[Congressional Record (Bound Edition), Volume 157 (2011), Part 4]
[House]
[Pages 5890-5905]
[From the U.S. Government Publishing Office, www.gpo.gov]




              REPEALING PREVENTION AND PUBLIC HEALTH FUND

  The SPEAKER pro tempore. Pursuant to House Resolution 219 and rule 
XVIII, the Chair declares the House in the Committee of the Whole House 
on the state of the Union for the consideration of the bill, H.R. 1217.

                              {time}  1520


                     In the Committee of the Whole

  Accordingly, the House resolved itself into the Committee of the 
Whole House on the state of the Union for the consideration of the bill 
(H.R. 1217) to repeal the Prevention and Public Health Fund, with Mr. 
Conaway in the chair.
  The Clerk read the title of the bill.
  The CHAIR. Pursuant to the rule, the bill is considered read the 
first time.
  The gentleman from Pennsylvania (Mr. Pitts) and the gentleman from 
New Jersey (Mr. Pallone) each will control 30 minutes.
  The Chair recognizes the gentleman from Pennsylvania.
  Mr. PITTS. Mr. Chairman, I yield myself such time as I may consume.
  Section 4002 of PPACA establishes a Prevention and Public Health 
Fund, which my bill, H.R. 1217, would repeal. The section authorizes 
the appropriation of and appropriates to the fund from the Treasury the 
following amounts: $500 million for FY 2010; $750 million for FY 2011; 
$1 billion for FY 2012; $1.25 billion for FY 2013; $1.5 billion for FY 
2014; and for FY 2015 and every fiscal year thereafter, $2 billion.
  The Secretary of Health and Human Services has the full authority to 
use this account to fund any programs or activities that she chooses 
under the Public Health Service Act without having congressional input, 
approval or oversight. HHS has already made disbursements from the 
fund, spending $500 million last year, and she has $750 million 
available for her to spend this year to fund prevention activities, the 
Nation's public health infrastructure, workforce expansion, increasing 
immunizations, and preventing a variety of diseases.
  The goals of some of these disbursements are laudable, but we must 
remember that this funding is over and above the amount that Congress 
has already authorized and appropriated for these activities. There 
have also been questionable projects that have been financed with these 
funds, including ``placing signs directing people to bike paths.''
  When Secretary Sebelius testified before my subcommittee, I asked her 
whether she needed further congressional approval to spend the money 
from the section 4002 fund, and she answered no.
  I then asked her if she could fund activities above and beyond the 
level Congress appropriated, and she stated yes.
  This should concern every Member that we have created a slush fund 
from which the Secretary can spend without any congressional oversight 
or approval. No one here can tell us how this funding will be used next 
year or 5 or 10 or 20 or 50 years from now. We can't predict how the 
money will be spent--and worse, we can't even influence it.
  I would suggest to my colleagues that, if you wanted more funding to 
go towards smoking cessation or to any other program, the health care 
law should have contained an explicit authorization, because you are 
not guaranteed that a dime of the money in this fund will go to your 
particular activity.
  By eliminating this fund, we are not cutting any specific program or 
activity. I am not against prevention and

[[Page 5891]]

wellness. This is not what this is about. This is about reclaiming our 
oversight role of how Federal tax dollars should be used.
  I urge support for my bill, H.R. 1217.
  I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the ranking member of 
the Energy and Commerce Committee, the gentleman from California (Mr. 
Waxman).
  Mr. WAXMAN. Mr. Chairman, this bill represents the Republicans' 
newest line of attack to disrupt, dismantle, and to ultimately destroy 
the Affordable Care Act. Today, they are doing so by sacrificing 
longstanding bipartisan policies to push a narrow partisan ideology.
  For many years, Republicans have joined with Democrats in supporting 
programs to prevent disease, to promote health and, in turn, to cut 
health care costs. But today, the House will vote to end funding for 
the first and only Federal program with dedicated, ongoing resources 
designed to make us a healthier Nation.
  Every State in the Union is already benefiting from the resources 
made available from the fund to fight chronic and costly conditions, 
such as obesity, heart disease and diabetes. Repealing the prevention 
fund is a blow against seniors. In States like California, Michigan, 
Iowa, Maine, North Carolina, and Massachusetts, they are using these 
funds to train personal home care aides who assist the elderly with 
Alzheimer's disease and other disabling conditions.
  Terminating the prevention fund is not only extremely shortsighted; 
it will also prove to be fiscally irresponsible. The return on this 
kind of upfront investment--targeted resources to help keep people 
healthy for as long as possible--will over time save precious health 
care dollars.
  We need to preserve the prevention fund because it can serve as a 
cornerstone for a health care system that finally recognizes that 
preventing illnesses is as important as treating them. Until now, 
prevention has too often been just a mere afterthought.
  American families support prevention. They want programs to educate 
seniors to use preventive health services, such as mammograms and 
colonoscopies, which can help extend their lives; and they want 
programs that focus on preventing childhood obesity and diabetes, which 
will help their children to grow up healthy and strong. The American 
people want us to start working together to solve the real problems 
facing our Nation.
  I urge my colleagues to oppose this partisan and divisive 
legislation.
  Mr. PITTS. Mr. Chairman, I yield 3 minutes to the distinguished vice 
chairman of the subcommittee, the gentleman from Texas, Dr. Burgess.
  Mr. BURGESS. I thank the chairman for yielding.
  Mr. Chairman, I do rise in support of H.R. 1217. The bill, as we have 
already heard, repeals the public health slush fund that was included 
in the Patient Protection and Affordable Care Act, which was passed 
just a little over a year ago.
  This fund, called the Prevention and Public Health Fund, is almost 
$18 billion, which accounts for the next 8 fiscal years, and the 
Secretary of Health and Human Services gets to spend this money on any 
program that he or she deems worthy. What the money will be used for 
and how it will be used are, essentially, unknowns. Neither this 
Congress nor subsequent Congresses have any earthly idea.
  It is yet, once again, an abdication of our authority here in the 
United States Congress. It is an abdication of power in deference to 
the executive branch. If that's what people think we were sent here to 
do, to simply carve off greater and greater pieces of our authority and 
hand it over to the White House, then I hope I'm wrong in that; but 
over and over again, with the health care bill, with the financial reg 
bill, it seems like that is the mantra here. It does put way too much 
discretion in the hands of the Secretary of the Department of Health 
and Human Services.

                              {time}  1530

  We've got a predicted shortfall in the Nation's health care provider 
workforce. Some of this money is going to go for scholarships, but it 
sets up a big problem. Under the Public Health Fund, some of those same 
students could receive a scholarship for 1 year, only to find that the 
Secretary has bigger and better things to spend it on next year. Maybe 
there's a new bike path that needs a sign, and that student would find 
their education unfunded because all of the discretion rests with the 
Secretary.
  Now, just a moment ago, the ranking member of the full committee 
stood up and said that it seems like all the Republicans want to do is 
defund and remove the Affordable Care Act. Well, I appreciate his 
noticing, because, Mr. Chairman, that is what the election of November 
2, 2010, was all about. We were elected to come here and do that work 
for the American people.
  And the duplication contained within the slush fund, the ranking 
member talked about smoking cessation. That's a good idea. I believe in 
that. I lost two parents due to tobacco-related illness. But wait a 
minute. What about the duplication? When the ranking member was 
chairman last year, last Congress, he created the Center for Tobacco 
Products at the Food and Drug Administration. We funded that lavishly 
with a brand-new tax, and now we're going to come back and fund it yet 
again with this public health slush fund?
  The ranking member asked about what programs we wanted to cut. 
Really, it's a question of do we want to be accountable to the American 
people who elected us here to do this job. They sent us here to ensure 
their money was spent responsibly and that every penny would be 
accounted for and justified before being spent. With the current state 
of the economy, Mr. Chairman, I'm not sure how the American people feel 
about the Secretary choosing to spend money on signs to direct people 
to bike paths. I know how they would feel about it in my district.
  The CHAIR. The time of the gentleman has expired.
  Mr. PITTS. I yield the gentleman 30 additional seconds.
  Mr. BURGESS. In this law that was signed in the East Room of the 
White House just a little over a year ago, section 4002 takes from 
Congress the oversight of spending, and it becomes a blank check for 
the Secretary to do with as she wishes without any other input from 
Congress. By doing that, it takes that authority away from the American 
people, because we are the closest contact the American people have 
with their Federal Government. And by taking us out of the equation, 
guess what, Madam Secretary? You've got a blank check. It's all yours.
  Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentlewoman from 
California (Mrs. Capps).
  Mrs. CAPPS. I thank the ranking member of my subcommittee for 
yielding me time.
  Mr. Chairman, I rise in strong opposition to H.R. 1217, a bill that 
would defund a key strategic investment in our Nation's long-term 
fiscal and physical health, the Prevention and Public Health Fund. 
Simply put, this fund is a critical effort to make our Nation healthier 
and, in turn, to bring down health care costs.
  This misguided bill would return our Nation to a system of ``sick 
care,'' a system that hasn't worked, rather than one focused on health 
and wellness. That's something we can't afford to do. We all know that 
health care costs are rising at an unsustainable rate. In fact, the 
Republican majority has cited these costs as a reason to propose ending 
Medicare as we know it, by turning it into a voucher program and by 
whacking away at poor people's health care by block-granting Medicaid.
  But one of the key drivers in entitlement spending growth is chronic 
disease, the exact problem addressed by this prevention fund. Yet this 
bill shortsightedly cuts back our efforts to reduce chronic illness and 
promote wellness programs.
  In California, we are putting these funds to work to slow the 
alarming rise in obesity rates, to train our next generation of public 
health professionals, to curb our tobacco use and improve our capacity 
to respond to disease outbreaks.
  At a time when counties have laid off thousands and struggled to 
maintain

[[Page 5892]]

essential public health services, the need for this fund becomes even 
more critical. That's why numerous local governments and national 
organizations, including the National Association of Counties and the 
American Public Health Association oppose this shortsighted bill.
  Furthermore, the fund is a sound investment. Trust for America's 
Health Research has shown that investments in proven, community-based 
programs to increase physical activity, to improve nutrition, and to 
prevent tobacco use could save the country more than $16 billion 
annually within 5 years. This is a return of over $5 for every dollar 
invested.
  Not only do these programs add to our constituents' quality of life, 
but it can also increase their economic output by keeping them healthy 
and in the workforce.
  These are some of the reasons I stand with these folks and urge a 
``no'' vote.
  Mr. PITTS. Mr. Chairman, at this time I yield 3 minutes to the 
gentlewoman from Tennessee (Mrs. Blackburn), who is on the Health 
Subcommittee.
  Mrs. BLACKBURN. Mr. Chairman, I do rise in support of H.R. 1217. I 
think this is an important bill for us to bring forward. And I want to 
thank the chairman for bringing it forward and for helping to lead this 
Congress in the repeal of ObamaCare. It is a message that the American 
people sent loud and clear last November. They do not want to see 
government coming in and controlling their health care choices. That is 
something that should be made by individuals, their family members, and 
their physicians and not by the Federal Government.
  I have found it so interesting, as we have been through the hearings 
on this and through the markups, that we continue to hear, well, this 
$17\3/4\ billion, well, it's just not that much money. Isn't that 
amazing that in the middle of a CR crisis and a debt crisis that we are 
hearing such rhetoric?
  I think it is amazing that we are being told, and through what we 
know--yes, and some of us did read the bill and so we do know what was 
in that bill--that the Secretary can spend this however she wants to. 
She does not have to come back to Congress another time to get 
permission for spending this slush fund. And isn't it amazing that some 
of our colleagues think that a fund will make people healthier? Money 
doesn't make people healthier. We all know that.
  And isn't it amazing that in the middle of all of this, we are out of 
money at the Federal level? We all know that the cost of health care is 
rising, and we know that one of the reasons that the cost of health 
care has risen so much in the last few years is government 
intervention. Those are some of the known components that we have.
  I think it's important to realize too, Mr. Chairman, eliminating the 
slush fund does not cut any specific program. And proponents of this 
fund want to claim that we're cutting, we're cutting, we're cutting. 
What we're doing is saying, no, you can't allow the Secretary to have 
control and just give it out. This needs to go through the normal, 
regular funding processes. That is very important. And it's time that 
we realize we have to do that.
  Yes, let's move forward. Yes, let's repeal ObamaCare. Yes, let's get 
it off the books. Let's do everything we can to get the Federal 
Government out of your pocket, out of the middle of your health care 
decisions. Let's make certain that those choices go to individuals and 
to their physicians and that they are not going to be dictated by the 
Secretary of Health and Human Services, who has a slush fund of $17.75 
billion to spend as she or he sees fit over the next 10 years.
  We need to be changing the way health care is going to work, and we 
need to do it with putting individuals in charge.
  Mr. PALLONE. Mr. Chairman, I now yield 2 minutes to the gentlewoman 
from Illinois (Ms. Schakowsky).
  Ms. SCHAKOWSKY. Here they go again. The Republicans failed in their 
efforts to repeal the Affordable Care Act, and now they are reversing 
course and trying to cripple implementation by attacking individual 
provisions of the law.
  The United States has a health care system designed to treat the 
sick, not to prevent disease from occurring in the first place. The 
Prevention and Public Health Fund is a crucial component of the health 
reform law's effort to remedy that weakness and transform today's sick 
care system into a prevention-focused health system.
  The Prevention and Public Health Fund will avert future illness, save 
lives and restrain the rate of growth of health care costs. It's a 
dedicated investment in community prevention and is a much-needed down 
payment on the health and economic well-being of all Americans.
  Federal investments from the Prevention and Public Health Fund have 
already begun to address improvements in the Nation's health status by 
supporting essential and proven prevention activities, such as 
immunization--immunization and tobacco cessation.
  The Prevention and Public Health Fund holds great promise to improve 
the capacities of State and local health departments to protect 
communities from health threats through the use of technology. It will 
increase numbers of highly skilled scientists and other public health 
professionals.
  I want to be very clear, and you've heard it yourselves. This is 
simply another attempt by Republicans to defund the Affordable Care Act 
and stop its implementation. I urge my colleagues to vote against this 
bill to repeal the Prevention and Public Health Fund.

                              {time}  1540

  Mr. PITTS. Mr. Chairman, the gentlelady kept saying it will, it will, 
it will. The simple fact is we don't know where the money is going to 
go.
  I yield 3 minutes to the distinguished gentleman from Georgia (Mr. 
Gingrey), who is a member of the subcommittee.
  Mr. GINGREY of Georgia. I thank my chairman for yielding.
  Mr. Chairman, at least some Members of this body can remember ads 
back years ago touting the miraculous benefits of Sal Hepatica and 
Carter's Little Liver Pills. Probably all of the Members can remember, 
because it was just a year ago, Andy Griffith touting the new health 
care reform bill. And those of us who are on Medicare remember getting 
those glossy mail outs, very expensive, slick-looking ads touting the 
benefits that ObamaCare has brought to Medicare, even though the new 
bill, the new entitlement creation took something like $550 billion out 
of Medicare, and yet they had the audacity to send these ads out, these 
fliers saying that it improved Medicare. ObamaCare improves Medicare; 
go figure. Well, that is a concern here. That is why I am standing in 
strong support of Chairman Pitts' bill, H.R. 1217.
  The Prevention and Public Health Fund is established under the 
Patient Protection and Affordable Care Act, ObamaCare, for prevention, 
wellness, and public health activities authorized in the Public Health 
Service Act and administered by Secretary Sebelius, the Secretary of 
Health and Human Services. But she can use those funds in any way she 
deems appropriate as long as she says it is for public health.
  Can it pay for political TV advertising for President Obama ahead of 
the 2012 elections? Absolutely she could. Nothing could stop her; the 
Congress couldn't as long as she deems it is necessary for public 
health. Pay for thousands of signs in communities all across the 
country declaring that PPACA is a success, nothing could stop this 
Secretary, or any Secretary from doing so, as long as they call it for 
public health. No, not even Congress.
  And as the chairman said, Mr. Chairman, the amount of $17 billion, 
almost $18 billion, is just a down payment, if you will, because in 
perpetuity $2 billion a year continues to be appropriated. And you do 
that with a bill that quite honestly this Member thinks will be 
declared within a year and a half, hopefully sooner, unconstitutional. 
So we are spending money that is absolutely unnecessary at a time when 
we are sitting here with $14 trillion worth of debt and listening to 
the Secretary of the Treasury say

[[Page 5893]]

within 6 weeks we are going to have to raise the debt ceiling so we can 
borrow more money. And here we are spending $17 billion, with a ``B,'' 
and that is not just chump change by any stretch of the imagination.
  Last year in 2010, the CDC actually spent some of $500 million to 
promote an increase in the excise tax on tobacco to the States; 
basically saying to the States, you need to make sure you raise taxes 
on tobacco.
  The CHAIR. The time of the gentleman has expired.
  Mr. PITTS. I yield the gentleman an additional 30 seconds.
  Mr. GINGREY of Georgia. I thank the chairman for yielding me this 
additional time.
  Let me just conclude that clearly this is a necessary bill to let 
Congress once again have the opportunity to control spending. That is 
our responsibility. That is our constitutional right. That's what the 
American people want. I think the chairman is absolutely right with 
this bill, and I fully support it. I urge all of my colleagues to do so 
as well.
  Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman 
from Connecticut (Ms. DeLauro), the ranking Democrat on the Labor, 
Health Appropriations Subcommittee.
  Ms. DeLAURO. I urge my colleagues to vote against this bill. It will 
cost money and endanger the health of the American people.
  We included the Prevention and Public Health Fund in the Affordable 
Care Act because we know preventive health care reduces health care 
costs. It dramatically increases Americans' quality of life. 
Preventable causes of death such as tobacco smoking, poor diet, 
physical inactivity, and the misuse of alcohol have been estimated to 
be responsible for 900,000 deaths annually, nearly 40 percent of total 
yearly mortality in the United States. Further, 7 in 10 deaths in 
America are from chronic diseases. And by 2020, the U.S. may spend $685 
billion a year on these chronic diseases. This fund works to bring down 
these numbers and to help Americans live longer, healthier lives.
  Preventive care is fiscally responsible. One example that would be 
impacted by this misguided legislation is vaccines. Estimates indicate 
that we save up to $400 for every illness averted by vaccination. And 
that does not even take into account the costs of further transmission 
in the case of a serious public health epidemic.
  By supporting our public health workforce and building health 
infrastructure, by promoting exercise, reducing tobacco use, the 
Prevention and Public Health Fund will go a long way towards reducing 
the surging costs of health care for Americans families and for our 
Nation. It is shortsighted folly to repeal this fund now, especially 
when you consider all the oil subsidies and breaks for corporate 
lobbyists that the majority has included in their budget. We should not 
be putting political ideology before public health. I urge my 
colleagues to oppose this bill.
  Mr. PITTS. Mr. Chairman, I yield 2 minutes to the gentleman from New 
Jersey (Mr. Lance), a member of the subcommittee.
  Mr. LANCE. Mr. Chairman, I rise today in support of H.R. 1217. As 
members of the Energy and Commerce Health Subcommittee, my colleagues 
and I have participated in a number of hearings that have explored the 
fiscal impact of the new health care law.
  These hearings have revealed the existence of several programs and 
mandatory spending provisions contained in the law. Health and Human 
Services Secretary Sebelius said during testimony that she had the sole 
discretion over billions of dollars in direct, unlimited mandatory 
spending under the law. This means without any congressional hearings, 
without any language in appropriations bills, and without any 
oversight, the executive branch has been granted unprecedented spending 
authority.
  Today's legislation, H.R. 1217, will repeal one of those little-known 
programs called the Prevention and Public Health Fund and subject it to 
the annual appropriations process. The aim may be worthy, Mr. Chairman, 
but this should be subjected to the annual appropriations process. This 
action, according to the Congressional Budget Office, will save 
American taxpayers $16 billion over the next 10 years.
  Mr. Chairman, as we all know, the Federal Government is $14 trillion 
in debt. Our deficit for this year will be at least $1.5 trillion. We 
must get Federal spending under control. We can start by repealing 
programs that run afoul of congressional oversight. I urge Members to 
support H.R. 1217.
  Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentlewoman from 
Colorado (Ms. DeGette).
  Ms. DeGETTE. Mr. Chairman, I am frankly stunned to have to come to 
the House floor today to talk about a bill that defunds the largest 
investment we have ever made in our population's health: the prevention 
and public health trust fund. The trust fund specifically says what it 
is going to be used for: reducing tobacco use, expanding opportunities 
for recreation and exercise, bringing healthier foods like fruit and 
vegetables to communities in need; and helping kids to eat healthier 
meals at school.
  All of us who have been involved in health issues for many years know 
that the biggest public health epidemic that we have right now is 
obesity. If we don't do anything to reverse these trends, then for our 
children and our children's children, we are not going to have good 
outcomes. Seventy-five percent of all health care costs are spent on 
the treatment of chronic diseases, many of them preventable. Our 
Nation's youth are confronting unprecedented levels of obesity, placing 
them at ever-increasing risk for those very same chronic health 
conditions. I think it is pathetic that we have children in this 
country who only have access to playgrounds at McDonald's with their 
8,000 playgrounds in this country. And so what this trust fund does is 
it supports research that examines evidence-based practices relating to 
prevention, including the translation of interventions from academic 
settings to real-world settings.

                              {time}  1550

  This is not, as the opponents of this trust fund say, a slush fund or 
something that is simply willy-nilly spending. Instead what it is, it's 
evidence-based and it's looking at ways that we can prevent childhood 
obesity and nutrition, reduce tobacco use, and expand opportunities for 
recreation and exercise.
  This is something all of us can get behind. This is something we 
should all support. I am sorry that it has become caught up in this 
partisan web, because frankly we should all support this for our kids.
  Mr. PITTS. Mr. Chairman, I have the copy of the law the gentlelady 
referred to. She says the trust fund refers to spending for fresh food 
and vegetables and other things. There's none of that in the language. 
I would welcome her to point it out.
  I reserve the balance of my time.
  Mr. PALLONE. I yield 1\1/2\ minutes to the gentlewoman from 
California (Ms. Roybal-Allard).
  Ms. ROYBAL-ALLARD. Mr. Chairman, H.R. 1217 is an attack on public 
health and disease prevention in this country. The prevention fund is 
our first national proactive, strategic commitment to changing the 
focus of our health care system from one of treatment to one of keeping 
Americans healthy.
  This change in focus is essential, because keeping people healthy 
improves the quality of their lives and that of their family, and it is 
our best means of controlling preventable chronic diseases, which 
account for seven out of 10 deaths and 75 percent of our Nation's 
annual health care costs, totaling $1.7 trillion.
  If H.R. 1217 passes, we lose a critical opportunity to control health 
care costs and we lose the opportunity to reduce unnecessary suffering 
and death from preventable chronic diseases. Adding to the assault of 
H.R. 1217 on public health and prevention is the FY 2011 continuing 
resolution which cuts CDC's budget by over $700 million.
  The result of these proposals is that millions of Americans will 
needlessly continue to suffer from preventable chronic diseases, costly 
treatments and

[[Page 5894]]

costly hospitalizations. Prevention saves lives and prevention saves 
money. Defeat H.R. 1217 and continue to build a healthier America.
  Mr. PITTS. I continue to reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentlewoman from 
the Virgin Islands (Mrs. Christensen).
  Mrs. CHRISTENSEN. Mr. Chairman and colleagues, I cannot believe that 
we are here debating a bill that would repeal the Prevention and Public 
Health Fund. At a time when we should be championing legislation to 
strengthen the health and well-being of Americans and this Nation, my 
colleagues on the other side of the aisle are doing the exact opposite 
with H.R. 1217.
  Currently, we have tens of millions of hardworking Americans who 
suffer and some die from preventable diseases, and without prevention 
and public health efforts, the very services this fund was created to 
support, tens of millions more will be affected in the future.
  With so much at stake--and we are talking about human lives--we 
should not be here fighting about the merit and value of keeping the 
Prevention and Public Health Fund in place. We would do better for our 
country in terms of health and savings if we were instead discussing 
increasing it.
  If my colleagues on the other side of the aisle are not moved by the 
disastrous human impact, then perhaps they will be moved by the equally 
disastrous economic impact that it will have, because not having 
prevention and effective public health measures in place costs money, 
and a lot of it.
  On the other hand, the Journal of Health Affairs reported that 
increasing the use of proven preventive services from their current 
levels to 90 percent would result in $3.7 billion in savings in just 1 
year. And we know from a Joint Center study that reducing health 
disparities, which this fund would help to do, could save as much as 
$1.24 trillion in direct and indirect medical costs in just a 3-year 
period.
  This bill to repeal the Prevention and Public Health Fund is not just 
misguided legislation, it is harmful and unjust. It is contrary to our 
values and a disrespect of the value of human life. It will not save 
money. In fact, it will cost this Nation more, both in human health and 
wellness as well as in actual health care spending.
  I strongly urge my colleagues to vote to protect all Americans and 
the moral standing of this country by voting ``no'' on H.R. 1217.
  Mr. PITTS. Mr. Chairman, may I ask how much time is remaining.
  The CHAIR. The gentleman from Pennsylvania controls 15\1/4\ minutes, 
and the gentleman from New Jersey controls 17\1/2\ minutes.
  Mr. PITTS. I continue to reserve the balance of my time.
  Mr. PALLONE. I yield myself such time as I may consume.
  Mr. Chairman, it's been 100 days of the Republicans' no jobs agenda 
and they've chosen to devote time and energy to bills and resolutions 
that would defund the Affordable Care Act, eliminate mandatory support 
for preventive care, and abolish any and all Federal support for 
Planned Parenthood. House Republicans know that these measures won't be 
approved by the Senate and would never be signed by the President. It's 
just another political gesture at a time when we should be working to 
create jobs and promote economic recovery.
  The bill on the floor this week, H.R. 1217, would abolish the 
affordable care law's Prevention and Public Health Fund. This is a fund 
that prevents disease, that detects it early, and that helps manage 
conditions before they become severe. All empirical data, all 
experience and plain old common sense informs us that prevention and 
early treatment not only save lives, they also save money. In fact, the 
Prevention and Public Health Fund addresses one of the major 
deficiencies in our approach to health in America, and that's 
preventing illness before people get sick.
  The Republican assertion that mandatory funding, which I've heard 
over and over again today and also in the Health Subcommittee, that 
this is somehow mandatory funding and it's unprecedented, that's 
completely not true. Medicaid and Medicare are funded with mandatory 
support, and there are a lot of other programs within our committee's 
jurisdiction and in Congress in general that are funded through 
mandatory funding.
  I don't know how many times I'm going to come to the floor and hear 
about repealing the health care reform. I understand tomorrow there's 
going to be an enrolled bill that goes along with the CR that's going 
to defund the whole Affordable Care Act. Here today we're going to 
defund one piece, the prevention fund. Tomorrow we've got another 
enrollment resolution that defunds the whole bill. Again, another 
resolution tomorrow to defund Planned Parenthood.
  How many times are we going to keep voting on the same thing over and 
over and over again? Meanwhile, I don't see a single piece of 
legislation coming to this floor that addresses jobs or the economy. 
When I go home, people want to know what we're doing about the economy. 
They know that their health care reform has passed, that they're 
benefiting from it, that it's gradually unfolding before them. They 
don't want us to continue to debate the same thing over and over again. 
Repeal, defund, and no suggestion about what you would do to replace it 
either, by the way.
  I reserve the balance of my time.
  Mr. PITTS. Madam Chair, I continue to reserve the balance of my time.
  Mr. PALLONE. I yield 2 minutes to the gentlewoman from Texas (Ms. 
Jackson Lee).
  Ms. JACKSON LEE of Texas. Let me thank the distinguished gentleman 
from New Jersey and let me thank the chairman of the committee as well.
  Madam Chairwoman, we just have a disagreement. I would venture to say 
that the bulk of sick people in America and others who every day 
struggle to maintain their health so they can provide for their 
families would vigorously disagree as well.
  I think there are two points that I would like to make, and that is 
that what we lose when we repeal this Affordable Care Act and the 
funding of it is more than the glory that we get from going home and 
bragging that we have undermined America's health care system, or some 
would say that we have taken away ObamaCare. Preventative care is an 
unbelievable plus that this bill has generated.
  I went to one of my emergency centers, a new one, that is crafted 
under the public health system. It is to take the load off the 
emergency centers, the emergency centers that ambulances go to. What an 
amazing sight, of people coming with broken toes and fingers and feet 
and bruises, maybe the beginning of heart disease and other problems. 
But it was a lower level emergency room, not particularly preventative 
care but the kind of intervention that can save millions of dollars.

                              {time}  1600

  I want to go even lower than that--and I don't use that terminology--
but I want people to be able to go and check on their cholesterol, 
check on their high blood pressure, understand whether they have sickle 
cell, understand what stage of diabetes they are in or understand what 
stage of heart disease they are in in a preventative care cycle. And 
everyone knows that economists document how many billions of dollar 
that will save. How can we vote against that?
  And then secondarily, there are two elements that the Affordable Care 
Act provides that is being repealed; research and training for health 
professionals that we absolutely need--whether you're in the private 
care system or not--and then of course protecting our most precious 
resource, and that is our children. If you can raise a child in a 
healthy manner in terms of nutrition, in terms of immunization, in 
terms of regular doctor visits, then you are able to save billions of 
dollars.
  This is wrong, headed in a wrong direction. Many of us are fasting. I 
said on this floor, we must pray because this is the wrong direction to 
go.
  Madam Chair, I rise today in opposition to H.R. 1217, which would 
repeal the provision of the Patient Protection and Affordable Care Act

[[Page 5895]]

(``Affordable Care Act'') that established the Prevention and Public 
Health Fund, a fund which serves as a great stride toward turning our 
``sick-care'' system, where we focus on treating the injured and ill, 
into a true ``healthcare'' system that puts focus on keeping the 
population well.
  It is because of all that the Prevention and Public Heath Fund 
accomplished in its first year, the overwhelming support the Fund has 
received from hundreds of organizations, and how essential prevention 
is to reducing the overall cost of healthcare for the American people, 
that I oppose the repeal of this Fund.
  Despite my general opposition to this bill, yesterday in the Rules 
Committee meeting, I offered amendments to H.R. 1217, in order to 
remind this chamber and emphasize to the American people the importance 
and benefits of preventative care for the American public.
  My amendments reaffirm to the American people that we as lawmakers 
understand the importance of preventative care by stating that it is 
the sense of Congress that prevention of disease and injury is 
overwhelmingly effective in improving our healthcare system and keeping 
that system affordable. Furthermore, preventative health care is an 
effective means for detecting and treating illnesses before they become 
serious and life threatening.
  My amendments also make us as lawmakers accountable to the American 
people who have been and would be benefitting from the services and 
support provided through this fund. It gives notice to the public, 
through the Department of Health and Human Services' website, of the 
rescission of funds and the amount rescinded, increasing government's 
accountability.
  I think most of my colleagues on both sides of the aisle would agree 
with me, as evidenced by the intense debate at the end of last week, 
when I say that we must address our nation's spending and growing 
deficit. However, it is of great concern to me that my friends on the 
other side of the aisle are attempting to do so by cutting cost-saving 
programs that are also essential to the health and wellbeing of 
Americans. This attempt, through H.R. 1217, to defund this essential 
program which was created under the Patient Protection and Affordable 
Care Act is of particular concern.
  Today's youth may be the first generation to live shorter and less 
healthy lives than that of their parents, and this is largely due to 
increased rates of diseases and conditions which are preventable with 
proper and consistent healthcare. 75% of our country's healthcare costs 
are attributed to treatment of chronic diseases, most of which are 
preventable. However, less than 5% of our healthcare spending goes 
towards preventing these diseases. Loss of productivity in the 
workforce attributed to chronic disease is estimated to cost the United 
States over $1 trillion each year.
  With that being said, the 111th Congress, with the intent of seeing 
these grim statistics changes, appropriated $16.5 billion to be used, 
over the next ten years to support preventative care and research. 
Since its establishment the Fund has already begun to strengthen the 
infrastructure of our healthcare system on the state and national 
level.
  The Prevention and Public Health fund, though it has only been in 
existence for one year, has already been used for:
  Programs to promote tobacco control and implement tobacco cessation 
services and campaigns;
  Obesity prevention which directly decreases risk for Diabetes;
  Improving nutrition and access to fresh fruits and vegetables;
  Increasing opportunities for recreational and physical activity;
  HIV prevention;
  Support of clinical and community-based disease prevention; and
  Bolstering the health workforce by increasing health care personnel.
  Money towards finding health solutions, rather than treating health 
problems, comes back to society in terms of increasing productivity, 
creating jobs, and reducing Medicare, Medicaid, and overall healthcare 
costs. With just a $10 per person investment towards improving 
community based activity, nutrition, and other preventative measures 
would create a return of $56 per person within only 5 years. That 
translates to a savings of $5.60 for every $1 invested in preventative 
health care. Most importantly, cost benefits extend beyond government 
to both American businesses and families; providing savings and an 
improved quality of life.
  As a result of the Prevention and Public Health Fund, Texas received 
$6 million last year that went towards creating committees, testing 
facilities, laboratories, and training centers which brought over $2 
million to the health prevention capacity of Houston alone.
  Congress must maintain that the prevention of illness, the saving of 
lives, and the securing of a healthy public are top priorities, and 
that prevention is an undeniably effective means to achieve these ends. 
My amendments will do just that.
  The total loss of $16 billion of funding for prevention efforts, an 
effective total eradication of our country's prevention program, will 
be unfortunate, and thus I urge my colleagues not to lose sight of 
importance of the Prevention and Public Health Fund's accomplishments 
and goals. Including:
  The improvement of state and local health departments, giving them 
the capacity to respond to infections, natural disasters, and terrorist 
threats;
  Creating a strong and healthy workforce that will be competitive in 
the global market; and
  Saving families, businesses, and the government money, opposed to 
simply cutting costs.
  While I do not support what H.R. 1217 purports to do, I urge my 
colleagues to join me in support of these essential changes to H.R. 
1217 to acknowledge the need for preventative care and hold ourselves 
accountable for what would most certainly be a great loss to the 
public.
  Mr. PALLONE. Madam Chairwoman, I yield myself the balance of my time.
  Madam Chair, we are simply never going to bend the cost curve on 
health care or improve America's quality of life until we focus much 
more on disease prevention, and that's what this prevention fund is 
for.
  I always thought that both Democrats and Republicans wanted to keep 
people out of the hospital, off of disability, leading productive 
lives, and trying to prevent diseases before they occur. I never 
thought this was a partisan issue. Because we need to have a system of 
well care, not sick care, if we're really going to have success in 
saving money and bending the cost curve.
  So I don't understand why my Republican colleagues so many times in 
the committee would talk about prevention, but all of a sudden now they 
want to abolish the prevention fund. It just doesn't make any sense.
  Before the Affordable Care Act, prevention activities were 
chronically underfunded, accounting for only 2 to 4 percent of the 
national health care expenditure by some estimates. Considering that 
chronic diseases eat up an estimated 75 percent of our $2 trillion in 
annual health care spending, to spend an additional $2 billion for 
wellness and prevention is a wise investment.
  Since the Affordable Care Act was enacted, every State has benefited 
from the prevention and wellness fund. This year, over $750 million in 
grants were dispersed--building on a $500 million investment last 
year--and repealing this program would mean putting the brakes on 
investments that are already beginning to make a difference.
  In my home State of New Jersey, many of my constituents have 
benefited from over $15 million in prevention and public health grants, 
funding for such things as HIV prevention, tobacco cessation, mental 
health care, critical public health infrastructure improvements, as 
well as support for primary care training and workforce development.
  I could do the same, I have a sheet here--I'm not going to read it, 
but I have a similar sheet for Mr. Pitts and Dr. Burgess and others on 
the Republican side who specified these are the types of grants that 
are being made available in their States.
  I simply don't understand. There are 600 national, State, and local 
organizations supporting the fund as a primary vehicle for making 
public health investments that would create jobs and help lower long-
term health care costs. The Energy and Commerce Committee and the 
Health Subcommittee have heard me many times say that we can never 
calculate the huge savings that come from prevention.
  We had the CBO in the other day and I said to the CBO, why don't you 
calculate prevention, because we would save trillions of dollars? Well, 
they don't do it. But the bottom line is we all know that prevention 
saves money. If you concentrate just on chronic diseases, this law 
helps move the Nation from a focus on sickness and disease to one based 
on wellness and prevention.

[[Page 5896]]

And if you take away this critical new investment in prevention, it's 
going to be harmful to the health of Americans now and also in the 
future.
  Madam Chairwoman--and I will address this directly to my Republican 
colleagues--in the last few weeks, when we had hearings in the Health 
Subcommittee on the various measures that the Republicans wanted to 
defund--and I know they want to repeal the whole bill and I know they 
want to defund everything, and that's what they're going to try to do 
again tomorrow. I understand all that. I totally disagree with it, but 
I understand that they're against the Affordable Care Act. They want to 
defund it, they want to do whatever they can to get rid of it.
  But it just seems to me that to pick the one fund that deals with 
prevention is really the worst thing you could have done today because 
what we're trying to do with the Affordable Care Act--and what I've 
sought to do in everything that we've done in the subcommittee since 
I've been on it--is to really stress prevention because we can avoid 
people going to hospitals, we can avoid people going to nursing homes. 
They can lead a better quality of life and we save money.
  So I just think it is really unfortunate today that after so many 
years of a bipartisan effort to deal with prevention, to fund 
prevention issues, that this is the one fund that's actually picked on 
today to come to the floor. I think it's really a horrible thing that 
that is the case.
  So I would urge my colleagues to vote against this resolution because 
if you really believe in prevention, if you really believe that we can 
make a difference in making people well and preventing them from 
getting sick, then you should vote against this bill.
  Madam Chairwoman, I yield back the balance of my time.
  Mr. PITTS. Madam Chair, it's time for a fiscal reality check. The 
Federal Government is now borrowing 42 cents of every dollar it spends. 
Washington is spending more than $1 of every $4 this country produces 
and we are facing a third straight year with a $1 trillion deficit. 
Yet, when the subcommittee voted on this straightforward bill to strip 
billions in unaccountable spending from the health care law based on 
the simple premise that Congress should fund prevention and wellness 
activities by prioritizing them in the regular annual spending process, 
the response from the other side of the aisle was to say, we're not 
broke. Madam Chair, I beg to differ.
  Our debate today is not about the virtue of preventive health care 
and wellness programs. I support prevention. The real question is 
whether our Nation can afford to authorize the Secretary of Health and 
Human Services to spend nearly $18 billion over and above what Congress 
appropriates over the next decade on programs of the administration's 
choosing.
  H.R. 1217 does not cut a single program because this fund does not 
guarantee funding for any particular program. Every Member who supports 
this fund on the assumption that it provides additional money for a 
project they deem worthy should understand that no one knows where this 
money will be spent. Perhaps it could be used to combat obesity, or for 
cancer screenings, or perhaps it will be used to post signs about the 
location of bike paths. The point is, Congress abdicates our authority 
and responsibility for investing in prevention by handing a perpetual 
blank check to the Secretary.
  Governing and solving our fiscal problems is difficult; it requires 
hard choices. It is easy to spend. The easy choice was to assign 
mandatory advanced appropriations to these initiatives rather than 
making them a budget priority. But it's only easy until the bill is due 
and the credit card is maxed out. Well, the bill is due and the credit 
card limit is approaching fast. Congress needs to reassert its role and 
set spending priorities rather than give the executive branch 
unfettered power to spend as it wishes.
  I urge my colleagues to support the bill.
  Mr. LANGEVIN. Madam Chair, I rise to express my strong support for 
the Prevention and Public Health Fund and to ask my colleagues to 
reconsider the elimination of a program whose sole purpose is not only 
to improve the overall health of Americans, but to help ``restrain the 
rate of growth in private and public sector health care costs.''
  If my colleagues across the aisle want to effectively cut spending 
and fix our long-term deficit, then I would remind them that health 
care costs are one of the biggest drivers of federal spending; and 
chronic diseases, such as heart disease, cancer, stroke and diabetes, 
account for 75 percent of the cost of care. If we invest in preventing 
these chronic diseases now, we could save our health care system 
hundreds of billions of dollars, reducing the costs to Medicare and 
Medicaid and saving countless lives.
  Instead, we are taking a penny-wise and pound-foolish approach by 
considering H.R. 1217, which repeals investments in prevention and 
primary care services to combat mental illness, obesity, cancer, as 
well as HIV and other acquired infections. Rhode Island has already 
received over $800,000 to support primary care, mental health services 
and health information technology that will improve the health of Rhode 
Island families before they are forced to seek treatment in the 
Emergency Department.
  Our nation cannot afford to cut now and worry about the consequences 
later. That approach has only earned our country the unfortunate 
distinction of being the nation with the highest adult obesity rate in 
the developed world with the highest mortality rates for various 
preventable chronic diseases. It has also done nothing to reign in our 
long-term deficits.
  Further, we are almost 100 days into the 112th Congress and Speaker 
Boehner has not put forward a single bill to create jobs. If my 
colleagues in Congress are serious about balancing the budget and 
creating a better health care system, then I hope we will move on from 
trying to dismantle the health reform law and focus on job creation. I 
ask my colleagues to oppose this measure and bring up a bill that will 
put Americans back to work.
  Mr. DINGELL. Madam Chair, today we rise to debate irresponsible 
legislation cloaked in fiscal responsibility, legislation that will 
assuredly put the nation's public health at risk.
  Today's debate is not one over concerns of mandatory funding for our 
nation's public health investments, it is another shot at the 
Affordable Care Act.
  Our health system is inherently designed to provide treatment for the 
sick and ill, but does not currently contain the incentives necessary 
to keep consumers from becoming sick in the first place.
  Just two years ago total health expenditures in the U.S. was $2.5 
trillion, and only 3 percent of that funding was spent on preventive 
health care services and health promotion.
  If we want to cut down on the costs of hospitalizations and 
inappropriate emergency room visits, we have to help American families 
better manage their chronic diseases like diabetes or asthma and help 
them stay well through vaccines and screenings.
  This was the purpose behind the Prevention and Public Health Fund--to 
make a strong investment into prevention and wellness programs and 
promote innovative prevention that will help to save our health system 
costs in the long run.
  And now we are seeing the good work that the Prevention and Public 
Health Fund is doing in our states.
  Michigan has received over $2 million for public health activities--
building capacity in our health departments, hiring and training 
epidemiologists and scientists to study infectious diseases, improving 
access and quality of health services in medically underserved 
communities, and helping to promote better primary care for those in 
need.
  Thus, the Prevention and Public Health Fund is not only creating 
much-needed jobs in my home state, but also undertaking meaningful 
projects that will help to improve the health of our country.
  Let us be clear that this legislation will not become law, and rather 
than use the time of this body for valuable legislation such as 
creating jobs and improving our economy and the health of our nation, 
my colleagues choose to focus their efforts on another vehicle to 
defend the Affordable Care Act.
  I urge my colleagues to vote against this legislation.
  Mr. ENGEL. Madam Chair, I rise in strong opposition to H.R. 1217. 
This irresponsible and short-sighted legislation would repeal the 
Prevention and Public Health Fund which is a fundamental component to 
the Affordable Care Act.
  The Prevention and Public Health Fund is a critical investment in 
public health and demonstrates a historic commitment to changing our 
health system from one that focuses on treating the sick to one that 
focuses on keeping people healthy in the first place. We all

[[Page 5897]]

agree that prevention is one of the most effective ways we can reduce 
health costs in the long run, rather than by simply cutting spending.
  My friends on the other side of the aisle claim that eliminating the 
fund does not cut any specific prevention programs and that the reason 
they want to repeal the Prevention and Public Health Fund is to recoup 
the funding appropriated for it.
  I would like to know from the Majority, are the short term cost 
savings from this bill worth the long term costs to our financial 
future and health? How do they plan to solve the public health problems 
of the future if they intend to gut programs like this one?
  The Prevention and Public Health Fund is one of a number of 
Affordable Care Act initiatives that is already in place and producing 
positive results. Currently, all 50 states and the District of Columbia 
are receiving Fund support. These valuable dollars are being used to 
support community-based initiatives to reduce tobacco use and obesity, 
prevent HIV infection, build epidemiology and laboratory capacity to 
track and respond to disease outbreaks, and train the public health 
workforce.
  Madam Chair, I know that we face difficult economic decisions, and I 
would be happy to have a discussion with my friends on the other side 
of the aisle on how we can reduce the deficit, but I feel that H.R. 
1217 is the wrong approach.
  Seventy-five percent of the two trillion dollars we spend in health 
care costs are spent on treatment of chronic diseases. Many of which 
can be prevented. Obesity alone costs us 147 billion dollars a year and 
chronic illness can cost us an additional 1 trillion dollars each year 
in lost productivity. In addition, studies have shown that proven 
community-based diabetes prevention programs can save as much as 191 
billion dollars over 10 years. So the fact is prevention saves money.
  Now, those are just the dollars and cents of the value that the 
Prevention and Public Health Fund bring. We know that prevention saves 
money, but what about the improvements to the health of our nation's 
citizens. Prevention saves lives, improves quality of life and is the 
most cost-effective way to spend our health care dollars. No matter 
what arguments the Majority may make, we cannot put price-tag on that.
  I urge my colleagues to vote ``no'' on H.R. 1217.
  Mr. VAN HOLLEN. Madam Chair, today we are considering a piece of 
legislation that will roll back important gains for public health and 
prevention. Specifically, today's bill proposes to repeal the 
Prevention and Public Health Fund under the Affordable Care Act.
  According to the Centers for Disease Control and Prevention, more 
than 75 percent of health care spending in the United States is due to 
chronic conditions, such as stroke, diabetes, and cancer. One of the 
ways to control health care spending is to invest ways to prevent 
disease and improving the public health of our nation. By investing in 
preventive health care services, we can reduce the number of people 
with chronic diseases while saving lives and money.
  Currently, funding from this program is being used by states and 
communities to prevent smoking, obesity, heart disease, and to increase 
physical activity and train the public health workforce. The Prevention 
and Public Health Fund presents a significant opportunity to rein in 
our health care spending and to promote healthy lifestyles and 
communities. In my judgment, repealing it will only increase 
preventable health care costs over time.
  Madam Chair, I urge my colleagues to oppose this misguided bill so 
that we can continue to protect the health of all Americans.
  Ms. ESHOO. Madam Chair, I rise in opposition to H.R. 1217, a bill to 
repeal the Prevention and Public Health Fund.
  Prevention works. It's the best way to keep costs down and keep 
people healthy.
  For decades our healthcare system has been designed to treat patients 
once they're sick. This is inefficient and costly. The Prevention and 
Public Health Fund included in healthcare reform is finally starting to 
change this backward system and invest efforts to keep people healthy.
  The Fund is important because it offers flexibility--grants are 
awarded to states, communities, and local public health groups to 
implement local prevention programs that work for the local community.
  Any person in this chamber who is concerned about the rising cost of 
healthcare in our country should be embracing the Prevention and Public 
Health Fund. Study after study has proven that prevention saves money. 
This legislation willfully ignores this fact and instead, favors an 
``every man for himself'' approach.
  Is it any wonder why we spend more on healthcare than any country in 
the world with lackluster results? Other nations are out-investing us 
in prevention, public health infrastructure, and primary care. Smart 
healthcare saves money.
  Unfortunately, we're also considering several bills this week to 
eliminate healthcare and none of them are wise. Efforts to chip away at 
the first meaningful health reform our country has ever seen are 
shortsighted and foolish . . . even worse is to take away basic 
preventive health services that women already have. Ninety seven 
percent of the services Planned Parenthood provides have nothing to do 
with abortion and everything to do with family planning, diabetes care, 
vaccines, physicals, and, for men, testicular cancer screenings. 
Eliminating funding for the preventive services of Planned Parenthood 
will increase the number of abortions in our country and reverse the 
positive results of mammograms and cervical care.
  I urge my colleagues to vote against these efforts.
  Ms. RICHARDSON. Madam Chair, I rise today in strong opposition to 
H.R. 1217, a bill that would repeal the Prevention and Public Health 
Fund established by the Affordable Care Act. The Prevention and Public 
Health Fund makes smart investments in state and community efforts to 
help the American people live longer, healthier lives.
  The Prevention and Public Health Fund represents a paradigm shift in 
the way we conceptualize health care in this country. Instead of 
focusing exclusively on treatment, the fund established by the 
Affordable Care Act recognizes the importance of prevention and 
encourages Americans to lead healthier lifestyles. All 50 states are 
already using these funds to target the obesity epidemic, HIV 
prevention, tobacco usage, and nutrition and physical activity.
  Not only does the Prevention and Public Health Fund promote healthier 
lifestyles, it also contributes to long-term savings in health care 
expenditures. As health care costs continue to rise, preventative care 
can help to rein in the out of control costs. Preventing chronic 
diseases like heart disease, cancer, diabetes, and stroke does not only 
make sense from a public health perspective, it makes sense from an 
economic perspective as well.
  The United States spends $270 billion annually due to chronic 
illness. Chronic diseases are also responsible for 70 percent of deaths 
in America and 75 percent of health care expenditures. Working to curb 
unhealthy behaviors that lead to chronic disease such as tobacco and 
alcohol consumption, physical inactivity, and poor diet will save lives 
and money.
  At a time when we are being forced to make tough decisions on 
government spending, targeting a program like the Prevention and Public 
Health Fund is misguided. Investing money into community-based 
preventative care initiatives that encourage people to engage in 
healthier behavior has the potential to save the country billions of 
dollars in costs associated with treatment of chronic disease.
  In California alone, the Department of Health and Human Services has 
already used the Prevention and Public Health Fund to grant $42.7 
million to organizations throughout the state that are engaged in 
prevention and wellness initiatives. Of this $42.7 million, $8.9 
million has been awarded to community and clinical prevention, $7.2 
million to public health infrastructure, and $26.4 million to primary 
care training.
  The cost of treating those with chronic illness totals billions of 
dollars annually and leads to billions of dollars in lost productivity. 
Preserving the overall health of the American people should be a 
priority of this body. The move by my colleagues on the other side of 
the aisle to repeal this important aspect of the Affordable Care Act is 
not only fiscally irresponsible, but it is also morally reprehensible.
  Developing programs that will encourage Americans of all ages to lead 
more active and healthy lifestyles will require significant investment 
at the community level. The Prevention and Public Health Fund does that 
by strengthening the capacity of state and local communities.
  Repealing the Prevention and Public Health Fund will threaten the 
well being of millions of Americans and I urge my colleagues to vote 
against this measure to repeal it.
  Mr. PITTS. Madam Chairman, I yield back the balance of my time.
  The Acting CHAIR (Mrs. Emerson). All time for general debate has 
expired.
  Pursuant to the rule, the bill shall be considered read for amendment 
under the 5-minute rule.
  The text of the bill is as follows:

                               H.R. 1217

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

[[Page 5898]]



     SECTION 1. REPEALING PREVENTION AND PUBLIC HEALTH FUND.

       (a) In General.--Section 4002 of the Patient Protection and 
     Affordable Care Act (42 U.S.C. 300u-11) is repealed.
       (b) Rescission of Unobligated Funds.--Of the funds made 
     available by such section 4002, the unobligated balance is 
     rescinded.

  The Acting CHAIR. No amendment to the bill is in order except those 
printed in House Report 112-61. Each such amendment may be offered only 
in the order printed in the report, by a Member designated in the 
report, shall be considered read, shall be debatable for the time 
specified in the report, equally divided and controlled by the 
proponent and an opponent of the amendment, shall not be subject to 
amendment, and shall not be subject to a demand for division of the 
question.

                              {time}  1610


          Amendment No. 1 Offered by Ms. Jackson Lee of Texas

  The Acting CHAIR. It is now in order to consider amendment No. 1 
printed in House Report 112-61.
  Ms. JACKSON LEE of Texas. I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       In section 1, add at the end the following:
       (c) Notice of Rescission of Unobligated Funds.--Not later 
     than 10 days after the date of the enactment of this Act, the 
     Secretary of Health and Human Services shall post on the 
     public website of the Department of Health and Human Services 
     a notice of--
       (1) the rescission, pursuant to subsection (b), of the 
     unobligated balance of funds made available by such section 
     4002; and
       (2) the amount of such funds so rescinded.

  The Acting CHAIR. Pursuant to House Resolution 219, the gentlewoman 
from Texas (Ms. Jackson Lee) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Texas.
  Ms. JACKSON LEE of Texas. Madam Chair, I know sometimes in the rush 
of legislating, many Members are faced with any number of challenges in 
understanding legislation, but I do know that the majority has come 
with their own roadmap. And I do want to respect the different 
viewpoints, and I don't say this in any way to malign.
  First of all, I'm grateful that this amendment was made in order, but 
I wish it wasn't because I understand that all legislation that passes 
needs to have in fact--or often has those who agree with it and those 
who do not. And that's fair enough.
  And the process that we usually use to handle that is to amend, not 
repeal. There are some sections here that I have looked at and have 
concern with. And many have heard me on the floor of the House 
discussing a number of issues regarding my local hospitals. But I will 
say to you that the repeal of this bill is putting us on the road to 
ruin.
  And my amendment is simple. It asks the HHS to place on its Web site 
the moneys rescinded so that the American people can see. For some it 
may be to see the great success of taking away money. For others, it 
may be to see what has happened to the resources that they need to take 
care of themselves.
  Very quickly, this amendment requires for fiscal years 2010, 2011, 
2012, 2013, 2014 to list the amount of money that is being taken away 
from good health care. But, Madam Chair, it will also hopefully point 
people to what they're losing.
  For example, look at this beautiful baby here. We will not have, 
under the repeal of this Affordable Care Act, the bounty of 
preventative care. For those with chronic diseases, Americans who are 
subject to chronic disease such as heart disease, cancer, stroke and 
diabetes, their only care will be the emergency room, high-priced 
emergency room when they're in a diabetic coma or they're in a stroke 
or they have a heart attack, rather than be able to go to their 
doctors.
  But we start early on with this little baby being able to go to 
wellness clinics or to their community health clinics. That's what the 
money that is being rescinded is going to do to you.
  In addition, you will find that chronic diseases resulted in $75.3 
billion loss in productivity in the State of Texas alone. This is going 
to be across America.
  The rescissions will also impact all of the States. I have a list of 
almost 50 States that have begun to receive dollars from the Affordable 
Care Act--from Alabama, to Alaska, to Pennsylvania, to Massachusetts, 
to Michigan, to Rhode Island, and South Carolina, and Tennessee, and 
Texas. All of the States that my good friends come from, they are 
receiving money right now.
  In addition to this issue of taking away money, Prevention for 
Healthy America concluded that investing $10 per person per year in 
proven community-based programs that increased physical activity, for 
example, improved nutrition, and prevents smoking and other tobacco 
could save the country more than $16 billion annually within 5 years.
  When you see how much money was taken away, just realize that you 
multiply that. If it's a total of $16 billion, you're going to lose $16 
billion a year because there will not be any wellness program. 
Community and clinical prevention, which is about $2 million. And so 
you will take away money from HIV prevention, and that is a very costly 
proposal.
  You'll take away from public health infrastructure; you'll take away 
from primary care residential expansion programs training residents and 
doctors. You'll take away from other medical assistance programs, 
expansion of physician assistant training. You'll take away from public 
health departments where they link people to needed health care. You'll 
take away childhood and adult immunizations and protecting the water we 
drink and the food we eat.
  Let me just say to you that my amendment is to shine the light on 
what will be happening to the health care of Americans. I want my 
colleagues to tell their constituents, not those that are already 
focused on negative aspects of what we're trying to do here, but those 
who are just simply hardworking mothers and fathers who are trying to 
make a living and who need this health care.
  Madam Chair, I would first like to state my clear position that I am 
adamantly opposed to H.R. 1217 and its repeal of the important 
Prevention and Public Health Fund created under the Affordable Care 
Act. The Fund saves lives and saves money.
  If H.R. 1217 to repeal the Prevention and Public Health Fund provided 
under section 4002 of the Patient Protection and Affordable Care Act is 
enacted into law:
  What my amendment does is: Requires the Department of Health and 
Human Services to post public notice on its official website of the 
Unobligated Funds from section 4002 of the Patient Protection and 
Affordable Care Act including the amount of the funds that will be 
rescinded.
  This amendment will provide the public with important information 
about Preventive Health Care funding that will no longer be available 
for them to receive necessary preventive health care services.
  This amendment also assists my Republican colleagues by permitting 
them to easily show the American public that they are cutting 
government spending, by how much they are cutting spending, and where 
they are cutting government spending. So I expect that my Republican 
colleagues will fully support this amendment.


 Purpose of the Prevention and Public Health Fund (Section 4002 of the 
                          Affordable Care Act)

  When Congress passed the Affordable Care Act in 2010 and the 
President signed it into law, the Department of Health of Human 
Services was given the power to administer the program to provide for 
expanded and sustained national health investment in prevention and 
public health programs to improve public health programs and help 
restrain the growth in private and public health costs. This was 
already a cost cutting measure.
  Nearly 11.7 million cases of seven common chronic diseases--cancers, 
diabetes, heart disease, hypertension, stroke, mental disorders, and 
pulmonary conditions--were reported in Texas in 2003.
  The cost of treating those with chronic disease in Texas totaled 
about $17.2 billion.
  Chronic diseases resulted in $75.3 billion in lost productivity and 
economic costs to Texas.
  A new focus on prevention will offer Texas and the rest of our nation 
the opportunity to not only improve the health of Americans, but also 
control health care spending. A report from Trust for America's Health 
entitled Prevention for a Healthier America concluded that

[[Page 5899]]

investing $10 per person per year in proven community-based programs 
that increase physical activity, improve nutrition, and prevent smoking 
and other tobacco use could save the country more than $16 billion 
annually within 5 years. This is a return of $5.60 for every $1 spent 
on preventive health care.


        How the Fund Improves Wellness and Prevention for Texans

  Since enactment of the Affordable Care Act on March 23, 2010, the 
Department of Health and Human Services has awarded approximately 
$17.63 million in grants to organizations in Texas through the 
Prevention and Public Health Fund to help improve wellness and 
prevention efforts, including:
  Community and Clinical Prevention ($2,956,000): This funding supports 
prevention activities that have been shown to be effective in reducing 
health care costs and promoting health and wellness.
  Primary and Behavioral Health Integration ($495,000). Assists 
communities with the integration of primary care services into 
community-based mental & behavioral health settings.
  HIV Prevention ($2,359,000). Focuses on HIV prevention in high risk 
populations and communities by increasing HIV testing opportunities, 
linking HIV-infected persons with appropriate services, and filling 
critical gaps in data and understanding of the HIV epidemic.
  Tobacco Cessation ($102,000). Strengthens Texas's ability to move 
towards implementing a plan to reduce tobacco use. It also enhances and 
expands the national network of tobacco cessation quitlines to 
significantly increase the number of tobacco users who quit each year.
  Public Health Infrastructure ($2,084,000): These grants strengthen 
state and local capacity to prepare health departments to meet 21st 
century public health challenges and support the training of existing 
and next generation public health professionals.
  Public Health Infrastructure ($800,000). Supports state, local, and 
tribal public health infrastructure to improve information technology, 
workforce training, and policy development.
  Epidemiology and Laboratory Capacity ($634,000). Builds state and 
local capacity to prevent, detect, and respond to infectious disease 
outbreaks.
  Public Health Training Centers ($650,000). Improve the public health 
system by enhancing skills of the current and future public health 
workforce.
  Primary Care Training ($12,586,000): These funds support the 
expansion of the primary care workforce.
  Primary Care Residency Expansion Program ($7,680,000). Increases the 
number of residents trained in family medicine, general internal 
medicine, and general pediatrics.
  Advanced Nursing Education Expansion Program ($1,426,000). Increases 
the number of primary care nurse practitioners and nurse midwives who 
graduate by expanding class sizes and accelerating graduation rates for 
part-time students.
  Expansion of Physician Assistant Training ($1,980,000). Improves 
access to primary care by funding the training of primary care 
physician assistants and expanding the primary care workforce.
  Nurse-Managed Health Clinics ($1,500,000). Provide primary care and 
wellness services to underserved and vulnerable populations through 
clinics that are managed by advanced practice nurses and provide 
valuable clinical training sites for primary care nurse practitioners.
  If the Prevention and Public Health Fund is cut and its Unobligated 
Funds Rescinded our health care costs will soar and the results will be 
catastrophic. The Fund saves lives and saves money.


                       if the funds are rescinded

  America's local health departments need the Prevention and Public 
Health Fund to help prevent diseases and protect health in ways that 
health insurance companies or medical care providers cannot.
  Local health departments:
  Link people who need healthcare with ways to get it.
  Detect and stop outbreaks of disease.
  Help people make healthier choices in diet, exercise, and tobacco use 
to prevent and reduce chronic disease.
  Provide childhood and adult immunizations.
  Protect the water we drink and the food we eat.
  Help new parents give babies a healthy start at home.
  Inspect schools and day care centers for health and safety.
  Conduct screenings for cancer, heart disease, diabetes, childhood 
lead poisoning, tuberculosis, and other infectious diseases.
  The Prevention and Public Health Fund is critically needed to 
stabilize the ability of local health departments to protect their 
communities from health threats and help individuals and families lead 
productive and healthy lives. Please oppose this attempt by H.R. 1217 
to eliminate funding for the Prevention and Public Health Fund. A 
healthy future depends on it.
  If H.R. 1217 passes this Chamber and is enacted into law, it is 
important for the American People to have notice of the rescission of 
funds for the Prevention and Public Health Fund program. Since the 
Department of Health and Human Services administers the Fund, it is 
only appropriate that public notice be given on the official HHS 
website and include the amount of funds rescinded. In this way, the 
American public will know that the public funding they rely upon has 
been cancelled for preventive health care and the Transparency of 
Spending Cuts will be further promoted in a manner that my Republican 
Colleagues will also appreciate.
  I would urge all Members of Congress to support my amendment.
  I yield back the balance of my time.
  Mr. PITTS. Madam Chair, at this point I rise in opposition to the 
amendment.
  The Acting CHAIR. The gentleman from Pennsylvania is recognized for 5 
minutes.
  Mr. PITTS. I will just mention to the gentlelady all of the wonderful 
programs that she mentioned are not mentioned in this section of the 
law. There is no guarantee that this money will be spent for any of 
that.
  H.R. 1217 repeals the Prevention and Public Health Fund and rescinds 
unobligated balances. The Jackson Lee amendment would require the 
Secretary of Health and Human Services to post on the HHS public Web 
site a notice of the rescission of unobligated balances of the 
Prevention and Public Health Fund and the amount of the rescission.
  I support transparency in government. I actually wish there was more 
transparency in how HHS has already spent the money from this fund. The 
lack of transparency and accountability regarding this fund is a 
primary reason I support H.R. 1217. And if the author feels this would 
increase transparency, then I support the amendment.
  I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from Texas (Ms. Jackson Lee).
  The amendment was agreed to.


            Amendment No. 2 Offered by Ms. Castor of Florida

  The Acting CHAIR. It is now in order to consider amendment No. 2 
printed in House Report 112-61.
  Ms. CASTOR of Florida. I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       At the end of the bill, add the following:

     SEC. 2. GAO STUDY ON THE IMPACTS THAT FUNDING THROUGH THE 
                   PREVENTION AND PUBLIC HEALTH FUND WOULD HAVE ON 
                   PREVENTING CHRONIC DISEASES AND PROMOTING 
                   HEALTH.

       The Comptroller General of the United States shall conduct 
     a study to determine the impacts that providing prevention, 
     wellness, and public health activities under the Prevention 
     and Public Health Fund, using the funding made available 
     under section 4002 of the Patient Protection and Affordable 
     Care Act (42 U.S.C. 300u-11), would have on preventing 
     chronic diseases and promoting health in the United States, 
     if such funding were not repealed and rescinded under section 
     1. Not later than the expiration of the 90-day period 
     beginning on the day of the enactment of this Act, the 
     Comptroller General shall submit to the Congress a report 
     setting forth the results and conclusions of the study under 
     this section.

  The Acting CHAIR. Pursuant to House Resolution 219, the gentlewoman 
from Florida (Ms. Castor) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Florida.
  Ms. CASTOR of Florida. Madam Chair, my amendment requires a 
government accountability study within 90 days of enactment of the law 
to study the impact the Prevention and Public Health initiative has on 
preventing chronic diseases and promoting public health.
  Madam Chair, prevention works. It's smart. It saves the taxpayers 
money. It saves families money. And it saves lives. The Prevention and 
Public

[[Page 5900]]

Health initiative empowers communities all across this great Nation to 
focus on prevention and wellness and what works for them when it comes 
to reducing cancer cases, reducing heart disease, reducing strokes back 
in our own hometowns.
  In Florida alone, there are over 10 million cases of the seven most 
common chronic diseases--cancer, diabetes, heart disease, hypertension, 
stroke, mental disorders and pulmonary conditions. We all know our 
neighbors, friends, families, folks we go to church with, folks we see 
in the grocery store that suffer from these diseases. In a lot of these 
cases, if they had gotten early detection or if we had worked harder on 
prevention, they wouldn't have fallen into that trap of the disease and 
all that it brings for families and communities.
  See, we have a better approach now. We are smarter in America. No 
longer should our health care system be focused only on taking care of 
folks in the hospital when they're sick or at the end stages. We're 
smarter. We can prevent a lot of this through education and being 
proactive and encouraging a healthier lifestyle.
  And that's what the Prevention and Public Health Initiative does. 
State and local communities are able to decide what works best for 
them. This isn't Washington dictating what you should do. This is 
saying to our local hometowns and communities, What do you think works 
best for you?

                              {time}  1620

  So I would encourage all of my colleagues to take a look at the 
grants that are being made. How are your local communities making these 
investments work in your own districts to invest in the long term 
health of our neighbors and the economic prosperity of our communities?
  For example, in my hometown in my district, the Pinellas County 
Health Department has brought together neighborhoods and all the 
nonprofits to determine--you know what's going to work best in Pinellas 
County is encouraging healthier lifestyles, because we have an obesity 
epidemic. So they want to build sidewalks, trails, bike lanes, better 
lighting to encourage people to exercise. They are going to make 
improvements to parks so children have the opportunity to get out and 
play after school instead of sitting in front of the television.
  I also have a great public university, the University of South 
Florida, in my district. They are training the modern health care 
workforce in Florida. These are professionals fighting on the front 
lines of our communities, and yes, creating jobs. This is creating jobs 
to encourage the healthier lifestyles that work. USF is able to 
identify where the gaps in training might be, develop updated curricula 
to ensure the public health care workforce receives the most up-to-date 
research, and then they can spread the word throughout the churches, 
the grocery stores, and our neighborhoods.
  The Florida Department of Health is also using these grants in 
checking on all of our strategies Statewide to determine what works. 
See, this is one of the important goals of the Affordable Care Act, to 
promote wellness and prevention, to ensure healthier outcomes for our 
families and neighbors. And the examples I have just shared with you 
are only a few of what's happening all across the country.
  We are smarter, Madam Chair. Prevention works. It saves taxpayers 
money. It saves families money. It saves lives.
  I reserve the balance of my time.
  Mr. PITTS. Madam Chair, I rise in opposition to the Castor amendment.
  The Acting CHAIR. The gentleman from Pennsylvania is recognized for 5 
minutes.
  Mr. PITTS. Madam Chair, the amendment before us directs the GAO to 
pontificate on the effectiveness of unspecified prevention, wellness, 
and public health activities financed by funds under section 4002 of 
PPACA.
  As we have pointed out, section 4002 gives the Secretary of HHS 
complete discretion to spend the slush fund with little limitation. Any 
program within the Public Health Service Act, regardless of its merit 
or effectiveness, is eligible for funding under section 4002. How can 
we ask the GAO to determine the effectiveness of spending dollars when 
we simply don't know how those dollars will be spent? Is GAO supposed 
to assume that funds will be used to train doctors or build jungle 
gyms? Will their report make the assumption that the money will be used 
to advocate for soda tax increases in States or build signs that direct 
people to bike paths? All of these activities can be funded through 
this slush fund.
  According to the Energy and Commerce minority views, Pitt County, 
North Carolina, received a grant from the fund that will be in part 
used to ``place signage within communities to point out public parks, 
other recreational opportunities, and the availability of bike lanes.''
  This amendment underscores the major problem with section 4002. 
Rather than letting Congress weigh the relative value of programs 
through the annual appropriations process, my friends on the other side 
of the aisle decided to throw dollars to a political appointee at HHS 
to spend billions of dollars on any program with no oversight. The 
amendment also places an unrealistic timetable on the GAO to issue a 
report within 90 days of enactment. It is simply a waste of money to 
ask GAO to conduct a study with little time to complete what is clearly 
an impossible task.
  I urge my colleagues to vote ``no.''
  I reserve the balance of my time.
  Ms. CASTOR of Florida. Madam Chair, how much more time do I have?
  The Acting CHAIR. The gentlewoman from Florida has 1 minute remaining 
and the gentleman from Pennsylvania has 2\1/2\ minutes remaining.
  Ms. CASTOR of Florida. Who has the right to close?
  The Acting CHAIR. The gentleman from Pennsylvania has the right to 
close.
  Ms. CASTOR of Florida. Madam Chair, what a waste of money it would be 
if we do not act on education and knowledge, because we know that 
prevention works in America. When you educate someone on healthier 
lifestyles, the likelihood is that they are going to live a healthier 
life. They can prevent disease. Maybe they get early detection of their 
cancer. And that would save them a lot of money. You know, it also 
would save the government a lot of money. So let's be smart about this. 
Prevention works.
  It reminds me now of my friends across the aisle, their proposal to 
end Medicare as we know it, because that is not smart. Again, like 
prevention, Medicare works. It saves families money. And the plan to 
privatize Medicare and turn it into a voucher program is not going to 
save any money. Indeed, it will shift the costs to families. They will 
have to pay more. So let's do what's smart. Prevention works.
  I urge adoption of my amendment.
  Mr. PITTS. Madam Chair, the simple fact is everything the gentlelady 
just mentioned she doesn't know will be funded. There is no guarantee 
to fund any of those things.
  I urge a ``no'' vote on this amendment.
  I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from Florida (Ms. Castor).
  The question was taken; and the Acting Chair announced that the noes 
appeared to have it.
  Ms. CASTOR. Madam Chair, I demand a recorded vote.
  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further 
proceedings on the amendment offered by the gentlewoman from Florida 
will be postponed.


            Amendment No. 3 Offered by Ms. Castor of Florida

  The Acting CHAIR. It is now in order to consider amendment No. 3 
printed in House Report 112-61.
  Ms. CASTOR of Florida. Madam Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       At the end of the bill, add the following:

[[Page 5901]]



     SEC. 2. GAO STUDY ON THE ECONOMIC IMPACTS THAT FUNDING 
                   THROUGH THE PREVENTION AND PUBLIC HEALTH FUND 
                   WOULD HAVE ON STATES AND COMMUNITIES.

       The Comptroller General of the United States shall conduct 
     a study to determine the economic impacts that providing 
     prevention, wellness, and public health activities under the 
     Prevention and Public Health Fund, using the funding made 
     available under section 4002 of the Patient Protection and 
     Affordable Care Act (42 U.S.C. 300u-11), would have on States 
     and communities in the United States, if such funding were 
     not repealed and rescinded under section 1. Not later than 
     the expiration of the 90-day period beginning on the day of 
     the enactment of this Act, the Comptroller General shall 
     submit to the Congress a report setting forth the results and 
     conclusions of the study under this section.

  The Acting CHAIR. Pursuant to House Resolution 219, the gentlewoman 
from Florida (Ms. Castor) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Florida.
  Ms. CASTOR of Florida. Madam Chair, my amendment requires a 
Government Accountability Office study within 90 days of enactment of 
this bill to examine the economic impact Prevention and Public Health 
grants have on States and local communities.
  Now, I can tell you we don't really need a study to understand how 
important prevention is and how important it is to empower our 
hometowns, local governments, nonprofits, whoever can come together on 
a local level and make these decisions about encouraging healthier 
lifestyles.
  The beauty of the Public Health and Prevention initiative is it's not 
Washington dictating all across the country a cookie-cutter approach, 
one size fits all. Instead, we empower our neighbors to make these 
decisions on what works best for them. I would say that what works best 
in my hometown back in Tampa probably would not work quite as well in 
Fargo or in Missouri.
  Prevention of disease is smart. It saves families money, and it saves 
taxpayers money as well. Now, over time we have all gotten smarter 
about preventing chronic diseases. Much of this cost-saving and life-
saving focus was brought to bear in the landmark Affordable Care Act 
and this Prevention and Public Health initiative, which is the most 
historic investment in public health of our communities in the history 
of our country.
  Now, far from the extreme arguments against prevention from my 
colleagues across the aisle, the Prevention and Public Health 
initiative empowers States, hometowns, and local communities to 
determine what works best for them. The annual treatment cost of 
chronic diseases costs the United States over $270 billion. And our 
economy has lost over $1 trillion in lost productivity. In Florida 
alone, we have lost over $68 billion in lost productivity and economic 
costs due to chronic diseases like heart disease, diabetes, and cancer.
  So not only does prevention help us reduce costs, it can be an 
economic boost to our communities. I can tell you back in Florida we 
need as many economic boosts as we can get. We still have a high 
unemployment rate. We have a large number of uninsured. So what could 
be smarter than targeting some of our communities and encouraging them 
on healthier lifestyles so they can get back to work?
  We are creating jobs through doing this. For example, at the 
University of South Florida College of Public Health, they've received 
one of the Prevention and Public Health grants where they're hiring and 
training the modern public health workforce. These are the folks with 
the most updated knowledge that are able to go out through communities 
and encourage them and educate them on what it would mean if they 
didn't smoke, if they didn't drink. Oftentimes, these initiatives have 
a great impact. They can save us money, and they can save us lives.

                              {time}  1630

  In Pinellas County they are combating childhood obesity, and they are 
already making a big economic impact in the community. Richard Curtin 
is the program manager for the Communities Putting Prevention to Work--
Pinellas. He informed me they have created already 18 jobs as a direct 
result of this lifesaving work.
  So I would encourage all of you to ask your folks back home what 
works best for them. Apply for these grants. We can make a difference 
all across America, save taxpayers money, save our families money, and 
save lives while we are at it.
  I reserve the balance of my time.
  Mr. PITTS. Madam Chair, I rise in opposition to the amendment.
  The Acting CHAIR. The gentleman from Pennsylvania is recognized for 5 
minutes.
  Mr. PITTS. Madam Chair, the Castor amendment directs the Government 
Accountability Office to make assumptions on the economic impacts of 
providing prevention, wellness, and public health activities under 
section 4002 of the PPACA. However, section 4002 gives the Secretary of 
HHS complete discretion to spend this slush fund with little 
limitation. The amendment asks the GAO to determine the economic impact 
of spending when no one except the Secretary knows how those dollars 
will be spent.
  What will GAO base their assumptions on? Does placing signage for 
bike paths produce economic activity or does advocating higher soda 
taxes benefit the economy? These activities have been financed by 
programs eligible for funding under section 4002.
  Members and the GAO cannot determine the economic impact of the fund 
because the Secretary controls how it is to be spent. Will GAO be 
charged with determining whether borrowing 42 cents of every dollar 
this fund spends has a positive economic impact?
  This amendment underscores the major problems with section 4002. 
Rather than letting Congress weigh the relative value of programs 
through the annual appropriations process, my friends on the other side 
of the aisle have decided to throw dollars to a political appointee at 
HHS to spend billions on any program with no oversight.
  The amendment also places an unrealistic timetable on the GAO to 
issue a report within 90 days of enactment. Like the previous 
amendment, we are not spending our resources wisely when we ask the GAO 
to conduct a study with little time to complete what is clearly an 
impossible task.
  I urge Members to oppose the amendment.
  I reserve the balance of my time.
  Ms. CASTOR of Florida. Madam Chair, we are spending our dollars 
wisely when we are investing in prevention and wellness because 
prevention works. Prevention saves money, it saves the taxpayers money, 
it saves families money and it saves lives.
  Now, there has been a great debate all across America about health 
care over the past few years. I think we can all agree on that. Part of 
the importance of the health care debate was that our health care 
system for too long has focused and spent money at the end game on 
sickness, when people have cancer, and that's fine, but we can be 
smarter about it. We have a lot more knowledge and a lot of experts 
that have advised us all that if you invest in prevention to encourage 
folks not to smoke, not to drink, those easy things, very easy in 
lifestyle, but oftentimes they need a little extra help. Parents should 
turn off the TV and the kids should go out and play. They should 
exercise.
  But sometimes it's that little extra push. And if we can make a dent 
in childhood obesity, diabetes, cancer, a stroke, because we have 
encouraged healthier lifestyles with this very modest investment, that 
will be a great accomplishment. And that's part of what the health care 
debate was about, taking this modest investment in public health and 
empowering our communities to make those decisions on what works for 
them. Prevention works. It's smart.
  I urge the adoption of my amendment.
  I yield back the balance of my time.
  Mr. PITTS. Madam Chair, once again the gentlewoman made my point. She 
has no guarantee that in the year 2015 the Secretary will fund programs 
like cessation of smoking or obesity. She has not a clue. What if the 
Secretary decided to use the whole $2 billion for

[[Page 5902]]

abstinence education in 2015? She has no clue what it will be used for.
  I urge the Members to oppose this amendment.
  I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from Florida (Ms. Castor).
  The question was taken; and the Acting Chair announced that the noes 
appeared to have it.
  Ms. CASTOR of Florida. Madam Chair, I demand a recorded vote.
  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further 
proceedings on the amendment offered by the gentlewoman from Florida 
will be postponed.


                    Announcement by the Acting Chair

  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, proceedings 
will now resume on those amendments printed in House Report 112-61 on 
which further proceedings were postponed, in the following order:
  Amendment No. 2 by Ms. Castor of Florida.
  Amendment No. 3 by Ms. Castor of Florida.
  The Chair will reduce to 5 minutes the time for the second electronic 
vote in this series.


            Amendment No. 2 Offered by Ms. Castor of Florida

  The Acting CHAIR. The unfinished business is the demand for a 
recorded vote on the amendment offered by the gentlewoman from Florida 
(Ms. Castor) on which further proceedings were postponed and on which 
the noes prevailed by voice vote.
  The Clerk will redesignate the amendment.
  The Clerk redesignated the amendment.


                             Recorded Vote

  The Acting CHAIR. A recorded vote has been demanded.
  A recorded vote was ordered.
  The vote was taken by electronic device, and there were--ayes 187, 
noes 237, not voting 8, as follows:

                             [Roll No. 261]

                               AYES--187

     Ackerman
     Andrews
     Baca
     Baldwin
     Barrow
     Becerra
     Berkley
     Berman
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Boren
     Boswell
     Brady (PA)
     Braley (IA)
     Brown (FL)
     Butterfield
     Capps
     Capuano
     Cardoza
     Carnahan
     Carney
     Carson (IN)
     Castor (FL)
     Chandler
     Chu
     Cicilline
     Clarke (MI)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly (VA)
     Conyers
     Cooper
     Costa
     Costello
     Courtney
     Critz
     Crowley
     Cuellar
     Cummings
     Davis (CA)
     Davis (IL)
     DeFazio
     DeGette
     DeLauro
     Deutch
     Dicks
     Dingell
     Doggett
     Donnelly (IN)
     Doyle
     Edwards
     Ellison
     Engel
     Eshoo
     Farr
     Fattah
     Filner
     Frank (MA)
     Fudge
     Garamendi
     Gonzalez
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hanabusa
     Harris
     Hastings (FL)
     Heinrich
     Higgins
     Himes
     Hinchey
     Hinojosa
     Hirono
     Holden
     Holt
     Honda
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson Lee (TX)
     Johnson (GA)
     Johnson, E. B.
     Kaptur
     Keating
     Kildee
     Kind
     Kissell
     Kucinich
     Langevin
     Larsen (WA)
     Larson (CT)
     Lee (CA)
     Levin
     Lewis (GA)
     Lipinski
     Loebsack
     Lofgren, Zoe
     Lowey
     Lujan
     Lynch
     Markey
     Matheson
     Matsui
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McIntyre
     McNerney
     Michaud
     Miller (NC)
     Miller, George
     Moore
     Moran
     Murphy (CT)
     Nadler
     Napolitano
     Neal
     Olver
     Owens
     Pallone
     Pascrell
     Pastor (AZ)
     Payne
     Pelosi
     Perlmutter
     Peters
     Peterson
     Pingree (ME)
     Polis
     Price (NC)
     Quigley
     Rahall
     Rangel
     Reyes
     Richmond
     Ross (AR)
     Rothman (NJ)
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schiff
     Schrader
     Schwartz
     Scott (VA)
     Scott, David
     Serrano
     Sewell
     Sherman
     Shuler
     Sires
     Slaughter
     Smith (WA)
     Speier
     Stark
     Sutton
     Thompson (CA)
     Thompson (MS)
     Tierney
     Tonko
     Towns
     Tsongas
     Van Hollen
     Velazquez
     Visclosky
     Walz (MN)
     Wasserman Schultz
     Waters
     Watt
     Waxman
     Weiner
     Welch
     Wilson (FL)
     Woolsey
     Wu
     Yarmuth

                               NOES--237

     Adams
     Aderholt
     Akin
     Alexander
     Altmire
     Amash
     Austria
     Bachmann
     Bachus
     Barletta
     Bartlett
     Barton (TX)
     Bass (NH)
     Benishek
     Berg
     Biggert
     Bilbray
     Bilirakis
     Bishop (UT)
     Black
     Blackburn
     Bonner
     Bono Mack
     Boustany
     Brady (TX)
     Brooks
     Broun (GA)
     Buchanan
     Bucshon
     Buerkle
     Burgess
     Burton (IN)
     Calvert
     Camp
     Campbell
     Canseco
     Cantor
     Capito
     Carter
     Cassidy
     Chabot
     Chaffetz
     Coble
     Coffman (CO)
     Cole
     Conaway
     Cravaack
     Crawford
     Crenshaw
     Davis (KY)
     Denham
     Dent
     DesJarlais
     Diaz-Balart
     Dold
     Dreier
     Duffy
     Duncan (SC)
     Duncan (TN)
     Ellmers
     Emerson
     Farenthold
     Fincher
     Fitzpatrick
     Flake
     Fleischmann
     Fleming
     Flores
     Forbes
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Gardner
     Garrett
     Gerlach
     Gibbs
     Gibson
     Gingrey (GA)
     Gohmert
     Goodlatte
     Gosar
     Gowdy
     Granger
     Graves (GA)
     Graves (MO)
     Griffin (AR)
     Griffith (VA)
     Grimm
     Guinta
     Guthrie
     Hall
     Hanna
     Harper
     Hartzler
     Hastings (WA)
     Hayworth
     Heck
     Heller
     Hensarling
     Herger
     Herrera Beutler
     Huelskamp
     Huizenga (MI)
     Hultgren
     Hunter
     Hurt
     Issa
     Jenkins
     Johnson (IL)
     Johnson (OH)
     Johnson, Sam
     Jones
     Jordan
     Kelly
     King (IA)
     King (NY)
     Kingston
     Kinzinger (IL)
     Kline
     Labrador
     Lamborn
     Lance
     Landry
     Lankford
     Latham
     LaTourette
     Latta
     Lewis (CA)
     LoBiondo
     Long
     Lucas
     Luetkemeyer
     Lummis
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     Marino
     McCarthy (CA)
     McCaul
     McClintock
     McCotter
     McHenry
     McKeon
     McKinley
     McMorris Rodgers
     Meehan
     Mica
     Miller (FL)
     Miller (MI)
     Miller, Gary
     Mulvaney
     Murphy (PA)
     Myrick
     Neugebauer
     Noem
     Nugent
     Nunes
     Nunnelee
     Olson
     Palazzo
     Paul
     Paulsen
     Pearce
     Pence
     Petri
     Pitts
     Platts
     Poe (TX)
     Pompeo
     Posey
     Price (GA)
     Quayle
     Reed
     Rehberg
     Renacci
     Ribble
     Rigell
     Rivera
     Roby
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rohrabacher
     Rokita
     Rooney
     Ros-Lehtinen
     Roskam
     Ross (FL)
     Royce
     Runyan
     Ryan (WI)
     Scalise
     Schilling
     Schmidt
     Schock
     Schweikert
     Scott (SC)
     Scott, Austin
     Sensenbrenner
     Sessions
     Shimkus
     Shuster
     Simpson
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Southerland
     Stearns
     Stivers
     Stutzman
     Sullivan
     Terry
     Thompson (PA)
     Thornberry
     Tiberi
     Tipton
     Turner
     Upton
     Walberg
     Walden
     Walsh (IL)
     Webster
     West
     Westmoreland
     Whitfield
     Wilson (SC)
     Wittman
     Wolf
     Womack
     Woodall
     Yoder
     Young (AK)
     Young (FL)
     Young (IN)

                             NOT VOTING--8

     Bass (CA)
     Culberson
     Giffords
     Maloney
     Meeks
     Reichert
     Richardson
     Rogers (MI)

                              {time}  1701

  Mr. WHITFIELD and Mr. HANNA changed their vote from ``aye'' to 
``no.''
  Messrs. CARSON of Indiana, McINTYRE, DINGELL, SMITH of Washington, 
ISRAEL, HINOJOSA, Ms. LORETTA SANCHEZ of California, Ms. PINGREE of 
Maine, and Ms. LINDA T. SANCHEZ of California changed their vote from 
``no'' to ``aye.''
  So the amendment was rejected.
  The result of the vote was announced as above recorded.
  Stated for:
  Ms. RICHARDSON. Madam Speaker, I was unavoidably detained earlier 
today and therefore was not present to be recorded on rollcall vote No. 
261. Had I been present I would have voted as follows:
  On rollcall No. 261, I would have voted ``aye'' (April 13) (Castor 
(FL) Amendment, Requiring the U.S. Government Accountability Office to 
conduct a study of the impact funds awarded through the Prevention and 
Public Health Fund would have on preventing chronic diseases and 
promoting health).


            Amendment No. 3 Offered by Ms. Castor of Florida

  The Acting CHAIR. The unfinished business is the demand for a 
recorded vote on the amendment offered by the gentlewoman from Florida 
(Ms. Castor) on which further proceedings were postponed and on which 
the noes prevailed by voice vote.
  The Clerk will redesignate the amendment.
  The Clerk redesignated the amendment.


                             Recorded Vote

  The Acting CHAIR. A recorded vote has been demanded.
  A recorded vote was ordered.
  The Acting CHAIR. This will be a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 188, 
noes 238, not voting 6, as follows:

[[Page 5903]]



                             [Roll No. 262]

                               AYES--188

     Ackerman
     Andrews
     Baca
     Baldwin
     Barrow
     Bass (CA)
     Becerra
     Berkley
     Berman
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Boren
     Boswell
     Brady (PA)
     Braley (IA)
     Brown (FL)
     Butterfield
     Capps
     Capuano
     Cardoza
     Carnahan
     Carney
     Carson (IN)
     Castor (FL)
     Chandler
     Chu
     Cicilline
     Clarke (MI)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly (VA)
     Conyers
     Cooper
     Costa
     Costello
     Courtney
     Critz
     Crowley
     Cuellar
     Cummings
     Davis (CA)
     Davis (IL)
     DeGette
     DeLauro
     Deutch
     Dicks
     Dingell
     Doggett
     Donnelly (IN)
     Doyle
     Edwards
     Ellison
     Engel
     Eshoo
     Farr
     Fattah
     Filner
     Frank (MA)
     Fudge
     Garamendi
     Gonzalez
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hanabusa
     Harris
     Hastings (FL)
     Heinrich
     Higgins
     Himes
     Hinchey
     Hinojosa
     Hirono
     Holden
     Holt
     Honda
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson Lee (TX)
     Johnson (GA)
     Johnson, E. B.
     Kaptur
     Keating
     Kildee
     Kind
     Kissell
     Kucinich
     Langevin
     Larsen (WA)
     Larson (CT)
     Lee (CA)
     Levin
     Lewis (GA)
     Lipinski
     Loebsack
     Lofgren, Zoe
     Lowey
     Lujan
     Lynch
     Maloney
     Markey
     Matheson
     Matsui
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McIntyre
     McNerney
     Michaud
     Miller (NC)
     Miller, George
     Moore
     Moran
     Murphy (CT)
     Nadler
     Napolitano
     Neal
     Olver
     Owens
     Pallone
     Pascrell
     Pastor (AZ)
     Payne
     Pelosi
     Perlmutter
     Peterson
     Pingree (ME)
     Polis
     Price (NC)
     Quigley
     Rahall
     Rangel
     Reyes
     Richardson
     Richmond
     Ross (AR)
     Rothman (NJ)
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schiff
     Schrader
     Schwartz
     Scott (VA)
     Scott, David
     Serrano
     Sewell
     Sherman
     Shuler
     Sires
     Slaughter
     Smith (WA)
     Speier
     Stark
     Sutton
     Thompson (CA)
     Thompson (MS)
     Tierney
     Tonko
     Towns
     Tsongas
     Van Hollen
     Velazquez
     Visclosky
     Walz (MN)
     Wasserman Schultz
     Waters
     Watt
     Waxman
     Weiner
     Welch
     Wilson (FL)
     Woolsey
     Wu
     Yarmuth

                               NOES--238

     Adams
     Aderholt
     Akin
     Alexander
     Altmire
     Amash
     Austria
     Bachmann
     Bachus
     Barletta
     Bartlett
     Barton (TX)
     Bass (NH)
     Benishek
     Berg
     Biggert
     Bilbray
     Bilirakis
     Bishop (UT)
     Black
     Bonner
     Bono Mack
     Boustany
     Brady (TX)
     Brooks
     Broun (GA)
     Buchanan
     Bucshon
     Buerkle
     Burgess
     Burton (IN)
     Calvert
     Camp
     Campbell
     Canseco
     Cantor
     Capito
     Carter
     Cassidy
     Chabot
     Chaffetz
     Coble
     Coffman (CO)
     Cole
     Conaway
     Cravaack
     Crawford
     Crenshaw
     Davis (KY)
     DeFazio
     Denham
     Dent
     DesJarlais
     Diaz-Balart
     Dold
     Dreier
     Duffy
     Duncan (SC)
     Duncan (TN)
     Ellmers
     Emerson
     Farenthold
     Fincher
     Fitzpatrick
     Flake
     Fleischmann
     Fleming
     Flores
     Forbes
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Gardner
     Garrett
     Gerlach
     Gibbs
     Gibson
     Gingrey (GA)
     Gohmert
     Goodlatte
     Gosar
     Gowdy
     Granger
     Graves (GA)
     Graves (MO)
     Griffin (AR)
     Griffith (VA)
     Grimm
     Guinta
     Guthrie
     Hall
     Hanna
     Harper
     Hartzler
     Hastings (WA)
     Hayworth
     Heck
     Heller
     Hensarling
     Herger
     Herrera Beutler
     Huelskamp
     Huizenga (MI)
     Hultgren
     Hunter
     Hurt
     Issa
     Jenkins
     Johnson (IL)
     Johnson (OH)
     Johnson, Sam
     Jones
     Jordan
     Kelly
     King (IA)
     King (NY)
     Kingston
     Kinzinger (IL)
     Kline
     Labrador
     Lamborn
     Lance
     Landry
     Lankford
     Latham
     LaTourette
     Latta
     Lewis (CA)
     LoBiondo
     Long
     Lucas
     Luetkemeyer
     Lummis
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     Marino
     McCarthy (CA)
     McCaul
     McClintock
     McCotter
     McHenry
     McKeon
     McKinley
     McMorris Rodgers
     Meehan
     Mica
     Miller (FL)
     Miller (MI)
     Miller, Gary
     Mulvaney
     Murphy (PA)
     Myrick
     Neugebauer
     Noem
     Nugent
     Nunes
     Nunnelee
     Olson
     Palazzo
     Paul
     Paulsen
     Pearce
     Pence
     Peters
     Petri
     Pitts
     Platts
     Poe (TX)
     Pompeo
     Posey
     Price (GA)
     Quayle
     Reed
     Rehberg
     Renacci
     Ribble
     Rigell
     Rivera
     Roby
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Rokita
     Rooney
     Ros-Lehtinen
     Roskam
     Ross (FL)
     Royce
     Runyan
     Ryan (WI)
     Scalise
     Schilling
     Schmidt
     Schock
     Schweikert
     Scott (SC)
     Scott, Austin
     Sensenbrenner
     Sessions
     Shimkus
     Shuster
     Simpson
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Southerland
     Stearns
     Stivers
     Stutzman
     Sullivan
     Terry
     Thompson (PA)
     Thornberry
     Tiberi
     Tipton
     Turner
     Upton
     Walberg
     Walden
     Walsh (IL)
     Webster
     West
     Westmoreland
     Whitfield
     Wilson (SC)
     Wittman
     Wolf
     Womack
     Yoder
     Young (AK)
     Young (FL)
     Young (IN)

                             NOT VOTING--6

     Blackburn
     Culberson
     Giffords
     Meeks
     Reichert
     Woodall

                              {time}  1709

  So the amendment was rejected.
  The result of the vote was announced as above recorded.
  The Acting CHAIR (Mr. Bishop of Utah). Under the rule, the Committee 
rises.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Westmoreland) having assumed the chair, Mr. Bishop of Utah, Acting 
Chair of the Committee of the Whole House on the state of the Union, 
reported that that Committee, having had under consideration the bill 
(H.R. 1217) to repeal the Prevention and Public Health Fund, and 
pursuant to House Resolution 219, reported the bill back to the House 
with an amendment adopted in the Committee of the Whole.
  The SPEAKER pro tempore. Under the rule, the previous question is 
ordered.
  The question is on the amendment.
  The amendment was agreed to.
  The SPEAKER pro tempore. The question is on the engrossment and third 
reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.


                           Motion to Recommit

  Mr. LOEBSACK. Mr. Speaker, I have a motion to recommit at the desk.
  The SPEAKER pro tempore. Is the gentleman opposed to the bill?
  Mr. LOEBSACK. I am opposed to the bill in its current form.
  Mr. PITTS. Mr. Speaker, I reserve a point of order on the motion to 
recommit.
  The SPEAKER pro tempore. A point of order is reserved.
  The Clerk will report the motion to recommit.
  The Clerk read as follows:

       Mr. Loebsack moves to recommit the bill H.R. 1217 to the 
     Committee on Energy and Commerce with instructions to report 
     the same to the House forthwith with the following amendment:
       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. PRESERVING PREVENTION AND PUBLIC HEALTH FUND FOR 
                   ACTIVITIES FOR SENIORS, SUBJECT TO AVAILABILITY 
                   OF APPROPRIATIONS.

       (a) In General.--Section 4002 of the Patient Protection and 
     Affordable Care Act is amended--
       (1) in subsection (a), by striking ``It is the purpose'' 
     and inserting ``Subject to subsection (c), it is the 
     purpose'';
       (2) in subsection (b), by striking ``, and appropriated''; 
     and
       (3) in subsection (c)--
       (A) by striking ``shall'' and inserting ``may, to the 
     extent and in the amounts made available for use by an 
     appropriations Act,''; and
       (B) by striking ``for prevention, wellness, and public 
     health activities including'' and all that follows through 
     the period at the end and inserting ``for prevention, 
     wellness, and public health activities for individuals 65 
     years of age or older.''.
       (b) Rescission of Unobligated Funds.--Of the funds 
     appropriated by such section 4002 before the date of the 
     enactment of this Act, the unobligated balance is rescinded.

  The SPEAKER pro tempore. The gentleman from Iowa is recognized for 5 
minutes in support of his motion.
  Mr. LOEBSACK. Mr. Speaker, while I oppose the underlying bill, I am 
offering this final amendment on a topic that I know is important to 
all of us--our Nation's seniors. Our seniors have worked hard all their 
lives. Many of them have lived through some of the most trying times in 
American history, including the Great Depression and two world wars. 
They have also been a part of some of our country's proudest 
achievements and moments, like putting the first man on the Moon.
  Along the way, our seniors have made incredible sacrifices for their 
families and for their country. My own grandmother helped take care of 
me while I was young, making sure that my siblings and I had a safe 
place to live and food on the table. That is why our seniors deserve 
the best care and treatment available as they age.
  I have visited seniors all across my district in Iowa, delivering 
Meals on

[[Page 5904]]

Wheels in Cedar Rapids and Muscatine, serving lunch at senior dining in 
Marion, and hosting events at senior centers and retirement communities 
like Westgate Towers in Ottumwa and Cedar County Senior Center in 
Tipton where this photo was taken.
  One of my proudest moments in Congress in fact was when I met with a 
group of World War II veterans who were here from Iowa on an honor 
flight tour. I was privileged to thank them for their service.
  When I talk to seniors in my district, I hear far too often that many 
of them are struggling. This is unacceptable. No senior should retire 
into poverty or have difficulty paying their medical bills. While we 
may disagree on the Republican budget, which would end Medicare as we 
know it, I think we can all agree that we owe seniors access to the 
preventive health care and public health efforts that the underlying 
bill would repeal. I am determined to fight for our seniors and to make 
sure that we keep our promises to them. That is why this final 
amendment will ensure that the repeal of the Prevention and Public 
Health Fund will not apply to prevention, wellness, and public health 
activities for individuals 65 years of age or older.
  This funding can be used for programs that promote wellness, that 
empower seniors to take personal responsibility for staying healthy as 
they age. It can also be used for prevention, including screenings for 
cancer, heart disease, and Alzheimer's disease. The fund can also be 
used for public health activities to ensure that seniors have the 
information they need to make the best possible decisions about their 
health. These funds can also be used for research, so we can find ways 
to prevent health problems associated with aging. What's more, by 
focusing on public health and prevention, this fund can reduce costs in 
the long run.
  We all know that early detection improves patient outcomes and saves 
money, and successful public health campaigns have demonstrated that we 
can decrease unhealthy behaviors by equipping people with good 
information. That is why I believe the underlying bill, itself, is 
penny wise but pound foolish. In the long run, the underlying bill only 
serves to hurt the Nation's seniors. It is unfortunate that some are 
choosing to make this shortsighted decision when the health of our 
seniors is at stake.
  Madam Speaker, the American people, we should keep in mind, sent us 
here not to fight with each other over critical issues such as the one 
before us today but to fight together for them. I urge all Members to 
join me in ensuring that our Nation's seniors have access to the 
preventive health care that will keep them healthy, allowing them to 
enjoy their friends and families and remain active in their 
communities. We owe the seniors in our districts at least that much.
  The passage of this amendment will not prevent the passage of the 
underlying bill. If the amendment is adopted, it will be incorporated 
into the bill and the bill will be immediately voted upon. I believe, 
Madam Speaker, that now is the time to show the American people that we 
as a body can indeed work effectively for them, and I urge all of my 
colleagues to vote for this commonsense final amendment.
  I yield back the balance of my time.
  Mr. PITTS. Madam Speaker, I withdraw my reservation and rise in 
opposition to the motion.
  The SPEAKER pro tempore (Mrs. Emerson). The reservation is withdrawn, 
and the gentleman from Pennsylvania is recognized for 5 minutes.
  Mr. PITTS. Thank you, Madam Speaker.
  Yesterday, we heard the House minority leader say that ``elections 
shouldn't matter as much as they do.''
  I strongly disagree. Members were brought here to get runaway 
spending under control; but rather than help us avoid a fiscal crisis, 
House Democrats have brought forward an MTR that guts the underlying 
bill and continues the runaway spending that the American people have 
rejected.
  As we have pointed out, section 4002 gives the Secretary of HHS 
complete discretion to spend the slush fund with little limitation. Any 
program within the Public Health Service Act, regardless of its merit 
or effectiveness, is eligible for funding under section 4002.
  Will section 4002 help train doctors, or will the money be used to 
build jungle gyms? Will the Prevention and Public Health Fund be used 
to advocate for soda tax increases in States or build signs that direct 
people to bike paths? All of these activities can be funded through 
this slush fund.
  This MTR underscores the major problem with section 4002. Rampant 
spending on the Federal credit card cannot continue. The Federal 
Government will be borrowing 42 cents of every Federal dollar spent 
from this fund. We are facing a $1.6 trillion deficit. The President's 
irresponsible budget will double the national debt from $14 trillion to 
$26 trillion. This endless spending is fiscally irresponsible and 
morally bankrupt. Spending today is debt that our children and 
grandchildren will pay tomorrow.
  I urge my colleagues to vote ``no'' on the MTR and ``yes'' on the 
underlying bill so we can help get our fiscal house back in order.
  I yield back the balance of my time.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered on the motion to recommit.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.


                             Recorded Vote

  Mr. LOEBSACK. Madam Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The SPEAKER pro tempore. Pursuant to clause 9 of rule XX, the Chair 
will reduce to 5 minutes the minimum time for any electronic vote on 
the question of passage.
  The vote was taken by electronic device, and there were--ayes 189, 
noes 234, not voting 9, as follows:

                             [Roll No. 263]

                               AYES--189

     Ackerman
     Altmire
     Andrews
     Baca
     Baldwin
     Barrow
     Bass (CA)
     Becerra
     Berkley
     Berman
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Boren
     Boswell
     Brady (PA)
     Braley (IA)
     Brown (FL)
     Butterfield
     Capps
     Capuano
     Cardoza
     Carnahan
     Carney
     Carson (IN)
     Castor (FL)
     Chandler
     Chu
     Cicilline
     Clarke (MI)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly (VA)
     Conyers
     Cooper
     Costa
     Costello
     Courtney
     Critz
     Crowley
     Cuellar
     Cummings
     Davis (CA)
     Davis (IL)
     DeFazio
     DeGette
     DeLauro
     Deutch
     Dicks
     Dingell
     Doggett
     Donnelly (IN)
     Doyle
     Edwards
     Ellison
     Engel
     Eshoo
     Farr
     Fattah
     Filner
     Frank (MA)
     Fudge
     Garamendi
     Gonzalez
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hanabusa
     Hastings (FL)
     Heinrich
     Higgins
     Himes
     Hinchey
     Hinojosa
     Hirono
     Holden
     Holt
     Honda
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson Lee (TX)
     Johnson (GA)
     Johnson, E. B.
     Kaptur
     Keating
     Kildee
     Kind
     Kissell
     Kucinich
     Langevin
     Larsen (WA)
     Larson (CT)
     Lee (CA)
     Levin
     Lewis (GA)
     Lipinski
     Loebsack
     Lofgren, Zoe
     Lowey
     Lujan
     Lynch
     Maloney
     Markey
     Matheson
     Matsui
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McIntyre
     McNerney
     Michaud
     Miller (NC)
     Miller, George
     Moore
     Moran
     Murphy (CT)
     Nadler
     Napolitano
     Neal
     Olver
     Owens
     Pallone
     Pascrell
     Pastor (AZ)
     Payne
     Pelosi
     Perlmutter
     Peters
     Peterson
     Pingree (ME)
     Polis
     Price (NC)
     Quigley
     Rahall
     Rangel
     Reyes
     Richardson
     Richmond
     Ross (AR)
     Rothman (NJ)
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schiff
     Schrader
     Schwartz
     Scott (VA)
     Scott, David
     Serrano
     Sewell
     Sherman
     Shuler
     Sires
     Smith (WA)
     Speier
     Stark
     Sutton
     Thompson (CA)
     Thompson (MS)
     Tierney
     Tonko
     Towns
     Tsongas
     Van Hollen
     Velazquez
     Visclosky
     Walz (MN)
     Wasserman Schultz
     Waters
     Watt
     Waxman
     Weiner
     Welch
     Wilson (FL)
     Woolsey
     Wu
     Yarmuth

                               NOES--234

     Adams
     Aderholt
     Akin
     Alexander
     Amash
     Austria
     Bachmann
     Bachus
     Barletta
     Bartlett
     Barton (TX)
     Bass (NH)
     Benishek
     Berg
     Biggert
     Bilbray
     Bilirakis
     Bishop (UT)
     Black
     Blackburn
     Bonner
     Bono Mack
     Boustany
     Brady (TX)
     Brooks
     Broun (GA)
     Buchanan
     Bucshon
     Buerkle
     Burgess
     Burton (IN)
     Calvert
     Camp

[[Page 5905]]


     Campbell
     Canseco
     Cantor
     Capito
     Carter
     Cassidy
     Chabot
     Chaffetz
     Coble
     Coffman (CO)
     Cole
     Conaway
     Cravaack
     Crawford
     Crenshaw
     Davis (KY)
     Denham
     Dent
     DesJarlais
     Diaz-Balart
     Dold
     Dreier
     Duffy
     Duncan (SC)
     Duncan (TN)
     Ellmers
     Emerson
     Farenthold
     Fincher
     Fitzpatrick
     Flake
     Fleischmann
     Fleming
     Flores
     Forbes
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Gardner
     Garrett
     Gerlach
     Gibbs
     Gibson
     Gingrey (GA)
     Gohmert
     Goodlatte
     Gosar
     Gowdy
     Granger
     Graves (GA)
     Graves (MO)
     Griffin (AR)
     Griffith (VA)
     Grimm
     Guinta
     Guthrie
     Hall
     Hanna
     Harper
     Harris
     Hartzler
     Hastings (WA)
     Hayworth
     Heck
     Heller
     Hensarling
     Herger
     Huelskamp
     Huizenga (MI)
     Hultgren
     Hunter
     Hurt
     Issa
     Jenkins
     Johnson (IL)
     Johnson (OH)
     Johnson, Sam
     Jones
     Jordan
     Kelly
     King (IA)
     King (NY)
     Kingston
     Kinzinger (IL)
     Kline
     Labrador
     Lamborn
     Lance
     Landry
     Lankford
     Latham
     LaTourette
     Latta
     Lewis (CA)
     LoBiondo
     Long
     Lucas
     Luetkemeyer
     Lummis
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     Marino
     McCarthy (CA)
     McCaul
     McClintock
     McCotter
     McHenry
     McKeon
     McKinley
     McMorris Rodgers
     Meehan
     Mica
     Miller (FL)
     Miller (MI)
     Miller, Gary
     Mulvaney
     Murphy (PA)
     Myrick
     Neugebauer
     Noem
     Nugent
     Nunes
     Nunnelee
     Olson
     Palazzo
     Paul
     Paulsen
     Pearce
     Pence
     Petri
     Pitts
     Platts
     Poe (TX)
     Pompeo
     Posey
     Price (GA)
     Quayle
     Reed
     Rehberg
     Renacci
     Ribble
     Rigell
     Rivera
     Roby
     Roe (TN)
     Rogers (AL)
     Rogers (MI)
     Rohrabacher
     Rokita
     Rooney
     Ros-Lehtinen
     Roskam
     Ross (FL)
     Runyan
     Ryan (WI)
     Scalise
     Schilling
     Schmidt
     Schock
     Schweikert
     Scott (SC)
     Scott, Austin
     Sensenbrenner
     Sessions
     Shimkus
     Shuster
     Simpson
     Smith (NE)
     Smith (TX)
     Southerland
     Stearns
     Stivers
     Stutzman
     Sullivan
     Terry
     Thompson (PA)
     Thornberry
     Tiberi
     Tipton
     Turner
     Upton
     Walberg
     Walden
     Walsh (IL)
     Webster
     West
     Westmoreland
     Whitfield
     Wilson (SC)
     Wittman
     Wolf
     Womack
     Woodall
     Yoder
     Young (AK)
     Young (FL)
     Young (IN)

                             NOT VOTING--9

     Culberson
     Giffords
     Herrera Beutler
     Meeks
     Reichert
     Rogers (KY)
     Royce
     Slaughter
     Smith (NJ)

                              {time}  1736

  So the motion to recommit was rejected.
  The result of the vote was announced as above recorded.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.


                             Recorded Vote

  Mr. PITTS. Madam Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The SPEAKER pro tempore. This is a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 236, 
noes 183, not voting 13, as follows:

                             [Roll No. 264]

                               AYES--236

     Adams
     Aderholt
     Akin
     Alexander
     Altmire
     Amash
     Austria
     Bachmann
     Bachus
     Barletta
     Bartlett
     Bass (NH)
     Benishek
     Berg
     Biggert
     Bilbray
     Bilirakis
     Bishop (UT)
     Black
     Blackburn
     Bonner
     Bono Mack
     Boren
     Boustany
     Brady (TX)
     Brooks
     Broun (GA)
     Buchanan
     Bucshon
     Buerkle
     Burgess
     Burton (IN)
     Calvert
     Camp
     Campbell
     Canseco
     Cantor
     Capito
     Carter
     Cassidy
     Chabot
     Chaffetz
     Coble
     Coffman (CO)
     Cole
     Conaway
     Cravaack
     Crawford
     Crenshaw
     Davis (KY)
     Denham
     Dent
     DesJarlais
     Diaz-Balart
     Dold
     Dreier
     Duffy
     Duncan (SC)
     Duncan (TN)
     Ellmers
     Emerson
     Farenthold
     Fincher
     Fitzpatrick
     Flake
     Fleischmann
     Flores
     Forbes
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Gardner
     Garrett
     Gerlach
     Gibbs
     Gibson
     Gingrey (GA)
     Gohmert
     Goodlatte
     Gosar
     Gowdy
     Granger
     Graves (GA)
     Graves (MO)
     Griffin (AR)
     Griffith (VA)
     Grimm
     Guinta
     Guthrie
     Hall
     Hanna
     Harper
     Harris
     Hartzler
     Hastings (WA)
     Hayworth
     Heck
     Heller
     Hensarling
     Herger
     Herrera Beutler
     Huelskamp
     Huizenga (MI)
     Hultgren
     Hunter
     Hurt
     Issa
     Jenkins
     Johnson (IL)
     Johnson (OH)
     Johnson, Sam
     Jones
     Jordan
     Kelly
     King (IA)
     King (NY)
     Kingston
     Kinzinger (IL)
     Kline
     Labrador
     Lamborn
     Lance
     Landry
     Lankford
     Latham
     LaTourette
     Latta
     Lewis (CA)
     LoBiondo
     Long
     Lucas
     Luetkemeyer
     Lummis
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     Marino
     McCarthy (CA)
     McCaul
     McClintock
     McCotter
     McHenry
     McIntyre
     McKeon
     McKinley
     Meehan
     Mica
     Miller (FL)
     Miller (MI)
     Miller, Gary
     Mulvaney
     Murphy (PA)
     Myrick
     Neugebauer
     Nugent
     Nunes
     Nunnelee
     Olson
     Palazzo
     Paul
     Paulsen
     Pearce
     Pence
     Peterson
     Petri
     Pitts
     Platts
     Poe (TX)
     Pompeo
     Posey
     Price (GA)
     Quayle
     Reed
     Rehberg
     Renacci
     Ribble
     Rigell
     Rivera
     Roby
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Rokita
     Rooney
     Ros-Lehtinen
     Roskam
     Ross (FL)
     Royce
     Runyan
     Ryan (WI)
     Scalise
     Schilling
     Schmidt
     Schock
     Schweikert
     Scott (SC)
     Scott, Austin
     Sensenbrenner
     Shimkus
     Shuster
     Simpson
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Southerland
     Stearns
     Stivers
     Stutzman
     Terry
     Thompson (PA)
     Thornberry
     Tiberi
     Tipton
     Turner
     Upton
     Walberg
     Walden
     Walsh (IL)
     Webster
     West
     Westmoreland
     Whitfield
     Wilson (SC)
     Wittman
     Wolf
     Womack
     Woodall
     Yoder
     Young (AK)
     Young (FL)
     Young (IN)

                               NOES--183

     Ackerman
     Andrews
     Baca
     Baldwin
     Barrow
     Bass (CA)
     Becerra
     Berkley
     Berman
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Boswell
     Brady (PA)
     Braley (IA)
     Brown (FL)
     Butterfield
     Capps
     Capuano
     Cardoza
     Carnahan
     Carney
     Carson (IN)
     Castor (FL)
     Chandler
     Chu
     Cicilline
     Clarke (MI)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly (VA)
     Conyers
     Cooper
     Costa
     Costello
     Courtney
     Critz
     Crowley
     Cuellar
     Cummings
     Davis (CA)
     Davis (IL)
     DeFazio
     DeGette
     DeLauro
     Deutch
     Dicks
     Dingell
     Doggett
     Donnelly (IN)
     Doyle
     Edwards
     Ellison
     Engel
     Eshoo
     Farr
     Fattah
     Filner
     Frank (MA)
     Fudge
     Garamendi
     Gonzalez
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hanabusa
     Hastings (FL)
     Heinrich
     Higgins
     Himes
     Hinchey
     Hinojosa
     Hirono
     Holden
     Holt
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson Lee (TX)
     Johnson (GA)
     Johnson, E. B.
     Kaptur
     Keating
     Kildee
     Kind
     Kissell
     Kucinich
     Langevin
     Larsen (WA)
     Larson (CT)
     Lee (CA)
     Levin
     Lewis (GA)
     Lipinski
     Loebsack
     Lofgren, Zoe
     Lowey
     Lujan
     Lynch
     Maloney
     Markey
     Matheson
     Matsui
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McNerney
     Michaud
     Miller (NC)
     Miller, George
     Moore
     Moran
     Murphy (CT)
     Nadler
     Neal
     Olver
     Owens
     Pallone
     Pascrell
     Pastor (AZ)
     Payne
     Pelosi
     Perlmutter
     Peters
     Pingree (ME)
     Polis
     Price (NC)
     Quigley
     Rahall
     Rangel
     Reyes
     Richardson
     Richmond
     Ross (AR)
     Rothman (NJ)
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schiff
     Schrader
     Schwartz
     Scott (VA)
     Scott, David
     Serrano
     Sherman
     Shuler
     Sires
     Slaughter
     Smith (WA)
     Speier
     Stark
     Sutton
     Thompson (CA)
     Thompson (MS)
     Tierney
     Tonko
     Towns
     Tsongas
     Van Hollen
     Velazquez
     Visclosky
     Walz (MN)
     Wasserman Schultz
     Waters
     Watt
     Waxman
     Weiner
     Welch
     Wilson (FL)
     Woolsey
     Wu
     Yarmuth

                             NOT VOTING--13

     Barton (TX)
     Culberson
     Fleming
     Giffords
     Honda
     McMorris Rodgers
     Meeks
     Napolitano
     Noem
     Reichert
     Sessions
     Sewell
     Sullivan

                              {time}  1743

  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.

                          ____________________