[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.
____________________