[Congressional Record Volume 163, Number 178 (Thursday, November 2, 2017)]
[House]
[Pages H8413-H8421]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           PROTECTING SENIORS' ACCESS TO MEDICARE ACT OF 2017

  Mr. PAULSEN. Mr. Speaker, pursuant to House Resolution 600, I call up 
the bill (H.R. 849) to repeal the provisions of the Patient Protection 
and Affordable Care Act providing for the Independent Payment Advisory 
Board, and ask for its immediate consideration.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore (Mr. Byrne). Pursuant to House Resolution 
600, the amendment in the nature of a substitute recommended by the 
Committee on Ways and Means, printed in the bill, shall be considered 
as adopted, and the bill, as amended, shall be considered read.
  The text of the bill, as amended, is as follows:

                                H.R. 849

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

     SECTION 1. SHORT TITLE.

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

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

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     sections) are repealed, and any provision of law amended by 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


[[Page H8414]]


  The SPEAKER pro tempore. The bill shall be debatable for 1 hour, 
equally divided among and controlled by the chair and ranking minority 
member of the Committee on Energy and Commerce and the chair and 
ranking minority member of the Committee on Ways and Means.
  The gentleman from Kentucky (Mr. Guthrie), the gentleman from New 
Jersey (Mr. Pallone), the gentleman from Minnesota (Mr. Paulsen), and 
the gentleman from Michigan (Mr. Levin) each will control 15 minutes.
  The Chair recognizes the gentleman from Minnesota.


                             General Leave

  Mr. PAULSEN. Mr. Speaker, I ask unanimous consent that all Members 
have 5 legislative days to revise and extend their remarks and insert 
extraneous material on the bill into the Record.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Minnesota?
  There was no objection.
  Mr. PAULSEN. Mr. Speaker, I yield myself such time as I may consume.
  I rise today in support of H.R. 849, the Protecting Seniors' Access 
to Medicare Act. This discussion is not new. Republicans and Democrats 
came together to pass this same bill back in 2015. This year there is, 
once again, strong bipartisan support with 45 Democratic Members and 
225 Republican cosponsors. It passed out of the Ways and Means 
Committee last month with bipartisan support, too.
  This bill will repeal the Independent Payment Advisory Board, or 
IPAB, created in ObamaCare, the Affordable Care Act. The IPAB puts 15 
unelected bureaucrats in charge of Medicare spending with significant 
unilateral powers to slash payments to providers, forcing them to stop 
seeing Medicare patients without any accountability, judicial review, 
or transparency.
  The board's unprecedented authority to alter Medicare policy could 
ultimately reduce seniors' access to healthcare and put the government, 
rather than the patient, at the center of the healthcare system.
  Putting Medicare on a sustainable financial footing is a top priority 
for all of us here in Congress, but passing the buck to a handful of 
unaccountable bureaucrats is not the right approach.
  Last year, the Medicare Trustees Report stated that this was to be 
the year that the IPAB's authority to make cuts would be triggered. 
Fortunately, this year's Medicare Trustees Report has given us slightly 
more time, but next year, they can come back and move that date up once 
again. This is a cloud that will hang over providers and beneficiaries, 
unless we act and pass this bill today.
  Now some have stated that this bill does not solve any immediate 
problem, and they have questioned the need to act on the bill today. I 
believe that our seniors and our healthcare providers are a priority. 
Why should we kick the can down the road when we can stop this today?
  There are letters of support from over 700 bipartisan groups 
representing patients, employers, hospitals, doctors, nurses, and other 
healthcare professionals all voicing strong support for IPAB repeal.
  They believe that the threat of this board is enough to warrant 
repeal and to place the decisionmaking back in the hands of elected 
Members of Congress, and I agree.
  Mr. Speaker, I reserve the balance of my time.
  Mr. LEVIN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, this is really the question: Why in the world are we 
taking up a bill to terminate a board that does not exist? Why in the 
world are we doing so when premiums are rising and action should be 
taken to strengthen them? Why in the world are we passing a bill that 
would increase the deficit by $17.6 billion? Pay for CHIP, the 
Republicans say, but not this bill.
  So however you feel about IPAB, this is the wrong time and the wrong 
bill for addressing it. The ACA enrollment period began yesterday, and 
because of actions of the Trump administration, consumers across the 
country face confusion and instability in the market.
  Rather than addressing these urgent issues, we are engaged today in a 
political exercise to repeal IPAB, a board that has no members under a 
provision that has never taken effect and is not projected to be 
triggered before 2021, according to CMS actuaries.
  In September, every Democratic member of the Ways and Means Committee 
wrote to Chairman Brady urging bipartisan action to stabilize the 
insurance market. But after repeated requests, we never received a 
response from the chairman, and, to date, the House has taken no action 
on behalf of consumers.
  In the meanwhile, the Trump administration has continued to work to 
undermine the law and access to healthcare by: one, cutting off funding 
for cost-sharing assistance for moderate-income enrollees; two, 
slashing funds to navigators that help consumers enroll in coverage--
the biggest navigator in Michigan had its funding cut by 90 percent; 
three, shortening the enrollment period; four, shutting down 
healthcare.gov on weekends; and five, proposing to chip away at 
consumer protections through executive fiat.
  These actions have significantly contributed to insurers exiting the 
market and raising premiums. It is nothing less than direct and 
deliberate sabotage; so, instead, the Republicans today bring up a bill 
about a board that does not exist, and the latest is it would not until 
2021, at the earliest.
  There are simple actions that we can take today to repair some of the 
damage and, thereby, improve the insurance markets. Senators Lamar 
Alexander and Patty Murray recently came to a bipartisan agreement that 
would provide funding for the cost-sharing reductions and outreach and 
enrollment activities that strengthen the risk pool in the marketplace.
  Unfortunately, as we see today, my Republican colleagues continue to 
ignore these and other important issues, while allowing an 
administration, obsessed with repeal of ACA, to do so through executive 
action what could not be done legislatively.
  What is more, they are bringing to the floor today a bill that the 
Congressional Budget Office estimates will raise the deficit by $17.5 
billion over the next decade. I repeat, raise the deficit by $17.5 
billion over the next decade. And this is just a small preview of the 
coming GOP tax bill, which would increase our Nation's debt by $1.5 
trillion according to the Republican's own budget resolution.

  And whatever happened to the crocodile tears we used to hear from 
Republicans about the deficit? In terms of today's bill lacking any 
offset, how about at least starting to address the staggering cost of 
prescription drugs, a step that would save both senior citizens and the 
Medicare program money.
  Mr. Speaker, the American people need Congress to take action to 
lower their healthcare costs and to stabilize the markets. They do not 
need today an irrelevant political bill such as H.R. 849. If you 
support real steps to lower health insurance premiums now, vote ``no'' 
on this bill.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PAULSEN. Mr. Speaker, I yield myself such time as I may consume, 
and let me just start by saying that some of my colleagues on the other 
side of the aisle have called on us to work with them over and over 
again to find common ground, to make fixes in the flaws in ObamaCare.

                              {time}  1600

  Today we have an opportunity to do exactly that. We should all be 
joining together. There is bipartisan support on this bill to eliminate 
this unnecessary and potentially very destructive body, one that I 
would define as a major flaw in the law. This is the exact process that 
we have been asking for--you have been asking for.
  The bill has been through regular order. We have had countless 
hearings on this topic. We have actually voted not once, but twice, in 
past Congresses to repeal the IPAB to keep it from harming access to 
seniors' care.
  So today we are bringing this bill forward--this legislation 
forward--as a stand-alone provision, not tied to any other policies, to 
once and for all allow Members to say whether they support or oppose 
this unaccountable board.
  Mr. Speaker, I yield 4 minutes to the gentleman from Tennessee (Mr. 
Roe), who has been a tireless champion for seniors in Tennessee and, 
since day one, has been working on this legislation to repeal the IPAB.
  Mr. ROE of Tennessee. Mr. Speaker, I rise in support of my bill, H.R. 
849, the

[[Page H8415]]

Protecting Seniors' Access to Medicare Act of 2017, a bipartisan bill 
with 270 cosponsors, that repeals two sections of the Affordable Care 
Act and terminates the Independent Payment Advisory Board--or the 
IPAB--once and for all. I thank Chairman Brady and Chairman Walden for 
bringing this important bill to the floor.
  I also want to start by thanking my lead Democrat cosponsor from 
California, Dr. Raul Ruiz. Dr. Ruiz and his staff have worked 
tirelessly with my staff to get more cosponsors this Congress than we 
have ever had before, including 45 Democrats. Seeing such strong 
bipartisan support for my bill only makes sense, however, since doing 
away with the IPAB has been a bipartisan idea since it was first 
proposed.
  In December of 2009, I joined Congressman Richard Neal and 72 other 
bipartisan Members in writing then-Speaker Pelosi expressing our 
opposition to the IPAB's creation. On the day the ACA passed the House, 
I filed legislation to repeal the IPAB, and have received bipartisan 
support in every Congress since. This is about access for seniors' care 
and quality of their care. By the way, the IPAB was not in the House 
version of the Affordable Care Act. Only the Senate sent that back over 
here. So it was not part of the House to begin with.
  We got lucky this summer that the Medicare trustees' report did not 
trigger the IPAB. Otherwise, there would have been significant 
statutory requirements to cut Medicare within a year. These cuts would 
have been made to provide reimbursements, which would do nothing but 
drive providers out of Medicare and would eliminate options for our 
seniors to receive healthcare.
  Peter Orszag, President Obama's Office of Management and Budget 
Director, said this was the greatest ceding of power from the Congress 
to a bureaucracy since the formation of the Federal Reserve. Remember, 
it has been stated here, Mr. Speaker, that the board hasn't been 
formed. That means one person makes these decisions, not the Congress. 
Medicare recipients can't come to their elected official and effect 
changes in this IPAB if it is enacted, and it will be.
  One of the major concerns we hear today is that the CBO has estimated 
that this bill will cost over $17 billion that is not paid for. First 
of all, the CBO describes its estimates as ``extremely uncertain'' 
because it is quite possible that under current law, the IPAB will not 
be triggered.
  Secondly, this is the same dilemma we were in with the sustainable 
growth rate--SGR. Medicare says to doctors: You go out and provide the 
care, but if you provide too much, we will cut your payments.
  As a physician myself, having seen how much havoc the SGR wreaked 
every year, we can't afford to put providers through this again. We 
spent months and years getting that corrected. Knowing that many 
Members were concerned about the offsets in previous years, we have a 
bill on the floor today that all of our cosponsors can support.
  I look forward to seeing all 270 of my cosponsors voting in favor of 
passage in order to preserve Medicare for our Nation's seniors. We have 
a chance to send a strong statement of support to Americans of Medicare 
age that do not want to see their healthcare arbitrarily cut by a body 
of 15 unelected, unaccountable bureaucrats, or the Secretary of HHS, if 
the board is not empaneled. If there are hard decisions to be made on 
Medicare, Congress should not abdicate that duty to a group of people 
with no oversight or legal recourse. Those decisions should be made by 
the people elected as representatives of the people.
  Mr. Speaker, I urge my colleagues to support final passage of this 
bill and maintain Medicare services for our Nation's seniors, because 
this is truly a bipartisan issue that will affect all seniors equally.
  Mr. LEVIN. Mr. Speaker, I yield 5 minutes to the gentleman from 
Wisconsin (Mr. Kind).
  Mr. KIND. Mr. Speaker, I thank my friend for yielding me this time.
  Mr. Speaker, I rise today in opposition of the repeal of the 
Independent Payment Advisory Board.
  This is another classic example of a solution in search of a problem. 
Of all the things that we should be working on in Congress in a 
bipartisan fashion to improve and to fix the problems that exist within 
our healthcare system, we have legislation on the floor before us today 
that calls for the repeal of a nonexisting commission, based on 
nonconsistent spending cuts being proposed for Medicare, based on a 
nonconsistent cost of rate of increase in spending under the Medicare 
program, all of which is going to add $17.5 billion to the deficit over 
the next 10 years because this bill isn't paid for. And the irony is 
they are coming forward with this legislation, which will add another 
$18 billion to the debt, on the same day they release a tax bill that 
calls for an additional $1.5 trillion worth of deficit spending because 
the tax bill hasn't been offset. At some point and at some time, we 
have got to take a bipartisan stand on fiscal responsibility in this 
place again because it is not happening today.

  Instead, we should be working on short-term, practical solutions to 
stabilize and bring more certainty to the health insurance marketplace, 
in light of what the administration is doing to completely undermine 
the marketplaces today. We ought to be working on delivery system 
reform proposals that will emphasize the establishment of accountable 
care organizations and medical homes and value-based purchasing and 
bundling arrangements and different alternative payment models to get 
us to a system of value, quality, and outcomes, and away from the fee-
for-service payment for the volume of services, regardless of results.
  Let's be honest, the real cost driver in our Federal budget--and it 
is true at the State and local level--has been healthcare costs because 
we have an aging population. That is the work that we should be working 
on together, is the delivery system reform and the payment reform, so 
we are aligning the incentives in the right direction where we are 
telling our healthcare providers: You will be compensated based on good 
results, not on how much you do.
  There is a lot within the Affordable Care Act giving our providers 
the very tools in order to accomplish that, and we ought to be 
enhancing that here today. Instead, we are wasting time on a commission 
that, according to the CMS's own actuary, says, at the very earliest, 
it might be comprised in 2021. But, even then, it warrants us, with the 
mission that we have given it, that: Hey, you have got healthcare 
spending within the healthcare system that, Congress, you need to deal 
with. And then come back with recommendations. And then it is up to us 
to make corrective action at that time.
  So all this talk about unelected bureaucrats making these decisions 
belies what the legislation actually calls for in the establishment of 
the IPAB. This was, however, another important cost containment tool 
that was put into the Affordable Care Act to try to restrain the growth 
of healthcare spending. We need more of those type of ideas, rather 
than efforts today to remove those tools and then possibly see just 
unbridled healthcare spending in the future.
  What is really disturbing is I know there is a lot of common ground 
in this area, yet the American people wouldn't know it, with this 
political ping-pong ball on healthcare reform going back and forth and 
the chaos and the confusion that it is causing, and that is 
unfortunate.
  So, instead, today, we ought to first take steps to stabilize the 
insurance exchanges, rather than an administration that is doing 
everything they can to limit the enrollment during the signup period, 
which actually started yesterday and lasts until December 15. They have 
cut by 90 percent funding for marketing of the exchanges. They have cut 
by almost 50 percent the funding for our navigators back home who are 
trying to help people get affordable healthcare coverage in their 
lives. They ended the cost-share payments, which only increases the 
cost for healthcare for everyone else because of the risk that the 
insurance plans now face.
  The other segment of the population that we should be focused on in 
helping is that 5 or 6 percent of the population that are in the 
individual market who don't qualify for premium tax credits because 
they are getting hammered today. You would think that would be another 
area of bipartisan commonality that we can come together on

[[Page H8416]]

to provide relief for those individuals who are in the individual 
market experiencing these higher premiums, part of it being done 
because of the elimination of the cost-sharing reduction payments, but, 
instead, nothing is being done on that front.
  My friend from Michigan also pointed out that we should be having 
hearings about the cost of prescription drugs in committee. That is one 
of the main cost drivers within the healthcare system, yet there is 
deafening silence in the Halls of Congress when it comes to taking 
measure on that front, even though President Trump promised during the 
course of his campaign and even earlier this year to try to take some 
action in a bipartisan way to address drug costs.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. LEVIN. Mr. Speaker, I yield an additional 1 minute to the 
gentleman from Wisconsin.
  Mr. KIND. It was an initiative that the President was even interested 
in trying to address. Yet, again, nothing is being done.
  So this legislation is much ado about nothing because there is 
nothing pending. In fact, nothing would be pending, according to the 
CMS actuary, until, at the earliest, 2021. Instead, we are wasting time 
and opportunity to address the real problems and finding the real fixes 
that are needed in the healthcare system. There I am confident there is 
a lot of bipartisan overlap, having worked with many of my colleagues 
on the committee and across the aisle, on many of these measures that I 
just mentioned here today.
  So I encourage my colleagues to vote ``no'' and allow this to go 
forward, because it does keep an eye on rising costs and it keeps the 
pressure where it belongs--right here in Congress--to take future 
action if the rate of growth starts spinning out of control.
  Mr. PAULSEN. Mr. Speaker, I yield 1 minute to the gentleman from 
Pennsylvania (Mr. Rothfus), who has been a tireless advocate working on 
Medicare issues as well.
  Mr. ROTHFUS. Mr. Speaker, I thank the gentleman for yielding.
  Mr. Speaker, I rise today in strong support of H.R. 849, the 
Protecting Seniors' Access to Medicare Act.
  The Independent Payment Advisory Board, known as the IPAB, was 
created under the ACA, and consists of a panel of 15 unelected, 
unaccountable government bureaucrats with the authority to single-
handedly cut Medicare spending. By doing this, the IPAB reveals the 
truth that government, rather than the patient, is at the center of our 
Nation's healthcare policy.
  In repealing the IPAB, we begin to help get rid of the notion of the 
mentality that Washington knows best when it comes to our healthcare. 
It is imperative that we act now before nominees are put forward to 
serve on the board and access to care is greatly decreased or denied.

  My constituents in western Pennsylvania rely on these funds for their 
healthcare needs. I am proud to see Congress working together in a 
bipartisan manner on this commonsense legislation that will keep 
patients and doctors in control of healthcare decisions and preserve 
Medicare for current and future seniors.
  Mr. LEVIN. Mr. Speaker, I reserve the balance of my time.
  Mr. PAULSEN. Mr. Speaker, I yield 1 minute to the gentleman from 
Indiana (Mr. Messer), a member of our leadership team.
  Mr. MESSER. Mr. Speaker, I thank the gentleman from Minnesota for his 
hard work on this topic.
  Mr. Speaker, Hoosiers continue to suffer under the negative impacts 
of ObamaCare each and every day. Despite the House keeping its promise 
to repeal this disastrous law, the Senate has failed to act.
  But, fortunately, we have an opportunity today to make a difference, 
to protect our seniors, and to get rid of one of ObamaCare's worst 
provisions: the Independent Payment Advisory Board, better known as the 
IPAB.
  This board consists of 15 unelected and unaccountable bureaucrats who 
have the power to ration healthcare for our seniors without any 
congressional oversight. For an individual patient, this board has the 
power to make your healthcare decisions for you, and that is not fair.
  This bill will change that. It disbands the board and ensures our 
seniors continue to have access to their healthcare that they need.
  Mr. Speaker, I urge my colleagues to roll back this dangerous 
ObamaCare provision and to support this commonsense legislation.
  Mr. LEVIN. Mr. Speaker, I continue to reserve the balance of my time.
  Mr. PAULSEN. Mr. Speaker, I yield 1 minute to the gentleman from 
Georgia (Mr. Allen), who is an original cosponsor of this legislation.
  Mr. ALLEN. Mr. Speaker, I rise today to urge my colleagues to support 
the Protecting Seniors' Access to Medicare Act.
  How many of you know what the Independent Payment Advisory Board is--
also known as the IPAB?
  How many of you know who serves on the board?
  I would venture to say that not many people know the 15 unelected, 
unaccountable bureaucrats who have unilateral authority to cut Medicare 
spending.
  When the Democrats passed ObamaCare, they created the Independent 
Payment Advisory Board, providing them with unprecedented power to 
alter Medicare policy, ultimately, having the chance to reduce seniors' 
access to healthcare and put the government at the center of our 
healthcare system with zero accountability or transparency.

                              {time}  1615

  My constituents deserve better and Americans across this Nation 
deserve better.
  A vote for this legislation is a vote to give seniors more control 
over their healthcare decisions. I urge my colleagues to support Dr. 
Roe's bill.
  Mr. LEVIN. Mr. Speaker, I reserve the balance of my time, unless Mr. 
Paulsen is ready to close.
  Mr. PAULSEN. Mr. Speaker, I have no more speakers.
  Mr. LEVIN. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, I want to say this to my colleagues, whom I very much 
respect, who signed on to this bill, many of them early on this year. 
There have been three changes of circumstance:
  First, right then, it appeared that IPAB might come into existence in 
2017. Now the actuary has made clear that will not happen under these 
circumstances until 2021.
  Secondly, since the bill was introduced, circumstances have changed. 
The administration has taken steps to undercut healthcare for 
Americans. So because of cost-sharing and other issues, premiums have 
been rising. That is a second change of circumstance why this is the 
wrong bill at the wrong time.
  Third, the last time it came up, it was paid for. In the Committee on 
Ways and Means, when we raised this issue, we were told, as always: 
Well, we don't have to pay for it in the committee, but it can be paid 
for on the floor.
  This is totally unpaid for, zero, no effort to pay for it, and it 
would add $17.5 billion to the national debt. Already, it is at its 
record level with, now, the threat of $1.5 trillion more.
  So I really urge, no matter what were the circumstances when you 
signed on, in almost every case they have changed, and so there is such 
good reason why this is the wrong bill at the wrong time, and I think 
to vote for this is really the wrong vote.
  Mr. Speaker, I yield back the balance of my time.
  Mr. PAULSEN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, my colleagues on the other side of the aisle have 
supported this bill in the Ways and Means Committee in regular order 
last month and in a prior vote, I will add, back in 2015.
  Rather than take control away from the American people and from our 
seniors, we should be expanding choice, expanding access, and expanding 
flexibility and competition in Medicare, and we can start that right 
now, today, by passing this legislation to terminate the IPAB once and 
for all.
  Now, my colleagues on the other side of the aisle have also called on 
us to work with them to find common ground, to work with them to fix 
those flaws in the Affordable Care Act. Well, today, with this vote, we 
have the opportunity to do just that, to join together to eliminate 
this unnecessary

[[Page H8417]]

and potentially destructive provision--certainly, it is a major flaw in 
the law--and pass this bipartisan legislation.
  Repealing IPAB is crucial to maintaining and expanding access to 
high-quality care for our Nation's seniors and ensuring that Medicare 
payment policy is not dictated to us and our constituents by a board of 
unelected and unaccountable bureaucrats.
  Mr. Speaker, I want to thank Dr. Roe and I want to thank Dr. Ruiz on 
the other side of the aisle for their leadership on this bill, along 
with the Energy and Commerce and Ways and Means Committee members.
  Mr. Speaker, I strongly urge my colleagues to support the passage of 
H.R. 849, and I yield back the balance of my time.
  Mr. GUTHRIE. Mr. Speaker, I yield myself as much time as I may 
consume.
  Mr. Speaker, I rise in support of H.R. 849, the Protecting Seniors' 
Access to Medicare Act of 2017.
  The Independent Payment Advisory Board, or IPAB, was created in the 
Affordable Care Act to reduce per capita rate of growth in Medicare 
spending. If a spending target is exceeded, cuts must be made, and the 
HHS Secretary is directed to implement the proposals made by this 15-
person board automatically unless Congress affirmatively acts to alter 
the proposals or to discontinue automatic implementation of the 
proposals. This board has not yet been formed, but the statute requires 
the HHS Secretary to come up with the required reductions instead.
  Medicare is crucial for our Nation's seniors to see their doctors, 
and the program's viability must be protected. There is no question 
that Medicare must be modernized in order to continue for future 
generations, but IPAB is not the right approach, and a bipartisan group 
of my colleagues agree that IPAB is not the answer to fixing Medicare's 
shortfalls.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield 3 minutes to the gentleman from 
California (Mr. Ruiz).
  Mr. RUIZ. Mr. Speaker, today I rise in strong support of my bill, the 
bipartisan Protecting Seniors' Access to Medicare Act of 2017.
  I was proud to introduce this commonsense, bipartisan bill with my 
friend on the other side of the aisle, Congressman Dr. Phil Roe.
  Mr. Speaker, I thank Dr. Roe and his staff for their many years of 
hard work and advocacy on this issue. I am pleased that our offices 
were able to work closely on this bill, building a strong, bipartisan 
working relationship.
  H.R. 849 eliminates the well-intentioned but misguided Independent 
Payment Advisory Board, or IPAB, that was created under the Affordable 
Care Act.
  Everyone can agree that we need to address the high cost of 
healthcare and strengthen the solvency of Medicare. However, the IPAB 
approach is misguided, because it establishes an appointed and 
unelected panel that would have the authority to make cuts to Medicare, 
with no accountability to seniors.
  Our constituents must be able to hold elected officials accountable 
for decisions made regarding changes to Medicare regardless of who is 
in power.
  What is more, if the board failed to act, the Health and Human 
Services Secretary, whether Democrat or Republican, would be able to 
singlehandedly make cuts to Medicare.
  Fortunately, the targeted Medicare growth rate to trigger IPAB has 
never been reached and the board has not yet been appointed. However, 
we must act now to ensure that it never happens.
  Again, we can all agree that we must address the high cost of care 
and strengthen the solvency of Medicare, but we should do this by 
addressing the overall long-term cost of care.
  I am pleased we are taking action in the House now, and I hope the 
Senate can consider this bill quickly. I encourage my colleagues to 
join me in passing this commonsense, bipartisan improvement to the 
Affordable Care Act and work together to protect and strengthen 
Medicare for our Nation's seniors.
  Mr. Speaker, I urge my colleagues to vote ``yes.''
  Mr. GUTHRIE. Mr. Speaker, I yield 3 minutes to the gentleman from 
Oregon (Mr. Walden), the chairman of the Energy and Commerce Committee 
and my good friend.
  Mr. WALDEN. Mr. Speaker, I want to thank Mr. Guthrie from Kentucky. 
He has done a terrific job on the Energy and Commerce Committee on many 
fronts related to improving healthcare, especially for seniors and low-
income Americans, among others.
  Mr. Speaker, today I rise in strong support of H.R. 849. This is the 
Protecting Seniors' Access to Medicare Act of 2017. This will repeal 
the Independent Payment Advisory Board, IPAB.
  The purpose of IPAB is to reduce Medicare's per capita growth rate. 
While, certainly, that is important work, this is not the solution.
  The IPAB, created by the Affordable Care Act, would be composed of 15 
unelected bureaucrats authorized to unilaterally make decisions 
regarding Medicare's finances, whether that be through draconian cuts 
to provider payments or by imposing policy changes that would reduce 
Medicare spending if the program exceeds an arbitrary growth rate 
target.
  In other words, they can do just about anything they want to cut 
Medicare, and we don't have much of a say in it. These changes would 
automatically go into effect, and the Secretary of Health and Human 
Services would be forced to implement these reductions should IPAB be 
triggered, unless Congress passed legislation that would achieve the 
same amount of savings.
  It is also worth noting that current law does not require a public 
comment period before IPAB issues their recommendations, so there would 
be no chance for the public to weigh in. And individuals and providers 
would have no recourse against the board--can you imagine that?--as its 
decisions are not subject to appeal or judicial review. This is hardly 
a model of transparency and accountability.
  While IPAB hasn't been constituted yet, the threat of this provision 
of law remains. So I cannot support IPAB. I never have, because its 
potential cuts to providers, our doctors and hospitals and others and 
healthcare facilities would increase out-of-pocket costs for seniors 
and potentially limit the availability of medical services, restricting 
seniors' access to care, particularly in our rural areas.
  Congress can and should act now to prevent IPAB and prevent the 
unelected bureaucrats from ever being at the helm of our country's 
Medicare Program.
  I know the importance of this program. It took very good care of my 
parents, my wife's parents, and others I know. We should reject the 
premise of surrendering our oversight and our responsibility to 
preserve and protect the Medicare Program to a board with the power to 
make binding decisions about Medicare policy, with little 
accountability.
  We know how to make sure seniors have an affordable, sound, reliable 
healthcare system. We have to create competition at every turn in the 
healthcare system and look for models that work, like Medicare part D.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in opposition to H.R. 849, the IPAB repeal.
  Mr. Speaker, Republicans have spent the last 9 months trying to 
repeal the Affordable Care Act and they have failed, but instead of 
working with Democrats to improve the ACA, they will stop at nothing to 
repeal the law piece by piece.
  The Republicans' partisan bill to reauthorize CHIP, community health 
centers, and other public health extenders is paid for on the back of 
Medicaid recipients, Medicare, low- and middle-income families with the 
Affordable Care Act health coverage, and the Prevention Fund, but yet 
they will not bother to pay for the $17.5 billion it will cost to 
repeal IPAB.
  IPAB was enacted as a backstop to the other cost-saving and quality-
improvement efforts in the ACA, such as accountable care organizations, 
patient-centered care models like Medical Homes, programs that pay for 
quality, not quantity and value-based purchasing.
  Because of the Affordable Care Act and these programs, Medicare 
spending growth has slowed and Medicare solvency has been extended.
  According to the CMS actuary, IPAB will not be triggered until 2021, 
so the

[[Page H8418]]

timing of today's repeal is premature and politically motivated.
  IPAB repeal would increase the deficit by $17.5 billion. This is 
fiscally irresponsible of Republicans, especially as they prepare to 
announce a tax package that will saddle our country with $1.5 trillion 
of debt in order to give tax cuts to the wealthy and corporations.
  IPAB repeal is not about helping seniors. Don't let the Republicans 
kid you. Contrary to what the Republicans say, IPAB is prohibited from 
sending recommendations to Congress that would harm seniors by 
increasing their out-of-pocket costs or cutting their benefits. In 
fact, it is the Republican ACA repeal efforts that would cut nearly a 
trillion dollars from Medicaid and Medicare, harming seniors and other 
vulnerable Americans, which would have truly led to the rationing of 
healthcare.

  So for all these reasons, I urge my colleagues to vote ``no'' on H.R. 
849, the IPAB repeal.
  Mr. Speaker, I reserve the balance of my time.
  Mr. GUTHRIE. Mr. Speaker, I yield 2 minutes to the gentleman from 
Florida (Mr. Bilirakis), a member of the Energy and Commerce Committee.
  Mr. BILIRAKIS. Mr. Speaker, I thank and appreciate my friend from 
Kentucky. He does a great job on the Energy and Commerce Committee and 
as vice chairman on the Health Subcommittee.
  Mr. Speaker, I rise in support of the Protecting Seniors' Access to 
Medicare Act. I am a proud cosponsor of this bill, and I am glad we are 
passing this much-needed bill.
  The Affordable Care Act created the Independent Payment Advisory 
Board. This board of unelected and unaccountable bureaucrats was 
charged with the single goal of cutting Medicare payments to physicians 
and hospitals. We can't let that happen.
  This poorly conceived scheme could force physicians to exit the 
Medicare Program or limit their Medicare patients. We can't let that 
happen.
  This would create an access-to-care problem for the 170,000 Medicare 
beneficiaries in my district. When I am back in the district talking to 
seniors, senior advocates, local physicians, hospitals, practically 
everyone has raised concerns with this board.
  This is a commonsense repeal bill. They say that it hasn't been 
implemented yet, it hasn't been set up yet. Okay. Well, let's get rid 
of it. Most people don't want it.
  Mr. Speaker, again, we need to pass this particular bill. We need to 
abolish this bad idea.

                              {time}  1630

  Mr. PALLONE. Mr. Speaker, I yield 4 minutes to the gentleman from 
Vermont (Mr. Welch), a member of our committee.
  Mr. WELCH. Mr. Speaker, the issue here about Medicare is one where 
there is universal support in this body for that program that was 
passed in 1965 by a bipartisan vote. It is a lifeline for many of our 
seniors--for all of our seniors. It is a program where, since everybody 
pays, everybody benefits. It gives all of us confidence that our 
parents or ourselves will have access to good healthcare.
  We have a challenge. The cost of healthcare in this country is far 
too expensive, and it is for a variety of reasons that our country 
spends twice as much on healthcare as most industrialized countries in 
the rest of the world and we don't get better results for that.
  The challenge for us, if we want to save healthcare, particularly 
Medicare, is to start focusing on reforms that bring the cost of 
healthcare down and don't compromise quality.
  The Affordable Care Act extended access to healthcare for millions of 
Americans, but it also included some steps that began bending the cost 
curve. The rate of growth in the Medicare spending has started to come 
down under the Affordable Care Act. It was patient-centered programs, 
it was accountable care organizations, it was value-based payment 
systems. These things where, for the first time, Congress talked not 
just about extending access, but trying to reform payment systems so 
that we could get the benefit of a more efficient system.
  The IPAB is simply one of the potential tools that would be used in 
order to present to Congress recommendations. Unlike what Mr. Walden 
said, it would be the final say of Congress whether we wanted to 
approve or not any recommendation by the IPAB.
  Here is the difference in how we are approaching healthcare. Many in 
this body on the Republican side have focused on the cost of 
healthcare, its contribution to the debt. The policy proposal in the 
form of repealing the Affordable Care Act, its way of reducing the cost 
of healthcare was to take healthcare away from 24 million Americans. 
That is what that bill did.
  That is one way to control the cost of healthcare, have people go 
without. It is the wrong way. We all know that. We have got to bite the 
bullet here and start addressing the fact that we spend too much. Some 
of it is wasteful procedures, some of it is gaming the system, some of 
it is these incredible maneuvers by drug companies.
  I am just going to give one example because I want to give this 
example as an indication of how right before our eyes bad things are 
happening that we are allowing to occur.
  HUMIRA, a very good drug by AbbVie. Their patent was expiring. That 
patent is legislatively provided to give them exclusive marketing and 
selling rights. They have a monopoly price. It is incredibly expensive, 
like $70,000 for a supply.
  Amgen had a biosimilar that was going to be marketed, and then you 
would have the benefit of competition. The price would go down.
  AbbVie and Amgen made a deal. We don't know how much AbbVie paid to 
Amgen, but suddenly Amgen is not going to bring its generic, in effect, 
to market until 2023, but--and this is part of their agreement--they 
are going to sell their biosimilar product in Europe now.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. PALLONE. Mr. Speaker, I yield an additional 2 minutes to the 
gentleman from Vermont.
  Mr. WELCH. Mr. Speaker, Europe is going to get the benefit of that 
lower price and the United States is not.
  My question to my colleagues--it is not just about the IPAB. It is 
about let's get real. Let's get real on drug prices. Let's get real on 
the fee-for-service as opposed to value-based system. Let's get real on 
cracking down on Medicare fraud. Let's get real on focusing on the cost 
side, where all of us acknowledge bad things are happening. This fear 
of these ``unelected bureaucrats,'' where it is 15 people who, at the 
end of the day, whatever recommendation they want to make to us, force 
us to make a hard decision as to whether it is a good recommendation or 
a bad recommendation.
  We are in charge. This is going to be rammed down our throat, but 
what it does force us to do is start looking where the money is; rip-
off drug prices, excessive procedures that actually create medical 
risk.
  Mr. Speaker, we do have a challenge of healthcare cost in this 
country, but the focus has to be on improving the delivery system and 
taking the rip-off pricing out of the system.
  Mr. GUTHRIE. Mr. Speaker, I yield 2 minutes to the gentleman from 
Pennsylvania (Mr. Costello), a member of the Energy and Commerce 
Committee.
  Mr. COSTELLO of Pennsylvania. Mr. Speaker, I rise in strong support 
of H.R. 849, the Protecting Seniors' Access to Medicare Act.
  Mr. Speaker, this bipartisan legislation would bring an end to the 
Independent Payment Advisory Board, also known as the IPAB. Since its 
creation as part of the ACA, the IPAB has threatened to put an 
unelected panel of 15 Washington bureaucrats at the center of the 
healthcare delivery model.
  Not only would the IPAB shift healthcare decisionmaking away from 
patients and physicians, it would also empower this panel with the 
unilateral ability to make arbitrary cuts to Medicare without proper 
oversight and with zero accountability to the very seniors and 
beneficiaries whose healthcare access they would affect.
  Mr. Speaker, it is time to end this unrealistic, unreasonable, and 
unpopular one-size-fits-all approach to healthcare delivery. It was the 
wrong approach from the start, and today's vote will help bring an end 
to this dangerous power grab once and for all.
  Mr. Speaker, I want to thank all those involved, and I encourage my 
colleagues to support this important bipartisan effort.

[[Page H8419]]

  

  Mr. PALLONE. Mr. Speaker, may I inquire as to how much time remains?
  The SPEAKER pro tempore. The gentleman from New Jersey has 5\1/2\ 
minutes remaining, and the gentleman from Kentucky has 8\1/2\ minutes 
remaining.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I can't help but put what is happening today in terms of 
the Republicans putting up this bill on the IPAB and what is happening 
tomorrow with the Republicans putting up a CHIP and community health 
centers bill but point out that collectively what they are trying to do 
is what they were not able to do in the first 9 months of this session 
when they sought very hard and pushed very hard to repeal the 
Affordable Care Act.
  What is going on here today and tomorrow with the IPAB and community 
health centers and CHIP is essentially an effort to repeal the 
Affordable Care Act piece by piece, in my opinion.
  What do we do?
  We see the IPAB, which is part of the Affordable Care Act. We see the 
pay-fors for community health centers and the CHIP tomorrow, taking 
away money from the Prevention Fund from the Affordable Care Act, 
limiting the grace period when people will lose their insurance that 
they have under the Affordable Care Act.
  This goes along also with what is happening with the President as 
well. The President has, in the last month or so, said that he is not 
going to pay the cost-sharing subsidies. He has cut back on the 
outreach so that people don't know what is in the Affordable Care Act. 
He has cut back on the period when people can sign up and get their 
insurance in half.
  What we are seeing, in my opinion, is the Republicans sabotaging the 
Affordable Care Act. They couldn't repeal it, so now they are doing 
whatever they can to sabotage it. It is really ironic or inconsistent, 
however you want to put it. On the one hand they are insisting that 
when it comes to kids and community health centers, which is a group of 
people you would think they would be most concerned about, they insist 
on paying for it by taking money from other healthcare programs. We are 
asked to take money from the Prevention Fund, which pays for vaccines 
for children, which pays for the children's lead poisoning program, 
which is a major part of our opiate prevention program. This is the 
money that comes from the Prevention Fund. Basically, they are taking 
that money and using it to pay for the community health centers and the 
Children's Health Initiative, which means that that money is lost. That 
money is lost for those other purposes.
  With regard to the grace period, they are saying, well, if you fail 
to pay your insurance, it used to be 90 days before you lost it. Now it 
would be 30 days before you lost it, which means that you end up with 
about 500,000 or 600,000 people who have insurance now under the 
Affordable Care Act that would lose it, according to the CBO.
  Yet, at the same time, with the IPAB repeal, which we are considering 
now, which costs $17.5 billion, and which, as my colleague from Vermont 
said, is a mechanism to try to save costs, they are saying: Well, we 
don't have to pay for that. We can just repeal it. We will forego those 
additional costs, which become part of the deficit.
  Mr. Speaker, for all these reasons, the bottom line is, what the 
Republicans are doing is not fair. It is not fair to the kids. It is 
not fair to the people who are going to lose their health insurance.
  I will say as the last thing that this is going nowhere. One of the 
reasons why Democrats have been urging the Republicans with regard to 
the CHIP and community health centers to work with us on a bipartisan 
basis is because we know if this bill passes today on a partisan vote, 
because we can't support it for the reasons I explained, then that 
means that it is going to go to the Senate and it is going to die 
because there is no reason to believe that the Senate is going to take 
up this partisan bill.
  I think it is just a huge mistake on the part of Republicans. 
Basically, what they are signaling today is that they don't really care 
about this. They wanted to stick around until the end of year, which 
means the community health centers and CHIP just basically wither on 
the vine for lack of funds. That is not fair. It is not fair to the 
kids. It is not fair to those who use community health centers.
  Mr. Speaker, for all these reasons, I would urge a ``no'' vote on the 
bill today, the IPAB repeal; and I will also ask for a ``no'' vote 
tomorrow on the CHIP and the community health centers legislation.
  Mr. Speaker, I yield back the balance of my time.
  Mr. GUTHRIE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, one, this IPAB effort is bipartisan. We have even heard 
on the floor both sides of the aisle support passage of the bill. It 
has been bipartisan.

  First, a couple of things. On the value-based payments--which I think 
is the direction we need to go to rein in the costs and make sure we 
have sustainable programs, but the IPAB's annual short-term focus 
savings provision would affect Medicare and the wider health system in 
unpredictable ways with potentially many negative unintended 
consequences by doubling down on the traditional practice of squeezing 
payment rates in order to slow spending with no meaningful eye to how 
these changes impact long-term incentives--the IPAB could work at cross 
purposes to broaden reform that would base Medicare payments on quality 
and value.
  On the offset, we did offset CHIP and the community health centers. 
We know that money is going to be spent. We know that when we authorize 
it, it is going to be spent. We believe it is going to be spent wisely. 
That is why we are moving forward with these bills.
  The IPAB has not been constituted, and repealing it should not have 
to be offset since it has not spent any money nor been charged yet with 
finding any savings. The IPAB trigger has never been hit. The CBO 
estimates that the IPAB would be triggered in 2023, 2025, and 2027. But 
by their own admission, and I quote from the report, ``Given the 
uncertainty that surrounds these projections, it is possible such 
authority would be invoked in other years,'' or we could also assume 
possibly never at all.
  The CBO estimate also has to assume the level of cuts required by the 
amount Medicare is spending that exceeds the trigger. The CBO also then 
has to speculate on how reductions made in any one year would impact 
the trigger in future years, further laying assumption upon guesswork. 
As the CBO notes in their estimate, the estimate represents a broad 
range of possible effects.
  The CBO admits they do not know if the IPAB will be triggered or what 
policies they might pursue if activated. Some of their assumptions are 
one-sided bets that may or may not achieve savings, and the CBO must 
further speculate on the probabilities associated with such variations.
  Mr. Speaker, in closing, I believe the IPAB will not be effective 
providing real solutions for Medicare solvency. It contributes 
disproportionately little to the projected cost savings needed in 
Medicare, but it has the potential to hurt seniors' access to care. 
Fundamentally, I believe it is a constitutional affront to the 
legislative branch.

                              {time}  1645

  The IPAB decisions don't come to Congress to be approved or 
disapproved. We can undo the IPAB decisions if we have dollar-for-
dollar replacement, but that could even be blocked by a minority vote 
in the Senate.
  So I urge my colleagues to support H.R. 849, to repeal the 
Independent Payment Advisory Board, and I hope there will continue to 
be bipartisan support for this important legislation.
  Mr. Speaker, I yield back the balance of my time.
  Ms. JACKSON LEE. Mr. Speaker, I rise in opposition to H.R. 849, the 
so-called ``Protecting Seniors' Access to Medicare Act of 2017,'' which 
repeals the Independent Payment Advisory Board (IPAB), that was 
established under the ACA in response to high rates of growth in 
Medicare expenditures and charged with developing proposals to ``reduce 
the per capita rate of growth in Medicare spending.''
  I opposed this bill when it came to the floor as H.R. 1190 in the 
114th Congress and I oppose it now because by repealing IPAB, the bill 
would eliminate an important safeguard that will help reduce the rate 
of Medicare cost growth responsibly while protecting Medicare 
beneficiaries.

[[Page H8420]]

  Mr. Speaker, H.R. 849 is nothing but another attempt, in a long line 
of House Republican efforts to undermine both the Medicare guarantee 
and the Affordable Care Act.
  Repealing IPAB would cost over $17.5 billion during the course of a 
ten year period according to the Congressional Budget Office (CBO).
  Mr. Speaker, Republicans do not even make an attempt to find an 
offset for this $17.5 billion increase to the deficit resulting from 
repeal of the IPAB, while at the same time they plan to bring to the 
floor a partisan bill to reauthorize CHIP, Community Health Centers, 
and other public health extenders by cutting Medicare and slashing 
funding for programs relied upon by Medicaid recipients, low and middle 
income families with Affordable Care Act health coverage.
  After more than seven years under the Affordable Care Act, more than 
20 million Americans have gained health coverage; up to 129 million 
people who could have otherwise been denied or who faced discrimination 
now have access to coverage.
  Mr. Speaker, given the real challenges facing our nation, it is 
irresponsible for the Republican majority to continue bringing to the 
floor unpaid for bills that would do serious harm to millions of 
Americans if they were to be enacted.
  House Republicans have tried more than 65 times to undermine the 
Affordable Care Act, which has enabled more than 20 million previously 
uninsured Americans to know the peace of mind that comes from having 
access to affordable, accessible, high quality health care.
  Their batting average to date is .000; they have struck out every 
time because the American people appreciate and strongly support the 
Affordable Care Act.
  Mr. Speaker, I ask my colleagues to look at the facts and abandon 
this misguided effort to undermine the ACA and impose significant 
negative impacts on Americans currently insured.
  The Independent Payment Advisory Board is to recommend to Congress 
policies that reduce the rate of Medicare growth and help Medicare 
provide better care at lower costs.
  IPAB membership by law is to be made up of 15 members appointed by 
the President and confirmed by the Senate and been comprised of the 
non-partisan CBO, economists, and health policy experts as contributing 
to Medicare's long-term sustainability.
  Mr. Speaker, the IPAB is already prohibited from recommending changes 
to Medicare that ration health care, restrict benefits, modify 
eligibility, increase cost sharing, or raise premiums or revenues.
  Under current law, the Congress retains the authority to modify, 
reject, or enhance IPAB recommendations to strengthen Medicare, and 
IPAB recommendations would take effect only if the Congress does not 
act to slow Medicare cost growth.
  Finally, Mr. Speaker, let me point out to our friends across the 
aisle that according to the CMS actuary, IPAB will not be triggered 
until 2021, so the timing of today's repeal is premature and 
politically motivated.
  IPAB was enacted as a backstop to the other cost saving and quality 
improvement efforts in ACA, such as accountable care organizations, 
patient-centered care models like medical homes, programs that pay for 
quality not quantity, and value based purchasing.
  Because of the ACA and these programs, Medicare spending growth has 
slowed and Medicare's solvency has been extended.
  Increasing the deficit by $17.5 billion as a result of repealing the 
IPAB would is fiscally irresponsible, especially now that Republicans 
have introduced a tax package that will saddle our country with $1.5 
trillion of debt in order to give tax cuts to the wealthy and 
corporations.
  Mr. Speaker, despite the Supreme Court's upholding of the law's 
constitutionality, the reelection of President Obama, and Speaker 
Ryan's admission that ``Obamacare is the law of the land,'' Republicans 
refuse to stop wasting time and taxpayer money in their effort to take 
away the patient protections and benefits of the Affordable Care Act.
  Mr. Speaker, I call upon House Republican leaders to stop wasting our 
time trying to take away healthcare protections that Americans depend 
on and to start addressing pressing national priorities.
  And they should start with working with Democrats on a bipartisan and 
responsible plan to reauthorize the Children's Health Insurance Program 
(``SCHIP'') which insures more than 9 million kids and fully funding 
the relief efforts needed to help American communities recover from the 
devastating effects of Hurricanes Harvey, Irma, and Maria.
  I urge my colleagues to join me in voting against H.R. 849.
  The SPEAKER pro tempore. All time for debate has expired.
  Pursuant to House Resolution 600, the previous question is ordered on 
the bill, as amended.
  The question is on the engrossment and third reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. PALLONE. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The vote was taken by electronic device, and there were--yeas 307, 
nays 111, not voting 14, as follows:

                             [Roll No. 604]

                               YEAS--307

     Abraham
     Aderholt
     Aguilar
     Allen
     Amash
     Amodei
     Arrington
     Babin
     Bacon
     Banks (IN)
     Barletta
     Barr
     Barragan
     Barton
     Beatty
     Bera
     Bergman
     Biggs
     Bilirakis
     Bishop (GA)
     Bishop (MI)
     Bishop (UT)
     Blackburn
     Blum
     Blunt Rochester
     Bost
     Boyle, Brendan F.
     Brady (TX)
     Brat
     Brooks (IN)
     Brownley (CA)
     Buchanan
     Buck
     Bucshon
     Budd
     Burgess
     Bustos
     Butterfield
     Byrne
     Calvert
     Capuano
     Carbajal
     Cardenas
     Carter (GA)
     Carter (TX)
     Castro (TX)
     Chabot
     Cheney
     Clarke (NY)
     Coffman
     Cole
     Collins (GA)
     Collins (NY)
     Comer
     Comstock
     Conaway
     Connolly
     Cook
     Correa
     Costello (PA)
     Courtney
     Cramer
     Crawford
     Crist
     Cuellar
     Culberson
     Curbelo (FL)
     Davidson
     Davis (CA)
     Davis, Rodney
     DeFazio
     DeGette
     Demings
     Denham
     Dent
     DeSantis
     DesJarlais
     Diaz-Balart
     Donovan
     Duffy
     Duncan (SC)
     Duncan (TN)
     Dunn
     Emmer
     Engel
     Estes (KS)
     Esty (CT)
     Farenthold
     Faso
     Ferguson
     Fitzpatrick
     Fleischmann
     Flores
     Fortenberry
     Foxx
     Frankel (FL)
     Franks (AZ)
     Frelinghuysen
     Gabbard
     Gaetz
     Gallagher
     Gallego
     Garrett
     Gianforte
     Gibbs
     Gohmert
     Gomez
     Gonzalez (TX)
     Goodlatte
     Gosar
     Gottheimer
     Gowdy
     Granger
     Graves (GA)
     Graves (LA)
     Graves (MO)
     Green, Gene
     Griffith
     Grothman
     Guthrie
     Handel
     Harper
     Harris
     Hartzler
     Hensarling
     Herrera Beutler
     Hice, Jody B.
     Higgins (LA)
     Higgins (NY)
     Hill
     Holding
     Hollingsworth
     Hudson
     Huizenga
     Hultgren
     Hunter
     Hurd
     Issa
     Jenkins (KS)
     Jenkins (WV)
     Johnson (GA)
     Johnson (LA)
     Johnson (OH)
     Johnson, Sam
     Jones
     Jordan
     Joyce (OH)
     Katko
     Keating
     Kelly (MS)
     Kelly (PA)
     Kihuen
     Kilmer
     King (IA)
     King (NY)
     Kinzinger
     Knight
     Krishnamoorthi
     Kuster (NH)
     Kustoff (TN)
     Labrador
     LaHood
     LaMalfa
     Lamborn
     Lance
     Larson (CT)
     Latta
     Lawrence
     Lewis (MN)
     Lieu, Ted
     LoBiondo
     Lofgren
     Long
     Loudermilk
     Love
     Lucas
     Luetkemeyer
     Lujan Grisham, M.
     Lynch
     MacArthur
     Maloney, Sean
     Marchant
     Marino
     Marshall
     Massie
     Mast
     McCarthy
     McCaul
     McClintock
     McHenry
     McKinley
     McMorris Rodgers
     McNerney
     McSally
     Meadows
     Meehan
     Meeks
     Meng
     Messer
     Mitchell
     Moolenaar
     Mooney (WV)
     Moulton
     Mullin
     Murphy (FL)
     Newhouse
     Noem
     Nolan
     Norcross
     Norman
     O'Halleran
     O'Rourke
     Olson
     Palazzo
     Palmer
     Panetta
     Pascrell
     Paulsen
     Pearce
     Perry
     Peterson
     Pittenger
     Poe (TX)
     Poliquin
     Posey
     Ratcliffe
     Reed
     Reichert
     Renacci
     Rice (SC)
     Richmond
     Roby
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rohrabacher
     Rokita
     Rooney, Francis
     Rooney, Thomas J.
     Ros-Lehtinen
     Rosen
     Roskam
     Ross
     Rothfus
     Rouzer
     Royce (CA)
     Ruiz
     Ruppersberger
     Rush
     Russell
     Rutherford
     Sanchez
     Sanford
     Schneider
     Schweikert
     Scott, Austin
     Sensenbrenner
     Sessions
     Sewell (AL)
     Shea-Porter
     Shimkus
     Shuster
     Sires
     Smith (MO)
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Smucker
     Soto
     Stefanik
     Stewart
     Stivers
     Suozzi
     Taylor
     Tenney
     Thompson (PA)
     Thornberry
     Tiberi
     Tipton
     Torres
     Trott
     Turner
     Valadao
     Vargas
     Veasey
     Vela
     Wagner
     Walberg
     Walden
     Walker
     Walorski
     Walters, Mimi
     Watson Coleman
     Weber (TX)
     Webster (FL)
     Wenstrup
     Westerman
     Williams
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Yoder
     Yoho
     Young (AK)
     Young (IA)
     Zeldin

                               NAYS--111

     Adams
     Bass
     Beyer
     Blumenauer
     Bonamici
     Brady (PA)
     Brown (MD)
     Carson (IN)
     Cartwright
     Castor (FL)
     Chu, Judy
     Cicilline
     Clark (MA)
     Clay
     Cleaver
     Clyburn
     Cohen
     Conyers
     Cooper
     Costa
     Crowley
     Cummings
     Davis, Danny
     Delaney
     DeLauro
     DelBene
     DeSaulnier
     Deutch
     Dingell
     Doggett
     Doyle, Michael F.
     Ellison
     Eshoo
     Espaillat
     Evans
     Foster
     Fudge
     Garamendi
     Green, Al
     Grijalva
     Gutierrez
     Hanabusa
     Hastings
     Heck
     Himes
     Hoyer
     Huffman
     Jackson Lee
     Jayapal
     Jeffries
     Kaptur
     Kelly (IL)
     Kennedy
     Khanna
     Kildee
     Kind
     Langevin
     Larsen (WA)
     Lawson (FL)
     Lee
     Levin
     Lewis (GA)

[[Page H8421]]


     Lipinski
     Loebsack
     Lowenthal
     Lowey
     Lujan, Ben Ray
     Maloney, Carolyn B.
     Matsui
     McCollum
     McEachin
     McGovern
     Moore
     Nadler
     Napolitano
     Neal
     Pallone
     Payne
     Pelosi
     Perlmutter
     Pingree
     Polis
     Price (NC)
     Quigley
     Raskin
     Rice (NY)
     Roybal-Allard
     Ryan (OH)
     Sarbanes
     Schakowsky
     Schiff
     Schrader
     Scott (VA)
     Serrano
     Sherman
     Slaughter
     Smith (WA)
     Swalwell (CA)
     Takano
     Thompson (CA)
     Thompson (MS)
     Titus
     Tonko
     Tsongas
     Velazquez
     Visclosky
     Walz
     Wasserman Schultz
     Waters, Maxine
     Welch
     Yarmuth

                             NOT VOTING--14

     Black
     Bridenstine
     Brooks (AL)
     Johnson, E. B.
     Nunes
     Peters
     Pocan
     Scalise
     Scott, David
     Simpson
     Sinema
     Speier
     Upton
     Wilson (FL)

                              {time}  1711

  Messrs. BEN RAY LUJAN of New Mexico, DANNY K. DAVIS of Illinois, 
SCOTT of Virginia, and Ms. KAPTUR changed their vote from ``yea'' to 
``nay.''
  Mr. HIGGINS of New York, Ms. GABBARD, Messrs. DENHAM, and McNERNEY 
changed their vote from ``nay'' to ``yea.''
  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.
  Stated for:
  Ms. SINEMA. Mr. Speaker, due to a technical glitch, my vote was not 
recorded. Had I been present, I would have voted ``yea'' on rollcall 
No. 604.
  Mr. PETERS. Mr. Speaker, my vote was not recorded on rollcall No. 604 
on H.R. 849--The Protecting Seniors' Access to Medicare Act due to my 
attendance at the Vatican's Health of People, Health of Planet and Our 
Responsibility: Climate Change, Air Pollution and Health. I intended to 
vote ``aye''.
  Mr. NUNES. Mr. Speaker, on the legislative day of Thursday, November 
2, 2017, I was unavoidably detained and was unable to cast a vote on a 
rollcall vote. Had I been present, I would have voted ``yes'' on 
rollcall No. 604.
  Stated against:
  Ms. WILSON of Florida. Mr. Speaker, had I been present, I would have 
voted ``nay'' on rollcall No. 604.

                          ____________________