[Congressional Record (Bound Edition), Volume 156 (2010), Part 4]
[House]
[Pages 5125-5136]
[From the U.S. Government Publishing Office, www.gpo.gov]




 PROVIDING FOR CONSIDERATION OF SENATE AMENDMENTS TO H.R. 4872, HEALTH 
             CARE AND EDUCATION RECONCILIATION ACT OF 2010

  Ms. SLAUGHTER, from the Committee on Rules, submitted a privileged 
report (Rept. No. 111-458) on the resolution (H. Res. 1225) providing 
for consideration of the Senate amendments to the bill (H.R. 4872) to 
provide for reconciliation pursuant to Title II of the concurrent 
resolution on the budget for fiscal year 2010 (S. Con. Res. 13), which 
was referred to the House Calendar and ordered to be printed.
  Ms. SLAUGHTER. Madam Speaker, by direction of the Committee on Rules, 
I call up House Resolution 1225 and ask for its immediate 
consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 1225

       Resolved, That upon adoption of this resolution, it shall 
     be in order to take from the Speaker's table the bill (H.R. 
     4872) to provide for reconciliation pursuant to Title II of 
     the concurrent resolution on the budget for fiscal year 2010 
     (S. Con. Res. 13), with the Senate amendments thereto, and to 
     consider in the House, without intervention of any point of 
     order except those arising under clause 10 of rule XXI, a 
     single motion offered by the chair of the Committee on 
     Education and Labor or his designee that the House concur in 
     the Senate amendments. The Senate amendments and the motion 
     shall be considered as read. The motion shall be debatable 
     for 10 minutes equally divided and controlled by the chair 
     and ranking minority member of the Committee on Education and 
     Labor. The previous question shall be considered as ordered 
     on the motion to final adoption without intervening motion or 
     demand for division of the question.

  The SPEAKER pro tempore. The gentlewoman from New York is recognized 
for 1 hour.
  Ms. SLAUGHTER. Madam Speaker, for the purpose of debate only, I yield 
the customary 30 minutes to the gentleman from California (Mr. Dreier). 
All time yielded during consideration of the rule is for debate only.


                             General Leave

  Ms. SLAUGHTER. I ask unanimous consent that all Members have 5 
legislative days within which to revise and extend their remarks and 
insert extraneous materials into the Record.

[[Page 5126]]

  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from New York?
  There was no objection.
  Ms. SLAUGHTER. I yield myself such time as I may consume.
  Madam Speaker, the rule provides for consideration of the Senate 
amendments to H.R. 4872. It shall be in order to take from the 
Speaker's table H.R. 4872, with the Senate amendments thereto, and to 
consider in the House, without intervention of any point of order 
except those arising under clause 10 of rule XXI, a single motion 
offered by the Chair of the Education Committee that the House concur 
in the Senate amendments. The Senate amendments and the motion shall be 
considered as read. The rule provides 10 minutes of debate equally 
divided and controlled by the Chair and the ranking minority member of 
the Committee on Education and Labor. Finally, the previous question 
shall be considered as ordered on the motion to final adoption without 
intervening motion or demand for division of the question.
  Madam Speaker, the disturbing atmosphere that we've seen around the 
Capitol recently is alarming. The rash of ominous threats, voice mails, 
letters, brick throwing, and other sordid acts of protests is downright 
despicable and marks a low point in the Nation's history. I say this in 
part from firsthand experience. As many of you know, my Niagara Falls 
office was the target of attack last week when someone hurled a brick 
through the window in the dark of night. Separately, I received a phone 
call on my campaign office phone line that referenced 16 sniper teams 
and an attempt that would be made to target the children of Members of 
Congress who voted for the health care legislation.
  Each day my four offices give me a careful log of phone calls and 
emails from people who have taken the time to share their opinions with 
me, and I read each of those comments because I value that input and 
want to hear from everyone, not just the people who agree with me. I 
daresay there isn't a single elected official in the country who has 
not had a heated run-in with someone who felt strongly that they had 
voted the wrong way on an issue. In fact, it is part of this country's 
great tradition that we not only tolerate dissent but we encourage it.
  To speak up and to take part in democracy is a noble and treasured 
part of the American way. But all that changed last year when suddenly 
town hall meetings across the country turned into vicious shouting 
matches. Persons who had taken the time to go to the town meeting to 
learn about the health care bill were oftentimes harassed and 
frightened and unable to learn anything except that they felt somewhat 
under siege. I remember that someone arrived at a meeting with a 
handgun holstered to his leg, and he could not have been more than 50 
yards away from the President of the United States.
  Spirited debate has become negative. All of us have noticed that in 
our offices. As I mentioned, I have four offices. The calls that came 
in--I thank my staff, and I'm sure all of you do, too, for simply 
tolerating it. It was all day. One day the calls came in so quickly 
that not another piece of work could be done in all my offices. We were 
threatened. We were cajoled. We were told--mostly by people from Texas 
and Oklahoma--that they would never vote for me again, which would be 
very unlikely in New York anyway.
  But I am happy to tell you that as of Sunday night and the passage of 
this bill, all of those calls are gone. We were getting up to--I would 
say totaling in the four offices nearly 100 a day. It's all gone now, 
and the people who call express sorrow for the trouble that has been 
put upon me, saying that their America does not do that to anyone, 
particularly someone that they have put their trust in.
  But this week, the leader of the national Republican Party said that 
Speaker Pelosi should be put ``on the firing line.'' Another Republican 
leader and former national party candidate placed rifle site targets on 
a national map showing congressional districts of Democrats who 
supported health care for all Americans, and that same leader urged her 
supporters, ``Don't retreat, reload.'' And even worse were the remarks 
made here by the minority leader, who recently said that one of my 
colleagues who backed the legislation was politically a ``dead man'' 
back home. Taken together with the incidents around the country, these 
episodes might prompt a quick and forceful repudiation of comments that 
would endorse violence, but instead, we get just the opposite.

                              {time}  1845

  When Republican Members went out onto the balcony off the Speaker's 
lobby Sunday to shout to and encourage rowdy protesters, they were 
implicitly encouraging a discourse that had already soured. In fact, I 
was dismayed to learn--not dismayed, dismayed doesn't cover it--I was 
angry. I was concerned. It terrified me, the thought that we would have 
to live through any of that again. When I found out that some of my 
colleagues were the victims of racial epithets, spitting, homophobic 
slurs, this sort of display is shocking even to someone who has seen 
some pretty terrible things over the years.
  Despite all this, Democrats move forward with hope and optimism. It 
is my sense that as more Americans learn about the provisions of the 
health care reform legislation, they will in increasing numbers support 
the vote over the weekend, and the polls show this already happening.
  It is a surprise to me today that with the passage of reconciliation 
by a 56-43 margin in the Senate, that the other side would continue to 
try to throw up petty roadblocks or complain that they haven't had time 
to read the bill.
  Do you want to know what we are debating here today? We are debating 
two sentences. That's it, two sentences. Does it make sense to anyone 
that the other side is demonizing a bill that has already been approved 
by both the House and Senate and signed into law? No, instead we should 
celebrate the incredible accomplishment of finally passing this 
legislation after a struggle of more than a hundred years.
  I won't even bother reciting all of the ways in which ordinary 
Americans will gain as we shift the balance of power away from 
insurance companies and back to patients, because they will know very 
shortly. I have already spoken at length about how under our bill 
families will no longer feel trapped by their coverage or fearful about 
children with preexisting conditions. Health care reform, I am happy to 
say, is now the law of the land. I encourage my colleagues to join me 
today in quickly adopting these small technical fixes to the 
legislation so we may move on to more pressing challenges.
  I reserve the balance of my time.


                         Parliamentary Inquiry

  Mr. TIAHRT. Parliamentary inquiry.
  The SPEAKER pro tempore. The gentleman will state his parliamentary 
inquiry.
  Mr. TIAHRT. Madam Speaker, this rule is to amend a reconciliation 
bill that is amending a bill that no longer exists. The bill has been 
signed into law. Therefore, the references in the reconciliation bill 
are no longer accurate. Is it possible for us to wait until the bill 
that has been signed into law has been codified so we can have accurate 
references in the reconciliation bill? Otherwise wouldn't the House be 
voting on an inaccurate piece of legislation?
  The SPEAKER pro tempore. The gentleman has not stated a proper 
parliamentary inquiry. The issue he raises is a matter of debate.
  Mr. TIAHRT. Madam Speaker, further parliamentary inquiry.
  The SPEAKER pro tempore. The gentleman will state his parliamentary 
inquiry. The issue he raises is a matter for debate.
  Mr. TIAHRT. Madam Speaker, I believe this bill will be inaccurate. 
The reconciliation bill is inaccurate in its current form, and the rule 
should be withdrawn until proper references can be made because an 
inaccurate bill will be voted upon.
  The SPEAKER pro tempore. The gentleman will suspend. The gentleman 
has not stated a proper parliamentary inquiry.

[[Page 5127]]


  Mr. TIAHRT. Madam Speaker, once again, doesn't it require that the 
legislation presented to the floor of the House has to be accurate in 
order for us to vote on it?
  The SPEAKER pro tempore. The Chair will not interpret the pending 
resolution.
  Mr. TIAHRT. Madam Speaker, parliamentary inquiry. Is it not true that 
when a bill becomes law it is no longer a bill; therefore, when we 
amend a nonexisting bill, we cannot vote on an accurate piece of 
legislation? Is it not in the rules of the House that we have to vote 
on accurate legislation?
  The SPEAKER pro tempore. The gentleman will suspend. The gentleman 
has not stated a proper parliamentary inquiry. The Chair will not 
entertain debate under the guise of a parliamentary inquiry at this 
time.
  Mr. TIAHRT. I'm not trying to debate; I'm simply trying to understand 
the rules. My question was not answered on the parliamentary inquiry.
  The SPEAKER pro tempore. The gentleman will suspend.
  The Chair recognizes the gentleman from California.
  Mr. DREIER. Madam Speaker, let me first extend my appreciation to my 
good friend from Rochester, New York, Ms. Slaughter, for yielding me 
the customary 30 minutes, and I yield myself such time as I may 
consume.
  Madam Speaker, last Sunday when we opened debate here on the rule, I 
opened by condemning the attacks that have been made on Members of this 
institution, their families and their staffs. Unfortunately, it is 
something which all of us who have been privileged to serve in elective 
office and as Members of Congress in particular have had to face for 
many years. I will reiterate, Madam Speaker, violence or the threat of 
violence is simply unconscionable, and we all join together in calling 
for an immediate end to these types of utterly unacceptable acts.
  Madam Speaker, last Sunday I also predicted that we would be back 
here voting once again on the reconciliation bill. And here we are.
  The need for another vote is further demonstration of just how flawed 
the tactics of the Democrats in charge of Congress have been. It 
shouldn't surprise anyone, Madam Speaker, that the reconciliation bill 
was found to violate Senate rules, as traditionally has been the case 
with the only exception in 1983. No legislation of this magnitude can 
be slapped together at the last minute and then withstand scrutiny. Our 
revote today is just further evidence of the perils of the refusal of 
the Democrats in charge to act in a bipartisan and open way.
  We have been debating the issue of health care reform in the Congress 
for a long period of time. As a Nation, we have been struggling with 
the very serious issue of increasing access to quality care for many, 
many, many years. We all want to expand coverage and improve quality 
for the American people. There are a number of key reforms that enjoy 
broad bipartisan support that would bring us much, much closer to that 
goal.
  Yet, despite these opportunities for bipartisanship, Madam Speaker, 
the Democrats in charge insisted on forcing through the most partisan 
and costly bill possible. And despite all the time that has been spent 
on this issue, they insisted on forcing through a reconciliation bill 
that was largely written the night before we voted on it. Again, Madam 
Speaker, this was written in large part the night before we voted on 
it. That is why it should be no surprise, and there were those of us 
last Sunday who predicted that we would be back here.
  Less than a week after that vote, serious mistakes in the legislative 
package have already been discovered, as I have said. Today's 
underlying package, as I said at the outset, has been returned to the 
House because it contained provisions that violated Senate rules.
  Far more significant, however, are the mistakes that have been 
uncovered relating to a key provision in the Senate health care bill 
that is now law, mistakes that will not be fixed today; and I 
underscore, mistakes that will not be fixed today. One of the 
centerpieces of that legislation was a provision to ensure that no 
child is denied coverage for a preexisting condition. This is an issue 
that again enjoys overwhelming bipartisan support. I believe very 
passionately in the need to ensure that no one is denied coverage for 
preexisting conditions.
  Madam Speaker, had we taken a responsible, step-by-step approach to 
reform, this provision dealing with preexisting conditions could have 
been signed into law months ago; but because the Democrats in charge 
shunned bipartisan cooperation and an open, transparent process, 
forcing through a hyper-partisan bill with no opportunity for open 
debate or any amendment, their $1 trillion bill passed Congress without 
any real accountability.
  The result? They botched the language on preexisting conditions and 
we now know, Madam Speaker, that children will not get the coverage 
that they were promised. This is the inevitable result of a closed, 
partisan process.
  Even the good ideas that are put out there that both Democrats and 
Republicans alike can come to an agreement on are undermined by a lack 
of scrutiny and transparency. Their bill was certainly filled with a 
lot of terrible ideas. Spending $1 trillion we don't have and hiring 
tens of thousands of new IRS agents to investigate hardworking 
Americans ranks at the very top of that list. But even the provisions 
like preexisting conditions that had bipartisan support are being 
undermined by shoddy work.
  While the legal experts sort out the mess that was made of the 
legislative language, job creators are assessing just how much damage 
has been done to them. Today, The Wall Street Journal pointed out that 
companies large and small are taking stock of the new taxes that have 
been imposed and what the impact will be.
  Now, we had an exchange upstairs about the fact that we have seen the 
stock market go up, and we all know that the stock market has gone up. 
But that does not belie the fact that Caterpillar will face $100 
million in new taxes in the first year alone. The medical device 
company Medtronic fears it may have to lay off 1,000 workers in order 
to pay the new taxes.
  Madam Speaker, with the national unemployment rate as we all know 
hovering just under 10 percent, this could not be a worse time to 
impose job-killing tax increases. The prospect of crippling new taxes 
and further job losses is not acceptable. We should focus on creating, 
not losing, good private sector jobs.
  The process of reforming the so-called reform bill and undoing the 
damage that has been done will take years, wasting untold taxpayer 
dollars we cannot afford. Wasting precious time while the American 
people wait for real reform that actually improves access to quality 
health care is a waste. It shouldn't be done, and this is a tragically 
missed opportunity.
  To the many Americans who are outraged by this bill and the process 
by which it was considered, and by the way, we are here under what is 
known as martial law rule. We just completed our meeting in the Rules 
Committee a few minutes ago, and without any consideration we have come 
right down to the House floor. People are outraged with this process. 
That has played a role in creating the anger that is there. I can only 
say there are still some Members of Congress, and I am one of them, who 
believe in bipartisan cooperation--in bipartisan cooperation, and we 
believe, as was promised in a new direction for America that then-
Minority Leader Pelosi put forth for the American people and said she 
would have when she took the oath in January of 2007, an open, 
transparent process. To many Americans who had high hopes for a true 
reform bill, I will say there are still some Members of Congress who 
will fight for real reform even if the Democrats in charge will not do 
that.
  We will fight to ensure that all Americans have effective guarantees 
of coverage despite preexisting conditions. We will fight for 
meaningful lawsuit abuse reform, and we will work to allow small 
businesses and States to band together to offer better and more 
affordable coverage.

[[Page 5128]]

  We will work to ensure that government bureaucrats never come between 
patients and doctors. We will make sure that no one will be forced to 
give up their current coverage if they do not so choose, and that those 
who have diligently saved in their health savings accounts are not in 
any way punished.
  If we can abandon the failed tactics that the Democrats in charge 
have put forward and work in an bipartisan and open fashion, these are 
the kind of real reforms that can be enacted so all Americans will have 
access to quality, affordable health insurance.
  I reserve the balance of my time.


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore. The Chair reminds Members and staff they 
should not traffic the well while a Member is under recognition.


                         Parliamentary Inquiry

  Mr. TIAHRT. Madam Speaker, I have a parliamentary inquiry.
  The SPEAKER pro tempore. The gentleman will state his parliamentary 
inquiry.
  Mr. TIAHRT. Madam Speaker, is it within the rules for the majority 
manager to withdraw a rule at this stage in the debate?
  The SPEAKER pro tempore. The gentleman is correct.
  Mr. TIAHRT. Is it also true that since the legislation that will be 
amended is inaccurate and does not have correct references to existing 
law, that we should not have a vote on it, that the rule should be 
withdrawn?
  The SPEAKER pro tempore. The gentleman has not stated a proper 
parliamentary inquiry.
  Mr. TIAHRT. Madam Speaker, since the bill that is being amended no 
longer exists, the references are inaccurate. How can we possibly have 
a vote on an inaccurate bill?
  The SPEAKER pro tempore. The gentleman will suspend. The gentleman is 
engaging in debate and has not stated a proper parliamentary inquiry. 
The Chair will not entertain debate under the guise of a parliamentary 
inquiry.

                              {time}  1900

  Ms. SLAUGHTER. Madam Speaker, I yield 3 minutes to the gentleman from 
Massachusetts (Mr. McGovern), a member of the Rules Committee.
  Mr. McGOVERN. Madam Speaker, the time is now. On the issue of health 
insurance reform, just about everything has been said and just about 
everyone has said it.
  On Sunday, this House passed the most meaningful health care bill in 
over 40 years. We voted to end the most abusive practices of the 
insurance companies, to provide coverage to millions of hardworking 
families, to bring down the costs of health care for families and small 
businesses, and to pass the biggest deficit reduction package in 25 
years. That reform is now the law of the land.
  Already, we hear from our friends on the other side of the aisle 
saying that they want to repeal that law. They want to allow insurance 
companies to once again discriminate against people because of 
preexisting conditions. They want to take away help for small 
businesses to purchase insurance for their workers. They want to 
continue to let families go bankrupt because of their medical bills. 
That doesn't make much sense to me, Madam Speaker.
  The bill before us today provides important improvements to the law 
by improving affordability for working families. It strengthens 
provisions to attack waste, fraud, and abuse in Medicare and Medicaid. 
It strengthens consumer protections, including prohibiting lifetime 
limits and the practice of dropping people when they get sick. It 
closes the doughnut hole in Medicare and extends the solvency of that 
vital program, and it removes the special fixes for Nebraska and 
Florida.
  This has been a contentious debate, and we have spent a lot of time 
arguing about things that don't matter a whole lot to people in their 
everyday lives; things like reconciliation and filibuster and CBO and 
parliamentarians. So I'd like to close by focusing this debate back 
where it belongs, on the American people.
  Last week, a letter to the editor appeared in the Orlando Sentinel, 
and I'd like to read it. And I quote:
  ``Three months ago, my wife became pregnant. Two months ago, she 
miscarried. Today, the insurance company refuses to insure her for at 
least 5 years because the company classifies a miscarriage as a 
preexisting condition. This is the only reason insurance is being 
denied.
  ``If life is to be truly valued in America, then we must all pull 
together to make health care available for all our citizens. This is 
the greatest moral issue facing our Nation today.''
  Signed, Blake Harrington, Orlando.
  Well, Mr. Harrington, your voice has been heard, and because of this 
Congress and this President, no family will have to go through what you 
did.
  The time is now, and I urge my colleagues to support this rule and 
the underlying bill.
  Mr. DREIER. Madam Speaker, at this time, I'm happy to yield 2 minutes 
to a very hardworking new Member who's an expert on TennCare, an 
obstetrician from Johnson City, Tennessee (Mr. Roe).
  Mr. ROE of Tennessee. Madam Speaker, a recent news article posed a 
question that gets at the heart of this debate: Will the law as the 
Democrats have planned spur economic growth by lowering health care 
costs and allowing companies to expand and hire new employees or, as 
many business advocates have argued, will the opposite occur? It's a 
good question. It is a fair question. So let's look at the evidence 
that we have.
  In Massachusetts, they passed a plan with broad mandates and an 
exchange-like health care marketplace. The plan has resulted in the 
highest insurance premiums in America, rising faster than anywhere else 
in America as a percent, and a large number of individuals forego 
insurance until they get sick, then they show up and get the care and 
pay a relatively low penalty.
  In Tennessee, where we've expanded our State's Medicaid program, we 
saw employers shift the cost to the public sector and then watch as our 
program tripled in costs. Now, before any of these expansions go into 
law, our State's being forced to limit enrollment and ration care.
  And nothing in this bill helps control costs like tort reform, and 
it's nowhere to be seen. And trust me, as an OB-GYN doctor, one of the 
things you could do for our patients is to work on this very needed 
bill, apart from this bill, and we could do it separately, and yet we 
haven't done that.
  What's being proposed now is combining the worst part of both State 
systems, and I think the evidence clearly shows that costs will be 
higher and with the decreased access and lower quality. The American 
people deserve to know that this bill flies in the face of real-world 
experience and it deserves to be defeated.
  Another comment, Madam Speaker, I'd like to make is that, in my years 
of experience, I have not seen a patient's health care denied or a 
preexisting condition because of a miscarriage. I have personally not 
seen that, and I'd like to see reference to that if I could.
  Ms. SLAUGHTER. Madam Speaker, I am pleased to yield 2 minutes to the 
gentlewoman from California (Ms. Matsui), a member of the Rules 
Committee.
  Ms. MATSUI. Madam Speaker, I rise today in support of the rule and 
underlying legislation.
  The health care package that we passed on Sunday and have the 
opportunity to finalize today represents years and sometimes decades of 
work put in by many of my colleagues here in the House, and it also 
represents the hopes and dreams of millions of Americans who live one 
accident away from bankruptcy, one paycheck short of making ends meet.
  I've heard from many of the families and seniors who live in my 
district who've been terrified as they see their insurance rates go up, 
and fearful of losing their insurance and high quality of care.
  But in between the time this House passed one of the most important 
legislative initiatives in our lifetime and today, I have started to 
hear from many Sacramentans with a simple message: Thank you. Thank you 
to this Congress for having the courage to stand up for what's right. 
Thank you to the Speaker for her leadership in delivering this bill to 
the American public.

[[Page 5129]]

  And I would like to say thank you back to the millions of Americans 
who voiced their strong support of the health care bill. You may not 
have always been the loudest voice in the room, but that doesn't mean 
we don't hear you.
  Thank you to my colleagues for standing up for the American people in 
the many hearings, markups, town halls, and floor debates we've had on 
this issue. I look forward to standing with you today as we pass these 
improvements on the historic legislation passed on Sunday.
  I urge my colleagues to support this rule and the underlying 
legislation as we stand together and ensure the quality health care 
Americans deserve at a cost they can afford.
  Mr. DREIER. Madam Speaker, I yield myself such time as I might 
consume, and I would like to engage in a discussion, if I might, with 
my good friend from Johnson City, Tennessee, who, as we say, appears to 
be the only medical doctor here on the House floor at the moment.
  He was just discussing his role and many years he's served, worked as 
an obstetrician, and one of the things that we have found, reports 
are--and this is before this bill was even considered--that there are 
many people who are in a position where they are being told, people who 
are under Medicare, that they are being refused an opportunity to have 
the kind of physician choice that they want.
  We regularly have heard throughout this debate that you'll be able to 
choose your own doctor. But, Madam Speaker, I ask the question: Will 
your doctor choose you? What kind of incentive do we have at this 
juncture for people to get into the medical profession?
  And I'd like to yield, if I might, to my friend from Johnson City, if 
he might respond to this notion of, well, you may be able to choose 
your doctor, but will your doctor choose you. And I am happy to yield 
to my friend.
  Mr. ROE of Tennessee. In our State right now, let me just give you 
some real-world experience as to what's going on in our State-run plan, 
TennCare, which is the State Medicaid plan.
  Right now, we're discussing limiting patient visits to eight per 
year, no matter how many times you may need to go to the doctor.
  Number 2, the State's considering paying only $10,000 in total for a 
patient visit to the hospital, no matter what the cost is, meaning that 
those costs are going to get shifted to private insurers. And over 
time, if that occurs, and we expand massively the Medicaid system 
around the country, you're going to shift more and more cost to the 
private insurers, and when that happens, eventually they're going to 
fail. And I think that may be the purpose here.
  The other thing is that I had a friend of mine visit this week from 
home, and right now, to get an orthopedic surgeon to see you, you're 
going to have to drive 100 miles to see this orthopedic surgeon.
  The State of Tennessee, as of the 1st of July of this year, will no 
longer cover rehabilitative services for a patient who's operated on or 
any rehabilitative services for an injury. That's what we have now. And 
we're asking our State to take on more and more cost.
  And what concerns me--it's not about the good things that are in this 
bill, and there are some things I agree with very much. But the other 
things are how do we pay for it, and how do we then find someone to pay 
for the care?
  The other little caveat is that these plans never pay for the cost of 
the care. TennCare, right now, pays about 60 percent of the cost and 
going down. Medicare, as you know, pays about 80 to 90 percent of 
physician cost.
  Mr. DREIER. I thank my friend for his remarks. And let me just say, 
this notion of you may choose your doctor but your doctor may not 
choose you, is that a fair assessment?
  I'm happy to further yield to my friend.
  Mr. ROE of Tennessee. It is a fair assessment. And now, countrywide, 
40 percent of our primary care physicians choose not to see a Medicaid 
patient, and 60 percent of specialists. It's estimated that it will be, 
when this plan goes into effect, 60 percent of primary care physicians 
won't see these patients and 80 percent of specialists won't see these 
patients.
  Mr. DREIER. And that's why I was arguing that it is really difficult 
to imagine why it is that people will pursue the medical profession, as 
the gentleman has done so ably over the years.
  And I am happy to further yield to my friend.
  Mr. ROE of Tennessee. Thank you for yielding.
  One of the things that is disturbing, and I have taught medical 
school and taught medical students, only 2 percent of our graduates now 
are going into primary care. And I'm in a group with 70 primary care 
doctors. I was in a group until I came to Congress. And we can't get 
our best and brightest to go into primary care. And it's a real quality 
issue, because what concerns me about our Medicare plan is this: At the 
time I came up here, I was having problems finding primary care 
doctors, internists, family practice to see my patients that I'd 
operated on.
  Mr. DREIER. I thank my friend.
  Madam Speaker, I reserve the balance of my time.
  Ms. SLAUGHTER. Madam Speaker, I feel I need to introduce Dr. Donna 
Christensen, who is a medical doctor from the Virgin Islands, for 15 
seconds.
  Mrs. CHRISTENSEN. The legislation that we have before us will take 
insurance companies out of the doctor/patient relationship. There will 
be more incentives for doctors. There will be more National Health 
Service Corps positions, more loan repayments to bring doctors into the 
system, and doctors will go into neighborhoods where they've never gone 
before because Medicaid will pay more and Medicare will pay more.
  Mr. DREIER. Madam Speaker, I reserve the balance of my time.
  Ms. SLAUGHTER. Madam Speaker, I yield 2 minutes to the gentleman from 
Colorado (Mr. Perlmutter), a member of the Rules Committee.
  Mr. PERLMUTTER. Madam Speaker, this morning I was at a meeting, a 
breakfast of the Epilepsy Foundation of America. I have a daughter who 
has epilepsy, and she and one of my other daughters and I attended this 
breakfast.
  And the relief that people feel, particularly parents, about us 
having passed this bill, us working to advance, really, freedom by 
doing away with the discrimination against people who have prior 
illnesses was palpable in that room. And as a dad, I can tell you, we 
have advanced the cause of millions of people across this country.
  Everybody in this room has somebody who's close to them. It could be 
a family member, could be a friend, a neighbor who has a prior illness, 
has some kind of condition, suffered in some accident, and what we've 
done is given those people the freedom to have some health care so they 
can seize the opportunities that this Nation provides.
  It's relief. It's freedom. It's civil rights that we passed in this 
last couple of days. And I know it's been contentious and I know there 
are strong philosophical differences, but when the rubber hits the 
road, for parents, for kids, for people who have these kinds of 
preexisting conditions, we really advanced the ball for them, and we 
advanced the cause of freedom.
  Mr. DREIER. Madam Speaker, I yield myself such time as I might 
consume, and I would like to engage in a discussion, if I might, with 
my friend and argue that I totally concur. We totally concur with the 
need to work on this issue of preexisting conditions.
  The problem, Madam Speaker, has been that while this was 
extraordinarily well-intentioned, we've already found that this 
shoddily put together bill has denied the addressing of preexisting 
conditions. There are people out there who unfortunately believe, Madam 
Speaker, that the issue of preexisting conditions has been taken care 
of. One needs to look at the news reports right now of the problems 
that exist with our shared bipartisan goal of addressing that issue.
  I reserve the balance of my time.

[[Page 5130]]



                              {time}  1915

  Ms. SLAUGHTER. Madam Speaker, I yield 2 minutes to the gentleman from 
California (Mr. Stark).
  Mr. STARK. I thank the gentlelady for yielding.
  Madam Speaker, since 1985, I have worked for today as we finish our 
job to enact health care reform in America. This reconciliation bill 
provides affordability of insurance premiums for low- and middle-income 
Americans. We've delayed the impact of the Cadillac tax plan on health 
benefits and ensured that changes are financed in a fair manner.
  The reform bill signed into law by President Obama is a historic step 
for our Nation. These bills provide health security for all families. 
The people with no coverage are guaranteed affordable coverage. Those 
who currently have insurance will find that coverage improved and more 
secure.
  I am honored to have helped to get us to this point. I look forward 
to working with all of my colleagues and the administration as we 
implement this vital new law. Today, we join all modern countries in 
providing quality, affordable health care to all. It's a great day for 
America.
  If I didn't think they'd take down my words, I would want to say 
``yippie.''
  Madam Speaker, the staff of the Committee on Ways and Means, as well 
as staff from the other Committees, leadership offices and support 
agencies, logged countless hours to make this legislation a reality. We 
owe them our thanks for their efforts to bring us to this day.
  Current and former staff from my office and from the Committee on 
Ways and Means who worked on this legislation over the past year 
include: Janice Mays, John Buckley, Cybele Bjorklund, Debbie Curtis, 
Chiquita Brooks-LaSure, Jennifer Friedman, Geoff Gerhardt, Tiffany 
Swygert, Drew Crouch, Marci Harris, Tom Tsang, Drew Dawson, Ruth Brown, 
John Barkett, Mark Schwartz, Matthew Beck, Lauren Bloomberg, Brian Cook 
and Cameron Branchley.
  Because this legislation was really a product of three committees, 
I'd like to also recognize the health staff of the Committees on Energy 
& Commerce and Education & Labor.
  We are truly indebted to the staff of the House Office of Legislative 
Counsel--Ed Grossman, Jessica Shapiro, Megan Renfrew, Henry Christrup, 
Wade Ballou, Lawrence Johnston and others in the office that I may have 
missed--who turn our ideas into legislative language.
  Finally, I'd like to recognize and thank the very capable analysts at 
the Congressional Budget Office and Joint Committee on Taxation. Doug 
Elmendorf, Phil Ellis, Holly Harvey and the rest of the CBO team, as 
well as Tom Barthold and the JCT professional staff, have worked 
tirelessly to provide guidance, technical assistance and key analyses 
of the costs and effects of the various proposals during consideration 
of health reform legislation over the past 15 months.
  On behalf of the Committee on Ways and Means, thank you all.
  Mr. DREIER. May I inquire of the Chair how much time is remaining on 
each side?
  The SPEAKER pro tempore. The gentleman from California has 14\3/4\ 
minutes remaining. The gentlewoman from New York has 15\1/2\ minutes 
remaining.
  Mr. DREIER. I will reserve the balance of my time, Madam Speaker.
  Ms. SLAUGHTER. I yield 2 minutes to the gentleman from New Jersey 
(Mr. Pallone).
  Mr. PALLONE. This is the last step that we must take to make health 
insurance reform a reality in this country for millions of Americans. 
For far too long, the Federal Government has allowed insurance 
companies to get away with the most abusive practices that prevent 
people from getting the medical treatment that they need to be healthy.
  Earlier this week, we said ``no more.'' Just as the leaders of the 
civil rights movement did before us, this House took the courageous 
step to put an end to the blatant discrimination that millions of 
Americans suffer from every year at the hands of insurance companies. 
We said that we aren't going to let insurance companies put profits 
before people anymore. We've said that we're going to put patients and 
their doctors back in charge.
  I know already I'm hearing from the other side of the aisle, Let's 
repeal and replace this bill. What I want to know is what do they want 
to repeal first? Closing the doughnut hole in Medicare so that seniors 
can afford their medicines? Or stopping insurance companies from 
dropping people's health insurance when they get sick and need it most? 
Or letting dependents stay on their parents' health care policy until 
the age of 26, especially amid a recession when it's hard for people to 
even find a job? Or maybe even providing small businesses with tax 
credits to help them afford health insurance for their employees.
  Madam Speaker, in the last few days I have heard from so many people 
here in Washington as well as at home about how important this bill is 
and makes a difference in their lives on a daily basis and is going to 
be good for them and their families.
  We've already taken a great step forward on behalf of the American 
people. Republicans shouldn't let us take it back. We can't let that 
happen. Let's just keep moving forward. Let's take this last step. 
Let's finish the job and pass this bill on behalf of America's 
families. Vote ``yes.''
  Mr. DREIER. Madam Speaker, at this time I am happy to yield 1\1/2\ 
minutes to a very hardworking member of the Committee on Rules, the 
latest recipient of the Ronald Reagan award, our friend from 
Grandfather Community, North Carolina (Ms. Foxx).
  Ms. FOXX. I thank my colleague from California for yielding time.
  I want to say that it has been said over and over again that 
Republicans want to block health care reform. We don't want to block 
health care reform. We want commonsense health care reform--not an 
overhaul of the system that is a government takeover of health 
insurance and health care in our country.
  One of the things that people tell me they dislike the most about the 
way the Congress operates is when the Democrats put together two bills 
that are totally unrelated because one of those bills cannot get passed 
on its own. That is what happened in the reconciliation bill, a bill 
totally unrelated to health care where the government is going to take 
over the student loan program in this country making the Federal 
Government the fifth largest bank. That is reprehensible to the people 
of this country. We shouldn't have done that.
  I offered an amendment in the Rules Committee to separate those two. 
The bill on student loans should have stood on its own but it can't and 
so it got attached to this bill. These are minor technical amendments, 
but we were denied major amendments. One hundred nine amendments were 
offered in the Rules Committee on Saturday. We had 13 hours of debate. 
Some of our amendments were excellent amendments and should have been 
accepted.
  We want reform. Republicans want to change many things. We want to 
take care of preexisting conditions; we want to lower the cost. The 
problem with this bill is it doesn't lower costs; it makes them larger.
  Ms. SLAUGHTER. Mr. Speaker, I yield 3 minutes to the gentleman from 
California (Mr. Waxman).
  Mr. WAXMAN. Mr. Speaker, earlier this week history was made with the 
enactment into law of the comprehensive access to quality affordable 
health insurance for all Americans. Tonight we complete action on this 
legislation and cement for all Americans their sense of security that 
they will always be able to afford and access health care for 
themselves and their families.
  Since our passage of the underlying legislation last weekend, the 
American people are beginning to fully appreciate the benefits that we 
have written into law. When fully implemented, reform will bring 32 
million uninsured Americans into the health insurance system, seniors 
will see immediate help with the cost of their prescription drugs, and 
people who have preexisting medical conditions will not be denied 
health insurance or charged more for that insurance. If you lose your 
job, you will not lose access to health care.
  Our vote tonight improves on what President Obama signed into law on 
Tuesday. This includes closing the gap in Medicare prescription drug 
coverage, including the rebate this year to eligible seniors; improving 
affordability for those with income up to 400

[[Page 5131]]

percent of the poverty level; eliminating the special Medicaid deal for 
Nebraska; and increasing matching rates to States for the costs of 
services to newly eligible individuals to 100 percent for the first 3 
years of coverage expansions.
  Increasing Medicaid payments. The rates will be increased for primary 
care physicians so that new Medicaid beneficiaries will have access to 
primary care and a greater investment into community health centers. 
These initiatives are fully funded and paid for.
  The reconciliation bill reduces the deficit by more than $1 trillion 
over the next two decades.
  Health security is a fundamental right for every American, and we 
remain faithfully committed to that objective.
  I want to use my time here to give special thanks to our health team 
on our staff. First of all I want to single out Karen Nelsen, who has 
been director of the health staff going back to the time I was chairman 
of the Health and Environment Subcommittee and during the time we were 
over at the Oversight and Government Reform Committee. With her able 
assistance, we have Jack Ebeler, Tim Gronniger, Andy Schneider, Purvee 
Kempf, Brian Cohen, Ruth Katz, Anne Morris, Tim Westmoreland, Stephen 
Cha, Virgil Miller, Katie Campbell, Bobbie Clark, Sarah Dupres and 
Naomi Seiler.
  I want to just close by saying I wish the Republicans would have 
worked with us instead of fighting this bill every step of the way. 
They're complaining now they didn't get amendments, but when we called 
on them to help us, they said no. They wouldn't work with us on the 
stimulus bill, they wouldn't work with us on the energy bill, they 
wouldn't work with us on the health bill, but we got it done anyway.
  Mr. Speaker, the bill is to be commended as a model of cooperative 
federalism. Under the new law, ``a State is free to establish a health 
insurance exchange if it so chooses. But if it declines, the Secretary 
will establish an exchange.'' This is a strong example of what the 
Supreme Court has recognized as an appropriate exercise of federal 
power to encourage State participation in important federal programs. 
``[W]here Congress has the authority to regulate private activity under 
the Commerce Clause, we have recognized Congress' power to offer States 
the choice of regulating that activity according to federal standards 
or having state law pre-empted by federal regulation. Hodel v. Virginia 
Surface Mining & Reclamation Assn., Inc., supra, 452 U.S., at 288, 101 
S.Ct., at 2366. See also FERC v. Mississippi, supra, 456 U.S., at 764-
765, 102 S.Ct., at 2140. This arrangement, which has been termed ``a 
program of cooperative federalism,'' Hodel, supra, 452 U.S., at 289, 
101 S.Ct., at 2366, is replicated in numerous federal statutory 
schemes.'' New York v. United States, 505 U.S. 144, 165 (1992).


                       Individual Responsibility

  The individual responsibility requirement requires individuals to pay 
a tax on their individual tax filings or provide information 
documenting they fulfill the requirements for having essential minimum 
coverage over the past year. Congress makes the following findings to 
support this requirement, these are in addition to those made on 
Sunday, March 21, 2010:
  (1) The requirement is necessary to achieve near-universal coverage 
while maintaining the current private-public system. It builds upon and 
strengthens private employer-based health insurance, which covers 
176,000,000 Americans nationwide. In Massachusetts, a similar 
requirement has strengthened employer-based coverage: despite the 
economic downturn, the number of workers offered employer-based 
coverage has actually increased. Sharon K. Long and Karen Stockley, 
Massachusetts Health Reform: Employer Coverage from Employees' 
Perspective, Health Affairs, October 1, 2009.
  (2) Under the Patient Protection and Affordable Care Act, if there 
were no requirement, many individuals would wait to purchase health 
insurance until they needed care. Those individuals would then get the 
benefit of the lower premiums that are a direct result of the Act's 
reforms, even though those lower premiums result in part from the fact 
that other younger and healthier people bought insurance at an earlier 
point. Higher-risk individuals would be more likely to enroll in 
coverage, increasing premiums and costs to the government. The Urban 
Institute, January 2008. The requirement will broaden the private 
health insurance risk pool to include healthy individuals, which will 
spread risk, stabilize the market, and lower premiums. Congressional 
Budget Office, An Analysis of Health Insurance Premiums Under the 
Patient Protection and Affordable Care Act, November 30, 2009. It is 
necessary to create effective private health insurance markets 
throughout the country in which improved health insurance products that 
are guaranteed issue and do not exclude coverage of pre-existing 
conditions can be sold.
  (3) Administrative costs for private health insurance, which were 
$90,000,000,000 in 2006, are 26 to 30 percent of premiums in the 
current individual and small group markets. Congressional Budget 
Office, December 2008. The requirement is necessary to create effective 
private health insurance markets throughout the country that do not 
require underwriting, eliminating its associated administrative costs. 
By significantly increasing health insurance coverage and the size of 
purchasing pools, which will increase economies of scale, the 
requirement, together with the other provisions of the Patient 
Protection and Affordable Care Act, will significantly reduce 
administrative costs and lower health insurance premiums.
  (4) Health insurance and health care services are a substantial part 
of the national economy. National health spending is projected to 
increase from $2,500,000,000,000, or 17.6 percent of the economy, in 
2009 to $4,700,000,000,000 in 2019. Centers for Medicare & Medicaid 
Services, Office of the Actuary, National Health Expenditure 
Projections, 2008-2018. Private health insurance spending is projected 
to be $854,000,000,000 in 2009, and pays for medical supplies, drugs, 
and equipment that are shipped in interstate commerce. Centers for 
Medicare & Medicaid Services, Office of the Actuary. Since most health 
insurance is sold by national or regional health insurance companies, 
health insurance is sold in interstate commerce and claims payments 
flow through interstate commerce.
  (5) The requirement, together with the other provisions of the 
Patient Protection and Affordable Care Act, will add more than 
30,000,000 consumers to the health insurance market. Congressional 
Budget Office, Patient Protection and Affordable Care Act, 
Incorporating the Manager's Amendment, December 19, 2009. In doing so, 
it will increase the demand for, and the supply of, health care 
services. According to one estimate, the use of health care by the 
currently uninsured could increase by 25 to 60 percent. Congressional 
Budget Office, December 2008.
  (6) Under the Employee Retirement Income Security Act of 1974, the 
Public Health Service Act, and the Patient Protection and Affordable 
Care Act, the Federal Government has a significant role in regulating 
health insurance. The requirement is an essential part of this larger 
regulation of economic activity, and the absence of the requirement 
would undercut Federal regulation of the health insurance market.
  (7) Payments collected from individuals who fail to maintain minimum 
essential coverage will contribute revenue that will help the Federal 
government finance a reformed health insurance system that ensures the 
availability of health insurance to all Americans.
  The preceding 7 points cite numerous studies and papers which 
illustrate the extensive evidence that the Patient Protection and 
Affordable Care Act, as amended by Section 1002 of the Health Care and 
Education Reconciliation Act, substantially affects interstate 
commerce. These citations are included as hyperlinks or in their 
written entirety for the record.
  Mr. DREIER. Mr. Speaker, it's nice to see you, but I should say for 
the record I did enjoy seeing Ms. Edwards in the chair more than I am 
enjoying seeing you here. But it's always good to see you.
  The SPEAKER pro tempore (Mr. Obey). The Chair thanks the gentleman.
  Mr. DREIER. With that, I would like to yield 1\1/2\ minutes to our 
very hardworking colleague from Bainbridge Township, Ohio (Mr. 
LaTourette).
  Mr. LaTOURETTE. I thank the gentleman for yielding.
  Mr. Speaker, I served 14 years on the Transportation and 
Infrastructure Committee and was proud of the wastewater treatment 
plants that we were able to install in my district. But I have to tell 
you on a busy Friday night, I saw less sewage go through those 
facilities than I've heard here this evening.
  The President invited people down to this big powwow down at Blair 
House. It reminded me of my favorite movie, ``Braveheart,'' where the 
king has all the Scottish nobles down and gonna talk peace, and winds 
up hanging them all in the barn. The takeaway from

[[Page 5132]]

that meeting, however, was the President said, These are the things 
that I agree with you Republicans on.
  So it really surprises me to hear my friend from California say that 
the Republicans didn't want to work together.
  One of the things the President said he thought was horrendous were 
the special deals in this bill. I've heard my friends proudly talk 
about Florida and Nebraska. Unless I am misunderstanding it, 
Connecticut, still a hundred million dollars for a hospital; Montana 
miners are treated differently than everybody else; North Dakota 
frontier counties get an enhanced physician payment; Massachusetts and 
Vermont get higher Medicaid reimbursement rates; and Nebraska and 
Michigan--I thought the health care insurance companies were evil 
around here--they don't have to pay the tax. And the pharmaceutical 
companies, I thought they were bad, but if they're in New Jersey, they 
get a billion dollars.
  Mr. Speaker, I'd like to take the gentleman from California at his 
word. I want to work together, and I would like to offer an amendment 
to this bill.
  So I would ask the distinguished chairwoman of the Rules Committee if 
she would yield to me for the purposes of a unanimous consent request 
so that I could offer an amendment.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. DREIER. I yield my friend an additional 15 seconds.
  Mr. LaTOURETTE. I would ask the gentlelady from New York, would you 
yield to me for the purposes of a unanimous consent request so I could 
amend this bill simply by keeping the President's word to remove these 
special deals.
  Ms. SLAUGHTER. I cannot yield for that purpose.
  Mr. LaTOURETTE. You can't or you won't? Of course you can.
  Ms. SLAUGHTER. I cannot.
  Mr. LaTOURETTE. You will not.
  The SPEAKER pro tempore. The time of the gentleman has again expired.
  Ms. SLAUGHTER. I am happy to yield 3 minutes to the gentleman from 
South Carolina (Mr. Spratt).
  Mr. SPRATT. I thank the gentlewoman for yielding.
  Mr. Speaker, the reconciliation bill before us does more than advance 
the cause of health care. It makes a landmark investment in education, 
one that will make college more affordable for millions of students, 
and all without adding a dime to the deficit.
  Under this bill, Federal student loans will now be made through the 
Direct Loan Program. That means the elimination of $61 billion in bank 
subsidies over the next 10 years. This bill then takes that $61 billion 
and reinvests $36 billion out of it in Pell Grants, raising the value 
of Pell Grants and making college a reality, a possibility, for more 
than 8 million students.
  The bill takes other steps to improve access to college and helps 
students graduate from college. For example, it includes more than $2 
billion for historically black colleges and universities, and it 
invests $2 billion in community colleges which are increasingly 
important in our economy as well as in our educational system because 
our economy more and more demands skilled and educated workers. 
Finally, it helps students after they graduate by lowering the amount 
they will have to repay.
  As we switch to making student loans through the less costly Direct 
Loan Program, I am pleased to see that this bill doesn't try to fix 
what ain't broke. It leaves the current Perkins Loan Program by which 
colleges provide low-interest loans from a revolving fund to low-income 
students, and it makes it easier for colleges to pursue public service 
by canceling loans, the debt incrementally, if they're employed in 
public service.
  Mr. Speaker, a productive economy demands an educated workforce, and 
this reconciliation bill moves us towards that goal at no additional 
cost to the American taxpayer and no impact on the deficit. It's a win-
win solution.
  I urge support for this bill.
  Mr. DREIER. Mr. Speaker, at this time, I am happy to yield 2 minutes 
to the gentleman from Ennis, Texas (Mr. Barton), the hardworking 
ranking minority member on the Committee of Energy and Commerce.
  Mr. BARTON of Texas. I think it's time for us to take a deep breath, 
take a timeout and go home and listen, Mr. Speaker. So I asked the 
Rules Committee this evening to not move this package tonight, but let 
us go home for the next 2 weeks and then come back week after next or 
week after 2 weeks and actually fix what needs to be fixed.
  I listened when my chairman, Mr. Waxman of California, talked about 
the reconciliation package before us fixes the Nebraska problem. Well, 
the way they fix it, Mr. Speaker, is by giving every other State the 
same sweet deal they gave to Nebraska but only for 4 years.

                              {time}  1930

  After 2014, that deal goes away for Nebraska and every other State. I 
don't think that's much of a fix.
  No one on the majority side, Mr. Speaker, has talked about the 
Medicaid trap. When this fully kicks in in 2014, everybody that's 
eligible for Medicaid in the country, that is below 133 percent of 
poverty, has to be in Medicaid and that's their only choice. They 
cannot be in a private sector plan. And obviously we all know they 
don't have the option of not taking the coverage.
  Some of us think that that may be unconstitutional. Even if it's not 
unconstitutional, I don't think it's fair to our low-income Americans 
to say that the only health insurance plan you can have is Medicaid.
  We have talked about the preexisting conditions, Mr. Speaker. This 
bill does require that preexisting conditions be covered. That's a good 
thing, not a bad thing. But it's not funded. They have only got $5 
billion in this bill for 4 years. That's a little over a billion 
dollars a year. You can't cover 8 to 10 million Americans that have 
preexisting conditions and no insurance today for $1.25 billion a year. 
I call that the preexisting short sheet.
  And, finally, this reconciliation package doesn't do anything to 
prevent the requirement in the original Senate bill that's now the law 
that elective funding of abortion be offered in at least one plan in 
each State. I really believe if there was an up-or-down vote on that 
again in this body, that that would be voted down.
  Please vote against this reconciliation package rule. Let us go home 
and listen to our constituents.
  ``Unorthodox Process'': My friend from California Mr. Dreier coined 
the process and procedure that has been forced upon as ``at best, 
unorthodox.'' But it doesn't have to be that way, Mr. Speaker. There is 
no deadline that says we need to push this through tonight. Let's do it 
right.
  Hoping for similar luck to have I had last Saturday when I asked that 
Rules drop the ``deem and pass'' scheme and they did, I asked this 
afternoon in the Rules Committee for an extension on this 
reconciliation vote until after the two-week recess. We could talk to 
our constituents, hear their thoughts. We could look for more issues 
that will need fixing and then fix them. There is no deadline that says 
we need to push this through tonight. Let's do it right.
  The new version of the reconciliation package that we vote on today 
reflects two relatively minor changes made by the Senate to education 
program provisions in the bill. We had to strike these provisions 
because they violated the Byrd Rule that governs budget reconciliation 
bills in the Senate. But that's the point, Mr. Speaker. We rushed, 
rushed, rushed and made mistakes. I shudder at the thought of the 
additional mistakes we'll need to fix as we finally have time to digest 
this massive law.
  My Democrat colleagues insist that the Senate bill is law, signed by 
the President, and that there should be no more debate on the policy. 
But just because it received an entirely partisan majority, and just 
because it was signed by the President, doesn't mean it's good law. 
This was a partisan process, a partisan bill, with bipartisan 
opposition.
  This Act increases the penalty on individuals who fail to comply with 
the new requirement to maintain Washington-bureaucrat-approved 
insurance coverage:
  Modifies the individual mandate penalty in three ways: (1) exempts 
income below the filing threshold from the calculation of the penalty, 
(2) lowers the flat dollar penalty from $495 to $325 in 2015, and from 
$750 to $695

[[Page 5133]]

in 2016, and (3) for individuals paying a penalty based on family 
income, changes the penalty from 0.5% to 1.0% of family income in 2014, 
from 1.0% to 2.0% of family income in 2015, and from 2.0% to 2.5% of 
family income for 2016 and later years.
  This Act increases the penalty on employers who fail to comply with 
the new requirement to buy their employees Washington-bureaucrat-
approved insurance coverage:
  Increases the annual per-employer penalty from $750 per employee to 
$2,000 per employee, and subtracts 30 full-time employees from the 
penalty calculation (e.g., a firm with 100 employees would have to pay 
the $2,000 annual penalty on 70 employees; (100 - 30) x $2,000 = 
$140,000 total annual penalty).
  This Act adds even more federal-mandates on all insurance plans:
  Makes health insurance more expensive by requiring grandfathered 
health insurance plans--those in existence today--to (1) eliminate 
lifetime limits on benefits; (2) restrict annual limits on benefits 
within six months of enactment; and (3) cover certain married and 
unmarried adult ``children'' up to age 26. Group plans may no longer 
exclude coverage for a pre-existing condition for any child under 19.
  This Act traps 90 million people into Medicaid, a broken welfare 
program that half of doctors refuse to accept:
  Increases federal outlays on the Medicaid program by $434 billion 
during 2010-2019, $48 billion more than the enacted bill. The bill 
eliminates the ``Cornhusker Kickback,'' (permanent 100% federal 
financing for Nebraska's newly eligible Medicaid populations) but it 
still includes the ``Louisiana Purchase'' (increased federal funding 
for the State of Louisiana) and other special deals for certain states.
  Ms. SLAUGHTER. I yield 1 minute to the gentleman from New York (Mr. 
Bishop).
  Mr. BISHOP of New York. Mr. Speaker, it has now been just 2 days 
since President Obama signed historic health care legislation into law, 
and it is already evident that the massive effort to frighten and 
mislead the American people is losing steam. Just since the bill 
passed, new polls indicate Americans see through the scare tactics and 
doomsday rhetoric and are growing in their enthusiasm about health care 
reform.
  Had reform been the economic disaster it was portrayed to be, why 
then did the stock market climb nearly 200 points in the day since the 
law was enacted? In a town hall meeting I held on Monday, it was 
evident that my constituents are rejecting the misinformation campaigns 
that have surrounded our efforts for reform and are instead focusing on 
what the bill will do for them both in the short term and the long 
term.
  The bill before us today is a huge step towards ensuring that 
Americans who get sick or injured can focus on their recovery rather 
than worrying about their coverage. Because of this legislation, my 
constituents are assured that they are in control of their own health 
care, not a government agency or a faceless insurance agency 
representative.
  Mr. Speaker, I commend the Senate for acting so quickly on this vital 
legislation. I urge my colleagues to support this rule and the 
underlying legislation.
  Mr. DREIER. Mr. Speaker, at this time I am happy to yield 1 minute to 
our hardworking colleague from Indianapolis, Indiana (Mr. Burton).
  Mr. BURTON of Indiana. I thank the gentleman for yielding.
  My wife's a doctor, and she and a lot of her colleagues have been 
talking, and they have seen these statistics that show that almost half 
of the doctors say they will leave their practices if this bill becomes 
law. Now let's just say that only 10 percent of that is accurate. That 
would be 5 percent of the doctors.
  And with 32 million people that you are adding to the rolls, how in 
the world can you say that you are going to save a trillion dollars 
over the next couple of decades? I mean, come on, nobody in America is 
going to believe that. You are adding 32 million people, you are going 
to have fewer doctors, and we are already short on doctors, and the 
cost is going to go down, and you are going to save money, and you are 
going to save a trillion dollars. Nobody in America believes it.
  And Medicaid, in the State of Indiana, we are going to pick up 
500,000 new people on Medicaid, and you are going to shift the burden 
to Indiana for 500,000 people? It's going to cost an arm and a leg. We 
are going to have to raise taxes there. You are going to have to end up 
raising a lot of taxes here. There is no question about it. You can't 
do what you say you are going to do, and the American people know it.
  Ms. SLAUGHTER. Mr. Speaker, I yield 1 minute to the gentleman from 
Connecticut (Mr. Courtney).
  Mr. COURTNEY. Mr. Speaker, it has been 2 days since President Obama 
signed this bill into law. And after all the overheated, over-the-top 
rhetoric about government takeover, you would expect that the health 
insurance industry would have collapsed in the wake of that act.
  Well, what have we seen from the stock market in the last few days? 
Aetna's stock is up, CIGNA's stock is up, United Health Care stock is 
flat. The fact of the matter is is what we have done is tried to 
reshape a private health insurance market so that people will have a 
coherent, understandable benefit that has a minimum level of consumer 
protection in a provision to make it affordable for working Americans, 
which will be a healthy, prosperous future for our health insurance 
industry, which the minority side indicates that that is something that 
they care about.
  All they have to do is look at their own benefits, their own 
purchasing exchange, which, as Members of Congress, they participate 
in, with a choice of private health insurance plans, comprehensive 
benefits, no rescissions, no lifetime limits, no annual limits. That's 
what we are giving to the American people, what Members of Congress 
have. It's time to move forward and create an end to the days of have 
and have not.
  Mr. DREIER. Mr. Speaker, I yield 1 minute to the gentleman from 
Athens, Georgia (Mr. Broun), another one of our very able medical 
doctors.
  Mr. BROUN of Georgia. I thank the gentleman for yielding.
  This bill, as well as the underlying bill is a farce, just two big 
farces. Let me tell you a couple of things that they won't do and some 
things that they will do.
  The first thing that it will do is it's going to drive millions of 
people out of work. Also, besides that, it's going to drive many 
doctors out of business, as Mr. Burton was just talking about. When 
people have that free health care insurance card issued by the Federal 
Government in their pocket, it's going to be about as worthless as the 
Confederate dollar was after the Civil War because you are not going to 
find any doctors who are going to be willing to take the government 
insurance card.
  So access is going to be worse. It's going to be worse for the people 
who can least afford it to be, and that's the poor people in this 
country as well as senior citizens.
  We need to repeal this bill. We need to stop this reconciliation 
process farce tonight. We need to repeal ObamaCare, and we need to 
replace it with policy that will create more access, create jobs, which 
will lower the cost of health care and not be a government takeover of 
the health care system.
  Ms. SLAUGHTER. Mr. Speaker, I yield 1 minute to the gentleman from 
New York (Mr. Hall).
  Mr. HALL of New York. I thank the gentlewoman for yielding.
  Mr. Speaker, critics are still screaming at the top of their lungs 
that this health reform is tyranny, an end to private hospitals and 
doctors, as we just heard, a government takeover of health care. These 
attacks are drowning out the truth, and I would like to set the record 
straight.
  Nothing in this law, not even that dreaded Washington bureaucrat, 
will come between you and your doctor. The law does keep insurance 
company bureaucrats from denying you care. Secondly, we are actually 
increasing access to private health insurance. In return for those 
millions of new customers, however, insurance companies must end 
abusive practices like dropping you when you get sick.
  Finally, since this bill has been passed, not one hospital or 
doctor's office has been taken over by the government, and I doubt that 
one will. There

[[Page 5134]]

is nothing to suggest that that will happen. That is overblown 
rhetoric, deceptive and wrong. It is time to start telling the truth 
and stop spreading fear. I urge my colleagues to support the rule and 
pass the final piece of health reform.
  Mr. DREIER. Mr. Speaker, I yield 1 minute to our friend from Goddard, 
Kansas (Mr. Tiahrt).
  Mr. TIAHRT. I thank the gentleman for yielding.
  Mr. Speaker, this rule should be withdrawn. The Senate bill is now 
law, and it's the greatest intrusion into our private lives that we 
have seen under this Congress. It's going to hurt our economy, it's 
going to cost us jobs. Plus, there are special provisions within the 
bill that's been signed into law that should have been corrected in the 
reconciliation bill, but this rule fails to address those corrections 
that need to be taken.
  The Louisiana purchase is still law today. It should have been 
corrected. The University of Connecticut hospital that received the 
earmark should have been corrected by this underlying legislation. The 
Hawaiian disproportionate share hospital program is exempt from cuts. 
Other States aren't.
  Tennessee is also exempt from the DSH. The frontier funding in 
counties in some rural areas is exempt and other rural areas are not. 
Montana received special benefits for asbestos, those workers who were 
exposed to asbestos. What about the other 49 States?
  Connecticut and Michigan have got a handful of hospitals that are 
going to get higher Medicare payments because of the legislation, and 
this rule fails to address it and change the underlying bill so that we 
can correct these improper measures.
  So I would request that we withdraw the rule and get a proper bill 
before us.
  Ms. SLAUGHTER. Mr. Speaker, may I inquire as to the time remaining?
  The SPEAKER pro tempore. The gentlewoman from New York has 5\1/2\ 
minutes remaining, and the gentleman from California has 6\1/2\ minutes 
remaining.
  Ms. SLAUGHTER. I reserve the balance of my time.
  Mr. DREIER. Mr. Speaker, may I inquire of my friend how many speakers 
she has remaining?
  Ms. SLAUGHTER. Yes, I have three.
  Mr. DREIER. We don't have that many.
  I reserve the balance of my time.
  Ms. SLAUGHTER. Mr. Speaker, I yield 1 minute to the gentleman from 
Texas (Mr. Hinojosa).
  Mr. HINOJOSA. Mr. Speaker, I rise today in support of this rule and 
the underlying legislation on health and higher education. I thank my 
colleagues in the Senate for their courage in passing this historic 
legislation this afternoon by making the single largest investment in 
financial aid in history.
  Our Nation is taking bold steps to ensure accessibility and 
affordability in higher education for years to come and lead us to 
prosperity, more affordable student loans, and investments of $36 
billion in Pell Grants, scholarships which will help students and 
families pay for college. I am proud that the investments of $2 billion 
in community colleges and $2.55 billion in minority-serving 
institutions will move us closer to building a world-class higher 
education system for all students.
  Over the next 10 years, it is estimated that Texas will receive at 
least $2.4 billion in Pell Grants and a total of at least $2.8 billion 
from the higher education programs funded in this reconciliation 
package.
  HBCUs and HSIs such as the University of Texas-Pan American, South 
Texas College, and Texas Southern University will greatly benefit from 
this legislation.
  This Federal funding will prepare a new generation of minority 
scientists, mathematicians, and innovators in Texas and across our 
Nation.
  I urge my colleagues to vote in favor of the rule and the underlying 
bill.
  Mr. DREIER. Mr. Speaker, at this time I yield 3 minutes to my very 
good friend, another medical doctor who is with us here, the gentleman 
from Lewisville, Texas (Mr. Burgess).
  Mr. BURGESS. I thank the gentleman for the recognition.
  You know, it's ironic, isn't it? Two days ago a bill was signed that 
is going to fundamentally change the way health care is delivered in 
this country for the next three generations, and 48 hours later we are 
back on the floor of this House trying to fix the problems in this bill 
because, Mr. Speaker, we all know when the Senate passed this bill 
Christmas Eve, they didn't intend for this bill to become law. This was 
never the vehicle that was intended to be passed through this House.
  This was a bill that was passed to get the Senate out of town before 
a snowstorm on Christmas Eve. They always planned to come back and fix 
it in conference, but because of an election in Massachusetts those 
plans went by the wayside.
  The Speaker of the House said in January, I don't have a hundred 
Members who will vote for this bill and yet, somehow, the line being 
the shortest distance between two points, we ended up passing this bill 
on Sunday night when we hoped, we hoped the American people were not 
looking at us.
  But we did pass it, and now we have got to come back tonight and fix 
the problems. We will be back next week. We will be back the week after 
that. This bill is going to require significant fixes, probably for the 
remainder of my lifetime on this Earth. This was probably the worst 
product we could have put out there for the American people.
  And what about the insurance companies, their stock prices going up? 
Of course they went up. They got everything they wanted. What did they 
want when this year started? They wanted an individual mandate and no 
public option.
  Guess what, ladies and gentlemen, that's exactly what they got. Who 
is standing on the side of the insurance companies? Who is standing on 
the side of the people? I think you have got that wrong.
  What about PhRMA? They got everything they want. Yeah, you can close 
the doughnut hole but you have got to buy brand-name drugs, and, oh, 
yeah, you can't import drugs from overseas.

                              {time}  1945

  They got exactly what they want and their stock prices have gone up 
this week. Let's not kid ourselves about who is fooling who here.
  I have asked for the White House to give me information on these 
special deals that were cut down at the White House, but we can't get 
that information. We get copies of press releases; we get copies of Web 
pages. The White House has no interest in being transparent in this 
process because they have so much to hide about this bill. This is a 
bad bill for America, it's a bad bill for medicine, it's a bad bill for 
patients. We should do the right thing, come back and try to fix these 
problems in a real way.
  And don't tell me Republicans didn't try, weren't there to help. I 
reached out my hand to the transition team and got it slapped. I 
reached out my hand to my committee chairman and got it slapped. We 
were there and ready to work, but you weren't interested in working 
with us.
  What was the bipartisan nature of this bill? We'll throw it over the 
transom on July 15. Read it quick, because we've got a markup in full 
committee the next day.
  This bill was never intended to pass this House. The Senate passed 
this bill as a last-ditch effort on Christmas Eve to get out of town. 
And what have we done? What have we done? We delivered this bill as the 
law of the land to the American people, and they are correctly outraged 
by what they see.
  You know, you had some experience back in 1988 or 1989; you passed a 
very bad catastrophic care bill. Seniors across this country said this 
will not stand. The former chairman of the Ways and Means got run out 
of his town hall. And we had to repeal that bill. I think we should 
follow that same trajectory here.
  Ms. SLAUGHTER. Mr. Speaker, I yield 1 minute to the gentlewoman from 
Texas (Ms. Jackson Lee).
  Ms. JACKSON LEE of Texas. Mr. Speaker, I have good news, and I thank 
the gentlewoman from New York. While my colleagues are talking about 
process, which has been approved by our Parliamentarians, and while 
profanity reigns on our phones, we are

[[Page 5135]]

saving lives: 45,000 who have died every year because they have not had 
insurance.
  No doctors' offices have closed. The hospitals are open. And the 
attorney generals are filing frivolous lawsuits, because if they would 
look at what the bill stands for and the present bill, they will know 
that the seniors' doughnut hole will be closed, that the special deals 
have been taken out, that community health centers that will allow you 
to come out of your house, walk down the street, and go to a 
physician's office is expanded by $11 billion.
  They will understand that Medicaid has been expanded and right now 
individuals, 133 percent or 400 percent of poverty, can actually go and 
see a doctor. Maybe the mother who has insurance that only covers the 
emergency rooms can now get her children preventative care. Vote for 
this reconciliation bill to save lives.
  Mr. DREIER. Mr. Speaker, may I inquire how much time is remaining on 
each side.
  The SPEAKER pro tempore. Both sides have 3\1/2\ minutes remaining.
  Mr. DREIER. May I inquire of the distinguished Chair of the Committee 
on Rules how many speakers she has remaining.
  Ms. SLAUGHTER. I have one more speaker.
  Mr. DREIER. And then you plan to close?
  Ms. SLAUGHTER. As soon as you have.
  Mr. DREIER. So then no more speakers other than your close. Is that 
it?
  Ms. SLAUGHTER. I have one more speaker, then I hope that you will 
close and then I will close.
  Mr. DREIER. I reserve the balance of my time.
  Ms. SLAUGHTER. I am pleased to yield 2 minutes to the gentleman from 
New Jersey (Mr. Andrews).
  Mr. ANDREWS. I thank the Speaker. I thank the gentlelady.
  The American people very clearly want bipartisanship, but equally 
clearly they don't want paralysis. They have had 40 years of talk about 
solving this problem, and now they want it solved.
  At the Blair House summit, the minority said it would be a good idea 
to have new ways to cut back on fraud and abuse in Medicare, so it's in 
the law the President signed on Monday and in this underlying bill as 
well.
  The minority said that they would like a way for small businesses to 
pool together and make it easier to buy health insurance, so it's in 
the law the President signed on Tuesday and it's in the bill tonight.
  The minority said that they would like to find a way that people 
could buy insurance across State lines, so the bill tonight says that 
the exchanges that are created can be regional across State lines so 
people can buy and sell that way.
  The minority said they would like to see a way to cut back on 
nuisance lawsuits, so it's in the bill the President signed on Tuesday.
  There are many good ideas from both sides in this bill and on the law 
signed on Tuesday, but the best idea is to finally act. After 40 years 
of promises, 40 years of politics, 40 years of paralysis, 40 years of 
inaction, isn't it time that people can't get turned away because they 
have preexisting conditions? Isn't it time that hardworking Americans 
can afford health insurance? Isn't it time that seniors can finally get 
the prescription drug coverage?
  The question tonight is, Whose time is it? It's time for the working 
families and seniors of America. It is time to end the paralysis, end 
the politics and vote ``yes.''
  Ms. SLAUGHTER. I did misspeak. Mr. Rangel has come in, and I would 
like to give him 1\1/2\ minutes.
  Mr. DREIER. I reserve the balance of my time.
  Ms. SLAUGHTER. Let me yield 1 minute to Mr. Rangel, the gentleman 
from New York.
  Mr. RANGEL. Thank you, Madam Chairperson. And on this historic 
occasion, I guess those of us who have served so long in the Congress 
hope and prayed that this day, this night will come. And, of course, a 
lot of us are concerned how we will be remembered. When you reach my 
age, that seems to be a little more important.
  And on this bill, when you just talk about health care and health 
reform, it seems to me that now is an opportunity even for those who 
fought this concept over the years and fought all the concepts such as 
Medicare and Social Security, to think about how they would like to be 
remembered. And I hope that that memory would be that even though the 
bill was not as perfect as they would want it to be, that they did vote 
for health reform, because that means Congresses that follow us, the 
same way we followed those that created Social Security, those that 
created Medicare, will have the opportunity to improve upon it.
  So we are not saying that this is the best legislation ever. We are 
saying this is the best and only opportunity that we have now.
  So I do hope that when the final vote is taken, that we will have it 
as a bipartisan vote.
  Mr. DREIER. Mr. Speaker, now may I inquire of the distinguished Chair 
of the Committee on Rules if she has three or four more speakers? I 
don't know, Mr. Speaker, if the distinguished Chair on the Committee on 
Rules has anymore speakers.
  Ms. SLAUGHTER. I have no further speakers.
  Mr. DREIER. I just wanted to clarify that.
  Mr. Speaker, I yield myself the balance of my time.
  The SPEAKER pro tempore. The gentleman is recognized for 3\1/2\ 
minutes.
  Mr. DREIER. Mr. Speaker, I am going to close the debate as I had 
begun, by denouncing the charges and smears that we have seen over the 
past several weeks. Tragically, those of us who serve as Members of 
Congress for years have dealt with that. It is unacceptable and 
outrageous, and we all join together in decrying the things that we 
have seen.
  Mr. Speaker, there is a high level of frustration over the process 
through which we have gone, and there is an understandable outrage from 
people all across this country for the final work product that we have.
  The process has been, at very best--I am trying to be generous--
unorthodox. The notion of utilizing reconciliation, which is designed 
to reconcile budget discrepancies, for this, is not the right thing to 
do. And it has never, ever, since passage of the 1974 Budget 
Entitlement Act, been used for such a monumental piece of legislation.
  We have tried desperately to work in a bipartisan way, and everyone 
talks about this. But, Mr. Speaker, we have reached out, as Mr. Burgess 
said, time and time again, and we have been rebuffed. The only thing 
bipartisan about this legislation and the vote that we will see 
tonight, Mr. Speaker, is not the support for it but the opposition to 
it.
  Our colleagues on the other side of the aisle have a 70-seat 
majority, and yet many of their Members will be joining us, as they did 
last Sunday night, in opposing this. Why? Because they know that this 
is badly flawed legislation. It's badly flawed legislation, because, as 
we listened to so many medical doctors point out, we are told that you 
can choose your own doctor. We constantly hear that refrain from the 
President and others. But the question is, With the decrease in the 
numbers of doctors out there, will your doctor choose you?
  And then, Mr. Speaker, we get to the question of, Will we or will we 
not be able to pay for this? Well, $1 trillion, 569.2 billion in tax 
increases, and tremendous uncertainty is not going to adequately 
address the challenges that we have.
  We all want to ensure that no one is denied access to health care 
because of preexisting conditions. We can do that in a bipartisan way. 
But, Mr. Speaker, unfortunately, this bill doesn't do that.
  There are people out there who today believe that they will not be 
denied access to insurance because of preexisting conditions. But, 
guess what? Because this bill was so poorly put together, right now 
they are denied access. We want to make sure, and we are happy to work 
in a bipartisan way, to address that concern.
  As we look at the fact that we are back here tonight because of those 
two

[[Page 5136]]

amendments that were problems in the Senate, the fact that we already 
have announced problems with the goal of ensuring that everyone has 
access, is not denied access because of preexisting conditions, and 
when we look at the challenges that have been put forward time and time 
again, we simply ask our colleagues: When we work to clean this up, Mr. 
Speaker, I hope very much we will be able to work in a bipartisan way.
  I urge a ``no'' vote.
  The SPEAKER pro tempore. The gentlewoman from New York is recognized 
for 30 seconds.
  Ms. SLAUGHTER. Mr. Speaker, let me just remind us that we have been 
all this time debating about three lines in the bill. If you want to 
take the nastiness out of the Senate bill, this is the bill you have to 
vote for.
  I ask a ``yes'' vote from all my colleagues on both the previous 
question and on the rule.
  I move the previous question on the resolution.
  The previous question was ordered.
  The SPEAKER pro tempore. The question is on the resolution.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. DREIER. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The vote was taken by electronic device, and there were--yeas 225, 
nays 199, not voting 5, as follows:

                             [Roll No. 193]

                               YEAS--225

     Ackerman
     Andrews
     Baca
     Baird
     Baldwin
     Bean
     Becerra
     Berkley
     Berman
     Berry
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Boccieri
     Boswell
     Boyd
     Brady (PA)
     Braley (IA)
     Brown, Corrine
     Butterfield
     Capps
     Capuano
     Cardoza
     Carnahan
     Carney
     Carson (IN)
     Castor (FL)
     Chu
     Clarke
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly (VA)
     Conyers
     Cooper
     Costa
     Costello
     Courtney
     Crowley
     Cuellar
     Cummings
     Dahlkemper
     Davis (CA)
     Davis (IL)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Dicks
     Dingell
     Doggett
     Donnelly (IN)
     Doyle
     Driehaus
     Edwards (MD)
     Ellison
     Ellsworth
     Engel
     Eshoo
     Etheridge
     Farr
     Fattah
     Filner
     Foster
     Frank (MA)
     Fudge
     Garamendi
     Giffords
     Gonzalez
     Gordon (TN)
     Grayson
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hall (NY)
     Halvorson
     Hare
     Harman
     Hastings (FL)
     Heinrich
     Higgins
     Hill
     Himes
     Hinchey
     Hinojosa
     Hirono
     Hodes
     Holt
     Honda
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson Lee (TX)
     Johnson (GA)
     Johnson, E. B.
     Kagen
     Kanjorski
     Kaptur
     Kennedy
     Kildee
     Kilpatrick (MI)
     Kilroy
     Kind
     Kirkpatrick (AZ)
     Kissell
     Klein (FL)
     Kosmas
     Kucinich
     Langevin
     Larsen (WA)
     Larson (CT)
     Lee (CA)
     Levin
     Lewis (GA)
     Lipinski
     Loebsack
     Lofgren, Zoe
     Lowey
     Lujan
     Lynch
     Maffei
     Maloney
     Markey (CO)
     Markey (MA)
     Matsui
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McMahon
     McNerney
     Meek (FL)
     Meeks (NY)
     Michaud
     Miller (NC)
     Miller, George
     Mollohan
     Moore (KS)
     Moore (WI)
     Moran (VA)
     Murphy (CT)
     Murphy (NY)
     Murphy, Patrick
     Nadler (NY)
     Napolitano
     Neal (MA)
     Oberstar
     Obey
     Olver
     Ortiz
     Owens
     Pallone
     Pascrell
     Pastor (AZ)
     Payne
     Perlmutter
     Perriello
     Peters
     Peterson
     Pingree (ME)
     Polis (CO)
     Pomeroy
     Price (NC)
     Quigley
     Rahall
     Rangel
     Reyes
     Richardson
     Rodriguez
     Rothman (NJ)
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Salazar
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schauer
     Schiff
     Schrader
     Schwartz
     Scott (GA)
     Scott (VA)
     Serrano
     Sestak
     Shea-Porter
     Sherman
     Sires
     Slaughter
     Smith (WA)
     Snyder
     Speier
     Spratt
     Stark
     Stupak
     Sutton
     Tanner
     Teague
     Thompson (CA)
     Thompson (MS)
     Tierney
     Titus
     Tonko
     Towns
     Tsongas
     Van Hollen
     Velazquez
     Visclosky
     Walz
     Wasserman Schultz
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Welch
     Wilson (OH)
     Woolsey
     Wu
     Yarmuth

                               NAYS--199

     Aderholt
     Adler (NJ)
     Akin
     Alexander
     Altmire
     Arcuri
     Austria
     Bachmann
     Bachus
     Barrett (SC)
     Barrow
     Bartlett
     Barton (TX)
     Biggert
     Bilbray
     Bilirakis
     Bishop (UT)
     Blackburn
     Blunt
     Boehner
     Bonner
     Bono Mack
     Boozman
     Boren
     Boucher
     Boustany
     Bright
     Broun (GA)
     Brown (SC)
     Brown-Waite, Ginny
     Buchanan
     Burgess
     Burton (IN)
     Calvert
     Camp
     Campbell
     Cantor
     Cao
     Capito
     Carter
     Cassidy
     Castle
     Chaffetz
     Chandler
     Childers
     Coble
     Coffman (CO)
     Cole
     Conaway
     Crenshaw
     Culberson
     Davis (KY)
     Davis (TN)
     Dent
     Diaz-Balart, L.
     Diaz-Balart, M.
     Dreier
     Duncan
     Edwards (TX)
     Ehlers
     Emerson
     Fallin
     Flake
     Fleming
     Forbes
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Garrett (NJ)
     Gerlach
     Gingrey (GA)
     Gohmert
     Goodlatte
     Granger
     Graves
     Griffith
     Guthrie
     Hall (TX)
     Harper
     Hastings (WA)
     Heller
     Hensarling
     Herger
     Herseth Sandlin
     Hoekstra
     Holden
     Hunter
     Inglis
     Issa
     Jenkins
     Johnson (IL)
     Johnson, Sam
     Jones
     Jordan (OH)
     King (IA)
     King (NY)
     Kingston
     Kirk
     Kline (MN)
     Kratovil
     Lamborn
     Lance
     Latham
     LaTourette
     Latta
     Lee (NY)
     Lewis (CA)
     Linder
     LoBiondo
     Lucas
     Luetkemeyer
     Lummis
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     Marshall
     Matheson
     McCarthy (CA)
     McCaul
     McClintock
     McCotter
     McHenry
     McIntyre
     McKeon
     McMorris Rodgers
     Melancon
     Mica
     Miller (FL)
     Miller (MI)
     Miller, Gary
     Minnick
     Mitchell
     Moran (KS)
     Murphy, Tim
     Myrick
     Neugebauer
     Nunes
     Nye
     Olson
     Paul
     Paulsen
     Pence
     Petri
     Pitts
     Platts
     Poe (TX)
     Posey
     Price (GA)
     Putnam
     Radanovich
     Rehberg
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Rooney
     Ros-Lehtinen
     Roskam
     Ross
     Royce
     Ryan (WI)
     Scalise
     Schmidt
     Schock
     Sensenbrenner
     Sessions
     Shadegg
     Shimkus
     Shuler
     Shuster
     Simpson
     Skelton
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Souder
     Stearns
     Sullivan
     Taylor
     Terry
     Thompson (PA)
     Thornberry
     Tiahrt
     Tiberi
     Turner
     Upton
     Walden
     Wamp
     Westmoreland
     Whitfield
     Wilson (SC)
     Wittman
     Wolf
     Young (AK)
     Young (FL)

                             NOT VOTING--5

     Brady (TX)
     Buyer
     Davis (AL)
     Reichert
     Space

                              {time}  2023

  Mr. ALTMIRE changed his vote from ``yea'' to ``nay.''
  So the resolution was agreed to.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.
  Stated against:
  Mr. SPACE. Mr. Speaker, during the recorded vote on H. Res. 1225, a 
resolution providing for the consideration of Senate amendments to the 
bill (H.R. 4872), I attempted to cast a vote in opposition. Due to a 
malfunction of my voting card, my vote was not recorded. I wish to 
express that my intention was to vote in opposition to the resolution.

                          ____________________