[Congressional Record (Bound Edition), Volume 157 (2011), Part 5]
[House]
[Pages 6501-6510]
[From the U.S. Government Publishing Office, www.gpo.gov]




   REPEALING MANDATORY FUNDING FOR SCHOOL HEALTH CENTER CONSTRUCTION

  The SPEAKER pro tempore. Pursuant to House Resolution 236 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. 1214.

                              {time}  1555


                     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. 1214) to repeal mandatory funding for school-based health center 
construction, with Mr. LaTourette 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 Texas (Mr. Burgess) and the gentleman from New 
Jersey (Mr. Pallone) each will control 30 minutes.
  The Chair recognizes the gentleman from Texas.
  Mr. BURGESS. Mr. Chairman, I yield myself such time as I may consume.
  The Patient Protection and Affordable Care Act included $105 billion 
of directly appropriated mandatory funding of numerous programs and 
provisions included in the law. For example, section 4101(a) of the 
Patient Protection and Affordable Care Act provides $50 million in 
mandatory spending for construction and expansion of school-based 
health centers every year, from the inception through 2013, for a total 
of $150 million. In our current financial situation, it is not only 
necessary but it is our responsibility that we examine all of our 
spending and make all necessary adjustments.
  H.R. 1214 is a simple bill aimed at a simple goal--to get some of the 
spending that the Patient Protection and Affordable Care Act advanced 
inappropriately. Section 4101(a) of the Patient Protection and 
Affordable Care Act funds only the construction of school-based health 
centers. The $50 million in grants are for construction only and there 
is an express prohibition on these funds being used to provide health 
services. No such provision was in the bill passed by the House. You 
will recall H.R. 3200 was the Health Care Reform Act that the House of 
Representatives worked through its committees of jurisdiction, on which 
we held hearings, on which we had debate on the floor of the House, and 
which passed the House in November of last year. It had no such 
provision in the House Democrats'-passed bill. Since no such provision 
was included in the health bill, and if the Senate Democrats considered 
the school-based health centers important enough to receive mandatory 
funding, why was the mandatory funding strictly limited to the 
construction of the buildings? Not one cent is guaranteed to see a 
child, but automatic checks out of the Treasury to build these centers.
  I will point out that section 4101(b) of the Patient Protection and 
Affordable Care Act created a new discretionary grant program for 
school-based health centers. But this grant program requires them to 
use the funding to provide health care services. However, the 
President's budget did not fund section 4101(b), failing to provide 
school-based health centers money expressly for the purpose of actually 
providing the service.
  Fundamentally, we might even have some agreement on school-based 
health centers. I am on record of having supported them in the past, 
and I believe opening health care points of access is important. I want 
to do more in this realm. But providing mandatory spending, forced 
spending to construct facilities without adequate safeguards if they 
will provide care is irresponsible and it certainly abdicates the 
pursestring nature of the House of Representatives. We are the people's 
House. It is our obligation to oversee the money that is spent on 
behalf of the people of the United States.
  Not one guarantee of a doctor, not one cent of payment for an 
immunization, not once ounce of common sense is included in the policy. 
I will note that this bill does not touch the discretionary program to 
provide care. I urge my colleagues to support restoring a little fiscal 
restraint and a little responsible policy to a small part of the law 
which will destroy the practice of medicine as we know it in the Nation 
and put the taxpayer on the hook for trillions of dollars in spending.
  I reserve the balance of my time.

                              {time}  1600

  Mr. PALLONE. I yield myself 3 minutes.
  Mr. Chairman, once again I'm listening to my colleague Dr. Burgess, 
whom I respect, and he's talking about the common sense being lacking 
on the Democratic side. After listening to him, I think the rationale 
and the common sense is lacking on the Republican side.
  My colleague from Texas has said over and over again he supports 
school-based clinics. He even supports Federal funding for school-based 
clinics. Then what is the possible rationale for posting this bill?
  Many of my colleagues on the other side have said today they're 
opposed to the entire Affordable Care Act. They're opposed to funding 
the entire Affordable Care Act. Yet somehow today they're taking little 
pieces of the Affordable Care Act that they even agree with, from my 
understanding in listening to my colleague from Texas, and still saying 
we're going to defund them. I defy my colleague to really understand 
why.
  School-based health clinics are a tremendous success story. These 
programs provide primary care, mental health, dental health services to 
vulnerable children across the country in every State. Multiple studies 
have found that these programs are cost-effective investments. They 
result in lower emergency room usage, hospitalizations, and Medicaid 
costs. In fact, patients seen at school-based health centers cost 
Medicaid on average $30.40 less than comparable non-school-based health 
center patients.
  This is saving the Federal Government money. That's the bottom line. 
And what we're trying to do here is to basically provide for 
construction, renovation, and equipment for these centers. Now, in 
order to get the grant for that, you have to show that you have the 
funds to operate the center. So when Dr. Burgess says, why are you 
paying for construction, why are you paying for renovation, but you're 
not paying or you're not providing for operations? Every one of these 
has to show that they have the money to do the operations before they 
get the money for construction. What does construction and renovation 
mean? It means jobs.
  I repeat again, when I was home for the last 2 weeks, all I heard 
from my

[[Page 6502]]

constituents is, When are you going to improve the economy more? When 
are you going to create more jobs? This is a program that creates jobs, 
helps kids, provides for their well-being and their health, and it's 
all preventative. These projects have to be shovel ready in order to be 
funded. So we're talking about money that's going to be immediately 
spent to put these centers together and to renovate them.
  I keep hearing my colleagues say repeal and replace. That's the 
mantra with the health care bill: We want to repeal it and replace it. 
But I never hear anything about replace. All I hear about is repeal, 
and in this case repealing a program that is a proven success.
  It makes absolutely no sense to pass this bill. I hear my colleagues 
on the other side say over and over again they're for these clinics, 
they're for these centers. Then why in the world do you bring this bill 
to the floor?
  I urge my colleagues to oppose this legislation.
  I reserve the balance of my time.
  Mr. BURGESS. Mr. Chairman, I yield myself 1 minute.
  This mandatory spending was not in H.R. 3200, the House-passed health 
care reform bill. Make no mistake, I voted against 3200 just as I voted 
against 3590. But, nevertheless, the bill that subcommittee Chairman 
Pallone last Congress brought through did not have mandatory spending 
for school-based health centers in his bill.
  Some of us get up today and act as if mandatory spending for this 
program is imperative, that it's the only way to go, that we can't 
provide care if we don't have mandatory spending for building the exam 
room. But, again, I remind my colleagues on the other side that simply 
an exam room with an exam table, a thermometer and a sphygmomanometer 
does not provide 1 ounce of care to a child. It does not save any money 
in an emergency room visit. It is simply an exam room sitting 
unutilized because the President of the United States said, I'm going 
to zero out the discretionary funding for staffing these clinics. 
That's why this makes no sense.
  I urge, again, support for the underlying bill. It is important to 
bring this back into the authorization process so our appropriate 
committees can have the oversight over the expenditure of these funds.
  I reserve the balance of my time.
  Mr. PALLONE. I yield myself such time as I may consume.
  Mr. Chairman, again, Dr. Burgess talks about how we're spending money 
on construction, renovation, but we don't provide mandatory spending 
for operations. As I said, in order to get the grant under the 
Affordable Care Act for construction of a school-based health center, 
you have to show that you have the money to operate.
  So what does that mean? That means that we are using some Federal 
dollars to attract either State or in many cases private dollars to set 
up these centers. What is wrong with that? They are guaranteed that 
once the money is spent on construction and creating the jobs that come 
from the construction or renovation that the money is available to 
operate the centers. There's nothing wrong with that. It's actually a 
good thing. It promotes a Federal-State cooperation, and it brings in 
some private dollars as well.
  The other thing I would point out is my colleague from Texas keeps 
talking about mandatory appropriations. The fact of the matter is that 
health care initiatives over the years, Democrat and Republican, have 
provided some mandatory, some discretionary. The same thing we're doing 
here. The fact of the matter is that Medicare, Medicaid, and a lot of 
other Federal health programs pay for health care services with 
mandatory expenditures. And a lot of that is for acute care, acute 
illness, injury, or chronic diseases. Now, there's no similar approach 
when it comes to promoting wellness, preventing disease, and protecting 
against health emergencies. So here for the first time now we're going 
to have a combination of some mandatory and some discretionary spending 
for a preventative program, a clinic, a center for kids in their 
schools that actually helps and prevents them from going to a hospital, 
to an emergency room, to be institutionalized. So I just think this is 
false, this notion of mandatory versus discretionary.
  The bottom line is if you care about school-based centers and you 
want to have them, then I think you should oppose this bill because the 
legislation that this bill is seeking to kill, the Affordable Care Act, 
for the first time provides funding to put up a lot of these school-
based centers. And this is what we need as a preventative measure to 
prevent these kids from having more serious problems, going to the 
emergency room. Let's give them primary care up front so they can stay 
well.
  I reserve the balance of my time.
  Mr. BURGESS. I yield myself 1 minute.
  Mr. Chairman, this language was put in the Senate's health care bill 
when the Senate was giving out favors, and there really was no rhyme or 
reason to put this program in as a program under mandatory funding.
  Congress has traditionally provided funds to health centers, 
including school-based health centers, to provide for care, not for 
construction. To do it the other way around would lead to situations 
where a center is built but no care is delivered. Both policy choices 
require local funds to be spent, but only the policy for paying for 
services, not construction, guarantees that money won't be wasted or, 
worse yet, never used to deliver 1 ounce of care.
  I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentleman from 
Connecticut (Mr. Courtney).
  Mr. COURTNEY. Mr. Chairman, I rise again in opposition to this bill.
  I do so with somewhat of a personal angle on this. My wife, Audrey, 
is a pediatric nurse practitioner. At one time she worked in a school-
based health center. She doesn't today, presently. But I certainly, 
through her, have gotten a chance to be exposed to the benefit of 
school-based health centers.
  There is no more efficient delivery system. It makes sure that kids 
get good, high-quality care at school, gets them back on their feet, 
back in class where they belong, rather than going to emergency rooms 
and spending hours waiting for care or being sent home many times in an 
unsupervised situation out of class. Again, the beauty of a school-
based health clinic is that it obviously is in a setting where children 
are located. Again, the turnaround in terms of making sure that they're 
back doing what's good for them and good for their future is just smart 
investment.
  I would also just give a small example in my district. I represent 
southeastern Connecticut. We're the proud location of the Groton sub 
base, the oldest sub base in America, 8,000 sailors, a lot of families 
with kids who are located at the base. And at Fitch High School in 
Groton, there's a school-based health center, which is the primary 
caregiver for many military families' children. Again, these are kids 
who move around the country. Oftentimes their care is disrupted from 
one place to the other. Having a school-based center ensures that these 
kids are going to have access to health care, that they're going to 
have their checkups to make sure that they can enter school, that they 
can enter school athletic programs. Again, in many instances for these 
military families, it is the primary health caregiver.

                              {time}  1610

  Two hundred twenty-seven families--I checked this morning with the 
center in Groton--get their care through the center. This program is 
going to be used to ensure that Fitch High School's footprint in terms 
of the school building will be expanded. It will be an investment in 
information technology.
  The Acting CHAIR (Mr. Yoder). The time of the gentleman has expired.
  Mr. PALLONE. I yield the gentleman an additional 30 seconds.
  Mr. COURTNEY. They will invest in information technology to, again, 
make sure that this terrific, efficient, cost-effective, high-quality 
program is, in fact, going to be there for, again, families who were 
serving in Libya, in the Mediterranean. Their parents were part of the 
USS Providence, the Florida,

[[Page 6503]]

the Scranton, which were part of the initial attack in Libya.
  Again, this is a program which works not only for those kids, for the 
community, but also for our Nation; and I would, again, respectfully 
rise in opposition to this measure which, again, I think really heads 
us in the wrong direction in terms of high-quality care for America's 
kids.
  Mr. BURGESS. I yield myself such time as I may consume.
  And nothing in the bill under consideration, H.R. 1214, would change 
anything about what was just relayed to us about the school-based 
clinics in the gentleman's district.
  Can I just point out, again, that the discussion that we're having 
today revolves around the use of advance appropriations in the Patient 
Protection and Affordable Care Act, thereby making that spending 
mandatory.
  Now, just a brief civics lesson. Medicare is mandatory spending. We 
have no discretion on that. We must fund Medicare to the extent of the 
number of dollars that are going to be drawn on the Federal Treasury. 
Same for Medicaid. We have other health care programs that are, in 
fact, discretionary. Our veterans, who I'm sure the gentleman would 
argue are no less worthy, are funded under a discretionary program.
  The difference between a mandatory and a discretionary program is 
that the authorizing committee, in this case the Committee on Energy 
and Commerce of which I am a member, of which the gentleman from New 
Jersey is a member, the authorizing committee sits down and decides 
whether or not the spending is useful. If it is, we authorize the 
expenditure. We send it over to the appropriations committee who, if 
they agree, writes a check for the amount of money that we have 
authorized and not one bit more.
  But the key here is it goes through a regular order process; and one 
of the things, I don't know about the gentleman from New Jersey, but 
what I heard when I went home is the Federal spending is out of 
control; you've got to get a handle on Federal spending. Well, here's a 
point where we can get a handle on some Federal spending. It should 
never have been an advance appropriation in the Patient Protection and 
Affordable Care Act.
  I don't know whether that was carelessness or Machiavellian, but it 
doesn't matter. It's got to be fixed. The American people want us to 
fix that. That was one of the reasons they voted en masse against the 
Patient Protection and Affordable Care Act November 2, 2010. That is 
one of the reasons that the gentleman is sitting in the Speaker's chair 
today is the public revulsion to how last Congress conducted its 
business.
  We have a chance now to reclaim a little of our honor, a little of 
our integrity. Let's bring that funding back into the authorization 
realm in which it belonged and not simply pass it off to the 
administration. It's mandatory funding. It has to be done. Whether or 
not the administration is going to fund a doctor or nurse to work in 
that clinic, you've got an exam bed, you've got a thermometer, you've 
got a sphygmomanometer, but you don't have one ounce of care delivered 
to the people who actually need it. Therefore, you are not saving 
money. You are only spending money. The American people have asked us 
to be wiser stewards with their cash.
  I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentlewoman from 
California (Mrs. Capps) who is probably the most knowledgeable person 
in this House on this subject of school-based care.
  Mrs. CAPPS. I thank my colleague for yielding.
  Mr. Chairman, I rise in very strong opposition to H.R. 1214. As a 
school nurse who worked in our schools for very many years, it's been 
100 days now of Republican rule, and we have not seen a jobs bill yet. 
Unlike previous efforts that just ignore job creation all together, 
today's debate is on a bill that will flat out hurt our economy and 
will keep people out of the workforce.
  You know, there are children in each of our States who will, if this 
bill passes, be deprived of having access to quality health care when 
they need it most. School-based health centers provide comprehensive 
and easily accessible preventive and primary health care services for 
millions of our students nationwide. Services that keep students 
healthy, in school, and learning almost always these are children who 
have no other source of care.
  And the need is clear: 350 centers from 46 States including many in 
my Republican colleagues' districts have already applied for these 
funds. They've taken the time and the resources to compile their 
applications. They are excited. They are expecting to hear in just a 
few weeks if their projects can move forward. To pull the rug out from 
under them now is simply a disgrace.
  The centers have long garnered bipartisan support, worked with many 
of my Republican colleagues on their behalf; and, yes, the majority is 
now using this as a political football in their obsession to repeal the 
Affordable Care Act. This is a true disservice to our children and also 
to our communities.
  No matter what my colleagues on the other side of the aisle say, 
today's vote isn't about types of funding or process. We don't need a 
civics class about it. H.R. 1214 is just another attempt by them to 
dismantle the Affordable Care Act.
  I encourage my colleagues to stop taking health care away from 
children to fulfill their political promises.
  Vote ``no'' on this misguided bill.
  Mr. BURGESS. I yield myself such time as I may consume.
  Mr. Chairman, here is the simple truth. What takes health care away 
from children is sending checks to localities for land acquisition when 
you've got no intention of staffing the clinic that is going to be 
built.
  Let me just remind people what the argument is about, and I will 
stipulate that we are not talking about a vast sum of money here like 
we were in the previous bill. But every instance of advance 
appropriation in the Patient Protection and Affordable Care Act 
represents an opportunity for this Congress to reclaim some of its 
function as the people's House in being in control of Federal spending.
  But here's what the argument is about. Section 4101(a) of the Patient 
Protection and Affordable Care Act under subtitle B, increasing access 
to clinical preventive services, paragraph 5 of 4101(a), 
appropriations: out of any funds in the Treasury, not otherwise 
appropriated, there is appropriated for each of the fiscal years 2010 
through 2013 $50 million for the purpose of carrying out this 
subsection. Funds appropriated under this paragraph shall remain 
available until expended. No funds provided under a grant awarded in 
this section shall be used for expenditures for personnel or to provide 
health services.
  It could not be clearer. Now, nothing in the bill that we have under 
consideration today actually does anything to the provision of services 
because, after all, those are under an authorization. Section 4101(b), 
authorization of appropriations: for purposes of carrying out this 
section, there are authorized to be appropriated such sums as may be 
necessary for each of the fiscal years 2010 through 2014.
  But the operative words here--``there are authorized to be 
appropriated''--not that there are appropriated from the Treasury. It's 
okay for us to authorize that appropriation. Our committee is an 
authorizing committee. We are not an appropriating committee.
  Mr. Chairman, I understand the difference between an authorizing 
committee and an appropriating committee. I take an annual field trip 
to the National Institutes of Health. At the National Institutes of 
Health you see all these beautiful buildings. They are all built, and 
they're named after very famous men who served in the United States 
Congress. Every one of those men is an appropriator. There is no 
building named after an authorizer.
  Still, the work we do is important--I submit it is vital--to the 
American people that we do our work to evaluate

[[Page 6504]]

whether or not the expenditures are indeed in the best interest of the 
American people; and, further, if we're really doing our job, we'll 
come back and do oversight over those authorizations to make sure those 
funds are expended in the manner in which they were intended. That's 
the way you guarantee that that care gets to the child that will 
ultimately save money to keep the child out of the emergency room, not 
just by sending checks to localities to purchase land.
  I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, can I inquire of the time on both sides?
  The Acting CHAIR. The gentleman from New Jersey has 20 minutes 
remaining. The gentleman from Texas has 18\1/2\ minutes remaining.
  Mr. PALLONE. I yield 2 minutes to our distinguished ranking member 
emeritus, the gentleman from Michigan (Mr. Dingell).
  Mr. DINGELL. I thank my friend.
  I rise today in vigorous opposition to H.R. 1214. This bill is not 
only going to cut access to health care for American children, but it's 
going to kill jobs in the construction industry and construction 
projects around the country. More than 1,900 school-based health 
centers across the country provide access for health care services to 
over 2 million people right now. For the first time, the Affordable 
Care Act authorized these centers and also offered a dedicated source 
of funding for construction, renovation, and equipment.

                              {time}  1620

  Three hundred fifty applicants, many of whom are currently running 
centers at this time, in 46 States and the District of Columbia have 
applied for the first round of competitive grants, including the Young 
Adults Health Center located in my 15th District of Michigan. These 
grants will be used to enhance the capabilities of these centers and 
will jump-start shovel-ready projects that will create immediate 
construction jobs and allow for the purchase of necessary supplies and 
equipment, boosting local businesses, but providing health care for our 
kids. Until more operating funds are available--and I would hope my 
colleagues on the other side will support such funding--we need to 
ensure that at least the facilities that are ready to apply for this 
kind of grant will be able to do so in order to better serve our 
children and the communities.
  I think that this would be an extremely unwise bill. It's a part of 
an announced plan by my Republican colleagues to first of all attack 
the whole of the health care reform bill over the last Congress and 
then to attack it piece by piece. What they seek to do here today is 
just a part of another step towards the gutting of the health care bill 
which will make things better for our people and which is paid for, 
which is not going to add to the deficit but which, in fact, is going 
to save better than $140 billion this 10 years and in the next 10 years 
$1.4 trillion.
  This is penny wise and pound foolish. Reject the bill.
  Mr. BURGESS. Mr. Chairman, let me respond to something that was just 
said by the chairman emeritus of the Democratic side of the Committee 
on Energy and Commerce. Of course I have all respect for the chairman 
emeritus and certainly treasure every day that I served under his 
direction as chairman in two Congresses.
  But the statement that I cannot let stand is that the Patient 
Protection and Affordable Care Act saves anyone in any universe, in any 
dimension, any money at all. This was refuted by the chief actuary for 
the Centers for Medicare & Medicaid Services less than a month after 
the President signed the Patient Protection and Affordable Care Act. I 
do not know why we have to continue to hear this fairy tale about $142 
billion being saved under PPACA.
  At this point, I would like to yield 2 minutes to the gentleman from 
Louisiana, Dr. Fleming.
  Mr. FLEMING. I thank the gentleman.
  I appreciate Dr. Burgess allowing me to speak on this specific bill, 
but let's just talk about the elephant that's in the room here this 
afternoon, and that is the so-called Affordability Act, the so-called 
Patients Affordability Act, PPACA. We call it ObamaCare affectionately.
  Folks, we've got a bill here which is now law that is, at best, 
questionably constitutional. We have a bill that is going to add 
another trillion dollars, ultimately, to our deficit. It's full of 
smoke and mirrors. We have got $500 billion that's going to be taken 
out of Medicare and then put on both Medicare extension and then on 
subsidy of the private health plans. Even if we ever saved that $500 
billion, this whole law has questionable financing. And then today 
we're talking about construction money that may or may not exist.
  So, Mr. Chair, I just have to say, as a physician with 30 years of 
practice, I was here during the health care debate of 2009 where this 
body has come up with and the President has signed into law something 
that is really a disgrace. The American people are not behind it. PPACA 
is, in some surveys, opposed by the American public two to one. It is a 
complete government takeover of our health care system.
  Just the other day, I got questioned from my constituents, 
physicians, who asked me: What about this IPAB? What is that? What is 
this board? And I had to explain to them that now when you are not sure 
how much you are going to be reimbursed for the health care that you 
provide, you can at least go to Congress and petition Congress.
  The Acting CHAIR. The time of the gentleman has expired.
  Mr. BURGESS. I yield the gentleman an additional 30 seconds.
  Mr. FLEMING. But under ObamaCare, we now have IPAB, which is a 
special board of unelected, unaccountable, unnamed bureaucrats that 
serve at the pleasure of the President who will then decide these 
things, creating a nonmarket responsive health care body out there that 
will then--we'll see much worse shortages than what we have today.
  I stand in support of Congressman Burgess and his bill and certainly, 
ultimately, the repeal of ObamaCare.
  Mr. PALLONE. I yield 2 minutes to the gentleman from California (Mr. 
Waxman), the distinguished ranking member of the full committee.
  Mr. WAXMAN. Thank you very much for yielding to me.
  I rise in strong opposition to H.R. 1214, and I urge my colleagues to 
join me in voting against this very shortsighted and misguided piece of 
legislation. This bill, of course, is part of a broader Republican 
strategy to tear down the new health reform law piece by piece. I will 
also note that they want to tear down the existing health care laws of 
Medicare and Medicaid in their budget.
  Well, I think that's all very disturbing. But what's especially 
troublesome is that our colleagues on the other side of the aisle are 
now going after programs where we all agree, Democrats and Republicans 
agree, that actually work, that actually do a good job and make a 
difference.
  Numerous studies have shown that school-based health centers are 
enormously successful in helping to improve students' access to care, 
promote healthy behaviors among children and adolescents, improve 
students' academic performance, decrease school absenteeism, and reduce 
health care expenditures. With a report card like that, why wouldn't we 
want to build or renovate more of these centers?
  We should not end the school-based center construction and renovation 
program before it even has a chance to make its mark. I urge a ``no'' 
vote on H.R. 1214.
  Mr. BURGESS. Mr. Chairman, I would just point out to the gentleman 
how shortsighted and misguided that is, that this language was put in 
by the Senate when they were giving out favors. Sending checks to 
localities without guaranteeing the actual coverage, without 
guaranteeing the actual doctor or nurse be there, does not do anything 
as far as furthering care.
  I would now yield 2 minutes to the gentlelady from North Carolina 
(Ms. Foxx).
  Ms. FOXX. I thank my colleague from Texas for yielding time.
  Mr. Chair, the American people know that we are borrowing 43 cents 
for

[[Page 6505]]

every dollar we spend these days. We do not need to be giving grants of 
dollars that we have collected from hardworking taxpayers to local 
entities to build or renovate school-based health centers. This is not 
a core function of the Federal Government. It is not a core function of 
our taxpayers. We do not need to be spending this money like the 
minority wanted to spend it when they were in the majority.
  It is also very duplicative, Mr. Chair. Between the stimulus bill and 
what we affectionately call ObamaCare, $3 billion in funds have been 
made available to Health Resources and Services Administration at the 
Department of HHS for facility improvements at community health 
centers. Providing an additional $50 million a year for construction is 
duplicative and unwarranted.
  This bill deserves the support of every Member here. We are soon 
going to have to have a vote to raise our debt limit. People say over 
and over again on both sides of the aisle, We have to cut spending. We 
have to cut spending. What better place to start than in these funds 
that are going out for a function that is not appropriate for the 
Federal Government to be involved in so that we don't have to continue 
to borrow 43 cents for every dollar that we spend. So I think we should 
cut out duplicative programs.
  This bill definitely needs to pass, and I give it my full support.

                              {time}  1630

  Mr. PALLONE. I yield 2 minutes to the gentlewoman from the Virgin 
Islands (Mrs. Christensen).
  Mrs. CHRISTENSEN. Mr. Chairman, here we go again, this time attacking 
a provision in the Affordable Care Act that would help to reach 
children and especially teens who otherwise might not have access to 
important health care services.
  And so, Mr. Chairman, today I join my Democratic colleagues to speak 
on behalf of our children and against H.R. 1214. Our future depends on 
the development of healthy, well-educated children. Unfortunately, 
often our children miss school, or sit in class too distracted to pay 
attention because of preventable and treatable health conditions that, 
if caught early and treated as these school-based health centers would 
do, would enable them to better learn and to reach higher levels of 
achievement.
  I've heard a lot of talk about protecting our children from future 
debt, something all of us are working to prevent. But if we really care 
about our children, why are we now considering this legislation that 
will harm them, not in the future, but today?
  Eliminating funding for school-based health centers would not just 
prevent a building from being built, but would eliminate the creation 
of the only medical home that many underserved students know and which 
creates access to needed mental, physical and dental care, centers that 
provide services that many students cannot or would not access anywhere 
else. And these services provide a support to the teachers so that they 
can focus on teaching these students.
  Taking away this funding for school-based health centers, as H.R. 
1214 would do, would be a step in the wrong direction, not just for the 
health and well-being of our children, but for our country's ability to 
win the future.
  Before I close, I want to just say that we did not pass any bill that 
is unaffectionately known as ObamaCare. The Affordable Care Act is 
about your, the American people's, care; and this provision is about 
our children's care.
  I urge my colleagues to vote for our children and vote ``no'' on H.R. 
1214.
  Mr. BURGESS. Mr. Chairman, I yield 3 minutes to the chairman emeritus 
of the full Committee of Energy and Commerce, the gentleman from Texas 
(Mr. Barton).
  Mr. BARTON of Texas. Mr. Chairman, I want to read the section of the 
law that we're trying to repeal today. It says, subparagraph 5: 
Appropriations. Out of any funds in the Treasury not otherwise 
appropriated, there is to be appropriated for each fiscal year 2010 
through 2013, $50 million for the purpose of carrying out this 
subsection. Funds appropriated under this paragraph shall remain 
available until expended.
  And then in this subsection: Definitions. ``School-based health 
center'' and ``sponsoring facility'' have the meanings given those 
terms under such and such and such and such.
  We're trying to repeal $50 million a year for 4 fiscal years, 2010, 
'11, '12 and '13, for these school-based health clinics. I support 
school-based health clinics. Dr. Burgess supports school-based health 
clinics. We both represent parts of Tarrant County. The public hospital 
in Tarrant County, Texas, is John Peter Smith. There are a number--I 
don't know the exact number, but I believe in the neighborhood of a 
dozen school-based health clinics in his district, in my district, 
Congresswoman Granger's district, Congressman Marchant's district. We 
support those health clinics. But we believe that the State and county 
should provide the facility, and the Federal Government should provide 
the funds to staff it. We don't believe, when we have a $1.5 trillion 
budget deficit each year, that we need to be spending another $50 
million or $200 million over 4 years to actually provide the facility, 
to provide construction. So it's not an opposition to the health clinic 
itself, school-based. I've gone to openings; I support them. I think 
they do excellent work.

  But until we get our budget balanced, Mr. Chairman, I think it's 
prudent to not require the Federal Government to not only fund the 
operation and the staffing, but also fund the construction and the 
facility itself. So this is a case where we're specifically repealing a 
specific appropriation, in this case $50 million a year for the years 
2010 through 2013, the fiscal years. And I think that is something 
that, with a $1.5 trillion budget deficit, is a prudent thing to do.
  So I rise in strong support of the bill and, at the appropriate time, 
would urge a ``yes'' vote.
  Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentleman from 
Virginia (Mr. Moran).
  Mr. MORAN. Mr. Chairman, as my friends from Texas well know, the 
potential recipients of this money have already shown that they have 
the operations and maintenance money available, but they can't 
establish a school-based health clinic without this funding.
  The other thing that I'm sure they are well aware of, is that the 
need is many times more than the money that is being made available.
  25 years ago, when I set up a school-based health clinic across the 
river in Alexandria, Virginia, people said that it's not needed and we 
can't afford it. But we now have 25 years' experience throughout the 
country, and we've found just the opposite. It's absolutely needed, and 
we can't afford not to have school-based health clinics.
  Adolescents have to have accessible, affordable health care. 
Otherwise, they don't go to hospitals or doctors until it's too late. 
In fact, we have more than 1,000 students who use our Alexandria 
school-based clinic. And we're told by the nurses, 80 to 90 percent of 
them would have to be going to the emergency room if that clinic were 
not available, at far greater cost.
  This saves money, but it also saves lives. Like the young woman who 
convinced her friend whose leg kept bothering her to have the leg 
checked, since the clinic was so close. Turned out she had bone cancer. 
It would have gotten through her whole body. She wouldn't have gone to 
a doctor. She would have put it aside. That's what adolescents do. 
That's what we did when were adolescents.
  They go in for the flu. While they're in for the flu, they get 
checked for sexually transmitted infections. They oftentimes get their 
physicals. There are hundreds of students, well, actually around the 
country there are hundreds of thousands who don't have the opportunity 
to play athletics because they have to have a physical fitness exam, 
and it's 75 bucks normally to go to a doctor to have a physical exam. 
They don't get it. But they can afford to go to a school-based health 
clinic where they get the exam free and then they can fully 
participate.
  A lot of children tell the doctors and nurses in these school clinics 
things

[[Page 6506]]

that they couldn't tell their parents. We're saving lives with this. 
We're saving money. We're preventing diseases from spreading. We're 
doing the right thing by the American people, particularly adolescents. 
They need accessible and affordable health care. This provides it. 
Let's defeat this amendment.
  Mr. BURGESS. Mr. Chairman, I yield 1 minute to the gentleman from 
Georgia (Mr. Graves).
  Mr. GRAVES of Georgia. Mr. Chairman, I guess I'd start off by saying 
only in Washington can spending money lead to saving money. That's what 
we just heard. But that's not the case.
  I think about what the impact that ObamaCare is having on the State 
of Georgia. This year alone hundreds of millions of dollars it's cost 
the taxpayers of Georgia, projected to be over $1 billion here in 
subsequent years.
  While I support full repeal of the program, I've already demonstrated 
that through my votes, this is specifically getting rid of a slush fund 
that's in place eliminating funding for the construction of facilities 
in local communities.
  I'm sure this is a laudable program in many areas, and there's 
probably a lot of laudable programs that folks want to fund. But the 
fact is we just can't do it. We don't have the resources to do it 
anymore.
  Number one, we need to find out what is the true role and function of 
this Federal Government. I do not believe this is it. We should allow 
the States and empower the States who are best equipped to handle the 
needs of the local community.
  So I certainly support this measure and urge my colleagues to vote 
``yes'' on H.R. 1214, and let's move on to repealing the full measure 
of ObamaCare.
  Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentleman from 
New York (Mr. Engel).
  Mr. ENGEL. I thank my friend for yielding to me.
  You know, give me a break. I hear speaker after speaker on the 
Republican side saying we don't have the resources to do these things. 
It seems that we always have the resources to give tax breaks for the 
rich. We don't worry so much about the budget deficit when it comes to 
protecting our rich friends.
  The Republicans, 2 weeks ago, spent time passing bills putting 
Medicare and Medicaid in jeopardy, and now they would deny these 
community health centers.

                              {time}  1640

  The majority doesn't bring bills to help create jobs in this country. 
So, once again, here we are--God knows how many times--with a bill 
that's trying to kill the Affordable Health Care Act. Again, it's 
political theater. It's not going to pass the Senate. The President 
would veto it. Let's put our heads together and do something 
constructive instead of saying ``no'' to health care.
  The value of school-based health centers is well-known. There are 
1,900 in the country. They provide access to high-quality, 
comprehensive medical care to nearly 2 million children and 
adolescents. Services are provided regardless of a student's ability to 
pay, and are provided right where they are at school. In my district, 
these are very important. Even the high school from which I graduated 
has a wonderful center. It's the kind of program that we should be 
promoting and replicating; but instead, we are considering a bill that 
would repeal the funding for the construction of these centers.
  The agency monitoring it is concerned about the sustainability of the 
health center. The Health Resources and Services Administration, or 
HRSA, is thinking of the sustained success of these programs, and it 
will only support those school-based health centers that are going to 
have long-term success.
  So, Mr. Chairman, let's be honest. Today's debate is not on the 
sustainability of these centers or on mandatory spending. Today's 
theatrics are simply one more attempt by the Republicans to undermine 
the Affordable Health Care Act. We are wasting time in doing this again 
and again, and we should stop. The Affordable Health Care Act makes 
health care affordable for the middle class, and it helps prevent the 
steady rise in health costs that has led to much of our budgetary woes 
over the years.
  I am for quality health care. We should vote ``no'' on H.R. 1214.
  Mr. BURGESS. I would agree that it is going to be an uphill battle in 
the Senate, but I believe we can be successful. I would just point out 
to the gentleman that the President has not issued a veto threat 
against this legislation.
  At this point, I yield 2 minutes to the gentleman from Georgia (Mr. 
Kingston).
  Mr. KINGSTON. I thank the gentleman, and wanted to speak in support 
of H.R. 1214 for three reasons.
  Number one, we have got to remember that we are now in our third year 
of a $1.6 trillion deficit. That's right. The Obama administration has 
now put us in our third year of a deficit of $1.6 trillion. For every 
dollar we spend, 40 cents is borrowed.
  At what point will that mean anything to our Democrat colleagues? I 
don't understand it. At what point will it mean anything to the 
administration? Do you really believe you can defy gravity over and 
over again and expect that it's not going to come back to haunt you? I 
don't understand it. I'm baffled by this.
  So, number one, we've got to impact the deficit as we've got to 
consider future generations.
  Number two is duplication. The stimulus bill and ObamaCare had $3 
billion that went to the Health Resources and Services Administration 
at the Department of Health and Human Services for improvements in 
community health centers that many of the school-based health care 
clinics are eligible for. This is strictly a duplication of $50 million 
on top of $3 billion.
  Number three, as an appropriator, I believe we have to be very 
careful about advanced appropriations. This goes to the year 2014. If 
it is so good, as we have heard--and certainly there is a level at 
which you can argue the effectiveness of this--why not let them get in 
line as soldiers have to? as educators have to? as hospitals have to? 
as researchers have to? As everybody else who gets Federal Government 
money, let them get in line each and every year, and let them justify 
their budgets. Then Congress, in weighing it out, will say, Okay. Let's 
fund it again this year.
  But what the Democrats are asking us to do is to obligate future 
Congresses on money to the year 2014 and to put it on automatic pilot. 
That's not fair. That's not right. In these budgetary times--again, 
when we are borrowing 40 cents for every dollar we spend--we do not 
need to be advance appropriating anything or any entity.
  The Acting CHAIR. The time of the gentleman has expired.
  Mr. BURGESS. I yield the gentleman an additional 30 seconds.
  Mr. KINGSTON. The point is, if it's a good program, then certainly 
they can justify their budgets each and every year just like the 
soldiers have to and just like everybody else has to. For those three 
reasons, I strongly support H.R. 1214.
  Mr. PALLONE. Mr. Chairman, I yield myself 30 seconds.
  I have listened to my colleague from Georgia (Mr. Kingston), and I 
can't believe he is blaming the deficit on President Obama. We had 8 
years and two wars under Bush, all of the giveaways to millionaires and 
the special interests, and now, all of a sudden, it's Obama who is 
responsible for the deficit. We are talking about $50 million a year 
for probably some of the best schools you could ever imagine with these 
school-based clinics, and the gentleman is talking about the deficit.
  I yield 2 minutes to the gentleman from California (Mr. Miller).
  Mr. GEORGE MILLER of California. Mr. Chairman, I rise in opposition 
to H.R. 1214 and its impact on our Nation's schoolchildren.
  School-based health centers have enjoyed wide bipartisan support 
because they ensure students are healthy. Healthy students are ready to 
learn, and in these centers, children can get health services when they 
need them. Children can't learn when they're chronically sick, when 
they have a

[[Page 6507]]

toothache, when they suffer from other dental diseases or when they 
suffer from chronic health problems. For too many children, a school-
based health center may be the only opportunity to receive needed care. 
This is particularly the case with oral health. Tooth decay is the most 
common disease among schoolchildren, and 80 percent of the time this 
disease occurs in children who have problems accessing care. That's why 
school-based health programs are so important, and that's why the 
American Dental Association is a strong supporter of this program.
  States also believe that these centers are critically needed. 
Indiana's Republican Superintendent of Public Instruction recently 
testified before the Education and the Workforce Committee that 
districts are prioritizing school-based health centers because ``they 
have made a difference in the lives of those children.'' Schools in 
Indiana are not alone in realizing the need and value of school-based 
health centers.
  In my district, West Contra Costa Unified has two operational school-
based health centers and four in development. The legislation before us 
today could essentially halt the development of these health centers by 
repealing the critical construction and renovation funding made 
available by the Affordable Health Care Act. This funding is critically 
important to these schools so that they can provide these centers. The 
Federal Government shouldn't randomly yank the support for school-based 
health centers. It should be letting the school districts make the 
decisions based upon their identified needs.
  This bill is nothing more than a continuation of the attack against 
the beneficiaries of the Affordable Health Care Act. Whether the 
beneficiaries are senior citizens or whether they're young children, we 
ought not to support this legislation.
  Mr. BURGESS. Mr. Chairman, may I inquire as to the amount of time 
that is left?
  The Acting CHAIR. The gentleman from Texas has 6\1/2\ minutes 
remaining. The gentleman from New Jersey has 8 minutes remaining.
  Mr. BURGESS. I yield 30 seconds to the gentleman from Georgia (Mr. 
Kingston).
  Mr. KINGSTON. I thank the gentleman for yielding.
  I want to respond to my friend from New Jersey. This is very 
important. If we added up the Bush deficits in those years, certainly 
the Bush administration overspent. There is absolutely no question 
about it that the Republican Party overspent. Yet not to be outdone, in 
1 year, the Obama administration ran up the deficit numbers higher than 
the Bush folks did in 8 years. It's outrageous. The year that the 
Democrats won the majority, the Bush deficit was $160 billion. I agree 
that it was way too high. But what did they do? $1.6 trillion. That's a 
lot of money, and that's all the more reason that we need to eliminate 
duplicative spending, which is what this is.
  Support H.R. 1214.
  Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentlewoman from 
California (Mrs. Davis).
  Mrs. DAVIS of California. Mr. Chairman, this bill will not create one 
job or help one American family cope with high gas or grocery prices, 
but I'll tell you what it will do. It will make it more difficult for 
over 1 million children to see a doctor or a nurse.
  In December, Central Elementary School in San Diego opened a school-
based clinic to give access to 860 children; 25 percent of those 
children are uninsured. Now Central students will get care when they 
need it, and they won't have to miss school for an appointment.
  ``This clinic is a dream come true,'' said Central's principal, Cindy 
Marten.
  Any principal knows that unaddressed health or mental health problems 
are enormous obstacles to student learning and student attendance. Many 
children have ongoing health problems, such as diabetes, causing 
chronic absenteeism, and they are health problems that you can treat 
right at a school clinic; and every child will need care for colds, the 
flu, strep throat, ear infections, and other illnesses that can spread 
through an entire classroom. My colleagues clearly didn't consult too 
many school principals while writing this misguided bill.
  Please vote against taking health clinics away from kids.

                              {time}  1650

  Mr. BURGESS. Mr. Chairman, I yield myself 1 minute.
  The Federal deficit is now the biggest concern of business economists 
and, indeed, the American people at large. Job creators are sitting on 
the sidelines while Washington continues to spend more money that it 
doesn't have.
  Despite the sobering facts, my colleagues on the other side of the 
dais in the Energy and Commerce Committee have not proposed a single 
cut, not one single spending cut under our committee's jurisdiction.
  Now, sure I can be criticized today for only trying to save, what, 
$200 million? I don't know about New Jersey, but in my district back in 
Texas, $200 million is still real money.
  When challenged at last week's subcommittee markup, all Mr. Waxman 
could come up with were tax increases and cuts to the farm program. We 
can and should do more to get our spending under control. Our 
committee, the Committee on Energy and Commerce, has an obligation to 
be front and center in that fight.
  I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield myself 30 seconds.
  From the very beginning today, Dr. Burgess, I have said, and many of 
us have said, the Affordable Care Act saves money and that school-based 
centers save money. The CBO estimates over $1 trillion in savings from 
the Affordable Care Act; $30.40 less than Medicaid costs for a kid that 
goes to a school-based clinic. By repealing this funding for school-
based clinics, you are going to cost the Federal Government more money.
  So don't talk to us about the deficit. We save money with our 
legislation, and you are spending more money by proposing this bill.
  I yield 2 minutes now to my colleague from New Jersey (Mr. Andrews).
  Mr. ANDREWS. I thank my friend for yielding.
  There are nearly 15 million unemployed people in America, and I think 
most of them and those who are employed would tell us that what they 
want the Congress to be doing is finding ways to work together so that 
businesses and entrepreneurs can create jobs for the American people.
  Here we are again arguing about the health care bill or another piece 
of it. And this legislation has behind it the novel idea that if 
children get immunizations and well visits and get to see a nurse or a 
doctor when they are not feeling well, that somehow is not a wise use 
of the public's money.
  Now, let's put aside for the moment the idea of whether it is right 
or wrong to deny health care coverage for children in school--I think 
it is very wrong--and let's look at the balance sheet. Which is more 
expensive: a child who is hospitalized with pneumonia or 25 or 30 
children who get a checkup? Which is more expensive: the outbreak of a 
flu that affects the entire school or the entire town or the early 
diagnosis and treatment with antibiotics of a kid with the flu?
  Common sense says that primary care for children saves money for 
everyone. Common sense says that children without insurance can most 
easily be reached in the school where, hopefully, they already are. 
Voluntary participation by children in a school with their parents' 
consent makes perfect sense.
  This legislation makes no sense to consider it now; it makes even 
less sense to pass it. I would urge a ``no'' vote on this legislation 
and urge the House to get back to the business of working together to 
help entrepreneurs create jobs for the American people.
  Mr. BURGESS. I yield myself 30 seconds.
  Again, let me remind people what we are talking about today. We are 
talking about taking away advance appropriations in the Patient 
Protection and Affordable Care Act for construction

[[Page 6508]]

purposes--not for running the darned clinic but for construction 
purposes.
  An eligible entity shall use funds provided under a grant ordered 
under this subsection only for expenditures for facilities. No funds 
provided under a grant ordered in this section shall be used for 
expenditures for personnel or to provide for health services.
  I yield 1 minute to the gentleman from Indiana, Dr. Bucshon.
  Mr. BUCSHON. Mr. Chairman, I rise today in support of H.R. 1214.
  This is just another section of the ObamaCare bill, which, of course, 
I proposed and promoted the repeal of the entire bill.
  This is another slush fund of mandatory spending in the bill, $200 
million, with no congressional oversight over the next 4 years; where 
the Secretary of Health and Human Services can grant construction and 
renovation for school-based health centers, again, at their own 
discretion.
  Again, as was just stated, none of this money can go to actually 
providing health care.
  It is deceptive to say that this section of the ObamaCare bill is to 
promote health for our students and others at schools. This is another 
indication of uncontrolled Federal Government spending with no 
congressional oversight, and I speak today on behalf of the bill to 
rescind that.
  The Acting CHAIR. The gentleman from New Jersey has 4 minutes 
remaining. The gentleman from Texas has 3\1/2\ minutes remaining.
  Mr. PALLONE. Mr. Chairman, I have no further requests for time, and I 
reserve the balance of my time.
  Mr. BURGESS. I yield myself 30 seconds.
  Mr. Chairman, we just heard a moment ago from the gentleman from New 
Jersey perpetuation of the fantasy that the Patient Protection and 
Affordable Care Act is going to save anyone in this universe or a 
parallel universe or a parallel dimension any money.
  Make no mistake: This law costs vast sums of money. When the 
subsidies and the exchanges hit, the tap on the Federal Treasury is 
going to be unlike anything this country has ever seen.
  Congressional Budget Office talk about saving money was pure fantasy. 
The chief actuary for the Centers for Medicare & Medicaid Services 
exposed that fantasy for what it was less than 1 month after Congress 
voted on this bill. We voted on this law without actually having 
correct information because I believe the Secretary withheld the 
information from us.
  I reserve the balance of my time.
  Mr. PALLONE. I will yield myself 2 of the 4 minutes and go back and 
forth with Dr. Burgess here.
  The fact of the matter is that the Congress uses the CBO as the 
official statement, if you will, of our budget and the cost of 
legislation. That is what we have all agreed on a bipartisan basis we 
are going to use. I don't always agree with CBO. You have heard me many 
times say that they don't score prevention enough. The fact of the 
matter is that is what we are going to use. We have all agreed. And the 
CBO says that the Affordable Care Act saves over $1 trillion over the 
life of the bill.
  Everyone knows, and I know that Dr. Burgess, even himself, believes 
in preventative care. That is what these school-based health clinics 
are all about. They work. They get kids into the clinic or the center, 
they get primary care. They prevent having to go to an emergency room, 
to a hospital, or any other kind of institutionalization.
  This is what we are trying to do with the Affordable Care Act. We are 
trying to save money by guaranteeing people get to see a doctor when 
they need one so they don't get sick. It is all about wellness. That is 
what it is about. And wellness saves money. The Federal Government 
doesn't have to spend the money when the person goes to the emergency 
room and doesn't have any insurance coverage. It is that simple.
  I have had this argument many times with Dr. Burgess. I think that, 
for the most part, he agrees with me, and he has even said today that 
he thinks the school-based centers are a good thing.
  So I really don't understand the basis of this legislation that is 
being proposed this evening, and I certainly would urge my colleagues 
to vote against it.
  I reserve the balance of my time.
  Mr. BURGESS. Mr. Chairman, I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, how much time is left?
  The Acting CHAIR. The gentleman from New Jersey has 2\1/2\ minutes. 
The gentleman from Texas has 3 minutes.
  Mr. PALLONE. I yield myself the remainder of my time.
  Mr. Chairman, I have said over and over again, I don't understand 
what the Republicans are up to today. They keep saying that they want 
to repeal the Affordable Care Act, the health care reform. They keep 
bringing bills to the floor on a regular basis that would either in a 
piecemeal or in a large fashion repeal the Affordable Care Act. But the 
arguments make less and less sense every day as they start to take the 
pieces of the legislation that they even agree with themselves.
  Today, we have been here for many hours. My colleague from Texas and 
others said that they support school-based clinics. They even went so 
far to say they wouldn't even have a problem with the Federal 
Government paying for it.

                              {time}  1700

  Support the Federal dollar. Support the concept. Agree that it is a 
preventative measure.
  Then they went on to say that maybe we shouldn't pay for 
construction; we should only pay for operations. Well, the fact of the 
matter is that when you submit an application for construction or 
renovation of the clinic, under this law you have to show that you have 
the money to operate, and it is pretty clear that if you don't have the 
building, you are not going to be able to operate.
  So, again, I don't understand what they are trying to accomplish 
here. We all know that these centers make sense. They bring kids who 
would otherwise not see a doctor to have that opportunity.
  I thought my colleague from Virginia (Mr. Moran) really brought home 
the point when he said that a lot of kids don't even participate in 
athletics unless they have a school-based clinic because they have to 
be certified that they are healthy in order to participate in athletics 
in the school. Well, doesn't that make sense, because then they don't 
sit around and become obese. They actually exercise. They participate 
in team sports. They get to the whole collegiality of being involved in 
a team sport and the exercise and the health benefits of that.
  This is a win-win situation. I wish you had picked something else 
today to bring to this floor to repeal, because this is the worst thing 
you could have brought to the floor. No one, including yourself, argues 
that these school-based centers are not valuable, so stop trying to cut 
them. Stop trying to come up with some fantasy about how you are going 
to fund some part of it and not fund the other part of it. It is a good 
thing. It is probably one of the best things we have in this 
legislation, the Affordable Care Act. I think it is not rational and 
makes no common sense to pick this out as something to spend two or 
three hours on to say that this is something we shouldn't do. We should 
do it. Oppose this legislation.
  Mr. BURGESS. I yield myself the balance of my time.
  Mr. Chairman, I'll tell you what's not rational. It's not rational to 
spend this money and say you're prohibited from providing care. Let's 
be honest. The money for construction is duplicative. It was offered up 
in the stimulus bill previously. So we're duplicating a previous 
Federal expenditure in forward funding, advance funding the Patient 
Protection and Affordable Care Act. That's what doesn't make sense.
  A previous speaker on the Democratic side called me mindless. That is 
mindless. It was mindless to pass this bill over the objections of the 
American people, to never listen to the voices of the people that were 
literally ringed around this Capitol a year ago who said kill this 
bill. Well, now we have a chance to bring back a little bit of that 
spending, to bring it back into the arena in which it belongs, which is

[[Page 6509]]

the United States House of Representatives, the people's House.
  The mandatory spending was not in the bill that passed this House in 
November of 2009. This language was put in by the United States Senate. 
And why was it put in by the United States Senate? Because they were 
playing ``Let's Make a Deal.'' They had to get to 60 votes. They didn't 
know how to get there. They got there by buying votes, and this small 
provision, someone must have sold out pretty cheaply, this small 
provision was one of the provisions that allowed them to do that.
  Again, I would remind my colleagues that you cannot use the money 
that is provided in 4101(a), you cannot use that money to have a doctor 
or a nurse in the clinic. In fact, you are expressly prohibited from 
that. I suspect that is why the President has not issued a veto threat 
on this particular piece of legislation, because he himself included no 
money on the discretionary side that is actually going to provide the 
services of a doctor or a nurse.
  Look, we've got one small chance to reclaim some small part of our 
sanity in the United States House of Representatives, in the people's 
House. The forward funding, the advance funding, the direct 
appropriations that were contained within the Patient Protection and 
Affordable Care Act were an anathema to everything that people in this 
country understand about what is the role of their Federal Government. 
After all, they willingly give up a little bit of their rights in order 
to have their lives run more orderly. But they don't ask us to run 
roughshod over Federal spending and then claim a greater and greater 
share of their lives.
  Yes, it is unfortunate that we have had to spend all day here 
debating this bill. I don't dispute that fact. We should never have 
been here in the first place. The advance funding should never have 
been included in the Patient Protection and Affordable Care Act. And 
why was it? Because the Democrats knew last year they never intended to 
do a single appropriations bill, so the only way to get this dog up and 
running after its passage last year was to push the appropriations out 
the door in the language of the bill. That's what we've got to correct 
right now. That's what these arguments are all about.
  Yes, it's going to be tough sledding in the Senate. Yes, we don't 
have an ally down at the White House. But the American people expect us 
to do this work and they want to see us do that work. I urge an ``aye'' 
vote on the underlying bill.
  Mr. STARK. Mr. Chair, I rise in strong opposition to H.R. 1214, yet 
another time-wasting attempt to defund part of health care reform. This 
bill would deny funding enacted as part of health reform for the 
construction of school-based health centers. It would effectively deny 
our most vulnerable kids their best option for getting critical health, 
mental health, and dental services. While claiming to save money, its 
effect would be the opposite. Eliminating preventive services and 
options for primary care only means that when kids do get sick, they 
will need Medicaid benefits to pay for far more expensive services that 
could have been avoided through early intervention at a school-based 
health clinic.
  School-based health centers (SBHCs) are considered one of the most 
effective strategies for delivering high quality, comprehensive, and 
culturally-competent primary and preventive health care to 
adolescents--a population that can be difficult to reach. They remove 
the barriers that most commonly keep young people away from health 
services. They are located where students spend most of their waking 
hours--at school--making them much more accessible than doctor's 
offices or a clinic. They provide services regardless of a child's 
ability to pay, eliminating discrimination caused by wealth or the lack 
thereof. SBHCs reduce absenteeism, tardiness, dropouts, and discipline 
referrals by helping youth remain in school and engaged in learning.
  SBHCs are also vital mental health providers for children and 
adolescents. Today, May 3rd, is National Children's Mental Health 
Awareness Day. I cannot think of a more destructive way to mark this 
day than by passing a bill that eliminates access to mental health 
services that children desperately need. Bullying, violence, depression 
and stress are rampant in our school classrooms and playgrounds. SBHC 
staff are on the scene with the time and resources to address these 
challenges. More importantly, evidence shows that young people are 
willing to go to a SBHC for counseling, while the stigma of mental 
health issues is often enough to keep them from seeking help from other 
providers. Research shows that students who report depression and past 
suicide attempts demonstrate greater willingness to seek counseling in 
a SBHC. Students with perceived weight problems report more willingness 
to use a school clinic for nutrition information. Sexually active 
students are more willing to seek information on pregnancy prevention 
and to have general disease screenings at a SBHC.
  More than 350 applications to build school-based health centers have 
already been received by the Department of Health and Human Services, 
from 46 states and the District of Columbia, in response to this new 
funding opportunity enacted as part of health reform. All of these 
projects are ready to go--which means immediate jobs for construction 
workers and others involved in building the centers. Defunding this 
provision is another example of the Republican disconnect from the real 
issues people care about--creating jobs and protecting children.
  Healthy students are better students. Why the Republicans want to 
eliminate a program that helps kids stay in school and provides 
opportunities for future success--and creates jobs in the present--is 
simply beyond my imagination. I urge my colleagues to vote against this 
bill and give our young people the chance they deserve to succeed.
  Mr. LEVIN. Mr. Chair, I rise in strong opposition to this 
legislation.
  This bill is a retreat from a core value: to care for our children. 
Instead of cutting construction for these school-based health centers, 
we should be building more clinics to help those in need.
  These centers work. They keep our children healthy. I see it at the 
two school-based clinics in my district in the Hazel Park and the 
Fitzgerald Public School systems.
  For instance, Melissa, the nurse practitioner at the Fitzgerald 
Clinic, helps those who can't get care in any other place because their 
families can't afford insurance or can't afford doctor's fees.
  Just this past Friday, she saw a 16-year-old boy who didn't have any 
insurance because his parents' employer doesn't offer a plan, they 
can't afford private premiums but earn too much for CHIP or Medicaid. 
He was desperately ill, with a high fever and nausea. Melissa was able 
to diagnose and treat his strep throat on the spot. He asked her, ``How 
much do I owe you?'' Melissa responded ``Nothing.'' The young man burst 
into tears because he had been so worried that his family wouldn't be 
able to pay her.
  Another boy couldn't afford to go to an emergency room, but Melissa 
was able to treat a foot infection that could have resulted in an 
amputation.
  I could give you example after example because the team at the 
Fitzgerald school does it all. She makes sure that students have the 
vaccinations they need to stay healthy--300 visits this year--and 
provides the physicals 200 children will need to play sports. They 
provide counseling for teens coping with their parents' unemployment 
and groups for those dealing with alcoholism and family violence.
  The bottom line is that these clinics work and we need more of them.
  I urge Members to vote no on these irresponsible cuts.
  Mr. VAN HOLLEN. Mr. Chair, I rise in opposition to this legislation 
that would eliminate funding for school-based health centers.
  School-based health centers provide much-needed health care services 
to vulnerable children and adolescents, including primary care, mental 
health, dental, vision, and nutrition services. They not only help 
improve children's health, but also help improve the academic 
performance of students. School-based health centers are a win-win for 
the student, but also for parents and the community.
  By repealing funding for school-based health centers, we will be 
taking away a health care option--and perhaps the only health care 
option--for low income children and their families. Without these 
centers, we will not be building a foundation to promote and advance 
preventive and wellness-based care that will help save health care 
costs over time.
  Mr. Chair, I urge my colleagues to oppose this misguided bill.
  Mr. GENE GREEN of Texas. Mr. Chair, I rise in opposition to H.R. 
1214, which repeals a provision in the Affordable Care Act that 
provides funding for the construction of school health centers. It also 
rescinds any unobligated funds that have already been appropriated to 
this program.
  The Majority has said their top priority is job creation and getting 
our economy back on track. This legislation is yet another example of 
the Republicans' misplaced priorities.
  If the Republicans cared about job creation, they would support 
school based health centers.

[[Page 6510]]

  School-based health centers started in the 1970s with the first 
centers opening in Dallas, Texas, and St. Paul, Minnesota. Today, there 
are approximately 1,700 centers across the country located in 45 states 
plus the District of Columbia.
  In Texas, there are approximately 85 school-based health centers. 
Most of these centers are located in a permanent facility on a school 
campus. The centers provide primary care, mental health care, and 
dental care.
  The reason these school-based health centers are so important to 
working families is because they support families. They allow parents 
to stay at work while attending to their child's routine health care 
needs and they save money for our economy as a whole by keeping 
children out of hospitals and emergency rooms.
  Once again, the Republicans are claiming they support helping our 
working families and yet again we are cutting another service that 
helps keep parents at work and children healthy.
  I strongly oppose this legislation.
  Mr. BLUMENAUER. Mr. Chair, I voted against H.R. 1214, which would 
repeal the grants for the construction and expansion of school-based 
health centers. The Affordable Care Act included funding to expand 
school-based health programs across America so that we can provide 
better care for our children. Students who are healthy are ready to 
learn.
  School-based health centers provide our children with quality, 
comprehensive care that includes mental health services, social 
services and preventative care. A survey conducted by the National 
Assembly on School-Based Health Care found that when properly funded, 
school-based health centers help fill the gap in access to health 
services, especially for rural and underserved populations.
  These centers are accountable to their communities through an 
advisory board made up of local representatives, family organizations 
and parents. These programs bring health care to our kids and provide 
service without concern for whether or not they can afford it.
  In my state of Oregon, we are part of the School Mental Health 
Capacity Building Partnership to examine and improve mental health 
programs to be used in school-based health centers. As an early-adopter 
state for these centers, Oregon was selected to be one of four states 
to lead the way on this research. This important work, focused on 
tailoring mental health care to better meet our children and youths 
needs, relies on the school-based health center funding and will be 
jeopardized by this legislation.
  H.R. 1214 would prevent us from investing in our children and driving 
down future health care costs. At the start of this Congress, the only 
alternative the Republicans offered to the Affordable Care Act was a 
repeal-and-do-not-replace approach that is irresponsible at best.
  The Affordable Care Act is not perfect, but Congress should be 
focused on implementing the Act, and refining--not repealing--its 
provisions. I oppose this legislation.
  Mr. DAVIS of Illinois. Mr. Chair, I make a motion to strike the last 
word. I oppose H.R. 1214, a bill that would repeal mandatory funding 
for school-based health centers construction.
  Funding for the school-based health centers will ensure that nearly 2 
million children and adolescents across the country will have access to 
quality comprehensive medical care, mental health services, oral health 
services, preventive care, social services, and youth development. 
These centers typically help children and adolescents who often do not 
have access to family doctors of their own.
  School-based health centers have demonstrated their successes and 
accomplishments in attracting harder to reach populations, especially 
minorities and males and providing crucial services such as mental 
health care and high-risk behavior screens. Some analysts have reported 
that 10 out of 21 adolescents were more likely to come to school-based 
health centers for mental health services than other types of health 
facilities. When students have access to health centers to receive 
counseling, they are less likely to miss school or be tardy to class 
versus those students who do not receive access to similar services.
  Students perform better in school when they are healthy and ready to 
learn. Our school-based health centers are cost effective and provide 
an ideal setting to administer preventative health care to children. 
Several research studies have shown that school-based health centers 
help in reducing Medicaid expenditures related to inpatient, drug, and 
emergency room use, and improvements in health outcome. It is important 
that we remain committed to funding these health centers and provide 
the necessary investments in our children and our nation's health.
  I urge all my colleagues to vote no on H.R. 1214.
  Ms. SCHAKOWSKY. Mr. Chair, I rise in opposition to H.R. 1214.
  School-based health centers are a critical component of our nation's 
health care safety net.
  More than 1,900 school-based health centers across the country 
provide access to care to nearly two million students.
  Centers in high schools in my district like Maine East, Evanston 
Township, and Sullivan and Senn in Chicago, ensure that students can 
get access to primary, mental, and dental health services.
  School-based health centers are often the only source of health care 
for many children and adolescents who would otherwise go without needed 
services, and services are provided regardless of students' ability to 
pay.
  They offer treatment to students who lack insurance or whose parents 
are unable to take time off work to take them to the doctor. They keep 
children from missing school, and they ensure that children's health 
care needs are met.
  Studies have shown that school-based health centers decrease 
emergency room visits and Medicaid expenditures while improving grades, 
school attendance, and graduation rates.
  The Affordable Care Act provides grants for construction, renovation, 
and equipment for school-based health centers to increase access--this 
bill denies access.
  If we are concerned about providing our children with access to 
health care--we must reject this bill.
  Mr. BURGESS. I yield back the balance of my time.
  The Acting CHAIR. All time for general debate has expired.
  Mr. BURGESS. Mr. Chairman, I move that the Committee do now rise.
  The motion was agreed to.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Chaffetz) having assumed the chair, Mr. Yoder, 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. 1214) to 
repeal mandatory funding for school-based health center construction, 
had come to no resolution thereon.

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