[Congressional Record Volume 164, Number 103 (Wednesday, June 20, 2018)]
[House]
[Pages H5294-H5302]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  1015
     PROVIDING FOR CONSIDERATION OF H.R. 6, SUBSTANCE USE-DISORDER 
PREVENTION THAT PROMOTES OPIOID RECOVERY AND TREATMENT FOR PATIENTS AND 
COMMUNITIES ACT; PROVIDING FOR CONSIDERATION OF H.R. 5797, INDIVIDUALS 
  IN MEDICAID DESERVE CARE THAT IS APPROPRIATE AND RESPONSIBLE IN ITS 
 EXECUTION ACT; AND PROVIDING FOR CONSIDERATION OF H.R. 6082, OVERDOSE 
                   PREVENTION AND PATIENT SAFETY ACT

  Mr. BURGESS. Mr. Speaker, by direction of the Committee on Rules, I 
call up House Resolution 949 and ask for its immediate consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 949

       Resolved, That at any time after adoption of this 
     resolution the Speaker may, pursuant to clause 2(b) of rule 
     XVIII, declare the House resolved into the Committee of the 
     Whole House on the state of the Union for consideration of 
     the bill (H.R. 6) to provide for opioid use disorder 
     prevention, recovery, and treatment, and for other purposes. 
     The first reading of the bill shall be dispensed with. All 
     points of order against consideration of the bill are waived. 
     General debate shall be confined to the bill and shall not 
     exceed one hour equally divided and controlled by the chair 
     and ranking minority member of the Committee on Energy and 
     Commerce. After general debate the bill shall be considered 
     for amendment under the five-minute rule. An amendment in the 
     nature of a substitute consisting of the text of Rules 
     Committee Print 115-76, modified by Rules Committee Print 
     115-78 and the amendment printed in part A of the report of 
     the Committee on Rules accompanying this resolution, shall be 
     considered as adopted in the House and in the Committee of 
     the Whole. The bill, as amended, shall be considered as the 
     original bill for the purpose of further amendment under the 
     five-minute rule and shall be considered as read. All points 
     of order against provisions in the bill, as amended, are 
     waived. No further amendment to the bill, as amended, shall 
     be in order except those printed in part B of the report of 
     the Committee on Rules. Each such further amendment may be 
     offered only in the order printed in the report, may be 
     offered only by a Member designated in the report, shall be 
     considered as read, shall be debatable for the time specified 
     in the report equally divided and controlled by the proponent 
     and an opponent, shall not be subject to amendment, and shall 
     not be subject to a demand for division of the question in 
     the House or in the Committee of the Whole. All points of 
     order against such further amendments are waived. At the 
     conclusion of consideration of the bill for amendment the 
     Committee shall rise and report the bill, as amended, to the 
     House with such further amendments as may have been adopted. 
     The previous question shall be considered as ordered on the 
     bill, as amended, and any further amendment thereto to final 
     passage without intervening motion except one motion to 
     recommit with or without instructions.
       Sec. 2.  At any time after adoption of this resolution the 
     Speaker may, pursuant to clause 2(b) of rule XVIII, declare 
     the House resolved into the Committee of the Whole House on 
     the state of the Union for consideration of the bill (H.R. 
     5797) to amend title XIX of the Social Security Act to allow

[[Page H5295]]

     States to provide under Medicaid services for certain 
     individuals with opioid use disorders in institutions for 
     mental diseases. The first reading of the bill shall be 
     dispensed with. All points of order against consideration of 
     the bill are waived. General debate shall be confined to the 
     bill and shall not exceed one hour equally divided and 
     controlled by the chair and ranking minority member of the 
     Committee on Energy and Commerce. After general debate the 
     bill shall be considered for amendment under the five-minute 
     rule. The amendment in the nature of a substitute recommended 
     by the Committee on Energy and Commerce now printed in the 
     bill, modified by the amendment printed in part C of the 
     report of the Committee on Rules accompanying this 
     resolution, shall be considered as adopted in the House and 
     in the Committee of the Whole. The bill, as amended, shall be 
     considered as the original bill for the purpose of further 
     amendment under the five-minute rule and shall be considered 
     as read. All points of order against provisions in the bill, 
     as amended, are waived. No further amendment to the bill, as 
     amended, shall be in order except those printed in part D of 
     the report of the Committee on Rules. Each such further 
     amendment may be offered only in the order printed in the 
     report, may be offered only by a Member designated in the 
     report, shall be considered as read, shall be debatable for 
     the time specified in the report equally divided and 
     controlled by the proponent and an opponent, shall not be 
     subject to amendment, and shall not be subject to a demand 
     for division of the question in the House or in the Committee 
     of the Whole. All points of order against such further 
     amendments are waived. At the conclusion of consideration of 
     the bill for amendment the Committee shall rise and report 
     the bill, as amended, to the House with such further 
     amendments as may have been adopted. The previous question 
     shall be considered as ordered on the bill, as amended, and 
     any further amendment thereto to final passage without 
     intervening motion except one motion to recommit with or 
     without instructions.
       Sec. 3.  Upon adoption of this resolution it shall be in 
     order to consider in the House the bill (H.R. 6082) to amend 
     the Public Health Service Act to protect the confidentiality 
     of substance use disorder patient records. All points of 
     order against consideration of the bill are waived. An 
     amendment in the nature of a substitute consisting of the 
     text of Rules Committee Print 115-75 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.
       Sec. 4.  In the engrossment of H.R. 6, the Clerk shall--
        (a) add the respective texts of H.R. 2851, H.R. 5735, and 
     H.R. 5797, as passed by the House, as new matter at the end 
     of H.R. 6;
       (b) assign appropriate designations to provisions within 
     the engrossment; and
       (c) conform cross-references and provisions for short 
     titles within the engrossment.

  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 gentleman from Massachusetts (Mr. 
McGovern), 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 
may have 5 legislative days to revise and extend their remarks.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. BURGESS. Mr. Speaker, House Resolution 949 provides for the 
consideration of three important bills aimed at curbing the deadly 
opioid epidemic plaguing this country and providing Americans with the 
tools to overcome their addictions: H.R. 6, the Substance Use-Disorder 
Prevention that Promotes Opioid Recovery and Treatment for Patients and 
Communities Act, or the SUPPORT Act; H.R. 5797, the Individuals in 
Medicaid Deserve Care that is Appropriate and Responsible in its 
Execution Act; and H.R. 6082, the Overdose Prevention and Patient 
Safety Act.
  The three bills included in today's rule all seek to accomplish one 
goal: assist Americans struggling with opioid addiction in controlling 
their addictions and moving forward in achieving productive and healthy 
lives.
  The rule provides for 1 hour of debate on H.R. 6, equally divided and 
controlled by the chair and ranking minority member of the Committee on 
Energy and Commerce. The rule makes in order eight amendments offered 
by both Republicans and Democrats. Further, the rule provides the 
minority with one motion to recommit with or without instructions.
  The resolution also provides for a structured rule for H.R. 5797, 
allowing 1 hour of debate to be divided and controlled between the 
chair and ranking minority member of the Energy and Commerce Committee. 
The rule also provides for debate on an amendment by Mrs. Mimi Walters 
of California, an active member of the Energy and Commerce Committee. 
Finally, the rule provides the minority with the customary motion to 
recommit with or without instructions.
  The final bill included in today's resolution, H.R. 6082, will also 
receive 1 hour of debate on the House floor, equally divided and 
controlled by the chair and ranking member of the Energy and Commerce 
Committee. As the Committee on Rules received no germane amendments to 
H.R. 6082, no amendments were made in order in today's rule. The 
minority does receive the customary motion to recommit with or without 
instructions.
  The statistics that many of us have heard on numerous occasions--at 
our district townhalls, in opioid roundtables with stakeholders, 
constituent meetings in our offices, and in our committee hearings--are 
truly heartbreaking stories, with more than 115 people dying in the 
United States every day from an opioid overdose. That is five people 
per hour.
  According to national reports, emergency room visits and opioid 
overdose deaths have more than quadrupled in the last 15 years, and a 
preliminary analysis indicates those numbers are to rise. The misuse of 
and addiction to opioids--including prescription pain medications, 
heroin, and synthetic opioids such as fentanyl--is, indeed, an urgent 
national crisis that continues to threaten our public health, social 
fabric, and economic welfare. Both community hospitals and local 
paramedics are frequently coming across people overdosing on an opioid 
drug or a drug laced with fentanyl.
  The opioid epidemic has affected families not only in my district in 
north Texas, but in communities large and small from Maine to 
California. It has also impacted American employers and businesses due 
to lost productivity and difficulty finding qualified candidates for 
employment. President Trump is right to call this epidemic the ``crisis 
next door.''
  The efforts of the Energy and Commerce Committee in the Comprehensive 
Addiction and Recovery Act and the 21st Century Cures Act in the 
previous Congress were a good start, delivering critical funding and 
resources to communities hit most hard by the opioid epidemic. But 
there was much more we still could do.
  To start this process, the Energy and Commerce Health Subcommittee, 
which I chair, held a Member Day last October, where more than 50 
bipartisan Members of this body, both on and off the committee, shared 
their personal stories from their districts and offered their 
solutions. This was followed by a series of three legislative hearings 
with markups where nearly 60 bills were considered and advanced to the 
full Energy and Commerce Committee that acted on these bills shortly 
thereafter.
  The culmination of the work from the Energy and Commerce Committee 
and other House committees has brought us to consider many of these 
policies over the course of the last 2 weeks on the House floor. It 
required an all-hands-on-deck approach, and I believe the American 
people will see that, by this week's end, we did, indeed, come together 
in a bipartisan fashion and worked to address this crisis.
  Today's rule provides for consideration of three important bills that 
will expand treatment options, deliver lifesaving services, and make 
necessary public health reforms, including Medicare and Medicaid, to 
bolster prevention and recovery efforts.
  First, H.R. 5797, the Individuals in Medicaid Deserve Care that is 
Appropriate and Responsible in its Execution Act, the IMD CARE Act, 
allows State Medicaid programs to remove the institutions for mental 
diseases exclusion for beneficiaries aged 21 to 64 with an opioid use 
disorder for 5 years' time. The bill provides the continuum of care

[[Page H5296]]

by removing a barrier of care under current law, so Medicaid can cover 
up to a total of 30 days of care in an institute for mental disease 
during a 12-month period, and eligible enrollees can get the care that 
they actually need.
  The IMD exclusion is one of the treatment barriers consistently 
identified by State Medicaid directors, health policy experts, and many 
provider groups. Currently, this exclusion under Medicaid significantly 
limits the circumstances under which Federal Medicaid matching funds 
are available for inpatient services or for outpatient treatments.

  Unfortunately, this policy has barred individuals with an opioid use 
disorder and mental illness from accessing short-term, acute care in 
psychiatric hospitals, or receiving treatment in residential substance 
use disorder treatment facilities. A 2017 Medicaid and CHIP Payment and 
Access Commission report stated that the Medicaid IMD exclusion is one 
of the few examples in the Medicaid program where Federal financial 
participation cannot be used for medically necessary and otherwise 
covered services for a specific Medicaid population receiving treatment 
in a specific setting.
  In the midst of the opioid crisis, States must leverage all available 
tools to combat this epidemic. Section 1115 demonstration waivers are 
an important tool, but, so far, less than half of the States have 
sought or received an appropriate waiver from the Centers for Medicare 
and Medicaid Services to help patients with substance use disorder.
  The IMD CARE Act also allows States the option to use the State plan 
amendment process, which is generally faster than using waivers. Under 
this process, once a State plan amendment is submitted, the Centers for 
Medicare and Medicaid Services has 90 days to decide or the proposed 
change will automatically go into effect.
  H.R. 5797 amends an outdated law that has been in effect since the 
enactment of the Medicaid program in 1965. Since that time, there have 
been advances in behavioral health, and there have been advances in 
addiction treatment services where more, improved treatment options now 
exist.
  It is long overdue to revisit this policy so that State Medicaid 
programs can better meet patients' needs and physicians can determine 
the most appropriate setting for care based on an individual's 
treatment plan.
  Next, H.R. 6082, the Overdose Prevention and Patient Safety Act, 
makes timely reforms to a privacy law that affects patient access to 
healthcare and creates barriers to treatment. Specifically, the bill 
updates the Public Health Service Act to permit substance use disorder 
records to be shared among covered entities and 42 CFR part 2 programs 
by aligning part 2 with the Health Insurance Portability and 
Accountability Act of 1996 for the purposes of treatment, payment, and 
healthcare operations.

                              {time}  1030

  As a physician, I believe it is vital that when making clinical 
decisions, I have all of the appropriate information to make the 
correct determination in the treatment of a particular patient. Those 
suffering from substance use disorder should receive the same level of 
treatment and care as other individuals.
  Patients afflicted with substance use disorder deserve to be treated 
by physicians who are armed with all of the necessary information to 
provide the best possible care.
  I certainly do understand and respect that patient privacy protection 
is paramount and should be held in the highest regard.
  The Overdose Prevention and Patient Safety Act maintains the original 
intent of the 1970s statute behind 42 CFR part 2 by protecting patients 
and improving care coordination. In fact, this bill increases 
protections for those seeking treatment by more severely penalizing 
those who share patient data to noncovered entities and non-part 2 
programs than under the current statute, with certain exceptions.
  Lastly, it requires the Secretary of Health and Human Services to, 
among other things, issue regulations prohibiting discrimination based 
on disclosed health data and requiring covered entities to provide 
written notice of privacy practices.
  The issue of the stigma associated with substance use disorder has 
been a constant in many of the discussions members of the Energy and 
Commerce Committee and the stakeholders have had in both our offices 
and in our hearings.
  This carefully crafted legislation seeks to help break the stigma and 
help individuals with this complex disease gain access to healthcare 
and support services critical to getting them on the road to recovery.
  We should not continue to silo the substance use disorder treatment 
information of a select group of patients if we want to ensure that 
these patients are indeed receiving quality care. This information 
should be integrated into our medical records and comprehensive care 
models to prevent situations where physicians, not knowing a patient's 
substance use disorder, may prescribe medications that have significant 
drug interactions, or worse, may prescribe a controlled substance that 
makes their patient's substance use disorder worse.
  As it currently stands, 42 CFR part 2 is actively prohibiting 
physicians from ensuring proper treatment and patient safety and, 
paradoxically, it is perpetuating that stigma.
  Providing high quality healthcare is a team effort, but physicians 
leading the team must have the necessary information to adequately 
coordinate care. We must align payment, operations, and treatment to 
allow coordination of both behavioral and physical health services for 
individuals with substance use disorder.
  There is a reason why the Substance Abuse and Mental Health Services 
Administration and most of the health stakeholder community are asking 
for this change. Clearly, there is an issue here that must be 
addressed. H.R. 6082 achieves the goal and contributes to Congress' 
effort in trying to stem the current crisis.
  Finally, Mr. Speaker, H.R. 6, the Substance Use-Disorder Prevention 
that Promotes Opioid Recovery and Treatment for Patients and 
Communities Act, is a package of bills that reform Medicare, Medicaid, 
and other health provisions to further combat this crisis by advancing 
many critical initiatives.
  As we all know, this opioid epidemic is in our hospitals, but it is 
also in our living rooms and on our streets. Our partners at Federal 
agencies must rise to the challenge and deliver vital resources for 
States and communities most devastated by the crisis. The SUPPORT for 
Patients and Communities Act will provide our Department of Health and 
Human Services, including the Centers for Medicare and Medicaid 
Services and the Food and Drug Administration, with the necessary tools 
to address this crisis.
  Title I of H.R. 6 addresses the ways in which Medicaid can be used to 
increase access to quality care and management for individuals 
suffering from substance use disorders. Some of these changes in 
Medicaid reflect the success of our State Medicaid programs by 
implementing State successes at the Federal level.
  Section 101 under title I will expand protection for at-risk youth by 
requiring State Medicaid programs to restore Medicaid coverage of a 
juvenile following their release from incarceration. The next section 
also allows former foster youth to maintain their Medicaid coverage 
across State lines until they turn 26 years of age. These are 
vulnerable populations of individuals that will greatly benefit from 
increased access to treatment.
  Section 105 builds on the current State Medicaid drug utilization 
review, which saves money and promotes patient safety. This section 
will require State Medicaid programs to have safety edits in place for 
opioid refills, monitor concurrent prescribing of opioids and certain 
other drugs, and monitor antipsychotic prescribing for children.
  Care for mothers suffering from substance use disorder and their 
babies who are born with neonatal abstinence syndrome is a growing 
problem in the face of this epidemic. Section 106 requires HHS to 
improve care for these infants with neonatal abstinence syndrome and 
their mothers. It also requires that the General Accountability Office 
study the gaps in Medicaid coverage for pregnant and postpartum women 
with substance use disorders.

[[Page H5297]]

  Section 107 of the bill provides additional incentives for Medicaid 
health homes for patients with substance use disorder.
  Mr. Speaker, these health homes will allow States to create a 
comprehensive person-centered system of care coordination for primary 
care, acute and behavioral healthcare, including mental health and 
substance use. As our healthcare system moves towards caring for the 
whole person, it is important that we enable our physicians and our 
payers to provide that comprehensive care.
  The SUPPORT for Patients and Communities Act also enables better pain 
management for our Nation's Medicare beneficiaries, ranging from 
increased access to substance use disorder treatment, including through 
the use of telehealth, to modification of physician payment for certain 
nonopioid treatments in Ambulatory Surgery Centers.

  Title II of the bill contains Medicare provisions that encourage the 
use of nonopioid analgesics where appropriate and also aims to decrease 
fraud and abuse regarding prescriptions by requiring e-prescribing for 
the coverage of Medicare Part D controlled substances.
  H.R. 6 strives to provide support for at-risk beneficiaries who might 
fall victim to substance use disorder. Section 206 of the bill 
accelerates the development and the use of drug management programs for 
at-risk beneficiaries. While this program is currently voluntary, by 
plan year 2021, it will become a mandatory program.
  Lastly, the bill expands Medicare coverage to include opioid 
treatment programs for the purpose of providing medication-assisted 
treatment. Opioid treatment programs are not currently Medicare 
providers, which forces Medicare beneficiaries who need medication-
assisted treatment to pay out-of-pocket costs for those services. These 
efforts should provide improved access to treatment for Medicare 
beneficiaries who have substance use disorders while also incentivizing 
the use of opioid alternatives, which hopefully will prevent the 
development of substance use disorders.
  Even though an estimated 46,000 Americans died from opioid overdoses 
from October 2016 to October 2017, there is a lack of innovation and a 
lack of investment in the development of nonaddictive pain and 
addiction treatment.
  A bill that I introduced, H.R. 5806, the 21st Century Tools for Pain 
and Addiction Treatments, is included in section 301 on H.R. 6 and 
requires the Food and Drug Administration to hold at least one public 
meeting to address the challenges and the barriers of developing 
nonaddictive medical products intended to treat pain or addiction.
  The Food and Drug Administration is also required to issue or update 
existing guidance documents to help address challenges to developing 
nonaddictive medical products to treat pain or addiction.
  Mr. Speaker, I did work closely with the Food and Drug Administration 
to get the policy in this section correct and to ensure that it will 
clarify those pathways for products that, in fact, are so desperately 
needed by America's patients.
  I have remaining concerns about the language in section 303 that will 
allow nonphysician providers to prescribe buprenorphine. While I 
understand and greatly appreciate the intent to increase access to 
medication-assisted treatment, as a physician, I also respect how 
complicated the treatment of patients suffering from substance use 
disorder may be.
  The Hippocratic Oath, we all know, is to first, do no harm. Patient 
safety should be our highest priority.
  This is a complex patient population, Mr. Speaker. On average, people 
with substance use disorder die 20 years sooner than other Americans.
  Additionally, buprenorphine is a schedule III drug that can be 
misused and could exacerbate the underlying problem. I am unsure about 
expanding these authorities to additional nonphysician providers at the 
risk of making the problem worse. I have worked to strengthen the 
reporting requirements of this section of H.R. 6 and look forward to 
reviewing that report on this particular policy.
  Taken together, H.R. 6, the SUPPORT for Patients and Communities Act, 
will improve access to care for individuals suffering from substance 
use disorder, provide our healthcare system with tools and resources 
that it needs to care for patients, and to help prevent future misuse 
of opioids.
  Before I close, I would like to share a quote from President Trump. 
He said: ``Together, we will face this challenge as a national family 
with conviction, with unity, and with a commitment to love and support 
our neighbors in times of dire need. Working together, we will defeat 
this opioid epidemic.''
  The number of bills and policies advanced on the House floor in the 
last 2 weeks illustrates our shared commitment, and I am confident that 
we will make significant progress in defeating this epidemic.
  Mr. Speaker, I urge my colleagues to support today's rule and the 
three underlying bills that are critical to our Nation's effort to stem 
the opioid crisis.
  Mr. Speaker, I reserve the balance of my time.
  Mr. McGOVERN. Mr. Speaker, I yield myself such time as I may consume.
  (Mr. McGOVERN asked and was given permission to revise and extend his 
remarks.)
  Mr. McGOVERN. Mr. Speaker, I thank the gentleman from Texas (Mr. 
Burgess) for yielding me the customary 30 minutes.
  Mr. Speaker, my Republican colleagues are rushing to congratulate 
themselves for finally addressing opioid addiction. But, Mr. Speaker, 
what took them so long? This is an epidemic that fueled more drug 
overdoses in America in 2016 than died in the Vietnam war. In fact, 
opioids now kill more people every year than breast cancer. 115 
Americans are dying from them every single day.
  These statistics aren't new. They have been staring the Republicans 
in the face for months. The public has been pushing this Congress to 
act. Democrats have been pushing measure after measure after measure to 
address opioid addiction, but the majority has used their restrictive 
amendment process to block them from even getting a vote on the House 
floor.
  More than a dozen amendments dealing with opioids have been blocked 
by the majority from even getting a debate. One of these amendments had 
bipartisan support, but it was blocked all the same.
  This from a Republican majority that has already turned this Congress 
into the most closed Congress in history. Let me say that again. These 
guys, my Republican colleagues, have presided over the most closed 
Congress in history. There have already been 86 completely closed rules 
during the 115th Congress, and it is only June.
  That number is expected to grow later this week as the majority 
considers their partisan immigration bills under a closed process.
  Mr. Speaker, as well-intentioned as these bills may be, we aren't 
considering them in a vacuum. And here is the deal: We are taking them 
up at a time when Republicans are continuing their crusade against the 
Affordable Care Act, a law that has helped millions of Americans 
suffering from substance use disorders.
  The Trump administration is refusing to defend the ACA. And get this: 
its Justice Department recently asked in a legal filing for the courts 
to invalidate this law's protections for preexisting conditions.
  Mr. Speaker, does the majority realize that substance use disorders 
are a preexisting condition?
  If Republicans are successful, they will make the opioid crisis even 
worse. And it doesn't stop there. Some conservative groups are pushing 
the majority to try repealing the ACA completely again before the 
summer is out.

                              {time}  1045

  This, after Republicans came within a few votes of taking healthcare 
from 23 million Americans last year, including those suffering from 
opioid addiction.
  These rightwing groups released their latest repeal plan yesterday, 
so the words from my Republican friends today ring particularly hollow.
  Mr. Speaker, we all know that the best answer to an epidemic is to 
get as many people as possible into treatment and to provide them and 
their families the support that they need. And one of the most 
effective ways to accomplish

[[Page H5298]]

this is to expand Medicaid and expand treatment options for substance 
abuse through the ACA.
  Last October, the Republicans made clear what they think of the 
hundreds of thousands of Americans suffering from opioid addiction and 
alcohol and drug abuse. They passed a budget that makes $1.3 trillion 
in cuts to healthcare, including a 30 percent cut to Medicaid.
  Mr. Speaker, Republicans can't bemoan the opioid epidemic on one hand 
and vote time and time again to cut the very healthcare systems 
required to treat addiction.
  Nor can you set up a biased, tiered system that grants access to 
treatment for opioid addiction at the expense of providing treatment 
for addiction and abuse of other substances, like key provisions in 
H.R. 5797. Not only is that inhumane and immoral, but it is also 
ineffective. It undermines the entire health system of treating 
substance abuse.
  Mr. Speaker, many Democrats have joined the majority in supporting 
one of these bills, H.R. 6, the SUPPORT for Patients and Communities 
Act. It is a good bill. It would help Medicare and Medicaid better 
respond to substance use disorders. We are working with the majority 
here.
  So, Mr. Speaker, why won't they work with us to defend the ACA, 
preserve protections for preexisting conditions, and expand Medicaid.
  Now, I know asking Congressional Republicans to show some empathy 
right now is a tall order. This is the group that has furthered 
President Trump's spin on family separations at the border, a policy he 
can change unilaterally, right now if he wanted to. I mean, children 
are being ripped out of their parents' arms in tears and kept in cages, 
warehouses, and tent cities. It is appalling and it is un-American.
  You don't have to take my word for it. Republicans, like First Lady 
Laura Bush and Senator John McCain, have spoken out against it. And a 
U.S. attorney in Texas made clear it was President Trump's policy 
choice alone. And get this: This is a U.S. attorney who the President 
himself appointed.
  But change is possible. Congressional Republicans can see the error 
of their ways. They can reject these calls for repeal. They can stop 
sitting idly by as President Trump attacks the Affordable Care Act. And 
they can start standing up for the 133 million Americans with 
preexisting conditions. That includes those suffering from addiction.
  They could stop giving the President cover when he falsely claims 
that Democrats caused the chaos at the border that he clearly caused.
  Stop playing with people's lives. We are talking about their 
healthcare. We are talking about getting treatment for addiction. For 
God's sake, we are talking about taking children out of the arms of 
their mothers. This isn't a handful of cases, it is thousands of cases. 
It is outrageous.
  It is time for the adults in Congress, men and women of conscience, 
to stand up for what is right, not only on the opioid crisis, but on so 
many other important issues facing this country. I hope the majority 
comes to its senses before it is too late.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield 3 minutes to the gentleman from 
Pennsylvania (Mr. Costello), a fellow member on the Committee of Energy 
and Commerce.
  Mr. COSTELLO of Pennsylvania. Mr. Speaker, I rise in support of the 
rule. I want to speak specifically on my support for H.R. 6082, which 
allows for the flow of information among healthcare providers and 
health plans that is necessary to foster care coordination, provide 
proper treatment, promote patient safety, make payment, and, 
ultimately, improve the individual's health status.
  Without alignment for treatment, payment, and operations, the 
following could not happen without an authorization: Coordinating care 
across behavioral and medical services. Case management to provide 
longer-term support after a patient ends treatment. Ensuring 
appropriate administrative and financial interaction between providers 
and plans, which support the core functions of treatment and payment 
for HIPAA-covered entities. Also conducting quality assessment and 
improvement activities to better integrate behavioral and medical 
services. This includes, Mr. Speaker, evaluating provider performance, 
conducting training programs, and accreditation, certification, and 
credentialing activities.
  People with substance use disorder die, on average, decades sooner 
than other Americans. This is largely because of a strikingly high 
incidence of poorly-managed, co-occurring chronic diseases, including 
HIV/AIDS, cardiac conditions, lung disease, and cirrhosis.
  Whatever we, as a Nation, are doing to coordinate care for this 
highly vulnerable patient population is utterly failing by any 
reasonable measure.
  An extraordinary array of organizations, hospitals, physicians, 
patient advocates, and substance use treatment providers have 
approached our committee to clearly state that existing Federal 
addiction privacy law--and that is what H.R. 6082 is focused on, 
existing privacy law--is actively interfering with case management/care 
coordination efforts, and preserving a failed and deadly status quo.
  Blocking certain substance use providers from accessing health 
records from these exchanges, which the part 2 regulations do, isolates 
patients in these programs from powerful exchanges of health 
information and from the protections of HIPAA and HITECH regulations 
governing these exchanges.
  Mr. Speaker, treating patients' substance use in isolation from their 
medical and mental conditions, which predominated care in the 1970s, is 
not the current standard of good medical practice today.

  There is overwhelming evidence now that patients' substance use 
cannot be treated in isolation from other physical and mental health 
conditions. In the 1970s, when part 2 was written, this was not widely 
known, and treatment for addiction was largely separate from treatment 
of other illnesses.
  By continuing to segregate substance use disorder records for any 
treatment setting means that you are willing to allow those patients to 
receive care that is lower quality at a higher cost. Medically-ill 
inpatients who have alcohol or drug disorders are at greatly increased 
risk of rapid rehospitalization after discharge and greater healthcare 
use and costs.
  Patients who have medical illnesses such as diabetes or 
cardiovascular disorders and who also have a substance use disorder use 
healthcare services two to three times more often than their peers with 
just diabetes or heart problems, and cost of care is similarly much 
higher.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. BURGESS. I yield the gentleman from Pennsylvania an additional 1 
minute.
  Mr. COSTELLO of Pennsylvania. Finally, Mr. Speaker, untreated alcohol 
or drug use during pregnancy dramatically increases risk of poor birth 
outcomes, neonatal intensive care use and greater infant and maternal 
healthcare use. But treated as part of prenatal care, birth outcomes, 
infant and maternal health use and costs are no different from their 
non-substance-using peers. That is why support of this rule and support 
of H.R. 6082 is so important.
  Mr. McGOVERN. Mr. Speaker, I yield myself such time as I may consume.
  Just let me remind my colleagues again, because I think it is worth 
emphasizing, that no matter what we do in the next couple of days with 
these bills that are going to be before the House, they are rendered 
meaningless if the Republicans continue in their effort to cut Medicaid 
and to take away protections for people with preexisting conditions.
  Substance use disorder is a preexisting condition and Republicans, 
working with the White House, are trying to eliminate that protection 
for people. I don't get it. It doesn't make sense. But we ought to make 
sure that we keep this debate in context and people know what is going 
on out there.
  Mr. Speaker, I yield 6 minutes to the gentlewoman from California 
(Ms. Matsui).
  Ms. MATSUI. Mr. Speaker, I rise in opposition to this rule. 
Throughout the Energy and Commerce Committee's process writing opioid 
legislation, I have raised the issue that we need to be making 
investments in the full spectrum of our behavioral health system

[[Page H5299]]

in order to truly address the root causes and the results of the opioid 
epidemic.
  While crisis and high-level inpatient care will always be necessary 
for a subset of the population, and we must ensure it is adequately 
funded, we cannot do so in a vacuum. We need to ensure that people also 
have access to adequate outpatient treatment and prevention services.
  And while the opioid epidemic is front and center in all our minds, 
we cannot forget patients suffering from other substance use disorders. 
It is important that we do not unintentionally set up a discriminatory 
system that will be useless during the next epidemic, whatever that 
might be. We want our legislative efforts to both save lives today and 
to prevent epidemics like this one in the future.
  States already have the option to work around outdated exclusions in 
IMD facilities. States like California are already doing so in a 
comprehensive way, taking into account the continuum of care for opioid 
and other substance use disorders.
  If we are going to be spending an additional nearly $1 billion in the 
Medicaid program, we need to spend it wisely on expanding access to 
services, and not narrowly duplicating something that is already 
available.
  Ever since the Excellence in Mental Health demonstration project 
passed into law in 2014, I have been fiercely advocating to expand the 
program.
  The demonstration project, which I coauthored with my Republican 
colleague, Congressman Lance, and my Senate colleagues, Senators 
Stabenow and Blunt, certifies community behavioral health clinics, 
known as CCBHCs. The demonstration is currently about halfway through 
its 2-year period in eight States and already showing great success.
  The National Council for Behavioral Health recently issued a report 
entitled, ``Bridging the Addiction Treatment Gap.'' It surveys CCBHCs 
operating in the Excellence Act demonstration States, and the results 
offer great hope.
  First, the demonstration has enabled near-universal adoption of 
Medication Assisted Treatment, or MAT, for opioid use disorder. Ninety-
two percent of certified clinics in the program are offering at least 
one type of FDA-approved MAT.
  Second, 100 percent of CCBHCs have expanded the scope of addiction 
treatment services under the demonstration. For many clinics, this is 
the first time such services have been available in their communities, 
very often in medically-underserved areas.
  Third, even while seeing more patients, two-thirds of surveyed CCBHCs 
have seen a decrease in patient wait times. After an initial call or 
referral, half of the clinics now offer same-day access to care, and 
four out of five can offer an appointment within a week or less.
  Mr. Speaker, the Excellence Act is showing concrete results in terms 
of patient outcomes. In western New York State, more than 1,000 people 
in Erie County died of opioid overdoses over the last 5 years; 142 
people lost their lives in 2016 alone.
  At the same time, according to media reports, local police chiefs are 
reporting a 60 percent reduction in overdose calls in 2018. Authorities 
specifically credit a certified behavioral health clinic in the city 
of Buffalo that is providing medication assisted treatment for people 
battling opioid addiction within 24 to 48 hours after initial 
assessment.

  We want to expand upon this success for certified community 
behavioral health clinics across the country by allowing Medicaid 
reimbursement on a larger scale. These clinics are the ones in people's 
neighborhoods and communities, the ones on the front lines of treating 
behavioral health and substance use disorder. If we do not build them 
up and integrate them with our health system, we will never achieve the 
full continuum of care that we are looking for.
  Every time I have pushed for an expansion of the Excellence program 
in the Energy and Commerce Committee on funding legislation on the 
floor, I have been told that we don't have the dollars available.
  However, today, we are talking about spending nearly $1 billion on 
something that is both redundant and, I believe, does not fully address 
the entire spectrum of care like the Excellence program has. That is 
why I offered an amendment to H.R. 5797, based on my bipartisan bill, 
H.R. 3931, and why I am here discussing this on the floor today.
  Mr. Speaker, I urge my colleagues to consider funding community 
behavioral health clinics and outpatient treatment to help address the 
opioid epidemic. When you look back on what we have done to address 
this crisis, this will have more of a positive impact today and in the 
long term in comparison with the other proposals we are considering.
  Mr. BURGESS. Mr. Speaker, I yield myself 1 minute.
  I do want to remind everyone that 18 months ago, in the previous 
Congress, with the passage of the 21st Century Cures Act and the 
Comprehensive Addiction Recovery Act, CARA, $1 billion was made 
available for treating people with substance use disorder. That was 
then supplemented with the passage of the more recent appropriations 
bill last month--2 months ago, with $4 billion.

                              {time}  1100

  Unprecedented amounts of money have been made available in the last 
18 months to combat this crisis.
  And then, finally, it is very, very difficult to integrate care if 
you don't reform the 42 CFR part 2, which is before us today.
  Mr. Speaker, I reserve the balance of my time.
  Mr. McGOVERN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, again, none of what we are doing here today is going to 
matter if the Republicans and the Trump administration are successful 
in cutting Medicaid and in basically removing the guarantee that people 
who have preexisting conditions cannot be denied insurance.
  I mean, if the Trump administration is successful, individuals with 
preexisting conditions all across the country, including individuals 
suffering from opioid use disorders, both in the individual and in the 
employer market, could face a denial of coverage or skyrocketing 
premiums beyond anything anybody could afford.
  I don't get it. I don't understand the hypocrisy here. I know that 
the efforts here today are well intentioned and people are trying to do 
the right thing, but then you ruin it all when you gut the funding 
sources that help people deal with the treatment they need.
  This has to stop.
  I know some of my friends have ideological blinders on when it comes 
to anything that was passed during the Obama administration, but we 
have got to put the American people first, and this is a crisis that 
affects every single community in this country. If this administration 
is successful in what they are trying to do to undercut the ACA, then 
countless people will not have access to healthcare and will not have 
access to the treatment they need.
  Mr. Speaker, our Nation is in the midst of a devastating opioid 
crisis that is spiraling out of control. Every day, more than 115 
people in the United States die after overdosing on opioids, according 
to the National Institute on Drug Abuse. The Centers for Disease 
Control and Prevention has also found that opioids are responsible for 
6 out of 10 overdose deaths in the United States.
  The American people are in desperate need of strong action by 
Congress to stem the tide of the opioid scourge. We need serious public 
investment to quell this exploding crisis, not just legislation on the 
peripherals. We must direct resources to the States and local 
communities on the front lines of this devastating public health crisis 
where assistance is needed the most.
  Mr. Speaker, I am going to ask my colleagues to defeat the previous 
question, and if we do, I will offer an amendment to bring up 
Representative Loebsack's legislation, H.R. 4501, the Combating the 
Opioid Epidemic Act. This bill would provide badly needed funding for 
State grants for the prevention, detection, surveillance, and treatment 
of opioid abuse.
  Mr. 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 
gentleman from Massachusetts?

[[Page H5300]]

  There was no objection.
  Mr. McGOVERN. Mr. Speaker, I yield 3 minutes to the gentleman from 
California (Mr. Ruiz).
  Mr. RUIZ. Mr. Speaker, as an emergency medicine physician, I know 
firsthand what this devastating opioid crisis does to families, to 
individuals, to children, to parents. I have taken care of many who 
have come in overdosed, blue in the face, not breathing, many of which 
I have been resuscitated successfully and a few tragic losses along the 
way.
  I know that many of them rely on being able to get the treatment 
whenever we are able to convince them to get treatment, but one of the 
biggest concerns that they have is: How much is this going to cost?
  Many of them rely on Medicaid to be able to take advantage of some of 
the rehabilitation and the medication-assisted treatments that are 
offered to them. But, unfortunately, many of them, being uninsured, are 
unable to do so, and so then they repeat the cycle of abuse and misuse, 
and unfortunately, again, they present themselves overdosed in the 
emergency department.
  I have an article here that sheds light on the importance of 
Medicaid. I bring Medicaid up because I feel like we are taking a few 
good steps forward in this opioid crisis, but we are missing the big 
picture when we have to defend Medicaid over and over again. Up to 45 
percent of opioid-addicted patients rely on Medicaid to get their 
opioid rehab or misuse treatments to get back on steady footing.
  There is an article here that I brought by Alana Sharp, et al., that 
was published in the May 2018 American Journal of Public Health, 
entitled: ``Impact of Medicaid Expansion on Access to Opioid Analgesic 
Medications and Medication-Assisted Treatment.''
  Basically, by using Medicaid enrollment and reimbursement data from 
2011 to 2016 in all States, they evaluated prescribing patterns of 
opioids and the three FDA-approved medications used in treating opioid 
use disorders by using two statistical models--I won't bore you with 
which ones they used--and they found that although opioid prescribing 
for Medicaid enrollees increased overall, they observed no difference 
between expansion and nonexpansion. These are States that expanded 
Medicaid.
  By contrast, per enrollee rates of buprenorphine and naltrexone 
prescribed increased more than 200 percent after States expanded 
eligibility, meaning that States that expanded Medicaid increased 
medication-assisted treatments for opioid misuse disorders by 200 
percent. That means it works. That means when people get Medicaid, they 
use their Medicaid insurance to help get off of their dependency on 
opioids.
  In the States that did not expand Medicaid, only less than 50 percent 
expansion of use.

  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. McGOVERN. Mr. Speaker, I yield an additional 2 minutes to the 
gentleman from California.
  Mr. RUIZ. Mr. Speaker, the States that didn't expand their Medicaid 
enrollment, you saw that there continued to be a disparity of patients 
between those States and States that expanded their Medicaid in their 
ability to seek treatment.
  So when we attempt to cut Medicaid in order to pay for the tax breaks 
we gave millionaires and billionaires, when we continue down that 
terrible path--or, I should say, government continues down that 
terrible path--to repeal the Medicaid expansion, which we must protect, 
then we are hurting patients. We are not providing them with tools that 
they need to get access to treatment.
  The other big picture here is that mental health and emergency care 
payments are part of the essential health benefits. We have just passed 
experiences where we had to defend keeping these essential health 
benefits within the Affordable Care Act from being repealed.
  We know that those patients who go to the emergency department at 
their last wits' end or that are suffering from overdose or severe side 
effects from misuse of the opioid medication, then they won't be 
covered if we repeal those essential health benefits.
  And then, finally, having an addiction is a chronic condition. It is 
a mental health disorder with addiction characteristics, and this can 
be considered a preexisting illness.
  We have States that are trying to repeal this through litigation. And 
when the government decides not to defend those protections for people 
with preexisting illnesses, they basically agree with those that want 
to repeal it and allow and facilitate the case to repeal those 
protections for preexisting illnesses. If that happens and if they are 
successful in doing so, that means that insurance companies can deny 
those who are addicted to opioids the insurance.
  So I just want to keep the big picture in mind as we go forward that 
taking 2 steps forward doesn't justify taking 10 steps backwards.
  Mr. BURGESS. Mr. Speaker, I yield myself 2 minutes.
  Mr. Speaker, the good news is that all forms of medication-assisted 
treatment are required for 5 years under H.R. 6. So I look forward to 
the gentleman's support when we get to the vote, and I reserve the 
balance of my time.
  Mr. McGOVERN. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, today, we are on the floor discussing the opioid crisis. 
This is an epidemic that is plaguing every community in the country, 
and it is killing 115 people every single day. It is heartbreaking, 
and, quite frankly, I am ashamed it is taking Congress so long to act.
  I would again point out that anything we do in the next few days and 
anything we have done gets erased if the Republicans succeed in cutting 
Medicaid and if the President succeeds in basically eliminating 
protections for people with preexisting conditions.
  But, Mr. Speaker, I think it is also important that people know there 
is a lot of stuff going on this week, and we are also awaiting word 
from the House Republicans when the Rules Committee will have an 
emergency meeting, I guess today, on two immigration bills that were 
posted after 9 p.m. last night.
  These bills were drafted without any Democratic input, and from what 
we can tell, they are dangerous and they are certainly not a 
comprehensive solution to immigration reform. They harm children, and 
they leave many Dreamers behind.
  This is not what our constituents want us to do. They want the 
President to do what he could easily do and stop separating children 
from their parents.
  The President says that he wants Democrats to come to the table, but 
we never get invited to anything. I tried to go and see the President 
yesterday when the Republicans were meeting with him, but I was not 
allowed to go into the room.
  I tried to shout at the President as he was walking by, but he was 
quickly escorted by. I wanted to show him the pictures on the border of 
these young children who are being taken away from their parents.
  The President continues to spread mistruths about immigration and 
practically every other issue that is before this Congress and before 
this Nation, and it seems just to be getting worse.
  There are such things as facts. There are such things as truth.
  Yesterday, The Washington Post published an article, entitled: 
``President Trump Seems to be Saying More and More Things That Aren't 
True.'' Well, I would like to take a few minutes to read this article, 
because these aren't my words, Mr. Speaker. They are the words of The 
Washington Post, specifically, Ashley Parker, who wrote the piece.
  If the President is watching, I think it is helpful for me to read 
because I know he doesn't read, so maybe he can hear this.
  ``He's done it on Twitter. He's done it in the White House driveway. 
And he's done it in a speech to a business group.
  ``President Trump, a man already known for trafficking in mistruths 
and even outright lies--has been outdoing himself with falsehoods in 
recent days, repeating and amplifying bogus claims on several of the 
most pressing controversies facing his Presidency.
  ``Since Saturday, Trump has tweeted false or misleading information 
at least seven times on the topic of immigration and at least six times 
on a Justice Department inspector general report into the FBI's 
handling of its investigation into Hillary Clinton's private email 
server. That is more than a

[[Page H5301]]

dozen obfuscations on just two central topics--a figure that does not 
include falsehoods on other issues, whether in tweets or public 
remarks.
  ``The false claims come as the President--emboldened by fewer 
disciplinarians inside the West Wing--indulges in frequent Twitter 
screeds. A Washington Post analysis found that in June, Trump has been 
tweeting at the fastest rate of his Presidency so far, an average of 
11.3 messages per day.

  ``Inside the White House, aides and advisers say they believe the 
media is unwilling to give Trump a fair shot and is knee-jerk ready to 
accuse him of lying, even in cases where the facts support his point.
  ``The President often seeks to paint a self-serving and self-
affirming alternate reality for himself and his supporters. Disparaging 
the `fake news' media, Trump offers his own filter through which to 
view the world--offering a competing reality on issues including 
relationships forged (or broken) at the Group of Seven summit in 
Canada, the success of the Singapore summit with the North Koreans, and 
his administration's `zero tolerance' policy on illegal immigration.
  `` `It's extraordinary how he is completely indifferent to the truth. 
There's just no relationship between his statements--anything he 
utters--and the actual truth of the matter,' said Thomas Murray, 
president emeritus of the Hastings Center, the founding institution in 
the field of bioethics. `As far as I can tell, the best way to 
understand anything he says is what will best serve his interests in 
the moment. It's irrespective to any version of the truth.'
  ``According to an analysis by The Post's Fact Checker through the end 
of May, Trump has made 3,251 false or misleading claims in 497 days, an 
average of 6.5 such claims per day of his Presidency.''

                              {time}  1115

  ``And within the past week, Trump seems to have ramped up both the 
volume and the intensity of his false statements on two of the most 
prominent topics currently facing his administration: the hardline 
immigration policy that has led to the separation of thousands of 
children from their parents--which Trump erroneously blames on others--
and the 500-page inspector general report that he claims, incorrectly, 
exonerates him in special counsel Robert S. Mueller III's probe of 
Russian interference in the 2016 election.
  ``Bella DePaulo, a psychology researcher at the University of 
California Santa Barbara, said Trump's use of repetition is a 
particularly effective technique for convincing his supporters of the 
veracity of his false claims, in part because most people have a `truth 
bias' or an initial inclination to accept what others say as true.
  `` `When liars repeat the same lie over and over again, they can get 
even more of an advantage, at least among those who want to believe 
them or are not all that motivated either way,' DePaulo said in an 
email. `So when people hear the same lies over and over again--
especially when they want to believe those lies--a kind of new reality 
can be created. What they've heard starts to seem like it is just 
obvious, and not something that needs to be questioned.'
  ``On immigration, Trump and many top administration officials have 
said that existing U.S. laws and court rulings have given them no 
choice but to separate families trying to cross illegally into the 
United States. But it is the administration's decision, announced in 
April, to prosecute all southern border crossings that has led to the 
separation of families.
  ``That hasn't stopped the President from blaming Democrats for his 
administration's decisions. `Democrats are the problem,' Trump wrote in 
one tweet. In another, he was even more blunt: `The Democrats are 
forcing the breakup of families at the border with their horrible and 
cruel legislative agenda. . . .' ''
  Mr. Speaker, let me divert a little bit here. The truth is that the 
President caused this crisis, and it is not just me saying it and The 
Washington Post saying it. Listen to what some of the Republicans have 
said, Lindsey Graham said: ``President Trump could stop this policy 
with a phone call. I'll go tell him: If you don't like families being 
separated, you can tell DHS, `Stop doing it.' ''
  Senator John McCain: ``The administration's current family separation 
policy is an affront to the decency of the American people, and 
contrary to principles and values upon which our Nation was founded. 
The administration has the power to rescind this policy. It should do 
so now.''
  Senator Susan Collins, former First Lady Laura Bush--and I can go on 
and on and on--a whole bunch of Republicans now are all agreeing with 
us that the President is not telling us the truth.
  So let me go back to the article: ``While Congress could pass a 
legislative fix, Republicans control both the House and the Senate--
making it disingenuous at best to finger the opposing party, as the 
President has repeatedly done.
  ``Speaking to the National Federation of Independent Business on 
Tuesday, Trump again falsely painted the humanitarian crisis as a 
binary choice. `We can either release all illegal immigrant families 
and minors who show up at the border from Central America, or we can 
arrest the adults for the Federal crime of illegal entry,' he said. 
`Those are the only two options.'
  ``On Twitter, the President twice in the past 4 days has singled out 
Germany as facing an increase in crime. `Crime in Germany is up 10 
percent-plus (officials do not want to report these crimes) since 
migrants were accepted,' Trump wrote. `Others countries are even worse. 
Be smart, America.' ''
  That is his tweet.
  ``In fact, the opposite is true. Reported crime in Germany was 
actually down by 10 percent last year and, according to German Interior 
Minister . . . the country's reported crime rate last year was actually 
at its lowest point in three decades.
  ``The President has also falsely claimed that the inspector general 
report `exonerated' him from Mueller's probe, when the report did not 
delve into the Russia investigation. When he made this argument Friday 
during an impromptu press gaggle in the White House driveway, a 
reporter pressed him on the falsehood.
  `` `Sir, that has nothing to do with collusion,' the reporter said. 
`Why are you lying about it, sir?' ''
  The bottom line, Mr. Speaker, is, we have a President who has a 
problem with the truth, and Congress needs to stand up and do the right 
thing. We need to speak the truth; we need to embrace the truth; and we 
need to solve some of the issues that are before the American people.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. Members are reminded to refrain from 
engaging in personalities toward the President.
  Mr. BURGESS. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, I don't need to remind anyone that the lie of the year 
for 2012 was: If you like your doctor, you can keep your doctor--words 
that will ring through this body probably for the rest of time.
  I want to read from the Statement of Administration Policy, back to 
the business at hand, the rule on the three bills that we are 
considering today. This is the Statement of Administration Policy: 
``Addressing the opioid crisis has been a top priority of the President 
since day one, and the administration welcomes legislation that 
complements its efforts to end the opioid crisis. The administration 
strongly supports House passage of bipartisan bills to protect patients 
enrolled in Medicare and Medicaid, create targeted programs for at-risk 
populations, expand access to medication-assisted treatment for opioid 
use disorders, and provide resources for States and communities 
struggling to deal with the scale of the opioid crisis.''
  The statement goes on, and it concludes: ``These initiatives 
represent bold, evidence-based steps to prevent and treat opioid abuse, 
and will help save the lives of countless Americans. The administration 
commends the House on taking up these important bills. . . . The 
administration supports House passage of H.R. 5797, H.R. 6082, and H.R. 
6. . . .''
  Mr. Speaker, today's rule provides for the consideration of these 
three important pieces of legislation aimed at

[[Page H5302]]

addressing the opioid crisis affecting so many of our fellow Americans.
  H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid 
Recovery and Treatment for Patients and Communities Act; H.R. 5797, the 
Individuals in Medicaid Deserve Care that is Appropriate and 
Responsible in its Execution Act; and H.R. 6082, the Overdose 
Prevention and Patient Safety Act, will all play a critical role in 
treating patients and providing Americans the tools to put the pieces 
of their lives back together again.
  I commend Chairman Walden for his efforts on bringing so many Members 
of this body into the discussion and taking the many ideas offered by 
Members, incorporating them into the legislative products. The result 
of those efforts is a legislative trio that this entire body can be 
proud of, and this entire body can support.
  I, therefore, urge my colleagues to support today's rule and the 
three underlying pieces of legislation.
  The text of the material previously referred to by Mr. McGovern is as 
follows:

          An Amendment to H. Res. 949 Offered by Mr. McGovern

       At the end of the resolution, add the following new 
     sections:
       Sec. 5. Immediately upon adoption of this resolution the 
     Speaker shall, pursuant to clause 2(b) of rule XVIII, declare 
     the House resolved into the Committee of the Whole House on 
     the state of the Union for consideration of the bill (H.R. 
     4501) to increase funding for the State response to the 
     opioid misuse crisis and to provide funding for research on 
     addiction and pain related to the substance misuse crisis. 
     The first reading of the bill shall be dispensed with. All 
     points of order against consideration of the bill are waived. 
     General debate shall be confined to the bill and shall not 
     exceed one hour equally divided and controlled by the chair 
     and ranking minority member of the Committee on Energy and 
     Commerce. After general debate the bill shall be considered 
     for amendment under the five-minute rule. All points of order 
     against provisions in the bill are waived. At the conclusion 
     of consideration of the bill for amendment the Committee 
     shall rise and report the bill to the House with such 
     amendments as may have been adopted. The previous question 
     shall be considered as ordered on the bill and amendments 
     thereto to final passage without intervening motion except 
     one motion to recommit with or without instructions. If the 
     Committee of the Whole rises and reports that it has come to 
     no resolution on the bill, then on the next legislative day 
     the House shall, immediately after the third daily order of 
     business under clause 1 of rule XIV, resolve into the 
     Committee of the Whole for further consideration of the bill.
       Sec. 6. Clause 1(c) of rule XIX shall not apply to the 
     consideration of H.R. 4501.

        The Vote on the Previous Question: What It Really Means

       This vote, the vote on whether to order the previous 
     question on a special rule, is not merely a procedural vote. 
     A vote against ordering the previous question is a vote 
     against the Republican majority agenda and a vote to allow 
     the Democratic minority to offer an alternative plan. It is a 
     vote about what the House should be debating.
       Mr. Clarence Cannon's Precedents of the House of 
     Representatives (VI, 308-311), describes the vote on the 
     previous question on the rule as ``a motion to direct or 
     control the consideration of the subject before the House 
     being made by the Member in charge.'' To defeat the previous 
     question is to give the opposition a chance to decide the 
     subject before the House. Cannon cites the Speaker's ruling 
     of January 13, 1920, to the effect that ``the refusal of the 
     House to sustain the demand for the previous question passes 
     the control of the resolution to the opposition'' in order to 
     offer an amendment. On March 15, 1909, a member of the 
     majority party offered a rule resolution. The House defeated 
     the previous question and a member of the opposition rose to 
     a parliamentary inquiry, asking who was entitled to 
     recognition. Speaker Joseph G. Cannon (R-Illinois) said: 
     ``The previous question having been refused, the gentleman 
     from New York, Mr. Fitzgerald, who had asked the gentleman to 
     yield to him for an amendment, is entitled to the first 
     recognition.''
       The Republican majority may say ``the vote on the previous 
     question is simply a vote on whether to proceed to an 
     immediate vote on adopting the resolution . . . [and] has no 
     substantive legislative or policy implications whatsoever.'' 
     But that is not what they have always said. Listen to the 
     Republican Leadership Manual on the Legislative Process in 
     the United States House of Representatives, (6th edition, 
     page 135). Here's how the Republicans describe the previous 
     question vote in their own manual: ``Although it is generally 
     not possible to amend the rule because the majority Member 
     controlling the time will not yield for the purpose of 
     offering an amendment, the same result may be achieved by 
     voting down the previous question on the rule. . . . When the 
     motion for the previous question is defeated, control of the 
     time passes to the Member who led the opposition to ordering 
     the previous question. That Member, because he then controls 
     the time, may offer an amendment to the rule, or yield for 
     the purpose of amendment.''
       In Deschler's Procedure in the U.S. House of 
     Representatives, the subchapter titled ``Amending Special 
     Rules'' states: ``a refusal to order the previous question on 
     such a rule [a special rule reported from the Committee on 
     Rules] opens the resolution to amendment and further 
     debate.'' (Chapter 21, section 21.2) Section 21.3 continues: 
     ``Upon rejection of the motion for the previous question on a 
     resolution reported from the Committee on Rules, control 
     shifts to the Member leading the opposition to the previous 
     question, who may offer a proper amendment or motion and who 
     controls the time for debate thereon.''
       Clearly, the vote on the previous question on a rule does 
     have substantive policy implications. It is one of the only 
     available tools for those who oppose the Republican 
     majority's agenda and allows those with alternative views the 
     opportunity to offer an alternative plan.

  Mr. BURGESS. Mr. Speaker, I yield back the balance of my time, and I 
move the previous question on the resolution.
  The SPEAKER pro tempore. The question is on ordering the previous 
question.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. McGOVERN. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this question will be postponed.

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