can serve as the
solution to the sustainable growth rate formula that most of us have
sought throughout our congressional careers.
Mr. Speaker, I do want to take a moment to thank some of the staff
members who have done so much work. I really wanted to start with Dr.
John O'Shea, who no longer is on the staff, but now works at the
Brookings Institute.
Dr. O'Shea, a physician from New York, was hired by committee staff
for the express purpose of helping develop the policy for repealing the
sustainable growth rate. In addition, James Decker

[[Page H2382]]

on my staff assists me with rules issues.
J.P. Paluskiewicz, known affectionately by his friends as J.P., has
put in extraordinary hours on this project, as have Sarah Johnson and
Adrianna Simonelli on my personal staff.
On the committee staff, Clay Alspach and Robert Horne have
additionally put in hours well above and beyond what ordinarily would
be required of committee staff in order to see this project come to
fruition.
I certainly want to thank Chairman Upton for making this a priority
during his chairmanship of the Committee on Energy and Commerce; and I
thank all of the staff--staff on Ways and Means and staff on Senate
Finance--who have worked on this issue and will continue to work on
this issue until it is solved.
Every success we have had at every point in this process was further
than we have ever come before, and that involved a lot of working
weekends; but ultimately, if we use this action to springboard to full
bicameral engagement on the package that can go to the White House and
get signed by the President, indeed, I think all involved would agree
that it would be worth it.
I look forward to passage. I look forward to continuing the process
with this Chamber and the other Chamber to embrace the underlying
policy and ultimately identify the offsets that can get this badly
needed policy into law. I urge my colleagues to support the rule and
both underlying bills.

[From the Hill, March 13, 2014]

ObamaCare's Secret Mandate Exemption

ObamaCare's implementers continue to roam the battlefield
and shoot their own wounded, and the latest casualty is the
core of the Affordable Care Act--the individual mandate. To
wit, last week the Administration quietly excused millions of
people from the requirement to purchase health insurance or
else pay a tax penalty.
This latest political reconstruction has received zero
media notice, and the Health and Human Services Department
didn't think the details were worth discussing in a
conference call, press materials or fact sheet. Instead, the
mandate suspension was buried in an unrelated rule that was
meant to preserve some health plans that don't comply with
ObamaCare benefit and redistribution mandates. Our sources
only noticed the change this week.
That seven-page technical bulletin includes a paragraph and
footnote that casually mention that a rule in a separate
December 2013 bulletin would be extended for two more years,
until 2016. Lo and behold, it turns out this second rule,
which was supposed to last for only a year, allows Americans
whose coverage was cancelled to opt out of the mandate
altogether.
In 2013, HHS decided that ObamaCare's wave of policy
terminations qualified as a ``hardship'' that entitled people
to a special type of coverage designed for people under age
30 or a mandate exemption. HHS originally defined and
reserved hardship exemptions for the truly down and out such
as battered women, the evicted and bankrupts.
But amid the post-rollout political backlash, last week the
agency created a new category: Now all you need to do is fill
out a form attesting that your plan was cancelled and that
you ``believe that the plan options available in the
[ObamaCare] Marketplace in your area are more expensive than
your cancelled health insurance policy'' or ``you consider
other available policies unaffordable.''
This lax standard--no formula or hard test beyond a
person's belief--at least ostensibly requires proof such as
an insurer termination notice. But people can also qualify
for hardships for the unspecified nonreason that ``you
experienced another hardship in obtaining health insurance,''
which only requires ``documentation if possible.'' And yet
another waiver is available to those who say they are merely
unable to afford coverage, regardless of their prior
insurance. In a word, these shifting legal benchmarks offer
an exemption to everyone who conceivably wants one.
Keep in mind that the White House argued at the Supreme
Court that the individual mandate to buy insurance was
indispensable to the law's success, and President Obama
continues to say he'd veto the bipartisan bills that would
delay or repeal it. So why are ObamaCare liberals silently
gutting their own creation now?
The answers are the implementation fiasco and politics. HHS
revealed Tuesday that only 940,000 people signed up for an
ObamaCare plan in February, bringing the total to about 4.2
million, well below the original 5.7 million projection. The
predicted ``surge'' of young beneficiaries isn't
materializing even as the end-of-March deadline approaches,
and enrollment decelerated in February.
Meanwhile, a McKinsey & Company survey reports that a mere
27% of people joining the exchanges were previously uninsured
through February. The survey also found that about half of
people who shopped for a plan but did not enroll said
premiums were too expensive, even though 80% of this group
qualify for subsidies. Some substantial share of the people
ObamaCare is supposed to help say it is a bad financial
value. You might even call it a hardship.
HHS is also trying to pre-empt the inevitable political
blowback from the nasty 2015 tax surprise of fining the
uninsured for being uninsured, which could help reopen
ObamaCare if voters elect a Republican Senate this November.
Keeping its mandate waiver secret for now is an attempt get
past November and in the meantime sign up as many people as
possible for government-subsidized health care. Our sources
in the insurance industry are worried the regulatory loophole
sets a mandate non-enforcement precedent, and they're
probably right. The longer it is not enforced, the less
likely any President will enforce it.
The larger point is that there have been so many unilateral
executive waivers and delays that ObamaCare must be
unrecognizable to its drafters, to the extent they ever knew
what the law contained.
____

Texas Medical Association,

Austin, TX, March 13, 2014.
Hon. Michael C. Burgess, MD,
U.S. House of Representatives,
Washington, DC.
Dear Representative Burgess: On behalf of the 47,000-plus
physician and medical student members of the Texas Medical
Association, I am writing to reiterate our strong support for
the work you have done to effectuate the repeal of Medicare's
Sustainable Growth Rate (SGR) formula. In conjunction with
your Texas colleague, Kevin Brady, you have gotten closer to
solving this challenging issue than ever before. And you have
done so with the support of every member of the Texas
delegation, both Democratic and Republican, on the Energy &
Commerce and Ways & Means Committees.
Perhaps more than anyone in Congress, you understand the
frustration and anxiety that the ongoing SGR uncertainty
creates for practicing physicians. You have worked tirelessly
to craft a piece of legislation that not only repeals the SGR
immediately, but also guarantees positive updates for
physicians for five years, removes potential causes of
liability against physicians, and eliminates some unnecessary
bureaucratic red tape that prevents physicians from
concentrating on patient care.
We especially appreciate your ongoing consultation and
dialogue with TMA and Texas physicians throughout this
process.
As you know well, the SGR Repeal and Medicare Provider
Payment Modernization Act of 2014 has made it this far
because of a bipartisan, bicameral agreement on the need to
replace the SGR. We are committed to helping you finish the
task.
Sincerely,
Stephen L. Brotherton, MD,
President.

The material previously referred to by Mr. Polis is as follows:

An amendment to H. Res. 515 offered by Mr. Polis of Colorado

Strike section 2 and replace with:
Sec. 2. 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.
4209) to amend title XVIII of the Social Security Act to
repeal the Medicare sustainable growth rate and improve
Medicare payments for physicians and other professionals, and
for other purposes. The first reading of the bill shall be
dispensed with. All points of order against consideration of
the bill are waived. General debate shall be confined to the
bill and shall not exceed one hour equally divided among and
controlled by the chair and ranking minority member of the
Committee on Energy and Commerce, the chair and ranking
minority member of the Committee on Ways and Means, and the
chair and ranking minority member of the Committee on the
Judiciary. After general debate the bill shall be considered
for amendment under the five-minute rule. The bill shall be
considered as read. All points of order against provisions in
the bill 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.
At the end of the resolution, add the following new
section:
Sec. 5. Clause 1(c) of rule XIX shall not apply to the
consideration of H.R. 4209
____

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 Democratic minority 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

[[Page H2383]]

the rule as ``a motion to direct or control the consideration
of the subject before the House being made by the Member in
charge.'' To defeat the previous question is to give the
opposition a chance to decide the subject before the House.
Cannon cites the Speaker's ruling of January 13, 1920, to the
effect that ``the refusal of the House to sustain the demand
for the previous question passes the control of the
resolution to the opposition'' in order to offer an
amendment. On March 15, 1909, a member of the majority party
offered a rule resolution. The House defeated the previous
question and a member of the opposition rose to a
parliamentary inquiry, asking who was entitled to
recognition. Speaker Joseph G. Cannon (R-Illinois) said:
``The previous question having been refused, the gentleman
from New York, Mr. Fitzgerald, who had asked the gentleman to
yield to him for an amendment, is entitled to the first
recognition.''
The Republican majority may 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. BURGESS. With that, I yield back the balance of my time, and I
move the previous question on the resolution.
The SPEAKER pro tempore. The question is on ordering the previous
question.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. POLIS. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 9 of rule XX, the Chair
will reduce to 5 minutes the minimum time for any electronic vote on
the question of adoption of the resolution.
The vote was taken by electronic device, and there were--yeas 227,
nays 193, not voting 10, as follows:

[Roll No. 125]

YEAS--227

Aderholt
Amash
Bachus
Barletta
Barr
Barton
Benishek
Bentivolio
Bilirakis
Bishop (UT)
Black
Blackburn
Boustany
Brady (TX)
Bridenstine
Brooks (AL)
Brooks (IN)
Broun (GA)
Buchanan
Bucshon
Burgess
Byrne
Calvert
Camp
Campbell
Cantor
Capito
Carter
Cassidy
Chabot
Chaffetz
Coble
Coffman
Cole
Collins (GA)
Collins (NY)
Conaway
Cook
Cotton
Cramer
Crawford
Crenshaw
Culberson
Daines
Davis, Rodney
Denham
Dent
DeSantis
DesJarlais
Diaz-Balart
Duffy
Duncan (SC)
Duncan (TN)
Ellmers
Farenthold
Fincher
Fitzpatrick
Fleischmann
Fleming
Flores
Forbes
Fortenberry
Foxx
Franks (AZ)
Frelinghuysen
Gardner
Garrett
Gerlach
Gibbs
Gibson
Gingrey (GA)
Gohmert
Goodlatte
Gowdy
Granger
Graves (GA)
Graves (MO)
Griffin (AR)
Griffith (VA)
Grimm
Guthrie
Hall
Hanna
Harper
Harris
Hartzler
Hastings (WA)
Heck (NV)
Hensarling
Herrera Beutler
Holding
Hudson
Huelskamp
Huizenga (MI)
Hultgren
Hunter
Hurt
Issa
Jenkins
Johnson (OH)
Johnson, Sam
Jones
Jordan
Joyce
Kelly (PA)
King (IA)
King (NY)
Kingston
Kinzinger (IL)
Kline
Labrador
LaMalfa
Lamborn
Lance
Lankford
Latham
Latta
LoBiondo
Long
Lucas
Luetkemeyer
Lummis
Marchant
Marino
Massie
McAllister
McCarthy (CA)
McCaul
McClintock
McHenry
McKeon
McKinley
McMorris Rodgers
Meadows
Meehan
Messer
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Mullin
Mulvaney
Murphy (PA)
Neugebauer
Noem
Nugent
Nunes
Nunnelee
Olson
Palazzo
Paulsen
Pearce
Perry
Petri
Pittenger
Pitts
Poe (TX)
Pompeo
Posey
Price (GA)
Reed
Reichert
Renacci
Ribble
Rice (SC)
Rigell
Roby
Roe (TN)
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Rokita
Rooney
Ros-Lehtinen
Roskam
Ross
Rothfus
Royce
Runyan
Ryan (WI)
Salmon
Sanford
Scalise
Schock
Schweikert
Scott, Austin
Sensenbrenner
Sessions
Shimkus
Shuster
Simpson
Smith (MO)
Smith (NE)
Smith (NJ)
Smith (TX)
Southerland
Stewart
Stivers
Stockman
Stutzman
Terry
Thompson (PA)
Thornberry
Tiberi
Tipton
Turner
Upton
Valadao
Walberg
Walden
Walorski
Weber (TX)
Webster (FL)
Wenstrup
Westmoreland
Whitfield
Williams
Wilson (SC)
Wittman
Wolf
Womack
Woodall
Yoder
Yoho
Young (AK)
Young (IN)

NAYS--193

Barber
Barrow (GA)
Beatty
Becerra
Bera (CA)
Bishop (GA)
Bishop (NY)
Blumenauer
Bonamici
Brady (PA)
Braley (IA)
Brown (FL)
Brownley (CA)
Bustos
Butterfield
Capps
Capuano
Cardenas
Carney
Carson (IN)
Cartwright
Castor (FL)
Castro (TX)
Chu
Cicilline
Clark (MA)
Clarke (NY)
Clay
Cleaver
Clyburn
Cohen
Connolly
Conyers
Cooper
Costa
Crowley
Cuellar
Cummings
Davis (CA)
Davis, Danny
DeFazio
DeGette
Delaney
DeLauro
DelBene
Deutch
Doggett
Doyle
Duckworth
Edwards
Ellison
Engel
Enyart
Eshoo
Esty
Farr
Fattah
Foster
Frankel (FL)
Fudge
Gabbard
Gallego
Garamendi
Garcia
Grayson
Green, Al
Green, Gene
Grijalva
Gutierrez
Hahn
Hanabusa
Hastings (FL)
Heck (WA)
Higgins
Himes
Hinojosa
Holt
Honda
Horsford
Hoyer
Huffman
Israel
Jackson Lee
Jeffries
Johnson (GA)
Johnson, E. B.
Kaptur
Keating
Kelly (IL)
Kennedy
Kildee
Kilmer
Kind
Kirkpatrick
Kuster
Langevin
Larsen (WA)
Larson (CT)
Lee (CA)
Levin
Lewis
Lipinski
Loebsack
Lofgren
Lowenthal
Lowey
Lujan Grisham (NM)
Lujan, Ben Ray (NM)
Lynch
Maffei
Maloney, Carolyn
Maloney, Sean
Matheson
Matsui
McCarthy (NY)
McCollum
McDermott
McGovern
McIntyre
McNerney
Meeks
Meng
Michaud
Miller, George
Moore
Moran
Murphy (FL)
Nadler
Napolitano
Neal
Negrete McLeod
Nolan
O'Rourke
Owens
Pallone
Pascrell
Pastor (AZ)
Pelosi
Perlmutter
Peters (CA)
Peters (MI)
Peterson
Pingree (ME)
Pocan
Polis
Price (NC)
Quigley
Rahall
Richmond
Roybal-Allard
Ruiz
Ruppersberger
Ryan (OH)
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Schakowsky
Schiff
Schneider
Schrader
Schwartz
Scott (VA)
Scott, David
Serrano
Sewell (AL)
Shea-Porter
Sherman
Sinema
Sires
Slaughter
Smith (WA)
Speier
Swalwell (CA)
Takano
Thompson (CA)
Thompson (MS)
Tierney
Titus
Tonko
Tsongas
Van Hollen
Vargas
Veasey
Vela
Velazquez
Visclosky
Walz
Wasserman Schultz
Waters
Waxman
Welch
Wilson (FL)
Yarmuth

NOT VOTING--10

Amodei
Bachmann
Bass
Courtney
Dingell
Gosar
Payne
Rangel
Rush
Wagner

{time} 1404

Mr. GALLEGO changed his vote from ``yea'' to ``nay.''
Messrs. BRADY of Texas, MEEHAN, and CALVERT changed their vote from
``nay'' to ``yea.''
So the previous question was ordered.
The result of the vote was announced as above recorded.

____________________