[Congressional Record (Bound Edition), Volume 161 (2015), Part 4]
[House]
[Pages 4506-4514]
[From the U.S. Government Publishing Office, www.gpo.gov]




    PROVIDING FOR CONSIDERATION OF H.R. 2, MEDICARE ACCESS AND CHIP 
 REAUTHORIZATION ACT OF 2015, AND PROVIDING FOR PROCEEDINGS DURING THE 
           PERIOD FROM MARCH 27, 2015, THROUGH APRIL 10, 2015

  Mr. BURGESS. Mr. Speaker, by direction of the Committee on Rules, I 
call up House Resolution 173 and ask for its immediate consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 173

       Resolved, That upon adoption of this resolution it shall be 
     in order to consider in the House the bill (H.R. 2) to amend 
     title XVIII of the Social Security Act to repeal the Medicare 
     sustainable growth rate and strengthen Medicare access by 
     improving physician payments and making other improvements, 
     to reauthorize the Children's Health Insurance Program, and 
     for other purposes. All points of order against consideration 
     of the bill are waived. The amendment printed in the report 
     of the Committee on Rules accompanying this resolution shall

[[Page 4507]]

     be considered as adopted. The bill, as amended, shall be 
     considered as read. All points of order against provisions in 
     the bill, as amended, are waived. The previous question shall 
     be considered as ordered on the bill, as amended, and on any 
     further amendment thereto, to final passage without 
     intervening motion except: (1) one hour of debate equally 
     divided among and controlled by the chair and ranking 
     minority member of the Committee on Energy and Commerce and 
     the chair and ranking minority member of the Committee on 
     Ways and Means; and (2) one motion to recommit with or 
     without instructions.
       Sec. 2.  On any legislative day during the period from 
     March 27, 2015, through April 10, 2015--
        (a) the Journal of the proceedings of the previous day 
     shall be considered as approved; and
       (b) the Chair may at any time declare the House adjourned 
     to meet at a date and time, within the limits of clause 4, 
     section 5, article I of the Constitution, to be announced by 
     the Chair in declaring the adjournment.
       Sec. 3.  The Speaker may appoint Members to perform the 
     duties of the Chair for the duration of the period addressed 
     by section 2 of this resolution as though under clause 8(a) 
     of rule I.
       Sec. 4.  Each day during the period addressed by section 2 
     of this resolution shall not constitute a calendar day for 
     purposes of section 7 of the War Powers Resolution (50 U.S.C. 
     1546).
       Sec. 5.  The Committee on Financial Services and the 
     Committee on Ways and Means each may, at any time before 5 
     p.m. on April 6, 2015, file reports to accompany measures.

  The SPEAKER pro tempore (Mr. Graves of Louisiana). The gentleman from 
Texas is recognized for 1 hour.
  Mr. BURGESS. Mr. Speaker, for the purpose of debate only, I yield the 
customary 30 minutes to the gentleman from Massachusetts (Mr. 
McGovern), pending which I yield myself such time as I may consume. 
During consideration of this resolution, all time yielded is for the 
purpose of debate only.

                              {time}  0915


                             General Leave

  Mr. BURGESS. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days to revise and extend their remarks.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. BURGESS. Mr. Speaker, House Resolution 173 provides for 
consideration of H.R. 2, the Medicare Access and CHIP Reauthorization 
Act of 2015, under a closed rule, reflecting the careful, intricate, 
bipartisan negotiations which brought this legislation to the floor.
  The rule provides for 1 hour of debate, equally divided among the 
chairs and ranking members of the Committees on Energy and Commerce and 
Ways and Means.
  As is customary, the rule allows the minority to offer a motion to 
recommit on the bill.
  Finally, the rule provides for the customary district work period 
authority.
  This bill, H.R. 2, resolves an issue that many of us have worked on 
for our entire congressional careers.
  This bill reflects years of bipartisan work, work across committees, 
and even work across the Capitol with the other body. We brought 
together Members of all ideological groups, as well as diverse outside 
groups. We coalesced around a policy that will help patients, help 
doctors, help providers to get out from under the constant threat of 
payment cuts under the Medicare sustainable growth rate formula.
  Everyone agrees that Medicare's sustainable growth formula has got to 
go. Today, we are considering a bill to realistically accomplish that 
goal.
  The SGR formula was enacted as part of the Balanced Budget Act of 
1997 in an attempt to restrain Federal spending in Medicare part B. We 
now know that that is not working.
  The SGR consists of expenditure targets which apply a growth rate 
designed to bring spending in line.
  Since 2002, the SGR formula has resulted in a reduction in physician 
reimbursement rates. However, even though Congress has consistently 
passed legislation to override the formula, these patches have resulted 
in hundreds of billions of spent funds that could have gone to 
improving the Medicare system.
  If Congress were to let the formula continue, physicians would face a 
21 percent reduction in reimbursement rates on April 1. The sustainable 
growth rate's unrealistic assumptions of spending inefficiency have 
plagued the healthcare profession and our Medicare beneficiaries for 
over 13 years.
  The bill before us repeals the sustainable growth rate formula, 
avoiding potentially devastating across-the-board cuts slated to go 
into effect next week. We do so at a cost lower than what Congress has 
already spent or is likely to spend over the next 10 years. The 
Congressional Budget Office has found that enacting H.R. 2 will cost 
less than if we patched this formula over the next 10 years.
  The bill before us today provides 5 years of payment transition. It 
allows improved beneficiary access and allows medicine to concentrate 
on moving to broad adoption of quality reporting and, most importantly, 
allows Congress to move past the distraction of the SGR formula and to 
begin identifying Medicare reforms that can further benefit our 
citizens. This will also allow providers the time to develop and test 
quality measures and clinical practice improvement activities, which 
will be used for performance assessment during phase II.
  During the stability period, physicians will receive annual increases 
of one half of 1 percent. It seems small, but it is above what has been 
provided over the past several years.
  The quality measures are implemented in what is called the Merit-
Based Incentive Payment System. That will be evidence-based and 
developed through a transparent process that values input from provider 
groups. Quality reporting will measure providers against their peers 
rather than a one-size-fits-all generic standard. Providers will also 
self-determine their measures.
  The bill consolidates three reporting programs into this incentive 
payment system, easing administrative burdens and furthering the 
congressionally established goals of quality, resource use, and 
meaningful use.
  This new reimbursement structure ensures continued access to high-
quality care while providing physicians with certainty and security in 
their reimbursements. They will be aware of the benchmark they are 
competing against and, unlike current law, all penalties assessed on 
those not meeting the benchmark will go to those who do, keeping the 
dollars in the Medicare system.
  Provider standards will be developed by professional organizations in 
conjunction with existing programs and will incorporate ongoing 
feedback to physicians, further ensuring that optimal care is provided 
to the patient.
  Realtime feedback will be gained through registries and performance 
data. Physicians will be encouraged to participate in the process 
through data reporting. For eligible professionals who choose to opt 
out of the fee-for-service program, alternative payment models will be 
available.
  These alternative payment models may include a patient-centered 
medical home, whether they are in primary or specialty care, bundled 
care, or episodes of care. Qualifying practices that move a significant 
amount of their patients into these alternative payment models could 
see a 5 percent quality bonus. By encouraging alternative payment 
models and care coordination, this legislation will foster and 
facilitate innovation.
  It is important to note that while taking these important steps 
toward ensuring quality care, the bill specifically states that these 
quality measures are not creating a Federal right of action or a legal 
standard of care.
  Mr. Speaker, from beginning to end, this bill is about access: access 
for our seniors, access for those who utilize the Nation's 9,000 
community health centers, and, very importantly, the over 8 million 
children who receive their care at some point during the year through 
the Children's Health Insurance Program.
  The bill also addresses health programs that have become known as 
``extenders.'' Most are extended for 2 years under the bill. By 
resolving the SGR, Congress will have the ability to commit itself to 
working through these policies in the future.

[[Page 4508]]

  The bill also puts into place important structural reforms to 
Medicare that are the first steps toward starting the Medicare program 
on a really long-term trajectory towards fiscal stability.
  The bill is consistent in its themes throughout: payment stability; 
reduce and streamline the administrative burden; increase 
predictability and provider's interactions with the Centers for 
Medicare and Medicaid Services; build transparency into systems; 
encourage innovation of delivery of services; and keep providers in the 
driver's seat.
  Most importantly, we provide access to care for our Nation's 
patients.
  America's providers agree:
  ``The American Osteopathic Association views this bipartisan 
legislation as a clear and definitive approach toward comprehensive 
reforms in our health care system for children, seniors, and our 
Nation's physicians.''
  Here is one from the American Academy of Family Physicians:
  ``This legislation is the result of bipartisan negotiations that have 
produced legislative responses to some of our Nation's most pressing 
health care issues.''
  America's Essential Hospitals praised this bill, stating:
  ``This legislation represents the first truly bipartisan major health 
care legislation in years. Please do not let this opportunity pass you 
by--approve H.R. 2 as swiftly as possible.''
  This is just a small sampling of the close to 800 organizations 
spanning the political spectrum who have come together to endorse this 
bill. From primary care, to specialists, to surgeons, to organized 
nursing, our Nation's hospitals, and everyone in between, they have 
supported this policy.
  For that reason, I encourage my colleagues to vote ``yes'' on the 
rule and ``yes'' on the underlying bills.
  I reserve the balance of my time.
  Mr. McGOVERN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I want to thank the gentleman from Texas (Mr. Burgess) 
for the customary 30 minutes. I also want to thank him for his work on 
this legislation.
  Mr. Speaker, for far too long, Congress has shirked its 
responsibility when it came to permanently fixing the sustainable 
growth rate formula. Since its inception, our Nation's doctors and 
hospitals were held hostage to a misguided funding formula that was 
included as part of the Balanced 
Budget Act of 1997.
  I voted against the Balanced Budget Act back then when I was a new 
Member of Congress. It was plain to me that the Medicare cuts and 
proposed financing included in that bill were simply impossible to 
sustain. I am glad that 18 years later Congress is finally doing the 
right thing and repealing the sustainable growth rate formula and 
replacing it with a payment system based on value.
  It is past time that we repeal this misguided formula that has 
wreaked havoc throughout our healthcare system. Year after year after 
year, Congress, whether controlled by Democrats or Republicans, was 
forced to temporarily patch this formula. And year after year after 
year, Congress did the bare minimum, providing a temporary fix without 
actually addressing the real problem and permanently repealing the 
formula.
  Today, Congress is finally doing the right thing. That alone is worth 
supporting. But this bill does more than just repeal the sustainable 
growth rate formula. Instead, it provides a clearly defined schedule of 
payment adjustments that will give physicians and healthcare providers 
the stability they need while ensuring quality and value in the 
services patients require.
  In addition, H.R. 2 also provides critical funding through September 
2017 for our Nation's community health centers, funding that was 
initially provided under the Affordable Care Act, and it also provides 
support for the Children's Health Insurance Program, or CHIP.
  I have already started to hear from hospitals in my district about 
why this bill is good for them and good for their patients. UMass 
Memorial Medical Center, in my hometown of Worcester, is one of the 
Nation's most distinguished academic healthcare systems and is the 
safety net hospital for all of central Massachusetts. The folks there 
are pleased to see the delay in additional cuts to safety net hospitals 
and the delay in the implementation of the two-midnight rule.
  Now, this bill is not perfect--nothing around here is ever perfect--
but this is the result of long and careful bipartisan negotiation. Even 
though there are many very positive aspects of this bill, there are 
some provisions that are more problematic, and I would be remiss if I 
didn't at least mention some of them.
  Most troubling is the inclusion of the Hyde amendment and its 
application to the funding for the community health centers. It is 
important to clarify that this language is not a permanent extension or 
codification of the Hyde amendment. It only applies to the funding for 
community health centers and expires when that funding expires. It does 
not affect non-Federal funds. In fact, it is the same language that has 
been included in annual appropriations bills for nearly three decades.
  Let me be clear: I do not support the Hyde amendment. However, the 
language in this bill mirrors both President Obama's executive order 
and the language included in the annual appropriations bills.
  And I wish the CHIP extension was for 4 years rather than 2. But in 
this environment, I think that having a 2-year extension is a good 
thing, is an accomplishment, is a step in the right direction.
  Mr. Speaker, this is an important accomplishment, and I want to thank 
both Speaker Boehner and Leader Pelosi for their work in reaching this 
compromise, a deal that will finally enable this House to move away 
from annual doc-fix patches and toward providing stability and 
certainty for Medicare physicians and patients.
  I am encouraged by the process taken to reach this agreement. For a 
Congress that I might say accurately has been called ``broken,'' 
``hopeless,'' ``helpless''--a Congress plagued by gridlock and extreme 
partisanship--this bill represents what I hope will be a renewed 
commitment by my friends in the majority to work across the aisle with 
Democrats to address some of our country's most pressing issues. It is, 
and has always been, the way Congress passes important, substantive, 
and even historic legislation.
  This place can work when we work together. Just look at what this 
House has done over the past few weeks. We responsibly kept the 
Department of Homeland Security open, and now we are on the verge of 
passing an incredibly vital bipartisan bill to repeal the sustainable 
growth rate, fund community health centers, and reauthorize CHIP.
  I hope this bipartisan approach is contagious. I hope this is not the 
exception but becomes the rule. Every Member represents the same number 
of constituents, and every voice in this House needs and deserves to be 
heard.
  Today--thanks to the leadership of Leader Pelosi and Speaker Boehner 
and so many others--we are doing something that we can feel good about, 
something more than a campaign slogan, something that is more than red 
meat for the political base.

                              {time}  0930

  This is something that will help seniors, kids, and low-income 
families. It deserves our support.
  Before I reserve my time, Mr. Speaker, I include for the Record the 
Statement of Administration Policy, which begins with the following:
  ``The Administration supports House passage of H.R. 2 because it 
would reform the flawed Medicare physician payment system to 
incentivize quality and value'' and ``would make reforms that could 
help slow health care cost growth, and would extend other important 
programs such as health care coverage for children.''

                   Statement of Administration Policy


          h.r. 2--medicare access and chip reauthorization act

               (Rep. Burgess, R-Texas, and 10 cosponsors)

       The Administration supports House passage of H.R. 2 because 
     it would reform the flawed Medicare physician payment system

[[Page 4509]]

     to incentivize quality and value (a proposal called for in 
     the President's Fiscal Year 2016 Budget), would make reforms 
     that could help slow health care cost growth, and would 
     extend other important programs such as health care coverage 
     for children.
       Medicare payments to physicians are determined under a 
     formula, commonly referred to as the ``sustainable growth 
     rate'' (SGR). This formula has called for reductions in 
     physician payment rates since 2002, which the Congress has 
     overridden 17 times. Under the SGR, physician payment rates 
     would be reduced by about 21 percent on April 1, 2015. A cut 
     of this magnitude could reduce access to physicians for 
     Medicare beneficiaries throughout the country. H.R. 2 would 
     replace this system with one that offers predictability and 
     accelerates participation in alternative payment models that 
     encourage quality and efficiency. The proposal would advance 
     the Administration's goal of moving the Nation's health care 
     delivery system toward one that achieves better care, smarter 
     spending, and healthier people through the expansion of new 
     health care payment models, which could contribute to slowing 
     long-term health care cost growth.
       The Administration also supports the legislation's 
     inclusion of a continuation of policies and funding for the 
     Children's Health Insurance Program (CHIP). The President's 
     Budget includes a four-year extension of this program, which 
     has provided meaningful health coverage to over eight million 
     children; extending CHIP would ensure continued, 
     comprehensive, affordable coverage for these children. H.R. 2 
     also includes other important proposals in the President's 
     Budget, such as an extension of the Home Visiting Program and 
     additional funding for the Community Health Center (CHC) 
     Fund, although the legislation includes restrictions on the 
     use of the CHC Fund which would be unnecessary given 
     Executive Order 13535. The Administration supports the 
     legislation's provision to make permanent the Qualifying 
     Individual program, which pays the Medicare Part B premiums 
     for certain low-income Medicare beneficiaries.
       The legislation would pay for costs above what is needed to 
     hold Medicare payments to physicians fixed at their current 
     level. The savings would come from sensible reforms, which 
     are expected to cover a larger share of the bill's costs over 
     the long run. These include cost-saving changes to Medicare 
     provider payments as well as increases in the income-related 
     premium for certain high-income Medicare beneficiaries, who 
     represent about five percent of those covered by Medicare. A 
     similar proposal was included in the President's Budget to 
     help improve the financial stability of the Medicare program 
     by reducing the Federal subsidy of Medicare costs for those 
     who need the subsidy the least. The bill also would, starting 
     in 2020, prohibit Medicare Supplemental Insurance (Medigap) 
     policies from covering the Part B deductible (currently $147) 
     for new beneficiaries. This would encourage more efficient 
     health care choices, lowering Medicare costs and Medigap 
     premiums.

  Mr. McGOVERN. Mr. Speaker, I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Louisiana (Mr. Fleming).
  Mr. FLEMING. I would like to thank my good friend, Dr. Burgess.
  Mr. Speaker, I rise in support of H.R. 2. As a family physician who 
has been in private practice since 1982, I have seen a lot of things 
happen with Medicare, and this idea of sustainable growth rate, SGR, 
which came up in 1997--a Republican idea--is not only flawed, it is 
idiotic.
  It requires physicians to control throughout the country the entire 
volume of services provided, something that is absolutely impossible to 
do. It actually has had the opposite effect that was desired, and it 
has actually increased the amount of activity because of the loss of 
the valuable economic foundations that are necessary to make this 
system work.
  What this repeal of SGR will do is, number one, actually show what 
the cost of this is. We have been hiding it, like a shell game, for 
years with temporary patches that last, oh, maybe a year and sometimes 
less.
  Not only will this pay for itself in the second decade, but it 
actually begins to lower that cost even in the first decade, and it 
does so by using several mechanisms but with two important reforms that 
my colleagues need to know about.
  One, it reforms Medigap policies, which gives patients skin in the 
game. It makes patients, once again, a part of the decision team so 
that they, by having some element of price sensitivity, can work with 
the doctors to decide what is necessary and what is not, what is 
affordable and what is not; also, it asks higher-income seniors to do 
their share.
  Remember that the current Medicare system is a highly subsidized 
system for everybody, including for Warren Buffett, a $40 billion 
billionaire who gets his health care subsidized.
  I urge my colleagues to support this. This will increase patient 
care.
  Mr. McGOVERN. Mr. Speaker, I yield 2 minutes to the gentleman from 
California (Mr. Bera).
  Mr. BERA. I want to thank my colleague from Massachusetts for 
yielding me this time.
  Mr. Speaker, as a doctor who has cared for hundreds of seniors on 
Medicare, this is an important step forward because, for over a decade, 
we have had this flawed formula that has put the security of seniors' 
health care access at risk.
  I want to applaud Dr. Burgess, and I want to applaud the bipartisan 
Doctors Caucus. You will hear from a lot of doctors here in Congress 
that this is a step forward because, when we took our oath to practice 
medicine, we took an oath to put our patients first.
  This is a good bill that puts our patients first: our seniors, folks 
who have worked their whole lives and who now, in retirement, need that 
security of being able to see their doctors. This bill repeals a flawed 
formula that has been patched 17 times over the years, and it replaces 
it with a better formula, a formula that moves us away from this fee-
for-service model and that moves us toward practicing higher quality 
care and putting our patients first.
  It is not a perfect bill. Like many, I am disappointed to see the 
Hyde amendment included in this bill. I have always stood against the 
Hyde amendment and against other attempts to restrict a woman's right 
to make her own reproductive health decisions.
  The Hyde amendment is a temporary rider that expires every year; and 
we, along with many women across this country, look forward to the day 
when it will end. I came to Congress to put people first. I came to 
Congress to work across the aisle in a bipartisan way and to put our 
country first, and this is a great attempt.
  Again, I applaud the doctors in Congress. I applaud the members of 
the Energy and Commerce Committee, the members of the Ways and Means 
Committee, the Speaker, and the leader of the Democratic Party here in 
the House for working together to put people first.
  This is a good bill as 7.4 million patients will still have access to 
care at community health centers, 8 million low-income children and 
pregnant women will still have access to care through the CHIP program, 
49 million patients are enrolled in Medicare, and another 10,000 baby 
boomers enroll every day. This is a good thing.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. McGOVERN. I yield the gentleman an additional 1 minute.
  Mr. BERA. Mr. Speaker, we have got to honor the promises that we have 
made to our constituents and to the people of America. We have got to 
honor the promises that we have made to our patients and doctors. This 
is a good bill.
  I look forward to voting for and passing this bill today and to 
continuing to move America forward.
  Mr. BURGESS. Mr. Speaker, I yield 1 minute to the gentleman from 
Michigan (Mr. Benishek).
  Mr. BENISHEK. Thank you, Mr. Chairman. Thank you for all of your good 
work on this piece of legislation.
  Mr. Speaker, I rise in support of the rule for H.R. 2.
  Since the current flawed Medicare payment rate was enacted in 1997, 
Congress has kicked the can down the road and has passed 17 different 
patches to avoid devastating cuts to Medicare. These patches have cost 
the taxpayers almost $170 billion, more money than it will cost to 
permanently fix this problem right now.
  Today, we have the opportunity to actually fix a major problem and 
pass meaningful legislation that will help keep Medicare solvent and 
ensure that seniors are able to get the medical care they deserve.
  As a doctor who has taken care of patients in northern Michigan for 
over 30

[[Page 4510]]

years, I know how terrible it would be if we failed to act today and 
how seniors would bear the brunt of that failure. Today's legislation 
may not be perfect; it is a bipartisan compromise that will ensure that 
Medicare continues to provide necessary health care for my constituents 
in northern Michigan.
  I urge all of my colleagues to support this commonsense and long 
overdue fix.
  Mr. McGOVERN. Mr. Speaker, I yield 2 minutes to the gentleman from 
California (Mr. Aguilar).
  Mr. AGUILAR. I want to thank the gentleman from Massachusetts.
  Mr. Speaker, this bipartisan compromise that we will address this 
afternoon over SGR will strengthen Medicare by lowering costs and by 
ensuring that seniors have the doctors of their choice. While this 
agreement has important provisions, including critical programs to help 
low-income seniors, families, and children, it does fall short in a few 
ways.
  As a member of the Pro-Choice Caucus, I am disappointed that this 
deal both ignores the need for women to have access to their healthcare 
providers and that it includes an antichoice provision. Today's bill 
falls short of measures to increase women's access to necessary health 
measures, such as annual exams or prescription medications.
  The other troubling aspect of today's bill is the inclusion of the 
Hyde amendment, as the gentleman from Massachusetts mentioned. This is 
clearly another attack to block access to reproductive care. The 
inclusion of this language is disappointing because it permits 
antichoice language in an otherwise pragmatic, bipartisan compromise in 
exchange for community health center funding.
  I plan to support this bipartisan compromise because it solves 
longstanding problems and is a step in the right direction.
  Mr. BURGESS. Mr. Speaker, may I inquire as to the time remaining?
  The SPEAKER pro tempore. The gentleman from Texas has 18\1/2\ minutes 
remaining, and the gentleman from Massachusetts has 21 minutes 
remaining.
  Mr. BURGESS. Mr. Speaker, I yield 3 minutes to the gentlewoman from 
California (Mrs. Mimi Walters).
  Mrs. MIMI WALTERS of California. Mr. Speaker, I rise today in support 
of H.R. 2, the Medicare Access and CHIP Reauthorization Act, which is a 
bill to repeal and replace the sustainable growth rate.
  This bill presents an historic opportunity for Congress to end the 
doc fix and comprehensively reform the Medicare physician payment 
system once and for all. SGR has been broken for over a decade, and 
Congress has passed a temporary patch for this law 17 times. The price 
of putting off a permanent fix has cost the taxpayers almost $170 
billion and has masked the insolvency of Medicare.
  According to the nonpartisan Congressional Budget Office, Mr. 
Burgess' legislation to repeal SGR would save $900 million over the 
next decade, compared to freezing payment rates for physician services.
  After a decade of Congress patching the flawed SGR formula, it is 
finally time to permanently repeal and replace the system once and for 
all. I urge my colleagues in the House and in the Senate to pass this 
bill and finally fix the doc fix.
  Mr. McGOVERN. Mr. Speaker, I include the following statements for the 
Record in support of H.R. 2: the statement by the Massachusetts 
Hospital Association, a statement by the Massachusetts Medical Society, 
a list of a number of groups in support of H.R. 2, statements by the 
American Hospital Association, SEIU, and others. They are all in 
support of this bill.

      Massachusetts Hospital Association (MHA) Statement on H.R. 2

                             March 25, 2015

       The Massachusetts Hospital Association gives its full 
     support to H.R. 2, the U.S. House bipartisan package to 
     permanently repeal the Medicare physician Sustainable Growth 
     Rate (SGR).
       We are especially relieved because there have been 17 
     short-term SGR fixes over the past few years, nearly all of 
     which included significant reimbursement cuts to hospitals 
     and other providers for nothing more than a couple-month band 
     aid. This bill draws these short term patches to an end. We 
     are relieved that Children's Health Insurance Program (CHIP) 
     funding, community health center funding, and a continued 
     delay to enforcement of the two-midnight rule are included.
       We support the bill not only for what it does, but also for 
     what it does not do; it rejects cuts to graduate medical 
     education, Medicare bad debt, site neutral cuts to hospital 
     outpatient departments and inpatient rehabilitation 
     facilities, and it does not include unsound and inequitable 
     area wage index and rural floor policies.
       Obviously, we would prefer not to be part of the offsets to 
     help pay for the package, but we are realistic and especially 
     so because we realize that if this deal falls through and 
     Congress must consider another one-year SGR delay, then these 
     cuts to providers will still be in play to pay for a 
     meaningless, additional one-year delay. We strongly prefer a 
     permanent SGR fix and therefore give our full support to this 
     bill.
       Most importantly, we thank our congressional delegation for 
     their efforts on behalf of hospitals. Given the political 
     environment that has been a barrier to collaboration on major 
     legislation, this bill represents an exceptional 
     accomplishment that benefits hospitals, physicians, other 
     providers, and most notably, the long term health of the 
     Medicare program.
                                  ____



                                Massachusetts Medical Society,

                                      Waltham, MA, March 25, 2015.
     Hon. James P. McGovern,
     Cannon House Office Building,
     Washington, DC.
       Dear Representative McGovern: I am writing you as President 
     of the Massachusetts Medical Society to urge you to vote in 
     support of HR 2, the Medicare Access and CHIP Reauthorization 
     Act. Your support for this legislation will be critical to 
     its success and our members' ability to continue to treat 
     Medicare and Tricare patients who need and deserve quality 
     health care. Moreover this bill will continue funding for the 
     CHIP program at increased levels for two years and provide 
     necessary funds for our Community Health Centers, a vital 
     component of our health care system.
       We have been extremely grateful for your ongoing support 
     for SGR reforms in the past. As you are well aware, Congress 
     has passed 17 temporary measures which ultimately have cost 
     the government more money than a permanent solution. We 
     believe the time has finally come to pass permanent Medicare 
     physician payment reform.
       The importance of the SGR reforms extends well beyond the 
     26,000 members of the Massachusetts Medical Society. It will 
     impact the nearly 71,597 military families who receive their 
     health insurance through Tricare, the 74,525 people employed 
     by physicians and the over 1,104,483 Medicare beneficiaries 
     who live in the Commonwealth. This bill will also impact 
     every hospital in the state that employs physicians, every 
     medical device manufacturer who sells products to physicians' 
     offices and the myriad of organizations that rely on Medicare 
     dollars. This bill is about ensuring seniors and military 
     families' access to care. It is about sustaining physician 
     practices. Of equal importance, this legislation will 
     significantly foster and reward changes in the health care 
     delivery system that we all hope to achieve.
       We also strongly support provisions reauthorizing the CHIP 
     program. The MMS has been a strong supporter of this program 
     since its inception. This legislation provides an opportunity 
     for Congress to address the health care needs of children and 
     low-income Americans by extending funding for the Children's 
     Health Insurance Program and providing critical support for 
     Community Health Centers. We believe a straightforward 2 year 
     reauthorization of the CHIP program at the 23% increased 
     rates set by the ACA would be critically important to the 
     patients served by this program. Should the program not be 
     reauthorized at these levels it is estimated that 
     Massachusetts could lose millions of dollars--funds that this 
     state desperately needs.
       We knew that passage of final SGR repeal would never be 
     easy. But we are truly at that point where we believe the 
     leadership has developed a SGR strategy that is achievable.
       As President of the Massachusetts Medical Society I want to 
     thank you for your ongoing support for Medicare payment 
     reform and urge you to continue your support by voting for HR 
     2 when it comes to the House floor.
           Sincerely,
     Richard S. Pieters, M.D.
                                  ____


    Some of the Groups Supporting H.R. 2, Medicare Access and CHIP 
                      Reauthorization Act of 2015

       Center for American Progress, Families USA, Center on 
     Budget and Policy Priorities, Center for Law and Social 
     Policy (CLASP), National Coalition on Health Care (coalition 
     of over 80 groups), Healthcare Leadership Council, March of 
     Dimes, JDRF (Juvenile Diabetes), Georgetown Center for 
     Children and Families, National Association of Community 
     Health Centers, Third Way, Bipartisan Policy Center, American 
     Medical Association, American College of Physicians,

[[Page 4511]]

     American College of Surgeons, American College of Cardiology, 
     American Congress of Obstetricians and Gynecologists, 
     American Academy of Pediatrics, American Osteopathic 
     Association, American Academy of Family Physicians.
       American College of Allergy, Asthma and Immunology, 
     American Association of Medical Colleges, Digestive Health 
     Physicians Association, American College of Radiology, 
     Council of Academic Family Medicine, American Society of 
     Cataract and Refractive Surgery, American Hospital 
     Association, Federation of American Hospitals, America's 
     Essential Hospitals, Children's Hospital Association, 
     Catholic Health Association of the United States, American 
     Health Care Association, National Center for Assisted Living.
       American Nurses Association, American Association of 
     Colleges of Nursing, American Association of Nurse 
     Practitioners, American Association of Nurse Anesthetists, 
     American College of Nurse-Midwives, Gerontological Advance 
     Practice Nurses Association, National Association of Clinical 
     Nurse Specialists, National Association of Nurse 
     Practitioners in Women's Health, Medical Group Management 
     Association, Premier healthcare alliance, VHA Inc., LUGPA 
     (Large Urology Group Practice Association), National 
     Association of Psychiatric Health Systems, National Retail 
     Federation.
                                  ____



                                American Hospital Association,

                                   Washington, DC, March 24, 2015.
     U.S. House of Representatives,
     Washington, DC.
       Dear Member of Congress: On behalf of the nearly 5,000 
     members of the American Hospital Association, I am writing to 
     express our support for H.R. 2, bipartisan legislation to 
     repeal the flawed Sustainable Growth Rate (SGR) formula for 
     physician payments under the Medicare program. We believe 
     Congress should move forward and address this issue on a 
     permanent basis.
       While we are disappointed that hospitals would be looked to 
     as an offset given that Medicare already pays less than the 
     cost of delivering services to beneficiaries, the package 
     strikes a careful balance in the way it funds the SGR repeal 
     and embraces a number of structural reforms to the Medicare 
     program. Equally important, the legislation rejects a number 
     of flawed policy options, including reductions to outpatient 
     hospital services (so-called ``site-neutral'' cuts), Medicare 
     bad debt payments, graduate medical education, critical 
     access hospitals and certain services provided in 
     rehabilitative hospitals. Moreover, the bill rejects a 
     further delay in the ICD-10 program, and prevents a potential 
     0.55 percent coding offset previously proposed by the Centers 
     for Medicare & Medicaid Services. The legislation also 
     eliminates cuts to the Medicaid Disproportionate Share 
     Hospital program in fiscal year 2017. Finally, the bill 
     includes a needed extension of a number of expiring provision 
     (so-called extenders), including the Medicare Dependent 
     Hospital program, the rural low-volume adjustment, the rural 
     ambulance add-on, the partial enforcement delay on Medicare's 
     ``two-midnight'' policy, and the Children's Health Insurance 
     Program.
       We commend the House Republican and Democratic leadership 
     in their design of this package, and urge the House to pass 
     it.
           Sincerely,
                                                 Rich Umbdenstock,
     President and CEO.
                                  ____



                                                         SEIU,

                                                   March 25, 2015.
       Dear Representative, The Service Employees International 
     Union (SEIU) expresses its support for H.R. 2, legislation 
     that would permanently replace the Sustainable Growth Rate 
     (SGR) formula used to determine Medicare payments to doctors. 
     We appreciate the bipartisan negotiations that led to this 
     compromise, and, at this point in the process, urge House 
     members to vote yes to move the process forward.
       Tens of millions of Americans, and approximately one 
     million of SEIU members, have jobs that depend on a strong 
     health care economy, and many work in environments that face 
     considerable strains as a result of the uncertainty created 
     by the SGR. For example, due to short-term SGR patches, 
     hospitals face the threat of problematic payment changes 
     every several months, creating an unpredictable landscape 
     that adversely affects the ability of hospitals to provide 
     care as well as their ability to support the health care 
     workforce. Long-term, the pressure that the SGR creates will 
     continue to grow because the cost of replacing the policy, in 
     both patches and in its entirety, only increases radically 
     over time. H.R. 2 permanently replaces the SGR formula, 
     offsetting $70 billion in costs, preventing significantly 
     higher and potentially more harmful cuts to Medicare and 
     other health care programs now and in the future.
       In addition to relieving the burden that the costs of SGR 
     patches and replacement place on the health care system, this 
     legislation extends, and in some case makes permanent, 
     programs that are essential to low- and moderate-income 
     families. H.R. 2 extends full funding under current law for 
     the Children's Health Insurance Program (CHIP) for an 
     additional two years. CHIP funding is set to expire in 
     September 2015. Millions of families, including those of our 
     members, depend on CHIP to provide health care coverage for 
     their children. Though we support extending CHIP funding 
     under current law for four years, extending CHIP funding 
     under current law for two years does provide predictability 
     that states need to appropriately administer the program and 
     prevents problematic changes in eligibility and coverage that 
     would limit access to care or increase costs for the CHIP 
     population. In addition, this legislation provides an 
     additional funding for Community Health Centers, a critically 
     important source of health care for millions of families. 
     Finally, the legislation makes permanent the Qualifying 
     Individual (QI) program, which covers the cost of Medicare 
     Part B premiums for low-income people with Medicare, and the 
     Transitional Medicaid Assistance (TMA) program, which 
     supports families losing coverage. These important programs 
     that protect low-income populations are set to expire and, 
     without passage of this legislation, face an uncertain 
     future, as historically they have been extended only on a 
     temporary basis.
       Like any compromise, this package has serious flaws. As 
     previously stated, House Republican leaders should have 
     agreed to fund CHIP under current law for an additional four 
     years and should not have required changes to Medicare 
     benefits in order to reach an agreement. While some of the 
     changes to Medicare are mitigated because they only apply to 
     consumers with truly higher incomes, we have concerns about 
     the precedents set by these changes and changes to Medigap 
     coverage policies. In addition, we continue to oppose any 
     language that expands policies that deny millions of women 
     the right to access the full range of reproductive health 
     care services. Lastly, in order to avoid policy changes that 
     put additional financial burdens on beneficiaries and 
     providers--who have already faced significant SGR-related 
     cuts--other stakeholders should have been required to 
     contribute more in terms of offsets. However, despite these 
     concerns, when considering the potential impact of this 
     package versus the adverse consequences that non-resolution 
     of both the SGR and CHIP funding may have on all health 
     programs and the populations they serve, we believe that this 
     is an acceptable solution that House members should support.
       For these reasons, we urge you to vote yes on this 
     compromise legislation. If you have any questions, please 
     call Ilene Stein, SEIU Assistant Legislative Director.
           Sincerely,
                                                   Mary Kay Henry,
     International President.
                                  ____


  Statement by Senior Fellow Allyson Schwartz, Senior Fellow Dr. Zeke 
       Emanuel, and Vice President for Health Policy Topher Spiro

       The Center for American Progress supports the Medicare 
     Access and CHIP Reauthorization Act, or MACRA. This 
     bipartisan legislation represents a significant achievement 
     because it reforms Medicare's payment system and maintains 
     critical funding for health care for millions of low-income 
     children, families, and seniors. While we urge Congress to 
     offer amendments that would improve the bill, enactment of 
     this legislation would be far better than resorting to 
     another short-term fix that could put these programs in 
     jeopardy. The addition of the Hyde language restricting 
     abortions is unnecessary and frankly offensive, but we 
     believe the deal is an important step forward.
       Unless Congress extends funding for these programs now, 
     they will face tremendous uncertainty and risk and could be 
     held hostage in partisan legislation later in the year. MACRA 
     addresses this serious risk by including the following:
       The bill extends the Children's Health Insurance Program, 
     or CHIP, for two years. Without this extension, about 2 
     million children would become uninsured, while millions more 
     would lose their current coverage and face higher costs. 
     Importantly, this is a ``clean'' extension that maintains 
     policies and funding included in the Affordable Care Act--and 
     that does not include detrimental policies or cuts proposed 
     by the Republican leadership in Congress. This clean 
     extension would be a significant feat given the political 
     realities of this Congress and should not be discounted. Even 
     so, we strongly urge Congress to amend MACRA to extend CHIP 
     for at least four years.
       The bill extends funding for community health centers 
     included in the Affordable Care Act. Without this funding, 
     7.4 million low-income patients--including 4.3 million 
     women--would lose access to health care. While not a change 
     to current policy, the bill applies the Hyde Amendment, which 
     restricts funding for abortions, to this funding. CAP opposes 
     the Hyde Amendment, which harms low-income women, and 
     ultimately wants this temporary restriction to expire for 
     good. The application of the Hyde Amendment is, at best, 
     unnecessary and, at worst, an indication that Republican 
     leadership in Congress will attempt to use every bill to 
     restrict access to abortion, which is unacceptable. In this 
     case, the offensive language does not change policy and--
     similar to the Hyde Amendment that has always applied to 
     funding for community health centers--is temporary and 
     expires along with the funding to which it applies. Even so, 
     we

[[Page 4512]]

     strongly urge Congress to amend MACRA to remove this 
     language.
       The bill extends the Maternal, Infant, and Early Childhood 
     Home Visiting program for two years. This funding supports 
     evidence-based programs that have been proven to reduce 
     health care costs, improve school readiness, and increase 
     family self-sufficiency and economic security. We strongly 
     urge Congress to amend MACRA to extend this program for at 
     least four years.
       The bill extends the Qualifying Individual Program--which 
     subsidizes Medicare premiums for low-income beneficiaries--
     permanently.
       By permanently correcting Medicare payments to physicians, 
     MACRA at long last provides much-needed certainty and 
     stability to the Medicare program. Importantly, the bill 
     provides financial incentives to reinforce the country's path 
     toward a health care system that rewards value and quality of 
     care.
       We recognize that any bipartisan compromise that could be 
     enacted by Congress would need to pay for at least a portion 
     of the additional spending that would result--and that the 
     pay-fors would need to include a roughly equal mixture of 
     cuts to providers and cuts to beneficiaries. We also 
     recognize that the alternative--a never-ending series of 
     short-term patches that are fully paid for--would likely 
     result in deeper and more painful cuts to the Medicare 
     program over time.
       On the beneficiary side, MACRA increases Medicare premiums 
     by $82.50 per month for couples with incomes from $267,000 to 
     $428,000 and singles with incomes from $133,500 to $214,000. 
     Because this premium increase is targeted to the top 2 
     percent of beneficiaries, it is the least objectionable 
     beneficiary cut that could have been included in such a 
     package. The bill does not otherwise increase premiums across 
     the board by $58 billion, as some have asserted, compared to 
     premium levels under current policy.
       MACRA's other beneficiary cut causes us more concern. 
     Currently, about 12 percent of beneficiaries purchase Medigap 
     supplemental policies to cover their out-of-pocket costs. The 
     bill prohibits these policies from covering the deductible 
     for physician services, which is $147 in 2015. The effect of 
     this change is limited because it goes into effect in 2020 
     and applies only to new beneficiaries. In addition, because 
     Medigap policies would no longer cover the deductible, 
     premiums for these policies would go down. For most affected 
     beneficiaries, the savings from lower Medigap premiums would 
     actually exceed the costs from deductibles. However, it is 
     possible that hundreds of thousands of beneficiaries with 
     incomes below 300 percent of the federal poverty line would 
     face net costs of less than $100 per year. We strongly urge 
     Congress to amend MACRA to protect low-income beneficiaries 
     from this change--either by exempting primary care from their 
     deductibles or by expanding cost-sharing subsidies for this 
     targeted group.
       While we would like to see this legislation strengthened, 
     as we have recommended above, this compromise legislation 
     takes an important step in Medicare payment reform and 
     ensures continued funding that improves the health and 
     welfare of millions of children, families, and seniors. We 
     urge Congress to enact it.
                                  ____


 BPC Urges Congress to Pass Legislation to Reform Medicare and Extend 
                      Children's Health Insurance

                    [Press Release, March 25, 2015]

       Washington, DC.--The Bipartisan Policy Center (BPC) issued 
     the following statement by BPC President Jason Grumet; Senior 
     Vice President Bill Hoagland; and Health Policy Director 
     Katherine Hayes regarding the Medicare Access and CHIP 
     Reauthorization Act of 2015:
       ``We urge Congress to act swiftly to pass H.R. 2, the 
     Medicare Access and CHIP Reauthorization Act introduced this 
     week by chairmen and ranking members of the House Energy & 
     Commerce and Ways & Means Committees. This bill would 
     permanently replace Medicare's sustainable growth rate (SGR) 
     physician payment system, extend funding for the State 
     Children's Health Insurance Program (CHIP), and implement 
     structural reforms in Medicare to improve care delivery and 
     slow rising costs.
       ``Like any good bipartisan compromise, this legislation 
     strikes a careful balance that will draw both praise and 
     criticism. By reconciling these competing views, the proposed 
     legislation offers a set of politically viable solutions that 
     deserve broad bipartisan support.
       ``A permanent SGR repeal--coupled with new incentives to 
     improve quality and value in Medicare--would end the 
     senseless perennial series of temporary patches to prevent 
     payment cuts to physicians; it would also enable Congress to 
     move forward on a broader set of reforms.
       ``A two-year extension of full CHIP funding with no 
     programmatic changes, would provide near-term certainty to 
     states and low-income families who rely upon this essential 
     program.
       ``A balanced package of policy `offsets'--including cuts 
     from providers and 2% of high-income seniors--would pay for a 
     significant portion of the legislation. Additional savings 
     from improved Medicare payment incentives may accrue over the 
     long term.
       ``A provision to make permanent the Medicare Qualifying 
     Individual program would provide extra help to lower income 
     seniors in paying their Medicare Part B premiums.
       ``We urge U.S. Senators and House members to act now to 
     extend and improve these critical programs for our nation's 
     seniors, children, and health care providers.''

  Mr. McGOVERN. Mr. Speaker, as I said, it is not a perfect bill, but 
it represents, I think, a major accomplishment.
  If I could inquire of the gentleman as to how many additional 
speakers he has.
  Mr. BURGESS. Mr. Speaker, we have no additional speakers at this 
time. I am prepared to close after the gentleman closes.
  Mr. McGOVERN. I yield myself the balance of my time, and I will take 
this opportunity to close my side of the debate, Mr. Speaker.
  Mr. Speaker, let me begin by thanking all of those who have been 
involved in this compromise, especially Speaker Boehner and Leader 
Pelosi. I want to thank Mr. Burgess. I want to thank all of the members 
of the Energy and Commerce Committee. I am grateful to the staffs of 
all of the relevant committees for all of the work that they have put 
into this.
  I especially want to acknowledge the incredible work of the staff who 
works in the Office of Legislative Counsel. They don't always get 
thanked, but they do so much of the work around here, not only on 
important and complicated legislation like what we are debating here 
today, but on all legislation, so we are grateful to them.
  I don't really know what else to say here except that I am happy we 
are doing something, and I am happy that we are actually putting 
forward a bill, a bipartisan bill, that will help a lot of the people 
who most need help.
  As Mr. Burgess said, in reality, this bill is about access, making 
sure our senior citizens have the access to the doctors and to the 
health care that they want. We are making that possible through this 
bill, as well as helping countless children and low-income families and 
supporting our community health centers.
  This has been kind of an incredible week. It is hard to believe. 
First, we read that Ted Cruz signs up for ObamaCare, and now, we have 
this bipartisan compromise on the doc fix, and it reauthorizes CHIP and 
provides money to our community health centers.
  Who knows. I mean, if this is contagious, maybe next week, we will 
deal with climate change, so I am feeling good as we close this week. 
Again, I hope this is a coming attraction of what we can see in the 
future: more bipartisan cooperation, more give and take.
  If we follow what we did here, we actually can accomplish a lot more 
for the American people, and I think that would be a good thing.
  Let's get this done.
  I yield back the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield myself the balance of my time.
  Today's rule provides for the consideration of legislation addressing 
the pernicious sustainable growth rate formula, the most threatening 
issue in Medicare, risking patient access to care for our seniors.
  As I close, I would like to note that each committee's work is 
represented in H.R. 2. The base policy of H.R. 2 has the backing of the 
House and Senate negotiators and of all three committees of 
jurisdiction.
  I certainly want to thank the Speaker and the minority leader and 
their staffs for building off of the policy work accomplished by the 
committees to present a political pathway forward for this bipartisan 
bill.
  I thank the chairmen and ranking members of the House Committees on 
Energy and Commerce and Ways and Means, as well as of the Senate 
Finance Committee, for coming together for our Nation's doctors and 
seniors.
  I must note Chairman Upton, Chairman Pitts, Chairman Ryan, Chairman 
Brady, and former Chairman Camp, as well as Ranking Members Pallone, 
Gene Green, Sander Levin, Jim McDermott, and former Ranking Member 
Henry Waxman.
  I would also like to thank all of the staffs who have worked on this 
issue--

[[Page 4513]]

who have labored on this issue--for years. I know I will miss some 
people, but I do want to mention a few at the committee level who have 
dedicated themselves to getting us here today.

                              {time}  0945

  Some have left or switched their roles, but their work from the 
beginning deserves recognition. Certainly I want to thank Clay Alspach, 
Robert Horne, Ryan Long, Dr. John O'Shea, Dr. Steve Ferrara, Amy Hall, 
Eddie Garcia, Tiffany Guarascio, Arielle Woronoff, Brett Baker, Brian 
Sutter, Matt Hoffmann, Erin Richardson, and J. P. Paluskiewicz on my 
staff.
  I also want to thank the unsung heroes at the House Legislative 
Counsel, namely, Jessica Shapiro, Ed Grossman, and Jesse Cross.
  Every success we have had at each point in this process was further 
than we had ever come before, and that involved a lot of work, a lot of 
negotiation, and a lot of overwhelming desire to see the process 
through to the end.
  Ultimately, if this is a package that can go to the White House, all 
of this will be worth it. I certainly do look forward to passage and 
hope that, given the positive signs evidenced over the past several 
days, the other Chamber will quickly embrace this package and 
ultimately get this badly needed policy into law.
  I certainly want my colleagues to support both the rule and the 
underlying bill.
  Ms. SLAUGHTER. Mr. Speaker, I rise today in support of H.R. 2, the 
Medicare Access and CHIP Reauthorization Act. This bill funds Community 
Health Centers for two years at $7.2 billion dollars. These community 
health centers serve many of the newly insured people in my district. 
Thanks to the Affordable Care Act, they have health insurance, but 
thanks to community health centers, they have health care.
  H.R. 2 also extends the CHIP program and keeps over 8 million low-
income children and pregnant women in families from losing their health 
insurance.
  Lastly, H.R. 2 finally fixes the SGR, the Medicare Sustainable Growth 
Rate. The SGR was an ill-conceived plan to control the growth in health 
care costs by slashing doctor pay. We were in danger of doctors 
dropping Medicare patients, putting seniors' access to critical medical 
care at risk. The yearly short-term fixes have cost us more over the 
years than it would have to get rid of it, so I am pleased we are 
finally doing the right thing today in a way that moves us toward 
quality health care for Americans.
  Mr. Speaker, I'd like to take this opportunity to clarify a provision 
in H.R. 2 and how it differs from S. 178--the Senate Justice for 
Victims of Trafficking Act of 2015 (JVTA).
  As you know, the Senate is having a debate about a provision to make 
the Hyde Amendment part of permanent law and to apply it to non-
taxpayer funds. As co-chair of the Pro Choice Caucus, I want to make 
this clear: the Senate bill creates a new Domestic Trafficking Victims' 
Fund that would be funded--not by taxpayer dollars--but through fines 
imposed on defendants convicted of human trafficking, sexual 
exploitation and human smuggling crimes. The Hyde Amendment only 
applies to taxpayer dollars. Hyde Amendment restrictions have never 
been applied on a federal fund containing zero taxpayer dollars. This 
new fund is not federal dollars and therefore not eligible for Hyde. 
The pro-choice senators who are fighting against this expansion have my 
full support.
  Mr. BURGESS. Mr. Speaker, I yield back the balance of my time, and I 
move the previous question on the resolution.
  The previous question was ordered.
  The SPEAKER pro tempore. The question is on the resolution.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. BURGESS. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The vote was taken by electronic device, and there were--yeas 402, 
nays 12, answered ``present'' 5, not voting 13, as follows:

                             [Roll No. 143]

                               YEAS--402

     Abraham
     Adams
     Aderholt
     Aguilar
     Allen
     Amodei
     Ashford
     Babin
     Barletta
     Barr
     Barton
     Bass
     Beatty
     Becerra
     Benishek
     Bera
     Beyer
     Bilirakis
     Bishop (GA)
     Bishop (MI)
     Bishop (UT)
     Black
     Blackburn
     Blum
     Blumenauer
     Bonamici
     Bost
     Boustany
     Boyle, Brendan F.
     Brady (PA)
     Brady (TX)
     Brat
     Bridenstine
     Brooks (IN)
     Brown (FL)
     Brownley (CA)
     Buchanan
     Buck
     Bucshon
     Burgess
     Bustos
     Butterfield
     Byrne
     Calvert
     Capps
     Capuano
     Cardenas
     Carney
     Carson (IN)
     Carter (GA)
     Carter (TX)
     Cartwright
     Castor (FL)
     Castro (TX)
     Chabot
     Chaffetz
     Chu, Judy
     Clark (MA)
     Clarke (NY)
     Clawson (FL)
     Clay
     Cleaver
     Clyburn
     Coffman
     Cohen
     Cole
     Collins (GA)
     Collins (NY)
     Comstock
     Conaway
     Connolly
     Cook
     Costa
     Costello (PA)
     Courtney
     Cramer
     Crawford
     Crenshaw
     Crowley
     Cuellar
     Culberson
     Cummings
     Curbelo (FL)
     Davis (CA)
     Davis, Danny
     Davis, Rodney
     DeFazio
     DeGette
     Delaney
     DeLauro
     DelBene
     Denham
     Dent
     DeSantis
     DeSaulnier
     DesJarlais
     Deutch
     Diaz-Balart
     Dingell
     Doggett
     Dold
     Doyle, Michael F.
     Duckworth
     Duffy
     Duncan (SC)
     Duncan (TN)
     Edwards
     Ellison
     Ellmers (NC)
     Emmer (MN)
     Engel
     Eshoo
     Esty
     Farenthold
     Farr
     Fattah
     Fincher
     Fitzpatrick
     Fleischmann
     Fleming
     Flores
     Forbes
     Fortenberry
     Foster
     Foxx
     Frankel (FL)
     Frelinghuysen
     Fudge
     Gabbard
     Garamendi
     Garrett
     Gibbs
     Gibson
     Gohmert
     Goodlatte
     Gowdy
     Granger
     Graves (GA)
     Graves (LA)
     Graves (MO)
     Grayson
     Green, Al
     Green, Gene
     Grijalva
     Grothman
     Guinta
     Guthrie
     Gutierrez
     Hahn
     Hanna
     Hardy
     Harper
     Harris
     Hartzler
     Hastings
     Heck (NV)
     Heck (WA)
     Hensarling
     Herrera Beutler
     Hice, Jody B.
     Higgins
     Hill
     Himes
     Holding
     Honda
     Hoyer
     Hudson
     Huffman
     Huizenga (MI)
     Hultgren
     Hunter
     Hurd (TX)
     Hurt (VA)
     Israel
     Issa
     Jackson Lee
     Jenkins (KS)
     Jenkins (WV)
     Johnson (OH)
     Johnson, E. B.
     Johnson, Sam
     Jolly
     Jordan
     Joyce
     Kaptur
     Katko
     Keating
     Kelly (IL)
     Kelly (PA)
     Kennedy
     Kildee
     Kilmer
     Kind
     King (IA)
     King (NY)
     Kinzinger (IL)
     Kirkpatrick
     Kline
     Knight
     Kuster
     LaMalfa
     Lamborn
     Lance
     Larsen (WA)
     Larson (CT)
     Latta
     Lawrence
     Lee
     Levin
     Lewis
     Lieu, Ted
     Lipinski
     LoBiondo
     Loebsack
     Lofgren
     Long
     Loudermilk
     Love
     Lowenthal
     Lowey
     Lucas
     Luetkemeyer
     Lujan Grisham (NM)
     Lujan, Ben Ray (NM)
     Lummis
     Lynch
     MacArthur
     Maloney, Carolyn
     Maloney, Sean
     Marchant
     Marino
     Matsui
     McCarthy
     McCaul
     McClintock
     McCollum
     McDermott
     McGovern
     McHenry
     McKinley
     McMorris Rodgers
     McNerney
     McSally
     Meadows
     Meehan
     Meng
     Messer
     Mica
     Miller (FL)
     Miller (MI)
     Moolenaar
     Mooney (WV)
     Moore
     Moulton
     Mullin
     Murphy (FL)
     Murphy (PA)
     Nadler
     Napolitano
     Neal
     Neugebauer
     Newhouse
     Noem
     Nolan
     Norcross
     Nugent
     Nunes
     O'Rourke
     Olson
     Pallone
     Palmer
     Pascrell
     Paulsen
     Pearce
     Pelosi
     Perlmutter
     Perry
     Peters
     Peterson
     Pingree
     Pittenger
     Pitts
     Pocan
     Poe (TX)
     Poliquin
     Polis
     Pompeo
     Posey
     Price (NC)
     Price, Tom
     Quigley
     Ratcliffe
     Reed
     Reichert
     Renacci
     Ribble
     Rice (NY)
     Rice (SC)
     Richmond
     Rigell
     Roby
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rohrabacher
     Rokita
     Rooney (FL)
     Ros-Lehtinen
     Roskam
     Ross
     Rothfus
     Rouzer
     Roybal-Allard
     Royce
     Ruppersberger
     Rush
     Russell
     Ryan (OH)
     Ryan (WI)
     Salmon
     Sanchez, Linda T.
     Sanchez, Loretta
     Sanford
     Sarbanes
     Scalise
     Schakowsky
     Schiff
     Schock
     Schrader
     Scott (VA)
     Scott, Austin
     Scott, David
     Sensenbrenner
     Serrano
     Sessions
     Sewell (AL)
     Sherman
     Shimkus
     Shuster
     Simpson
     Sinema
     Sires
     Slaughter
     Smith (MO)
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Speier
     Stefanik
     Stewart
     Stivers
     Swalwell (CA)
     Takai
     Takano
     Thompson (CA)
     Thompson (MS)
     Thompson (PA)
     Thornberry
     Tiberi
     Tipton
     Titus
     Torres
     Trott
     Turner
     Upton
     Valadao
     Van Hollen
     Vargas
     Veasey
     Vela
     Velazquez
     Visclosky
     Wagner
     Walberg
     Walden
     Walker
     Walorski
     Walters, Mimi
     Walz
     Wasserman Schultz
     Waters, Maxine
     Watson Coleman
     Weber (TX)
     Webster (FL)
     Welch
     Wenstrup
     Westerman
     Westmoreland
     Whitfield
     Williams
     Wilson (FL)
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Yarmuth
     Yoder
     Yoho
     Young (IA)
     Young (IN)
     Zeldin
     Zinke

                                NAYS--12

     Amash
     Brooks (AL)
     Cicilline
     Cooper
     Gallego
     Graham
     Huelskamp
     Jones
     Massie
     Rangel
     Tonko
     Tsongas

                        ANSWERED ``PRESENT''--5

     Gosar
     Griffith
     Labrador
     Mulvaney
     Stutzman

[[Page 4514]]



                             NOT VOTING--13

     Conyers
     Franks (AZ)
     Hinojosa
     Jeffries
     Johnson (GA)
     Langevin
     Meeks
     Palazzo
     Payne
     Ruiz
     Schweikert
     Smith (WA)
     Young (AK)

                              {time}  1011

  Mr. AMASH changed his vote from ``yea'' to ``nay.
  Messrs. BISHOP of Georgia, WALZ, LOEBSACK, McNERNEY, CAPUANO, 
O'ROURKE, HANNA, and SEAN PATRICK MALONEY of New York changed their 
vote from ``nay'' to ``yea.''
  So the resolution was agreed to.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.
  Stated for:
  Mr. CONYERS. Mr. Speaker, I was not present for rollcall vote No. 
143. Had I been present, I would have voted ``aye.''
  Ms. TSONGAS. Mr. Speaker, on rollcall vote No. 143, I voted ``no'' 
and I intended to vote ``yes.''

                          ____________________