[Congressional Record Volume 161, Number 97 (Wednesday, June 17, 2015)]
[House]
[Pages H4449-H4455]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




PROVIDING FOR CONSIDERATION OF H.R. 160, PROTECT MEDICAL INNOVATION ACT 
   OF 2015, AND PROVIDING FOR CONSIDERATION OF H.R. 1190, PROTECTING 
                SENIORS' ACCESS TO MEDICARE ACT OF 2015

  Mr. BURGESS. Mr. Speaker, by direction of the Committee on Rules, I 
call up House Resolution 319 and ask for its immediate consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 319

       Resolved, That upon adoption of this resolution it shall be 
     in order to consider in the House the bill (H.R. 160) to 
     amend the Internal Revenue Code of 1986 to repeal the excise 
     tax on medical devices. All points of order against 
     consideration of the bill are waived. The amendment in the 
     nature of a substitute recommended by the Committee on Ways 
     and Means now printed in the bill, modified by the amendment 
     printed in part A 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 further amendment 
     thereto, to final passage without intervening motion except: 
     (1) one hour of debate equally divided and controlled by the 
     chair and ranking minority member of the Committee on Ways 
     and Means; and (2) one motion to recommit with or without 
     instructions.
       Sec. 2.  Upon adoption of this resolution it shall be in 
     order to consider in the House the bill (H.R. 1190) to repeal 
     the provisions of the Patient Protection and Affordable Care 
     Act providing for the Independent Payment Advisory Board. 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 
     further 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 Ways and Means and the 
     chair and ranking minority member of the Committee on Energy 
     and Commerce; and (2) one motion to recommit with or without 
     instructions.

  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 319 provides for a rule to 
consider two separate bills, which will address two of the most flawed 
and ill-conceived provisions contained within the so-called Affordable 
Care Act.
  The rule provides for 1 hour of debate on H.R. 160 dealing with the 
repeal of the medical device tax, equally divided between the majority 
and minority on the Committee on Ways and Means, as well as the 
standard motion to recommit provided for the minority.
  The rule further provides for 1 hour of debate on H.R. 1190, which 
would repeal the Independent Payment Advisory Board. This is equally 
divided between the majority and minority of both the Committee on Ways 
and Means and the Committee on Energy and Commerce. Further, the rule 
provides that the Pitts amendment, which will cover the cost of 
repealing the Independent Payment Advisory Board by using the 
Affordable Care Act's prevention fund, a slush fund for the Secretary, 
which has been used to pay for everything from urban gardening to 
lobbying for higher cigarette taxes, be added to the bill. As with H.R. 
160, the standard motion to recommit is also provided to the minority 
on H.R. 1190.

[[Page H4450]]

  It is well documented that many provisions contained within the 
Affordable Care Act will have negative consequences on patients, both 
in access to care and in affordability. Yet two provisions have been so 
universally criticized that, on a large bipartisan nature, their repeal 
was called for almost immediately after the passage of the Affordable 
Care Act in 2010. One such provision was the tax contained within the 
bill on medical device manufacturers.
  It seems illogical that within a piece of legislation that was 
purported to make medical care more accessible to all Americans, the 
Federal Government would want to tax the very providers of medical 
innovation that creates the devices to improve the delivery of health 
care. Nevertheless, the President and then-Majority Leader Harry Reid 
in the Senate included this provision in order to pay for part of the 
astronomical price tag that accompanied this massive bill.
  This tax is an unfair burden that actually increases the cost that 
consumers will pay at the doctor's office. The tax has also been cited 
by dozens of medical device manufacturers who have or are considering 
moving their operations overseas so that they can continue to innovate 
without the heavy burden of the Internal Revenue Service stifling their 
growth. This tax slows the creation of new techniques, slows the 
creation of new devices, all of which could make the delivery of 
medicine more efficient. It also puts at risk the jobs associated with 
the creation of those devices.
  And lest anyone think that we are merely talking about the largest 
and most expensive pieces of technology found within a hospital, such 
as the MRI or the CAT scanner and surgical equipment, let's be clear 
that this tax covers every piece of medical equipment from those large 
machines to the smallest of items, including the syringes that are used 
to deliver lifesaving antibiotics and vaccines. In my own district, I 
have met with a number of constituents, including the owner of 
Retractable Technologies, which makes those very syringes, and have 
been shown firsthand how this tax is creating a burden on the growth of 
his company.
  The medical device tax has led to the elimination of thousands of 
good-paying jobs, and repealing it would be the first step in bringing 
those jobs back to stem the loss of future jobs within an industry that 
is vital to the country in helping to mitigate the rising cost of 
health care due to other burdensome provisions within the Affordable 
Care Act.
  Mr. Speaker, plain and simple, this is a tax on business, a tax on 
small business, a tax on consumers, a tax on innovation. To date, 
33,000 jobs have been lost in the medical device industry since the 
passage of the Affordable Care Act, and it is projected that well over 
100,000 additional jobs are on the chopping block.
  Actually, who could be surprised about this? Excise taxes, which this 
tax is, are meant to lead to a reduction in the consumption of the good 
being taxed. We place an excise tax on cigarettes to discourage their 
use, making it burdensome to afford a smoking habit. Did the President 
and Harry Reid intend to make it more burdensome to use more efficient 
medical devices?
  Of course, not only is this burdensome tax ill-conceived as a 
concept, it was ill-conceived in a practical sense as well. Last year, 
a Treasury inspector general audit found that the Internal Revenue 
Service issued 217 erroneous penalties to device companies in a 6-month 
period. We have all seen how poorly much of the Affordable Care Act was 
written. One need only to look at the most recent Supreme Court cases 
for that determination. But how difficult is it to write a clear-cut 
tax provision? Apparently, for Harry Reid, it is quite difficult.
  H.R. 160 has bipartisan and bicameral support and currently has 282 
cosponsors. In fact, 18 Democrats in this body sent a letter to Speaker 
John Boehner and Minority Leader Nancy Pelosi calling for the timely 
passage of this bill. Republican leadership in the House heard their 
requests and the calls from many other Members of this body and is 
moving this bill in a responsible way to put Americans back to work and 
lower the cost of health care for all.
  The second bill contained in today's rule, H.R. 1190, repeals one of 
the most poorly thought-out ideas ever to come out of Congress, and 
that is really quite impressive considering the many disquieting ideas 
that have originated in the Pelosi-led House of Representatives. The 
Independent Payment Advisory Board is an unelected, unaccountable board 
dedicated to set up within the Affordable Care Act for the sole purpose 
to cut Medicare payments to providers if Medicare targets within the 
bill are not met.

  Let's be very clear about this. President Obama, Majority Leader 
Harry Reid, Speaker Nancy Pelosi created a board of unelected officials 
in order to ration Medicare, to cut Medicare, and every Democrat who 
supported the Affordable Care Act voted in favor of this Board.
  The Independent Payment Advisory Board is a regulatory board composed 
of 15 health professionals appointed by the President. There is no 
requirement that any of these professionals have ever actually 
practiced medicine a day in their lives, and we are well aware that 
this President prefers academics to those who have real-world 
experience.
  The Board's stated responsibility is to develop proposals to reduce 
the growth of Medicare spending. What does that mean? It means seniors 
will face cuts to their health care with no recourse if they don't 
agree with what the Board proposes.
  Former Office of Management and Budget Director Peter Orszag, the 
President's top budget adviser, called the Independent Payment Advisory 
Board the single biggest yielding of power to an independent entity 
since the creation of the Federal Reserve. Think about that. Let that 
sink in. The Independent Payment Advisory Board has been given the 
authority to do for Medicare policy what the Fed is able to do with 
monetary policy. That should be terrifying to every American.
  The Independent Payment Advisory Board is set to recommend cuts, 
amounting to one-half of 1 percent of Medicare spending, and then the 
number rises until it hits 1\1/2\ percent. It makes these cuts by 
reducing the rates that Medicare pays for medical procedures and drugs, 
which means the Independent Payment Advisory Board can only make cuts 
to providers' reimbursements. Instead of being allowed to make real 
lasting structural reforms that could actually help the solvency of 
Medicare, this Board's approach to saving money is one of the 
clumsiest, most bureaucratic ways of achieving this goal.
  The Independent Payment Advisory Board has massive structural and 
constitutional defects in its design. If Congress fails to act on the 
Board's recommendations, they automatically go into effect. And even if 
the Congress did pass a bill countering the Board's cuts to Medicare, 
the President can simply veto the bill. And the judiciary--and how this 
passes constitutional muster, I seriously question--specifically the 
judiciary, is forbidden to review the Independent Payment Advisory 
Board's recommendations.
  For these and many other reasons, over 500 organizations have urged 
Congress to get rid of this thing--repeal the Independent Payment 
Advisory Board--including the American Medical Association, the 
American College of Surgeons, and the Veterans Health Council.
  Repealing the Independent Payment Advisory Board would protect 
seniors' access to Medicare, encourage us to do real Medicare reforms, 
and put an end to the constitutionally questionable Board of unelected 
bureaucrats--right now under the President's healthcare law--the very 
decisions that they are empowered to make changes to Medicare.
  All Americans will benefit from the repeal of this draconian idea. It 
is a clumsy way that then-majority Democrats were able to buck their 
responsibility at addressing cost concerns over entitlements. 
Government by bureaucrats instead of government by the people, 
government by bureaucrats instead of government by representatives, it 
is no way to run this country. And yet that is how then-Majority Leader 
Harry Reid and then-Speaker Nancy Pelosi preferred that we operate.

[[Page H4451]]

                              {time}  1245

  The Independent Payment Advisory Board's design undermines seniors' 
access to Medicare and the health care that they need and have paid for 
throughout their working lives.
  This Board should have been repealed years ago, but so long as Harry 
Reid was majority leader in the Senate, the Independent Payment 
Advisory Board continued to live. Last year's election created a sea 
change over in the other body, changed the majority leader in the 
Senate, and now, the American people may finally see their government 
begin to work for them yet once again.
  Mr. Speaker, I reserve the balance of my time.
  Mr. POLIS. Mr. Speaker, I thank the gentleman from Texas for yielding 
me the customary 30 minutes, and I yield myself such time as I may 
consume.
  Mr. Speaker, today, I rise in opposition to the rule which, once 
again, deprives Members of this body the opportunity to debate 
amendments that will improve the underlying legislation.
  I rise in opposition to this body's misguided priorities. Again, the 
American people are seeing Congress rehash the same tired debates. How 
many references were there to people that were Speakers of this House, 
that were Senate majority leaders, to healthcare reform, which has 
already withstood several elections and is the law of the land?
  What we have before us today are two more bills that repeal part of 
the Affordable Care Act. We have now considered over 60 bills to 
repeal, defund, or dismantle the Affordable Care Act, rather than 
improve and build upon it.
  With all the work that remains to be done, we could be debating 
legislation to renew our expiring highway trust fund and repair our 
crumbling roads and bridges.
  We could take up legislation to renew the charter of the Import-
Export Bank, and we will be offering that soon on the previous 
question.
  We could consider a bill to repair our broken immigration system or 
help the millions of Americans who are living below the poverty line, 
even though they work two jobs and it is increasingly hard to support 
their families; or we could take on the critical matter of climate 
change and confront the fact that it has contributed to one of the 
worst droughts in our Nation's history.
  But, oh, no, it is more important to have the 61st and 62nd repeal of 
parts of the Affordable Care Act, rather than move forward with a 
future-oriented agenda for the American people.
  Now, let's get into some of the specifics of the underlying 
legislation. The most recent estimate by the Congressional Budget 
Office found that a total of 27 million people will gain access to 
healthcare coverage through the Affordable Care Act over the next 10 
years, who otherwise would not have had coverage.
  That is to say nothing of the additional millions of Americans who 
benefit from the Affordable Care Act by having coverage for preexisting 
conditions for the first time in their lives, are no longer subject to 
lifetime caps that could leave them bankrupt if they get a serious 
illness, or people that are able to stay as young adults up to age 26 
on their parents' plan.
  Constituents from all areas of my district have shared stories of 
their success using our State's health exchange, Connect for Health 
Colorado, and described how the Affordable Care Act's coverage provided 
by the ACA has improved their lives.
  I have heard from constituents like Morgan, from Nederland, Colorado, 
who used the exchange to enroll in the exact same plan she had before 
the Affordable Care Act, but her premiums decreased, and the services 
that were covered expanded--more value for her money.
  Or Donna, who recently moved to Boulder, Colorado--Donna is an 
outdoor enthusiast, like so many in my district, but was afraid to make 
her way to the mountains until she had secured healthcare coverage.
  Through Connect for Health Colorado and the premium tax credits she 
has access to under the Affordable Care Act, she is now enrolled in a 
comprehensive medical and dental plan that ensures she won't become 
bankrupt if she sustains an injury.
  These are far from isolated cases. In my home State of Colorado, 16.5 
percent of people lacked health insurance before ACA. According to a 
recent study of the Kaiser Family Foundation, that figure has dropped 
to 9 percent by last year.
  The success is not limited to my State. According to a Gallup poll 
released in April, the percentage of Americans lacking health care 
nationwide has dropped by more than a third since the marketplace 
opened at the end of 2013, from 18 percent to under 12 percent.
  The Affordable Care Act is working; instead of continuing in that 
vein, once again, the Republican Congress is seeking to repeal various 
parts of that law, rather than move forward and improve it.
  The first of today's two bills, the so-called Protecting Seniors' 
Access to Medicare Act, doesn't protect anyone's access to anything. 
The Advisory Board it seeks to repeal, which has been vilified and 
completely mischaracterized in the past, is actually something far more 
mundane and important to the processes of Medicare.
  It is a board of advisers who make nonbinding recommendations to 
Congress about how we can reduce healthcare costs and strengthen 
Medicare solvency over the long term, without sacrificing the quality 
of care, something that all of us, as cost-conscious Members of 
Congress, should be interested in seeing.
  Now, we can debate all day the exact composition of the Board or 
which committees in Congress should have jurisdiction over its 
recommendations. Those are valid considerations--or, instead, we can 
discuss repealing the Board in its entirety, which is what we are 
talking about here today. This Advisory Board will provide critical 
advice to help Congress reduce the cost of providing health care.
  Now, interestingly enough, this amendment pays for the $7 billion 
cost of eliminating this Board by slashing nearly $9 billion in funding 
from the prevention and public health fund. This fund is used for vital 
preventative health programs, like childhood vaccines, helping people 
quit smoking, stroke prevention, and maternal wellness. The cornerstone 
of health savings is preventative medicine.
  In fact, I cosponsor a bill with my friend, Mr. Burgess, who is 
managing the bill on the other side, that would allow the Congressional 
Budget Office to account for the long-term savings of preventative 
health initiatives when it scores legislation.
  If Mr. Burgess' own bill were to become law, and I hope it does, it 
would show that the so-called way that we are paying for this repeal is 
illusory. Eliminating the preventative healthcare program actually can 
cost money in the long run. Under the congressional scoring model that 
we both support, it would likely not even register as a cost saving, or 
if it did, it would be much less than the $9 billion.
  The second bill being considered, the Protect Medical Innovation Act, 
aims to do something that many of us on both sides support, repealing 
the Affordable Care Act's excise tax on medical devices. The medical 
device tax is one of the measures originally included by the Senate in 
the Affordable Care Act to fund the badly needed consumer protections 
and benefits that form the core of the bill.

  Now, again, it is easy to support tax cuts. This body has put before 
us many, tax cut after tax cut after tax cut that are unfunded. The 
whole discussion about how you can afford to cut taxes is how you pay 
for it. What government waste do you cut? What other taxes or income do 
you use to offset the cost of these tax cuts?
  Of course, we don't want to slow the pace of progress with 
unnecessary costs and burdens, and we want to make sure that medical 
device manufacturers have every incentive to increase their research 
and development and not pass these costs along to consumers.
  Unfortunately, even though I, along with Alma Adams from North 
Carolina and Matt Cartwright from Pennsylvania, offered an amendment in 
the Rules Committee that would have paid for repealing the medical 
device tax using a commonsense approach that wouldn't suppress economic 
growth, our amendment was not allowed to even be discussed here on the 
floor of the House.
  Not only would our amendment to pay for the medical device repeal 
have avoided adding nearly $30 billion to our

[[Page H4452]]

deficit, as this bill would do before us today, but it also would have 
helped bring balance to our Nation's energy sector by stopping the 
government from choosing winners and losers in energy and lessen our 
dependence on fossil fuels.
  Unfortunately, under this rule, we don't get a vote or debate on the 
floor. We are left with two bad choices. We can, of course, leave in 
place a tax that many of us want to remove; or we can add $25 billion 
to our deficit. Neither of those are the right answers for the American 
people or for medical device companies or the consumers who use medical 
device products.
  The American people deserve better. If we defeat this rule, an open 
process will allow Republicans and Democrats to offer real, 
constructive, better ideas of how to improve upon these two pieces of 
legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Indiana (Mr. Bucshon), a member of our Committee on Energy and 
Commerce.
  Mr. BUCSHON. Mr. Speaker, in Indiana, the medical device industry 
employs over 20,000 Hoosiers in over 300 medical device companies. 
These are good-paying jobs that pay 56 percent more than the average 
wage.
  As Indiana Governor Mike Pence recently put it in a letter to our 
delegation: ``This industry is vital to Indiana's economy and the 
health and well-being of people across the Nation and the world.''
  Unfortunately, this critical industry is living under the shadow of a 
job-killing tax put in place to pay for the Affordable Care Act. In 
fact, companies in Indiana have already halted research projects and 
plans for expansion.
  The medical device tax is crippling innovation of lifesaving products 
like the ones I used as a surgeon, and it is putting patients and jobs 
at risk. This is about patients, at the end of the day, and their 
access to health care.
  We have had broad bipartisan support for repeal of the medical device 
tax in both Chambers before. It is time to put an end to this onerous 
tax once and for all.
  I also support an IPAB repeal. As a physician, I urge my colleagues 
to support the rule and the underlying bills.
  Mr. POLIS. Mr. Speaker, if we defeat the previous question, I will 
offer an amendment to the rule to allow for the consideration of 
legislation that would reauthorize the Export-Import Bank for 7 years.
  To discuss our proposal, I yield 3 minutes to the gentlewoman from 
California (Ms. Maxine Waters), the distinguished ranking member on the 
Committee on Financial Services.
  Ms. MAXINE WATERS of California. Mr. Speaker, I thank the gentleman 
from Colorado, as well as Leader Pelosi and Whip Hoyer, for their 
unyielding support for thousands of American jobs and businesses.
  I rise to urge my colleagues to defeat the previous question in order 
to force a vote on legislation sponsored by myself, Mr. Heck, Ms. 
Moore, Mr. Hoyer, and 186 other Democrats that will renew and reform 
the Export-Import Bank's charter for the long term.
  Mr. Speaker, Congress has just 5 days to act before the Export-Import 
Bank shuts down. We are in the eleventh hour, and despite a recent 
bipartisan vote in the Senate and broad support across the aisle in 
this House, we are still fighting to keep this engine of job creation 
and economic growth alive.
  It is interesting to note that, contrary to most of the disagreements 
that take place in this Chamber, in the debate over the Export-Import 
Bank, the facts remain undisputed.
  Over the past 5 years, it is estimated that the Bank has created or 
sustained more than 1.3 million private sector jobs, 164,000 in the 
past year alone. In 2014, the Bank returned more than $674 million back 
to the American taxpayers, an amount totaling $6.9 billion over the 
past two decades.
  Democrats, Republicans, business, and labor all understand the 
important role that the Export-Import Bank plays in our economy. 
Presidents, ranging from Ronald Reagan and George W. Bush to Bill 
Clinton, have been outspoken in their support for the Bank's ability to 
create and sustain American jobs and keep our businesses competitive.
  Ex-Im levels the playing field with countries like China, Russia, and 
countless others, all of which have their own version of the Bank 
supporting American competitors.
  Mr. Speaker, Democrats are coming to the floor today to implore our 
numerous Republican colleagues who support the Export-Import Bank, 
starting with Speaker Boehner, to stand up for jobs, businesses, and 
American competitiveness by standing up to the extremists who want to 
close the Bank.
  Let's send a strong message to America's manufacturers, businesses, 
and workers, that we are committed to preserving an institution that, 
for decades, has helped this Nation create jobs and grow the economy.
  I would urge a ``no'' vote on the previous question.
  Mr. BURGESS. Mr. Speaker, at this time, I yield 1 minute to the 
gentleman from Florida (Mr. Bilirakis), a valued member of the Energy 
and Commerce Committee.
  Mr. BILIRAKIS. I thank the chairman.
  Mr. Speaker, I rise today in support of the rule for H.R. 160, the 
Protect Medical Innovation Act. Last August, I held two 21st Century 
Cures roundtables in my district in the Tampa Bay area.
  The second roundtable featured healthcare providers. One participant 
was Lisa Novorska, CFO of Rochester Electro-Medical. Rochester Electro-
Medical is a medical device manufacturer in my district, and it is a 
small business.
  The medical device tax, originally included in the President's 
healthcare law, is devastating to these small businesses. Eighty 
percent of the device manufacturers in Florida have less than 25 
employees. In total, Florida has 662 device manufacturers, and one-
third of them are in the Tampa Bay area, as I said, in the area that I 
represent in the Congress.
  This bill has over 280 bipartisan cosponsors. Voting for this rule 
and bill should be easy, despite the administration's veto threat. 
Let's support device manufacturers and give them the flexibility to 
innovate and help our constituents.

                              {time}  1300

  Mr. POLIS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Washington (Mr. Heck), a leader in the effort to reauthorize the 
Export-Import Bank.
  Mr. HECK of Washington. Mr. Speaker, I rise to oppose the previous 
question so that we might, indeed, get to H.R. 1031, the Promoting U.S. 
Jobs through Exports Act of 2015.
  H.R. 1031--which, as it has been indicated, reauthorizes the Export-
Import Bank--is a deficit-cutting, job-creating machine. And why is it 
important that we get to it? Because, indeed, the charter of the Bank 
expires in 5 legislative days.
  Last week, I was at home and had occasion to be channel surfing, and 
I came across, inarguably, one of the top 10 movies in all of the 
history of American cinema, ``Blazing Saddles.'' And there is this 
wonderful scene where the actor, Cleavon Little, rides into town, and 
he is not met very favorably by the townsfolks. They all pull their 
guns on him. And in response, he pulls his revolver, and he puts it to 
his head, and he says, Stop, stop, or I will shoot myself.
  Well, of course, what he was doing, given the situation, was 
completely turning logic on its ear and confusing everybody in his 
presence. And that is how I feel about this.
  Those who want to end the Export-Import Bank purport to be in favor 
of cutting the deficit. But the Export-Import Bank has reduced the 
Federal deficit by $6 billion over the last 20 years. Those who want to 
terminate the Export-Import Bank say they are in favor of faster 
economic growth. But the Export-Import Bank supported 164,000 jobs just 
last year alone in virtually every congressional district in this great 
land.
  Make no mistake, if the Bank expires, we will lose jobs; and we will 
lose jobs immediately here and there and everywhere.
  And stop and think about that. What is more important than a job? It 
is the means by which we provide for ourselves. We are self-sufficient.
  Is anyone suggesting we have too many jobs? Is anybody suggesting 
that work isn't worthwhile?
  The SPEAKER pro tempore. The time of the gentleman has expired.

[[Page H4453]]

  Mr. POLIS. I yield the gentleman an additional 30 seconds.
  Mr. HECK of Washington. I will never forget when former Vice 
President Mondale once said, You want to know how important work is in 
this society? Stop, ask yourself what is the first thing you ask 
somebody when you meet them. ``What do you do?''
  Work is important. Jobs are important. The Export-Import Bank creates 
jobs. Vote ``no'' on the previous question. Reauthorize the Export-
Import Bank. We have 5 legislative days to go.
  Mr. BURGESS. Mr. Speaker, I yield 3 minutes to the gentlewoman from 
North Carolina (Ms. Foxx), the vice chairman of the Committee on Rules.
  Ms. FOXX. I thank my colleague on the Rules Committee, who handles 
our rules and legislation so effectively on the floor.
  Mr. Speaker, I rise today in support of the rule and the underlying 
bills. When the Democrat-controlled Congress rammed the so-called 
Affordable Care Act through this Chamber, I joined my Republican 
colleagues in expressing our grave concerns over the effects of the 
law's tax increases. Specifically, we warned that the excise tax on 
medical devices would hinder innovation as well as restrict growth and 
job creation in an industry that has improved the quality of life for 
millions around the world.
  And just as we cautioned, this tax on devices that restore mobility, 
keep hearts in rhythm, and help doctors diagnose life-threatening 
diseases earlier than ever before has cost us local jobs and reduced 
research capabilities.
  Cook Medical is a privately owned company, with facilities around the 
world. It employs about 500 people in Winston-Salem, North Carolina, 
where the company focuses on endoscopic and urological medicine.
  Since the medical device tax was levied in 2013, Cook Medical has 
paid roughly $13 million annually. As a result, the company has pulled 
back on capital improvements as well as research and development 
investments. They have also considered moving manufacturing capacity 
outside the United States.
  Scott Sewell, vice president of technology acquisition and 
development for the company's Winston-Salem office, recently told the 
Triad Business Journal that if the medical tax device is repealed, they 
would look at expanding operations in North Carolina with a new plant 
in Winston-Salem.
  I would like to submit for the Record this May 1 article from the 
Triad Business Journal.

               [From Triad Business Journal, May 1, 2015]

             Device Tax Thwarts Expansion in Winston-Salem

                          (By Owen Covington)

       The push to repeal an Affordable Care Act tax on the sale 
     of medical devices appears to be gaining steam with a 
     prominent device manufacturer with a strong Triad presence 
     recently lobbying Congress for action.
       In written testimony to a Senate committee this month, Cook 
     Medical Board Chairman Stephen Ferguson said the company has 
     had to pull back on capital improvements and R&D investments 
     because of the tax. Cook is also considering moving 
     manufacturing capacity outside the country.
       ``Make no mistake about it: We want to develop and 
     manufacture our devices in the U.S., but this tax is 
     preventing this growth in this country,'' Ferguson wrote.
       I caught up with Scott Sewell, vice president of technology 
     acquisition and development at Cook Medical's Winston-Salem 
     operation, where the focus is on endoscopy and urological 
     medicine.
       Just for further explanation, the tax is a 2.3 percent levy 
     on the sale of many medical devices that's expected to 
     generate $29 billion during its first 10 years.
       Proponents have argued that increased health insurance 
     coverage will mean more sales for these companies, which also 
     have the option of passing that increase along to consumers 
     rather than absorbing it themselves.
       Sewell said that since the tax was levied in 2013, Cook 
     Medical has paid roughly $13 million annually. That accounts 
     for only a portion of Cook's overall sales, since it isn't 
     paid on the roughly 60 percent of Cook's products that are 
     sold abroad.
       Both Sewell and Ferguson said that uptick in sales hasn't 
     occurred, and the company has generally been unable to pass 
     along the cost of the tax to consumers, which are typically 
     very cost-conscious hospitals. That's meant pulling back on 
     plans to expand in Winston-Salem and elsewhere, Sewell said.
       ``I think if the device tax were repealed, in the next 
     couple of years, we would probably be looking at a new plant 
     in Winston-Salem,'' he said.
       Cook's arguments are grabbing the attention of more in 
     Congress. That said, advocates of the tax say claims like 
     those of Cook are overblown.
       ``A manufacturer can't avoid the tax by shifting production 
     abroad, doesn't pay the tax for devices it produces here but 
     sells abroad, and suffers no competitive disadvantage from 
     foreign producers, who also have to pay the tax for devices 
     that they sell here,'' wrote Chad Stone, chief economist of 
     the left-leaning Center on Budget and Policy Priorities, in 
     U.S. News & World Report.

  Ms. FOXX. It is clear that ObamaCare's medical device tax has 
directly and negatively impacted the people who live in North 
Carolina's Fifth District, as well as people around the country and 
around the world.
  Mr. Speaker, this tax must be repealed, and its harmful effects 
undone.
  Mr. POLIS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Michigan (Mr. Kildee).
  Mr. KILDEE. I thank my friend from Colorado for yielding.
  Mr. Speaker, I rise today to speak in opposition to the previous 
question in order to make in order a vote to reauthorize the Export-
Import Bank.
  For Americans, the Export-Import Bank means jobs. It means economic 
growth. Failing to reauthorize Ex-Im threatens American jobs, threatens 
American businesses, threatens our economy.
  Supporting Ex-Im used to be a bipartisan issue. Just read a little 
history: Dwight Eisenhower supported it. Ronald Reagan supported it. If 
you want a more recent example, George W. Bush supported it.
  This never has been a partisan issue until just recently, where even 
the House leadership--the Speaker, I think, supports it--has now been 
captured by a small group of very far right-leaning ideologues to whom, 
apparently, much is owed because we can't get a floor vote on a piece 
of legislation supported by a majority of the House of Representatives 
that helps American business and helps American workers. What is wrong 
with this picture? This makes no sense whatsoever.
  The Export-Import Bank is an essential part of a growing economy, and 
particularly in supporting American businesses to grow their exports 
and put Americans to work.
  In my home State alone, 228 companies, $11 billion in export value, 
are at risk if we don't reauthorize the Export-Import Bank, and we have 
5 days to do it. But we could do it in 5 minutes if we defeat the 
previous question, bring to the floor of the House legislation, H.R. 
1031, that would reauthorize the Export-Import Bank through 2022.
  Let's let the will of the American people and, frankly, the will of a 
majority of the United States Congress, be manifest in our policy. A 
majority of Congress supports the reauthorization of the Export-Import 
Bank. Bring a vote to the floor of the House. Let's put America to 
work, support American business, support American workers, and support 
the Export-Import Bank.
  Mr. BURGESS. Mr. Speaker, I yield myself 1 minute.
  Mr. Speaker, previously it was brought up about the prevention fund, 
which was being used as one of the offsets for the repeal of the 
Independent Payment Advisory Board. And I just wanted to give the 
Congress a sense of some of the activities that have been funded under 
the Secretary's so-called prevention fund.
  How about pickle ball? I didn't even know what that was. I had to 
Google it after that came to light in our committee. Massage therapy, 
kickboxing, kayaking, and Zumba--a separate grant was given for that. A 
grant for signage for bike lanes. A grant to promote free pet 
neutering. A grant for urban gardening. A grant to lobby for a soda tax 
in New York, block construction of job-creating fast food small 
businesses, and another grant to boost bike clubs.
  These are the types of activities that are being funded in the 
prevention fund, not actual activities that would result in the 
prevention of disease. This is a good use of these dollars, and I urge 
adoption.
  I reserve the balance of my time.
  Mr. POLIS. I yield 2 minutes to the gentlewoman from Wisconsin (Ms. 
Moore), the ranking member on the Financial Services Subcommittee on 
Monetary Policy and Trade.
  Ms. MOORE. Mr. Speaker, the clock is ticking on the global 
competitiveness of U.S. workers, and the GOP has yet--has yet--has yet 
to put to a vote the reauthorization of the Export-Import Bank.

[[Page H4454]]

  The Export-Import Bank levels the playing field globally for U.S. 
businesses to compete with subsidized foreign competitors. Our U.S. 
exporters and workers will pay the price if this majority, this 
Republican Congress fails to reauthorize the Bank. My Milwaukee 
exporters will pay the price if this Republican Congress fails to 
reauthorize the Bank.
  Yes, deals will still be made with the other 60 or so credit agencies 
around the world, but they will be done without U.S.-made goods and 
services.
  You know, it is so ironic that we have all kinds of deals being cut 
to get partnership trade agreements with these 12 different Pacific 
countries so we could export jobs to other places in the world. But 
there are no deals being made so that we can export U.S.-made goods and 
services to other parts of the world. That is probably why we have such 
a huge trade deficit.
  With the leadership of Ranking Member Waters, Representatives Heck of 
Washington, Hoyer, and I, we have introduced H.R. 1031, the Promoting 
U.S. Jobs Through Exports Act. It makes targeted and prudent reforms to 
the Bank that enhance its mission, including promoting additional small 
business participation, greater transparency, and improved governance.
  Defeat the previous question. Bring the Export-Import Bank deal to 
the floor. The American people deserve an opportunity to work.
  Mr. BURGESS. Mr. Speaker, may I inquire as to the time remaining?
  The SPEAKER pro tempore. The gentleman from Texas has 13 minutes 
remaining, and the gentleman from Colorado has 12 minutes remaining.
  Mr. BURGESS. Mr. Speaker, I reserve the balance of my time to close.
  Mr. POLIS. Mr. Speaker, I yield myself the remainder of my time.
  First, with regard to the comments of the gentleman from Texas on the 
preventative health fund, I want to give a few examples of the 
important ways that fund helps reduce health care costs. For instance, 
expenditures on hospitals promoting breast-feeding, on breast and 
cervical cancer early awareness and diagnosis.
  So, I mean, again, the fund community initiative that support breast-
feeding mothers has a demonstrable effect in reducing the incidence of 
disease in infants and promotes better health.
  With regard to early identification: breast cancer screenings, 
outreach through State, territorial, and tribal health organizations, 
chronic disease self-management--again, making sure that people have 
better compliance with their regime that can reduce health care costs.
  So there are a lot of items in there that I am confident, if our bill 
were to pass--the bill that I cosponsor with the gentleman from Texas--
clearly that $9 billion in savings is illusory. Now whether that will 
come back as a net-positive program or not, under the new CBO scoring, 
we will just need to pass our bill to see. But it wouldn't be $9 
billion. Again, maybe it would be $3 billion in savings. Maybe it would 
be $1 billion. Again, maybe it would be a negative amount because these 
preventative expenditures could very well save more than they cost 
because if you can get an early diagnosis around breast and cervical 
cancer, not only does it lead to a better outcome for the patient but 
saves a lot more money, as does making sure that people are able to 
successfully manage their chronic diseases and not wind up in emergency 
rooms at a very high cost.
  We have before us--no bones about it--two more partial repeals of the 
Affordable Care Act.
  So far this year, the Republicans have brought to the floor $586 
billion in unpaid-for tax extenders and special interest tax 
expenditures. Those bills have blown through the sequestration caps, 
all while continuing to cut funding for education programs, violence 
prevention initiatives, and medical research.
  This bill adds another $25 billion to that $586 billion. Again, 
everybody likes to have their cake and eat it too. But unfortunately 
budgets have to work, and numbers have to add up.

                              {time}  1315

  That is why I was particularly disappointed that the Rules Committee 
didn't allow my amendment that would have simply paid for the medical 
device tax repeal to come forward. Instead, the Republicans are 
insisting on adding $25 billion on top of the $586 billion in 
expenditures that they are blowing through the deficit with and 
increasing the size of the deficit by half a trillion dollars.
  This bill also provides for consideration of a bill that cuts $9 
billion from the preventative health initiatives to repeal an advisory 
board. Again, I would argue that we won't know if that is truly paid 
for or not until our other bill passes, and I hope that we can bring 
forward the bill I share with Mr. Burgess to allow for the proper 
scoring of that.
  So I am ready to say that I don't know if it is paid for or not. I 
suspect it is not. I suspect that it might cost us more money in the 
long run to repeal the important expenditures around breast and 
cervical cancer early diagnosis and chronic disease self-management, 
but the only way to know that for sure would be to change the way that 
the CBO scores the bills to allow for preventative measures to show the 
savings that are reasonably estimated by experts absent any particular 
bias.
  Mr. Speaker, I think there is a lot of interest in reforming the 
Advisory Board, and I think that is a valid conversation to have: What 
should its priorities be? What should the reporting process be? What 
should the membership be composed of? But repealing it and adding costs 
and preventing simple, cost-saving recommendations from even coming to 
Congress, how does that make sense? And how does that further the goal 
of providing high-quality health care to the American people at the 
lowest cost possible?
  We also shouldn't be taking funding away for programs that help 
Americans prevent injuries or illness in order to pay for the repeal of 
an advisory board that makes nonbinding recommendations to Congress.
  Mr. Speaker, a vote for this rule is yet another vote for misplaced 
priorities, for increasing the Federal deficit, and for passing 
policies that are at odds with the needs of the American people and 
constitute the 62nd time that this body has chosen to repeal part of 
the Affordable Care Act rather than move forward with a future-oriented 
agenda to help the American people. This is a vote to add billions of 
dollars to our deficit at the expense of the basic healthcare needs of 
the American people.
  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, this body can do better. If we defeat this 
rule, we might have an opportunity to do something about the deficit, 
to do something about it by going back and getting a rule that if this 
body chooses to proceed with repealing the medical device tax allows a 
commonsense way for that to be paid for. If we repeal this rule, we can 
go back and look at improving the advisory panel rather than repealing 
it in its entirety, making sure that, if there are costs associated 
with that, that they are paid for in a real way rather than a way that 
is illusory.
  Mr. Speaker, if we repeal this rule, we can go back and bring forward 
Mr. Burgess' and my bill that would allow proper scoring around 
preventative health care. That would allow a proper discussion on 
whether this way of paying for a repeal of the advisory panel is even a 
real way of paying for anything or not.
  For those reasons, Mr. Speaker, I strongly urge my colleagues to vote 
``no'' and defeat the previous question.
  I yield back the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, we have talked a lot about the Affordable Care Act here 
on the floor of this House, and one of the reasons we have talked a lot 
about it is because, very famously, it was passed before we read it. We 
had to pass it to find out what was in it. Let me just talk about a 
couple of those things because I think they are germane to our 
discussion today.
  This is June 17. Around the country, many Members' offices are being 
contacted by groups asking why Congress

[[Page H4455]]

itself isn't following the law that Congress passed. I am referring 
specifically to section 1312(d) in the bill. It says:

       Members of Congress in the exchange requirement 
     notwithstanding any other provision in law, after the 
     effective date of this subtitle, the only health plans that 
     the Federal Government may make available to Members of 
     Congress shall be health plans that are, number one, created 
     under this act, or two, offered through an exchange 
     established unto this act. The term ``Member of Congress'' 
     means any Member of the House of Representatives or the 
     Senate.

  The fact of the matter is most people don't follow the law. I did, 
Mr. Speaker, and I think it was important to follow the law. I bought 
my health care in the individual market, in healthcare.gov, started 
October 1 of 2013. You may remember that night. That was the night the 
fiscal year ended and the famous government shutdown began. I began 
early that morning in trying to sign up for the Affordable Care Act 
because I knew, as a Member of Congress, we were supposed to sign up 
through healthcare.gov, an unsubsidized policy in the individual 
market. So I performed as indicated.
  It took 3\1/2\ months for the check to clear the bank. It was one of 
the most uncomfortable, god-awful experiences I have ever been through 
in my life. What is the final result? I have a bronze plan in the 
individual market in healthcare.gov, the Federal fallback provision in 
the State of Texas.
  Mr. Speaker, that plan cost $560 a month the first year that I was 
enrolled, and then it went up 24 percent the next year. It is now up to 
$700 a month for me for an individual. These are after-tax dollars. Do 
you know the worst part, Mr. Speaker? The worst part is that the 
deductible is $6,000.
  Now, some people have asked me, they say: Well, gee, are you worried 
about the fact that the networks are so narrow on these plans that you 
can't see your doctor?
  I honestly don't know. I don't know if my doctor is included on the 
plan. I haven't looked because I ain't going. At a $6,000 deductible, 
someone will have to drag me in the backdoor by the time I am dying.
  What has happened, Mr. Speaker, is we have created a whole subset of 
individuals in this country who are functionally uninsured because the 
cost of their care is so high. Had Members of Congress followed the 
law, they would be as aware of that as our constituents are.
  Mr. Speaker, today's rule provides for the consideration of two bills 
that begin to right some of the many wrongs included in the Affordable 
Care Act: H.R. 160, repealing the Independent Payment Advisory Board 
charged with cutting Medicare; and H.R. 1190, repealing the medical 
device tax. These are two steps that the House can take this week to 
help lower the rising costs of health care created under the 
President's healthcare law.
  Mr. Speaker, I urge the adoption of the rule before us and the 
passage of the two important pieces of legislation.
  The material previously referred to by Mr. Polis is as follows:

      An Amendment to H. Res. 319 Offered by Mr. Polis of Colorado

       At the end of the resolution, add the following new 
     sections:
       Sec. 3. 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. 
     1031) to reauthorize the Export-Import Bank of the United 
     States, and for other purposes. 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 Financial Services. 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. 4. Clause 1(c) of rule XIX shall not apply to the 
     consideration of H.R. 1031.
                                  ____


        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 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. Mr. Speaker, I yield back the balance of my time, and I 
move the previous question on the resolution.
  The SPEAKER pro tempore. The question is on ordering the previous 
question.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. POLIS. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this question will be postponed.

                          ____________________