[Congressional Record Volume 161, Number 98 (Thursday, June 18, 2015)]
[House]
[Pages H4528-H4535]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           PROTECTING SENIORS' ACCESS TO MEDICARE ACT OF 2015

  Mr. RYAN of Wisconsin. Mr. Speaker, pursuant to House Resolution 319, 
I call up the bill (H.R. 1190) to repeal the provisions of the Patient 
Protection and Affordable Care Act providing for the Independent 
Payment Advisory Board, and ask for its immediate consideration in the 
House.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore. Pursuant to House Resolution 319, the 
amendment printed in part B of House Report 114-157 is adopted, and the 
bill, as amended, is considered read.
  The text of the bill, as amended, is as follows:

                               H.R. 1190

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Protecting Seniors' Access 
     to Medicare Act of 2015''.

     SEC. 2. REPEAL OF THE INDEPENDENT PAYMENT ADVISORY BOARD.

       Effective as of the enactment of the Patient Protection and 
     Affordable Care Act (Public Law 111-148), sections 3403 and 
     10320 of such Act (including the amendments made by such 
     sections) are repealed, and any provision of law amended by 
     such sections is hereby restored as if such sections had not 
     been enacted into law.

     SEC. 3. RESCINDING FUNDING AMOUNTS FOR PREVENTION AND PUBLIC 
                   HEALTH FUND.

       Section 4002(b) of the Patient Protection and Affordable 
     Care Act (42 U.S.C. 300u-11(b)) is amended--
       (1) in paragraph (2), by striking ``2017'' and inserting 
     ``2016'';
       (2) in paragraph (5)--
       (A) by striking ``2022'' and inserting ``2026''; and
       (B) by redesignating such paragraph as paragraph (7); and
       (3) by striking paragraphs (3) and (4) and inserting the 
     following:
       ``(3) for fiscal year 2017, $390,000,000;
       ``(4) for each of fiscal years 2018 and 2019, $487,000,000;
       ``(5) for each of fiscal years 2020 and 2021, $585,000,000;
       ``(6) for each of fiscal years 2022 through 2025, 
     $780,000,000; and''.

  The SPEAKER pro tempore. The bill shall be debatable for 1 hour 
equally divided and controlled by the chairs and ranking minority 
members of the Committee on Ways and Means and the Committee on Energy 
and Commerce.
  The gentleman from Wisconsin (Mr. Ryan), the gentleman from Michigan 
(Mr. Levin), the gentleman from Pennsylvania (Mr. Pitts), and the 
gentleman from New Jersey (Mr. Pallone) each will control 15 minutes.
  The Chair recognizes the gentleman from Wisconsin.


                             General Leave

  Mr. RYAN of Wisconsin. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days within which to revise and extend 
their remarks and include extraneous material on H.R. 1190, Protecting 
Seniors' Access to Medicare Act of 2015, currently under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Wisconsin?
  There was no objection.
  Mr. RYAN of Wisconsin. Mr. Speaker, I yield myself such time as I may 
consume.
  What we are bringing to the floor today is Dr. Roe's bill to repeal 
the Independent Payment Advisory Board. This is a bill that came out of 
the Committee on Ways and Means with a bipartisan vote. This is an 
agency that Members on both sides of the aisle believe does not have 
the right to exist, should not exist, and does not follow our 
democratic process.
  Let me explain why we are doing this. There is no greater example of 
the conflict of visions than this. ObamaCare created something called 
IPAB, the Independent Payment Advisory Board. It is a board of 15 
people who are not elected or appointed.
  They have the power to cut Medicare's payments for treatment. They 
have a quota which they have to hit in order to find the same number to 
actually cut. Every year, a formula kicks in, and the 15 unelected 
bureaucrats

[[Page H4529]]

find where they are going to cut Medicare payments to providers to hit 
that quota.
  They can do all of this without Congress' approval. The idea, of 
course, is that unelected bureaucrats know best, unelected bureaucrats 
know better than patients, their doctors, or their representatives in 
Congress; they will know which treatment works the best because they 
are detached, they are distant, they are above the fray, they are not 
involved in the emotions or the personal relationships that such 
personal decisions like your health care ultimately involve.
  That is the big problem. They are totally unaccountable. They are 
divorced from reality. Health care is not a statistic. It is not a 
formula. It is not uniform. It is not cookie cutter. It is personal. It 
is individual. It is distinct.
  Every patient is different. This is why patients, along with their 
doctors, need to be put in charge of their health care. What IPAB would 
essentially do is ration health care. It would take control away from 
patients.
  Now, the other side says, Hey, no, not so fast; Congress can override 
them--but that is only with a supermajority vote.
  Mr. Speaker, we have seen this movie before. It never ends well. 
Seniors will suffer the consequences. Medicare is more than a program; 
Medicare is a promise. Seniors have worked hard; they have paid their 
taxes; they have planned on Medicare throughout all their working 
lives, and now that they are retired, it is something that they 
deserve, a secure retirement. It needs to be there, just like it has 
been for our parents.
  Think about what a Member of Congress will do. This Board of 
unelected bureaucrats will say, We are cutting Medicare X, Y, and Z 
ways to these providers for Medicare, which will deny services to 
seniors; and they will do it according to this formula that is in law.
  If Congress doesn't like it, then the law says Congress has to go cut 
Medicare somewhere else and overturn this ruling with a three-fifths 
supermajority vote in the House and the Senate--as if that would ever 
happen.
  All this thing has done, it is designed to basically go around 
Congress, go around the laws, and have unelected and unaccountable 
bureaucrats ration care for our seniors.
  This is wrong; it is undemocratic; it does not fit with our 
Constitution, and we think it ought to be repealed. That is why we are 
bringing this bill to the House.
  I reserve the balance of my time.

                                         House of Representatives,


                             Committee on Energy and Commerce,

                                    Washington, DC, June 12, 2015.
     Hon. Paul Ryan,
     Chairman, Committee on Ways and Means, Washington, DC.
       Dear Chairman Ryan: I write in regard to H.R. 1190, 
     Protecting Seniors' Access to Medicare Act of 2015, which was 
     ordered reported by the Committee on Ways and Means on June 
     2, 2015. As you are aware, the bill also was referred to the 
     Committee on Energy and Commerce. I wanted to notify you that 
     the Committee on Energy and Commerce will forgo action on 
     H.R. 1190 so that it may proceed expeditiously to the House 
     floor for consideration.
       This is done with the understanding that the Committee on 
     Energy and Commerce's jurisdictional interests over this and 
     similar legislation are in no way diminished or altered. In 
     addition, the Committee reserves the right to seek conferees 
     on H.R. 1190 and requests your support when such a request is 
     made.
       I would appreciate your response confirming this 
     understanding with respect to H.R. 1190 and ask that a copy 
     of our exchange of letters on this matter be included in the 
     Congressional Record during consideration of the bill on the 
     House floor.
           Sincerely,
                                                       Fred Upton,
     Chairman.
                                  ____

                                         House of Representatives,


                                  Committee on Ways and Means,

                                     Washington, DC, June 9, 2015.
     Hon. Fred Upton,
     Chairman, Committee on Energy and Commerce, Washington, DC.
       Dear Mr. Chairman: Thank you for your letter regarding the 
     Committee's jurisdictional interest in H.R. 1190, the 
     Protecting Seniors' Access to Medicare Act of 2015, and your 
     willingness to forego consideration by your committee.
       I agree that the Committee on Energy and Commerce has a 
     valid jurisdictional interest in certain provisions of the 
     bill and that the Committee's jurisdiction will not be 
     adversely affected by your decision to forego consideration. 
     As you have requested, I will support your request for an 
     appropriate appointment of outside conferees from your 
     committee in the event of a House-Senate conference on this 
     or similar legislation should such a conference be convened.
       Finally, I will include a copy of your letter and this 
     response in the Congressional Record during the floor 
     consideration of H.R. 1190. Thank you again for your 
     cooperation.
           Sincerely,
                                                        Paul Ryan,
                                                         Chairman.

  Mr. LEVIN. I yield myself such time as I may consume.
  The real purpose of this bill at this time, indeed, is to take a 
further effort to repeal ACA. That is really what this is about at this 
particular moment. The Republican leadership is, yet again, taking aim 
at ACA. H.R. 1190 would repeal the Independent Payment Advisory Board, 
IPAB. This would really be the 59th vote to repeal or undermine ACA.
  Since it passed, we have seen the slowest growth in healthcare prices 
over any period of that length in nearly 50 years. Growth in per 
enrollee healthcare spending across both the public and private sectors 
has been controlled.
  The three slowest years of growth in real per capita national health 
expenditures on record were 2011, 2012, and 2013. The ACA, in essence, 
has changed the healthcare cost landscape, keeping cost increases down 
and keeping or helping, at least, to keep families out of debt.
  While we know the Medicare delivery system reforms have been working 
to deliver value and lower costs, the IPAB was created as a backstop--a 
backstop--only to come into effect if other efforts weren't successful. 
This should be clear. IPAB only comes into being if delivery system 
reforms aren't doing their job to manage Medicare.
  According to the CBO, Medicare growth rates are projected to remain 
beneath IPAB targets throughout the entire budget window, thereby not 
triggering the Board's provisions until 2024. I think, when you 
subtract 2015 from 2024, you get 9 years; so here we are, on this date, 
at this time, 9 years, according to CBO, before the provisions would 
come into effect, asking this Congress to repeal the IPAB provision.
  If the ACA's delivery system efforts continue to be successful, IPAB 
may never even need to be constituted. It is specifically prohibited 
from cutting benefits or raising costs on seniors.
  What IPAB can do, however, is to make recommendations to go after 
overpayments, go after fraud and abuse, and try to improve, if needed, 
the way there is reform of the delivery system. IPAB will not take away 
Medicare benefits; it will not shift costs to seniors.
  If we in Congress are doing our job as stewards of Medicare, we can 
manage cost growth while protecting beneficiaries on the front end. In 
the event IPAB makes recommendations, Congress always has the ability 
to disapprove or modify them. If we do our job, we won't need IPAB. If 
we fail to do our job, IPAB will prod us to action 9 years from now or 
perhaps even later.
  Let me talk a few words about the offset. It is a significant 
reduction of funding for the prevention and public health fund. While 
the Republicans so far have come forth with their proposals that are 
never paid for, this time, they have decided to have a pay-for, but it 
would cut by half or more than that the current funding for the 
prevention and public health fund.
  That fund was established in the ACA to provide expanded and 
sustained national investments in prevention and public health and will 
provide $900 million this year alone for interventions that will reduce 
smoking, tackle heart disease, and help improve prenatal outcomes.
  I have a listing of what it has meant for Michigan, just as one 
example: $3.5 million for State health department efforts to prevent 
obesity and diabetes; $3.8 million to address chronic disease risk 
factors among African Americans, American Indians, Latinos, and other 
minorities; $3.3 million for community transformation grants in central 
Michigan to address heart disease prevention and diabetes; and almost 
$3 million for tobacco use prevention.
  Here we are, at long last, the Republicans come forth with a pay-for, 
and they are paying for it by taking away something that really, really 
matters.
  We have in front of us a Statement of Administration Policy, and I 
ask that it be placed in the Record. It just repeats some of the points 
that I have

[[Page H4530]]

made, so I will leave it just to be entered into the Record; and, 
therefore, I will now say that we should not vote for this legislation.
  It would repeal a part of ACA designed to help keep healthcare costs 
under control, and so importantly, it would cut critical public health 
and prevention funding.
  I reserve the balance of my time.

                   Statement of Administration Policy


     H.R. 1190--Protecting Seniors' Access to Medicare Act of 2015

                    (Rep. Roe, R-TN, June 15, 2015)

       The Affordable Care Act has improved the American health 
     care system, on which Americans can rely throughout life. 
     After more than five years under this law, 16.4 million 
     Americans have gained health coverage. Up to 129 million 
     people who could have otherwise been denied or faced 
     discrimination now have access to coverage. And, health care 
     prices have risen at the slowest rate in nearly 50 years. As 
     we work to make the system even better, we are open to ideas 
     that improve the accessibility, affordability, and quality of 
     health care, and help middle-class Americans.
       The Independent Payment Advisory Board (IPAB) will be 
     comprised of fifteen expert members, including doctors and 
     patient advocates, and will recommend to the Congress 
     policies that reduce the rate of Medicare growth and help 
     Medicare provide better care at lower costs. IPAB has been 
     highlighted by the non-partisan Congressional Budget Office 
     (CBO) economists, and health policy experts as contributing 
     to Medicare's long-term sustainability. The Board is 
     prohibited from recommending changes to Medicare that ration 
     health care, restrict benefits, modify eligibility, increase 
     cost sharing, or raise premiums or revenues. Under current 
     law, the Congress retains the authority to modify, reject, or 
     enhance IPAB recommendations to strengthen Medicare, and IPAB 
     recommendations would take effect only if the Congress does 
     not act to slow Medicare cost growth.
       H.R. 1190 would repeal and dismantle the IPAB even before 
     it has a chance to work. The bill would eliminate an 
     important safeguard that, under current law, will help reduce 
     the rate of Medicare cost growth responsibly while protecting 
     Medicare beneficiaries and the traditional program. While 
     this safeguard is not projected to be needed now or for a 
     number of years given recent exceptionally slow growth in 
     health care costs, it could serve a valuable role should 
     rapid growth in health costs return.
       CBO estimates that repealing the IPAB would increase 
     Medicare costs and the deficit by $7 billion over 10 years. 
     The Administration would strongly oppose any effort to offset 
     this increased Federal budget cost by reducing the Prevention 
     and Public Health Fund. The Affordable Care Act created this 
     Fund to help prevent disease, detect it early, and manage 
     conditions before they become severe. There has been 
     bipartisan and bicameral support for allocation of the Fund, 
     and the Congress directed uses of the Fund through FY 2014 
     and FY 2015 appropriations legislation. The Fund supports 
     critical investments such as tobacco use reduction and 
     programs to reduce health-care associated infections. By 
     concentrating on the causes of chronic disease, the Fund 
     helps more Americans stay healthy.
       The Administration is committed to strengthening Medicare 
     for those who depend on it and protection of the public's 
     health. We believe that this legislation fails to accomplish 
     these goals. If the President were presented with H.R. 1190, 
     his senior advisors would recommend that he veto the bill.

  Mr. RYAN of Wisconsin. Mr. Speaker, I yield 4 minutes to the 
distinguished gentleman from Tennessee (Mr. Roe), the author of the 
legislation.
  Mr. ROE of Tennessee. Mr. Speaker, I rise as a proud sponsor of H.R. 
1190, the Protecting Seniors' Access to Medicare Act. This bipartisan 
legislation, which I introduced with my colleague, Linda T. Sanchez, 
would repeal the Independent Payment Advisory Board, or IPAB.
  Created by the Affordable Care Act, this panel of 15 unaccountable, 
unelected bureaucrats exists to cut Medicare spending to meet arbitrary 
budgets and have been given enormous powers to do so.
  Listen to this carefully. Peter Orszag, President Obama's former 
budget director, has noted IPAB represents the single biggest yielding 
of power to an independent entity since the creation of the Federal 
Reserve. Let me repeat that: the single biggest yielding of power to an 
independent entity since the creation of the Federal Reserve.
  Mr. Speaker, we just spent, in a bipartisan way, 3 years working 
through SGR reform. Seventeen times, we kicked the can down the road so 
our seniors wouldn't be denied access to care. This bill is basically 
SGR on steroids. It trumps all the work we just did on SGR reform.
  Any proposal made by IPAB will be considered using expedited 
procedures, and without a three-fifths vote in the Senate, Congress can 
only modify the type of cuts proposed, not the amount, so we have to do 
the amount. If Congress doesn't act on IPAB's recommendation, the cuts 
will automatically go into effect. To make matters worse, the Board is 
exempt from administrative or judicial review.
  On the projections between 2020 and 2024, the CBO can't tell me from 
year to year, within the tens of billions of dollars, what the budget 
deficit is going to be each year, so I don't put a lot of stock in 
that.
  If the President does not nominate individuals to serve on the IPAB 
or if the IPAB fails to recommend cuts when required to do so, the 
Secretary of Health and Human Services has the power to make the 
changes unilaterally.

                              {time}  1315

  One person will make those changes for the entire country. Think 
about that for a second. One person would have the ability to reshape a 
program that has 55 million enrollees. Whatever you may think about the 
President's healthcare law, this just isn't right.
  After practicing medicine for more than 30 years, I can tell you that 
no two patients are the same and that different approaches are required 
for different needs. IPAB is blind to that fact and will ration 
seniors' access to care through a one-size-fits-all payment policy.
  Medicare desperately needs reform to ensure it continues to be there 
for current beneficiaries and the next generation, but this is not the 
way. We can do better.
  It is time to go back to the drawing board. I urge my colleagues to 
support this bill and put medical decisions back where they belong. Mr. 
Speaker, that is between patients and doctors.
  Mr. LEVIN. Mr. Speaker, I yield 3 minutes to the gentleman from 
Washington (Mr. McDermott), ranking member on the Health Subcommittee.
  (Mr. McDERMOTT asked and was given permission to revise and extend 
his remarks.)
  Mr. McDERMOTT. Mr. Speaker, I rise in opposition to this bill.
  This legislation is a ghost hunt. It doesn't exist. There is no IPAB. 
There is nobody that has been appointed. Nothing is going to happen 
until 2024.
  So the question you have to ask yourself is: Why are we out here? 
Well, we are out here because some people think that trying to control 
costs in health care is a bad idea.
  If you go back and read the Medicare legislation when it was put in, 
the AMA extracted from this Congress the right to charge their usual 
and customary fees. They have been driving the costs, and we have been 
trying to control it with all kinds of mechanisms all the way through 
it. Only with the incidence of the ACA have we seen the curve come 
down.
  We have actually extended the life of Medicare to 2030. Right now, we 
are spending 17 percent of our gross domestic product on health care. 
When I came to this Congress, it was about 12 or 13 percent. It has 
only gone up. We have not been able to do it ourselves. So the creators 
of this bill said: Let's put something in on the outside that can give 
us some suggestions.
  Now, when we had Simpson-Bowles--and I know the chairman of the Ways 
and Means Committee thought the Simpson-Bowles idea was a good idea--
what happened after it was brought out in public? Nothing. We ignored 
it.
  The reason for IPAB is to put pressure on the Congress to act to 
control costs. I guess Republicans don't care about costs because they 
don't understand that there are 10,000 people signing up for Social 
Security every single day. That is 3.5 million people.
  The numbers are going up. The costs are going to go up. People are 
going to run around here saying we have got to cut benefits; we have 
got to shift the costs to the old people; we have got to do all this. 
The IPAB was a way to force the Congress to face the consequences of 
their own inaction.
  Dr. Roe is correct; we spent 16 years kicking the can down the road 
on this issue of SGR. That was, again, an attempt to control costs. It 
never worked. It was ill-conceived in the beginning.
  This is an issue where there is some real muscle in it, and people 
are afraid of that. They are afraid of it 9 years

[[Page H4531]]

out because they know how the Congress does. This is just another way 
to try to undercut and make Medicare and the ACA not work.
  Mr. Levin pointed out the other thing that is important, and that is 
the place they look for the money is to go to community health, health 
departments. Nobody needs health departments. Why do you need people 
looking at restaurants to see if they are safe to go into, or to look 
at the water supply or look at what is happening in sewage? You don't 
need that stuff.
  This $7 billion they are going to grab here is straight out of the 
health departments of our country. Every one of your counties is going 
to be facing the impact of this.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. LEVIN. I yield the gentleman an additional 1 minute.
  Mr. McDERMOTT. The only thing that I think one can say is that it is 
a bad idea to get rid of some muscle to force us to look at costs, but 
it is worse to pay for it by taking money away from health departments. 
They are the ones that always get cut.
  Who wants inspectors? The other side says: We don't like regulations. 
It is regulations that are ruining America. We have got to get those 
regulations out.
  You don't want regulations enforced in restaurants? Then take $7 
billion away from it and see what kind of restaurant problems you start 
to have.
  Milwaukee had the cryptosporidium organism in the water supply. That 
is a health problem that is dealt with by the actual health department 
in the county. We are taking $7 billion to pay for this badly 
constructed idea.
  Mr. RYAN of Wisconsin. Mr. Speaker, I yield 2 minutes to the 
gentleman from Tennessee (Mr. Roe).
  Mr. ROE of Tennessee. Mr. Speaker, I have spent going on four decades 
taking care of patients in rural east Tennessee, and I saw access 
becoming more and more and more of a problem. It is a serious issue 
now, as Medicare costs have gone up and up and up.
  I have a mother who is almost 93. She has a difficult time affording 
her health care and other needs that she has. One of the things I am 
very concerned with, as Dr. McDermott said, we have 10,000 seniors a 
day getting on that program. We need to leave those decisions to 
doctors and patients, not to bureaucrats.
  Let me give a little more information. There is a similar panel in 
England called NICE, the National Institute for Health and Care 
Excellence, I believe is what the acronym is. The other day, the Royal 
College of Surgeons talked about how they noticed that over 75, almost 
nobody got operated on for breast cancer, almost nobody over 75 got a 
gall bladder operation, almost nobody over 75 got a knee fixed, and 
almost nobody over 75 got a hip fixed. That is wrong, and that is 
exactly the pathway we are going down if we don't stop this nonsense.

  There is a very good article in the New England Journal of Medicine 
published in 2011. I recommend you all read it. It is a look back from 
25 years. That is the only information they had. This particular author 
was not for IPAB or against it; he just analyzed it.
  Twenty-one of those 25 years, IPAB would have kicked in, meaning 
those cuts would have happened. And I can tell you this right now: our 
seniors better look at this with a laser beam on because their care is 
going to be cut if this goes into effect. We need to get rid of it now, 
before that happens.
  Mr. LEVIN. Mr. Speaker, it is my pleasure to yield 3 minutes to the 
gentlewoman from California (Ms. Linda T. Sanchez of California), a 
very active member of our committee.
  Ms. LINDA T. SANCHEZ of California. Mr. Speaker, I rise to speak 
about H.R. 1190, the Protecting Seniors' Access to Medicare Act.
  I am the Democratic lead, along with Congressman Phil Roe, and I am 
proud of the bipartisan work we have done to repeal the unelected 
bureaucracy known as the Independent Payment Advisory Board, or IPAB. I 
proudly voted for the ACA, and I think time has shown that the law 
works. The ACA has reduced the number of uninsured Americans, lowered 
healthcare costs, prevented disease, and increased access to cures.
  Despite the success of the law, no bill is perfect. I believe that 
there are certain areas for improvement in the ACA, and I am committed 
to working in a bipartisan manner to solve these issues and provide our 
constituents with the world-class health care that they deserve.
  The ACA is a good law and a few small tweaks can make it stronger, 
and that is why I decided to reach across the aisle to work with 
Congressman Roe on this legislation. Repealing IPAB is not the 
exclusive purview of the Republican Party, and it is a bipartisan 
effort.
  Unfortunately, much like the last time Congress considered IPAB 
repeal in 2012, an unpalatable pay-for undermined the bipartisan 
support for a deal. I know Congressman Roe has worked tirelessly to 
avoid repeating the pay-for battle that we had back in 2012 in order to 
retain Democratic support.
  Despite these efforts, Republican leadership has chosen to draw from 
the prevention and public health fund to pay for H.R. 1190. This is 
something that I simply cannot support, and it is with great 
disappointment that I must cast my vote against H.R. 1190. I truly 
believe that repealing IPAB is the right thing to do, but I cannot 
support gutting a great provision in the ACA to get rid of a bad one.
  The prevention and public health fund is an unprecedented investment 
in public health to prevent costly and life-threatening diseases. The 
fund has invested nearly $5.25 billion in States, cities, and 
communities to keep our constituents healthy and safe before they need 
costly, long-term care to manage their illnesses.
  The fund also exists to prevent stroke, cancer, tobacco use, and 
obesity, while also funding vital childhood immunization programs, and 
invests in detecting, tracking, and responding to infectious diseases. 
County public health departments rely on this fund to serve their 
constituents, and I know my home State of California has received over 
$195 million thus far.
  Despite all this, the Republican leadership has decided to take 
approximately $8.85 billion from the fund which actually helps lower 
the cost of health care through prevention, eliminating the need, 
ironically, for IPAB in the first place.
  In closing, I again want to thank Congressman Roe and the 235 
bipartisan cosponsors for their hard work. I am disappointed that I 
must vote against my own bill, because I know the underlying policy is 
good policy, but I cannot vote for something that drains an essential 
fund from the ACA.
  Mr. RYAN of Wisconsin. Mr. Speaker, may I inquire as to the time 
allotment remaining?
  The SPEAKER pro tempore. The gentleman from Wisconsin has 6\1/2\ 
minutes remaining. The gentleman from Michigan has 1\1/2\ minutes 
remaining.
  Mr. RYAN of Wisconsin. I yield 2 minutes to the gentleman from Ohio 
(Mr. Wenstrup).
  Mr. WENSTRUP. Mr. Speaker, let me take a couple of minutes to explain 
why Americans fear the Independent Payment Advisory Board, as it 
meddles with their health care.
  As I stand here today, I will tell you that I am a physician, and I 
can tell you what is already taking place within private insurance with 
these peer reviews when you recommend something.
  I recommended an MRI to a patient. That afternoon, I get on the 
phone. The woman says: I have had a problem for 10 years. I have had 
cortisone injections, physical therapy, blah, blah, blah.
  I said: You need an MRI.
  I am being denied the MRI by the insurance company because I have 
only seen her once. And I said to the gentleman, the doctor on the 
phone: How many times have you seen her?
  None.
  I said: What State do you have a license to practice in?
  Not Ohio, which is where we were.
  And so I said: Tell me your specialty.
  My specialty is foot and ankle. This woman was in for a foot problem.
  He said: I am an emergency room doctor.
  I said: Well, then you would refer her to a specialist, which is 
where she is today.
  He said: Well, I am not going to let you get that MRI.
  I said: I hope this call is monitored for quality assurance, because 
I want someone to hear what you said to me today.

[[Page H4532]]

  And then I asked the patient if she would go to her HR director and 
call the insurance company and say: We are going to drop the insurance 
because you are not letting the patients get the care their doctor 
recommends.
  And then we got it. Within 3 weeks, I had her better because I knew 
what was wrong once I had the MRI.
  Imagine trying to have that type of a discussion with the Independent 
Payment Advisory Board. If they pick up their phone, will they have a 
conversation with you about the patient?
  This is a problem. This is what Americans are fearing today. And this 
is why the Independent Payment Advisory Board should go away.
  Mr. LEVIN. Mr. Speaker, I yield back the balance of my time.
  Mr. RYAN of Wisconsin. It is a great bill. We should pass it. IPAB is 
a bad agency. It should not have been created in the first place.
  I yield back the balance of my time.

                              {time}  1330

  Mr. PITTS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise today in support of H.R. 1190, the Protecting 
Seniors' Access to Medicare Act of 2015.
  Mr. Speaker, the bill before us today repeals the Independent Payment 
Advisory Board, IPAB, one of the most ominous provisions in the 
sweeping overhaul of health care known as the Affordable Care Act.
  The stated purpose of IPAB is to reduce Medicare's per capita growth 
rate. The Board is to be made up of 15 unelected, unaccountable 
bureaucrats--by the way, you can't have a majority of docs on the 
Board--who will be paid $165,300 a year to serve 6-year terms on the 
Board.
  This panel of 15 unelected and unaccountable government bureaucrats 
is tasked with reducing Medicare costs through arbitrary cuts to 
providers, limiting access to care for seniors. If Medicare growth goes 
over an arbitrary target, the Board is required to submit a proposal to 
Congress that would reduce Medicare's growth rate.
  These recommendations will automatically go into effect, unless 
Congress passes legislation that would achieve the same amount of 
savings. In order to do so, Congress must meet an almost impossible 
deadline and clear an almost insurmountable legislative hurdle.
  The Board has the power to make binding decisions about Medicare 
policy, with no requirement for public comment prior to issuing its 
recommendations, and individuals and providers will have no recourse 
against the Board because its decisions cannot be appealed or reviewed. 
In other words, the Board will make major healthcare legislation 
essentially outside the usual legislative process.
  The Board is also limited in how it can achieve the required savings. 
Therefore, IPAB's recommendations will be restricted to cutting 
provider reimbursements. In many cases, Medicare already reimburses 
below the costs of providing services; and we are already seeing 
doctors refusing to take new Medicare patients--or Medicare patients at 
all--because they cannot afford to absorb the losses.
  Any additional provider cuts will lead to fewer Medicare providers, 
and that means that beneficiary access will suffer. Seniors will be 
forced to wait in longer and longer lines to be seen by an ever-
shrinking pool of providers or have to travel longer and longer 
distances to find a provider willing to see them.
  Clearly, Medicare growth is on an out-of-control trajectory that 
endangers the solvency and continued existence of the program. IPAB, 
however, is not the solution.
  Mr. Speaker, the House voted 223-181 in 2012 to repeal the 
Independent Payment Advisory Board. Today, H.R. 1190, Protecting 
Seniors' Access to Medicare Act of 2015, enjoys the support of 235 of 
our House colleagues who have signed on as cosponsors.
  The time has come for the House to once again repeal this flawed 
policy, and I urge all of my colleagues to support H.R. 1190.
  I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise today in opposition to H.R. 1190. This bill would 
repeal the Independent Payment Advisory Board, or IPAB, and pay for it 
by drastically reducing our investment in prevention and public health.
  Mr. Speaker, I do not support IPAB. I oppose independent commissions 
playing a legislative role other than on the recommendatory basis. It 
is not the job of an independent commission to make decisions on 
healthcare policy for Medicare beneficiaries. Congress simply must stop 
ceding legislative power to outside bodies.
  However, IPAB remains an insignificant provision from the Affordable 
Care Act, as it has not even been convened. Because of how well other 
provisions of the ACA are working, Medicare cost growth rates are 
projected to remain beneath IPAB targets through the entire budget 
window, thereby not triggering the IPAB provisions until 2024 at the 
earliest.
  That said, I urge this House to oppose H.R. 1190, which would pay for 
IPAB repeal by effectively gutting the Affordable Care Act's prevention 
and public health fund, an incredibly significant provision from the 
ACA.
  The prevention and public health fund is a mechanism to provide 
expanded and sustained national investments in prevention and public 
health, to improve health outcomes, and to enhance healthcare quality. 
The fund has worked to reduce tobacco use, promote community prevention 
and use of preventive services, and combat healthcare associated 
infections.
  This year the fund will invest nearly $1 billion in programs that 
will benefit every State, and these dollars go to proven, effective 
ways to keep Americans healthier and more productive.
  In my home State of New Jersey, we have received more than $47.5 
million for prevention and public health fund programs. This bill would 
walk back these and other important strides we have made in public 
health and prevention.
  This bill is yet another Republican attempt to attack and undermine 
the Affordable Care Act. I urge my colleagues to vote ``no.''
  Mr. Speaker, I ask unanimous consent to have the gentleman from 
Maryland (Mr. Sarbanes) manage the remainder of the Committee on Energy 
and Commerce time on the Democratic side.
  The SPEAKER pro tempore (Mr. Jody B. Hice of Georgia). Is there 
objection to the request of the gentleman from New Jersey?
  There was no objection.
  Mr. PITTS. Mr. Speaker, at this time, I am pleased to yield such time 
as he may consume to the gentleman from Florida (Mr. Bilirakis), a 
valued member of our Health Subcommittee.
  Mr. BILIRAKIS. Mr. Speaker, I rise today in support of H.R. 1190, the 
Protecting Seniors' Access to Medicare Act.
  The President's healthcare law included the creation of the 
Independent Payment Advisory Board, or IPAB. Despite its name, IPAB is 
the opposite of independent, Mr. Speaker. IPAB is a group of 15 
unelected members, unaccountable to the American people. IPAB's job is 
to control Medicare spending. That sounds nice, but they only have one 
way to do that, by cutting reimbursement rates for doctors and 
hospitals.

  Seniors rely on Medicare, as well as the doctors who will see them. 
If this unelected, unaccountable Board cuts reimbursement rates, 
doctors will stop seeing Medicare patients. That is bad for the 180,000 
seniors in my district.
  Support this bill, and let's abolish IPAB. I look forward to a 
bipartisan vote in support of H.R. 1190.
  Mr. SARBANES. Mr. Speaker, I am opposed to this legislation, H.R. 
1190, for reasons that I will detail in a moment.
  At this time, I yield such time as he may consume to the gentleman 
from Maryland (Mr. Hoyer), the minority whip.
  (Mr. HOYER asked and was given permission to revise and extend his 
remarks.)
  Mr. HOYER. The gentleman indicated there were 235 people for this 
bill in this House. I just observed a few minutes ago there are 240 
people for Export-Import Bank. We have brought this bill to the floor. 
I would hope the gentleman would urge his side, when 60 of his folks 
are for it, all of ours are for it, to bring the Export-Import Bank to 
the floor because it is about jobs.
  Having said that--and I want to acknowledge that I am a good friend 
and

[[Page H4533]]

have great respect for the sponsor of this bill, Dr. Roe. He and I have 
worked together on anaphylactic shock and the dangers caused by the 
eating of peanuts. He is a good doctor. He is a good person.
  We happen to disagree on this bill, however. This, essentially, will 
be the 60th vote, over the next 2 days, 4 days, on the repeal of the 
Affordable Care Act.
  We obviously have a difference of opinion on the Affordable Care Act. 
I believe it is working. I believe that millions of people are covered 
by insurance. Because of the Affordable Care Act, millions of children 
are covered under their parents' policy, and millions of seniors are 
paying less for prescription drugs. Millions of people with a 
preexisting condition have the confidence that they can get insurance.
  The bill we are debating today and voting on next week would repeal 
the Independent Payment Advisory Board, or IPAB, as it is referred to.
  Now, I was disappointed at the reference of ``bureaucrats.'' It is 
used as an epithet, unfortunately, not as a descriptive term.
  The fact of the matter is these folks are appointed and they make 
recommendations. They make recommendations to the Congress of the 
United States, and the Congress of the United States can reject them; 
and/or the President of the United States, if the Congress passes 
legislation to set that aside, can consider it as well.
  IPAB develops proposals to contain the rate of growth of Medicare 
spending. The Board hasn't been formed. There are no members appointed 
yet; yet Republicans are asking taxpayers to spend $7-plus billion over 
the next 10 years to eliminate it. It is not that it has acted badly. 
It is not that they are irresponsible. There are no people appointed to 
this Board yet.
  The Affordable Care Act has slowed the growth of healthcare costs to 
its lowest rate in 50 years. That helps every American, whether they 
are covered by the Affordable Care Act or private employer insurance or 
self-insured.
  As a result, CBO predicts that action by the Board would not even be 
triggered until 2024, but the cuts to the prevention fund would act 
now. Republicans are paying for this bill by cutting funding for 
disease prevention and public health now. Even then, CBO reports that 
this bill still bends the healthcare cost curve in the wrong direction 
over the long run.
  Today, as has been observed, we passed another bill. That one was 
without offsets. That will create an additional $24 billion deficit.
  Mr. Speaker, the House has a choice. It can continue the same old 
partisan attacks against affordable health care and add billions to the 
deficit, undermine prevention and public health, bringing deficit-
financed tax cuts passed by this Republican-led Congress up to $610.7 
billion since January.
  Somebody is going to pay that bill because we are not. My generation 
is not being asked to pay for it, $610.7 billion.
  It could reject, of course, the politics as usual and, instead, work 
together in a bipartisan way to focus on creating jobs, lowering the 
deficit, and investing in a competitive economy.
  You heard the sponsor of this bill saying, I cannot support it, the 
gentlewoman from California, because the proponents of this bill would 
rather attack the Affordable Care Act than they would to pass this 
bill.
  Now, they want to pass this bill, but their priority is undermining 
the Affordable Care Act, which is why they didn't work with 
Congresswoman Sanchez and others who agree with them on the policy. I 
have to disagree with them on the policy; but they have even put people 
who agree with them in a place where they cannot support the 
undermining of the Affordable Care Act and preventive health in 
America.
  Let's choose to work together to do what American people are asking 
us to do, not undermine the critical healthcare reforms that are 
containing costs, increasing access, and improving quality.
  That is why I opposed the medical device tax bill, and that is why I 
am urging my colleagues to defeat this one as well.
  Mr. PITTS. Mr. Speaker, I would say to the distinguished minority 
whip, I do support Ex-Im Bank and urge my leaders to act on it. We are 
together on support of that.
  Let me just mention a few things to correct the record. Number one, 
we had Secretary Burwell before the committee earlier this year and Dr. 
Larry Bucshon, on our Health Subcommittee, asked her specifically, when 
the IPAB cuts would begin to take effect. She said in 2019. In fact, 
the President's own budget request would begin the cuts of IPAB in 
2019.
  Now, you don't have to have the members of the IPAB appointed in 
order to have the cuts. The law, IPAB, designates the Secretary of HHS 
with the authority to make those cuts. To overcome those cuts, you 
really have to have two-thirds votes in the House and the Senate, with 
commensurate cuts from somewhere else in Medicare to replace those cuts 
that you are overcoming.

                              {time}  1345

  So this is a Board that has tremendous power that will deal with 
provider payments and cuts.
  We just dealt with the SGR, the sustainable growth rate, in a 
bipartisan manner. We acted to repeal the sustainable growth rate that 
required cuts to provider payments for seniors, and it was supported 
overwhelmingly.
  But if you liked the SGR, you will love IPAB. This is the SGR on 
steroids. It will be very difficult to overcome these 15 unelected 
bureaucrats, experts, whatever you want to call them--it can't be a 
majority of docs, by the way--or the Secretary, whoever makes the 
recommendations.
  We use the prevention fund as a pay-for, taking funds from the 
prevention fund until 2025 to reach the $7.1 billion. But this 
prevention fund gets $2 billion every year, beginning this year and 
every year ad infinitum. So $2 billion in 2015, 2016, '17, '18, '19, 
'20, '21, '30, '31, '40, '41. Every year, the Secretary gets $2 billion 
to use at her sole discretion. She doesn't have to use it for public 
health purposes. She has sole discretion on how this money is used.
  Would you like to know some of the things she has used the money for 
so far?
  Well, $450 million was used for the Navigator program and 
implementing the Affordable Care Act; $400,000 has been used for 
pickle-ball; $235,000 for massage therapy, kick boxing, and Zumba 
classes, whatever that is; $7.5 million on promoting free pet 
neutering; $3 million for the New York Department of Health to lobby 
for the passage of a soda tax; money for gardening projects, fast food, 
small businesses, bike clubs.
  Rather than spend money on questionable projects, lobbying campaigns 
for higher taxes, and for Affordable Care Act media campaigns, H.R. 
1190 would rather use these funds to protect Medicare seniors and their 
health care because the money for the operation of IPAB, for these 
salaries, for their travel, for all their expenses comes directly out 
of the trust fund moneys for seniors, used for seniors and those with 
disabilities. That is wrong.
  We are constraining. We are not repealing the prevention fund to pay 
for this, but we need to constrain the use of that fund. And good 
public health policy ought to come before the Congress, not be at the 
sole discretion of this one Secretary or czar or however you might want 
to term it.
  So, Mr. Speaker, I am pleased to speak in favor of this legislation, 
H.R. 1190, and I urge the Members to support it.
  I reserve the balance of my time.
  Mr. SARBANES. Mr. Speaker, I yield myself such time as I may consume, 
and I oppose H.R. 1190.
  If the Republican appetite for the repeal of the Independent Payment 
Advisory Board was based solely on its merits, I might be a little bit 
more charitable about their bringing this bill to the floor because, as 
you have seen from the speakers on our side, there is a legitimate 
debate on the merits. I have some concerns myself about the IPAB. But, 
unfortunately, I think that where this is coming from is this impulse, 
this kind of ceaseless impulse to undermine and dismantle the 
Affordable Care Act, and the evidence of that is in the pay-for.
  Why would you want to go undermine the public health portion, really, 
a significant commitment that was made through the ACA to begin to turn 
our healthcare system towards prevention, towards public health? 
Frankly,

[[Page H4534]]

we need as many resources as we can muster to put behind that. And the 
pay-for for this repeal would take $8.85 billion that has been set 
aside for the prevention and public health fund away from that fund and 
undermine all of the various activities that are being funded by it.
  I don't know why it is that our colleagues on the other side cannot 
restrain themselves when it comes to this shiny object of repealing the 
ACA when we now have plenty of evidence at our fingertips as to the 
positive impact that the Affordable Care Act is having: 3 million young 
people who now can stay on the health insurance coverage of their 
parents, who were not covered before; millions more that are benefiting 
from the health exchanges across the country; seniors who now have less 
anxiety about falling into the so-called doughnut hole under the part D 
prescription drug benefit program because, under the ACA, we are 
beginning to close that doughnut hole; insurance companies now being 
barred from discriminating against people based on a preexisting 
condition; preventive care screening for our seniors under the Medicare 
program; tests and other screenings that they used to have to come out 
of pocket for, now that is completely covered as a result of the 
Affordable Care Act.
  You ask the average person out there about any of those things I just 
mentioned, and they say: Why would we want to give these up?
  These are important to our health, important to the strength of our 
families and our community. Yet our colleagues just don't seem to be 
able to help themselves when it comes to wanting to attack the 
Affordable Care Act.
  Furthermore, if you view this IPAB as an important mechanism in terms 
of controlling costs, as has already been said, the trigger mechanism 
would not kick in for a number of years here anyway. In other words, 
the costs are being controlled currently. So that basis for sort of the 
urgency of it now in terms of bringing these other pay-fors into the 
mix doesn't make a whole lot of sense.
  Let's acknowledge that one of the reasons that that trigger isn't 
going to come any time soon is because, again, the Affordable Care Act 
is working when it comes to controlling costs. So that is the other 
side of the discussion. The Affordable Care Act is working in terms of 
providing more coverage and improving treatment and management of 
chronic care on the one hand, and the evidence is that it is also 
reducing cost on the other hand. So it makes sense to try to preserve 
that, and I think the public health fund and prevention fund is a 
critical piece.
  I urge my colleagues to oppose this legislation for the reasons 
enumerated.

  I reserve the balance of my time.
  Mr. PITTS. I reserve the balance of my time.
  Mr. SARBANES. Mr. Speaker, I yield myself the balance of my time.
  I just want to read into the Record, so that we have this 
information, a couple of observations from some of the groups out there 
that are most engaged in prevention and public health across the 
country and the perspective that they bring in terms of this offset, of 
undermining and depleting the prevention and public health fund.
  The American Lung Association said, using money from the prevention 
fund as a pay-for would have a devastating effect on our Nation's 
public health.
  The American Heart Association: Cardiovascular disease is a leading 
cause of death in the United States and is our most costly disease. The 
fund supports evidence-based initiatives like WISEWOMAN, a preventive 
health services program that provides lifestyle programs and health 
counseling that help low-income, uninsured, and underinsured women ages 
40 to 54 prevent, delay, or control heart disease and stroke.
  The American Cancer Society Cancer Action Network observes that the 
national breast and cervical cancer early detection program is funded 
in 31 States through the fund.
  And there are others that have observed--the March of Dimes, the 
Campaign for Tobacco-Free Kids--that it doesn't make any sense to go 
raid the prevention and public health fund to support this repeal of 
the IPAB.
  For those reasons and the others that have been presented here today, 
I urge my colleagues to oppose H.R. 1190.
  I yield back the balance of my time.
  Mr. PITTS. Mr. Speaker, I yield myself the balance of my time.
  While the programs enumerated by the gentleman from Maryland are 
laudable, there is nothing in the prevention and public health fund 
that guarantees that these will be funded or that they are priorities. 
It is at the sole discretion of the Secretary as to what she would 
allocate the funds for. And rightly, these kinds of funds should come 
before Congress, and Congress should approve these kinds of public 
health funds.
  I might mention that CBO estimates that H.R. 1190, the Protecting 
Seniors' Access to Medicare Act of 2015, as amended, would have no 
budgetary effect on fiscal years 2015-16. It would reduce direct 
spending by $1.8 billion over the 2016-2020 period, and reduce the 
direct spending by $45 million over the 2016-25 period.
  With that, Mr. Speaker, I urge Members to support H.R. 1190, the 
Protecting Seniors' Access to Medicare Act, and repealing IPAB.
  I yield back the balance of my time.
  Mr. PASCRELL. Mr. Speaker, I reluctantly rise in opposition to the 
Protecting Seniors' Access to Medicare Act. It was critical that the 
Affordable Care Act (ACA) included the cutting edge delivery and 
payment reforms that it did. But, I have never believed that the 
Independent Payment Advisory Board (IPAB) will be effectively able to 
fulfill its stated mission of cost containment. I have concerns with 
how IPAB will operate and that it gives up important Congressional 
authority over payment.
  For these reasons, I am a proud cosponsor of this bill, but once 
again, the House Republican majority has decided to kill the 
bipartisanship of this bill with a controversial pay-for. My Republican 
colleagues continue to prove that they would rather have an anti-ACA 
talking point rather than a real solution.
  Since the Affordable Care Act became law, my home state of New Jersey 
has received more than $20 million for evidence-based programs to 
prevent heart attacks, strokes, cancer, obesity, and smoking from the 
ACA's Prevention and Public Health Fund. This bill, as it is being 
considered today, would completely gut this fund by cutting $8.8 
billion--nearly $2 billion more than is needed to pay for repealing 
IPAB.
  Mr. Speaker, I urge my Republican colleagues to work with Democrats 
to find an agreeable way to pay for this bill, and I urge opposition to 
this bill in its current form.
  Mr. GENE GREEN of Texas. Mr. Speaker, I rise in opposition to H.R. 
1190, the Protecting Seniors' Access to Medicare Act.
  While I support repealing the Independent Payment Advisory Board 
(IPAB), I oppose offsetting the cost of repeal with funds from the 
Prevention and Public Health Fund.
  The Prevention and Public Health Fund is the nation's single largest 
investment in prevention programs. Established under the Affordable 
Care Act, the Fund represents an unprecedented investment in preventing 
disease, promoting wellness, and protecting our communities against 
public health emergencies.
  Since its creation, the Fund has invested in a broad range of 
evidence-based initiatives. These include community prevention 
programs, research, surveillance and tracking efforts, increased access 
to immunizations, and tobacco prevention programs.
  Much of this work is done through partnerships with state and local 
governments, which leverage Prevention Fund dollars to best meet the 
local need. These monies have been used for important work, such as 
controlling the obesity epidemic, detecting and responding to 
outbreaks, and reducing health disparities.
  Congress has a distinct responsibility to formulate and fund programs 
and initiatives that promote public health and wellness. The Prevention 
and Public Health Fund is one means by which Congress fulfils this 
obligation.
  While I opposed the creation of the IPAB and support its repeal, 
gutting the Fund would be a significant step backwards on the path 
towards improving our nation's health. Rescinding $8.85 billion to 
offset the costs of H.R. 1190 will have a devastating effect on our 
nation's health. It is not an acceptable trade off.
  We spend billions of dollars on treating disease once people become 
sick. This investment in prevention is a key component of efforts to 
improve health and bend the health care cost curve. Using this money to 
pay for other priorities will only damage the long-term health of our 
nation.
  I urge my colleagues to protect the federal government's only 
dedicated investment in prevention and vote against H.R. 1190.
  Ms. JACKSON LEE. Mr. Speaker, I rise in opposition to H.R. 1190, the 
Protecting Seniors' Access to Medicare Act of 2015, which repeals the 
Independent Payment Advisory Board (IPAB), that was established under 
the ACA in response to high rates of growth in Medicare expenditures 
and charged with developing proposals to ``reduce the per capita rate 
of growth in Medicare spending.''

[[Page H4535]]

  I oppose this bill strongly because by repealing IPAB before it has a 
chance to work, the bill would eliminate an important safeguard that 
will help reduce the rate of Medicare cost growth responsibly while 
protecting Medicare beneficiaries.
  Mr. Speaker, H.R. 1190 is nothing but another attempt, in a long line 
of House Republican efforts to undermine both the Medicare guarantee 
and the Affordable Care Act.
  Repealing IPAB cost over $7 billion during the course of a ten year 
period according to the Congressional Budget Office (CBO).
  Republicans have chosen to pay for the cost of this repeal with cuts 
to the ACA's Prevention and Public Health Fund.
  This fund has invested nearly $5.25 billion into programs that 
support a number of public health initiatives, including obesity 
prevention and childhood immunization.
  It has been used to increase awareness of and access to preventive 
health services and reduce tobacco use--concentrating on the causes of 
chronic disease to help more Americans stay healthy.
  Eliminating these funds in the name of damaging the sustainability of 
Medicare is a two-pronged attack on our nation's public health.
  After more than five years under the Affordable Care Act, 16.4 
million Americans have gained health coverage; up to 129 million people 
who could have otherwise been denied or faced discrimination now have 
access to coverage.
  Mr. Speaker, given the real challenges facing our nation, it is 
irresponsible for the Republican majority to continue bringing to the 
floor bills that have no chance of becoming law and would harm millions 
of Americans if they were to be enacted.
  House Republicans have tried 58 times to undermine the Affordable 
Care Act, which has enabled more than 16 million previously uninsured 
Americans to know the peace of mind that comes from having access to 
affordable, accessible, high quality health care.
  Their record to date is 0-58; it will soon be 0-59 because the 
President has announced that he will veto this bill if it makes it to 
his desk.
  Mr. Speaker, I ask my colleagues to look at the facts before 
prematurely repealing sections of the ACA that have significant 
negative impacts on Americans currently insured.
  The Independent Payment Advisory Board recommends to Congress 
policies that reduce the rate of Medicare growth and help Medicare 
provide better care at lower costs.
  IPAB has been highlighted by the non-partisan CBO, economists, and 
health policy experts as contributing to Medicare's long-term 
sustainability.
  The Board is already prohibited from recommending changes to Medicare 
that ration health care, restrict benefits, modify eligibility, 
increase cost sharing, or raise premiums or revenues.
  Under current law, the Congress retains the authority to modify, 
reject, or enhance IPAB recommendations to strengthen Medicare, and 
IPAB recommendations would take effect only if the Congress does not 
act to slow Medicare cost growth.
  Despite the Supreme Court's upholding of the law's constitutionality, 
the reelection of President Obama, and Speaker John Boehner's 
declaration that: ``Obamacare is the law of the land,'' Republicans 
refuse to stop wasting time and taxpayer money in their effort to take 
away the patient protections and benefits of the Affordable Care Act.
  Mr. Speaker, I ask that we stop wasting our time in taking away 
healthcare protections and benefits and work to ensure that we support 
the current law.
  A law that is providing access to an industry once denied to so many 
Americans and now supports millions.
  I urge my colleagues to join me in voting against H.R. 1190.
  The SPEAKER pro tempore. All time for debate has expired.
  Pursuant to House Resolution 319, the previous question is ordered on 
the bill, as amended.
  The question is on the engrossment and third reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. PITTS. 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.

                          ____________________