[Congressional Record Volume 163, Number 178 (Thursday, November 2, 2017)]
[House]
[Pages H8395-H8402]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




PROVIDING FOR CONSIDERATION OF H.R. 849, PROTECTING SENIORS' ACCESS TO 
                          MEDICARE ACT OF 2017

  Mr. BURGESS. Mr. Speaker, by direction of the Committee on Rules, I 
call up House Resolution 600 and ask for its immediate consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 600

       Resolved, That upon adoption of this resolution it shall be 
     in order to consider in the House the bill (H.R. 849) 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 in the nature of a 
     substitute recommended by the Committee on Ways and Means now 
     printed in the bill 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 Energy and 
     Commerce and the chair and ranking minority member of the 
     Committee on Ways and Means; and (2) one motion to recommit 
     with or without instructions.

  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 gentlewoman from New York (Ms. Slaughter), 
pending which I yield myself such time as I may consume. During 
consideration of this resolution, all time yielded is for the purpose 
of debate only.


                             General Leave

  Mr. 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 600 provides for the 
consideration of a bipartisan bill reported by the House Ways and Means 
Committee and the Energy and Commerce Committee.
  The rule provides for 1 hour of debate equally divided and controlled 
by the chairs and ranking members of the Committee on Energy and 
Commerce and the Committee on Ways and Means.
  The rule adopts the amendment in the nature of a substitute 
recommended by the Committee on Ways and Means.
  Further, the rule waives all points of order and makes in order no 
further amendments to the legislation. However, the minority is 
afforded the customary motion to recommit.
  Mr. Speaker, on behalf of millions of seniors in my home State of 
Texas and all across the United States, I am grateful that the House is 
considering H.R. 849, the Protecting Seniors' Access to Medicare Act of 
2017.
  This bill has been championed by my good friend from Tennessee, Dr. 
Phil Roe, in this Congress and in previous

[[Page H8396]]

Congresses. It accomplishes a very simple task: To repeal the unpopular 
Independent Payment Advisory Board created under the Affordable Care 
Act.
  This repeal has strong bipartisan support in both the Energy and 
Commerce Committee, on which I serve, and in this entire body.
  As of today, there are 270 Republican and Democratic cosponsors to 
the bill who all agree that the creation of this board was a very bad 
idea.
  More than 800 organizations representing every State support this 
bill. If I may add, this includes seniors, patient advocacy groups, 
physician groups, and other healthcare provider organizations.
  This board is charged with broad, sweeping powers to reduce Medicare 
spending when Medicare spending exceeds an arbitrary target.
  The board is a panel composed of 15 members appointed by the 
President, confirmed by the Senate for up to two consecutive 6-year 
terms. Fewer than half of the Independent Payment Advisory Board 
members can be healthcare providers, and no one--and this is an 
important point--on the board may receive outside income. So that means 
by its very definition that this board is comprised of people who 
cannot be practicing physicians.
  The other members will come from the ranks of think tanks, unions, 
and academia.
  For a panel with so much authority over Medicare spending, there 
could be little to no clinical expertise amongst the board members.
  Is this what Americans really want?
  Now, here is some good news. The board has yet to be formed. Hooray 
for that. According to the 2017 Annual Report on the Boards of Medicare 
Trustees from the Centers for Medicare and Medicaid Services' Office of 
the Actuary, the Independent Payment Advisory Board may not be formed 
until at least 2021, based on the current Medicare spending rate 
projections.
  Well, that is good news to seniors and their doctors and their 
families, but these projections are just numbers and they can change. 
In fact, last year the projection was very different, that the 
Independent Payment Advisory Board would be triggered this year rather 
than the delay.
  The concern of many of us here in the House and hundreds of 
stakeholders I have heard from is that under the law, the Independent 
Payment Advisory Board's proposals are required to be implemented by 
the Secretary of Health and Human Services unless Congress acts by 
creating its own proposal to achieve the exact same savings or by 
preventing the automatic implementation process as defined by law.
  So what is that process?

       The law mandates immediate introduction of legislation 
     encompassing the Independent Payment Advisory Board proposed 
     bills in Congress--

  Stop and think about that for a minute. That is not a bill introduced 
by a Member of Congress. That is a bill introduced by an outside board. 
That is a bill introduced by the administration. Let me recapitulate.

       The law mandates immediate introduction of legislation 
     encompassing the Independent Payment Advisory Board proposed 
     bills in Congress and establishes strict deadlines for 
     committee and Senate floor consideration, and places limits 
     on the appropriations process.
       While Congress is permitted to modify the type of cuts to 
     Medicare, it must achieve identical savings amounts to 
     Medicare spending as contained in the board's plan. The law 
     bars Congress from changing the Independent Payment Advisory 
     Board fiscal targets in any other legislation it considers, 
     and it creates procedures whereby a super majority vote is 
     required in the Senate to waive this requirement.
       If the Independent Payment Advisory Board fails to report 
     recommendations or never becomes operational, the Secretary 
     of the Department of Health and Human Services is given the 
     power to implement the cuts unilaterally.

  Well, you might think that, then, of course this would be under 
judicial or administrative review, but the Independent Payment Advisory 
Board is exempt from administrative or judicial review.
  No matter what your views are on the Affordable Care Act, we should 
all agree that giving this much power to a panel of unelected and 
unaccountable officials or a Cabinet Secretary, whoever he or she may 
be in any administration, giving away this much power is simply bad 
policy. The House shouldn't be for that.

                              {time}  1230

  This process is extremely complicated, and maybe that was the intent 
of the people who wrote the provision creating this board under the 
Affordable Care Act.
  I also fundamentally believe that the Independent Payment Advisory 
Board infringes on the separation of powers by shifting authority from 
the legislative to the executive branch. Not only does the creation of 
this board significantly limit Congress' authority, it eliminates 
needed transparency from hearings and debate. It eliminates any 
meaningful opportunity for stakeholder input.
  I believe leaving Medicare payment decisions in the hands of those 
who are unelected and unaccountable, with little congressional 
oversight, will actually harm seniors' access to quality healthcare.
  Congress has played an integral role in shaping policies that best 
reflect the needs of our districts and our States, and our constituents 
demand that. That is the reason they sent us here.
  Lastly, as a physician, I treasure the doctor-patient relationship. I 
believe we must do more to honor this relationship and prevent the 
Federal Government from further eroding this precious commodity.
  Mr. Speaker, I reserve the balance of my time.
  Ms. SLAUGHTER. Mr. Speaker, I yield myself such time as I may 
consume, and I thank the gentleman for yielding me the customary 30 
minutes.
  Mr. Speaker, the Independent Payment Advisory Board was created, in 
fact, by the Affordable Care Act, as we have heard. It will be a 15-
member panel composed of Presidentially appointed and Senate-confirmed 
experts charged with developing proposals to prevent Medicare costs 
from getting too high. It is about fiscal prudence.
  The majority and its allies, however, spread many mistruths about the 
board. It has even been called a death panel, if you remember that. In 
reality, nothing could be further from the truth. Its recommendations 
may not increase cost-sharing premiums or taxes, or reduce benefits. 
They have no way to do that.
  Not a single soul has been nominated to the board. It is not yet 
instituted as an entity. Today, in the absence of an appointed board, 
the Secretary of Health and Human Services is directed to submit 
recommendations to Congress if a trigger is met.
  The independent Medicare actuaries predict that this board will not 
be triggered until at least 2021, 4 years from now.
  Mr. Speaker, I think we have to ask: Why are we spending time today, 
with everything facing us, addressing a problem that could exist 4 
years from now? Is the majority so desperate to undermine the 
Affordable Care Act that they are repealing a panel whose sole purpose 
is keeping Medicare costs in line?
  According to Gallup, 55 percent of the public approves of the 
healthcare law. They want to see it strengthened, not eviscerated.
  In contrast, under the majority's leadership, Congress has an 
approval rating of just 13 percent.
  Should 13 percent be telling 55 percent what they need to do?
  Instead, since the majority has so far been unable to repeal it, they 
are going to undermine it brick by brick. The President is even 
sabotaging the Affordable Care Act administratively, slashing the 
budget to publicize the law by 90 percent, and cutting the open 
enrollment period in half.
  In the interest of public service, let me say that the enrollment 
period started yesterday and continues to December 15. Please go and 
take care of your health insurance.
  What the White House has done is make a direct attempt to cause chaos 
to weaken signups under the open enrollment period that began this 
week.
  The Kaiser Family Foundation estimated that, as a result of the 
Affordable Care Act, Medicare growth has been historically low. The 
growth in healthcare prices is at its lowest level in 50 years. The 
nonpartisan Congressional Budget Office projected that Medicare growth 
rates will remain beneath this panel's targets until 2021, hence the 
reason for not doing a panel for 4 more years.
  It is really too bad that this Congress and the majority insist on 
sabotaging

[[Page H8397]]

the Affordable Care Act, chipping away at its benefits. We should be 
strengthening it. Remember that every President since Theodore 
Roosevelt just about has tried to do a healthcare bill like the one 
that we have today. Perhaps just because Barack Obama did it that there 
is so much problem with it in the majority.
  There is a bipartisan Senate bill crafted by Senator Alexander and 
Senator Patty Murray that the nonpartisan Congressional Budget Office 
found last week would save money, stabilize the insurance marketplace, 
and reduce the debt by $3.8 billion. That is all without anyone losing 
their insurance.
  Why won't we take up that bill?
  We never get an answer for that question.
  What is it about trying to take healthcare away from poor people or 
that we won't put a bill on the floor that has all the advantages and 
savings that we know and that is totally bipartisan? Is it because the 
majority knows it will pass?
  Our Nation has urgent problems. Our infrastructure is crumbling, 
education costs skyrocket so high so fast that it is unattainable to 
many students. We desperately need to stabilize our health insurance 
markets by passing the compromise by Senators Alexander and Murray. 
That is what we should be doing here today.
  There are Members on both sides of the aisle who want to see 
improvements to the board, but that is not what the bill does. It 
terminates it altogether. It is the wrong approach at definitely the 
wrong time.
  Regardless of what you think about this board, we should be able to 
agree that this Congress has more important things to do than address a 
problem that might not exist for 4 years, if at all.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield 5 minutes to the gentleman from 
Tennessee (Mr. Roe), the chief sponsor of the bill.

  Mr. ROE of Tennessee. Mr. Speaker, I rise today in support of the 
rule for my bill, H.R. 849, the Protecting Seniors' Access to Medicare 
Act of 2017.
  Mr. Speaker, this bill would repeal the Independent Payment Advisory 
Board, or IPAB, which was created solely as a cost containment 
mechanism as part of the Affordable Care Act. It has nothing to do 
about quality of care or access to care. I can't think of anything more 
important, Mr. Speaker, that this Congress should be doing than 
providing quality care and access to care for our senior citizens of 
this country, some 58 million of them.
  Whatever your feelings may be about the ACA, this provision has had 
strong bipartisan opposition from its beginning, and it was not 
contained in the House Democrat's version of the bill, but was jammed 
in by the Senate at the end.
  If you still need convincing on just how unpopular this provision of 
the law is, ask yourself: How often do we see a bill come to the floor 
under a rule that has 270 bipartisan cosponsors?
  Passing this bill will send a strong message to our Senate colleagues 
that the time to act is now.
  Mr. Speaker, the overwhelming bipartisan support for Members is only 
outdone by the overwhelming nationwide coalition of support.
  Mr. Speaker, I include in the Record a letter from the Protect My 
Doctor and Me coalition, a letter that has been signed by nearly 800 
groups representing patients, providers, and all sectors of the 
healthcare industry with support in all 50 States.

                                                September 6, 2017.
       Dear Member of Congress: The undersigned organizations--
     representing Medicare beneficiaries and patients, all sectors 
     of the healthcare industry as well as employers and other 
     purchasers of health care--believe strongly that the Medicare 
     program must protect patient access to quality healthcare. 
     The Independent Payment Advisory Board (IPAB), a provision of 
     the Patient Protection and Affordable Care Act (PPACA), not 
     only poses a threat to that access but also, once activated, 
     will shift healthcare costs to consumers in the private 
     sector and infringe upon the decisionmaking responsibilities 
     and prerogatives of the Congress. We request your support to 
     repeal IPAB.
       IPAB, as constructed under PPACA, is a board comprised of 
     Presidential appointees who will be charged with making 
     recommendations to cut Medicare expenditures if spending 
     growth reaches an arbitrary level. Once the Secretary of 
     Health and Human Services (HHS) implements an IPAB 
     recommendation, that action is not subject to administrative 
     or judicial review. As constructed, IPAB is granted 
     unprecedented powers--even the ability to change laws 
     previously enacted by Congress--with virtually no oversight.
       The potential impact of this board causes deep concern 
     among our organizations and the millions of Americans we 
     represent. IPAB proponents suggest that the board will be an 
     asset in developing needed healthcare delivery reforms. That 
     goal, however, is not realistically achievable. The law 
     requires IPAB to achieve scoreable savings within a one-year 
     time period. Thus, instead of pursuing long-term reforms that 
     may not achieve immediate savings, IPAB is more likely to 
     consider short-term savings in the form of payment cuts for 
     healthcare providers. This was, in fact, the conclusion of 
     the Congressional Budget Office, which stated that IPAB is 
     most likely to focus on payment rates or methodologies for 
     services provided by non-exempt providers.
       This would be devastating for patients, affecting access to 
     care and innovative therapies. Already, the number of 
     physicians unable to accept new Medicare patients due to low 
     reimbursement rates has been increasing over the past several 
     years. IPAB-generated payment reductions would only increase 
     the access difficulties faced by too many Medicare 
     beneficiaries. Furthermore, payment reductions to Medicare 
     providers will almost certainly result in a shifting of 
     health costs to employers and consumers in the private 
     sector.
       Under IPAB's provisions, the responsibility for enacting 
     healthcare system changes of this magnitude would be 
     transferred from the legislative branch to the executive. 
     More specifically, an unelected board without adequate 
     oversight or accountability would be taking actions 
     historically reserved for the public's elected 
     representatives in the U.S. House and Senate. This is an 
     unacceptable decisionmaking process for a program that 
     millions of our nation's seniors and individuals with 
     disabilities rely upon.
       Moreover, if IPAB does not act within the law's required 
     timeframe or if IPAB members are not appointed by the 
     President or confirmed by the Senate, the law transfers 
     IPAB's responsibilities solely to the HHS Secretary. This 
     places an enormous degree of power in the hands of one 
     unelected individual.
       We strongly support bringing greater cost-efficiency to the 
     Medicare program. We also advocate continuing efforts to 
     improve the quality of care delivered to Medicare 
     beneficiaries.
       The Independent Payment Advisory Board will achieve neither 
     of these objectives and will only weaken, not strengthen, a 
     program critical to the health and well-being of current and 
     future beneficiaries. We urge Congress to eliminate the IPAB 
     provision.
           Sincerely,
       1 in 9: The Long Island Breast Cancer Action Coalition; 60 
     Plus Alabama; 60 Plus Association; A Partnership of 
     Diabetics; Abbott; Actelion Pharmaceuticals; Action CF; ADAP 
     Advocacy Association (aaa+); AdvaMed--the Advanced Medical 
     Technology Association; Advocacy Council of ACAAI; Advocates 
     for Responsible Care (ARxC); AIDS Alliance for Women, 
     Infants, Children, Youth & Families; AIDS Community Research 
     Initiative of America; AIDS CT; AIDS Foundation of Chicago; 
     AIDS Outreach Montana; AIDS Resource Center Ohio; AIDS 
     Response Seacoast; AIDS Services for the Monadnock Region; 
     Alabama ACEP.
       Alabama Association of Ambulatory Surgery Centers; Alabama 
     Council of Community Mental Health Boards; Alabama Hospital 
     Association; Alabama Lifespan Respite Resource Network; 
     Alabama Podiatric Medical Association; Alabama Society for 
     Clinical Social Work; Alabama Society for the Rheumatic 
     Diseases; Alaska Behavioral Health Association; Alaska ACEP; 
     Alaska Rheumatology Alliance; Alaska State Medical 
     Association; Alliance for Patient Access; Alliance of 
     Specialty Medicine; Alzheimer's & Dementia Alliance of 
     Wisconsin; Alzheimer's Arkansas; Alzheimer's Association--
     Capital of Texas Chapter; Alzheimer's Texas; American Academy 
     of Allergy, Asthma & Immunology; American Academy of 
     Dermatology Association; American Academy of Facial Plastic 
     and Reconstructive Surgery.
       American Academy of Neurology; American Academy of 
     Ophthalmology; American Academy of Otolaryngology-Head and 
     Neck Surgery; American Academy of Physical Medicine & 
     Rehabilitation; American Association for Hand 
     Surgery; American Association for Pediatric Ophthalmology 
     and Strabismus; American Association of Clinical 
     Endocrinologists; American Association of Clinical 
     Urologists; American Association of Hip and Knee Surgeons; 
     American Association of Neurological Surgeons; American 
     Association of Oral and Maxillofacial Surgeons; American 
     Association of Orthopaedic Surgeons; American Autoimmune 
     Related Diseases Association; American Behcet's Disease 
     Association; American College of Allergy, Asthma & 
     Immunology; American College of Cardiology; American 
     College of Emergency Physicians (ACEP); American College 
     of Mohs Surgery; American College of Osteopathic Family 
     Physicians; American College of Osteopathic Surgeons.
       American College of Radiology; American College of 
     Rheumatology; American College of Surgeons; American Congress 
     of Obstetricians & Gynecologists; American Congress of

[[Page H8398]]

     Obstetricians & Gynecologists, Oklahoma Chapter; American 
     Gastroenterological Association; American Glaucoma Society; 
     American Kidney Fund; American Liver Foundation; American 
     Liver Foundation Pacific Coast Division; American Medical 
     Association; American Military Society; American Nurses 
     Association; American Orthopaedic Foot and Ankle Society; 
     American Orthopaedic Society for Sports Medicine; American 
     Osteopathic Academy of Orthopedics; American Osteopathic 
     Association; American Osteopathic College of Rheumatology; 
     American Physical Therapy Association; American Podiatric 
     Medical Association.
       American Shoulder and Elbow Surgeons; American Society for 
     Dermatologic Surgery Association; American Society for Mohs 
     Surgery; American Society for Surgery of the Hand; American 
     Society of Anesthesiologists; American Society of Cataract 
     and Refractive Surgery; American Society of Echocardiography; 
     American Society of Nuclear Cardiology; American Society of 
     Ophthalmic Administrators; American Society of Ophthalmic 
     Plastic and Reconstructive Surgery; American Society of 
     Plastic Surgeons; American Spinal Injury Association; 
     American Urological Association; American Uveitis Society; 
     AmerisourceBergen; Amgen; AMN Healthcare; Arizona Bioindustry 
     Association (AZBio); Arizona College of Emergency Physicians; 
     Arizona Radiological Society.
       Arizona United Rheumatology Alliance; Arizona Urological 
     Society; Arkansas Chapter ACEP; Arkansas Medical Society; 
     Arkansas Ophthalmological Society; Arkansas Orthopaedic 
     Society; Arkansas Podiatric Medical Association; Arkansas 
     Rheumatology Association; Arthritis Foundation; Arthritis 
     Foundation South Central Region; Arthroscopy Association of 
     North America; Ascension; Association of Black Cardiologists; 
     Association of University Professors in Ophthalmology; Asthma 
     and Allergy Foundation of America; Asthma and Allergy 
     Foundation of America, New England Chapter; Atrius Health; 
     Austin Radiological Association; BEACON--Biomedical 
     Engineering Alliance & Consortium; Better Medicare Alliance.
       Bingham County Senior Center; Bio Nebraska Life Sciences 
     Association; BioBuzz Workforce Foundation; Biocom; 
     BioFlorida; BIOForward; BioHouston; BioKansas; BioNJ; 
     BioNorthTX; BioOhio; Bioscience Association of West Virginia; 
     Biotechnology Industry Organization (BIO); BioUtah; 
     Birmingham Neurosurgery and Spine Group, PC; Brain Injury 
     Alliance of Oregon; Brain Injury Association of Nebraska; 
     California Academy of Eye Physicians and Surgeons; California 
     ACEP; California Asian Pacific Chamber of Commerce; 
     California Association of Health Facilities; California 
     Association of Neurological Surgeons, Inc; California Chronic 
     Care Coalition.
       California Health Collaborative, California Hepatitis C 
     Task Force; California Life Sciences Association--CLSA; 
     California Medical Association California Orthopaedic 
     Association; California Podiatric Medical Association; 
     California Rheumatology Alliance; California Senior 
     Advocates League; California Society for Cardiac 
     Rehabilitation; California Urological Association; 
     Cambridge Chamber of Commerce; Campbell Clinic; Caregiver 
     Action Network; Center for Health Care Services; Center 
     for Healthcare Innovation; Center of Health Engagement; 
     Central Coast Medical Society; Central Florida Behavioral 
     Health Network; Centro de mi Salud; Cervical Spine 
     Research Society.
       Charleston Parkinson's Support Group; Chattanooga-Hamilton 
     County Medical Society; Chemed Corporation; Citrus Council 
     NKFF; City of New Orleans; Cleveland Clinic; CNY HIV Care 
     Network; COAAA; Coalition of Asian-American IPA; Coalition of 
     State Rheumatology Organizations (CSRO); Colon Cancer 
     Alliance; Colorado BioScience Association; Colorado Cross-
     Disability Coalition; Colorado Gerontological Society; 
     Colorado Medical Society; Colorado Podiatric Medical 
     Association; Colorado Radiological Society; Colorado 
     Rheumatology Association; Colorado Society of Eye Physicans & 
     Surgeons; Colorado's Insurance Consultant, LLC.
       Communicating for America, Inc.; Community Access National 
     Network (CANN); Community Health Action Network; Community 
     Health Charities of Nebraska; Community Liver Alliance; 
     Community Oncology Alliance; Congress of Neurological 
     Surgeons; Connecticut Orthopaedic Society; Connecticut 
     Podiatric Medical Association; Council for Affordable Health 
     Coverage; Council of State Neurosurgical Societies; CPEM, 
     Inc; Crohn's & Colitis Foundation of America, Georgia 
     Chapter; CSRA Area Agency on Aging; Delaware Academy of 
     Ophthalmology; Delaware Ecumenical Council on Children and 
     Families; Delaware HIV Consortium; Dia de la Mujer Latina; 
     Easter Seals; Easter Seals Central and Southeast Ohio Inc.
       Easter Seals Central Texas; Easter Seals Iowa; Easter Seals 
     Massachusetts; Easter Seals Nebraska; Easter Seals North 
     Georgia; Easter Seals of Southeastern PA; Eastern Orthopaedic 
     Association; EDSers United Foundation; Eisai Inc.; Eli Lilly 
     and Company; ELLAS; Emergency Department Practice Management 
     Association; Enchantment Healthcare; Endometriosis 
     Association; Enterprise Family Healthcare; Epilepsy 
     Association of the Big Bend; Epilepsy Foundation of Greater 
     Chicago; Epilepsy Foundation of Greater Southern Illinois; 
     Epilepsy Foundation of Hawaii; Epilepsy Foundation of San 
     Diego County.
       Epilepsy Foundation of Western Wisconsin; Familia Unida 
     Living with MS; FCEP Florida College of Emergency Physicians; 
     Federation of American Hospitals; Federation of Families for 
     Children's Mental Health--CO Chapter; First Step House; Fleet 
     Reserve Association; Florida Allergy, Asthma & Immunology 
     Society; Florida Neurosurgical Society; Florida Orthopaedic 
     Society; Florida Osteopathic Medical Association; Florida 
     Partners in Crisis; Florida Podiatric Medical Association; 
     Florida Society of Dermatology and Dermatologic Surgery; 
     Florida Society of Rheumatology; Florida State Hispanic 
     Chamber of Commerce; Friends of Our Lady of Good Counsel; 
     Geaux Group; Georgia Bio; Georgia College of Emergency 
     Physicians.
       Georgia Commission on Women; Georgia Neurosurgical Society; 
     Georgia Orthopaedic Society; Georgia Osteoporosis Initiative; 
     Georgia Podiatric Medical Association; Georgia Society of 
     Clinical Oncology;
       Georgia Society of Dermatology and Dermatological Surgery; 
     Georgia Society of Ophthalmology; Georgia Society of 
     Rheumatology; Georgia Women's Institute; Global Genes; Global 
     Healthy Living Foundation; Global Liver Institute; Granite 
     State Taxpayers; Greater North Dakota Chamber; Greater 
     Providence Chamber of Commerce; H.E.A.L.S of the South 
     (Hepatitis Education, Awareness and Liver Support); Hawaii 
     ACEP; Hawaii Independent Physicians Association; Hawaii 
     Medical Association.
       Hawaii Podiatric Medical Association; Health Agents for 
     America, Inc. (HAFA); Healthcare Innovation Exchange; 
     HealthCare Institute of New Jersey (HINJ); Healthcare 
     Leadership Council; HealthHIV; Healthy African American 
     Families; Hispanic CREO; Home Care Association of Washington; 
     Hopkins County Memorial Hospital; ICAN, International Cancer 
     Advocacy Network; Idaho Association of Nurse Anesthetists; 
     Idaho Medical Association; Idaho Orthopaedic Association; 
     Idaho Orthopaedic Society; Idaho Osteopathic Physicians 
     Association; Idaho Podiatric Medical Association; Idaho State 
     Dental Association; Illinois Biotechnology Innovation 
     Organization; Illinois College of Emergency Physicians.
       Illinois Manufacturers' Association; Illinois Neurological 
     Institute; Illinois Podiatric Medical Association; Illinois 
     Society of Eye Physicians & Surgeons; Illinois State 
     Ambulance Association; Illinois State Medical Society; 
     INACEP; Independent Medical Providers Action Council; Indiana 
     Academy of Ophthalmology; Indiana Health Industry Forum; 
     Indiana Medical Device Manufacturers Council; Indiana 
     Neurosurgical State Society; Indiana Podiatric Medical 
     Association; Indiana State Medical Association; Indiana 
     University Health, Inc.; Infectious Diseases Society of 
     America; Insight Human Services; Integral Rheumatology and 
     Immunology Specialists (IRIS); International Foundation for 
     Autoimmune Arthritis; International Institute of Human 
     Empowerment.
       International Society for the Advancement of Spine Surgery; 
     ION Solutions; Iowa Academy of Ophthalmology; Iowa ACEP; Iowa 
     Biotechnology Association; Iowa Orthopaedic Society; Iowa 
     Osteopathic Medical Association; Iowa Podiatric Medical 
     Society; Iowa State Grange; J. Robert Gladden Orthopaedic 
     Society; JobKeeper Alliance; Johnson & Johnson; Julian CNA 
     Training School; Kansas Association of Osteopathic Medicine; 
     Kansas Orthopaedic Society; Kansas Podiatric Medical 
     Association; Kansas Rheumatology Alliance; Kansas Society of 
     Eye Physicians & Surgeons; Kansas Urological Association; 
     Kendall Square Association.
       Kentuckiana Rheumatology Alliance; Kentucky Academy of Eye 
     Physicians and Surgeons; Kentucky ACEP; Kentucky Chamber of 
     Commerce; Kentucky Life Sciences Council; Kentucky Medical 
     Association; Kentucky Psychiatric Medical Association; Kidney 
     Cancer Association; Kidney Care Partners; Latin American 
     Chamber of Commerce; Latino Commission on AIDS; Latino 
     Diabetes Association; Licensed Professional Counselors 
     Association; Life Science Tennessee; Life Sciences Greenhouse 
     of Central PA; Life Sciences Pennsylvania; Limb Lengthening 
     and Reconstruction Society; Louisiana Alumni, Sigma Kappa 
     GNO; Louisiana Association of Neurological Surgeons; 
     Louisiana Liberty 64.
       Louisiana Lifespan Respite Coalition; Louisiana Orthopaedic 
     Association; Louisiana Podiatric Medical Association; 
     Louisiana Womens' Network; Lower New York Chapter, The 
     American Association of Clinical Endocrinologists; Lupus 
     Alliance of Long Island/Queens; Lupus Alliance of Upstate New 
     York; Lupus and Allied Diseases Association;
       Lupus Foundation New England; Lupus Foundation of America; 
     Lupus Foundation of America, DC/MD/VA Chapter; Lupus 
     Foundation of Arkansas, Inc.; Lupus Foundation of Colorado; 
     Lupus Foundation of Florida, Inc.; Lupus Foundation of 
     Northern California; Lupus Foundation of PA; Lupus Foundation 
     of Southern California; Lupus LA; Lupus Society of Illinois; 
     MA Health Council.
       MACEP--Massachusetts College of Emergency Physicians; Maine 
     ACEP; Malecare Cancer Support; Mallinckrodt Pharmaceuticals; 
     Manufacture Alabama; Maryland Chapter American College of 
     Emergency Physicians; Maryland Orthopaedic Association; 
     Maryland Society of Eye Physicians and Surgeons; 
     Massachusetts Association for Mental Health, Inc; 
     Massachusetts, Maine, and New Hampshire Rheumatology 
     Association; Massachusetts Medical Device Industry

[[Page H8399]]

     Council (MassMEDIC); Massachusetts Medical Society; 
     Massachusetts Orthopaedic Association; Massachusetts Society 
     of Eye Physicians and Surgeons; MassBio; Maxim Healthcare 
     Services; Maxima Home Health LLC; Meals on Wheels North 
     Carolina; MedChi, The Maryland State Medical Society; Medical 
     Alley.
       Medical Association of Georgia; Medical Association of the 
     State of Alabama; Medical Device Manufacturers Association 
     (MDMA); Medical News; Medical Oncology Association of 
     Southern California; Medical Society of New Jersey; Medical 
     Society of the State of New York; Medical University of South 
     Carolina (MUSC); MedTech Association; MemorialCare Health 
     System; Mended Hearts; Men's Health Network; Mental Health 
     America of Montana; Mental Health Systems; Merck; 
     Metropolitan Milwaukee Association of Commerce; Michigan 
     Association of Neurological Surgeons; Michigan Association of 
     Osteopathic Family Physicians; Michigan Biosciences Industry 
     Association--MichBio; Michigan Chamber of Commerce.
       Michigan College of Emergency Physicians; Michigan Lupus 
     Foundation; Michigan Orthopaedic Society; Michigan 
     Osteopathic Association; Michigan Rheumatism Society; 
     Michigan Society of Eye Physicians and Surgeons; Minnesota 
     Academy of Ophthalmology; Minnesota Chapter ACEP; Minnesota 
     Medical Association; Minnesota Neurosurgical Society; 
     Minnesota Organization of Registered Nurses; Minnesota 
     Orthopaedic Society; Minnesota State Grange; Mississippi 
     Academy of Eye Physicians and Surgeons; Mississippi 
     Osteopathic Medical Association; Mississippi Society of Eye 
     Physicians and Surgeons; Mississippi State Medical 
     Association; Missouri Ambulance Association; Missouri 
     Association of Rural Health Clinics; Missouri Biotechnology 
     Association.
       Missouri Chamber of Commerce and Industry; Missouri 
     Hospital Association; Missouri State Medical Association; 
     Missouri Urological Society; MoCEP--Missouri College of 
     Emergency Physicians; Montana ACEP; Montana BioScience 
     Alliance; Montana Chamber of Commerce; Montana Medical 
     Association; Montana Orthopedic Society; Multiple Sclerosis 
     Resources of Central New York, Inc; Musculoskeletal Tumor 
     Society; NAMI--Sheridan; NAMI Alabama; NAMI Anchorage; NAMI 
     Buffalo & Erie County; NAMI Clackamas; NAMI Florida; NAMI 
     Greater Des Moines; NAMI Hernando.
       NAMI Illinois; NAMI Indiana; NAMI Iowa; NAMI Kansas; NAMI 
     Knox Licking County Ohio; NAMI Lewis County; NAMI Maine; NAMI 
     Maryland; NAMI Mass; NAMI Minnesota; NAMI Montana; NAMI 
     Nebraska; NAMI Nevada; NAMI New Mexico; NAMI North 
     Carolina; NAMI North Dakota; NAMI Northern Nevada; NAMI 
     Ohio; NAMI Rochester; NAMI Sioux Falls.
       NAMI Skagit; NAMI Stark County; NAMI Upper Valley Idaho; 
     NAMI Virginia; NAMI Washington; NAMI York County; NASW Texas 
     Chapter; National Alliance on Mental Illness; National 
     Alliance on Mental Illness of Central Suffolk; National 
     Alliance on Mental Illness of Park County, WY; National 
     Association for Home Care & Hospice; National Association for 
     Uniformed Services; National Association of Hepatitis Task 
     Forces; National Association of Manufacturers; National 
     Association of Nutrition and Aging Services Programs 
     (NANASP); National Association of Social Workers--NC Chapter; 
     National Association of Social Workers--Virginia Chapter; 
     National Association of Spine Specialists; National Center 
     for Policy Analysis; National Coalition for LGBT Health.
       National Council for Behavioral Health; National Council of 
     Asian Pacific Islander Physicians; National Fibromyalgia & 
     Chronic Pain Association; National Grange; National Hispanic 
     Medical Association; National Minority Quality Forum; 
     National Psoriasis Foundation; National Retail Federation; 
     National Rural Health Association; National Spasmodic 
     Torticollis Association; NCCEP North Carolina College of 
     Emergency Physicians; NC State Grange; Nebraska Medical 
     Association; Nebraska Rural Health Association; Nebraska 
     State Grange; Nebraska Taxpayers for Freedom; Neuro Network 
     Partners; Neurofibromatosis, Inc. Mid-Atlantic; Neurosurgical 
     Society of Kentucky; Nevada Academy of Ophthalmology.
       Nevada Chapter ACEP; Nevada Health Care Association; Nevada 
     Orthopaedic Society; New England Biotech Association; New 
     Jersey Academy of Ophthalmology; New Jersey Association of 
     Mental Health and Addiction Agencies, Inc.; New Jersey 
     Chapter ACEP; New Jersey Mayors Committee on Life Science; 
     New Jersey Orthopaedic Society; New Jersey Rheumatology 
     Association; New Jersey State Nurses Association; New Mexico 
     Biotechnology & Biomedical Association (NMBio); New Mexico 
     Association of Nurse Anesthetists; New Mexico Chapter ACEP; 
     New Mexico Health Care Association; New Mexico Podiatric 
     Medical Association; New York ACEP; New York Regional Society 
     of Plastic Surgeons; New York State Neurological Society; New 
     York State Ophthalmological Society.
       New York State Rheumatology Society; New York State Society 
     of Orthopaedic Surgeons, Inc.; New York State Society of 
     Plastic Surgeons, Inc; New York State Urological Society; 
     NHACEP; North American Neuro-Ophthalmology Society; North 
     Carolina Alliance for Retired Americans; North Carolina 
     Biosciences Organization; North Carolina Chamber; North 
     Carolina Foot & Ankle Society; North Carolina Psychological 
     Association; North Carolina Rheumatology Association; North 
     Carolina Society of Eye Physicians and Surgeons; North Dakota 
     Chapter ACEP; North Dakota Medical Association; North Dakota 
     Podiatric Medical Association; North Dakota Society of Eye 
     Physicians and Surgeons; North Macon Family Healthcare 
     Associates; Northeast Kidney Foundation; Northern Utah 
     Coalition, Inc.
       Northwest Urological Society; Novartis Pharmaceuticals 
     Corporation; Occasional Riot; Ogden Branch of the NAACP; Ohio 
     ACEP; Ohio Association of County Behavioral Health 
     Authorities; Ohio Association of Medical Equipment Services; 
     Ohio Association of Rheumatology; Ohio Chamber of Commerce; 
     Ohio Council for Home Care and Hospice; Ohio Foot and Ankle 
     Medical Association; Ohio Jewish Communities;
       Ohio Orthopaedic Society; Ohio Osteopathic Association; 
     Ohio State Grange; Ohio Veterans United; OKBio; Oklahoma 
     Academy of Ophthalmology; Oklahoma ACEP; Oklahoma Association 
     of Nurse Anesthetists.
       Oklahoma Osteopathic Association; Oklahoma Podiatric 
     Medical Association, Inc.; Oklahoma Society of 
     Anesthesiologists; Oklahoma Society of Oral and Maxillofacial 
     Surgeons; Oklahoma State Medical Association; ONEgeneration; 
     Oregon Academy of Opthalmology; Oregon Chapter of American 
     College of Emergency Physicians; Oregon Medical Association; 
     Oregon Neurosurgical Society; Oregon Podiatric Medical 
     Association; Oregon Rheumatology Alliance; Oregon Society of 
     Anesthesiologists; Oregon Urological Society; Orthopaedic 
     Research Society; Orthopaedic Society of Oklahoma; 
     Orthopaedic Trauma Association; Osteopathic Physicians & 
     Surgeons of California; Pacific Northwest Chapter of TRIO; PA 
     Prostate Cancer Coalition.
       Partnership to Fight Chronic Disease; PCa Blue Inc.; 
     Pediatric Orthopaedic Society of North America; Pennsylvania 
     Chamber of Business and Industry; Pennsylvania College of 
     Emergency Physicians; Pennsylvania Neurosurgical Society; 
     Pennsylvania State Grange; Perennial Services Network; 
     Pfizer; Pharmaceutical Care Management Association; 
     Philadelphia Rheumatism Society; PhRMA; Plaza Community 
     Services; Premier healthcare alliance; Prescription 
     Assistance Network of Stark County, Inc; Prevent Blindness 
     Iowa; Prevent Blindness, Ohio Affiliate; Progressive 
     Democrats of Central New Mexico; Progressive Leaders of 
     Louisiana; Prostate Health Education Network.
       Radiology Associates of Macon; Rainy Day Patriots; 
     Respiratory Health Association; RetireSafe; Rheumatism 
     Society of the District of Columbia; Rheumatology Alliance of 
     Louisiana; Rheumatology Association of Iowa; Rheumatology 
     Association of Minnesota and the Dakotas; Rheumatology 
     Association of Nevada; Rheumatology Society of North Texas; 
     Rhode Island Chapter ACEP; Rhode Island Medical Society; 
     Rhode Island Society of Eye Physicians and Surgeons; Rhode 
     Island Tech Collective; Rio Grande Valley Diabetes 
     Association; RIPMA; Rocky Mountain Stroke Center; RTI 
     Surgical Inc.; Rush To Live; SAGE Utah.
       Saint Agnes Healthcare; Salud U.S.A.; Sandhills Adult Day 
     Health Center, Inc.; San Diego County Podiatric Medical 
     Association; Sanofi US; SC Podiatric Medical Association 
     (SCPMA); Scoliosis Research Society; Sea Island Pediatrics; 
     Senior Connections, The Capital Area Agency on Aging; Seniors 
     Golden Hammer; Seniors Hospitality Center / Bonners Ferry 
     Senior Center; Sickle Cell Disease Association of Florida; 
     Sjogren's and Lupus Foundation of Hawaii; Sjogren's Syndrome 
     Foundation; Small Business & Entrepreneurship Council; Smile 
     Community Action Partnership; Society of Academic Urologists; 
     Society for Cardiovascular Angiography and Interventions; 
     Society for Vascular Surgery; Society of Military Orthopaedic 
     Surgeons.
       Society of Urologic Oncology; Solidarity Project Advocacy 
     Center; South Carolina BIO; South Carolina Hospital 
     Association; South Carolina Medical Association; South 
     Carolina Medical Group Management Association (SCMGMA); South 
     Carolina Nurses Association; South Carolina Orthopaedic 
     Association; South Carolina Rheumatism Society; South 
     Carolina Society of Ophthalmology; South Carolina Urological 
     Association; South Dakota Biotech; South Dakota State Medical 
     Association; South Dakota State Orthopaedic Society; South 
     Florida Cancer Association; Southern Orthopaedic 
     Association; State Chamber of Oklahoma; State of Texas 
     Association of Rheumatologists; State of Texas Kidney 
     Foundation; Statewide Independent Living Council of 
     Hawaii.
       StopAfib.org; Suicide Awareness Voices of Education; 
     Sunovion Pharmaceuticals Inc.; Survivors Cancer Action 
     Network; Takeda Pharmaceuticals, USA Inc.; TCEP Texas College 
     of Emergency Physicians; Tech Council of Maryland; Tennessee 
     Association of Long Term Care Physicians; Tennessee 
     Geriatrics Society; Tennessee Hemophilia and Bleeding 
     Disorders Foundation; Tennessee Medical Association; 
     Tennessee Orthopaedic Society; Tennessee Rheumatology 
     Society; Texas Association for Home Care and Hospice; Texas 
     Association of Business; Texas Association of Neurological 
     Surgeons; Texas BioAlliance; Texas Health Resources; Texas 
     Healthcare and Bioscience Institute; Texas Life-Sciences 
     Collaboration Center.
       Texas Medical Association; Texas Neurological Society; 
     Texas Nurse Practitioners; Texas Orthopaedic Association; 
     Texas Osteopathic Medical Association; Texas Pain Society; 
     Texas Radiological Society; Texas State

[[Page H8400]]

     Grange; The AIDS Institute; The Arc in Hawaii; The Arc of 
     Anchorage; The Benefits Consultancy; The Jewish Federations 
     of North America; The Macula Society; The Marilyn Fagan 
     Ovarian Cancer Patient Advocacy Program (ICAN-Hawaii); The 
     Meeting Group, Inc.; The Michael J. Fox Foundation for 
     Parkinson's Research; The National Association of Catholic 
     Nurses--U.S.A.; The National Catholic Bioethics Center; The 
     New England Council.
       The New Mexico Association for Home and Hospice Care; The 
     Retina Society; The Surgery Center of Huntsville; The US 
     Oncology Network; The Vision Care Center; The Wall Las 
     Memorias Project; Twin Falls Senior Center; U.S. Chamber of 
     Commerce; U.S. Pain Foundation; Union Pacific Railroad 
     Employees Health Systems; Urban Pain Institute; Utah 
     Advocates; Utah Medical Association; Utah Podiatric Medical 
     Association; Utah Pride Center; Utah State Orthopedic 
     Society; Utah Support Advocates for Recovery Awareness; 
     Vermont Medical Society; Vermont State Association of 
     Osteopathic Physicians & Surgeons, Inc.; Veterans Health 
     Council; Vietnam Veterans of America.
       Vietnamese Social Services of Minnesota; Virginia Bio; 
     Virginia Chamber of Commerce; Virginia Hispanic Chamber of 
     Commerce; Virginia Podiatric Medical Association; Virginia 
     Society of Eye Physicians and Surgeons; Visiting Nurse 
     Association; Visiting Nurse Association of Ohio; VITAS 
     Healthcare; Vizient, Inc.; Washington ACEP; Washington 
     Biotechnology & Biomedical Association; Washington 
     Rheumatology Alliance; Washington Rural Health Association; 
     Washington State Medical Association; Washington State 
     Orthopaedic Association; Washington State Podiatric Medical 
     Association; Washington State Prostate Cancer Coalition; 
     Washington State Urology Society; Wellness and Education 
     Community Action Health Network; Wellness Station.
       West Virginia Academy of Eye Physicians & Surgeons; West 
     Virginia Academy of Otolaryngology--Head and Neck Surgery, 
     Inc.; West Virginia Orthopaedic Society; West Virginia State 
     Rheumatology Society; Western Orthopaedic Association; 
     Western Section of the American Urological Association; 
     Wisconsin Academy of Nutrition and Dietetics; Wisconsin 
     Academy of Ophthalmology; Wisconsin Association of 
     Osteopathic Physicians & Surgeons (WAOPS); Wisconsin Hospital 
     Association; Wisconsin Manufacturers & Commerce; Wisconsin 
     Medical Society; Wisconsin Rheumatology Association; 
     Wisconsin State Grange.
       Wound Care Clinic--ESU; WPMA--Wisconsin Podiatric Medical 
     Association; Wyoming Chapter American College Emergency 
     Physicians; Wyoming Epilepsy Association; Wyoming Medical 
     Society; Wyoming Ophthalmological Society; ZERO--The End of 
     Prostate Cancer.

  Mr. ROE of Tennessee. Mr. Speaker, let me just read one paragraph:
  ``IPAB, as constructed under PPACA, is a board comprised of 
Presidential appointees who will be charged with making recommendations 
to cut Medicare expenditures if spending growth reaches an arbitrary 
level. Once the Secretary of Health and Human Services implements an 
IPAB recommendation, that action is not subject to administrative or 
judicial review. As constructed, IPAB is granted unprecedented powers--
even the ability to change laws previously enacted by Congress--with 
virtually no oversight.'' Peter Orszag, President Obama's Office of 
Management and Budget Director, said it was the largest transfer of 
power from the legislative branch to a bureaucratic branch since the 
Federal Reserve, and that is a mouthful.
  Democrats and Republicans may not always agree on how to get things 
done around here, but when you can bring 270 House Members together on 
one bill, it is pretty clear that something needs to be done 
immediately.
  We were lucky this summer that the Medicare trustees report indicated 
that IPAB would not trigger until 2021 or 2022, but our back is against 
the wall and we must act. We cannot afford to let 15 unelected, 
unaccountable bureaucrats make decisions for our Nation's 58 million 
Medicare enrollees with no checks from Congress.
  Mr. Speaker, I urge my colleagues to support this.
  I refer also to a bipartisan letter I signed on December 17, 2009, 
that was written to the Speaker of the House at that time, Nancy 
Pelosi, which said the following:
  ``Finally, as the people's elected representatives, we must oppose 
any proposal to create a board that would surrender our legislative 
authority and responsibility for a Medicare program to unelected, 
unaccountable officials within the very same branch of government that 
is charged with implementing the Medicare policies that affect so many 
Americans.''
  Mr. Speaker, I urge my colleagues to support this rule and support 
the final passage because that will show the American people you stand 
with America's seniors.
  Mr. BURGESS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Florida (Mr. Dunn), who is also a physician.
  Mr. DUNN. Mr. Speaker, I thank my friend for yielding me time.
  Mr. Speaker, I rise in support of Protecting Seniors' Access to 
Medicare Act, sponsored by my colleague and fellow physician, 
Representative Roe.
  ObamaCare's establishment of the Independent Payment Advisory Board, 
or IPAB, is perhaps the most insidious part of the Affordable Care Act.
  With IPAB, 15 unelected bureaucrats would be in power to make health 
coverage decisions for 55 million Americans who are Medicare 
beneficiaries. Care would be rationed, physicians like myself would be 
unable to pursue the course of treatment we think is appropriate for 
our patients, seniors would lose access to the best care, all without 
any input from Congress or any accountability to voters.
  With all of the divisiveness that we see in Washington, the IPAB 
repeal bill we consider today is genuinely bipartisan. Mr. Speaker, I 
urge my colleagues to give an overwhelming bipartisan vote and show the 
country we are serious about keeping our promises to our seniors.
  Mr. BURGESS. Mr. Speaker, I yield myself 1\1/2\ minutes.
  Mr. Speaker, I did want to delineate the membership of this board, as 
is outlined in the Affordable Care Act. The board will be appointed by 
the President with the advice and consent of the Senate, with the 
advice and consent of the Secretary or the Administrator of the Centers 
for Medicare and Medicaid Services, and the Administrator of the Health 
Resources and Services Administration. All of those individuals will 
serve as ex officio nonvoting members. But here are the qualifications 
for the actual board:
  ``The appointed membership of the board shall include individuals 
with national recognition for their expertise in health finance and 
economics, in actuarial science, health facility management, health 
plans, and integrated delivery systems, and reimbursement of healthcare 
facilities. . . .''
  Missing from that picture, of course, are the people who actually 
provide the care to people who are involved in that doctor-patient 
relationship. Almost as an afterthought, here at the end of that 
paragraph, ``allopathic and osteopathic physicians.''
  The other aspect is that no member of the board can receive outside 
income. That may be a good idea, but that guarantees there will not be 
a practicing physician on that board. I think that is a significant 
oversight.
  Mr. Speaker, I reserve the balance of my time.
  Ms. SLAUGHTER. Mr. Speaker, I yield myself 1 minute.
  Mr. Speaker, I am very troubled by this. I don't want to insult my 
learned colleagues, but it plainly says in the legislation that IPAB 
cannot ration healthcare, cannot raise taxes or increase deductibles 
and copayments. Under the current law, section 1899A, 42 U.S.C. clearly 
states: ``The proposal shall not include any recommendation to ration 
healthcare; raise revenues or Medicare beneficiary premiums; increase 
the cost sharing, including deductibles, coinsurance, and copayments; 
or otherwise restrict benefits or modify eligibility criteria.''

                              {time}  1245

  I regret I have to do that, because it is a direct contradiction of 
what my good friends on the other side have told the country and what I 
assume that they believe.
  Mr. Speaker, Russia interfered with our 2016 election. That much is 
clear from special counsel Mueller's investigation, which led to 
indictments against two Trump campaign aides. The legitimacy of our 
electoral system is at stake, and it is time the Republican-controlled 
Congress sets aside the partisan politics and treats this threat with 
the gravity it deserves.
  If we defeat the previous question, I will offer an amendment to the 
rule to bring up Representative Swalwell and Representative Cummings' 
bill, which would create a bipartisan commission to investigate the 
Russian interference in the 2016 election.

[[Page H8401]]

  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 
gentlewoman from New York?
  There was no objection.
  Ms. SLAUGHTER. Mr. Speaker, one of the worst political stories I have 
heard in my lifetime is what we just talked about, the ``death panel,'' 
what it is going to do, even though it is prohibited by the written law 
to do the things that it has been accused of being able to do. Most of 
that, PolitiFact talked about the death panel part of it and said that 
that was the 2009 lie of the year. But here we are, 8 years later, and 
we keep hearing mistruths about the panel and its intent. The board is 
about keeping Medicare growth in line, nothing more, nothing less.
  So let's be honest about what the bill really is about: attacking the 
Affordable Care Act. Regardless of what you think about the Independent 
Payment Advisory Board, the Nation has immediate problems today that 
deserve our attention, from healthcare to education, to infrastructure.
  We should not be taking this valuable House time talking about a 
board that may or may not come into existence 4 years from now. That is 
not what we need to deal with today. So I urge a ``no'' vote on the 
previous question and the rule.
  I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield 1 minute to the gentleman from 
Georgia (Mr. Carter).
  Mr. CARTER of Georgia. Mr. Speaker, ObamaCare was packed full of 
provisions that took power and healthcare choices away from the 
American people. One of the most egregious examples of ObamaCare's 
overreach is the Independent Payment Advisory Board, IPAB.
  The architects of ObamaCare designed the IPAB as a panel of 15 
unelected and unaccountable people who were tasked with making 
arbitrary cuts to Medicare after a certain level of spending is 
reached. Mr. Speaker, the American people elected Congress to make 
decisions on healthcare policy, and I know my constituents agree that 
Medicare is too important to be left in the hands of unaccountable 
people.
  The IPAB would take an ax to Medicare spending, adversely affecting 
untold numbers of vulnerable seniors, instead of allowing Congress to 
implement patient-centered reforms that increase value to seniors and 
lowers cost.
  The IPAB approach would lead to rationing healthcare, which would put 
bureaucrats--bureaucrats, not doctors--in charge of deciding what 
procedures folks would receive through Medicare.
  Mr. Speaker, the American people deserve thoughtful and deliberative 
decisions by their elected officials, and that is why I support 
repealing the IPAB, and I ask my colleagues to join me in doing so.
  Ms. SLAUGHTER. Mr. Speaker, I yield back the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield myself such time as I may consume.
  I recall things a little differently. I recall the lie of the year 
being, if you like your doctor, you can keep your doctor, but I guess 
that is a debate for another day.
  Mr. Speaker, today's rule provides for consideration of an important 
piece of legislation to protect seniors' access to healthcare from the 
ill-advised Medicare Independent Payment Advisory Board created by the 
Obama administration within the Affordable Care Act.
  I thank the authors, Chairman Brady and Dr. Roe, and the 270 House 
cosponsors of H.R. 849 for their thoughtful and bipartisan legislation, 
and I urge my colleagues to support the rule providing for 
consideration of this underlying bill, and then support the bill.
  Mr. ROE of Tennessee. Mr. Speaker, I would like to include in the 
Record the following letter:

                                Congress of the United States,

                                Washington, DC, December 17, 2009.
     Hon. Nancy Pelosi,
     Speaker, House of Representatives,
     Washington, DC.
       Dear Madam Speaker: In July, 75 members of the U.S. House 
     of Representatives wrote to express strong opposition to 
     proposals, such as the ``Independent Medicare Advisory 
     Council (IMAC) Act of 2009'' and the ``Medicare Payment 
     Advisory Commission (MedPAC) Reform Act of 2009'' (H.R 2718, 
     S. 1110, S. 1380), that would divest Congress of its 
     authority for Medicare payment policy and place this 
     responsibility in an executive branch commission or board. 
     This letter clearly stated opposition to the inclusion of 
     these or any other similar proposals in health reform or any 
     other legislation, but with recent developments, we, the 
     undersigned members, believe it is imperative to restate our 
     strong opposition to any proposal or legislation that would 
     place authority for Medicare payment policy in an unelected, 
     executive branch commission or board.
       Consistent with the July letter, on November 7, 2009, the 
     House passed the ``Affordable Health Care for America Act'' 
     (H.R. 3962) did not include provisions to create an unelected 
     Medicare board. Yet, at present, the Senate is considering 
     the ``Patient Protection and Affordable Care Act of 2009,'' 
     which includes provisions to create an ``Independent Medicare 
     Advisory Board'' (IMAB) that would effectively end Congress's 
     authority over Medicare payment policy.
       To create an unelected, unaccountable Medicare commission 
     as envisioned in the Senate's IMAB proposal would end 
     Congress's ability to shape Medicare to provide the best 
     policies for beneficiaries in our communities around the 
     country. Through the legislative process, and from Medicare's 
     beginning, Members have been able to represent the needs of 
     their communities by improving benefits for seniors and the 
     disabled, affecting policies that fill the health care 
     workforce pipeline, and ensuring that hospitals are equipped 
     to care for diverse populations across our individual 
     districts. Such a responsibility is one that is not taken, 
     nor should be given away, lightly.
       These proposals would severely limit Congressional 
     oversight of the Medicare program, and to place this 
     authority within the executive branch, without Congressional 
     oversight or judicial review, would eliminate the 
     transparency of Congressional hearings and debate. Without 
     the open and transparent legislative process, Medicare 
     beneficiaries and the range of providers who care for them 
     would be greatly limited in their ability to help develop and 
     implement new policies that improve the health care of our 
     nation's seniors. An executive branch Medicare board would 
     also effectively eliminate Congress's ability to work with 
     the Centers for Medicare and Medicaid Services to create and 
     implement demonstration and pilot projects designed to 
     evaluate new and advanced policies such as home care for the 
     elderly, the patient-centered medical home, new less invasive 
     surgical procedures, collaborative efforts between hospitals 
     and physicians, and programs designed to eliminate fraud and 
     abuse.
       The creation of a Medicare board would also effectively 
     eliminate state and community input into the Medicare 
     program, removing the ability to develop and implement 
     policies expressly applicable to different patient 
     populations. Instead, national policies that would flow from 
     such a board would ignore the significant differences and 
     health care needs of states and communities. Geographic and 
     demographic variances that exist in our nation's health care 
     system and patient populations would be dangerously 
     disregarded. Furthermore, all providers in all states would 
     be required to comply even if these policies were detrimental 
     to the patients they serve. Such a commission could not only 
     threaten the ability of Medicare beneficiaries, but of all 
     Americans, to access the care they need.
       Finally, as the people's elected representatives, we must 
     oppose any proposal to create a board that would surrender 
     our legislative authority and responsibility for the Medicare 
     program to unelected, unaccountable officials within the very 
     same branch of government that is charged with implementing 
     the Medicare policies that affect so many Americans. 
     Therefore, we must strongly oppose the creation of IMAB, 
     IMAC, a reconstituted MedPAC or any Medicare board or 
     commission that would undermine our ability to represent the 
     needs of the seniors and disabled in our own communities. 
     Again, we urge you to reject the inclusion of these or any 
     like proposal in health reform or any other legislation.
           Sincerely,
       Richard Neal, Gary Ackerman, Shelley Berkley, Brian 
     Bilbray, Tim Bishop, Marsha Blackburn, Mary Bono Mack, Ginny 
     Brown-Waite, Michael Burgess, G.K. Butterfield, Steve Buyer, 
     Kendrick Calvert, Michael Capuano, Russ Carnahan, Bill 
     Cassidy, Donna Christensen, Judy Chu, Yvette Clarke, William 
     Lacy Clay, Joe Courtney.
       Joseph Crowley, Susan Davis, William Delahunt, Eliot Engel, 
     Sam Farr, Bob Filner, John Fleming, Barney Frank, Phil 
     Gingrey, Alan Grayson, Gene Green, Brett Guthrie, John Hall, 
     Maurice Hinchey, Mike Honda, Steve Israel, Hank Johnson, 
     Steve Kagen, John Lewis, Nita Lowey.
       Steve Lynch, Daniel Maffei, Carolyn Maloney, Edward Markey, 
     Eric Massa, Doris Matsui, Jim McDermott, Jim McGovern, Jerry 
     McNerney, Kendrick Meek, Gregory Meeks, Jerrold Nadler, John 
     Olver, Bill Pascrell, Donald Payne, Laura Richardson, Phil 
     Roe, Mike Rogers, Dana Rohrabacher.
       Bobby Rush, Linda Sanchez, Allyson Schwartz, Pete Sessions, 
     Pete Stark, Mike Thompson, Patrick Tiberi, John Tierney, 
     Edolphus Towns, Lynn Woolsey.

  The material previously referred to by Ms. Slaughter is as follows:

[[Page H8402]]

  


          An Amendment to H. Res. 600 Offered by Ms. Slaughter

       At the end of the resolution, add the following new 
     sections:
       Sec. 2. Immediately upon adoption of this resolution the 
     Speaker shall, pursuant to clause 2(b) of rule XVIII, declare 
     the House resolved into the Committee of the Whole House on 
     the state of the Union for consideration of the bill (H.R. 
     356) to establish the National Commission on Foreign 
     Interference in the 2016 Election. The first reading of the 
     bill shall be dispensed with. All points of order against 
     consideration of the bill are waived. General debate shall be 
     confined to the bill and shall not exceed one hour equally 
     divided and controlled by the chair and ranking minority 
     member of the Committee on Foreign Affairs. 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 her 
     consideration of the bill.
       Sec. 3. Clause 1(c) of rule XIX shall not apply to the 
     consideration of H.R. 356.
                                  ____


        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.
  Ms. SLAUGHTER. Mr. Speaker, on that, I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this question will be postponed.

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