[Congressional Record Volume 163, Number 178 (Thursday, November 2, 2017)]
[House]
[Pages H8402-H8410]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PROVIDING FOR CONSIDERATION OF H.R. 3922, COMMUNITY HEALTH AND MEDICAL
PROFESSIONALS IMPROVE OUR NATION ACT OF 2017
Mr. BURGESS. Mr. Speaker, by direction of the Committee on Rules, I
call up House Resolution 601 and ask for its immediate consideration.
The Clerk read the resolution, as follows:
H. Res. 601
Resolved, That upon adoption of this resolution it shall be
in order to consider in the House the bill (H.R. 3922) to
extend funding for certain public health programs, and for
other purposes. All points of order against consideration of
the bill are waived. In lieu of the amendment in the nature
of a substitute recommended by the Committee on Energy and
Commerce now printed in the bill, the amendment printed in
part A of the report of the Committee on Rules accompanying
this resolution, modified by the amendment printed in part B
of that report, shall be considered as adopted. The bill, as
amended, shall be considered as read. All points of order
against provisions in the bill, as amended, are waived. The
previous question shall be considered as ordered on the bill,
as amended, and on any further amendment thereto, to final
passage without intervening motion except: (1) one hour of
debate equally divided and controlled by the chair and
ranking minority member of the Committee on Energy and
Commerce; and (2) one motion to recommit with or without
instructions.
The SPEAKER pro tempore. The gentleman from Texas is recognized for 1
hour.
Mr. BURGESS. Mr. Speaker, for the purpose of debate only, I yield the
customary 30 minutes to the 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 in which 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 601 provides for the
consideration of a critical bill to provide health insurance and
healthcare to millions of underprivileged children. This package, which
includes two separate bills: H.R. 3922, the Community Health And
Medical Professional Improves Our Nation, CHAMPION, Act of 2017; and
H.R. 3921, the Healthy Kids Act. This was reported out of the Committee
on Energy and Commerce after lengthy deliberation and negotiation and a
lengthy markup.
The rule provides for 1 hour of debate, equally divided and
controlled by the chair and the ranking member of the Committee on
Energy and Commerce.
The rule adopts an amendment from the chairman of the Energy and
Commerce Committee, modified by a second amendment by the same author,
combining the two bills into the package on the floor today.
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.
The congressionally appropriated stream of funding for the Children's
Health Insurance Program expired at the end of September. Funding for
other important public health programs, such as community health
centers, the National Health Service Corps, and Teaching Health Center
Graduate Medical Education, also expired at the end of September.
While every State that receives Federal funding through these
programs continues to have adequate dollars to maintain health
insurance for every enrolled child, several States are beginning to
exhaust their unspent 2017 funds and redistributed funds from the
Center for Medicare and Medicaid Services. With November now upon us,
waiting any longer will only put more
[[Page H8403]]
pressure on those States to begin sending notifications to children and
families that they are losing their coverage for those programs; so it
is important that we reauthorize funding for the Children's Health
Insurance Program and other programs now.
H.R. 3922, the CHAMPIONING HEALTHY KIDS Act, will achieve that
important task. It is essential to our efforts to ensuring that these
programs continue to meet the healthcare needs of children and families
who have come to rely upon them.
Today, more than 8 million low-income children across our country
depend on the Children's Health Insurance Program for many of their
healthcare services. These include routine doctor visits,
immunizations, prescription medicines, and dental care. Through
flexible, capped allotments to the States, the program has been able to
successfully support these children, while providing States with
opportunities to tailor their respective programs as best meet the
needs of their respective populations.
The CHAMPIONING HEALTHY KIDS Act would extend CHIP for another 5
years, which is the longest extension since its inception in 1996. An
extension through fiscal year 2022 will provide financial stability for
every State's CHIP program and certainty for those children and their
families who are covered. Additionally, ensuring coverage for CHIP-
eligible children will make them less likely to have to enroll in
Medicaid or ObamaCare.
This bill also contains and maintains a provision under the
Affordable Care Act that provided 23 percent increased matching for 2
years; then that draws down to an increase of 11.5 percent matching in
the third year; and then, finally, provides funding at pre-ACA levels
for the final 2 years.
These funding levels will provide the States enough time to plan
their budgets before returning to the regular CHIP matching rates,
thereby restoring the fiscally responsible Federal-State Medicaid
partnership.
While reauthorizing CHIP funding is the primary focal point of this
legislation, the CHAMPIONING HEALTHY KIDS Act also includes other
important provisions relating to our Nation's healthcare. The bill
provides a 2-year extension of funding for Federally Qualified Health
Centers, community health centers.
One in thirteen individuals nationwide relies upon a community health
center to receive healthcare services. The Community Health Center Fund
plays an important role in supplementing the services that Federally
Qualified Health Centers are able to deliver to underserved communities
by providing care to all Americans, regardless of income or ability to
pay.
Funding for the Teaching Health Center Graduate Medical Education
program is also extended for another 2 years.
The legislation includes a 2-year extension of other important health
programs, including funding for the National Health Service Corps,
Family-to-Family Health Information Centers, the Youth Empowerment
Program, the Personal Responsibility Education Program, the Special
Diabetes Program for Type 1 Diabetes, and the Special Diabetes Program
for American Indians.
In addition to the important funding streams addressed in this bill,
the Committee on Energy and Commerce incorporated a way to help our
Nation's territories in a time of need following recent natural
disasters. The bill includes more than $1 billion for the Medicaid
programs in both Puerto Rico and the U.S. Virgin Islands. This funding
should assist our territories in providing care for their populations
who have faced substantial devastation from Hurricanes Irma and Maria.
The Medicare funding issue is unique to Puerto Rico and the United
States citizens living in the territories. This was a problem that
predated the hurricanes, but it was exacerbated by the devastation that
the storm brought to the islands. Without a legislative fix from
Congress, this will be an ongoing and festering problem until it is
properly addressed, and the bill before us today begins to do just
that.
{time} 1300
Additionally, the bill delays the $5 billion in cuts to many of the
hospitals across the country from the Affordable Care Act-mandated
Medicaid disproportionate share hospital reductions for fiscal years
2018 and 2019. I am sure that many of my colleagues have heard from
hospitals in their districts whose ability to remain operational and to
continue to provide care could be jeopardized by these payment cuts.
These cuts are offset in future years, adding an additional $6
billion in reductions in fiscal year 2021, 2022, and 2023. This delays
but does not fix a problem that ObamaCare created for safety net
hospitals. It is one which we will have to revisit, but it delays the
cuts that have already been affected by current law and protects these
safety net hospitals which provide care to the neediest citizens in our
country.
Not only does the CHAMPIONING HEALTHY KIDS Act reauthorize funding
for essential health programs, the bill is fully offset. It will not
add to the national debt. The Committee for a Responsible Federal
Budget called this a ``responsible health package,'' noting that the
$18 billion cost of the bill is fully offset with savings beyond the
10-year budget window.
One of the ways that costs are offset was to alter the qualified
health plan grace period so that it would align with State law grace
period requirements. This involved changing, in the Affordable Care
Act, the grace period for subsidized individuals from 90 days to 30
days unless a State specifically allows otherwise.
It also redirected $6.4 million from the Prevention and Public Health
Fund to help pay for the legislation. This fund is required by law to
receive $2.5 billion in annual appropriations which must be used for
prevention, wellness, and public health initiatives administered by the
Department of Health and Human Services. If Congress--let me say it
again--if Congress does not direct these funds toward specific efforts,
the Secretary of Health and Human Services has the authority to spend
the funds however he or she deems fit.
While we are redirecting these taxpayer dollars, the overarching
purpose of the funding is still to improve the health and wellness of
Americans through existing mechanisms, and community health centers
will do just that.
We allow for certain wealthy Medicare beneficiaries with individual
incomes of over $500,000 to pay increased premiums in order to offset
some of the cost of authorizing these programs. These beneficiaries
will be subject to higher premiums, thereby increasing their overall
cost, but still their cost will be lower than if they purchased
insurance on the exchange.
The CHAMPIONING HEALTHY KIDS Act is a fiscally responsible way to
fund some of our Nation's most important public health programs. The
bill would ensure continued access to care for children and individuals
who rely on the programs for vital healthcare services.
Mr. Speaker, this is a good bill. Mr. Speaker, these offsets are
reasonable. For these reasons, I encourage my colleagues to support
today's rule and support the underlying bill, and 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, 33 days ago, funding for the Children's Health Insurance
Program, which 9 million children rely on for their healthcare and
well-being, expired after the program was allowed to lapse. States
crafted budgets, assuming Federal CHIP funding would arrive on time as
it has always done, and they are now scrambling to develop a patchwork
solution to keep the program alive.
Six States and the District of Columbia have warned they will run out
of funding by December, next month. Thirteen States say they will soon
have to tell enrollees they could lose coverage without immediate
congressional action. Utah officials have even considered sending
letters to enrollees as early as this week letting them know the
program is being forced to wind down.
The Kaiser Family Foundation has found that 32 States are expected to
run out of funding by March if Congress fails to act. I am glad we are
here today with a bill to reauthorize CHIP and other public health
programs, but they are woefully inadequate.
This bill is paid for by eviscerating funding from one of the most
important parts, again, of the Affordable
[[Page H8404]]
Care Act that helps to keep people well: the Prevention Fund. This fund
focuses on children's health, expanding access to lifesaving vaccines
and reducing the risk of lead poisoning, among many other things.
This is a particularly heartless cut when you consider that many
residents of Flint, Michigan, still can't get a clean glass of water
from the faucet or bathe in uncontaminated water 3 years after the
water crisis began. Children there in Flint will be forced to live for
the rest of their lives with impacts ranging from neurodevelopmental
damage and behavioral changes to hypertension and anemia, damage caused
by a government that failed to act.
If it fails to adequately fund Medicaid for Puerto Rico and the U.S.
Virgin Islands as they continue to try to rebuild following the
devastating recent hurricanes, that would be a compounding of the
tragedy. This bill fails to waive the requirement that both of those
islands match Federal investment before they can access any of the
Medicaid funding, and we don't deal with that at all, even for CHIP.
Seventy percent of Puerto Rico doesn't even have power 6 weeks after
Hurricane Maria hit. I am proud to say that a lot of New York utility
workers are down there now, and I am sure we will see results soon.
Residents of Puerto Rico are washing clothes and bathing in
contaminated streams and rivers, and drinking it as well. A million
people there still don't have any running water. They don't have the
ability to put up millions of dollars, either, to match these funds
because they are struggling to survive. We don't address that. These
are American citizens, and we have an obligation to help them.
These reauthorizations are a chance to really work together and
deliver, but we are worried about this opportunity because there is no
indication that this bill could pass the Senate with the cuts that it
has made to the Affordable Care Act. I am referring, of course, to the
ones that relate to preventive care. That would be a major tragedy.
As I have already said, so many States are right at the edge of not
being able to fund the program at all. Other States are ready to tell
both community health services and CHIP that they are no longer
providing for them.
This partisan approach will only delay the extension of the programs
even further. I consider that a major dereliction of our duties.
Mr. Speaker, I reserve the balance of my time
Mr. BURGESS. Mr. Speaker, I yield myself 30 seconds in response
before yielding to the chairman of the Rules Committee.
It pains me to hear people talk about the 33-day delay in getting
SCHIP funding resubmitted. I just want to assure the House of
Representatives that Republicans on the Subcommittee of Health in the
Energy and Commerce Committee have been ready to go with this
legislation. We did our legislative hearings early in the summer, as
the gentleman will recall because he was there, and we were ready for
our markup in the month of September.
Why was it delayed? Let me reference an article from CQ News, October
23, 2017: ``Democrats do not want a children's health insurance bill to
come to the floor this week for a vote, said Frank Pallone, Jr.,
ranking member of the House Energy and Commerce Committee at a district
event. . . .''
`` `The idea is to not have the bill come to the floor this week,'
said Pallone. . . .''
I include in the Record a copy of the CQ News article.
[From CQ News, Oct. 23, 2017]
House Democrats Push To Delay Children's Health Vote
(By Sandhya Raman)
Democrats do not want a children's health insurance program
bill to come to the floor this week for a vote, said Frank
Pallone Jr., ranking member of the House Energy and Commerce
Committee at a district event broadcast on Facebook Live on
Monday.
``The idea is to not have the bill come to the floor this
week,'' said Pallone, emphasizing that Democrats still want
to find a bipartisan compromise and will not accept the
changes to Medicare or Medicaid that Republicans want to use
to fund the coverage. He later added, ``This is supposed to
come up Thursday. Hopefully, it won't.''
Pallone suggested that the process could be lengthy if the
House passes a partisan bill and the Senate does not act
quickly to pass their bipartisan measure. The two likely
would have to be reconciled through conference negotiations.
``We're going to just delay this for months, and the end
result could be we don't deal with this until the end of the
year,'' said Pallone, speaking at a community health center.
Democrats disagree with the offsets in House bills to
reauthorize CHIP (HR 3921) and community health centers and
other safety net programs (HR 3922). The CHIP bill's offsets
include increasing premiums for Medicare recipients with
income over $500,000 a year and limiting Medicaid benefits
for lottery winners. In addition, Democrats take issue with
an offset that would bill other insurance before Medicaid for
recipients who use more than one form of coverage.
The offsets for the community health centers include
changes to undermine the 2010 health care law (PL 111-148, PL
111-152) including cutting almost $6.4 billion from the
Prevention and Public Health Fund over 10 years. Republicans
also would allow states to create their own grace periods for
individuals on the exchanges to pay their premiums or use a
default one-month grace period. The current grace period is
three months.
``If you miss it and you don't pay it, you can't get your
insurance. You've got to re-enroll for the next year,''
Pallone said about the grace period.
``The problem is that they haven't been willing to give
much on taking this money from the Affordable Care Act or
Medicare, but why do they even have to come out of health
care at all? Why can't we use another vehicle to pay for
it?'' said Pallone, adding, ``Part of that could be cut back
significantly.''
Democrats also object to the way Puerto Rico's Medicaid
funding in the CHIP bill would be addressed.
``They're still requiring a state match from Puerto Rico,''
said Pallone. ``The bill funds a little bit, but it's totally
worthless if Puerto Rico has to come up with the match.''
The island does not have money to contribute, Democrats
say.
Earlier this month, Committee Chairman Greg Walden of
Oregon asked his Democratic colleagues to suggest offsets
that may be more amenable than those currently in the bill
that the committee passed. Last week, Walden said in a
statement that he had not received any Democratic offers.
Democrats contend they have put suggestions on the table.
One idea would require drug companies to help seniors
better afford their prescriptions by closing a funding gap,
known as the ``doughnut hole,'' in Medicare coverage.
Currently, seniors have to pick up more costs after a certain
spending threshold until they hit another limit when Medicare
resumes paying for coverage.
``We've been making offers back. One of the things we said
is make the drug companies pay for the doughnut hole. We
still have a doughnut hole for Medicare Part D. So if they
pay for the cost of that, that could be used as a payfor,''
said Pallone.
``This bill that may go to the floor next week is going
nowhere,'' said Pallone, stating that it would ``be a totally
partisan vote.''
Federal funding for CHIP expired Sept. 30. The Centers for
Medicare and Medicaid Services has redistributed unused CHIP
funds to nine states and territories including Arizona,
California, Minnesota, Washington, American Samoa, Guam,
Northern Mariana Islands, U.S. Virgin Islands and Oregon. The
funds come from unused CHIP allotments from previous years
and are used to help states that are running low on their
current year funds.
Mr. BURGESS. Mr. Speaker, I yield 5 minutes to the gentleman from
Texas (Mr. Sessions).
Mr. SESSIONS. Mr. Speaker, I really appreciate the distinguished
gentleman from Lewisville, Texas, Dr. Michael Burgess, who serves
several roles in this House of Representatives. First of all, he is
chairman of the Subcommittee on Health for the Energy and Commerce
Committee--actually, his favorite committee--and then his duties at the
Rules Committee, and Mike has spent a good number of years in service
to the entire body. I want to thank Dr. Burgess for his personally
handling not only this matter, but bringing to Congress a really strong
attitude that he has about children.
Dr. Burgess, for a number of years since his early days in Parkland
Hospital in Dallas, Texas, as a resident and then becoming an
obstetrician-gynecologist who served not only the Dallas area,
thousands of people, but he brought to that a love of children, women,
and families to give precious life to the United States of America, I
want to thank him for his healthy child bill that he brought to the
Energy and Commerce Committee.
Mr. Speaker, let me say this. The gentlewoman from New York, the
ranking member of the Rules Committee, and the entire committee
yesterday spent a great deal of time not only looking at this
particular bill, but other very germane issues related to healthcare.
My colleagues, including
[[Page H8405]]
the gentlewoman from New York, really have the best heart in this. I
believe this is an issue where we agree. We agree that children's
health is not only an important part of what Congress should be
involved in but, actually, resolving the issues.
She is very correct. Several weeks ago it was brought up in the Rules
Committee the timeliness of this issue, the appropriateness of the
Rules Committee handling this bill to get it to the floor so that we
would allow not only the American people to understand what we were
doing, but, really, to put it in play so that this could be handled by
the United States Senate and the President.
I want to congratulate my colleagues. I think that my colleagues, to
a person, understand the importance of this--and certainly Mike
Burgess' leadership at Energy and Commerce Committee--but also the
Rules Committee. So reauthorizing the Children's Health Insurance
Program, or CHIP, as it is known, is vitally important. It is important
because there are some 400,000 children in Texas, alone, where Chairman
Burgess and I live.
We see not only families, but we see the healthcare community. We see
other elected officials and just normal people at home who expect us to
get our work done. We are today. In fact, we are not only getting it
done, but, as Chairman Burgess has talked about and even as the
gentlewoman, Ms. Slaughter, has talked about, there will be States at
the end of November that will be running on fumes, be running on empty,
and a good number of States are funded until probably February or
March. But that is not a reason for us to delay.
So we are here, respectfully, to ask the entire body, Republicans and
Democrats, and also to let the American people know that the Children's
Health Insurance Program, through the efforts of Mike Burgess and
through the efforts of Greg Walden as chairman of the committee, who
have worked very diligently to make sure that it not only comes to the
floor, but that the new nuances of the bill that will include many,
many good bipartisan ideas will be offset, and it will be offset. We
are going to have to make sure as we move forward that those are
careful instructions that we all understand.
But the bottom line to this is, Mr. Speaker, this Congress, because
of the bipartisanship, because of the ability, because of the
importance of CHIP, is handling this today.
We are going to ask all Members if they did not have a chance to see
what I thought was a robust, distinguished panel that came to us
yesterday to talk about this, but also the thoughtful ideas from our
Members about the importance of this, I think we can convince this
body--this body, Republicans and Democrats--that the underlying
legislation helps secure for 5 more years--which is what the goal was,
5 more years--to make sure that we can move forward; and it gives
States the authority and the responsibility, gives the American people
confidence that what we are doing to take care of this issue has not
only been done, but presented in such a way that it will be successful.
That is our job, Mr. Speaker. Our job is to take the work that comes
from the committee of jurisdiction--in this case, the Energy and
Commerce Committee--and move that through, look at it, vet it, and make
sure the best ideas happen. I am pleased and proud to be here today.
Ms. SLAUGHTER. Mr. Speaker, I yield 3 minutes to the gentlewoman from
California (Ms. Matsui), a distinguished member of the Energy and
Commerce Committee.
Ms. MATSUI. Mr. Speaker, I thank the gentlewoman for yielding.
Mr. Speaker, I rise in opposition to this rule. For months, House
Republicans have delayed action to fund CHIP and community health
centers. These programs are critical in our communities and cannot
survive without this funding.
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They have always been bipartisan, but, unfortunately, the bill before
us today is not. Instead of working with us, Republicans have focused
on TrumpCare and sabotaged the ACA. Now they have put forward this bill
full of poison pills that will only further delay funding these
critical public health programs, and to turn what has been
traditionally a bipartisan process into a political game does a
disservice to families.
H.R. 3922 eliminates the ACA's Prevention and Public Health Fund
which helps people in my district and other districts get vaccines,
prevent diabetes, and combat heart disease. The reason we put the
preservation fund in the ACA in the first place was to reorient our
health system towards prevention, which ultimately saves money and
keeps people healthier.
We all want to ensure kids have the insurance that they need to
access affordable care, but slashing benefits that will in the long
term hurt the very children and families that CHIP and the community
health centers help, as this bill does, is the wrong way to go. Through
its cuts to the Prevention Fund, this legislation is another attempt by
Republicans to undermine the ACA.
Unfortunately, this is just one of many acts of sabotage that we have
seen over the last year from the Trump administration and congressional
Republicans.
On top of these attacks on the Affordable Care Act, H.R. 3922 creates
a false choice between helping seniors and helping kids. This
legislation makes changes to Medicare that will hurt all seniors'
benefits in the long term.
Democrats have offered solutions that would pay for funding CHIP and
community health centers in a way that doesn't rob Peter to pay Paul. I
support the substitute amendment offered by Ranking Member Pallone
which would do just that.
Mr. Speaker, I am extremely disappointed that the Republicans have
chosen this partisan path for programs that are so dear to our
communities, and I urge my colleagues to vote ``no'' on H.R. 3922 and
to support the Democratic substitute.
Mr. BURGESS. Mr. Speaker, I yield myself 30 seconds for the purpose
of a response before I yield to the gentleman from Georgia.
Mr. Speaker, if we are going to tell stories, then ``once upon a
time'' should be part of our opening.
This bill merely takes some of the discretion for the Prevention and
Public Health Fund away from the administration and returns it to
Congress where it is supposed to be in the first place, so we take
discretion over some of the Prevention and Public Health Fund dollars
away from the executive branch and redirect these dollars to proven
public health programs that enjoy broad, bipartisan support in Congress
like the community health centers. Every Democrat voted for the Cures
for the 21st Century, and it did exactly the same thing.
Mr. Speaker, I yield 1 minute to the gentleman from Georgia (Mr.
Carter).
Mr. CARTER of Georgia. Mr. Speaker, we are here over a month late to
reauthorize CHIP while the families of 9 million children are holding
their breath to see whether their kids are going to have health
insurance. We are bringing this up now because my colleagues on the
other side of the aisle asked us to delay, and, in good faith, we did.
Over 232,000 children in Georgia rely on CHIP for their health
insurance. My constituents are asking why we delayed it. I am sad to
have to tell them that my colleagues on the other side of the aisle
decided to delay our efforts to pass the bill out of the Energy and
Commerce Committee, and they then decided to delay bringing the bill to
the floor for a vote.
I would hope that they would have a good reason for these delay
tactics, but the truth is that they opposed a provision that was
requested by President Obama in his fiscal year 2013 through fiscal
year 2017 budgets that has a minor impact on the highest earners under
Medicare.
This is politics at its worst, and I stand here today to say that
enough is enough.
The Energy and Commerce Committee's markup of this bill was stalled
three times because our friends decided to oppose a policy that the
previous administration supported. When the American people tell us
that they are fed up with the partisan politics, this is exactly what
they are talking about.
Mr. Speaker, I ask my colleagues to join me today in putting the
needs of 9 million children above short-term political interests.
[[Page H8406]]
Ms. SLAUGHTER. Mr. Speaker, I yield 5 minutes to the gentlewoman from
Connecticut (Ms. DeLauro).
Ms. DeLAURO. Mr. Speaker, I rise to voice my opposition to this rule
and to the underlying bill.
First, by the way, my colleague from California (Ms. Matsui) talked
about the Democratic substitute. But let's be clear, it is our
Republican colleagues, the majority, who would not make a Democratic
substitute in order that would allow us to come here to have a debate
on their proposal and what we proposed. How about that for democracy in
the United States House of Representatives? No Democratic substitute.
So let's leave that aside and focus on what we have here today.
Again, opposed to the rule, opposed to the bill.
The Children's Health Insurance Program is vital for millions of our
Nation's most vulnerable citizens--our children. The gentleman before
spoke about 9 million children. Yes. But do you know how long we have
waited for the majority to reauthorize the Children's Health Insurance
Program? The length of time is shameful. But even more shameful is how
the majority intends to pay for the Children's Health Insurance
Program.
This is what the bill does. The bill includes massive cuts to
something called the Prevention and Public Health Fund. What is the
Prevention and Public Health Fund? It is inclusive of many of the
programs that we rely on in order to save lives.
Yes. They are the programs that go to help our community health
centers be able to treat people who come to their door. Twenty-three
million people in the United States use community health centers. It is
often their primary care.
But let me lay out for you what some of these programs are: the
Centers for Disease Control childhood vaccines--vaccinations and
immunizations for our kids being cut--lead poisoning prevention. You go
to any community in this country, and they will tell you whether it is
water or whether it is paint. Some of our children have the highest
levels of lead, and what we need to be doing is screening them at a
very early age so that we can address the issue. They cut this out,
also the Centers for Disease Control heart disease program, stroke and
diabetes programs, breastfeeding grants for hospitals, childhood
obesity prevention, and suicide prevention. We are looking today at an
opioid crisis in this Nation that so often results in suicides, and
they are willing to cut the heart out of the Prevention Fund programs
to fund the Children's Health Insurance Program.
So we are harming children at one end of the spectrum and robbing the
money from that end of the spectrum to pay for the Children's Health
Insurance Program, which I am a big supporter of. So we are stealing
from this prevention program.
Now today, my Republican colleagues have offered a tax cut proposal.
Take a hard look at it because the richest, the wealthiest, and those
with the most lobbyists are the biggest beneficiaries of these tax
cuts, and middle class working families will get the short end of the
stick. Those people who make over $1 million--several million dollars--
are going to get the benefit of the tax cut. Why aren't we taking that
money and paying to reauthorize the Children's Health Insurance Program
rather than taking the money from the Prevention and Public Health
Fund?
So instead of providing tax cuts today for the richest 1 percent of
Americans, we could have a strong Children's Health Insurance Program,
and we could have a strong Prevention and Public Health Fund that does
not have to make these egregious cuts.
I think there is one more point that people need to know about this
bill. The bill cuts something that was in the Affordable Care Act--the
grace period. They cut that back to 30 days. That means if someone
misses one health insurance payment, they can lose their insurance for
the remainder of the year.
Today, our biggest economic challenge as a nation is that people are
in jobs that just don't pay them enough to live on. They can't afford
their healthcare. It is cruel, and it is a brazen attempt to undermine
the Affordable Care Act, which, quite frankly, has been the majority's
agenda for a very long time.
The SPEAKER pro tempore (Mr. Guthrie). The time of the gentlewoman
has expired.
Ms. SLAUGHTER. Mr. Speaker, I yield the gentlewoman from Connecticut
an additional 30 seconds.
Ms. DeLAURO. There is no need to play off children's health insurance
against the Prevention and Public Health Fund. There is no need to cut
back on the grace period for the folks who may miss one health
insurance payment.
So I urge my colleagues: don't be cruel; don't be inhumane. To those
of my colleagues who will say no to this, you stand on solid ground.
You stand with families in this Nation. You stand with children when
you say no to cuts that are going to hurt their lives.
Mr. BURGESS. Mr. Speaker, I am pleased to yield 3 minutes to the
gentleman from Alabama (Mr. Byrne), who is a fellow member of the House
Rules Committee.
Mr. BYRNE. Mr. Speaker, I thank my colleague for yielding, and I rise
to extend my support for this rule and the underlying legislation.
This legislation funds critical, bipartisan health programs that help
keep our communities healthy.
Mr. Speaker, I have long been a strong supporter of CHIP because I
have seen it in action back in my home State of Alabama. I served on
the Alabama State School Board back when Alabama implemented our CHIP
program, known as ALL Kids. ALL Kids was the first CHIP program in the
country, and it has made a real difference. In fact, the uninsurance
rate for children in Alabama has gone from 20 percent pre-CHIP to 2.4
percent today.
For 83,000 Alabama children under 19, the program offers low-cost,
comprehensive healthcare coverage that includes regular checkups,
immunizations, sick child doctor visits, prescriptions, vision care,
dental care, and much more.
CHIP has always been a bipartisan program, and I hope this
reauthorization will earn bipartisan support for the children of
America.
This legislation also reauthorizes the community health centers fund.
I am a huge champion of community health centers because, again, I have
seen them work in Alabama from the Mostellar Medical Center in Bayou La
Batre to Franklin Primary Health in Mobile to Southwest Alabama Health
Services in McIntosh. These centers are vitally important to so many
Americans, but especially to low-income families and those in rural
areas.
One in 13 people nationwide rely on a health center for their
healthcare needs, and this reauthorization is necessary to ensure those
individuals continue to receive access to medical care.
This legislation also includes many other healthcare provisions to
meet other priorities. Among these provisions, I am pleased the
legislation continues Medicaid disproportionate share hospital
payments, or DSH payments, as they are commonly known.
DSH provides funding to hospitals that treat a large number of
indigent patients. DSH is absolutely critical to the life of Alabama's
hospitals, and failure to renew these important payments could result
in numerous hospital closures in our State.
So, Mr. Speaker, I urge my colleagues on both sides of the aisle to
get behind this legislation and ensure it gets across the finish line.
We should not let petty political arguments keep us from ensuring that
children have access to affordable health insurance, keeping the doors
open at community health centers, or allowing Alabama's hospitals to
continue serving communities in need.
Ms. SLAUGHTER. Madam Speaker, I yield 5 minutes to the gentleman from
New Jersey (Mr. Pallone), who is the distinguished ranking member of
the Committee on Energy and Commerce.
Mr. PALLONE. Madam Speaker, I want to thank the ranking member of the
Rules Committee.
I just want to express the tremendous frustration that I have and
that Democrats have in general with the way the Republican leadership
has handled the CHIP bill, IPAB, and community health centers, the
legislation we are considering today and tomorrow.
First of all, I need to point out that it was over a year ago when I
asked
[[Page H8407]]
leadership of our committee to try to come up with bipartisan
legislation with regard to community health centers and SCHIP, the
children's initiative, and all they wanted to do from January until
September--9 months--was repeal the Affordable Care Act.
{time} 1330
That is all they were interested in. They didn't want to hear
anything about CHIP or community health centers, just repeal the
Affordable Care Act.
My colleagues on the other side suggested that somehow, because of
CHIP, they are very concerned about kids. Well, the fact of the matter
is, if you repeal the Affordable Care Act, children--everyone--and
community health centers would suffer such damage because they would
lose their health insurance or the underpinnings of the community
health centers, which have been financed with the Affordable Care Act,
that any suggestion that somehow because you are concerned now about
CHIP or community health centers is belied by the fact that you spent
the last 9 months, through September, trying to repeal the Affordable
Care Act. If you really cared about these things, then you would not
have sought that repeal.
Once that repeal seemed to be over in September, then the Republicans
on the committee and the leadership were willing to talk about CHIP and
community health centers. But mind you, the authorization for those two
programs ended September 30. So it was literally too late.
Now my colleagues on the other side say: Oh, well, we are bringing
this bill up today because we really care about kids and community
health centers.
Exactly the opposite. If you did care, in the sense that you wanted
to get legislation passed, then you wouldn't bring this bill up today.
We all know that if the bill is not bipartisan, which it is not, it
will never pass the Senate. What is going to happen is these bills will
pass on a partisan vote on Friday and, as a consequence, they will go
to the Senate and there will be no action and we will have to deal with
this at the end of the year as part of some larger omnibus spending
bill or whatever we do at the end of the year.
So anyone who tells you that the Republicans, in trying to pass a
partisan bill, are actually moving forward on CHIP or on community
health centers, that is simply not true.
Now, what are we facing here with these three bills? And I include
IPAB, CHIP, and community health centers. What we are really facing is
another effort on the part of the Republican leadership to repeal or
sabotage the Affordable Care Act.
All these things are part, in some fashion, of either pay-fors or
authorization of the Affordable Care Act. The fact of the matter is, we
are now seeing what I would call piecemeal repeal.
You couldn't repeal it outright, so you do a piecemeal repeal. You
repeal IPAB. You basically use funding from the Prevention Fund and you
gut that so you can pay for the CHIP funding. You change the grace
period so something like half a million people lose their health
insurance. Meanwhile, the President of the United States is out there
every day issuing executive orders to get rid of cost-sharing subsidies
to cut back on the outreach program.
If you look at all this, it is nothing more than a piecemeal repeal
of the Affordable Care Act. It is sabotaging the Affordable Care Act.
This has not changed. The first 9 months to September, outright
repeal. Now, between now and the end of the year, piecemeal repeal.
Every day, a different bill.
The real inconsistency, which is the best I can say about what is
going on, is to say that we have to come up with offsets to pay for the
Children's Health Initiative Program and the community health centers,
but we don't have to do it for IPAB. $17.5 million is what it is going
to cost, according to the CBO, to repeal IPAB. If you use that money,
it would almost pay for the CHIP and the community health centers bill
that will be considered the next day.
So, again, we have this total inconsistency suggesting that somehow
we care about one thing. What is really go on is robbing Peter to pay
Paul. The way that you pay for the community health centers and the
CHIP bill, basically, sabotaging the Affordable Care Act, is you
shorten the grace period from 90 days to 30 days, when people, if they
don't pay their premium, will lose their health insurance. We know that
maybe almost 688,000 people, according to the CBO, will lose their
health insurance.
The SPEAKER pro tempore (Ms. Foxx). The time of the gentleman has
expired.
Ms. SLAUGHTER. Madam Speaker, I yield an additional 1 minute to the
gentleman from New Jersey.
The SPEAKER pro tempore. Members are reminded to address their
remarks to the Chair.
Mr. PALLONE. Then you have the Prevention Fund, which is used for
children's lead poisoning programs, children's vaccines, and for the
opioid program that the Republicans say they care so much about. These
are going to go away in order to pay for CHIP and community health
centers.
What is going on here is unbelievable. I just say to my colleagues:
look at what is actually happening. We had a Democratic substitute and
the Rules Committee wouldn't even let us consider it.
So it is not just the underlying issue of what is actually happening
here in terms of the substance of the bills. It is also the process
that is being used. That is why I am glad I am talking during the Rules
Committee time.
We had a Democratic substitute that would have had a great piece of
legislation that paid for the community health centers, paid for CHIP,
without sacrificing other healthcare programs that help kids and other
Americans. They wouldn't even let us consider it here today.
So I say to my colleagues: basically, vote ``no'' on the rule. Turn
down this rule and let us have another opportunity to actually do
something that is important and that is meaningful.
Mr. BURGESS. Madam Speaker, I yield myself 30 seconds.
First off, the gentleman may not remember that we had a legislative
hearing in June on this very bill. It was delayed from June 14. The
gentleman may recall there was an unfortunate circumstance of a
shooting at a congressional baseball practice. In fact, a member of our
committee, Majority Whip Steve Scalise, was in surgery, and most felt
we couldn't go through with the hearing that day, but we had it 2 weeks
later as soon as we could get the hearing time. So it was done well in
advance of the expiration of the funding.
Furthermore, as far as the substitute goes, the minority is afforded
the customary motion to recommit. I look forward to the gentleman
introducing a substitute at that time.
Madam Speaker, I yield 2 minutes to the gentlewoman from Tennessee
(Mrs. Blackburn).
Mrs. BLACKBURN. Madam Speaker, I thank the gentleman from Texas for
his work that has just been so consistent on how we meet the needs of
our health centers, the Children's Health Insurance Program, and also
on the repeal for IPAB.
When we talk about IPAB, it is so important that we mention our
colleague and my fellow Tennesseean, Dr. Phil Roe, who is a Member of
this Chamber. I applaud him for his consistent work on keeping that in
front of us.
I think it is fair to say, as Chairman Burgess has said, that we have
worked diligently on the CHIP issue. I know that the gentleman from New
Jersey is not pleased with how that is going to be paid and how we
address the payments.
But I have to say, our goal, Madam Speaker, is to make certain that
the States have the funding that is necessary for them to meet the
needs of children who are needing these health services. This is
something that we have been diligent in our work to meet those needs
and to work with our States and to see how best to do this so that
needs are being met right there where those children have them and that
the States have the resources they need.
When it comes to the Independent Payment Advisory Board, we ought not
have to be discussing this today because this is something that should
never have been passed in the first place. It is something that was
completely unnecessary. We are looking at going in and changing this,
and for good reason.
There is a bipartisan agreement that you have to get down the costs
that are
[[Page H8408]]
in Medicare, and I know that is not going to be an easy task.
The SPEAKER pro tempore. The time of the gentlewoman has expired.
Mr. BURGESS. Madam Speaker, I yield an additional 30 seconds to the
gentlewoman from Tennessee.
Mrs. BLACKBURN. Madam Speaker, I think one of the things that we
know, when you are looking at IPAB, you don't want to give those
decisions of how you are going to adjust healthcare for Medicare
enrollees to 15 unelected, appointed bureaucrats that really have no
responsibility to anyone in this process.
This is our responsibility. It is appropriate that Congress recoup
that responsibility, that we make these decisions. I support the
legislation that is in front of us.
Ms. SLAUGHTER. Madam Speaker, I yield 2 minutes to the gentlewoman
from Texas (Ms. Jackson Lee).
Ms. JACKSON LEE. Madam Speaker, let me make a proclamation here on
the floor of the House, and that is that all the sweat and tears of the
Democratic Members, although we offered the opportunity to our
Republican friends to do something about healthcare, all of our sweat
and tears proved to be a successful response to the 25 million
uninsured Americans.
No matter how much our friends on the other side of the aisle try to
nitpick and pick away at a successful affordable care program, they
simply cannot do it.
To the American people: It worked. It worked because we included and
supported healthcare for children with CHIP. It worked because we
supported and expanded community health centers. It worked because we
had IPAB, which is not going to be in effect until 2021 and not to do
anything but preserve Medicare.
On the other hand, today we have a pronounced tax bill that will
jeopardize the Medicare trust fund, will take millions and billions
away from Medicaid. The last hammer in the coffin will be the
destruction of the Children's Health Insurance Program and community
health clinics.
Let me be very clear: I happen to be in an area in the southern part
of Texas, from Corpus to Port Aransas, to Rockport, to Beaumont, to
Houston and Harris County, where Hurricane Harvey devastated our
community.
Healthcare is crucial. Many of our hospitals were under water. People
were not able to access healthcare. The community health clinics are
the best neighborhood source of healthcare.
The SPEAKER pro tempore. The time of the gentlewoman has expired.
Ms. SLAUGHTER. Madam Speaker, I yield an additional 1 minute to the
gentlewoman from Texas.
Ms. JACKSON LEE. Madam Speaker, the legislation by my friends is to
destroy Peter to prop up Paul, rather than take the Pallone amendment--
which I want to thank Ms. Slaughter for offering in the Rules
Committee--to provide real funding and that would find a way to
effectively support the Children's Health Insurance Program and, of
course, the community health clinics, which, in the State of Texas, has
been a lifesaver for all of our communities.
We were the poster child for having the largest number--a quarter of
our people in Texas--who did not have health insurance. With the
Affordable Care Act and, of course, the community health clinics, we
were able to do it.
Let me finish by saying it was a bipartisan effort in 1997, with a
balanced budget, that we created the Children's Health Insurance
Program. It has been an effective, strong armor, if you will, around
children's health.
Everywhere I go, such as the Texas Children's Hospital, they are
raving about the Children's Health Insurance Program and Medicaid.
Today or tomorrow, we are going to break that system by taking money
from somewhere else to destroy another healthcare program and putting
in this program.
Mr. BURGESS. Madam Speaker, may I inquire as to how much time is
remaining?
The SPEAKER pro tempore. The gentleman from Texas has 6\1/2\ minutes
remaining. The gentlewoman from New York has 9 minutes remaining.
Mr. BURGESS. Madam Speaker, I yield myself 2 minutes.
Madam Speaker, I want to address the issue of the Prevention and
Public Health Fund.
The bill before us does redirect $8.9 billion for the Prevention and
Public Health Fund to support critically important public health
programs that expand access to care and improve health outcomes.
The Prevention Fund was established in the Affordable Care Act as
mandatory funding for prevention and public health programs to improve
health and help restrain the rate of growth in private and public
sector healthcare costs.
According to statute, billions of dollars in advanced appropriations
are to be used for the broad purpose of supporting programs authorized
by the Public Health Service Act for prevention, wellness, and public
health activities. However, prevention, wellness, and public health
activities are allowable, but no Prevention Fund-specific or generally
applicable definitions of these terms are to be found in the Public
Health Service Act, the Affordable Care Act, or anywhere else in
Federal law.
The Affordable Care Act was not accompanied by committee reports in
either Chamber. The Department of Health and Human Services has not
published regulations, guidance, or other information to clarify the
Department's views about the types of activities that are within the
scope of the Prevention Fund.
{time} 1345
Annual mandatory appropriations, the Prevention Fund, continue in
perpetuity. If Congress does not explicitly allocate the funding, then
the Secretary of HHS has the authority to spend these dollars without
congressional oversight.
This bill takes discretion over some of the--some, not all--some of
the Prevention Fund dollars. It takes it away from the executive branch
and redirects these dollars to proven public health programs that enjoy
broad bipartisan support in Congress like community health centers, a
program that employs 190,000 people and served over 24 million patients
in 2015.
This has been supported in the past in other legislation, most
recently in the Cures initiative, where Democrats and Republicans
supported the redirecting of funding for the Prevention Fund for the
specific purpose of preserving public health.
Madam Speaker, I reserve the balance of my time.
Ms. SLAUGHTER. Madam Speaker, I yield myself such time as I may
consume.
Madam Speaker, in May, the Republican majority recklessly passed
their healthcare repeal bill without any analysis at all from the
nonpartisan Congressional Budget Office, finding out a month later that
it would have taken insurance away from 23 million people.
I fear the majority is going to make the same dangerous mistake with
their tax bill. The New York Times reported that some sections of the
bill released today are placeholders that will ``allow Republican
leaders to work out the details of a new set of revenue-raisers that
would be inserted in the bill before the full House votes on it''--in
other words, they will be a surprise.
After the Ways and Means Committee marks up the bill, they will
rewrite the bill in a back room and jam it through the House. It is
beyond irresponsible to vote on a bill of this magnitude without
knowing how it will impact hardworking Americans.
We employ dozens of well-qualified, nonpartisan expert economists and
public policy analysts with advanced degrees in the Congressional
Budget Office precisely for moments like this, and it appears the
majority is again, this year, prepared to move so fast that no Member
will have the benefit of their nonpartisan advice.
So if we can defeat the previous question, I will offer an amendment
to the rule that will prevent this massive tax cut bill from coming to
the House floor unless nonpartisan analysis from the experts at the
Congressional Budget Office has been available for at least 2 days.
Madam Speaker, I ask unanimous consent to insert the text of my
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?
[[Page H8409]]
There was no objection.
Ms. SLAUGHTER. Madam Speaker, I yield myself the balance of my time.
Madam Speaker, we don't have time to spare playing games here with
the CHIP program. It is on life support in many States, with officials
scrambling to try to keep it alive. This is a program, you have heard
before, that 9 million children rely on.
And 2,800 community health centers are at risk of closing their doors
if we do not reauthorize the community health centers. That would leave
millions of people without healthcare, cost more than 50,000 jobs, and
already the centers nationwide have been forced to consider cutting
services following the majority's failure to reauthorize the program
before it expired on September 30.
Everybody knows that these centers do remarkable work. They deliver
quality care at lower cost. More than 330,000 veterans relied on them
for healthcare last year alone. They could be reauthorized under a
clean bill in seconds. Instead, the majority is putting them at risk
through this partisan bill, which seems unlikely to pass the Senate,
and we will then be nowhere.
If you want to know why only 13 percent of the public approves of
Congress under the leadership, just look at the bill before us today.
Republican leaders have turned even the most bipartisan programs into
endeavors that seem unlikely to become law.
They have disallowed the Democratic Party to have any substitute with
any other ideas that they did not have before so that we can, as Ms.
DeLauro mentioned, have an honest debate. We see that time after time
in the Rules Committee, the inability for our side to even get
amendments passed. But not to allow a substitute bill of this magnitude
is, I think, really a dereliction of duty. It speaks volumes about the
inability to get things done.
And lastly, Madam Speaker, I want to recognize George Agurkis. He is
sitting here with me. George has been on the Rules Committee staff for
9\1/2\ years. He is leaving us at the end of the week to take a
wonderful new job and new project. He is a Pennsylvania neighbor we
always could count on. He is a lot of fun. We are going to miss that
and his aunt, Rose, who works in the cloakroom. And we know that she
gives the best birthday parties in the world, and we don't know what we
are going to do. We hope that George will come back and celebrate those
with us and Rose will once again delight us with every kind of sweet
thing in the world.
=========================== NOTE ===========================
November 2, 2017, on page H8409, the following appeared: that
and his wife, Rose, who works in
The online version has been corrected to read: that and his
aunt, Rose, who works in
========================= END NOTE =========================
So back to the bill at hand. I urge a ``no'' vote on the previous
question, on the rule, and on the bill, and I yield back the balance of
my time.
Mr. BURGESS. Madam Speaker, I yield myself the balance of my time.
I do want to address one of the things that has come up in the
discussion, and that is the issue of the language in the underlying
bill that supports the citizens, the American citizens in Puerto Rico.
There was a problem in Puerto Rico with their Medicare system, the
way people were not automatically enrolled as they were in every other
State and territory. There was a problem under the Affordable Care Act
where they faced a Medicaid funding cliff.
These problems existed prior to the two hurricanes that hit the
island, and a request was made to Chairman Walden and me, on behalf of
the people of Puerto Rico, to fix these problems prior to the storms
coming ashore, and that is what we fixed in the language of this bill.
I might remind this body that, when Hurricane Katrina came ashore
around Labor Day of 2005, a similar problem was encountered.
Ultimately, the State's share of that FMAP payment was made. It was
made with funds from the Deficit Reduction Act, which were allocated on
September 30, 2006, over a year later.
The fact is that there are going to be funds available to Puerto Rico
to help offset their part, their match of their State's share of the
Federal match, but it will likely come through the money that is
appropriated for disaster relief. But we are fixing their underlying
problem that existed before the hurricanes. If we don't fix it, it
continues to be a problem year in and year out, and the American
citizens of Puerto Rico are poorly served by that.
So this body is taking that up today, and I am proud of the fact that
our subcommittee and our full committee recognize that and provided
that relief.
Madam Speaker, I want to enter into the Record a letter from Texas
Health Resources, Mr. Barclay Berdan. I want to quote from this letter:
``We . . . appreciate your leadership on delaying cuts to Medicaid DSH,
which took effect on October 1, 2017.''
``Thankfully, H.R. 3922 would eliminate the scheduled Medicaid DSH
reductions in fiscal years 2018 and 2019, thus allowing a critical
source of funding to continue for safety net hospitals.''
Texas Health Resources,
November 1, 2017.
Hon. Michael Burgess,
House of Representatives,
Washington, DC.
Dear Representative Burgess: As one of the nation's largest
faith-based, nonprofit health care systems, Texas Health
Resources (Texas Health) provides more than 350 points of
access throughout North Texas, including 29 hospitals (acute-
care, short-stay, behavioral health, rehabilitation and
transitional care) and more than 100 outpatient facilities,
satellite emergency rooms, surgery centers, behavioral health
facilities, fitness centers and imaging centers. The system
also includes a large physician group, home health,
preventive and well-being services as well as more than 250
clinics and physician offices to provide the full continuum
of care for all stages of life. I am writing to thank you for
your leadership on the Championing Healthy Kids Act of 2017
(H.R. 3922) to extend funding for the Children's Health
Insurance Program (CHIP). We strongly support a five-year
extension of CHIP funding, along with the elimination of
reductions in fiscal years (FY) 2018 and 2019 to the Medicaid
disproportionate share hospital (DSH) payments.
Texas Health has supported CHIP since its inception, and
the program currently covers 8.9 million children with family
incomes above Medicaid eligibility limits who lack access to
affordable private coverage. The nation's uninsured rate for
children is a record low of 5 percent due in part to Medicaid
and CHIP coverage. While CHIP is authorized by Congress to
operate until October 1, 2019, legislative action is needed
to continue funding beyond FY 2017. Failure to extend CHIP
funding could result in coverage losses for millions of
children and increased financial pressure for states that may
lead to reductions in eligibility and benefits This
legislation safeguards the program by providing for a five-
year extension of funding.
We also certainly appreciate your leadership on delaying
cuts to Medicaid DSH, which took effect on October 1, 2017.
As you know, Medicaid DSH payments support Texas Health's
hospitals in serving north Texas' most vulnerable
individuals--the poor, the elderly, and the disabled.
Congress reduced Medicaid DSH payments in the Affordable Care
Act, reasoning that hospitals would care for fewer uninsured
patients as health coverage expanded. However, the projected
increase in coverage has not been fully realized, and
Congress subsequently delayed the start of the cuts that were
scheduled to begin in FY 2014. As a result, Texas hospitals
will sustain a $148 million cut in vital payments in federal
fiscal year 2018. The cumulative loss for Texas hospitals for
2018 through 2024 is $3.2 billion. Thankfully, H.R. 3922
would eliminate the scheduled Medicaid DSH reductions in
Fiscal Years 2018 and 2019, thus allowing a critical source
of funding to continue for safety net hospitals.
Thank you for your steadfast leadership on addressing these
important programs by supporting H.R. 3922. As Congress moves
forward on these important issues, we appreciate your
continued willingness to work with us to extend funding for
CHIP, eliminate reductions to Medicaid DSH payments, and
safeguard programs critical to hospitals. If we can provide
you or your staff with additional information, please do not
hesitate to contact.
Sincerely,
Barclay Berdan,
FACHE, Chief Executive Officer,
Texas Health Resources.
Mr. BURGESS. Madam Speaker, I also have a letter from the Children's
Hospital Association, which renews the call for bipartisan CHIP
extension: ``Children's hospitals thank Congress for its long-term
bipartisan commitment to CHIP and for the children it serves. We look
forward to working with lawmakers to maintain a strong CHIP program and
strengthen healthcare for children in the future.''
Children's Hospitals Renew Call for Bipartisan CHIP Extension
Children's hospitals urge Congress to protect children and
families by passing a bipartisan five-year extension of the
Children's Health Insurance Program (CHIP) as soon as
possible.
We are pleased that members of the House Energy and
Commerce Committee have developed bipartisan CHIP policies
that reflect the needs of children, including a five-year
extension of the program that provides for robust CHIP
funding, and continue important beneficiary protections such
as the Maintenance of Effort provision, funding for
[[Page H8410]]
the Pediatric Quality Measures Program, express lane
eligibility, and outreach and enrollment grants. These
policies are also included in the bipartisan Senate proposal
on CHIP, and we thank the committees of jurisdiction in both
chambers for including these crucial policies.
If CHIP funding is not extended soon, CHIP-enrolled
children may become underinsured or uninsured altogether.
CHIP is an important bipartisan health coverage program for
over 6 million low-income children. CHIP builds off of a
strong Medicaid program by providing age-appropriate and
affordable coverage for children who fall above Medicaid
eligibility levels, but lack access to other health coverage
options.
Concerning reports indicate that states are taking steps to
limit programs in order to address the looming funding
shortfall, despite receiving federal redistribution funds. We
urge Congress to act now and avoid potentially disastrous
consequences caused by further delay by enacting a strong,
bipartisan five-year extension of CHIP.
Children's hospitals thank Congress for its long-term
bipartisan commitment to CHIP and the children it serves. We
look forward to working with lawmakers to maintain a strong
CHIP program and strengthen health care for children into the
future.
Mr. BURGESS. Finally, Madam Speaker, I will tell you I am perplexed.
I, frankly, do not understand why there is reticence to providing an
offset for funding of children's health insurance by income relating to
part B premiums for people who earn over $500,000 a year, seniors who
earn over $500,000 a year, or a couple who earns over $875,000 a year.
This was language that was included in President Obama's budget, so
don't tell me it is not bipartisan, because it was bipartisan.
Now, Madam Speaker, today's rule provides for the consideration of an
important piece of legislation to maintain the important funding
streams for millions of underprivileged children depending on the
program.
I want to thank Chairman Walden for his efforts to continually work
with the minority on the Energy and Commerce Committee, repeatedly
providing the requested extensions by the ranking member in order to
continue discussions on the legislation.
The package reflects hours of work to create legislation that will
benefit millions of America's children so that they can lead healthier
lives. I urge my colleagues to support today's rule and the underlying
legislation, the CHAMPIONING HEALTHY KIDS Act
The material previously referred to by Ms. Slaughter is as follows:
An Amendment to H. Res. 601 Offered by Ms. Slaughter
At the end of the resolution, add the following new
section:
Sec. 2. It shall not be in order to consider a
comprehensive tax reform measure or matter reported pursuant
to Sections 2001 or 2002 of House Concurrent Resolution 71 in
the House or in the Committee of the Whole House on the state
of the Union unless easily searchable electronic estimates
and comparisons prepared by the Director of the Congressional
Budget Office and Joint Committee on Taxation have been made
available on a publicly available website of the House 48
hours in advance.
(b) It shall not be in order to consider a comprehensive
tax reform measure or matter reported pursuant to Sections
2001 or 2002 of House Concurrent Resolution 7l in the House
or in the Committee of the Whole House on the state of the
Union, that is called up pursuant to a rule or order that
makes an amendment in order or considers such an amendment to
be adopted, unless easily searchable updated electronic
estimates and comparisons prepared by the Director of the
Congressional Budget Office and Joint Committee on Taxation
reflecting such amendment have been made available on a
publicly available website of the House 48 hours in advance.
(c) It shall not be in order to consider a rule or order
that waives the application of paragraph (a) or paragraph
(b). As disposition of any point of order under paragraphs
(a) and (b), the Chair shall put the question of
consideration with respect to the measure, matter, or rule as
applicable. The question of consideration shall be debatable
for 10 minutes by the Member initiating the point of order
and for 10 minutes by an opponent, but shall otherwise be
decided without intervening motion except one that the House
adjourn.
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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. Madam 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. Madam 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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