[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.

                              {time}  1315

  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.
                                  ____


        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.

                          ____________________