[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]
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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
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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
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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.
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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.
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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.
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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
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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.
____________________