[Congressional Record (Bound Edition), Volume 154 (2008), Part 10]
[House]
[Pages 13454-13468]
[From the U.S. Government Publishing Office, www.gpo.gov]




MEDICARE IMPROVEMENTS FOR PATIENTS AND PROVIDERS ACT OF 2008--Continued

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Pallone) and the gentleman from Texas (Mr. Barton) each 
will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days to revise and extend their remarks and 
include extraneous material on the bill under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Mr. Speaker, I ask unanimous consent that the gentleman 
from New York (Mr. Rangel) be permitted to control 10 minutes of my 
time.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  I rise in strong support of H.R. 6331, the Medicare Improvements for 
Patients and Providers Act of 2008, and I urge my colleagues on both 
sides of the aisle to offer their support for this bill.
  H.R. 6331 would make a number of improvements that are important to 
protecting the health and well-being of our seniors. The legislation 
also addresses the reimbursement concerns of doctors who treat Medicare 
patients. It also completely is paid for by implementing sensible 
reforms to the Medicare Advantage program that is supported by almost 
every expert body, including MedPAC and GAO.
  Mr. Speaker, while I still believe that the CHAMP Act, which the 
House passed last year, was the best way to address Medicare's future, 
the bill before us today is a reasonable compromise that both Democrats 
and Republicans should support. In the end this legislation would allow 
us to take the steps necessary to keep Medicare working for America's 
seniors, doctors, and taxpayers. And with less than a week to go before 
the impending physician cuts go into effect, it is time to put politics 
aside and pass this commonsense policy.
  Mr. Speaker, I reserve the balance of my time, and I ask unanimous 
consent that the gentleman from Georgia (Mr. Barrow) be permitted to 
control the balance of my time.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. BARTON of Texas. Mr. Speaker, I would ask unanimous consent that 
the gentleman from Michigan (Mr. Camp) be allowed to control 10 minutes 
for debate purposes of the time that I control.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. BARTON of Texas. Mr. Speaker, I yield myself 2 minutes.
  Mr. Speaker, I rise today in opposition to H.R. 6331, the Medicare 
bill that is put before this Congress today on a suspension vote.
  Somehow I missed it, but I didn't see the notice of the legislative 
hearing in the Energy and Commerce Committee hearing on this. I didn't 
see the notice

[[Page 13455]]

of the subcommittee markup on this bill. I didn't see the full 
committee notice to have a markup. I didn't get any notice of the 
technical corrections of the bill, which we received at 10 minutes 
until 10 a.m. this morning.
  The majority seems to be under the mistaken impression that the less 
input and the less Republicans know about major bills, the more likely 
we are to vote for them. Well, I have a news flash. When we were not a 
part of the process, when we don't have any input into the policy, 
there is over a 95 to 100 percent we are going to be ``noes'' 
regardless of the substance of the bill.
  On this particular bill, had we had some input, we would have 
strongly opposed the cuts to Medicare Advantage. A large number of us 
would have opposed the delay in the durable medical equipment 
competitive bidding that's supposed to go into effect on July 1 and, 
under the current bill, is also delayed for 18 months. There is 
obviously a need to fix the current physician reimbursement system. We 
have been in session now in this Congress almost 18 months, perhaps 
longer. You would think that in that time period, there could have been 
some legislative hearings. There could have been some draft proposals 
floated. There could have been some markups and some discussion and 
some give and take, and we could have found a compromise that would 
pass on the suspension calendar. But that has not been the case, as it 
was not the case on the CHAMP Act that my good friend from New Jersey 
just referred to.
  So, Mr. Speaker, on this particular piece of legislation for this 
morning, I would strongly urge a ``no'' vote and ask all Members of 
this body that believe in regular process and give and take in policy 
reform to vote ``no,'' and then sometime when we come back after the 
July 4th work period, perhaps we can work together to do what needs to 
be done.
  Mr. Speaker, I rise today to oppose H.R. 6331, the Medicare bill put 
before this Congress today on a suspension vote. While I a agree that 
we should do something to address the Medicare physician payment cut 
that will take affect in just a few days, I do not support cutting 
Medicare Advantage to pay for this short-term fix.
  This legislation cuts close to $50 billion from Medicare Advantage, a 
program that benefits seniors in every State and a program in which our 
seniors are deeply satisfied. I believe people benefit when they have 
the kind of choices that only market competition can provide, and that 
certainly includes choice in health care. As we have seen with the 
Medicare Part D drug benefit, when an entitlement program is subjected 
to market forces, everyone is a winner. The taxpayer gets lower 
spending in an entitlement program; the beneficiary pays lower premiums 
and co-pays; and we get to provide broader access to affordable and 
accountable health care for our seniors.
  Yes, it is true that this bill provides temporary relief for payment 
cuts for physician services for the next year or so. So I guess as 
Members we can rest assured that this problem will disappear for the 
next 18 months.
  But what else have we signed on to if we are to pass this bill today? 
We have signed on to massive entitlement expansion through the 
revisions to the low-income subsidy and Medicare savings program. We 
have signed on to eliminating private, fee-for-service Medicare 
Advantage plan options that are currently available in 48 States. We 
have signed on to significant cuts in payment to all Medicare Advantage 
plans that work with teaching hospitals across this country. And last 
but not least, we have signed on to a process by which our own 
committees are now rendered useless in this Congressional body.
  Over the course of the past year, there has not been one single 
Medicare hearing in the Energy and Commerce Committee. Not one. I guess 
the doc fix is so important that it justifies taking a significant, 
political, and complex bill straight to the floor under a vote by 
suspension of the rules.
  That means no consideration by the committees of jurisdiction and no 
amendments on the floor. For an issue that the Democrats like to 
consider bipartisan--avoiding a physician payment crisis--one has to 
ask, why not work with Republicans to enact something earlier and more 
meaningful?
  We know why we are here today. If the Speaker is able to jam this 
down our throats today, we know that it will hit a brick wall in the 
Senate. How do we know this? Because this bill is just about like the 
one that recently failed in the Senate. And, the President has 
indicated that he will veto it, in the unlikely event that it passes 
both bodies.
  So, we see that today's vote for a physician payment fix is merely 
the political exercise Republicans must endure so that Democrats may 
turn to their constituents when they return for the holiday next week 
and say, ``See, I tried to help you but those abominable old 
Republicans, why they just wouldn't let me. They don't even like 
puppies, I heard.''
  This bill temporarily stops the hemorrhaging, but it does not fix the 
long-term problem of physician payment. And the cure is likely worse 
than the illness--the doc fix is at the expense of our senior who enjoy 
their MA benefit.
  I oppose this bill. I oppose the process--no committee hearings; no 
committee markups; no mention of the word Medicare in our committee at 
all.
  Last year, I decried the politics of some of debates we had, and I 
was told that politics is a good thing for this body. Well, we're all 
elected to these seats, so we know a thing or two about politics, but 
at some point the people who elected us expect us to quit politicking 
and start governing. Too often this new Democratic Majority lacks the 
ideas they need to govern, and so they revert to politics.
  Mr. Speaker, I reserve the balance of my time.
  Mr. RANGEL. Mr. Speaker, I yield myself 3 minutes, and I ask 
unanimous consent that the remainder of my time go to the distinguished 
chairman of the Health Subcommittee of the Committee on Ways and Means.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New York?
  There was no objection.
  Mr. RANGEL. Mr. Speaker, I wish we weren't legislating this way, as 
the gentleman has pointed out, on the suspension calendar, but as you 
know, it's difficult working with the other House. They have our CHAMP 
bill over there, and there is no telling what we might do if we don't 
come right now and deal with this emergency before these provisions 
expire.
  This would allow the Secretary to add preventative benefits without 
waiting for the Congress. It would help us out in Medicare. And we have 
been able to gather the support of the doctors, the hospitals, the 
pharmacists, those that are concerned with durable medical expenses, 
the dialysis people, wheelchair. And so we made an attempt, even though 
it is patchwork and it's not a piece of legislation we're proud of. But 
if we don't move in this House, the effects of not doing anything would 
be more detrimental than trying to get a perfect bill.
  We have been working desperately hard to try to get something that 
all of the people could agree to, but, unfortunately, we haven't had an 
opportunity to do that. And we also are concerned with the teaching 
hospitals with suggestions that we have heard that they would pay for 
the whole thing when we know that a physician's fee for service is an 
area that should equally bear the costs of trying to get this 
legislation through.
  So I really don't think we have much of a choice. Our votes are being 
recorded. People are watching what we do. And I do hope that we can do 
a better job next year. But the whole idea is to make certain that the 
House is responsible, and while we don't have any indication of what's 
going to happen in the other body, it seems to me that we should move 
on this bill.
  I want to thank Congressman Stark for the great work he and his staff 
have done. It's always a moving target as to what we can get in, what 
we can't get in. But I don't think there is anyplace we can go for now 
except to support the suspension, and then whatever corrections we have 
to do, we should do it next year.
  Mr. Speaker, I reserve the balance of my time.
  Mr. CAMP of Michigan. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, Medicare bills should be bipartisan and should be fully 
debated, not on some shortened suspension calendar. My question is just 
what about this bill worries the majority that they won't fully debate 
it?
  Today we are discussing a serious issue, how to prevent Medicare from 
cutting physicians' payments by over 10 percent by next Tuesday. Make 
no

[[Page 13456]]

mistake. That will happen if Congress does not act, and despite 
virtually every Member of this House being opposed to such a cut to 
doctors, here we are only a week away from that happening.
  And, sadly, this shouldn't surprise any of us. Shortly after Congress 
passed the last short-term extension in December, the chairman of the 
Ways and Means Health Subcommittee noted that he was inclined to do 
nothing to stop the cut from taking place. And that's exactly what this 
majority has done for the past 6 months: nothing.
  In the last couple of days, this bill has been drafted in secret, and 
a recent version just appeared at 10 o'clock this morning, 278 new 
pages of bill. But this bill has been drafted in secret without 
committee hearings, without committee markups, without committee 
amendments, and without any chance for public review.
  This is the most restrictive Congress in our Nation's history. 
Neither the minority or majority should find this way of doing the 
people's business acceptable. It is certainly not what the Speaker 
promised us or promised the American people.
  Maybe that's why when you break the public's trust in this way, your 
approval numbers plummet. This is the most unpopular Congress ever, and 
that's saying a lot. The American people want an open, accessible, and 
accountable government, and they are not getting it from this majority.
  So today here we are rushing to pass a bill that couldn't muster 
enough support in the Senate to even be debated and one that is sure to 
be vetoed by the President, if it ever got that far. It's the first 
time I have ever seen this House in such a rush to take up the scraps 
of the Senate, and, frankly, we would be equally wise to reject this 
so-called fix. I know I speak for all of my colleagues on this side of 
the aisle when I say we want to prevent this cut and, in fact, we want 
to provide physicians with a payment increase. Yet with this bill, we 
are cutting seniors' access to affordable health care under Medicare 
some $47 billion, causing 2 million seniors to lose access to health 
care through Medicare Advantage. What we give some providers we 
directly take away from beneficiaries. This is no way to manage 
Medicare.
  It is my sincere hope that we can ultimately pass a bipartisan 
compromise this week. A compromise is imminent in the Senate as we 
speak. Physicians deserve no less, and certainly beneficiaries, 
America's seniors, and the disabled deserve no less.
  I urge my colleagues to vote ``no'' and to demand a Medicare doctor 
fix that is workable for all parties involved.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BARROW. Mr. Speaker, I yield myself 2 minutes.
  Mr. Speaker, without H.R. 6331 many doctors across the country will 
not be able to afford to see and treat Medicare patients. In a rural 
district like mine where a greater percentage of the population depends 
on Medicare for their health care, that's not acceptable. We are lucky 
to have world-class health care in this country, but health care is 
only as good as an individual's ability to get to that health care and 
their ability to afford it. H.R. 6331 will keep our doctors in business 
so that our Nation's poor and elderly can get the health care that they 
need.
  I am proud of the fact that H.R. 6331 contains some specific relief 
for folks in rural areas, making sure that rural doctors get paid 
fairly, increasing payments to critical access hospitals, and covering 
the additional fuel costs faced by ambulances in rural districts. This 
bill will also help poor seniors by increasing the amount of assets 
that a low-income beneficiary can have and still qualify for financial 
help with Medicare costs.
  I recently spent a week touring just about every kind of health care 
facility in my district. Folks back home have a lot of problems with 
our health care system. While this bill doesn't fix everything that's 
broke with Medicare, it is a big step forward and we absolutely need 
it.
  Mr. Speaker, we have until July 1 to stop these cuts from taking 
effect.

                              {time}  1130

  Unless we adopt this legislation before then, doctors all across the 
country will have to start turning away Medicare patients that they are 
seeing right now. We can't let that happen. I therefore urge my 
colleagues to support this bill.
  I reserve the balance of my time.
  Mr. BARTON of Texas. Mr. Speaker, I want to yield 2 minutes to a 
member of the Energy and Commerce Committee, the gentlewoman from 
Tennessee (Mrs. Blackburn).
  Mrs. BLACKBURN. I thank the gentleman from Texas.
  Mr. Speaker, he mentioned earlier in his comments the lack of 
hearings that we have had on this issue. Indeed, this morning over in 
Energy and Commerce there is a hearing on health issues, but nothing to 
do with Medicare reform, nothing to do with this situation that is 
before us right now. Indeed, late notice was mentioned.
  Mr. Speaker, I think that what we see here is a pattern that is 
developing with the majority party, and when they don't want to talk 
about something, they don't want to debate it on the floor, they want 
to maybe cover a few things into the bill, then we have it on 
suspension calendar. I find that very unfortunate.
  I will say this. With H.R. 6331, 89 percent of our seniors in 
Tennessee that are enrolled in Medicare Advantage would be adversely 
impacted by this bill. This is something, this bill, H.R. 6331, would 
leave a lot of our elderly patients and doctors in peril, while the 
leadership in this body is playing politics with Medicare.
  We have heard about the 10 percent cut on July 1. We have heard about 
procrastinating and leaving this until the 11th hour rather than taking 
significant action. Mr. Speaker, I think that we have to look at what 
is happening to Medicare. I am deeply concerned about this issue and 
how it impacts our seniors.
  We know that the Medicare trust fund is likely to go bankrupt in 
2019. These aren't my figures, these are the Congressional Budget 
Office figures. We know that this year, we hit the 45 percent trigger, 
which occurs when Congress is obliged to find a new way to curb 
Medicare spending. This bill does not do one thing to curb that 
spending. It makes it worse. It is unfair to our seniors.
  I urge a ``no'' vote.
  Mr. STARK. Mr. Speaker, I yield myself 2 minutes.
  Mr. Speaker, I urge my colleagues to support H.R. 6331. For whatever 
reasons, people may be concerned with process. To me, that is a snare 
and a delusion. Basically, this bill protects the physicians from their 
10 percent cuts. If you vote against it, you're voting to cut 
physicians by 10 percent.
  It improves benefits for seniors and people with disability, it ends 
discriminatory mental health copayments. So vote against the bill and 
seniors don't get mental health treatment. It targets extra help to 
low-income people. Vote against the bill and you're, as Republicans 
like to do, trashing low-income people for the benefit of rich 
insurance companies, the only one group that opposes this bill.
  It delays the durable medical equipment competitive bidding 
demonstration, which we have agreed on a bipartisan basis should be 
delayed. Vote against the bill and let the medical equipment 
competitive bidding go ahead. It makes improvements in quick pay for 
pharmacists. Vote against the bill and talk to your local pharmacists, 
my Republican friends, and see what they think about your voting 
against the bill, which would otherwise provide them prompt payment.
  The clinical labs, therapy services, rural providers, psychologists, 
social workers, dialysis patients all get help in this bill. So vote 
against it and go back and talk to your constituents who depend on 
those services for their quality of life.
  I am ready to have you do that because all of this is paid for in a 
balanced, fair method, suggested, I might add, by the administration's 
own actuary, and the Government Accountability Office and MedPAC all 
say that

[[Page 13457]]

trimming the payments to Medicare Advantage is the right thing to do, 
and will extend the life of the Medicare trust fund.
  So it's not a bill I wish we were considering. The CHAMP Act, which 
many of you voted, is one. But this is a modest compromise. I urge its 
support.
  For several years now, I have pushed to modernize Medicare's 
reimbursement for ESRD, consistent with longstanding recommendations 
from the Medicare Payment Advisory Commission, MedPAC, and the 
Government Accountability Office, GAO. The current payment system 
includes a perverse financial incentive to dose higher levels of the 
anti-anemia drug, Epogen, which can put patients at risk of death and 
serious cardiovascular events. Both MedPAC and GAO recommend replacing 
this system by reimbursing providers with one ``bundled'' payment for 
dialysis services and related drugs and labs, thereby removing the 
incentive to overuse items and services that are currently separately 
billed. This will encourage more efficient provider behavior while 
maintaining and improving patient care. This modernized payment system 
is consistent with the philosophy governing many of Medicare's other 
payment systems.
  It is imperative bundling be done in a way that is sensitive to 
individual patient needs, protects against provider stinting, and is 
not ``one-size-fits all.'' Including an outlier pool, risk adjustment, 
and a strong quality performance system all work to ensure that 
appropriate care is ensured.
  That is why I was very proud when the Children's Health and Medicare 
Protection, CHAMP, Act, which passed the House in August 2007, advanced 
ESRD bundling with these patient protections. That is also why I am 
disheartened by the ESRD bundling proposal before us today, as I have 
several serious concerns with this package.
  First, I am very disappointed to see that much of this package is 
designed to appease the profit-hungry interests of the dialysis and 
pharmaceutical companies. I have long believed that dialysis providers 
should meet strong quality standards in order to receive increased 
payments. I oppose the automatic updates in this bill. I hope that when 
structuring the quality incentive program, CMS pushes dialysis 
providers to meet a rigorous set of standards in order to get payment 
increases. In CHAMP, providers had to meet a clear and strong set of 
quality measures in order to receive bonus payment.
  Unfortunately, the initial anemia management quality measure in this 
bill is seriously flawed. The MIPPA quality measure tells providers 
that they are providing acceptable care as long as they haven't gotten 
worse than their past track record. That's like telling a D-student 
that they are doing fine as long as they keep getting at least D 
grades.
  This is wrong. We should be encouraging providers to improve the care 
provided. There are serious health issues at stake, with the FDA 
warning that using anti-anemia drugs in a way that raises red blood 
cell levels too high puts ESRD patients at risk of death or 
cardiovascular events. Sadly, the measure in MIPPA gives providers a 
pass as long as the care provided just doesn't get worse.
  Instead, we should be encouraging providers to get more patients 
within FDA's recommended range for anemia management. We tried to do 
this in CHAMP when we designed something that pushed providers to at 
least meet the national average, with the bar getting raised in 
subsequent years. If the MIPPA quality measure is enacted into law, I 
intend to work to override or modify it. I hope that the Centers for 
Medicare and Medicaid Services will instead develop a system that 
pushes providers toward improved performance and assesses them against 
anemia management measures that are consistent with the FDA label.
  A second flaw in this package is that it allows the large dialysis 
organizations, LDOs, to benefit from a mandated low-volume adjustment. 
I have no problem with a low-volume adjustment if it is warranted and 
set right. However, LDOs don't need it, and they shouldn't get it. 
Repeated studies by the HHS Office of Inspector General show that LDOs 
are able to get much better prices on dialysis-related drugs than 
smaller dialysis organizations. Even if an LDO has a low-volume 
facility, that facility still benefits from the price discounts 
negotiated with the parent corporation. Giving LDOs a low-volume 
adjustment is an unnecessary waste of money.
  Another flaw with the MIPPA package is that it only lets facilities 
fully opt-in to the bundled payment system in the first year of the 
phase-in. I suspect that facilities will find the incentives for 
practice patterns under the old system and new systems to be in 
conflict, and may quickly realize that moving directly to bundling in 
year two is easier. To the extent bundling incentivizes more efficient 
behavior and has the necessary patient protections, if a facility wants 
to opt-in in year two or three, I see no reason to stop them.
  I would also like to clarify something about the bundle itself. 
MedPAC has repeatedly pushed for a broader ESRD bundle. My 
understanding of the MIPPA language is that it provides for inclusion 
of all oral dialysis-related drugs in the bundle, including 
calcimimetics and phosphate binders. Specifically the term ``items and 
services'' at clause (14)(B)(iv) of the Social Security Act, as amended 
by MIPPA, and the reference to ``other drugs and biologicals'' at 
clause (14)(B)(iii), both afford the Secretary broad discretion to 
include oral drugs furnished to an individual for the treatment of end 
stage renal disease that don't necessarily have an IV equivalent.
  I know why some pharmaceutical companies want to exclude these drugs 
from the bundle. They want another product line where they can play 
their separately billable game and try to drive up utilization and 
corporate profits. That is contrary to the philosophy of bundling and 
not the intent of Congress.
  These drugs should be included in the bundle to prevent cost shifting 
to Part D in order to circumvent the new bundled payment. Most 
importantly, it would ensure that decisions as to which drug a patient 
receives are driven by clinical decisions not reimbursement policy. 
This will also ensure that all drugs furnished to patients for the 
treatment of ESRD are captured in the new bundled payment.
  I also believe the bundle should set in a way, including any 
appropriate adjustments, so that more frequent home dialysis, both 
peritoneal and hemodialysis, is adequately paid and encouraged.
  ESRD bundling is long overdue, but it is unfortunate that industry 
has demanded such a high price for it. If this bill becomes law, I 
intend to keep pushing for these changes and will be watching and 
weighing-in heavily as CMS moves forward with implementation.


                Announcement By the Speaker Pro Tempore

  The SPEAKER pro tempore. Members are reminded to address their 
remarks to the Chair.
  Mr. CAMP of Michigan. I yield 1 minute to a respected physician, the 
gentleman from Louisiana (Mr. Boustany).
  Mr. BOUSTANY. I thank my colleague for yielding time to me.
  As a physician, I am deeply disappointed in the way we are 
legislating on health care. Here we are, on one hand, physicians are 
facing a 10 percent cut in reimbursement, which is going to deeply have 
an impact on access. Furthermore, a 5 percent cut coming up in January. 
On the other hand, we are going to cut $47 billion out of a Medicare 
program that is extremely valuable to rural America.
  I have a substantial number of citizens, constituents in my district, 
who depend on this program for access, not just coverage. Coverage is 
something on paper. Coverage gets you, hopefully, into the door, but 
not necessarily into the door of a physician's office where they can 
have a physician-patient relationship, a meaningful relationship that 
focuses on prevention and screening and not just treating everybody as 
if they are just a cog or an animal.
  We want to do good health care, and this is an irresponsible way to 
do this. This bill does not pay attention to access; it simply glosses 
over it. It pits seniors, seniors against physicians. As a physician, I 
deeply resent that.
  Mr. BARROW. Mr. Speaker, I am pleased to yield 1\1/2\ minutes to the 
distinguished chairman of the Committee on Energy and Commerce, the 
gentleman from Michigan (Mr. Dingell).
  Mr. DINGELL. Mr. Speaker, I thank my good friend from Georgia, and I 
congratulate him on the way he is handling this legislation. We are 
proud of him and his service.
  Mr. Speaker, the legislation before us today is critical to ensuring 
high quality physician services for Medicare beneficiaries. If you want 
to cabal about that, you're making a great mistake. If this legislation 
fails, physicians are going to face a 10 percent pay cut, and that is 
going to drive them out of Medicare and it's going to threaten the 
security and the health care of senior citizens and the disabled.
  At the same time, this legislation provides additional protections 
for low-income beneficiaries, adds benefits to the traditional Medicare 
program, such as coverage for more preventive benefits. It will also 
address the Medicare

[[Page 13458]]

drug benefit and make it work better for pharmacists and therefore 
seniors.
  Finally, the legislation addresses one of the most egregious 
problems, and that is private plans operating in Medicare. Private Fee-
for-Service plans, or PFFS plans, which is one type of Medicare 
Advantage plan. There, they are cutting a fat hog at the expense of the 
public. If you do away with that particular vice, you will find you are 
making it more solvent over a long period of time and you are using a 
mechanism which will help our senior citizens to know that their 
Medicare is protected and seeing to it that the doctors are there to 
provide the care that is needed. We are also assuring that the 
pharmacists are able to stay in this business by addressing a 
significant hurt that they are undergoing.
  I urge my colleagues to support this legislation and not to cabal 
about the perfection of the process.
  Mr. BARTON of Texas. Mr. Speaker, I yield myself 30 seconds.
  I think we are entitled to cabal about the process. We represent 
about 48 percent of the American people and have had absolutely no 
input into a multi, multibillion-dollar temporary fix. This would only 
go into effect for 1 year. It doesn't solve the long-term program. So I 
think we are entitled to a little caballing, as they said.
  I want to yield 2 minutes to the distinguished gentlewoman from 
Florida (Ms. Ginny Brown-Waite).
  Ms. GINNY BROWN-WAITE of Florida. I thank the gentleman from Texas.
  Florida 5 is the district that I represent, and it is not a wealthy 
area. I have the highest number of people on Social Security of any 
Member of this Congress, and obviously a huge number on Medicare.
  Medicare Advantage is a very popular program. And why is it popular? 
It's popular because many of the programs, and by the way, there's a 
large variety of programs for the seniors to choose from, many of the 
programs will actually pay the seniors' part B cost.
  When you represent a district that isn't wealthy, let me assure the 
Members of both sides of the aisle that this is an important medical 
program and it does give them choices. Nobody is forced into the 
Medicare Advantage plans, but they join them because it saves them 
money, while offering quality health care.
  Yes, we all want to fix the cuts to the doctors. Yes, we want to make 
sure that the DME program is revised, and revised well. But we all know 
that it has already been said the Senate won't accept it, the President 
has just issued a veto threat on it, and so my question is: Why are we 
here?
  Obviously, July 1 is right around the corner, and to take this up at 
the last minute when the bill was only available at 10 o'clock this 
morning, I think is an insult. It's an insult to the people who like 
the Medicare Advantage program and it certainly is an insult to every 
Member of this Chamber, 278 pages of a bill that we really don't know 
everything that is in it because it's now a little after 11:30 in the 
morning. So obviously nobody has had the time to adequately review the 
bill.
  Medicare Advantage is a good program that helps so many low-income 
seniors. People have to ask: Why does the Democrat Party want to do 
away with this program? Shame, shame, shame.
  Mr. STARK. Mr. Speaker, I yield 1 minute to the gentleman from 
Georgia (Mr. Lewis).
  Mr. LEWIS of Georgia. Mr. Speaker, I want to thank my friend, the 
chairman of the Subcommittee on Health, for yielding.
  Mr. Speaker, like any other great and necessary journey, the journey 
to improve Medicare must start with a first step. Although we can and 
must do more, this bill is that first step.
  I want to just mention the pulmonary rehabilitation benefit and the 
kidney provision, which I strongly support, and the increase in the 
community health center cap. Seniors deserve a Medicare program that 
delivers services, supports doctors, and prevents disease.
  Take this first step. It is a good step, it is a necessary step. It 
is the right thing to do. I urge all of my colleagues to support this 
bill.
  Mr. CAMP of Michigan. I yield 2 minutes to a physician and respected 
Member of this House, the gentleman from Georgia (Mr. Price).
  Mr. PRICE of Georgia. I thank the gentleman.
  As a physician, nothing is more important to me than patients and the 
ability of doctors to take care of them. One of the reasons that I ran 
for public office was to work as diligently as I could to get politics 
out of the clinical exam room and out of the operating room.
  The process that has brought this bill to the floor, a new bill of 
over 270 pages, just this morning, reveals the cynical and solely 
political activity of the majority leadership, a crisis of leadership 
in this House. No hearing, no amendments, no fairness, no recognition 
of the true needs of patients and doctors.
  Politics over policy, politics over people. Shame, Mr. Speaker. 
Shame.
  MR. BARROW. Mr. Speaker, I am pleased to yield 2 minutes to the 
gentlewoman from Colorado (Ms. DeGette).
  Ms. DeGETTE. Mr. Speaker, the Medicare Improvements for Patients and 
Providers Act not only eliminates the scheduled 20 percent cut to 
physicians, which is set to take place next week, but it also will 
provide numerous other protections. It provides incentives for 
prescriptions for e-prescribing technology and it extends and vastly 
improves low-income assistance programs for very low-income Medicare 
beneficiaries.

                              {time}  1145

  And this bill includes a very important 2-year reauthorization of the 
special diabetes programs for type 1 diabetics and American Indians. 
Thanks to over a decade of investment in these programs, we can point 
to tangible and significant progress, like the creation of an 
artificial pancreas. It is vital for a multiyear reauthorization 
because of the structure of the NIH funding cycle, and I want to thank 
my chairman and the leadership for including this language in the bill. 
There are other wonderful protections in the bill for diabetics and for 
other Medicare beneficiaries.
  I just want to close by saying one thing: The language in this bill 
and the concepts are not new today. We have been talking them to death 
for 2 years. This program expires next week, and I don't think that the 
patients of America and the doctors of America are going to be too 
sympathetic about process arguments, when what they really care about 
is being able to provide quality medical services to low income and to 
senior citizens in this country.
  Mr. BARTON of Texas. Mr. Speaker, I yield myself 1 minute.
  Mr. Speaker, again, I have missed the legislative hearing on this 
issue in the last 18 months. Maybe they had it in the other body, but 
we haven't had it here. The actual bill that we are addressing, we got 
it at 10 minutes until 10 this morning. This is the same group that 
passed a farm bill that left out a complete title, and we are passing a 
278 page bill that the original substance I think we got Friday or 
Monday, the technical corrected copy we got at 10 until 10.
  I may be mistaken, but I believe if we had a process that worked and 
had enough time to think about it, if we had actually been holding 
hearings and substantive markups and all that is on the books of how 
the Congress is supposed to work, we would probably have a bill for the 
suspension calendar that both parties could work for. But the way our 
friends in the majority are operating these days, the proof is in the 
pudding.
  I would strongly recommend a ``no'' vote, and then let's do it right. 
Let's do it right so we can vote for it.
  Mr. STARK. Mr. Speaker, I would like to yield to the gentlewoman from 
Kansas (Mrs. Boyda) for a unanimous consent request.
  Mrs. BOYDA of Kansas. Mr. Speaker, I rise in support of H.R. 6331, 
along with the National Community Pharmacists Association, the Kansas 
Pharmacists, the National Rural Health Care Association, the American 
Medical Association, the Kansas Medical

[[Page 13459]]

Society, the American Hospital Association, the Kansas Hospital 
Association, the Federation of American Hospitals, and on and on.
  These people agree that passage of this bill is vital for Medicare 
and America's seniors, and certainly for people with disabilities.
  Mr. STARK. Mr. Speaker, I yield to the gentleman from Rhode Island 
(Mr. Kennedy) for the purpose of making a unanimous consent request.
  Mr. KENNEDY. Mr. Speaker, I rise in support of H.R. 6331, to extend 
my support along with Mental Health America for equal coverage for our 
seniors for mental health. This bill supports mental health parity, and 
that is why we should pass this bill.
  Mr. STARK. I yield to the gentleman from Washington (Mr. McDermott) 
for the purpose of making a unanimous consent request.
  Mr. McDERMOTT. I rise in support of H.R. 6331, along with the 
American College of Cardiology, the American College of Physicians, the 
American College of Radiology and the American College of Surgeons. All 
the medical organizations are supportive of this bill.
  Mr. STARK. Mr. Speaker, I am happy to yield 1 minute to the 
distinguished gentleman from California (Mr. Becerra).
  Mr. BECERRA. I thank the gentleman for yielding.
  Mr. Speaker, 2 years of debate, a 10 percent cut, 40 million American 
seniors at risk, and 6 days before the clock strikes 12. That is where 
we are. Regardless of what anyone says, that is where we are. We need 
to do something. The time to act is now.
  The bill before us is actually a Senate version of an attempt to come 
up with a modest bipartisan fix. Is it the best bill we could have? 
Absolutely not. But it is a fix that avoids a 10 percent cut, which 
could cause many physicians across the country to say no mas. I cannot 
afford to do this. And it would cause 40 million American seniors to 
say where do I get my health care?
  We need to do something. That is why the Alliance for Retired 
Americans, the American Association for Health Care, the American 
College of Physicians, the American College of Surgeons, the American 
Medical Association, the Federation of American Hospitals, the National 
Committee to Preserve Social Security and Medicare, the National 
Community Pharmacists Association, and the National Rural Health 
Association have said please stop the partisanship. Pass this bill.
  Mr. CAMP of Michigan. Mr. Speaker, I yield 2 minutes to the 
distinguished ranking member of the Committee on Ways and Means, the 
gentleman from Louisiana (Mr. McCrery).
  Mr. McCRERY. Mr. Speaker, I rise in opposition to the bill on the 
floor today. I have some prepared remarks that I am going to submit for 
the Record, but rather than reiterate the problems that we have with 
the process that brought this bill to the floor, let me say my good 
friend Mr. Stark has been talking with us all along about this problem. 
We have all been aware of it. And, frankly, it was our understanding in 
talking with the distinguished chairman of the Health Subcommittee of 
the Ways and Means Committee that we were going to try to let the 
Senate, our colleagues in the Senate, work out a bipartisan solution to 
this take that we could then embrace and bring to the floor.
  They were not able to do that at first in the Senate, so we frankly 
were kind of scrambling to figure out what we were going to do. But now 
we are told that our friends in the Senate have indeed reached a 
bipartisan compromise on this issue. They hope to bring it to the floor 
within the next day or two. At that time, we could take that bill on a 
bipartisan basis in the House and embrace it and pass it and get this 
problem behind us. So why are we doing this today? I am not really 
sure. It baffles me.
  This is a bill that does not have bipartisan support. It did not get 
60 votes in the Senate. It couldn't even come up on the floor for a 
vote. The President would veto it. It is clear this bill is not going 
to become law.
  So I think we are wasting our time here today, to be frank. We ought 
to be joining arms and hoping that the Senate gets that bill to us, the 
new compromise bipartisan bill, in a timely fashion so we can get it 
done this week and avert the drastic cut to reimbursements for 
physicians, as well as the other things that will occur with caps on 
services to seniors and the like.
  So, Mr. Speaker, I would urge us to defeat this bill today on a 
bipartisan basis, and then get about the serious business of passing a 
bipartisan bill later this week that can become law.
  I rise in opposition to H.R. 6331.
  The Majority notified us at 10 o'clock this morning that they have 
made a number of changes to the bill that they told us would be on the 
floor. Members have had just one hour to review this 278-page bill, 
which moves tens of billions of dollars around in the Medicare program. 
The limited time for review of such an important measure should give 
every Member pause.
  For six months now, the Democratic Majority in the House has known 
that physicians face a looming 10.6 percent cut to their Medicare 
payments.
  Now with just six days left before this cut is scheduled to take 
effect, they are bringing a bill to the floor that we all know will 
never be signed into law. The Senate considered a similar bill 2 weeks 
ago and they could not even get the 60 votes necessary to be able to 
debate the bill. We also know that the President would veto this bill, 
because of the changes it makes to the Medicare Advantage program.
  Yet here we are, playing games with less than a week before 
physicians' Medicare reimbursements are scheduled to be cut, therapy 
services for some seniors will be ended, and billions of dollars that 
assist rural physicians and hospitals will be terminated. Once this 
bill fails today, we'll still be faced with the same expiring Medicare 
policies, but we will have one less day to fix them.
  If anyone actually believes that this bill is a serious effort to fix 
these problems, they need only look to page 253 of the bill. Here 
you'll find a ``Sense of the Senate'' provision. Mr. Speaker, the last 
time I checked, this is the House of Representatives. This raises the 
question of whether, in their rush to bring this bill up for a vote, 
the Majority even read their own 278-page bill, which they introduced 
an hour ago, or if they simply copied the failed Senate bill word for 
word.
  Well, my staff has read the bill, and here's what else they found. 
The bill cuts approximately $50 billion from Medicare Advantage. CBO 
predicts that more than 2 million seniors would lose access to their 
Medicare Advantage plan if this bill were enacted. The President has 
said repeatedly that he would veto any bill that contained these 
reductions. Thankfully, he won't have to, because the Senate already 
rejected these cuts two weeks ago.
  Mr. Speaker, if the Majority was really serious about helping 
Medicare beneficiaries and providers, we would take up the compromise 
bill that Senators Baucus and Grassley have worked out. That bill will 
eliminate the physician payment cuts in 2008 and 2009, extend rural 
payment add-ons and the existing exceptions process for therapy 
services and fully pay for these changes without changing the rules 
governing private fee for service plans. I believe that bill will pass 
the Senate, and then we in the House will have an opportunity, on a 
bipartisan basis, to protect physicians from the looming drastic cut in 
their reimbursement.
  Mr. BARROW. Mr. Speaker, I am pleased to yield 2 minutes to the 
distinguished gentlewoman from Illinois (Ms. Schakowsky).
  Ms. SCHAKOWSKY. I thank the gentleman for yielding, and I thank him 
for his leadership. I also want to thank Energy and Commerce Chair John 
Dingell and the Health Subcommittee Chairman Frank Pallone, as well as 
Chairmen Rangel and Stark of the Ways and Means Committee for their 
continued leadership.
  Last year, we passed the CHAMP bill to prevent a 10.6 percent cut in 
payments to Medicare providers and to make critical improvements, and 
today we are trying again. This bill would prevent physician payment 
cuts in 2008 and provide an increase in 2009. And, something of 
particular concern to me, it would address the cuts to mental health 
providers that have already taken place.
  While we need to do more, we have to act now. And there are many, 
many reasons to support the passage of this bill. It provides mental 
health parity. It expands access to low-income assistance for seniors 
and people with disability struggling to pay their health

[[Page 13460]]

care costs. It extends the moratorium on physical therapy caps. It 
eliminates cuts to oxygen treatment and wheelchairs. It postpones 
competitive bidding for durable medical equipment. On the diabetes 
front, it includes a 2-year reauthorization of the special diabetes 
program, prompt pay requirements for pharmacies, and on and on.
  If you think it is more important to continue excess payments to 
private Medicare Advantage plans, plans that are getting 13 percent 
more than Medicare, you should vote no. In 2008, this meant that 
Medicare Advantage plans saw a 6 percent increase, while physicians are 
scheduled for a 10.6 percent cut. Next year, Medicare Advantage plans 
will see between a 5 and 7 percent increase, while physicians are 
scheduled for a 5 percent cut. But if you think it is more important to 
prevent Medicare cuts to physicians and providers and to help senior 
citizens and persons with disabilities, then you will vote yes.
  I hope that all my colleagues on both sides of the aisle will make 
the right choice. I hope you will side with Medicare physicians and 
their patients and pass H.R. 6331.
  Mr. BARTON of Texas. Mr. Speaker, can I inquire as to the time 
remaining on the four sides.
  The SPEAKER pro tempore. The gentleman from Texas has 2\1/2\ minutes 
remaining; the gentleman from Georgia has 1\1/2\ minutes remaining; the 
gentleman from Michigan has 3 minutes remaining; and the gentleman from 
California has 3\1/2\ minutes remaining.
  Mr. BARTON of Texas. Mr. Speaker, I have no other speakers, so I 
reserve the balance of my time and am prepared to close.
  Mr. STARK. Mr. Speaker, I recognize the distinguished gentlewoman 
from California (Mrs. Davis) for a unanimous consent request.
  Mrs. DAVIS of California. Mr. Speaker, I join with the California 
Medical Association, the Center for Medicare Advocacy, the Clinical 
Social Work Association, the Federation of American Hospitals, the Food 
Marketing Institute and Kidney Care Partners in supporting H.R. 3631.


                         Parliamentary Inquiry

  Mr. CAMP of Michigan. Mr. Speaker, parliamentary inquiry. Is this 
coming out of the gentleman's time?
  The SPEAKER pro tempore. A Member asking to insert remarks may 
include a simple declaration of sentiment for the question under 
debate, but should not embellish the request with extended oratory.
  Mr. CAMP of Michigan. Mr. Speaker, the answer is yes?
  The SPEAKER pro tempore. The Chair may charge time in the case of 
extended oratory.
  Mr. CAMP of Michigan. I am sorry, could you repeat that?
  The SPEAKER pro tempore. The Chair may charge time in the case of 
extended oratory.
  Mr. CAMP of Michigan. I would certainly urge the Chair to charge 
time, because you have repeated extended oratories during this debate, 
and we would like the rules to be followed.
  The SPEAKER pro tempore. The gentleman is correct.
  Mr. STARK. I would like to yield 1 minute to the distinguished 
gentleman from California (Mr. Thompson).
  Mr. THOMPSON of California. Mr. Speaker, I thank the gentleman for 
yielding and also for his leadership on this issue.
  Mr. Speaker, today's vote is about maintaining access to health care 
for seniors and people with disabilities. Although this bill stops cuts 
to physician payments, it is not about how much we pay doctors. This 
bill is about access to health care for patients, people that need 
medical attention.
  The data are convincing. Over 60 percent of California physicians 
would leave Medicare or stop taking new Medicare patients if these cuts 
are implemented. In rural California, like rural America, we are 
already facing a physician shortage crisis. The impact on seniors would 
be devastating if Medicare beneficiaries lose access to thousands of 
physicians in California because of this cut.
  Fortunately, we can prevent those cuts and further strengthen 
Medicare through expanded preventive health services, enhanced low 
income protections and other improvements to help people in need of 
care by passing H.R. 6331.
  There may not be bipartisan support in this House for this bill, but 
there is bipartisan support across the country for this bill. I urge 
everyone to vote for it.
  Mr. CAMP of Michigan. Mr. Speaker, I yield 1 minute to the 
distinguished member of the Ways and Means Committee, the gentleman 
from Texas (Mr. Brady).
  Mr. BRADY of Texas. Mr. Speaker, this bill offers a false choice 
between helping our physicians and our pharmacists, who need fair 
reimbursement, and helping our seniors, especially those in minority 
communities and those in rural communities from being able to see a 
doctor who they know and knows them.
  Unfortunately, this Congress is full of false choices. In Texas, I 
know if we pass this bill, we have got over 800,000 seniors, mainly in 
rural communities and in very poor communities, who will not be able to 
see a doctor, will not be able to get the health care that they chose 
under Medicare, because this Congress has decided that they are going 
to pit those poor seniors against physicians and pharmacies in our 
communities. Those false choices is why this Congress has the lowest 
approval rating since they began taking polls.
  Let's stop playing games with our doctors, let's stop playing games 
with our pharmacists, and let's stop playing games with the lives of 
our seniors. We can do better than this.
  Mr. BARROW. Mr. Speaker, it is a pleasure for me to yield 1 minute to 
the distinguished gentlewoman from California (Mrs. Capps).
  Mrs. CAPPS. I thank my colleague.
  Mr. Speaker, I rise in support of H.R. 6331. The alternative to this 
bill is a 10 percent pay cut for doctors who serve critical seniors and 
those with disabilities. Our doctors are desperate for this. It is 
emergency care. It is a band-aid approach, but at least it will stop 
the bleeding.
  Last year we had a much better package, the CHAMP Act, which we did 
debate on this floor and which we did vote out. It hit a roadblock in 
the other body and at the White House. This bill at least ensures our 
physicians can continue practicing in our communities and serving the 
Medicare population.
  I do want to mention two important items, a cost saving provision 
which will improve services for the Medicaid beneficiaries by expanding 
the numbers of patients who can be covered by the county organized 
health systems in Ventura and other counties in California. This is a 
proven way to provide cost-effective access to quality health care, and 
it has been in place in my County of Santa Barbara for many years.
  I also want to commend the inclusion of E-Prescribing language. I was 
proud to work on this with my colleagues Allyson Schwartz and Jon 
Porter. E-Prescribing will ensure prescriptions are transmitted safely.
  I urge my colleagues to vote ``yes'' on this legislation.

                              {time}  1200

  Mr. BARTON of Texas. I reserve the balance of my time.
  Mr. STARK. Mr. Speaker, I am pleased to yield 1 minute to the 
distinguished gentleman from Illinois (Mr. Emanuel).
  Mr. EMANUEL. Mr. Speaker, when it comes to health care reform, my 
colleagues on the other side say the most important priority is the 
relationship between a patient and a doctor. Why isn't that true for 
seniors?
  Today, our Republican friends are once again confronted with a simple 
choice: Stand with seniors and their physicians, or stand with the big 
insurance companies and tax cheats.
  Seniors on Medicare are at risk of losing access to the doctor they 
know and trust. We have a plan to ensure that doesn't happen, and 
strengthen Medicare while doing it. Our plan stops overpayments to big 
insurance companies. We tell providers that owe billions in taxes that 
they cannot continue to cheat the taxpayers and go unpunished.
  I know some of my colleagues on the other side of the aisle oppose 
this bill.

[[Page 13461]]

Under their plan, seniors would go without care, tax cheats go 
unpunished, and insurance companies go to the bank. That is a tough 
argument to make here in Congress, and it is an even tougher argument 
to make to the American people.
  I hope my Republican colleagues reconsider and lend their support to 
this legislation, which continues the relationship between seniors and 
their physician of choice.
  Mr. CAMP of Michigan. Mr. Speaker, I reserve the balance of my time.
  Mr. BARROW. Mr. Speaker, I reserve the balance of my time.
  Mr. BARTON of Texas. Mr. Speaker, I am prepared to close if everybody 
else is prepared to close.
  I yield myself the balance of my time.
  The SPEAKER pro tempore. The gentleman is recognized for 2\1/2\ 
minutes.
  Mr. BARTON of Texas. We do have a serious issue here, Mr. Speaker. We 
have known for several years that we needed to fix the current system 
for physician reimbursement. We also have known that in some of the 
other issues that have been put into this bill, that there are areas of 
reform that need to be implemented. One of the things that I have 
worked on for over 12 years is a competitive bidding process for 
durable medical equipment which is supposed to go into effect July 1 of 
this year. The pending bill has a moratorium on that implementation I 
believe for 18 months, which I think is ill-advised.
  But I do think that when each of us gets elected to this body, when 
we go out and campaign and ask for Members and voters to support us, we 
don't say: If you vote for me, I will go to Washington and I will make 
sure that I have no input into major issues, and when they are put up 
at the last minute I will go vote ``yes'' on the suspension calendar. 
That is not what we say.
  This is a serious issue. There are serious issues that need to be 
addressed in this bill. I am not sure this bill is even a House bill. 
My understanding is that it is a failed version of a Senate bill that 
has been patched together for purposes of a vote today just in case 
there is not a bipartisan compromise later in the week, as Congressman 
McCrery spoke about earlier.
  Process does count. Policies are better if there is bipartisan input 
and you go through the give and take of subcommittee, full committee 
markup where stakeholders and Congressmen and women on both sides of 
the aisle can be involved. That has not happened here.
  Again, this is a multibillion-dollar bill. Even if it were to be 
passed, it only has the effect for the rest of this year and the next 
calendar year. It is not a permanent fix. It doesn't address long term 
these issues. And all of the groups that are supporting the bill today 
that have been enunciated by the majority, when they have been in to 
see me they are talking about a permanent fixes, they are not talking 
about a temporary quick fix, patch it, go on down the road, kick the 
can fixes, which is what this is if it were to be implemented.
  So I really hope that we can vote against this. Since it is a 
suspension vote, it only needs 146 ``no'' votes and it would fail, and 
then we could work together to perhaps on a permanent way fix some of 
these in a bipartisan way. So I urge a ``no'' vote.
  Mr. STARK. Mr. Speaker, I yield myself the balance of my time, and 
urge my colleagues to support the bill.
  The distinguished gentleman from Louisiana was quite correct; we have 
worked together on this. But for us now to depend on the other body is 
sheer folly. We quite have an idea of what they will send us, and it 
will be much less. There will be no prompt pay for pharmacists in the 
other body's bill. They will cut payment to oxygen providers and 
wheelchair providers. There will be less for low income seniors. There 
will be no preventative services. The only difference will be a 
slightly less cut to the private fee for service plans, and the 
administration actuaries have just recently sent us an e-mail saying 
this will extend the life of the Medicare trust fund.
  And I apologize also to my distinguished ranking member on the Health 
Subcommittee, and I understand when we have 50 groups supporting our 
bill and you only have one, the lobbyists for the private fee for 
service plan, it gets a little annoying. But we will see if we can find 
one other group to support your bill. I doubt it, but we will try.
  I urge this. This may be the last chance. I won't discuss process, 
but we all know that we cannot rely on the other body to come together 
and work as well as we have on a bipartisan basis.
  Every part of this bill has had support on a bipartisan basis over 
the last year in this House. It is put together to get as much as we 
can for as little cost to the providers, to extend benefits to the 
seniors, to provide preventative care, to give mental health parity, 
and pay the doctors what they are entitled to. Please support the bill, 
and let us finish our work this week.
  Mr. CAMP of Michigan. Mr. Speaker, I yield myself such time as I may 
consume.
  I would just say, if we are really worried about cuts to physicians, 
why bring up a bill that has already failed in the Senate?
  And frankly, I would say to my good friend that every person or group 
that supports this bill will also support the bipartisan Senate bill 
that is going to come over from the Senate later this week.
  And let me just say, if anyone actually believes still that this bill 
is a serious effort to fix these problems, they need only look to page 
253 of the bill. As my friend from Texas pointed out, this is the group 
that left a whole section out of the farm bill so we had to revote on 
it a second time. But here we will find a ``Sense of the Senate 
provision.'' And, Mr. Speaker, the last time I checked, this is the 
House of Representatives. And this really raises the question of 
whether in the rush to bring this bill up for a vote the majority even 
read their own 278 page bill because they introduced it at about 10:00, 
2 hours ago, or if they just simply copied the Senate bill word for 
word.
  So, frankly, I think if we could look at the Senate bill that I just 
got an e-mail that their bipartisan issue is imminent, that they are 
working and they are close to a deal. This could have happened in the 
House as well if the majority had decided to honestly debate this 
issue.
  So I urge my colleagues to vote ``no'' on this bill that is dead 
before it even arrived, as it has already failed in the Senate.
  At this time I yield back the balance of my time.
  Mr. BARROW. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, we have until July 1 to stop these cuts from taking 
effect. Unless we adopt this legislation before then, doctors all 
across the country will start turning away Medicare patients. We cannot 
let that happen.
  I want to thank the distinguished chairman of the Committee on Energy 
and Commerce for his leadership on this matter. I urge my colleagues to 
support this bill.
  Mr. ENGEL. Mr. Speaker, I rise today in strong support for H.R. 6331, 
the ``Medicare Improvements for Patients and Providers Act of 2008.''
  As a senior member of the Health Subcommittee of the House Energy and 
Commerce Committee, I have worked hard throughout my career in Congress 
to pass commonsense healthcare measures. I am proud to have worked with 
my colleagues on the underlying legislation. H.R. 6331 prevents the 
pending 10 percent payment reduction for physicians in Medicare, 
enhances Medicare preventive and mental health benefits, and improves 
and extends programs for low-income Medicare beneficiaries.
  Our physicians are the backbone of our communities and we must 
guarantee that they are fairly compensated for the good work they do. 
By eliminating the physician payment reduction and through the other 
measures included in H.R. 6331, we can ensure our patients' continued 
access to quality care.
  Mr. Speaker, I am deeply trouble by some of the rhetoric on the other 
side of the aisle. It is absolutely disgraceful that the Republican 
leadership has been urging a ``no'' vote in part because we are 
strengthening the Medicare program in this bill. There have been 
comments from the Republican side opposing the expansion of the 
Medicare Savings Program,

[[Page 13462]]

MSP, in this bill--a program specifically designed to provide a extra 
assistance to low-income seniors who desperately need it. Republicans 
also oppose he expansion of Medicare's coverage of preventive services 
in this bill. We all know that improving access to quality health care, 
such as by providing preventive services will save millions of Medicare 
dollars down the line. It is backwards thinking to simply wait till 
seniors' healthcare erodes beyond repair before we take action.
  Democrats will stand by our Medicare beneficiaries and doctors and 
vote ``yes'' on H.R. 6331 today. Republicans should do the same. 
Anything different is simply unconscionable.
  Mrs. JONES of Ohio. Mr. Speaker, I rise in support of the Medicare 
Improvements for Patients and Providers Act of 2008. This legislation 
prevents the pending 10-percent payment reduction for physicians in 
Medicare, enhances Medicare preventive and mental health benefits, 
improves and extends programs for low-income Medicare beneficiaries, 
and extends expiring provisions for rural and other providers.
  While I do have some concerns regarding the lack of protections for 
African American end stage renal disease patients, I am encouraged by 
many of the provisions included in this legislation. I am particularly 
pleased that the bill extends and improves low-income assistance 
programs for Medicare whose income is below $14,040.00 including the 
qualified individual program that pays part B premiums for low-income 
beneficiaries. Additionally, the bill adds new preventative benefits to 
the Medicare program and reduces out of pocket expenses for mental 
health care.
  Specifically, provisions of the legislation include modest steps to 
reduce Medicare payments to private plans that receive more than 100 
percent of the cost to treat a beneficiary in fee-for-service Medicare. 
The legislation would accomplish this by phasing out the Indirect 
Medical Education double-payment, eliminating the Medicare ``slush'' 
fund to further increase payments to private plans, and ensuring that 
Private Fee-for-Service, PFFS, plans comply with quality requirements 
and have adequate access to providers.
  Additionally, the legislation provides assistance to physicians and 
pharmacies including eliminating the pending 10-percent cut in Medicare 
payments to physicians through 2008, a 1.1 percent update in Medicare 
physician payments for 2009, and requires Medicare Advantage plans to 
pay pharmacies promptly within a 14-day period.
  Mr. KLEIN of Florida. Mr. Speaker, I rise in support of H.R. 6331, 
the ``Medicare Improvements and Patients and Providers Act of 2008,'' 
and thank Chairmen Rangel and Dingell for their leadership in bringing 
it to the House floor today. This legislation, among other things, will 
block a devastating 10.6 percent cut in reimbursement fees for 
physicians who accept Medicare patients.
  Mr. Speaker, Medicare used to be known as the ``Gold Standard'' for 
physicians because it provided them with fair and sustainable 
reimbursement rates, but not anymore. As a result of the President 
trying to balance the budget on the backs of doctors, physicians all 
across the country are facing severe cuts in their Medicare 
reimbursements on July 1.
  In south Florida, we're currently facing a severe shortage of 
qualified physicians in part because of the way physicians are paid 
under Medicare, and the pending cut could hasten this exodus, 
potentially leaving many elderly and other vulnerable populations 
without doctors to treat them.
  This is an unacceptable situation for south Florida or for any region 
of this country. Eliminating the cuts and providing physicians with a 
1.1 percent increase in 2009 is simply the right thing to do.
  But we cannot be satisfied with short-term patches to this systemic 
problem. During the next 18 months, let us once and for all end all 
talk of patches or fixes, and come together in a bipartisan way to find 
a permanent solution to the way we pay our doctors.
  We owe it to our seniors, to the men and women who helped to make 
this country the greatest in the world, to ensure that when they are 
sick, a doctor will be there to see them. It's a fair deal, and one we 
must not turn our backs on.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I rise today in strong support 
of H.R. 6331, the ``Protecting the Medicaid Safety Net Act of 2008.'' I 
would like to thank my colleague from New York, Chairman Charles Rangel 
for his leadership in this important issue.
  This legislation could not come at a more crucial time. Americans are 
in need of support. Rising gas prices, food costs at an all-time high, 
and a rocky housing market have pushed this great Nation towards an 
economic downturn. Families are clinging to basic necessities and 
quality healthcare is one of those essential needs.
  I am pleased to see that there is no language that inhibits physician 
ownership of general acute care hospitals. I have worked tirelessly 
with Members of leadership and with the Texas delegation to support 
general acute-care hospitals and their future development. Physicians 
who have decided to build in areas where often no other hospital will--
should not be penalized for their commitment to work on the clinical 
and business side of health care.
  General acute-care hospitals still need to be able to: maintain a 
minimum number of physicians available at all times to provide service; 
provide a significant amount of charity care; treat at least 1/6 of 
their outpatient visits for emergency medical conditions on an urgent 
basis without requiring a previously scheduled appointment; maintain at 
least 10 full-time interns or residents-in-training in a teaching 
program; advertise or present themselves to the public as a place which 
provides emergency care; serve as a disproportionate share provider, 
serving a low income community with a disproportionate share of low 
income patients; and have at least 90 hospital beds available to 
patients.
  This issue is of the utmost importance to me because I, like others 
in the Democratic Caucus, have hospitals and hospital systems such as 
University Hospital Systems of Houston in my district that would have 
been greatly affected by this provision.
  For example, 2 years ago, St. Joseph Medical Center, downtown 
Houston's first and only teaching hospital, was on the verge of closing 
its doors. However, a hospital corporation in partnership with 
physicians purchased it, and as a result of proper and responsible 
management, has made it the premier hospital in the region, with a 
qualified emergency room responsive to a heavily populated downtown 
Houston. St. Joseph Medical Center is also in the process of reopening 
Houston Heights Hospital, the fourth oldest acute care hospital in 
Houston. This hospital will be serving a large Medicare/Medicaid 
population.
  I am committed to this issue and to the issue of health care for all 
Americans. Provisions that could end the expansion of truly 
compassionate hospital care in places like Texas, Maryland, New York 
and California have no place in healthcare legislation.
  What I do support is legislation that seeks to aid our elderly, our 
disabled, our veterans, our children and our indigent populations. I 
stand here today to show my support not only for the physicians and 
medical care providers of Houston, Texas, but for all of our healthcare 
providers across this country. We need them to continue to be able to 
care for our underserved and elderly--this bill allows them to do just 
that.
  This bill provides a delay of 18 months for the competitive bidding 
program for Durable Medical Equipment, DMEPOS. It also prevents the 
10.6 percent pay cut to physicians that is scheduled to take place on 
July 1, and provides a 1.1 percent update starting January 1, 2009.
  This bill also includes important beneficiary improvements such as 
Medicare mental health parity, improved preventive coverage, and 
enhanced assistance for low-income beneficiaries.
  It contains provisions that will protect the fragile rural health 
care safety net. In my home State of Texas, we have not only great 
urban areas such as Houston, Dallas and Austin, we have over 300 rural 
areas in Texas with cities such as Rollingwood and Hamilton.
  Our rural health care providers are scheduled to receive steep cuts 
in Medicare reimbursement rates on July 1 unless we take action now. 
Such cuts are catastrophic in rural America, where a disproportionate 
number of elderly Americans live. These seniors are, per capita, older, 
poorer and sicker (with greater chronic illnesses) than their urban 
counterparts. Additionally, recruitment and retention of providers to 
much of rural America is often daunting. Provider shortages are rampant 
throughout many rural and most frontier regions.
  Additionally, H.R. 633 also includes several other critical 
provisions for rural providers which, cumulatively, create a rural 
package that will help protect both the rural health safety net and the 
health of tens of millions of seniors who call rural America home.
  H.R. 6331 focuses on strengthening primary care and takes significant 
strides in protecting rural seniors' access to care by correcting 
certain long-standing inequities between rural and urban providers.
  Thank you both for your continued concern for the health of rural 
Americans. So many enduring inequities in health care must be faced by 
rural patients and providers daily. H.R. 6331 offers critical 
assistance and will go far to improving the health of millions of rural 
Medicare beneficiaries.
  Quality measures must continue to be adequately funded in order to 
promote quality,

[[Page 13463]]

cost-effective health care for consumers and employers. The uncertainty 
of Medicare payments makes it increasingly difficult for surgeons and 
their practices to plan for the expenses that they will incur as they 
serve their patients.
  The provisions included in H.R. 6331 would enable surgeons and 
surgical practices to plan for the rising costs that they will continue 
to face over the next year and a half.
  By addressing payment levels through 2009, Chairman Rangel has given 
us more time to study the payment issues surrounding Medicare and allow 
us to look at the systemic reforms needed to preserve access to quality 
surgical care and other physician services.
  As a long-time advocate for universal health care, I believe we must 
continue to support our essential medical providers so that they can 
focus on patient care. We need more physicians as we seek to expand 
health care for all Americans. Yet, how can we expect to grow that 
workforce when we continue to cut their reimbursement levels? We must 
support our physicians so that they may support and care for their 
patients. We have to continue to look at how we can save Medicare and 
expand it to care for those who need it most.
  I am proud to cosponsor legislation that will add support for our 
healthcare workforce. I urge my colleagues to join me in supporting 
this legislation.
  Mr. VAN HOLLEN. Mr. Speaker, I rise in strong support of H.R. 6331, 
the Medicare Improvements for Patients and Providers Act of 2008.
  Most importantly, this legislation prevents the impending 10 percent 
cut in Medicare payments to physicians for the remainder of 2008 and 
provides a 1.1 percent update in physician payments for 2009. The 
uncertainty of Medicare payments makes it difficult for physicians and 
their practices to plan for the expenses that they will incur as they 
serve Medicare beneficiaries. And in turn, beneficiaries will face 
increasing difficulties accessing physicians who accept Medicare. What 
we need to do is address this issue in the long term by reforming the 
flawed reimbursement formulas. By addressing this issue in the short 
term through 2009, we will provide Congress with the needed time to 
study and develop a long term solution to this problem.
  Not only would we prevent cuts in Medicare physician reimbursements, 
the bill will make important and necessary improvements to the Medicare 
program by enhancing Medicare preventative and mental health benefits, 
improving assistance for low-income Medicare beneficiaries, and 
extending expiring provisions for rural and other providers.
  And this legislation is fully paid for. It reduces Medicare Advantage 
Indirect Medical Education IME, overpayments, which are being paid 
twice: once to the teaching facility itself, and again to Medicare 
Advantage plans, with no requirement that plans pass the IME payment 
along to the teaching facility. H.R. 6331 will eliminate the needless 
double payment by still reimbursing the teaching facility directly for 
the higher cost of care, but ceasing IME payments to Medicare Advantage 
plans.
  I am pleased that this legislation contains a provision that makes a 
technical correction to ensure that all physicians, including 
podiatrists, are permitted to perform required face-to-face 
examinations so that they are able to prescribe Medicare-covered 
durable medical equipment, prosthetics, orthotics and supplies, DMEPOS. 
This provision corrects a drafting error in the 2003 Medicare 
Modernization Act that pointed to the wrong definition of physician in 
the Social Security Act when requiring face-to-face examination in 
order to prescribe DMEPOS items.
  I am also pleased that the bill includes a two-year reauthorization 
of the Special Diabetes Programs for Type 1 Diabetes and the Special 
Diabetes Programs for Native Americans at current funding levels. It is 
vital that this successful program be reauthorized on a multi-year 
basis so that the National Institutes of Health, NIH, can invest in new 
research. Without this reauthorization, NIH would have to begin to shut 
down research projects that are currently underway.
  Mr. Speaker, we owe it to provide and beneficiaries to make these 
modest improvements to the Medicare program now. This bill will protect 
our seniors. The clock is ticking. I urge my colleagues to support this 
much-needed legislation.
  Mr. BLUMENAUER. Mr. Speaker, today I am proud to support H.R. 6331, 
the Medicare Improvements for Patients and Providers Act of 2008. This 
legislation addresses issues within Medicare that have been too long 
ignored, including preventing the pending 10 percent payment reduction 
for, enhancing preventive and mental health benefits, improving and 
extending programs for low-income Medicare beneficiaries, and extending 
expiring provisions for rural providers.
  By addressing the critical issue of physician payment under Medicare 
through 2009, Congress will have the time to study and develop the 
systemic, sustainable reforms necessary to preserve patient access to 
physician services under Medicare. And the 18-month delay in 
implementation of the flawed competitive bidding program for Durable 
Medical Equipment, DMEPOS, allows Congress time to evaluate and improve 
this policy.
  I am heartened this legislation passed with such overwhelming 
bipartisan support, demonstrating that we can come together with 
thoughtful solutions that better the lives of Americans.
  Mr. FARR. Mr. Speaker, I would like to add my comments for the record 
on this Medicare bill that we debate today.
  Yes, it is a critical bill. It will prevent a 10.6 percent cut in 
payments to doctors who treat America's senior citizens, the wide 
network of doctors in the Medicare system. In addition, it shores up 
those payments with a 1.1 percent payment increase in 2009.
  But though I applaud what is in this bill, I bemoan what is not in 
the bill.
  The negotiators on this bill have heard from me--and others--long and 
loud about the flaws in the formula that determines Medicare doctor 
fees. In a number of States across the country the formula knowingly 
and erroneously designates some areas as being rural in nature when 
they are by all other definitions clearly urban. The result of this 
deliberate misclassification is to pay doctors at low rural 
reimbursement rates rather than at their true costs of operating a 
medical practice in a high-end urban setting.
  Doctors in my district and 9 other counties in California are paid 
upwards of 10 to 12 percent less than the law--yes, the law--says they 
ought to be paid. But because the Centers for Medicare and Medicaid 
Services, CMS, won't make the necessary technical formula adjustment in 
a factor called the Geographic Practice Cost Index or GPCI, these 
doctors are underpaid. Doctors in Santa Cruz, Sonoma, Monterey, San 
Diego, Santa Barbara, Sacramento, El Dorado, Marin, and San Benito 
counties in California are mistreated by CMS. But nothing in the bill 
we debate today will help them.
  Previously this House did take a step to correct this inequity. In 
H.R. 3162, the original CHAMP bill that we passed last summer, Section 
308 fixed the GPCI factor. But despite my efforts and those of my 
colleagues from affected counties throughout California and in 
similarly impacted States of New York, Texas and elsewhere, H.R. 6331 
maintains the flawed formula and perpetuates the clear disparities of 
this CMS payment policy. Even the GAO in its report last year, GAO-07-
466, showed that without a doubt the CMS formula did not fairly 
compensate doctors and needed serious reform. Despite mountains of 
evidence and years of engaging the Ways and Means Committee on this 
issue, H.R. 6331 ignores an opportunity to do what's right by these 
doctors.
  I am not going to vote against this bill. But I have to say that it 
is a sad day when this House votes to pass a doctor payment reform bill 
that only reforms doctor payments for some and not for all.
  Mr. ETHERIDGE. Mr. Speaker, I rise in strong support of H.R. 6331, 
The ``Medicare Improvements for Patients and Providers Act of 2008.'' 
This bill fulfills America's promise to its seniors and disabled 
citizens, protecting access to high quality health care without 
unreasonable costs.
  For more than 40 years, Medicare has helped meet the needs of many 
vulnerable Americans. It cannot continue to do so if providers are paid 
unreasonable reimbursements, if rules hinder quality patient care, or 
if the burden of paperwork and payment delays keeps small businesses 
out of the health care market. This bill ensures physicians, 
pharmacists, durable medical equipment suppliers, and other health care 
providers can continue to support the health and well being of Medicare 
beneficiaries in many ways.
  H.R. 6331 will ensure health care is available in rural areas of this 
country, like those in the Second District of North Carolina. By 
replacing a 10 percent cut in pay with a slight increase, it ensures 
doctors can afford to stay in business wherever they choose to practice 
medicine. By improving payments to hospitals that provide care where no 
other provider is available, and by making sure rural hospitals are 
paid equally for clinical services, it ensures those services are 
available throughout the country. By increasing access to telehealth, 
it expands the reach of professional advice beyond the doctor's office.
  H.R. 6331 is also a boon for small businesses. The vast majority of 
medical providers are small businesses, and by ensuring they can afford 
to provide care we support the engine of our economy. Especially in 
rural areas,

[[Page 13464]]

our small community pharmacies and medical equipment suppliers are the 
face of medicine for many Medicare beneficiaries. Health care is 
improved when people know their providers, and this makes them more 
likely to comply with medical directives. I am pleased that H.R. 6331 
includes several provisions for these small suppliers that I have 
advocated for some time, including prompt payment provisions and a 
delay in rules from the Centers for Medicare and Medicaid Services, 
CMS. Before proceeding, we need to be sure that these initiatives, 
including competitive bidding for durable medical equipment and the 
implementation of the Average Manufacturing Price, AMP, system, help to 
preserve and improve patient care by allowing community suppliers to 
remain open so that they may continue to serve, and, more importantly, 
operate at a level that facilitates the provision of the best possible, 
safest medical care.
  Mr. Speaker, this legislation improves the health and health care of 
Medicare beneficiaries, the ability of medical professionals to provide 
that care, and the quality of medical care throughout our country. I 
urge my colleagues to join me in supporting H.R. 6331.
  Mr. ABERCROMBIE. Mr. Speaker, I rise today in support of H.R. 6331, 
the ``Medicare Improvement for Patients and Providers Act of 2008.'' 
This bill makes some important changes in the Medicare program that 
help assure access for our seniors to quality medical care.
  The bill defers the 10.6% cut in physician reimbursements mandated by 
the Sustainable Growth Rate (SGR) that would go into effect on July 1, 
2008. Instead, the bill continues the present reimbursement rate for 18 
months and then increases it by 1.1%.
  The bill also provides important improvements for our senior 
citizens, increasing the allowable income and asset maximums for 
premium assistance. The co-payments for mental health services are 
reduced from 50% to 20%, the same as any other doctor visit.
  The legislation addresses problems within Medicare to pay for these 
benefits, reforming the system that overpays to Medicare Advantage (MA) 
plans, private plans that operate within Medicare, which cost the 
government on average 12% more than traditional services. The bill will 
also require that any delinquent taxes owed by Medicare providers be 
deducted from their Medicare reimbursements.
  In addition to improving Medicare services, the legislation also 
makes important changes to Medicaid, including a provision that is 
particularly vital for the people of Hawaii: Disproportionate Share 
Hospital (DSH) payments.
  Following an oversight in the Balanced Budget Act of 1997, only 
Hawaii and Tennessee have not received DSH payments in Medicaid, which 
provide additional support to hospitals that treat large numbers of 
Medicaid and uninsured patients. This bill provides a temporary remedy, 
which will help keep these hospitals open.
  I have been working with Senator Daniel Akaka, the Hawaii Delegation 
and my colleagues on the Committee on Energy and Commerce to ensure 
that Hawaii and Tennessee receive equal treatment in the matter of DSH 
payments from the Federal Government. H.R. 6631 extends DSH payments 
for Hawaii and Tennessee through December 31, 2009, and provides an 
additional $15 million for Hawaii. This extension authorizes the 
submission by the State of Hawaii of a State plan amendment covering a 
DSH payment methodology to hospitals which is consistent with the 
requirements of existing law. The purpose of providing a DSH allotment 
for Hawaii is to provide additional funding to the State of Hawaii to 
permit a greater contribution toward the uncompensated costs of 
hospitals that are providing indigent care. It is not meant to alter 
existing arrangements between the State of Hawaii and the Centers for 
Medicare and Medicaid Services (CMS) or to reduce in any way the level 
of Federal funding for Hawaii's QUEST program.
  I will continue to work toward a permanent solution to the DSH 
matter, but until then, I urge my colleagues to support this measure. 
It is not an earmark, but merely provides Hawaii and Tennessee equity 
with everyone else.
  Again I want to thank Chairman Rangel, Chairman Dingell, Chairman 
Pallone, and Chairman Stark on this important piece of legislation that 
protects our seniors and provides equity for the State of Hawaii. I 
urge my colleagues to pass this vital bill.
  Mr. POMEROY. Mr. Speaker, I rise in strong support of H.R. 6331, the 
Medicare Improvements for Patients and Providers Act, legislation that 
strengthens the Medicare Program and maintains our commitment to rural 
America.
  Rural America continues to be challenged by shortages of health care 
providers, barriers to health care access, and geographic isolation. In 
my own home State of North Dakota, approximately 80 percent of the 
State is designated as a partial or full county Health Professional 
Shortage Area. In order to address these unique challenges, the 
Medicare Modernization Act, MMA, enacted special payment enhancements 
to make sure that rural health care facilities and providers have the 
resources they need to deliver quality care in their communities.
  Unfortunately, many of these important provisions are set to expire 
and further assistance is needed to ensure that seniors living in rural 
America have access to quality, affordable health care. That is why I 
introduced H.R. 2860, the Health Care Access and Rural Equity, H-CARE, 
Act, bipartisan legislation that addresses these and other barriers to 
quality health care by recognizing the unique characteristics of health 
care delivery in rural areas and assisting rural health care providers 
in their efforts to continue to provide quality care to rural 
Americans.
  I am pleased that the Medicare Improvements for Patients and 
Providers Act, MIPPA, of 2008 incorporates many important provisions 
from H-CARE that will do much to protect the fragile rural health care 
safety net. More specifically, MIPPA will do the following:
  Reauthorize and expand the FLEX Grant Program to include a new grant 
program that could mean up to $1 million to Richardton, North Dakota, 
as they convert from their status as a Critical Access Hospital;
  Extend Section 508 of the Medicare Modernization Act which provides 
nearly $10 million a year to North Dakota hospitals to give them the 
resources they need to compete in an increasingly competitive labor 
market;
  Ensure that rural doctors are paid the same rate for their work as 
their urban counterparts by extending the 1.0 work floor on the 
Medicare work geographic adjustment applied to physician payments 
bringing in $9 million to North Dakota through 2009;
  Improve Medicare reimbursements for Critical Access Hospitals by 
directly increasing payments for critical lab services such as blood 
testing and other diagnostic services;
  Boost reimbursements to sole community hospitals by updating the data 
used to calculate their Medicare reimbursements;
  Protect access to rural ambulance services by providing rural 
ambulance providers an additional 3 percent of their Medicare 
reimbursement in order to help cover their costs;
  Require prompt payment to rural pharmacies by Medicare prescription 
drug plans;
  Extend a provision that allows 19 North Dakota hospital-based labs to 
directly bill Medicare for pathology services; and
  Expand access to telehealth services by allowing hospital-based renal 
dialysis facilities, skilled nursing facilities, and community mental 
health centers to be reimbursed under Medicare for telehealth services.
  I would also like to express my appreciation of the Chairman's 
consideration of technical corrections to recently enacted reforms to 
the Long Term Care Hospital payment system under Medicare and I look 
forward to continuing to work with him to resolve this issue.
  Medicare Improvements for Patients and Providers Act is a good bill 
that has been endorsed by the National Rural Health Association and 
deserves every Members' support.
  Mr. BACA. Mr. Speaker, I rise today to support of H.R. 6331, the 
Medicare Improvements for Patients and Providers Act.
  My top priorities are the patients and their families from my 
District.
  Over the past several months, I've received several phone calls from 
hard-working families. These families are worried whether the Medicare 
physician payment cuts will prevent them from being able to see their 
doctor.
  These families are worried about their ability to receive life saving 
medicines and medical supplies in the mail next time they run out.
  These families are worried about their local pharmacy's ability to 
offer discounts on medicines.
  For these families, I stand here in support of H.R. 6331.
  This bill delays physician payment cuts, protecting our seniors from 
facing difficulty in accessing needed healthcare. In these times of 
skyrocketing gas prices, this bill improves low-income assistance 
programs for Medicare beneficiaries. Many working families from the 
Inland Empire, in California, are faced with putting food on the table 
or paying for medicines.
  Furthermore, my constituents will face a unique situation when the 
competitive bidding process rolls out on July 1st. This bill delays 
this process; preventing any possible harmful interruptions in the 
shipment of medical supplies to patients.
  Time is quickly running out, these deadlines are approaching and we 
must not stand by and watch.
  I urge my colleagues to vote for H.R. 6331, our working families are 
counting on us.

[[Page 13465]]


  Mr. CONYERS. Mr. Speaker, I rise to voice my strong support for H.R. 
6331, the Medicare Improvements for Patients and Providers Act of 2008. 
This important legislation amends titles XVIII and XIX of the Social 
Security Act to extend, for 18 months, expiring provisions under the 
Medicare Program. This critical bill prevents the implementation of a 
scheduled 10.6 percent cut in Medicare reimbursements for physicians 
and other health care professionals, and extends the 0.5 percent 
payment update for 2008 and provides a 1.1 percent payment increase for 
physicians in 2009.
  Cutting funds to Medicare, in any way, threatens to up heave the very 
system that millions of Americans rely upon to provide life saving 
medical care and services. It boggles the mind to think that, with an 
aging population and a worsening physician shortage, we would even 
consider cutting reimbursement rates to our hard-working physicians who 
care for millions of Medicare patients across the country. If these 
cuts were allowed to go into effect, many physicians would opt out of 
accepting Medicare, and would therefore be unable to provide necessary 
medical services to our seniors.
   Mr. Speaker, we are in the midst of a bona fide health care crisis. 
One-in-three Americans either have either no health insurance 
whatsoever, or have insurance that is so inadequate that it can 
potentially lead to financial ruin. For those lucky enough to have 
survived these misadventures in our fragmented non-system of care, 
Medicare and Medicaid is their singular saving grace.
  Allowing Medicare to unravel before our eyes is unacceptable. It, 
along with Medicaid, represents a lone island in a sea of broken 
services representative of our fragmented, non-system of health care. 
We must not only keep Medicare afloat, but improve and expand its 
ideals and principals if we are to ever truly provide quality health 
care to all.
   Mr. Speaker, passage of H.R. 6331 is simply a necessity. However, we 
as a Congress must confront head-on the looming health care crisis and 
make the difficult decisions our constituents expect us to make. 
Revising the Sustained Growth Rate Formula, which is used to set 
Medicare's physician payment rate, represents only a portion of reforms 
which are needed to ensure that our seniors are cared for in the sunset 
of their lives. Patch-work fixes and temporary solutions are no 
substitution for real answers to difficult problems. After all, what we 
put off today must be dealt with tomorrow.
  Mr. LANGEVIN. Mr. Speaker, I rise in support of H.R. 6331, the 
Medicare Improvement for Patients and Providers Act of 2008. I am 
pleased that the House of Representatives is taking action to address 
some immediate concerns within the Medicare program. This matter has 
regrettably become stalled in the Senate, and passage of this bill will 
affirm our commitment to ensuring continued access to care for 
America's Medicare beneficiaries.
  This measure includes a number of important provisions, including 
increased access to low income assistance, additional supports for 
rural providers and beneficiaries, and an extension of access to 
therapy services through 2009. Additionally, this bill delays the 
impending 10.6 percent cut in Medicare physician reimbursements 
scheduled to take effect on July 1, 2008. Instead, it freezes payments 
for the remainder of 2008 and provides a modest 1.1 percent increase in 
2009. This legislative fix, although temporary, will help ensure that 
access to care is not compromised and physicians can continue serving 
our most vulnerable populations. It is my hope that Congress will use 
these next 18 months as an opportunity to find a permanent and 
sustainable solution for the flawed reimbursement formula so that it 
more accurately represents the costs of providing care in the current 
market.
  Also included in this bill is a provision to delay Medicare's 
competitive bidding program for durable medical equipment. Although 
competitive bidding was instituted to reduce spending within the 
already overburdened Medicare system, serious concerns have been raised 
over the implementation and potential consequences of this program. 
H.R. 6331 halts the implementation of the competitive bidding program 
for one year, while making necessary improvements to the bidding 
process and establishing quality standards for suppliers. This will 
constitute an important step towards a more efficient system that 
maintains the quality and access that beneficiaries deserve.
  Americans everywhere are counting on this Congress to take action 
before July 1, to ensure that access to Medicare services is not 
jeopardized. I urge my colleagues to support this bill so that 
lawmakers can begin to discuss long-term, viable solutions to reform 
and stabilize the Medicare program.
  Mr. GEORGE MILLER of California. Mr. Speaker, this is a very 
important bill that will prevent the pending payment reduction of 10 
percent for physicians in Medicare, enhance Medicare preventive and 
mental health benefits, and includes many important improvements to the 
Medicare program to the benefit of our constituents.
  I strongly support the legislation.
  Mr. GENE GREEN of Texas. Mr. Speaker, I rise today in support of H.R. 
6331. This important piece of legislation will delay the physician 
payment cut, which is scheduled to go into effect on July 1.
  It has been over a decade since the physician fee schedule was put in 
place to help control increases in Medicare payments to physicians.
  The Medicare program reimburses physicians who treat seniors using a 
complex formula that is based on a number of factors.
  Unfortunately, payments for physician services matched the SGR and 
expenditure targets for only the first 5 years.
  Since then, the actual expenditures have exceeded the target by so 
much that the system is no longer realistic.
  As we have learned in recent years the formula reduces payments to 
physicians when the economy goes down--a time when doctors are least 
able to absorb the extra costs.
  These payment reductions have caused many physicians to hold off on 
accepting new Medicare patients, withdraw from the program, or retire 
altogether.
  In areas like mine that rely heavily on Medicare and Medicaid, we 
probably will not be in a situation where doctors stop taking Medicare.
  Rather, we will see access problems created by attrition--where the 
gap created physician retirements is not filled by new crops of doctors 
willing to take Medicare patients.
  If we reach that point, Medicare will have failed in its mission to 
provide equality in access to health care for our senior citizens.
  Twice we have tried to pass legislation to address the physician 
payment cut and these bills were vetoed twice by the President.
  H.R. 6331 will delay by 18 months the 10.6% physician pay-cut in 
Medicare reimbursement rates due to take effect July 1 and will give 
physicians a 1.1 % payment update for 2009.
  This bill is not a long term solution to the physician payment and 
SGR problem, but it does give Congress time to revamp the program.
  Mr. DAVIS of Illinois. Mr. Speaker, I wish to take a moment to 
express my enthusiastic support for H.R. 6331, the Medicare 
Improvements for Patients and Providers Act, which amends titles XVII 
and XIX of the Social Security Act and extends expiring provisions 
under the Medicare program. H.R. 6331 not only prevents the 10.6 
percent pay cut to physicians scheduled to take effect July 1 while 
maintaining current payment levels for the rest of 2008, but it 
replaces the additional 5.4 percent cut scheduled on January 1, 2009 
with a 1.1 percent increase in Medicare physician payments. By 
preventing these cuts, suppliers will be able to anticipate the costs 
that they will incur and will be less likely to withdraw from the 
program. H.R. 6331 also has a very positive outcome for beneficiaries 
as well. The provisions will improve choice and access to health care 
providers by changing the network requirements for the Medicare 
Advantage Private Fee for Service Plan. Further the bill will reduce 
cost-sharing for mental health services and increase coverage for 
preventive services.
  These policy improvements will translate into significant relief for 
the national medical community, including the 21 hospitals in the 
Illinois Seventh Congressional District; a district which also has some 
of the most medically-underserved constituents of any in this nation. 
Many of these individuals are Medicare beneficiaries that seek hundreds 
of Chicago doctors to provide Medicare services. Therefore, it is in 
the best interest of my constituents as well as Medicare providers, 
suppliers, and recipients across this nation that Congress enacts H.R. 
6331, The Medicare Improvement for Patients and Providers Act. As a 
testament to the importance of this issue to Chicago, I received over 
50 calls within the last few days urging me to support this bill. I 
stand with these constituents and Chicago more broadly to support this 
bill.
  I would like to thank Chairman Rangel for spearheading this 
legislation. I have fought and will continue to advocate vigorously in 
Congress alongside my colleagues for the improvement of Medicare 
resources in support of Medicare providers, suppliers, and 
beneficiaries.
  Mrs. BACHMANN. Mr. Speaker, I must reluctantly rise in opposition to 
H.R. 6331, the Medicare Improvements for Patients and Providers Act. 
While I applaud the House for taking under consideration a bill to 
address the

[[Page 13466]]

impending cut to Medicare physician reimbursement payments, H.R. 6331 
contains provisions that would rob America's seniors of crucial health 
care access in the form of funding cuts to Medicare Advantage.
  Indeed, H.R. 6331 contains a provision that would reverse the 
scheduled 10.1 percent payment cut set to take effect on July 1, 2008, 
a provision I have supported in the past. That being said, the bill 
also contains deep cuts to Medicare Advantage plans, which millions of 
seniors depend on to serve their broad health care needs. These cuts, 
totaling nearly $50 billion, would place the burden of leadership's 
failed Medicare reform policies directly on the backs of America's 
seniors.
  To be sure, Medicare Advantage is popular choice for seniors across 
the Nation. With nearly 10 million Medicare beneficiaries currently 
enrolled in Medicare Advantage plans, up nearly 60 percent since 2004, 
it is clear that America's seniors are seeing the benefits of the 
competition-driven plans. These plans offer greater choice, lower out-
of-pocket costs, and expanded service to America's seniors who seek 
value and quality in their health care coverage.
  Specifically, H.R. 6331 would target those beneficiaries who have 
chosen Private Fee-for-Service, PFFS, plans through Medicare Advantage 
by requiring PFFS plans to establish costly provider networks if they 
wish to continue to operate in areas that already have two or more 
networked plans. This requirement would apply to 96 percent of all 
counties in the United States, and, according to the nonpartisan 
Congressional Budget Office, CBO, disrupt PFFS plans for more than 2 
million seniors by 2013. In my State of Minnesota, each of the nearly 
73,000 individual Medicare Advantage PFFS plans would be in jeopardy.
  Furthermore, it is unfortunate that rather than considering a bill 
that will remedy the problem at hand, Democrat leadership chose to 
bring a bill to the floor that has been given a veto threat from the 
President. Both providers and patients deserve a bill that can be 
seriously considered for signature into law. This is not a topic on 
which we should play political games.
  Mr. Speaker, America's physicians need Congress to prevent a 
devastating cut to their Medicare reimbursement payments. However, the 
burden of the solution should not be placed on the shoulders of 
America's seniors, gambling with access to the health coverage on which 
they rely.
  Mr. PAUL. Mr. Speaker, Congress is once again forsaking an 
opportunity to begin addressing Medicare's long-term fiscal problems. 
Instead, the legislation before us today, while not without its merits, 
exacerbates the problems facing Medicare by giving new authority to the 
Center for Medicare and Medicaid Services (CMS), even though CMS's 
excessive power is a major reason why so many physicians and patients 
are dissatisfied with the current Medicare system.
  One clear indicator of the lack of seriousness with which this issue 
is being treated is the fact that this bill is coming before us on 
suspension, a procedure generally used for noncontroversial 
legislation, such as bills naming Post Offices. This significant 
Medicare legislation will receive only 40 minutes of debate, and 
members will have no opportunity to offer amendments.
  I certainly recognize the need to make adjustments in physicians' 
payments. Many physicians are already losing money treating Medicare 
patients, thanks to CMS's low reimbursements and the cost of having to 
comply with CMS's numerous rules and regulations. Unless Congress acts, 
many physicians will simply refuse to see Medicare patients. I think we 
all agree that driving physicians out of the Medicare program is not 
the proper way to reform the system.
  Therefore, if H.R. 6331 only contained the provisions dealing with 
the physicians' rate cut, I would vote for it. However, H.R. 6331 
further endangers Medicare's fiscal situation by giving almost $20 
billion in new funds to CMS, and giving CMS new regulatory authority.
  Instead of simply pretending we can delay the day of reckoning by 
giving CMS more money and power, we should be looking for ways to shore 
up Medicare by making cuts in other, lower priority programs, using 
those savings to ensure the short-term fiscal stability of Federal 
entitlement programs while transitioning to a more stable means of 
providing health care for senior citizens. I have been outspoken on the 
areas I believe should be subject to deep cuts in order to finance 
serious entitlement reform that protects those relying on these 
programs. I will not go into detail on these cuts, although I will 
observe that today the House Committee on Financial Services is 
planning to authorize billions of new foreign aid spending, perhaps 
some of those billions might be better spent reforming the Medicare 
system.
  Congress should also reform the Medicare system by providing Medicare 
patients more control over their health care than is available under 
either traditional Medicare or the Medicare Advantage program.
  Mr. Speaker, H.R. 6331 may provide some short-term benefit to 
Medicare providers, however, it does so by further jeopardizing the 
long-term fiscal soundness of the Medicare program. Thus, passage of 
this bill will ultimately damage the very Medicare providers and 
patients the bill aims to help.
  Ms. WOOLSEY. Mr. Speaker, H.R. 6331, the Medicare Improvements for 
Patients and Providers Act will delay cuts in physician payments under 
Medicare until next year. I hope that this is the last temporary delay 
and next year we will implement a permanent fix to this problem. It's 
important to Medicare patients and physicians that there is a 
continuity of payments so physicians can continue to treat Medicare 
patients and Medicare patients do not lose access to the physician most 
familiar with their medical needs.
  When we implement a permanent fix to the Medicare physician payment 
cuts, I hope to address the issue of the Medicare physician geographic 
payment discrepancy that is faced by many areas in California and 
across the country. One of these areas is Sonoma County, in my 
District. This inconsistency has led to doctor's reimbursements being 
based upon geographic location and not the true cost of providing 
services. Because of this discrepancy, doctors in Sonoma County receive 
a lower payment for the same services than doctors in next door Marin 
County and this discrepancy is causing doctors to leave Sonoma County. 
Congress must act to fix this discrepancy and ensure that physicians 
with Medicare patients can continue to afford to see Medicare patients 
regardless of where a practice is located.
  I urge my colleagues to support H.R. 6331, Medicare Improvements for 
Patients and Providers Act and look forward to working together to 
provide a permanent solution to the Medicare physician payment issues 
so that our Nation's seniors receive the best possible care from the 
physician who knows the patient the best.
  Mr. KENNEDY. Mr. Speaker, I rise in support of H.R. 6331, the 
Medicare Improvement for Patients and Providers Act. This important 
bill includes mental health parity for Medicare beneficiaries. 
Currently, there is a discriminatory 50-percent copayment requirement 
for mental health services, while a 20-percent copayment exists for 
physical health care services under Medicare.
  As the lead sponsor of H.R. 1424, the Paul Wellstone Mental Health 
and Addiction Equity Act, I am fighting to enact mental health parity 
for individuals who receive their insurance in the private sector. 
Federal employees, including Members of Congress, have had equal access 
to mental health and addiction services since 2001 with little or no 
cost increase. It's time for the private sector and Medicare to join in 
this effort to protect the health of all Americans, regardless of age 
or diagnosis.
  In my home State of Rhode Island, I spend countless hours in senior 
centers and high-rises talking to my constituents, and it's clear that 
there is an epidemic of undiagnosed and untreated mental illness among 
older Americans. In fact, as many as one-quarter of seniors have 
significant clinical depression. But the one thing we must remember is 
that depression does not have to be a byproduct of aging--it isn't 
``normal'' to get depressed as you get older. Allowing mental illness 
to go untreated in our seniors is not only unethical, but it increases 
health care costs, especially for those seniors with depression who are 
unable to manage their chronic illnesses.
  Tragically, only 3 percent of older adults with mental illness ever 
seek mental health treatment. Often, this is due to stigma. Stigma that 
is reinforced by our reimbursement structure that favors the treatment 
of our physical health over our mental health. H.R. 6331 ends this 
stigma by phasing in a 20-percent copayment for Medicare mental health 
services over 6 years. By ending arbitrary and discriminatory financial 
limits and making treatment more affordable, we can ensure that all 
seniors have access to mental health services. I urge my colleagues to 
support H.R. 6331.
  Mr. JOHNSON of Illinois. Mr. Speaker, I rise today in support of H.R. 
6331, the Medicare Improvement for Patients and Providers Act of 2008. 
Due to a flight delay on June 24, 2008, I was unable to cast my vote in 
favor of this important piece of legislation.
  The Medicare Improvement for Patients and Providers Act is critical 
to my district as it stops the scheduled cut in physician payment rates 
under the Medicare program and provides for a 1.1 percent increase in 
2009. If

[[Page 13467]]

these cuts are not halted by Congressional action, under current law, 
physicians across the country are to receive a 10.6 percent cut in 
their Medicare payment rates. This will lead to a loss of health care 
access for Medicare beneficiaries in every Congressional district. 
Short of a permanent fix to the sustainable growth rate for doctors, it 
is imperative that Congress pass short-term extensions, such as this, 
to ensure that physicians around the country are reimbursed by Medicare 
for the care they are providing to our Nation's seniors. It is 
important to recognize that many of these doctors own small businesses 
and the services they provide to their communities are undeniable and 
necessary. We must ensure that Medicare beneficiaries have access to 
doctors, and passing this legislation will ensure access to care.
  While I was disappointed that the bill included cutting Medicare 
Advantage payments in order to pay for the physician payment increase, 
I believe that the underlying issue of physician payments must take 
precedence in order to preserve access for Medicare beneficiaries with 
their local physicians.
  As the President has given Congress until July 15 to act on this 
issue, I look forward to having an opportunity to pass legislation to 
fix this issue for our physicians and Medicare beneficiaries.
  Mrs. MALONEY of New York. Mr. Speaker, I strongly support H.R. 6331, 
the Medicare Improvements for Patients and Providers Act of 2008. The 
14th Congressional District of New York, which I represent, is home to 
18 hospitals--perhaps more than any other district in the nation. Of 
course, along with hospitals come physicians who regularly report to me 
about the crisis of healthcare in this country. I am grateful that H.R. 
6331 helps America's doctors while also significantly helping Medicare 
beneficiaries and hope that the other body will act swiftly on this 
much needed legislation.
  H.R. 6331 eliminates the pending 10.6 percent cuts in the Medicare 
Sustainable Growth Rate (SGR) to physicians for the remainder of 2008 
and provides a 1.1 percent update in payments for 2009. I have 
thousands of doctors in my district who tell me that the uncertainty of 
Medicare payments makes it increasingly difficult to plan for expenses. 
Unfortunately, we are seeing that for many doctors, the response to the 
uncertainty is to stop taking new patients, or even more dire, end 
their participation with the Medicare program. This is catastrophic for 
patient access and care. This bill is a positive first step toward 
eliminating that uncertainty and allowing time for Congress to develop 
reforms to the current system.
  I am proud that this bill strengthens Medicare for those 
beneficiaries who are in greatest need and ensures access to good 
quality care while remaining fiscally responsible. I thank Chairmen 
Dingell and Rangel for this important bill and urge my colleagues to 
support America's seniors by voting in favor of H.R. 6331.
  Mr. BARROW. I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Capuano). The question is on the motion 
offered by the gentleman from New Jersey (Mr. Pallone) that the House 
suspend the rules and pass the bill, H.R. 6331, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. BARTON of Texas. Mr. Speaker, I object to the vote on the ground 
that a quorum is not present and make the point of order that a quorum 
is not present.
  The SPEAKER pro tempore. Evidently a quorum is not present.
  The Sergeant at Arms will notify absent Members.
  The vote was taken by electronic device, and there were--yeas 355, 
nays 59, not voting 20, as follows:

                             [Roll No. 443]

                               YEAS--355

     Abercrombie
     Ackerman
     Aderholt
     Alexander
     Allen
     Altmire
     Andrews
     Arcuri
     Baca
     Bachus
     Baird
     Baldwin
     Barrow
     Bean
     Becerra
     Berkley
     Berman
     Berry
     Biggert
     Bilbray
     Bilirakis
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Bonner
     Bono Mack
     Boozman
     Boren
     Boswell
     Boucher
     Boyd (FL)
     Boyda (KS)
     Brady (PA)
     Braley (IA)
     Brown (SC)
     Brown, Corrine
     Brown-Waite, Ginny
     Buchanan
     Burgess
     Burton (IN)
     Butterfield
     Calvert
     Capito
     Capps
     Capuano
     Cardoza
     Carnahan
     Carney
     Carson
     Castle
     Castor
     Cazayoux
     Chabot
     Chandler
     Childers
     Clarke
     Clay
     Cleaver
     Clyburn
     Coble
     Cohen
     Conyers
     Cooper
     Costa
     Costello
     Courtney
     Cramer
     Crowley
     Cubin
     Cuellar
     Cummings
     Davis (AL)
     Davis (CA)
     Davis (KY)
     Davis, David
     Davis, Lincoln
     Davis, Tom
     Deal (GA)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Dent
     Diaz-Balart, L.
     Diaz-Balart, M.
     Dicks
     Dingell
     Doggett
     Donnelly
     Doyle
     Drake
     Dreier
     Edwards (MD)
     Edwards (TX)
     Ehlers
     Ellison
     Ellsworth
     Emanuel
     Emerson
     English (PA)
     Eshoo
     Etheridge
     Everett
     Fallin
     Farr
     Fattah
     Feeney
     Ferguson
     Filner
     Forbes
     Fortenberry
     Fossella
     Foster
     Foxx
     Frank (MA)
     Gallegly
     Gerlach
     Giffords
     Gilchrest
     Gillibrand
     Gingrey
     Gonzalez
     Goode
     Goodlatte
     Gordon
     Graves
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hall (NY)
     Hall (TX)
     Hare
     Harman
     Hastings (FL)
     Hastings (WA)
     Hayes
     Heller
     Herseth Sandlin
     Hill
     Hinchey
     Hinojosa
     Hirono
     Hobson
     Hodes
     Hoekstra
     Holden
     Holt
     Honda
     Hooley
     Hoyer
     Hunter
     Inglis (SC)
     Inslee
     Israel
     Issa
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Johnson (GA)
     Johnson, E. B.
     Jones (NC)
     Jones (OH)
     Kagen
     Kanjorski
     Kaptur
     Keller
     Kennedy
     Kildee
     Kilpatrick
     Kind
     King (NY)
     Kingston
     Kirk
     Klein (FL)
     Kline (MN)
     Knollenberg
     Kucinich
     Kuhl (NY)
     LaHood
     Lampson
     Langevin
     Larsen (WA)
     Larson (CT)
     Latham
     LaTourette
     Latta
     Lee
     Levin
     Lewis (CA)
     Lewis (GA)
     Lipinski
     LoBiondo
     Loebsack
     Lofgren, Zoe
     Lowey
     Lucas
     Lynch
     Mack
     Mahoney (FL)
     Maloney (NY)
     Manzullo
     Markey
     Marshall
     Matheson
     Matsui
     McCarthy (CA)
     McCarthy (NY)
     McCaul (TX)
     McCollum (MN)
     McCotter
     McDermott
     McGovern
     McHugh
     McIntyre
     McKeon
     McMorris Rodgers
     McNerney
     Meek (FL)
     Meeks (NY)
     Melancon
     Michaud
     Miller (FL)
     Miller (MI)
     Miller (NC)
     Miller, Gary
     Mitchell
     Mollohan
     Moore (KS)
     Moore (WI)
     Moran (KS)
     Moran (VA)
     Murphy (CT)
     Murphy, Patrick
     Murphy, Tim
     Murtha
     Musgrave
     Myrick
     Nadler
     Napolitano
     Neal (MA)
     Oberstar
     Obey
     Olver
     Ortiz
     Pallone
     Pascrell
     Pastor
     Payne
     Pearce
     Perlmutter
     Peterson (MN)
     Petri
     Pickering
     Platts
     Poe
     Pomeroy
     Porter
     Price (GA)
     Price (NC)
     Putnam
     Rahall
     Ramstad
     Rangel
     Regula
     Rehberg
     Reichert
     Richardson
     Rodriguez
     Rogers (AL)
     Rogers (KY)
     Rohrabacher
     Ros-Lehtinen
     Ross
     Rothman
     Roybal-Allard
     Ruppersberger
     Ryan (OH)
     Salazar
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schiff
     Schmidt
     Schwartz
     Scott (GA)
     Scott (VA)
     Serrano
     Sestak
     Shays
     Shea-Porter
     Sherman
     Shuler
     Shuster
     Simpson
     Sires
     Skelton
     Slaughter
     Smith (NJ)
     Smith (TX)
     Smith (WA)
     Snyder
     Solis
     Souder
     Space
     Spratt
     Stark
     Stearns
     Stupak
     Sullivan
     Sutton
     Tanner
     Tauscher
     Taylor
     Terry
     Thompson (CA)
     Tiahrt
     Tiberi
     Tierney
     Towns
     Tsongas
     Turner
     Udall (CO)
     Udall (NM)
     Upton
     Van Hollen
     Velazquez
     Visclosky
     Walberg
     Walden (OR)
     Walsh (NY)
     Walz (MN)
     Wamp
     Wasserman Schultz
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Welch (VT)
     Weldon (FL)
     Weller
     Wexler
     Whitfield (KY)
     Wilson (NM)
     Wilson (OH)
     Wilson (SC)
     Wittman (VA)
     Wolf
     Woolsey
     Wu
     Yarmuth
     Young (AK)
     Young (FL)

                                NAYS--59

     Akin
     Bachmann
     Barrett (SC)
     Bartlett (MD)
     Barton (TX)
     Blackburn
     Blunt
     Boehner
     Boustany
     Brady (TX)
     Broun (GA)
     Buyer
     Camp (MI)
     Campbell (CA)
     Cantor
     Carter
     Cole (OK)
     Conaway
     Crenshaw
     Culberson
     Doolittle
     Duncan
     Flake
     Franks (AZ)
     Frelinghuysen
     Garrett (NJ)
     Granger
     Hensarling
     Herger
     Hulshof
     Johnson, Sam
     Jordan
     King (IA)
     Lamborn
     Lewis (KY)
     Linder
     Lungren, Daniel E.
     Marchant
     McCrery
     McHenry
     Mica
     Neugebauer
     Paul
     Pitts
     Radanovich
     Renzi
     Rogers (MI)
     Roskam
     Royce
     Ryan (WI)
     Sali
     Scalise
     Sensenbrenner
     Sessions
     Shadegg
     Shimkus
     Smith (NE)
     Thornberry
     Westmoreland

                             NOT VOTING--20

     Bishop (UT)
     Cannon
     Davis (IL)
     Engel
     Gohmert
     Higgins
     Johnson (IL)
     McNulty
     Miller, George
     Nunes
     Pence
     Peterson (PA)
     Pryce (OH)
     Reyes
     Reynolds
     Rush
     Saxton
     Speier
     Tancredo
     Thompson (MS)

                              {time}  1236

  Mr. DANIEL E. LUNGREN of California changed his vote from ``yea'' to 
``nay.''
  Messrs. CHABOT, WHITFIELD of Kentucky, FRANK of Massachusetts, 
GRAVES, HASTINGS of Washington, WELLER of Illinois, LATTA, FARR, Mrs. 
MYRICK, Messrs. GALLEGLY,

[[Page 13468]]

REICHERT, Mrs. MILLER of Michigan, Messrs. McKEON, MANZULLO, MILLER of 
Florida, BOOZMAN, WILSON of South Carolina, MACK, DREIER, ISSA, 
CALVERT, HALL of Texas, Mrs. DRAKE, Messrs. HUNTER, ROGERS of Kentucky, 
GARY G. MILLER of California, McCAUL of Texas, KLINE of Minnesota, 
RAMSTAD, Mrs. McMORRIS RODGERS, Ms. FALLIN, Messrs. KINGSTON, DEAL of 
Georgia, and BROWN of South Carolina changed their vote from ``nay'' to 
``yea.''
  So (two-thirds being in the affirmative) the rules were suspended and 
the bill, as amended, was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.
  Stated for:
  Mr. GEORGE MILLER of California. Mr. Speaker, because I was chairing 
a hearing today on whether OSHA is failing to adequately enforce 
construction safety rules, I was unable to vote on the Medicare 
Improvements for Patients and Providers Act of 2008, H.R. 6331.
  I strongly support the legislation, and I would have voted in favor 
of H.R. 6331 had I been present during the vote.

                          ____________________