[Congressional Record Volume 170, Number 22 (Wednesday, February 7, 2024)]
[House]
[Pages H509-H519]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          PROTECTING HEALTH CARE FOR ALL PATIENTS ACT OF 2023


                             General Leave

  Mrs. RODGERS of Washington. Mr. Speaker, I ask unanimous consent that 
all Members may have 5 legislative days in which to revise and extend 
their remarks and to insert extraneous material in the Record on H.R. 
485.
  The SPEAKER pro tempore (Mr. Thompson of Pennsylvania). Is there 
objection to the request of the gentlewoman from Washington?
  There was no objection.
  The SPEAKER pro tempore. Pursuant to House Resolution 996 and rule 
XVIII, the Chair declares the House in the Committee of the Whole House 
on the state of the Union for the consideration of the bill, H.R. 485.
  The Chair appoints the gentleman from Pennsylvania (Mr. Meuser) to 
preside over the Committee of the Whole.

                              {time}  0915


                     In the Committee of the Whole

  Accordingly, the House resolved itself into the Committee of the 
Whole House on the state of the Union for the consideration of the bill 
(H.R. 485) to amend title XI of the Social Security Act to prohibit the 
use of quality-adjusted life years and similar measures in coverage and 
payment determinations under Federal health care programs, with Mr. 
Meuser in the chair.
  The Clerk read the title of the bill.
  The CHAIR. Pursuant to the rule, the bill is considered read the 
first time.
  General debate shall be confined to the bill and amendments specified 
in this section and shall not exceed 1 hour equally divided and 
controlled by the chair and ranking minority member of the Committee on 
Energy and Commerce or their respective designees.
  The gentlewoman from Washington (Mrs. Rodgers) and the gentleman from 
New Jersey (Mr. Pallone) each will control 30 minutes.
  The chair recognizes the gentlewoman from Washington.
  Mrs. RODGERS of Washington. Mr. Chairman, I yield myself such time as 
I may consume.
  Mr. Chairman, I rise in strong support of H.R. 485, my Protecting 
Health Care for All Patients Act, which affirms every person's life has 
value by banning the use of quality-adjusted life years, or QALYs, and 
similar discriminatory measures from all Federal healthcare programs.
  As many of you know, my son Cole was born with an extra 21st 
chromosome. Most of you know it as Down syndrome.
  When Cole was born, the doctors gave us a long list of challenges and 
chances for heartache. It was difficult, but I could have never 
imagined just how positively he would impact my life, my family's life, 
and the world.
  Today, Cole is a fun-loving 16-year-old with big dreams. He wants to 
be a football player, a pastor, and a race car driver. He is on the 
basketball team. He plays the drums. For Cole, the sky is the limit.
  Cole and others with disabilities deserve every opportunity to 
succeed. We shouldn't be discounting their potential or prejudging the 
quality of their life just because of their disabilities.
  Unfortunately, several tools frequently used in our healthcare system 
do just that. QALYs, and other similar discriminatory measures, assign 
a dollar value on the life of a patient to decide if a certain 
treatment is cost effective, oftentimes discounting an individual's 
worth and the need for care solely because of their disability or 
chronic illness.
  It means a bureaucracy coldly determines the value of someone's life 
and could deny necessary healthcare due to that calculation.
  Measurements like QALYs remove the consideration of unique 
circumstances and health conditions of a patient and their doctor's 
judgment from deciding what is best for the patient.
  I am not alone in opposing the use of these measures.
  Democrats acknowledged this when they passed the Affordable Care Act, 
and they banned the use of QALYs in Medicare.
  In 2020, the Democratic National Committee platform stated that: 
``Democrats will ensure that people with disabilities are never denied 
coverage based on the use of quality-adjusted life year (QALY) 
indexes.''
  The nonpartisan National Council on Disabilities wrote a report in 
2019 titled: ``Quality-Adjusted Life Years and the Devaluation of Life 
with a Disability'' that condemned the usage of QALYs and they have 
continued to write additional letters to Congress urging us to ban 
their use.
  Additionally, we have heard from nearly 200 advocacy groups spanning 
the political spectrum who are calling on Congress to prohibit the use 
of QALYs and other discriminatory measures.
  This legislation, the Protecting Health Care for All Patients Act, 
bans Federal payers, like Medicaid and VA healthcare, from using QALYs 
or other discriminatory measures that devalue the lives of people with 
disabilities and chronic or rare diseases, and it does it by simply 
applying the current ban on QALYs and other similar measures that exist 
in Medicare today to all Federal payers.
  In passing this bill, it will mean that healthcare bureaucracies can 
no longer discriminate against the weakest and most vulnerable 
patients, and it will help ensure that people can get the healthcare 
that they need and that their doctors think is best.
  This would be a big deal.
  Medicaid is the largest payer for people with disabilities, and we 
are letting it use measures that discriminate against the very people 
it was designed to support.
  That is nothing to say of the millions of injured or disabled 
veterans who rely on the VA for their healthcare, which is also allowed 
to use these types of measures.
  However, let me be clear in this: H.R. 485 does not prohibit 
healthcare programs from rewarding value or finding other ways to hold 
down costs.

  For example, if a treatment does not work or shouldn't be covered or 
it is more appropriate to start with other more cost-effective 
treatments first, nothing in this bill will preclude the Federal payers 
from continuing to make these kinds of coverage decisions.
  In fact, the National Council on Disability has already identified 
alternative ways to measure value that do not devalue the life of 
someone with a disability or chronic illness.
  Because of Cole, I have spent my time in Congress as an ability 
advocate, encouraging people to focus on every individual's God-given 
talent and potential.
  Millions of Americans like Cole need their voices to be heard. 
Whenever I meet someone with a disability or chronic illness, or with 
their family, I hear the same thing over and over: They want the same 
chances to succeed in life as everyone else.
  You know what? We are all just one car accident or one diagnosis away 
from having a disability ourselves.
  I hope that banning the use of discriminatory measures by Federal 
payers against people with disabilities and chronic illness and 
affirming every person's life has value is something that we can agree 
on. Let's give people with disabilities, rare diseases, or chronic 
diseases hope.
  Mr. Chairman, I urge support of this important legislation, and I 
reserve the balance of my time.
  Mr. PALLONE. Mr. Chair, I yield myself such time as I may consume.
  Mr. PALLONE. Mr. Chairman, I rise in strong opposition to H.R. 485, 
the so-called Protecting Health Care for All Patients Act, a bill that, 
unfortunately, does not live up to its name.
  This legislation is not about protecting healthcare for patients. 
Instead, it is a Trojan horse intended to undermine the progress that 
President Biden and Democrats have made in lowering prescription drug 
costs for American families.
  My Republican colleagues say this bill is intended to prevent the 
Secretary of Health and Human Services from using a measure called 
``quality-adjusted life years,'' or QALYs, which could be 
discriminatory against Americans living with disabilities, but Federal 
law, including the Inflation Reduction Act, already prohibits Medicare 
from using QALYs in its coverage determination, and State Medicaid 
programs are required by law to cover all drugs.

[[Page H510]]

  Instead, H.R. 485 goes further than current law and opens a back door 
that will be used to bar the use of any value measures by the Federal 
Government. These measures are used by Federal agencies such as the 
Centers for Medicare & Medicaid Services, the Department of Veterans 
Affairs, and by States to negotiate fair prices for prescription drugs.
  When this bill came before the Energy and Commerce Committee, I 
sought to clarify its intent through an amendment during markup. My 
amendment would have ensured the legislation could not be construed to 
undermine Federal agencies or the Biden administration's ongoing work 
to lower prescription drug prices for Americans, but that amendment was 
rejected on a party-line vote.
  I still do not understand why the Republican majority would be 
opposed to clarifying that the bill before us today is not intended to 
undermine the Federal Government's efforts to determine fair prices for 
prescription drugs.
  Now, I respect the chairman of our committee a great deal, but she 
keeps talking about how she is banning similar discriminatory measures. 
Well, the fact of the matter is that the bill doesn't say ``similar 
discriminatory measures.''
  If she had said during the markup that she was willing to ban things 
that were discriminatory, it might have been a different situation. We 
might have had a consensus, but that is not what is going on here. This 
says ``QALYs or similar measures,'' not similar discriminatory 
measures.
  Some may say: Well, what is the difference?
  The difference is the word ``discriminatory'' is not in the language 
of the bill.
  We have no problem banning things that are discriminatory, like QALYs 
or similar discriminatory measures, but that is not in there.
  So the problem is that this will be used by pharma to raise prices. 
The vagueness of the language opens up the door to pharma and the drug 
companies to sue and say that negotiated prices and efforts to try to 
reduce costs are not acceptable.
  I am not suggesting that that is what the Republicans have in mind 
necessarily, but that is the reality of it. This is backed by pharma, 
by the pharmaceutical industry because they want to use it to undermine 
every effort the Democrats have made to try to bring down costs for 
prescription drugs in the Medicare market, in the Medicaid market, in 
Veterans Affairs, and on down the list.
  I am deeply concerned that the ambiguity in the bill text would be a 
prime target for litigation by the pharmaceutical industry, an industry 
that has already shown a willingness to sue to keep outrageously high 
prescription drug prices in place.
  We know that Big Pharma is already using similar tactics to try to 
fight the implementation of the Medicare drug price negotiation program 
enacted by the Inflation Reduction Act. This bill could give them yet 
another point of entry to undermine Medicare's ongoing work to 
negotiate prescription drug prices.
  Now, in addition, the Congressional Budget Office agreed that this 
legislation will hinder the ability of our Federal health programs to 
lower costs. CBO estimates that this bill will increase spending for 
prescription drugs in Medicare, Medicaid, and other Federal health 
programs, including the Department of Defense and Veterans Affairs' 
health programs by $1.1 billion in the next 10 years, and potentially 
tens of billions in the years that follow.
  So because of the fact that this bill raises prices for the Federal 
Government, increases costs for prescription drugs, the Republicans had 
to put a pay-for in the bill.

  The Republican bill before us today would gut the Affordable Care 
Act's Prevention and Public Health Fund in order to pay this $1.1 
billion for the legislation. It has long been the goal of Republicans 
to decimate the ACA's essential funding stream to lower healthcare 
costs through prevention. This funding in the prevention fund goes to 
our State and local partners to improve public health and prevent 
chronic diseases.
  The prevention fund encourages smoking cessation, prevents childhood 
lead poisoning, and enhances infectious disease control.
  This fund plays a critical role in our efforts to help the American 
people live healthier lives. House Republicans' decision to cut the 
prevention fund in order to throw more money at their Big Pharma 
friends makes it clear that they are not interested in reaching 
consensus or finding a bipartisan solution.
  Instead, they would rather jam through a partisan bill that would 
hurt the very communities that they claim to be helping.
  Mr. Chair, this bill is nothing more than a giveaway to Big Pharma at 
the expense of the American people and our Nation's public health. I 
strongly oppose the bill and urge my colleagues to oppose it, as well.
  Mr. Chairman, I reserve the balance of my time.
  Mrs. RODGERS of Washington. Mr. Chairman, I yield myself such time as 
I may consume.
  The reasons that the ranking member says to oppose the bill, they do 
not match what the bill actually says.
  Current law already prohibits the use of QALYs and other similar 
measures in Medicare. Current law reads: ``The Secretary shall not 
utilize such an adjusted life year or (such a similar measure) as a 
threshold to determine coverage. . . . ''
  I am not sure why all of a sudden we have this concern about other 
measures. All the bill would do is apply current Medicare law to other 
Federal payers, and if people are insistent that other measures are not 
discriminatory, then they should have no problem in using them.
  I will also point out to anyone who may be listening, according to 
CBO's cost estimate: ``CBO does not expect that enacting H.R. 485 would 
affect the prices that result from negotiations between the Secretary 
and drug manufacturers.''
  I don't support this capping or government price fixing of drugs. I 
don't support it. I would like to see us work together to reduce the 
cost of drugs, but this bill, according to CBO, does not expect that 
H.R. 485 would affect the prices that result from negotiations between 
the Secretary and drug manufacturers.
  Don't get distracted from the underlying bill here.
  Mr. Chair, I yield 2 minutes to the gentleman from Kentucky (Mr. 
Guthrie).

                              {time}  0930

  Mr. GUTHRIE. Mr. Chair, I rise in strong support of H.R. 485, the 
Protecting Health Care for All Patients Act led by Energy and Commerce 
Committee Chair Rodgers. This bill would permanently ban the use of 
quality-adjusted life years or similar measures under any Federal 
healthcare program.
  Quality-adjusted life years. Think of that term. Should an academic 
or Washington bureaucrat be able to say some people are more valuable 
than others, that vulnerable populations like those with disabilities 
don't deserve the same access to treatment as others?
  Individuals with disabilities, chronic conditions, and others to whom 
quality-adjusted life years or similar measures may discriminate 
against, deserve the chance to choose which treatments they access 
without a Washington bureaucrat or an academic with no clinical 
experience making the decision for them.
  I support this legislation. I appreciate the chair for bringing it 
forward and sharing her personal story of why this is important. We all 
know and love Cole. I didn't know he wanted to be a race car driver. I 
think I did at 16, as well. He is a wonderful young man, and he 
represents a great group of people who don't deserve to be 
discriminated against.
  Mr. Chair, I support this legislation and urge my colleagues to do 
so.
  Mr. PALLONE. Mr. Chairman, I yield 3 minutes to the gentlewoman from 
California (Ms. Eshoo), the ranking member of the Health Subcommittee.
  Ms. ESHOO. Mr. Chair, I rise, sadly, in opposition to this bill, H.R. 
485.
  I support, and everyone here supports, banning quality-adjusted life 
years, also known as QALYs. It is a discriminatory metric that should 
not be used, and Democrats are the ones who recognized this in 2010 
when we banned Medicare's use of QALYs in the Affordable Care Act.

[[Page H511]]

  If this bill simply banned QALYs, it would pass the House, the 
Senate, and become law. It would become law quickly. However, the 
problem is that the legislation bans QALYs and ``similar measures.'' I 
have repeatedly said that this vague ``similar measures'' phrase is a 
problem, including during the hearing and the markup of the bill.
  This overly broad ``similar measures'' phrase weakens the Federal 
Government's ability to negotiate drug prices by ruling out any type of 
comparative effectiveness. Without this analysis, CBO found that States 
and the Federal Government would have less leverage for drug discounts.
  The CBO estimates that this ``similar measures'' phrase will raise 
Federal costs in Medicaid by nearly half a billion dollars--that is 
with a b--and by nearly a quarter of a billion dollars in TRICARE and 
the VA. It also means out-of-pocket costs will rise for veterans and 
Federal workers, and State budgets will be hit by higher Medicaid 
spending.
  Mr. Chair, I have tried everything I could to fix this legislation. I 
voted ``present'' in the markup to continue bipartisan negotiations and 
met with the chairwoman about changing the language, but the bill 
before us today is the same bill that passed out of committee. It adds 
insult to injury because the Republicans are using the Affordable Care 
Act Public Health Prevention Fund to pay for it. Over 170 patient and 
public health groups oppose using this fund as an offset.
  My Republican colleagues have said they wish the legislation could be 
bipartisan, but their actions say otherwise. This bill has only five 
cosponsors, all Republicans, no Democrats. It has a poisonous pay-for, 
and the Veterans' Affairs and Armed Services Committees never heard the 
bill despite its major impact on the VA and TRICARE.
  This is, in my view, a partisan bill that needlessly cuts public 
health to increase drug spending, and that is why I urge my colleagues 
to vote against it.
  Mrs. RODGERS of Washington. Mr. Chairman, this bill should be 
bipartisan. This legislation before us today takes the language that 
the Democrats put into the Affordable Care Act, and again I will quote 
it: ``The Secretary shall not utilize such an adjusted life year (or 
such a similar measure) as a threshold to determine coverage. . . .'' 
We take that language from Medicare inserted by the Democrats in the 
Affordable Care Act, and we apply it to all Federal payers. It should 
be bipartisan.
  Mr. Chairman, I yield 2 minutes to the gentleman from Florida (Mr. 
Bilirakis).
  Mr. BILIRAKIS. Mr. Chairman, I rise in support of H.R. 485, the 
Protecting Health Care for All Patients Act, which would ban the use of 
the quality-adjusted life years metric in our Federal health programs.
  I thank Chair Rodgers for her leadership on this issue and her 
staunch advocacy for American patients, no matter their background. The 
use of QALYs when determining coverage and payment policies in 
healthcare at its core devalues the lives of patients with disabilities 
and chronic conditions.
  As co-chair of the Rare Disease Caucus, I am concerned about how the 
use of QALY metric impacts payment decisions for chronic rare disorder 
patients, potentially making it more difficult for them to get access 
to lifesaving treatments. We can't have that.
  I am also concerned about how this metric could be used by 
bureaucrats to make decisions that discriminate against our Nation's 
disabled veterans, our heroes. These lives have value and should not be 
discriminated against when determining the cost-effectiveness of 
treatments, plain and simple.
  Pricing measurements and discriminatory methodologies such as QALYs 
have been condemned by the National Council on Disability. Even the 
Affordable Care Act contained a narrow ban of this metric, and I guess 
into Medicare, and I am disappointed that the Democrats have decided to 
turn their back on individuals with preexisting conditions like they 
have here today.
  Let's ban this metric and support H.R. 485, which has been endorsed 
by the National Down Syndrome Society. Disability Rights Education & 
Defense Fund, and more than 100 other disability and patient advocacy 
groups. That speaks volumes, as far as I am concerned. I thank the 
chair of the Energy and Commerce Committee for putting this forward, 
and let's pass it today.

  Mr. PALLONE. Mr. Chairman, I yield 3 minutes to the gentleman from 
California (Mr. Takano), the ranking member of the Veterans' Affairs 
Committee.
  Mr. TAKANO. Mr. Chairman, I rise in strong opposition to H.R. 485, 
the so-called Protecting Health Care for All Patients Act of 2023.
  I have to say that it is a bit rich to hear my colleague talk about 
preexisting conditions and their party's concern for it when he has 
been part of the party that has been completely opposed to protecting 
people with preexisting conditions because they have repeatedly, over 
and over, tried to repeal the Affordable Care Act.
  The bill before us today does almost nothing to protect healthcare 
for patients and, instead, would likely increase healthcare costs 
across the board.
  As the ranking member of the House Veterans' Affairs Committee, I am 
especially alarmed at the impact this bill would potentially have on 
our veterans' care, and I have to say I wonder why this bill was not 
referred also to the Veterans' Affairs Committee, given its impact on 
this jurisdiction.
  Under current law, multiple Federal programs like VA's have special 
pricing arrangements for prescription drugs that rely on up-front 
discounts and rebates. It is a win-win system for both taxpayers and 
veterans.
  The VA keeps costs lower and is able to make sure veterans get access 
to the drugs they need. In fact, I would daresay the Department of 
Veterans Affairs has the most robust negotiations over the drugs on its 
formulary. However, this bill would upend this proven system and 
instead inject uncertainty into drug pricing.
  That chaos has a very real cost for VA and DOD: $240 million for the 
2023-2033 time period, according to the CBO. ``Other similar measures'' 
simply does seem to have a measurable effect for CBO, those words, 
``other similar measures.'' This will diminish VA's ability to deliver 
care to veterans and force the Department to make cuts to services 
elsewhere.
  Consequently, that begs the question, who benefits from this 
disarray? Big Pharma does. They reap the rewards and push up their 
profits. I have to say, their lobbyists will really have earned their 
outrageously large paycheck if this bill passes because it is so 
clearly a rip-off. Taxpayers and veterans lose, while Big Pharma wins? 
Give me a break.
  However, House Democrats are opposed to this blatant rip-off and will 
fight it tooth and nail. Instead of doing Big Pharma's bidding, we are 
focused on lowering drug prices for Americans. House Democrats are 
proud to have worked with the Biden administration to deliver on 
capping the cost of insulin at $35 per month for seniors, finally 
allowing Medicare to negotiate lower prescription drug prices, and 
requiring drug companies to pay rebates to Medicare if they raise 
prices faster than inflation.
  The Acting CHAIR (Mr. Luttrell). The time of the gentleman has 
expired.
  Mr. PALLONE. Mr. Chairman, I yield an additional 1 minute to the 
gentleman from California.
  Mr. TAKANO. Let me add, Democrats have also locked in $800 per year 
in health insurance savings for 15 million Americans.
  Members should ask themselves who has more credibility on protecting 
Americans' healthcare and saving them money and lowering costs. I would 
submit the Democrats do.
  Mr. Chair, I urge my colleagues to oppose this bill. It will cost 
taxpayers money, it will cost the VA more money, and just give more 
profits to Big Pharma.
  Mrs. RODGERS of Washington. Mr. Chair, I yield 2 minutes to the 
gentleman from Georgia (Mr. Carter).
  Mr. CARTER of Georgia. Mr. Chair, if you go to the VA's website, they 
have an entire page devoted to QALYs where they say outright, to date 
the quality-adjusted life year is the preferred metric for estimating 
health effects. There is a perfect example of what we are talking about 
right there on the VA website.
  Mr. Chairman, I had surgery December 28, and I have been on this 
scooter ever since. It really does give you a different perspective for 
people with disabilities. For me, it is temporary, but

[[Page H512]]

it has made me realize that people with disabilities, people with 
certain health challenges, it is not temporary for them. They deal with 
this all the time.
  Are they any less of a person than I am or than you are? No.
  That is what we are trying to say here. They deserve the same 
treatment as anyone else does.
  I am in strong support of this Protecting Health Care for All 
Patients Act because it will expand access to lifesaving treatments and 
prevent discrimination against Americans with disabilities.
  The way that we come up from the Rayburn Building up to the second 
floor, to the House Chamber, well, you know those escalators are broken 
right now. The other day, I am coming up, trying to make it to a vote. 
Both escalators are broken. I tried to get on the elevator, and someone 
has changed the elevator to where you have to have a badge to get on 
it. If there had not been someone who came by with a badge, I would 
still be sitting there right now.

                              {time}  0945

  This is serious. This is what we are talking about. These are real 
people. This is good legislation, and I thank the gentlewoman for 
bringing this. I support this, and I hope you will, too.
  Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentlewoman from 
Texas (Mrs. Fletcher), a member of our Energy and Commerce Committee.
  Mrs. FLETCHER. Mr. Chair, I rise in opposition to H.R. 485, the so-
called Protecting Health Care for All Patients Act of 2023.
  This legislation harms the very people it says it protects, increases 
prescription drug costs, and decimates funding for essential public 
health programs.
  Last Congress, Democrats passed the Inflation Reduction Act, landmark 
legislation that gives the Secretary of Health and Human Services the 
power to negotiate drug prices for Medicare. This critical step is 
estimated to lower drug prices by at least 25 percent, saving seniors 
and taxpayers tens of billions of dollars and ensuring that people with 
Medicare get better, fairer prices for prescription drugs.
  The nonpartisan Congressional Budget Office estimated that this 
provision in the IRA alone will save the government $100 billion over 
the next 10 years. In contrast, the CBO estimates that the bill before 
us today would not only increase drug prices across Federal health 
programs, but it would also increase Federal spending by $1.1 billion 
over the next 10 years by eliminating important tools to manage drug 
prices. Without effective tools to determine the value of a drug, the 
government is at a disadvantage, and the taxpayers pay the higher 
price.
  We know that 8 in 10 adults in the United States today say that the 
cost of prescription drugs is too high, and we know that 3 in 10 say 
that they don't take all of their prescriptions as prescribed because 
they can't afford them. It is simply unacceptable.
  It is unacceptable that Americans struggle so much to pay for the 
lifesaving and critical drugs that they need to ensure their quality of 
life.
  Just last week, the Biden administration announced that it had sent 
initial offers to participating drug companies for the first 10 drugs 
selected for price negotiation, a milestone in implementing the IRA. 
These 10 drugs alone cost seniors $3.4 billion in out-of-pocket costs.
  The Acting CHAIR. The time of the gentlewoman has expired.
  Mr. PALLONE. Mr. Chair, I yield an additional 1 minute to the 
gentlewoman from Texas.
  Mrs. FLETCHER. Mr. Chair, let me repeat that: These 10 drugs alone 
cost seniors $3.4 billion in out-of-pocket costs in 2022.
  While Democrats and President Biden are fighting for lower drug 
costs, House Republicans want to stop negotiations altogether.
  Democrats are delivering, and we will continue to work to lower 
prescription drug prices for seniors and families across our country, 
but this bill does not do that.
  For this reason, at the appropriate time, I will offer a motion to 
recommit this bill back to committee. If the House rules permitted, I 
would have offered this motion with an important amendment to the bill 
to prevent this bill from taking effect until the Secretaries of HHS, 
Defense, and Veterans Affairs, as well as the Director of the Office of 
Personnel Management, certify that it will not result in an increase in 
prescription drug prices or an increase in patient costs in the United 
States.
  Mr. Chair, I include in the Record the text of my amendment.

       Mrs. Fletcher moves to recommit the bill H.R. 485 to the 
     Committee on Energy and Commerce with instructions to report 
     the same back to the House forthwith, with the following 
     amendment:
       Add at the end the following new section:

     SEC. 3. EFFECTIVE DATE.

       The amendments made by this Act shall not take effect until 
     the Secretaries of Health and Human Services, Defense, and 
     Veterans Affairs, and the Director of the Office of Personnel 
     Management certify that such amendments will not result in an 
     increase in prescription drug prices or an increase in 
     patient costs in the United States.

  Mrs. RODGERS of Washington. Mr. Chairman, if this legislation harms 
people who we are intending to help, why do we have support letters 
from nearly 200 disability patient advocate groups across the political 
spectrum? Down Syndrome Society, Autism Speaks, Disability Law Center, 
and ARC all support this bill.
  If the Democrats want to suggest that they are committed to lowering 
the cost of prescription drugs and that the reason to oppose this bill 
is because it is going to increase costs, the only reason this bill 
would increase costs is if you are denying care to people who have 
disabilities. That is the only reason. You are discriminating against 
people. That is the only reason this bill would cost any money.
  CBO already estimates that this bill is going to cost $1.1 billion. 
Why is that? Why would this legislation cost $1.1 billion? Because CBO 
is forecasting that there are going to be discriminatory measures used 
against individuals, and we are going to ban that. We are going to make 
sure that doesn't happen.
  Mr. Chair, I am pleased to yield 2 minutes to the gentleman from 
Pennsylvania (Mr. Joyce).
  Mr. JOYCE of Pennsylvania. Mr. Chair, I thank the gentlewoman for 
yielding, and I specifically thank Chair McMorris Rodgers for her 
incredible work on this vital legislation.
  As America continues to lead the way in research, development, and 
innovation of new therapies and medical devices, it is vital that these 
cures are available to the Americans who need them the most.
  That is why today we are taking action to expand healthcare options 
to more patients than ever before by banning the use of quality-
adjusted life years in all Federal programs.
  More than 55,000 veterans live in Pennsylvania's 13th Congressional 
District, many of whom were injured or disabled while serving in 
uniform for our country. For years, I cared for patients at the Van 
Zandt VA Medical Center in Blair County. This legislation will provide 
more protection for disabled veterans.
  By passing the Protecting Health Care for All Patients Act, we can 
ensure that institutions like the VA will never again use QALY formulas 
to determine if a disabled veteran should receive the treatment that 
they need, should receive the treatment that they deserve.
  It is time to ensure that patients are protected and receiving the 
best quality care. All Americans, all patients, deserve that.
  Mr. Chair, I urge my colleagues to vote in favor of this legislation.
  Mr. PALLONE. Mr. Chairman, I yield myself such time as I may consume.
  Republicans are pointing to the Congressional Budget Office's score 
of their bill as proof that healthcare programs are already using the 
QALY to discriminate against people, but that is simply not what the 
CBO score says.
  It is ironic Republicans would point to CBO's analysis, given it 
highlights my exact concern that this bill's reference to other 
``similar measures'' is ambiguous and undermines drug price 
negotiations.
  It is precisely this uncertainty that would result in a chilling 
effect on States and Federal agencies being willing to look at the cost 
of prescription drugs.
  Again, I take no issue with banning QALYs, and I offered an amendment 
in committee to ban QALYs when this

[[Page H513]]

bill was marked up, but that is not what this is about.
  This is an effort by the Republicans to back up pharma and make sure 
that we don't look at cost measures; that we don't negotiate prices, 
which they oppose in Medicare; and that we simply let the 
pharmaceutical companies charge whatever they want.
  Imagine what it would be like if the pharmaceutical companies could 
charge whatever they want. Not only would it cost another $1.1 billion, 
which is what the CBO says, but it could undermine any efforts to lower 
the cost of prescription drugs throughout any Federal and State 
programs.
  What does that mean? What does that mean for people? How would we 
continue to fund programs for seniors, for the disabled, for anyone if 
we cannot adjust the cost issue and keep costs down for prescription 
drugs?
  There is no effort here on the Democrats' part to continue with 
QALYs. We are opposed to them, but you have to continue to be able to 
look at costs in a nondiscriminatory way.
  That is what is not going to happen if this bill becomes law. There 
will not be any way or any effective way for any Federal, State, or 
local agencies to look at cost measures, and costs will continue to 
skyrocket, exactly what pharma wants.
  Mr. Chair, I reserve the balance of my time.
  Mrs. RODGERS of Washington. Mr. Chair, I am pleased to yield 1\1/2\ 
minutes to the gentleman from Indiana (Mr. Pence).
  Mr. PENCE. Mr. Chair, I thank Chairwoman Rodgers for yielding time.
  I am proud to support the Protecting Health Care for All Patients Act 
championed by my good friend and a true leader, Chairwoman Rodgers.
  We need to recognize and affirm that every life is precious and a 
gift from God. It is unconscionable that healthcare payers use quality-
adjusted life years as a measurement to determine if treatment options 
for patients are cost-effective.
  Federal healthcare programs should provide patients with the best 
care available, regardless of preexisting conditions and those 
suffering with disabilities.
  It is important we find fiscally and ethically responsible solutions 
to reduce healthcare costs in this country without devaluing the 
sanctity of life.
  Mr. Chair, I urge support for final passage.
  Mr. PALLONE. Mr. Chairman, I reserve the balance of my time.
  Mrs. RODGERS of Washington. Mr. Chair, I am pleased to yield 2 
minutes to the gentlewoman from Tennessee (Mrs. Harshbarger).
  Mrs. HARSHBARGER. Mr. Chair, I rise in strong support of Chair 
Rodgers' Protecting Health Care for All Patients Act, which addresses 
the Federal Government's discriminatory practices toward disabled and 
chronically ill patients through the use of quality-adjusted life 
years.

  Quality-adjusted life years are used by bureaucrats and healthcare 
administrators to assign a numerical value to an individual's life, 
which is then used to make coverage decisions for medical treatments 
and services.
  Current law already largely prevents the Department of Health and 
Human Services from using this metric in Medicare ``in a manner that 
treats extending the life of an elderly, disabled, or terminally ill 
individual as of lower value.'' This discriminatory metric has even 
been proposed to be used by the Centers for Medicare and Medicaid 
Services.
  The bottom line is this: The Federal Government should not play a 
role in determining the value of a patient's life.
  As a pharmacist for over 30 years, I understand that ensuring 
patients with disabilities and chronic illnesses have continued access 
to quality care is of utmost performance.
  The Protecting Health Care for All Patients Act will ban the use of 
quality-adjusted life years in Federal healthcare programs, expanding 
access to healthcare for Americans and protecting patients across the 
country.
  As a healthcare provider, we take an oath to first do no harm. Mr. 
Chair, I urge my colleagues to support this landmark legislation led by 
Chair McMorris Rodgers and put the interests of patients first.
  Mr. PALLONE. Mr. Chair, I reserve the balance of my time.
  Mrs. RODGERS of Washington. Mr. Chairman, I am pleased to yield 2 
minutes to the gentlewoman from Iowa (Mrs. Miller-Meeks)
  Mrs. MILLER-MEEKS. Mr. Chairman, I rise today in support of H.R. 485, 
the Protecting Health Care for All Patients Act.
  Quality-adjusted life years, or QALYs, are a metric used to assign a 
dollar value on someone's life and ration healthcare treatments 
accordingly, often discriminating against those with disabilities.
  This isn't the first time we have heard this. I remember a former 
President, in advocating for the Affordable Care Act, said if someone 
has a broken hip, and they are elderly, they are just going to have to 
deal with it.
  Current law prevents the Secretary of Health and Human Services from 
using QALYs in Medicare specifically in a manner that treats extending 
the life of an elderly, disabled, or terminally ill individual as of 
lower value.
  This legislation simply extends the QALYs prohibition to other 
Federal healthcare programs not included under current law.
  As a doctor, it is outrageous for government bureaucrats to determine 
whether a person's life is worth saving.
  It is interesting to hear the other side of the aisle concerned about 
cost after advancing the Affordable Care Act when they knew it would 
lead to increased costs, increased premiums, which it has done, and 
patients losing their doctors and their healthcare plans.
  If my colleagues are concerned about veterans' affairs, I happen to 
be the chair of the Health Subcommittee of the Committee on Veterans' 
Affairs. We can introduce this there, as well.
  Mr. Chairman, I urge my colleagues to support this legislation.

                              {time}  1000

  Mr. PALLONE. Mr. Chairman, I continue to reserve the balance of my 
time.
  Mrs. RODGERS of Washington. Mr. Chairman, I yield 2 minutes to the 
gentlewoman from Florida (Mrs. Cammack).
  Mrs. CAMMACK. Mr. Chairman, I thank my good friend and colleague, 
Representative McMorris Rodgers for yielding.
  Mr. Chair, I rise today in support of H.R. 485, the Protecting Health 
Care for all Patients Act. This bill, led by Chairwoman Rodgers, would 
prohibit all Federal healthcare programs from using quality-adjusted 
life years, or as you may hear them called, QALYs, as criteria to 
determine coverage for often life-altering treatments for patients. 
Quality-adjusted life years are measures that discount the value of a 
life based on disability, age, or terminal illness, and are currently 
used by all Federal healthcare payers, except for Medicare.
  Put plainly, programs like Medicaid and the Department of Veterans 
Affairs allow unelected, nameless, faceless bureaucrats to put a dollar 
value on the life of a patient to determine whether the treatment is 
cost-effective or not. In doing so, these programs and agencies 
discount an individual's worth and need for medical care based upon 
their disability status and whether they have a chronic illness.
  Ultimately, the use of QALYs amounts to discrimination, something 
that is all too common in our healthcare system. Patients with 
disabilities, for instance, are often denied the ability to receive 
lifesaving organ transplants.
  As the sponsor of the Charlotte Woodward Organ Transplant 
Discrimination Prevention Act, I personally and firmly believe that 
patients with disabilities and other chronic conditions should receive 
equal treatment, whether it is for an organ transplant or coverage of 
essential medicines.
  I applaud Chairwoman Rodgers' efforts to protect the lives of all 
patients, and I urge my colleagues to support this legislation.
  No bureaucrat should be able to coldly determine the life and value 
of a patient.
  This bill that we have an opportunity to vote on today is a huge step 
forward in fighting discrimination within our healthcare system.
  Mr. PALLONE. Mr. Chairman, I continue to reserve the balance of my 
time.

[[Page H514]]

  

  Mrs. RODGERS of Washington. Mr. Chairman, may I inquire as to how 
much time is remaining on each side.
  The Acting CHAIR. The gentlewoman from Washington has 8 minutes 
remaining. The gentleman from New Jersey has 13 minutes remaining.
  Mrs. RODGERS of Washington. Mr. Chairman, I yield 2 minutes to the 
gentleman from Ohio, (Mr. Wenstrup).
  Mr. WENSTRUP. Mr. Chairman, I rise here today in support of H.R. 485, 
the Protecting Health Care for all Patients Act, and I thank Chairwoman 
McMorris Rodgers for bringing this important legislation forward.
  I am a physician who is proud to join my colleagues in leading this 
bill that bans the use of quality-adjusted life years, QALYs, as it is 
called, in all Federal programs.
  As a physician I took an oath, determined to treat each patient as a 
human being first and foremost. Quality metrics intentionally devalue 
treatments for disabled and chronically ill patients in determining 
whether a treatment is cost-effective. In other words, telling the 
patient, you are not worth it.
  The bottom line is this: These cost measurements put an artificial 
dollar value on a person's life, valuing the lives of Americans 
differently.
  In doing so, QALYs interferes with the sacred duty of a physician to 
care for all patients equally. Treating all patients equally and with a 
personal touch is something that I have always taken great pride in.
  Our healthcare system must value all lives and ensure every person is 
treated with dignity. Our government should never deny healthcare to 
all Americans based on how much a life is perceived to be worth. This 
is a check on our morality. This is a check on our values. We should 
value human life and work towards healthier human lives, not devalue 
human life nor indignify one another.
  Mr. Chair, I urge all my colleagues to join me in blocking government 
bureaucrats from putting an arbitrary price tag on the life of every 
American--bureaucrats that will never meet you or take responsibility 
for your care.
  Mr. PALLONE. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, there is no doubt that the pharmaceutical industry 
would like to see the gains we have made to lower drug prices through 
the Inflation Reduction Act halted or reversed. That is why they have 
brought numerous Federal lawsuits against the law in courts throughout 
the country, even as the Department of Health and Human Services just 
announced opening offers for the first 10 drugs selected for 
negotiation to bring down costs.
  This bill would simply provide a new avenue for the pharmaceutical 
industry to pursue litigation intended to hamper the IRA and the 
negotiation program overall, and it doesn't stop there. It could strip 
States of one of the only tools that they have to negotiate Medicaid 
drug rebates.
  Now, while proponents of this legislation would have you believe that 
this bill just extends current law, unfortunately, that is not the 
case. It expands and changes current law. It applies the language from 
the Inflation Reduction Act in a new context and broadens its 
applicability to ban the use of other similar measures across the 
Federal Government, and that means limiting the ability to look at 
costs. If we don't have the ability to compare drugs and see which ones 
are effective and which ones cost more, then we won't have the ability 
to lower costs. What that means is we allow pharma to charge whatever 
they want.

  The CBO says this is going to cost another $1.1 billion, which is why 
the Republicans seek to cut the Prevention and Public Health Fund to 
pay for it. But this is going to lead us down the path of saying that 
we can't look at cost at all. That means that costs will balloon for 
Medicare, for Medicaid, and for prescription drugs. The consequence of 
that is you can't pay for other programs that help seniors, that help 
poor people, that help veterans, that help those in the military with 
their health and the quality of their health.
  This is a very dangerous piece of legislation, and Democrats are 
speaking out against it because of the consequences and our ability to 
fund health programs around the country at every level.
  Mr. Chairman, I reserve the balance of my time.
  Mrs. RODGERS of Washington. Mr. Chair, I yield 2 minutes to the 
gentleman from Minnesota (Mr. Stauber).
  Mr. STAUBER. Mr. Chairman, I rise in strong support of the Protecting 
Health Care for all Patients Act of 2023 led by Chairwoman Rodgers.
  I rise today not only as a Congressman, Mr. Chair, but as a father to 
a 21-year-old man with Down syndrome, a young man who has never been 
defined by his disability, but rather, his ability. The use of quality-
adjusted life years is disgusting.
  Mr. Chair, it is disgusting. Using a cost benefit analysis to 
determine if someone deserves healthcare, if their life has value, is 
just plain wrong, Mr. Chair.
  This is the result of socialized healthcare medicine, the future that 
the Democrats want. It is a future where a doctor will turn you away 
because your treatment just doesn't make economic sense.
  This is called rationalized healthcare, Mr. Chair, meaning the 
government will determine if your life is worth living. The bureaucrats 
in Washington, D.C., will determine if the lives of senior citizens in 
northern Minnesota should be saved and healthcare provided to them.
  I thank Chairwoman Rodgers for introducing this bill, which prevents 
the Federal healthcare programs from deciding the future of not only my 
son but all the children in this country that have a disability--from 
deciding if their life is valuable in comparison to others.
  This bill is a beacon of hope for families like mine and the hundreds 
of thousands across this great Nation who are blessed to have children 
living with Down syndrome and other disabilities that enrich our 
communities. It is a promise that we will not stand idly by while our 
most vulnerable citizens are viewed as less than in a broken healthcare 
system.
  The Acting CHAIR (Mr. Perry). The time of the gentleman has expired.
  Mrs. RODGERS of Washington. Mr. Chair, I yield an additional 1 minute 
to the gentleman from Minnesota.
  Mr. STAUBER. Mr. Chair, this bill ensures that individuals with 
disabilities, the elderly, our veterans, and the terminally ill are 
protected from discrimination and have access to affordable, 
comprehensive healthcare.
  Let me tell you something. I am a spouse of an Iraq war veteran, and 
if you look on the Department of Veterans Affairs' site, Mr. Chair, 
they have quality-adjusted life years for our veterans. Since when do 
we determine the life of a veteran who signed up to give his or her 
life for this Nation, Mr. Chair?
  The Democrats want to take it away, quality-adjusted life years. It 
is sad.
  We are fighting for our elderly, the veterans, and our disabled 
community. For the bureaucrats to tell me or tell any of us whether a 
life is worth living or not is unconscionable, and we will not stand 
for it.
  Mr. Chair, I thank the gentlewoman for bringing this bill to the 
floor, and I urge my colleagues to support this legislation.
  Mr. PALLONE. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, the Republicans' decision to offset this bill by 
raiding the Prevention and Public Health Fund underscores the real 
intentions. They are not seeking to improve the lives of those with 
disabilities or end the use of discriminatory measures, but to push 
forward with a partisan bill that will raise prices and cut critical 
funding used to improve public health.
  The Prevention and Public Health Fund was established in the 
Affordable Care Act to provide for expanded and sustained national 
investment in health prevention and restrain the rate of growth in 
healthcare costs. Republicans have consistently sought to undermine, 
slash, and redirect these essential funds for unintended purposes.
  Cutting the Prevention and Public Health Fund decimates our ability 
to effectively prepare for the next pandemic, respond to ongoing public 
health threats, and puts our States and local healthcare partners at a 
disadvantage moving forward.

[[Page H515]]

  Nearly 200 public health organizations sent a letter earlier this 
week expressing strong concerns with the manager's amendment, noting 
how detrimental cuts to the Prevention and Public Health Fund would be.
  It is the height of irony that Republicans claim this bill would 
reduce discrimination for those with disabilities, while also cutting 
Federal investment in programs that improve the lives of those with 
disabilities.
  The American people deserve better.
  Mr. Chairman, I reserve the balance of my time.
  Mrs. RODGERS of Washington. Mr. Chairman, I am prepared to close, and 
I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield myself the balance of my time to 
close.
  Mr. Chairman, I feel very strongly about why we need to oppose this 
bill, and I urge my colleagues to oppose it.
  Democrats, and, hopefully, some Republicans, too, have spent a lot of 
time trying to reduce the cost of prescription drugs--and the States, 
as well. The bottom line is that we know that prescription drugs 
now are, if not the majority, a significant portion of healthcare 
costs.

  If the Federal Government or the State government, or any government, 
is going to continue to provide quality care in this country, we must 
rein in the cost of prescription drugs, not only the cost but also have 
our agencies determine what drugs are effective and what drugs are not. 
We have no problem as Democrats in banning QALYs.
  I have said that over and over again today, and I will keep repeating 
it. The bottom line is the way the language of this bill is 
constructed, it could easily lead to a situation where no Federal, 
State or government agency could effectively look at whether or not a 
drug is effective and what the cost is or make any decisions to pay for 
it based on the actual costs.
  Now, sure, we could live in a world where the government pays 
unlimited amounts of money for everything--and I am sure pharma would 
love that because they like to charge whatever they want to increase 
their profits--but that is not a real situation. If you don't rein in 
the cost of prescription drugs, it not only is going to cost more for 
individuals out of their pocket, but it also means that the government 
can't provide services to people with disabilities or to seniors or to 
veterans.
  That is why the CBO was saying that this bill is going to cost 
another $1.1 billion, at a minimum, and possibly even more in the 
future, if you read what the CBO has actually said.
  Republicans have a pay-for rule, so they say that if it is going to 
cost more, they have to pay for it in some way.
  Well, how do they pay for it?
  They cut the Prevention and Public Health Fund, the very fund that is 
used to prevent worse diseases, worse outbreaks, fund local public 
health programs so they can deal with public health in an effective 
way.
  How is that beneficial to people with disabilities or anyone? It 
certainly isn't.
  That is why there is so much opposition by various public health 
agencies to cutting this prevention fund to pay for this bill.

                              {time}  1015

  There is no justification for this bill. There was an opportunity in 
the Energy and Commerce Committee. I submitted language that would say 
not only would we ban QALYs, but we would ban any kind of 
discriminatory measures being used. The Republicans wouldn't accept 
that. This is what we are left with, a bill that is very dangerous, 
that is just a giveaway to pharma.
  Mr. Chair, I urge my colleagues to oppose what I consider rather 
dangerous legislation, and I yield back the balance of my time.
  Mrs. RODGERS of Washington. Mr. Chair, I yield myself the balance of 
my time.
  We have worked together on important legislation to lower costs, 
provide more transparency, bipartisan legislation from the Committee on 
Energy and Commerce. I am quite disappointed today that my colleagues 
on the other side of the aisle have refused to come to the table on 
this one.
  We just heard that there is no justification for this legislation. 
The ranking member actually said it is dangerous. Let me just point out 
again, nearly 200 advocacy groups, spanning the political spectrum, are 
calling on Congress to prohibit the use of QALYs and other 
discriminatory measures, perhaps because they see the VA's website 
today. Go to the VA's website and you will read, to date, the quality-
adjusted life year, QALY, is the preferred metric for estimating health 
effect.
  We have also heard that this bill is a big giveaway, a blank check, 
to pharma. Republicans agree, we must lower the cost of prescription 
drugs, and we have worked on it. Discriminatory action, discriminatory 
metrics against people with disabilities and chronic illnesses is not 
the way to do it.
  We have heard today that the offset is a partisan pill. Let me just 
highlight that Senator Sanders is using the prevention fund. Senator 
Sanders is proposing right now to use the prevention fund to offset 
increased funding for community health centers. The Senate passed this 
provision 90-6. It is disappointing that now this is an issue of 
offsetting costs of no longer discriminating against those with 
disabilities.
  Yes, we have to offset the cost of no longer discriminating against 
those with disabilities. That is why there is even a CBO score on this 
bill.
  I also note that ``similar measures,'' which seems to be an issue 
today with my colleagues across the aisle, are current law for 
Medicare. We are simply expanding that same language in Medicare to 
other Federal health programs. Why have different standards?
  Mr. Chair, this should be the law of the land. This legislation is 
important. Those with disabilities and the advocacy groups are asking 
for Congress to take action. We have addressed the issues in the 
underlying bill.
  Mr. Chair, I urge support. I hope today that we can come together, 
Republicans and Democrats, as Americans, to protect the healthcare and 
the access to healthcare for every individual with disabilities and 
chronic illnesses. As I mentioned, we are all just one car accident or 
diagnosis away from being that person. Vote ``yes.''
  Mr. Chair, I yield back the balance of my time.
  Ms. McCollum. Mr. Chair, I rise in opposition to H.R. 485, the so-
called Protecting Health Care for All Patients Act.
  The truth is this bill fails to protect health care for all patients. 
Instead, this bill undermines the Affordable Care Act by stripping 
funds from the Prevention and Public Health Fund, our nation's first 
mandatory funding system dedicated to improving our nation's public 
health system and lowering public health care costs. This critical 
funding has helped the Centers for Disease Control reduce the leading 
causes of death and disability nationwide and support early detection 
of and response to public health threats.
  This legislation is a step in the wrong direction. If passed, this 
bill would make it more difficult to improve the affordability of 
prescription drugs. House Republicans claim that this bill will help 
prevent discriminatory policies because it prohibits Medicaid, Medicare 
Advantage (MA) plans, Medicare Part D Plans (PDPs), the VA, and the 
Defense Health Agency from using Quality Adjusted Life Years (QALYs). 
The truth is federal law already prohibits Medicare from using QALYs in 
its coverage determinations, and state Medicare plans are required by 
law to cover all drugs.
  If House Republicans were serious about ensuring all Americans have 
access to affordable, comprehensive health care treatments, they would 
have supported clarifying amendments to this bill that would ban 
discriminatory practices. Instead, we are presented with another bill 
that does not address the problem and does not put the interests of 
patients and taxpayers first.
  The Acting CHAIR. All time for general debate has expired.
  Pursuant to the rule, the bill shall be considered for amendment 
under the 5-minute rule.
  The amendment in the nature of a substitute recommended by the 
Committee on Energy and Commerce, printed in the bill, modified by the 
amendment printed in part A of House Report 118-374, shall be 
considered as adopted. The bill, as amended, shall be considered as the 
original bill for the purpose of further amendment and shall be 
considered as read.

                                H.R. 485

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Protecting Health Care for 
     All Patients Act of 2023''.

[[Page H516]]

  


     SEC. 2. PROHIBITING THE USE OF QUALITY-ADJUSTED LIFE YEARS 
                   AND SIMILAR MEASURES IN COVERAGE AND PAYMENT 
                   DETERMINATIONS UNDER FEDERAL HEALTH CARE 
                   PROGRAMS.

       (a) In General.--Section 1182(e) of the Social Security Act 
     (42 U.S.C. 1320e-1(e)) is amended--
       (1) by inserting ``or treats extending the life of an 
     elderly, disabled, or terminally ill individual as of lower 
     value than extending the life of an individual who is 
     younger, non-disabled, or not terminally ill'' after 
     ``because of an individual's disability'';
       (2) by inserting ``described in the preceding sentence'' 
     after ``such a similar measure'';
       (3) by striking ``The Secretary shall not'' and inserting 
     ``A Federal agency (including the CMI (as described in 
     section 1115A)) or State may not'';
       (4) by striking ``under title XVIII.'' and inserting the 
     following: ``under any Federal health care program (as 
     defined in section 1128B, except that such term shall include 
     the health program established under chapter 89 of title 5, 
     United States Code).''; and
       (5) by adding at the end the following new sentence: 
     ``Notwithstanding any other provision of law, a Federal 
     agency (including the CMI) or State may not waive the 
     application of the provisions of this subsection (or the 
     provisions of section 1852(o), section 1860D-12(h), section 
     1902(a)(88), section 1932(b)(9), or section 2102(e)) under 
     section 1115, section 1115A, or any other demonstration or 
     waiver authority.''.
       (b) Conforming Amendments.--
       (1) Medicaid.--
       (A) In general.--Section 1902(a) of the Social Security Act 
     (42 U.S.C. 1396a(a)) is amended--
       (i) in paragraph (86), by striking ``and'' at the end;
       (ii) in paragraph (87)(D), by striking the period and 
     inserting ``; and''; and
       (iii) by inserting after paragraph (87) the following new 
     paragraph:
       ``(88) provide for compliance with the requirements of 
     section 1182(e) (relating to prohibiting the use of certain 
     measures in coverage determinations, reimbursement, and 
     incentive programs).''.
       (B) Managed care organizations.--Section 1932(b) of the 
     Social Security Act (42 U.S.C. 1396u-2(b)) is amended by 
     adding at the end the following new paragraph:
       ``(9) Prohibition on use of quality-adjusted life years.--
     The provisions of section 1182(e) shall apply to the 
     utilization of a dollars-per-quality adjusted life year or 
     similar measure (as described in such section) by a medicaid 
     managed care organization under this title (or a prepaid 
     inpatient health plan or prepaid ambulatory health plan, as 
     defined in section 438.2 of title 42, Code of Federal 
     Regulations (or any successor regulation), under a contract 
     with the State) in the same manner as such provisions apply 
     to the utilization of such a year or measure by a State under 
     this title.''.
       (2) CHIP.--Section 2102 of the Social Security Act (42 
     U.S.C. 1397bb) is amended by adding at the end the following 
     new subsection:
       ``(e) Prohibition on the Use of Quality-Adjusted Life Years 
     and Similar Measures.--A State child health plan shall 
     provide for compliance with the requirements of section 
     1182(e) (relating to prohibiting the use of certain measures 
     in coverage determinations, reimbursement, and incentive 
     programs).''.
       (3) Medicare advantage.--Section 1852 of the Social 
     Security Act (42 U.S.C. 1395w-22) is amended by adding at the 
     end the following new subsection:
       ``(o) Prohibition on Use of Quality-adjusted Life Years.--
     The provisions of section 1182(e) shall apply to the 
     utilization of a dollars-per-quality adjusted life year or 
     similar measure (as described in such section) by an MA plan 
     in the same manner as such provisions apply to the 
     utilization of such a year or measure by the Secretary under 
     this title.''.
       (4) Medicare part d.--Section 1860D-12 of the Social 
     Security Act (42 U.S.C. 1395w-112) is amended by adding at 
     the end the following new subsection:
       ``(h) Prohibition on Use of Quality-adjusted Life Years.--
     The provisions of section 1182(e) shall apply to the 
     utilization of a dollars-per-quality adjusted life year or 
     similar measure (as described in such section) by a 
     prescription drug plan in the same manner as such provisions 
     apply to the utilization of such a year or measure by the 
     Secretary under this title.''.
       (c) Implementation.--The amendments made by this section 
     shall apply beginning on January 1, 2025.

     SEC. 3. PREVENTION AND PUBLIC HEALTH FUND.

       Section 4002(b) of the Patient Protection and Affordable 
     Care Act (42 U.S.C. 300u-11) is amended by striking 
     paragraphs (7), (8), and (9) and inserting the following:
       ``(7) for each of fiscal years 2024 and 2025, 
     $1,102,000,000;
       ``(8) for each of fiscal years 2026 and 2027, 
     $1,327,000,000;
       ``(9) for each of fiscal years 2028 and 2029, 
     $1,526,000,000; and''.

  The Acting CHAIR. No further amendment to the bill, as amended, shall 
be in order except those printed in part B of House Report 118-374. 
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.


                Amendment No. 1 Offered by Mr. Molinaro

  The Acting CHAIR. It is now in order to consider amendment No. 1 
printed in part B of House Report 118-374.
  Mr. MOLINARO. Mr. Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Add at the end the following new section:

     SEC. 3. REPORT.

       Not later than 1 year after the date of the enactment of 
     this Act, and annually thereafter, the Comptroller General of 
     the United States shall submit to Congress a report on how 
     quality-adjusted life years negatively impacts individuals 
     with intellectual and developmental disabilities and their 
     access to care.

  The Acting CHAIR. Pursuant to House Resolution 996, the gentleman 
from New York (Mr. Molinaro) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from New York.
  Mr. MOLINARO. Mr. Chair, I begin first by expressing my support for 
the Protecting Health Care for All Patients Act and my appreciation to 
the leadership of Chairwoman McMorris Rodgers.
  This bill seeks to address a longstanding concern for the disability 
community, a community that I have spent the better part of the last 20 
years working in and among. It bans the use of quality-adjusted life 
years, QALYs, measures from being used in Federal healthcare programs.
  As we know, QALY measures have devalued the lives of disabled and 
chronically ill patients when it comes to deciding if a certain 
treatment is cost effective, putting a dollar sign on their lives and 
barriers to accessing proper treatment.
  You heard a moment ago my colleague across the aisle refer to the 
bill in chief as dangerous. As the parent of a child living with 
epilepsy and on the autism spectrum, I can tell you what is dangerous 
is the way in which the healthcare system too often treats children and 
adults like her. It is neither progressive nor compassionate to put a 
dollar sign on the lives of those who need such life-affirming care.
  The use of QALYs has put those with chronic illnesses and 
disabilities, like epilepsy, ALS, and Down syndrome, at the back of the 
line for treatment, too often denying them access and creating barriers 
to the support they need. It undermines our commitment to life-
affirming care for our most vulnerable. No matter how it is expressed, 
no matter how it is denied, this practice devalues the lives of 
American citizens and loved ones like my own child.
  My amendment seeks to provide additional oversight into the negative 
impact QALYs have on those with intellectual, developmental, and 
physical disabilities.
  The amendment is simple. It directs the Comptroller General to submit 
a report to Congress to thoroughly assess the damage QALYs have on our 
IDD community and how this measure adversely affects their access to 
lifesaving treatments and medical care. It is simple and meant to 
provide additional oversight.
  As noted, as the father of four children, one who lives on the autism 
spectrum with a seizure disorder, and a staunch advocate for our 
disability community, I again applaud Chairwoman McMorris Rodgers' work 
on crafting the Protecting Health Care for All Patients Act to ensure 
our most vulnerable populations have access to the medical treatments 
and services to manage their conditions and lead longer, healthier, and 
freer lives.
  Mr. Chair, I urge my colleagues to adopt this amendment, and I 
reserve the balance of my time.
  Mr. PALLONE. Mr. Chair, I claim the time in opposition to the 
amendment.
  The Acting CHAIR. The gentleman from New Jersey is recognized for 5 
minutes.
  Mr. PALLONE. Mr. Chair, I appreciate and respect the views of the 
disability community and their strongly held belief that the use of 
QALYs in Federal health programs is discriminatory. That is why I do 
not oppose this amendment.
  However, the amendment does not cure the problem with the underlying 
bill. This bill is a Trojan horse that purports to ban discriminatory 
measures like QALYs but in reality does a

[[Page H517]]

lot more. This bill has the potential to ban a broad swath of cost 
containment measures that are not discriminatory and could harm the 
very communities that this bill is purported to help.
  Those with disabilities need access to lower drug prices and 
healthcare services, and the Federal Government's and States' ability 
to use nondiscriminatory health measures is essential to bringing down 
costs. Otherwise, without leverage to get a better deal, we are stuck 
paying whatever pharma wants. The CBO agrees. That is why they estimate 
this bill will increase Federal spending by over a billion dollars in 
the next 10 years and potentially tens of billions of dollars more in 
the years ahead.
  For this reason, I do not oppose the amendment, but, unfortunately, 
it does not resolve my concerns with the underlying bill.
  Mr. Chair, I reserve the balance of my time.
  Mr. MOLINARO. Mr. Chair, I appreciate my colleague's support of the 
amendment. I will close with addressing the ``yes, but'' argument.
  Those who live with intellectual, physical, and developmental 
disabilities and those who love them are quite familiar with the ``yes, 
but'' argument. Yes, we care about you, but others face struggles, too. 
Yes, we want you to have access, but others may have obstacles, too. 
Yes, we care about your lives, but we care about others more.
  That is the basis of the argument against this bill, ``yes, but.'' My 
daughter has heard it every day of her life. I have experienced it 
every day. Yes, we hope to educate her, but we don't have time for it. 
Yes, we want to give you access to vaccines and care, but you are not 
our priority. Yes, during COVID we wanted to ensure every life was 
protected, but we didn't have the time to work it out for you.
  This bill is not perfect. The chairwoman doesn't expect it to be, nor 
do I. QALYs devalue the lives of Americans who have far too many 
obstacles in their place.
  My argument in response to the argument against this bill is ``yes, 
but.'' Yes, kids like mine deserve access to quality care; yes, those 
with disabilities deserve to have life-affirming services; and, yes, 
those with disabilities face far too many obstacles to living and 
pursuing a life of happiness; but we can take this one step.
  Mr. Chair, I urge my colleagues to support this amendment, and I 
yield back the balance of my time.
  Mr. PALLONE. Mr. Chair, I yield the balance of my time to the 
gentlewoman from Texas (Ms. Jackson Lee).
  Ms. JACKSON LEE. Mr. Chair, I thank the distinguished gentleman for 
yielding.
  We want to rise and help all of the families, particularly those 
families who every day are dealing with children and family members 
with disabilities.

  This is an instance where I say can we all get together and can we 
try to find a resolution toward making sure that we have good 
healthcare for these families and for these persons?
  What I would offer is that presently this legislation undermines the 
Affordable Care Act by stripping dollars from the Prevention and Public 
Health Fund and undermining its critical investments in health and 
well-being. It makes it very difficult to help those who need help. It 
would stop funding from the Prevention and Public Health Fund, which 
supports critical investments to help prevent disease.
  At the same time, this legislation opens the possibility of limiting 
the use of any value metrics when determining a drug price.
  Furthermore, the Congressional Budget Office determined that this 
bill would raise drug costs for Medicare, Medicaid, and the Department 
of Defense. The CBO also estimates that this legislation would increase 
costs for Veterans Affairs health programs, raising Federal spending on 
prescription drugs by $1.115 billion over 10 years and billions more in 
the following decades.
  Americans are looking for answers, and they are looking for answers 
for all persons who need healthcare. To pay for these increased costs, 
there are plans to cut from the Prevention and Public Health Fund and 
cutting programs to improve public health and to prevent chronic 
diseases such as childhood lead poisoning and improving immunization 
rates.
  Democrats in Congress, along with the Biden-Harris administration, 
are working to ensure all Americans have access to affordable care and 
effective healthcare treatments. This bill claims to protect people 
from discrimination. It would, in fact, result in harm to patients if 
enacted into law.

                              {time}  1030

  I believe that people with disabilities deserve equality, inclusion, 
and access to all aspects of American life.
  Instead of prioritizing legislation that could lower prices for them, 
access value, and improve health, Republicans are attempting to pass 
legislation that undermines the work that we have done over a 10-year 
period to really include the disabled community.
  If this bill is enacted, then the language referring to similar 
measures in the current version of the bill would introduce ambiguity 
across the health sector. It could invite lengthy lawsuits from an 
industry eager to stop any efforts to constrain its ability to set 
prices as high as it wants.
  I simply want to say, as I started, can we all work together?
  All aspects of our community need access to good healthcare--
certainly, our disabled community--and this does more to undermine 
their access than to expand their access.
  Mr. Chair, I ask my colleagues to send this back to the committee so 
that we can find common ground and really serve the disabled community 
and many others and not allow those who seek profit to overcome those 
who seek good healthcare, including our seniors, our veterans, and many 
aspects of our community that have chronic diseases.
  Mr. Chair, I rise today to discuss the issue concerning H.R. 485, the 
Protecting Health Care for All Patients Act.
  The Protecting Health Care for All Patients Act of 2023 does not 
protect health care for patients, but rather undermines our progress in 
lowering prescription drug costs for American families.
  This bill claims to prevent the federal government from using a 
measure called the Quality Adjusted Life Year (QALY).
  This is a red herring, as the Inflation Reduction Act already 
explicitly prohibits the use of QALYs.
  The legislation goes further by banning the use of the QALY ``or such 
a similar measure,'' across all federal health care programs, without 
defining what such a similar measure could include.
  A long-standing criticism of QALY has been that it would:
  Discriminate against people in poor health.
  Extending the lives of individuals with underlying health conditions 
gains fewer QALYs than extending the lives of `healthier' individuals.
  This blanket prohibition on the use of ``similar measures'' applied 
across the federal government.
  This legislation opens the possibility of limiting the use of any 
value metrics when determining a drug's price.
  Furthermore, the Congressional Budget Office determined that this 
bill would raise drug costs in Medicare, Medicaid, the Department of 
Defense (DoD).
  CBO also estimates that this legislation would increase costs for 
Veterans Affairs health programs, raising federal spending on 
prescription drugs by $1.115 billion over 10 years and billions more in 
the proceeding decades.
  Americans are looking for Congress to lower drug prices further, not 
increase them.
  To pay for these increased costs, there are plans to cut from the 
Prevention and Public Health Fund and cutting programs to improve 
public health and prevent chronic diseases, such as childhood lead 
poisoning, and improving immunization rates.
  Democrats in Congress along with the Biden Harris Administration are 
working to ensure all Americans have access to affordable and effective 
health care treatments.
  This bill claims to protect people from discrimination but would in 
fact result in harm to patients if enacted into law.
  I believe that people with disabilities deserve equality, inclusion, 
and access in all aspects of American life.
  Instead of prioritizing legislation that could lower prices, assess 
value, and improve health Republicans are attempting to pass 
legislation that undermines the work of Congress and the Biden 
Administration.
  If this bill is enacted the language referring to ``similar 
measures'' in the current version of the bill would introduce ambiguity 
across the health sector.
  It could invite lengthy lawsuits from an industry eager to stop any 
efforts to constrain its ability to set prices as high as it wants for 
any drug--regardless of the drug's value.

[[Page H518]]

  In closing, it is imperative that health care be made affordable for 
those with disabilities.
  Disabled patients in this country deserve a reliable health care 
system.
  We need to consider real legislation that will address prescription 
drug pricing at its core.
  Mr. PALLONE. Mr. Chair, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from New York (Mr. Molinaro).
  The amendment was agreed to.
  The Acting CHAIR. It is now in order to consider amendment No. 2 
printed in part B of House Report 118-374.
  There being no further amendments under the rule, the Committee 
rises.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Mast) having assumed the chair, Mr. Perry, Acting Chair of the 
Committee of the Whole House on the state of the Union, reported that 
that Committee, having had under consideration the bill (H.R. 485) to 
amend title XI of the Social Security Act to prohibit the use of 
quality-adjusted life years and similar measures in coverage and 
payment determinations under Federal health care programs, and, 
pursuant to House Resolution 996, he reported the bill, as amended by 
that resolution, back to the House with a further amendment adopted in 
the Committee of the Whole.
  The SPEAKER pro tempore. Under the rule, the previous question is 
ordered.
  The question is on the amendment.
  The amendment was agreed to.
  The SPEAKER pro tempore. The question is on the engrossment and third 
reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.


                           Motion to Recommit

  Mrs. FLETCHER. Mr. Speaker, I have a motion to recommit at the desk.
  The SPEAKER pro tempore. The Clerk will report the motion to 
recommit.
  The Clerk read as follows:

       Mrs. Fletcher moves to recommit the bill H.R. 485 to the 
     Committee on Energy and Commerce.

  The SPEAKER pro tempore. Pursuant to clause 2(b) of rule XIX, the 
previous question is ordered on the motion to recommit.
  The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Mrs. FLETCHER. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 9 of rule XX, this 15-
minute vote on the motion to recommit will be followed by a 5-minute 
vote on passage of the bill, if ordered.
  The vote was taken by electronic device, and there were--yeas 207, 
nays 210, not voting 14, as follows:

                             [Roll No. 39]

                               YEAS--207

     Adams
     Aguilar
     Allred
     Amo
     Auchincloss
     Balint
     Barragan
     Beatty
     Bera
     Beyer
     Bishop (GA)
     Blumenauer
     Blunt Rochester
     Bonamici
     Bowman
     Boyle (PA)
     Brown
     Brownley
     Budzinski
     Bush
     Caraveo
     Carbajal
     Cardenas
     Carson
     Carter (LA)
     Cartwright
     Casar
     Case
     Casten
     Castor (FL)
     Castro (TX)
     Cherfilus-McCormick
     Chu
     Clark (MA)
     Clarke (NY)
     Cleaver
     Clyburn
     Cohen
     Connolly
     Correa
     Costa
     Courtney
     Craig
     Crow
     Cuellar
     Davids (KS)
     Davis (IL)
     Davis (NC)
     Dean (PA)
     DeGette
     DeLauro
     DelBene
     Deluzio
     DeSaulnier
     Dingell
     Doggett
     Escobar
     Eshoo
     Espaillat
     Evans
     Fletcher
     Foster
     Foushee
     Frankel, Lois
     Frost
     Gallego
     Garamendi
     Garcia (IL)
     Garcia (TX)
     Garcia, Robert
     Golden (ME)
     Goldman (NY)
     Gomez
     Gonzalez, Vicente
     Gottheimer
     Grijalva
     Harder (CA)
     Hayes
     Himes
     Horsford
     Houlahan
     Hoyer
     Hoyle (OR)
     Huffman
     Ivey
     Jackson (IL)
     Jackson (NC)
     Jackson Lee
     Jacobs
     Jayapal
     Jeffries
     Johnson (GA)
     Kamlager-Dove
     Kaptur
     Keating
     Kelly (IL)
     Khanna
     Kildee
     Kilmer
     Kim (NJ)
     Krishnamoorthi
     Kuster
     Landsman
     Larsen (WA)
     Lee (CA)
     Lee (NV)
     Lee (PA)
     Leger Fernandez
     Levin
     Lieu
     Lofgren
     Lynch
     Magaziner
     Manning
     Matsui
     McBath
     McClellan
     McCollum
     McGarvey
     McGovern
     Meeks
     Menendez
     Meng
     Mfume
     Moore (WI)
     Morelle
     Moskowitz
     Moulton
     Mrvan
     Mullin
     Nadler
     Napolitano
     Neal
     Neguse
     Nickel
     Norcross
     Ocasio-Cortez
     Omar
     Pallone
     Panetta
     Pappas
     Pascrell
     Payne
     Peltola
     Perez
     Peters
     Pettersen
     Pingree
     Pocan
     Porter
     Pressley
     Quigley
     Ramirez
     Raskin
     Ross
     Ruiz
     Ruppersberger
     Ryan
     Salinas
     Sanchez
     Sarbanes
     Scanlon
     Schakowsky
     Schiff
     Schneider
     Scholten
     Schrier
     Scott (VA)
     Scott, David
     Sewell
     Sherman
     Sherrill
     Slotkin
     Smith (WA)
     Sorensen
     Soto
     Spanberger
     Stansbury
     Stanton
     Stevens
     Strickland
     Swalwell
     Sykes
     Takano
     Thanedar
     Thompson (CA)
     Thompson (MS)
     Titus
     Tlaib
     Tokuda
     Tonko
     Torres (CA)
     Torres (NY)
     Trahan
     Trone
     Underwood
     Vargas
     Vasquez
     Veasey
     Velazquez
     Wasserman Schultz
     Waters
     Watson Coleman
     Wexton
     Wild
     Williams (GA)
     Wilson (FL)

                               NAYS--210

     Aderholt
     Alford
     Allen
     Amodei
     Armstrong
     Arrington
     Babin
     Bacon
     Baird
     Balderson
     Banks
     Barr
     Bean (FL)
     Bentz
     Bergman
     Bice
     Bilirakis
     Bishop (NC)
     Boebert
     Bost
     Brecheen
     Buchanan
     Buck
     Bucshon
     Burchett
     Burgess
     Burlison
     Calvert
     Cammack
     Carey
     Carl
     Carter (GA)
     Chavez-DeRemer
     Ciscomani
     Cline
     Cloud
     Clyde
     Cole
     Collins
     Comer
     Crawford
     Crenshaw
     Curtis
     D'Esposito
     Davidson
     De La Cruz
     DesJarlais
     Diaz-Balart
     Donalds
     Duarte
     Duncan
     Dunn (FL)
     Edwards
     Ellzey
     Emmer
     Estes
     Ezell
     Fallon
     Feenstra
     Ferguson
     Finstad
     Fischbach
     Fitzgerald
     Fitzpatrick
     Fleischmann
     Flood
     Foxx
     Franklin, Scott
     Fry
     Fulcher
     Gaetz
     Gallagher
     Garbarino
     Garcia, Mike
     Gimenez
     Gonzales, Tony
     Gooden (TX)
     Gosar
     Granger
     Graves (LA)
     Graves (MO)
     Green (TN)
     Greene (GA)
     Griffith
     Grothman
     Guest
     Guthrie
     Hageman
     Harris
     Harshbarger
     Hern
     Higgins (LA)
     Hill
     Hinson
     Houchin
     Hudson
     Huizenga
     Hunt
     Issa
     Jackson (TX)
     James
     Johnson (LA)
     Johnson (SD)
     Jordan
     Joyce (OH)
     Joyce (PA)
     Kean (NJ)
     Kelly (MS)
     Kelly (PA)
     Kiggans (VA)
     Kiley
     Kim (CA)
     Kustoff
     LaHood
     LaLota
     LaMalfa
     Lamborn
     Larson (CT)
     Latta
     LaTurner
     Lawler
     Lee (FL)
     Lesko
     Letlow
     Loudermilk
     Lucas
     Luetkemeyer
     Luttrell
     Mace
     Malliotakis
     Maloy
     Mann
     Massie
     Mast
     McCaul
     McClain
     McClintock
     McCormick
     McHenry
     Meuser
     Miller (IL)
     Miller (OH)
     Miller (WV)
     Miller-Meeks
     Mills
     Molinaro
     Moolenaar
     Moore (AL)
     Moore (UT)
     Moran
     Murphy
     Nehls
     Newhouse
     Nunn (IA)
     Obernolte
     Ogles
     Owens
     Palmer
     Pence
     Pfluger
     Posey
     Reschenthaler
     Rodgers (WA)
     Rogers (AL)
     Rogers (KY)
     Rose
     Rosendale
     Rouzer
     Roy
     Rutherford
     Salazar
     Schweikert
     Scott, Austin
     Self
     Sessions
     Simpson
     Smith (MO)
     Smith (NE)
     Smith (NJ)
     Smucker
     Spartz
     Stauber
     Steel
     Stefanik
     Steil
     Steube
     Strong
     Tenney
     Thompson (PA)
     Tiffany
     Timmons
     Turner
     Valadao
     Van Drew
     Van Duyne
     Van Orden
     Wagner
     Walberg
     Waltz
     Weber (TX)
     Webster (FL)
     Wenstrup
     Westerman
     Williams (NY)
     Williams (TX)
     Wilson (SC)
     Wittman
     Womack
     Yakym
     Zinke

                             NOT VOTING--14

     Biggs
     Carter (TX)
     Crane
     Crockett
     Good (VA)
     Green, Al (TX)
     Langworthy
     Luna
     Mooney
     Norman
     Pelosi
     Perry
     Phillips
     Scalise

                              {time}  1106

  Messrs. RESCHENTHALER, GREEN of Tennessee, LAMBORN, Mrs. HARSHBARGER, 
Messrs. BURGESS, CARTER of Georgia, THOMPSON of Pennsylvania, ROGERS of 
Alabama, Mrs. KIGGANS of Virginia, Mr. BACON, Mmes. HOUCHIN and CAMMACK 
changed their vote from ``yea'' to ``nay.''
  Ms. McCLELLAN, Mr. EVANS, Mses. BARRAGAN, STANSBURY, Mr. CARTER of 
Louisiana, Mses. McCOLLUM, STEVENS, Messrs. MRVAN, MULLIN, and 
MOSKOWITZ changed their vote from ``nay'' to ``yea.''
  Ms. GRANGER changed her vote from ``present'' to ``nay.''
  So the motion to recommit was rejected.
  The result of the vote was announced as above recorded.
  Stated against:
  Mr. PERRY. Mr. Speaker, I was unavoidably detained. Had I been 
present, I would have voted ``nay'' on rollcall No. 39.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.


                             Recorded Vote

  Mr. PALLONE. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The SPEAKER pro tempore. This is a 5-minute vote.

[[Page H519]]

  The vote was taken by electronic device, and there were--ayes 211, 
noes 208, not voting 11, as follows:

                             [Roll No. 40]

                               AYES--211

     Aderholt
     Alford
     Allen
     Amodei
     Armstrong
     Arrington
     Babin
     Bacon
     Baird
     Balderson
     Banks
     Barr
     Bean (FL)
     Bentz
     Bergman
     Bice
     Biggs
     Bilirakis
     Bishop (NC)
     Boebert
     Bost
     Brecheen
     Buchanan
     Buck
     Bucshon
     Burchett
     Burgess
     Burlison
     Calvert
     Cammack
     Carey
     Carl
     Carter (GA)
     Chavez-DeRemer
     Ciscomani
     Cline
     Cloud
     Clyde
     Cole
     Collins
     Comer
     Crane
     Crawford
     Crenshaw
     Curtis
     D'Esposito
     Davidson
     De La Cruz
     DesJarlais
     Diaz-Balart
     Donalds
     Duarte
     Duncan
     Dunn (FL)
     Edwards
     Ellzey
     Emmer
     Estes
     Ezell
     Fallon
     Feenstra
     Ferguson
     Finstad
     Fischbach
     Fitzgerald
     Fitzpatrick
     Fleischmann
     Flood
     Foxx
     Franklin, Scott
     Fry
     Fulcher
     Gaetz
     Gallagher
     Garbarino
     Garcia, Mike
     Gimenez
     Gonzales, Tony
     Good (VA)
     Gooden (TX)
     Gosar
     Granger
     Graves (LA)
     Graves (MO)
     Green (TN)
     Greene (GA)
     Griffith
     Grothman
     Guest
     Guthrie
     Hageman
     Harshbarger
     Hern
     Higgins (LA)
     Hill
     Hinson
     Houchin
     Hudson
     Huizenga
     Hunt
     Issa
     Jackson (TX)
     James
     Johnson (SD)
     Jordan
     Joyce (OH)
     Joyce (PA)
     Kean (NJ)
     Kelly (MS)
     Kelly (PA)
     Kiggans (VA)
     Kiley
     Kustoff
     LaHood
     LaLota
     LaMalfa
     Lamborn
     Latta
     LaTurner
     Lawler
     Lee (FL)
     Lesko
     Letlow
     Loudermilk
     Lucas
     Luetkemeyer
     Luttrell
     Mace
     Malliotakis
     Maloy
     Mann
     Massie
     Mast
     McCaul
     McClain
     McClintock
     McCormick
     McHenry
     Meuser
     Miller (IL)
     Miller (OH)
     Miller (WV)
     Miller-Meeks
     Mills
     Molinaro
     Moolenaar
     Moore (AL)
     Moore (UT)
     Moran
     Murphy
     Nehls
     Newhouse
     Norman
     Nunn (IA)
     Obernolte
     Ogles
     Owens
     Palmer
     Pence
     Perry
     Pfluger
     Posey
     Reschenthaler
     Rodgers (WA)
     Rogers (AL)
     Rogers (KY)
     Rose
     Rosendale
     Rouzer
     Roy
     Rutherford
     Salazar
     Schweikert
     Scott, Austin
     Self
     Sessions
     Simpson
     Smith (MO)
     Smith (NE)
     Smith (NJ)
     Smucker
     Spartz
     Stauber
     Steel
     Stefanik
     Steil
     Steube
     Strong
     Tenney
     Thompson (PA)
     Tiffany
     Timmons
     Turner
     Valadao
     Van Drew
     Van Duyne
     Van Orden
     Wagner
     Walberg
     Waltz
     Weber (TX)
     Webster (FL)
     Wenstrup
     Westerman
     Williams (NY)
     Williams (TX)
     Wilson (SC)
     Wittman
     Womack
     Yakym
     Zinke

                               NOES--208

     Adams
     Aguilar
     Allred
     Amo
     Auchincloss
     Balint
     Barragan
     Beatty
     Bera
     Beyer
     Bishop (GA)
     Blumenauer
     Blunt Rochester
     Bonamici
     Bowman
     Boyle (PA)
     Brown
     Brownley
     Budzinski
     Bush
     Caraveo
     Carbajal
     Cardenas
     Carson
     Carter (LA)
     Cartwright
     Casar
     Case
     Casten
     Castor (FL)
     Castro (TX)
     Cherfilus-McCormick
     Chu
     Clark (MA)
     Clarke (NY)
     Cleaver
     Clyburn
     Cohen
     Connolly
     Correa
     Costa
     Courtney
     Craig
     Crockett
     Crow
     Cuellar
     Davids (KS)
     Davis (IL)
     Davis (NC)
     Dean (PA)
     DeGette
     DeLauro
     DelBene
     Deluzio
     DeSaulnier
     Dingell
     Doggett
     Escobar
     Eshoo
     Espaillat
     Evans
     Fletcher
     Foster
     Foushee
     Frankel, Lois
     Frost
     Gallego
     Garamendi
     Garcia (IL)
     Garcia (TX)
     Garcia, Robert
     Golden (ME)
     Goldman (NY)
     Gomez
     Gonzalez, Vicente
     Gottheimer
     Grijalva
     Harder (CA)
     Hayes
     Himes
     Horsford
     Houlahan
     Hoyer
     Hoyle (OR)
     Huffman
     Ivey
     Jackson (IL)
     Jackson (NC)
     Jackson Lee
     Jacobs
     Jayapal
     Jeffries
     Johnson (GA)
     Kamlager-Dove
     Kaptur
     Keating
     Kelly (IL)
     Khanna
     Kildee
     Kilmer
     Krishnamoorthi
     Kuster
     Landsman
     Larsen (WA)
     Lee (CA)
     Lee (NV)
     Lee (PA)
     Leger Fernandez
     Levin
     Lieu
     Lofgren
     Lynch
     Magaziner
     Manning
     Matsui
     McBath
     McClellan
     McCollum
     McGarvey
     McGovern
     Meeks
     Menendez
     Meng
     Mfume
     Moore (WI)
     Morelle
     Moskowitz
     Moulton
     Mrvan
     Mullin
     Nadler
     Napolitano
     Neal
     Neguse
     Nickel
     Norcross
     Ocasio-Cortez
     Omar
     Pallone
     Panetta
     Pappas
     Pascrell
     Payne
     Pelosi
     Peltola
     Perez
     Peters
     Pettersen
     Pingree
     Pocan
     Porter
     Pressley
     Quigley
     Ramirez
     Raskin
     Ross
     Ruiz
     Ruppersberger
     Ryan
     Salinas
     Sanchez
     Sarbanes
     Scanlon
     Schakowsky
     Schiff
     Schneider
     Scholten
     Schrier
     Scott (VA)
     Scott, David
     Sewell
     Sherman
     Sherrill
     Slotkin
     Smith (WA)
     Sorensen
     Soto
     Spanberger
     Stansbury
     Stanton
     Stevens
     Strickland
     Swalwell
     Sykes
     Takano
     Thanedar
     Thompson (CA)
     Thompson (MS)
     Titus
     Tlaib
     Tokuda
     Tonko
     Torres (CA)
     Torres (NY)
     Trahan
     Trone
     Underwood
     Vargas
     Vasquez
     Veasey
     Velazquez
     Wasserman Schultz
     Waters
     Watson Coleman
     Wexton
     Wild
     Williams (GA)
     Wilson (FL)

                             NOT VOTING--11

     Carter (TX)
     Green, Al (TX)
     Harris
     Kim (CA)
     Kim (NJ)
     Langworthy
     Larson (CT)
     Luna
     Mooney
     Phillips
     Scalise

                              {time}  1113

  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.
  Stated for:
  Mrs. KIM of California. Mr. Speaker, had I been present, I would have 
voted ``aye'' on rollcall No. 40.


                          PERSONAL EXPLANATION

  Mr. LANGWORTHY. Mr. Speaker, due to a family emergency, I was unable 
to be present for votes today. Had I been present, I would have voted 
``no'' on rollcall No. 39 and ``aye'' on rollcall No. 40.


                          PERSONAL EXPLANATION

  Mr. LARSON of Connecticut. Mr. Speaker, I mistakenly voted ``nay'' on 
Motion to Recommit H.R. 485, rollcall Vote 39. I intended to vote 
``yea.'' Additionally, I regrettably missed recording my vote On 
Passage of H.R. 485, rollcall Vote 40. Had I recorded my vote, I would 
have voted ``no.''

                          ____________________