Amendment Text: H.Amdt.296 — 112th Congress (2011-2012)

There is one version of the amendment.

Shown Here:
Amendment as Offered (05/24/2011)

This Amendment appears on page H3368 in the following article from the Congressional Record.



[Pages H3361-H3388]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




       REPEALING MANDATORY FUNDING FOR GRADUATE MEDICAL EDUCATION

  The SPEAKER pro tempore. Pursuant to House Resolution 269 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. 1216.

                              {time}  1442


                     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. 1216) to amend the Public Health Service Act to convert funding 
for graduate medical education in qualified teaching health centers 
from direct appropriations to an authorization of appropriations, with 
Mr. Poe of Texas 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 Kentucky (Mr. Guthrie) and the gentleman from 
Texas (Mr. Gene Green) each will control 30 minutes.
  The Chair recognizes the gentleman from Kentucky.
  Mr. GUTHRIE. I yield myself such time as I may consume.
  Mr. Chairman, I rise today in support of H.R. 1216.
  The health care bill that was signed into law last year spent over a 
trillion dollars and empowered Federal bureaucrats more than it did the 
American

[[Page H3362]]

people. As a member of the Energy and Commerce Committee, I have been 
working on legislation that takes steps to peel back a few of the many 
mandatory programs that were instituted in the health care law and 
limit the Federal Government's unprecedented power.
  Section 5508 of the health care law authorizes the Health and Human 
Services Secretary to award teaching health centers development grants 
and appropriates $230 million from 2011 through 2015. H.R. 1216 amends 
the Public Health Service Act to convert funding for graduate medical 
education in qualified teaching health centers from direct 
appropriations to an authorization of appropriations.
  This bill is not about the merits of graduate medical education or 
teaching health centers.
  Everyone agrees that there is a strong need for more primary care 
physicians in our health care system, but picking and choosing one 
program over another to receive automatic funding is irresponsible. 
Making these programs mandatory spending is unfair to all of the other 
health care programs that have to compete every year to continue to 
receive funds.
  For example, as HHS Secretary Kathleen Sebelius said during her 
testimony before the House Energy and Commerce Committee earlier this 
year, the President's fiscal year 2012 budget eliminates Graduate 
Medical Education for Children's Hospitals. While children's hospitals 
must go through the regular appropriations process to fight for 
funding, teaching health centers will receive automatic appropriations.
  We are $14.3 trillion in debt, and our deficit for this year will 
approach $1.5 trillion. Congress is making difficult decisions about 
which programs to fund and which to reduce. We must prioritize, and I 
find it unfair that some programs are completely shielded and do not 
have to prove their merit to earn continued funding.
  I urge my colleagues to vote ``yes.''
  I reserve the balance of my time.
  Mr. GENE GREEN of Texas. I yield myself such time as I may consume.
  Mr. Chairman, I rise today in strong opposition to H.R. 1216, 
legislation to convert mandatory funding authorized under the 
Affordable Care Act for Teaching Health Centers to authorized funding.
  The Affordable Care Act authorized and appropriated $230 million for 
a 5-year payment program to support accredited primary care residency 
training operated by community-based entities, including community-
based health centers. This training takes place in community-based 
settings such as community health centers.
  Research shows that CHC-trained physicians, for example, are more 
than twice as likely as their non-CHC-trained counterparts to work in 
underserved areas, ensuring that that kind of training takes place, 
which is what mandatory spending support for programs does. It will 
help strengthen the primary care workforce in underserved areas, 
particularly in areas that struggle to recruit and retain a sufficient 
workforce.
  The Teaching Health Center program supports the training of 
individuals who will practice family medicine, internal medicine, 
pediatrics, internal medicine pediatrics, obstetrics and gynecology, 
psychiatry, general dentistry, pediatric dentistry, and geriatrics--
those disciplines where we're experiencing significant physician 
shortages.
  It's hypocritical for my Republican colleagues to take away this 
funding. They continue to argue that there are not enough physicians to 
provide care to people who need them in primary care services. This 
program is designed to help address this very problem. But they keep 
trying to have it both ways in health reform debate, and this is just 
another example.
  Today, the majority is going to say they have an obligation to ensure 
this program is subject to the appropriations process due to the need 
for transparency in our spending process and current budget process. 
Let me remind the majority that we're not the only party who's directed 
mandatory funding for programs. The majority must have certainly 
supported autopilot spending, as Representative Foxx described the 
Teaching Health Center program earlier this afternoon, when they passed 
the Medicare Modernization Act of 2003, which required mandatory 
funding for transitional programs. I suppose at that time, the majority 
certainly felt they knew better than the appropriators that the MMA was 
a worthy program and deserved mandatory funding, even though they 
passed it under the cover of night with a lot of arm-twisting.
  I can't understand the opposition, particularly from my Republican 
colleagues. They repeatedly and inaccurately complain that we don't do 
enough to promote health workforce expansions, and now they're going to 
cut funding for the health workforce expansion.
  Turning the Health Center program into a discretionary one will make 
it challenging for these 11 programs that have already made the 
decision to participate in consultation with key stakeholders, like 
teaching hospitals and their boards, and based on the expectation that 
continued funding will be available. Converting this program to 
discretionary funding will also deter other entities from making the 
business decision necessary to expand residency training, since funding 
over the next few years could be subject to the annual appropriations 
fight.
  This is yet another political stunt by the majority to attempt to 
defund health reform--this, through their playing games with funds 
dedicated to ensure that we have physicians in our country.
  Several weeks ago, they couldn't stop talking about how Medicaid will 
be greatly improved with the Ryan budget because it provides States 
with block grants to run their Medicaid programs. How great would it be 
to eliminate Medicare by giving seniors vouchers to purchase health 
insurance? And this week, we're busy taking away funds to ensure that 
we train enough physicians to ensure all Americans have access to 
affordable care. Once again, the majority has their own priorities.
  Mr. Chairman, I reserve the balance of my time.
  Mr. GUTHRIE. Mr. Chairman, I yield 2 minutes to the gentleman from 
Pennsylvania (Mr. Pitts), the chairman of the subcommittee.

                              {time}  1450

  Mr. PITTS. I would like to thank the gentleman from Kentucky for his 
leadership on this issue.
  Section 5508 of PPACA authorizes the Secretary to award grants to 
teaching health centers to establish newly accredited or expanded 
primary care residency training programs. The new health care law, 
PPACA, provides a mandatory appropriation of $230 million for this 
purpose for the period from FY 2011 through FY 2015.
  You may recall that in the President's fiscal year 2012 budget, he 
eliminated funding for training at children's hospitals. Because of 
this, I and the ranking member of the Health Subcommittee, the 
gentleman from New Jersey (Mr. Pallone) have introduced H.R. 1852, a 
bill to reauthorize the Children's Hospitals Graduate Medical Education 
program for an additional 5 years at the current funding levels.
  While the administration couldn't find money in its budget for 
training at children's hospitals, PPACA somehow was able to provide a 
direct mandatory appropriation of $230 million for other teaching 
health centers, with no further action, input, or approval required by 
Congress. And PPACA did this with a number of funds, mandatory 
appropriations.
  The bill before us today, H.R. 1216, simply converts PPACA's 
mandatory appropriations to an authorization, subject to the annual 
appropriations process, just like the Children's Hospital GME program, 
making it discretionary. Passage of the bill will also save $215 
million over 5 years.
  I urge support of the bill.
  Mr. GENE GREEN of Texas. Mr. Chairman, I yield 2 minutes to my 
colleague from the Energy and Commerce Committee, the gentlewoman from 
California (Mrs. Capps).
  Mrs. CAPPS. I thank my colleague for yielding.
  Mr. Chairman, I rise in strong opposition to this reckless bill. I 
cannot count the number of times Members on both sides of this aisle 
have decried shortages in the primary care workforce of our 
communities, and working, often in a bipartisan manner, to develop ways 
to increase the primary

[[Page H3363]]

care ranks. Yet today, the next victim in the Republican obsession with 
repealing the Affordable Care Act is a program that does deal with 
these shortages. It increases our primary care physician ranks, and 
trains them with special expertise in serving the community.
  The bill before us would defund this program, taking many qualified 
Americans out of the primary care workforce before they even have an 
opportunity to join it. Moreover, cutting these training programs would 
also affect already existing jobs at the 11 community-based entities 
that have already expanded their programs to train these new doctors. 
Taking away this funding will force possible layoffs and have a 
chilling effect on other sites developing this type of program.
  Yes, it is paid for through mandatory funding. But that is not 
unheard of or even unusual. In fact, the federally funded Graduate 
Medical Education program, which has had measured success in 
strengthening our health care workforce, is a mandatory spending 
program. The program the Republicans are trying to cut today is simply 
a complement to this GME program, focused on community-based care and 
prevention.
  The choice on H.R. 1216 is clear: if you believe that we do not have 
a jobs problem and that we have all the doctors we will ever need, then 
go ahead and vote for this bill. But if you believe that we need to 
create good jobs and the professionals to fill them, that we need more 
primary care providers, you must vote against H.R. 1216 and protect 
this very important program. We can't have it both ways.
  I urge a ``no'' vote.
  Mr. GUTHRIE. Mr. Chairman, I yield 4 minutes to my friend from 
Tennessee (Mrs. Blackburn).
  Mrs. BLACKBURN. I thank the gentleman from Kentucky for his 
leadership on this bill.
  Mr. Chairman, it is so interesting to me. We had a 2,700-page health 
care bill that basically was a government takeover of health care. What 
we have heard from so many people in this country is gosh, you know, I 
wish somebody would have read that bill before they passed it. And the 
former Speaker said we need to pass the bill, and then we can read it 
and find out what is in it.
  One of the things that many of the people did not like that was in 
that bill was many of these mandatory provisions that were put in 
place, programs that had been on the books for years that were 
discretionary programs that all of a sudden became mandatory. And the 
confusing thing, Mr. Chairman, is there didn't seem to be any 
consistency. As the subcommittee chairman who spoke before me had said, 
Mr. Pitts had said, you know, you don't tend to children's hospitals in 
the same way, you don't tend to nurses and technicians in the same way. 
But here was this conversion from discretionary to mandatory for 
teaching hospitals, a total of $230 million, over $40 million a year.
  Now, it doesn't matter if you need the money or not. It doesn't 
matter if you know exactly where you are going to use it or not. The 
money is going to be appropriated. It's put on autopilot. Doesn't 
matter what we say is going to happen with the government, if we need 
to reduce it. They're going to get that money. That is why this bill is 
so important.
  You will notice, Mr. Chairman, that 2,700-page bill, we are able to 
delete $230 million of that appropriation, mandatory appropriation with 
a bill that basically is about 2 pages long. What we do in this 2 pages 
is responsibly address what the American people want to see us address. 
They know that the Federal mandates are costing private sector jobs. 
They know that the Federal Government coming in and taking over health 
care is costing private sector health care jobs. Indeed, we have study 
after study that is saying we have already lost over a million jobs.
  It seems like every time we turn around, whether it is our health 
care delivery systems, whether it is our hospitals, whether it is our 
physicians' offices, we are hearing about the loss of jobs to health 
care providers and in the health care sector because of the passage of 
PPACA, or ObamaCare, as many people in our country refer to the bill.
  One of the reasons we have to go about repealing these slush funds, 
Mr. Chairman, is because we simply can't afford this. Every second of 
every day, every single second of every single day we are borrowing 
$40,000. We are borrowing 41 cents of every single dollar that we 
spend. This government is so overspent, we are spending money we don't 
have for programs that our constituents don't want. And instead of 
eliminating, what we are saying is, look, let's eliminate a mandatory 
program and turn it back to what it was for years, discretionary, so 
that Members of this body bring their discretion to bear on the issues 
of the day and bring the opinions of their constituents to bear on how 
this Chamber spends the taxpayers' money.
  Mr. Chairman, it is not Federal money; it is the taxpayers' money. 
This government is overspent. We cannot afford all these Federal 
mandates. It is time to move these programs back to the discretion of 
this Chamber.
  Mr. GENE GREEN of Texas. Mr. Chairman, I gladly yield 3 minutes to 
our ranking member of the full Energy and Commerce Committee, the 
gentleman from California (Mr. Waxman).
  Mr. WAXMAN. Mr. Chairman, there was so much misinformation just given 
out by the previous speaker that it's hard to know where to start. The 
Republicans have said they don't like the Affordable Care Act. But what 
do they have to replace it with? They said they're going to repeal it 
and replace it. What are they going to do about the uninsured in this 
country, about the high cost of health care, about the people who can't 
even buy insurance even if they have the money because they have 
preexisting medical conditions?
  We have had no proposal from the Republicans, except in their budget 
they want to take Medicare away from future seniors by making it a 
block grant. And they want to cut the Medicaid program, which cuts a 
big hole in the safety net for the poor to get their health care needs, 
which means people in nursing homes would be dumped out of those 
nursing homes.

                              {time}  1500

  But the bill before us now is to stop the program that would train 
primary care physicians. Does anybody disagree with the notion that we 
need more primary care physicians? Evidently, the Republicans do 
because as we heard from the last speaker, she wants to make it an 
appropriated program, not a mandatory spending program.
  Well, it's been in the mandatory program in spending in Medicare and 
Medicaid since 1965. Training physicians should be supported with 
assured funding that we could rely on. We can't train a doctor in just 
1 year. Doctors need a number of years where they are going to be 
assured of their continuation in medical schools, and that's why we 
have had a short funding through Medicare and Medicaid. And in the The 
Affordable Care Act, the purpose was to train physicians for primary 
care in community settings.
  That's what the Republicans want to repeal. And if they can afford it 
from one year to the next, they will put in funds; but if they can't 
and their mood is to give another tax break to the wealthy, we won't be 
able to afford it. With all the costs to go to medical school and all 
the loans that are required, we ought to ensure spending for primary 
care doctors.
  I urge my colleagues to oppose this bill. It's incomprehensible to me 
why we even have it on the House floor. It's another one of those 
efforts that Republicans have been putting up to chip away at health 
care reform. They want to repeal it, they want to chip away at it, but 
we don't even know what they want to replace it with.
  And the American people and our constituents are entitled to know, 
are they just going to leave people on their own without the ability to 
buy health insurance because of preexisting conditions? Are they going 
to tell the elderly they are on their own and see who they want to 
insure them?
  I urge a ``no'' vote on this bill.
  Mr. GUTHRIE. Mr. Chairman, I yield myself such time as I may consume.
  First there were a number of amendments, I think over 100 amendments, 
to the health care bill that were offered by the Republicans. An 
alternative was offered by the Republicans as voted on as we went 
forward.
  Block grants, several Governors have come to Washington and talked 
about

[[Page H3364]]

block granting Medicaid to give them the opportunity to not just deal 
with Medicaid in their States but there was the other part of their 
budget.
  But I can tell in Kentucky, because I used to be a member of the 
State legislature, as Medicaid has continued to consume more of the 
State budget, it becomes more difficult to adequately fund. Higher 
education tuition rates are going up directly because of the pie of 
Medicaid that's moving forward.
  We passed medical liability reform, which saves the Federal 
Government $54 billion, as estimated by the Congressional Budget 
Office. We are going to have the bill tomorrow to purchase health 
insurance across State lines to make health insurance more affordable 
instead of more expensive on those who spend money out of their own 
pocket, as we have seen the estimates for the health care bill.
  Now, the one thing about relying on funding for 1 year, we do 
appropriations for everything from defense to other things on an annual 
basis. And I will tell you there are not people turning down Federal 
money because you are only appropriating it for 1 year, we don't want 
to commit to a long-term program.
  But if you buy that argument, you look at what's in the bill. All we 
are saying is we want the teaching health centers to be treated equally 
to other parts of the bill. So if the argument is if you don't do it 
automatically, you are not going to have anybody participating in the 
program, which I think is what I just heard, then it means training in 
general in pediatric and public health dentistry, section 5303, is an 
annual appropriation; geriatric education and training, mental and 
behavioral health education training; nurse retention, section 5309; 
section 5316, family nurse practitioner training; section 2821, 
epidemiology laboratory capacity grants; research and treatment for 
pain care management, 4305; section 775 investment in tomorrow's 
pediatric health care workforce.
  I mean, obviously, the argument that was made was if we don't have 
the teaching health centers on a 5-year automatic appropriation, then 
people aren't going to participate in the program. That argument would 
have to apply to these directly. And I guarantee you, I would be 
willing to say, without fear of contradiction, that people will be 
applying for these programs as this moves forward.
  I reserve the balance of my time.
  Mr. GENE GREEN of Texas. Mr. Chairman, I yield 2 minutes to a 
classmate and also the vice chair of our Democratic Caucus, the 
gentleman from California (Mr. Becerra).
  Mr. BECERRA. I thank the gentleman from Texas for yielding me the 
time.
  Mr. Chairman, to put everything in perspective, we are told by the 
American Academy of Family Physicians that today, today we can foresee 
a shortage of some 40,000 primary care physicians in this country in 
less than 10 years. Within another 5 years, that shortage will grow to 
about 42,000 to 46,000 primary care physicians.
  Graduate medical education funds does something very simple. It says 
to some of these clinics, some of these health care providers, that if 
you guarantee that you will make graduate medical training available to 
our future doctors, then we will guarantee that there will be money 
behind that training so that there will be a consistency so that 
medical students can finish training.
  Well, we just heard that this money that's available to these health 
care providers, these clinics, should no longer be guaranteed. And so 
the question you have to ask, if you want to become a physician and you 
are going to medical training, and certainly the question you have to 
ask if you are one of these clinics throughout the entire country where 
you want to train someone to be a family medical doctor, an internist, 
a pediatrician, an obstetrician/gynecologist, a psychiatrist, a 
dentist, a pediatric dentist, someone who specializes in gerontology, 
you have to ask yourself, if I am going to try to train someone, but I 
don't have the resources to fully provide the education, how do I 
guarantee that medical student that I could be there with the funds to 
pay them for education, to pay them for the work they are going to be 
doing? You can't. And that's why GME is so important.
  But we were just told a second ago that this is a slush fund pot of 
money. Furthest thing from the truth. We are told the real truth, when 
we heard one of the speakers on the Republican side say we are going to 
delete this money--that's exactly what's going to happen, because if 
you don't guarantee it, it's gone.
  So, Mr. Chairman, the truth is we have to make sure we can train the 
next generation of medical leaders; and, therefore, I urge my 
colleagues to vote against this legislation.
  Mr. GUTHRIE. Mr. Chairman, I yield myself 1 minute.
  The merits of having training in general in pediatric and public 
health dentistry, I agree that we have to have that training. The issue 
here is if you do it in a teaching health center, then you guarantee 
funding for 5 years. If you do it in a children's hospital, if you do 
it in a regular hospital, profit or nonprofit, then you are subject to 
the annual appropriations.
  Someone came before our committee to testify, a State Senator from 
New Jersey, said we need this provision because we need more nurses.
  I will agree with that. However, this provision doesn't cover nurses. 
If you are going through a nurse training program, it's authorized in 
the bill, and you go through an annual appropriations process.
  All we are saying here is that we should treat graduate medical 
education at children's hospitals, hospitals and teaching health 
centers exactly the same and not give one an advantage over the other 
two.
  I reserve the balance of my time.
  Mr. GENE GREEN of Texas. Mr. Chairman, I yield myself 15 seconds.
  I will be glad to cosponsor the bill to make it mandatory funding for 
children's hospitals. I think if health care is a priority, we ought to 
do that.
  I reserve the balance of my time.
  Mr. GUTHRIE. Mr. Chairman, I have no further requests for time, and I 
reserve the balance of my time.
  Mr. GENE GREEN of Texas. Mr. Chairman, how much time remains on each 
side?
  The CHAIR. The gentleman from Texas has 19\1/4\ minutes remaining, 
and the gentleman from Kentucky has 18\1/2\ minutes remaining.
  Mr. GENE GREEN of Texas. I yield myself such time as I may consume.
  When Congress dealt with The Affordable Care Act last year and the 
year before, our subcommittee on Energy and Commerce spent exhaustive 
hearings, late-night hearings, we had markups overnight, and so we knew 
what we were doing. We knew we were going to make a priority in 
providing primary care for our country.
  That's why it's mandatory spending. I would assume in 2003, when we 
passed the provision for the prescription drug act for Medicare, my 
Republican colleagues did the same thing at the time in the majority: 
they wanted to make sure that that was mandatory spending.

                              {time}  1510

  And here we are today trying to take away mandatory spending from 
primary care physicians in community-based settings. I have a great 
example of this in our own district, and I know the chairman knows 
this.
  We have a community-based health center in Denver Harbor in east 
Harris County. They have had a partnership with the Baylor College of 
Medicine for a number of years, and what they have been able to do is 
provide those residencies to come out to a nonwealthy area of town so 
those doctors can learn that they can make a living serving folks that 
are not wealthy. That's what this is all about. We found out that the 
statistics showed that if they do their residency through a community-
based health center, they will actually be more likely to come back and 
serve those communities. And that's why there needs to be mandatory 
spending, Mr. Chairman.
  I reserve the balance of my time.
  Mr. GUTHRIE. Mr. Chairman, I yield 2 minutes to the gentleman from 
California (Mr. Bilbray).
  Mr. BILBRAY. Mr. Chairman, I wasn't planning on addressing this item, 
but I heard so many of my colleagues, especially those on the other 
side, talk about the crisis of providing the doctors that are going to 
be essential for health care, and finally we are talking about health 
care, not health care insurance.

[[Page H3365]]

  As somebody who spent 10 years supervising the safety net for a 
community of 3 million in San Diego County, I just wish my colleagues 
on the other side, when they're worried about pediatricians and primary 
health care people, would understand that if you really want to protect 
those providers, why don't we sit down and talk about true tort reform, 
especially for the pediatricians. This is a cost that is bearing down. 
And when you're asking young people to get an education to be a primary 
health care provider, especially a pediatrician, explain to them why 
somebody on public assistance, on welfare, has more right to sue their 
physician than those men and women who are serving in uniform.
  The fact is there is no way that we should be sitting up here saying 
that we really want the next generation to get into health care unless 
we're willing to tell our friends who are the trial lawyers that we're 
going to take the physicians off the counter; we're not going to allow 
lawsuits to be part of the overhead that is driving people out of the 
health care business.
  And I hope to say to both sides, if you really want to make sure 
there are future doctors, then let's have the bravery to stand up today 
and do something about the tort that those future doctors are looking 
at before they go into school.
  Mr. GENE GREEN of Texas. Mr. Chairman, I yield myself as much time as 
I may consume.
  My colleague from California must have this bill confused with 
medical malpractice. In fact, the State of California and the State of 
Texas already have medical malpractice reform. That's not what this 
bill is about. This bill is about training primary care physicians to 
be able to serve everyone. I want them to serve the military. I want 
them to serve our veterans.
  In fact, again, I have a VA hospital in Houston that has a 
cooperative arrangement with the Baylor College of Medicine for a 
residency program. That's great. I want them also to be able to do that 
in their clinics. But I also want it for community-based health 
centers. And our statistics show us that if we have that example and 
it's mandatory spending that they make these agreements, that those 
folks will come back. They may go back to a military clinic, they may 
come back to a community-based health center, or they may come back and 
open up their practice in an area that's not the wealthiest part of 
town. That's why this mandatory legislation is so important.
  If you put a priority on making sure our constituents can go see a 
doctor, I can't imagine repealing this--voting for this bill.
  I reserve the balance of my time.
  Mr. GUTHRIE. Mr. Chairman, I yield an additional 2 minutes to the 
gentleman from California (Mr. Bilbray).
  Mr. BILBRAY. Mr. Chairman, I want the gentleman from Texas to 
understand that when a physician or a student is planning on getting 
into a field, they not only look at will the government guarantee that 
I'll be able to get the tuition, but they're looking at what field am I 
moving into. And let me just tell you, as a fact, in California, even 
with our tort reform, somebody who wants to volunteer as a Medicaid 
volunteer has to file an $80,000 or $90,000 insurance policy just for 
volunteering.
  So when the gentleman talks about the educational side, that it's 
essential that we encourage people to get into the field, my point for 
being here is you cannot talk about the educational when you ignore the 
environment that you're asking them to go into. And the fact is: What 
parent would ask somebody to go into this field and be a physician with 
all the education and all the expenses when they can tell their kids to 
be a lawyer and sue those physicians for every cent they have ever been 
able to earn?
  That's why we've got to talk about both of these together. But you 
can't stand up and say we want these essential services but not be 
willing to get the trial lawyers off the backs of these physicians so 
they can provide those essential services.
  Mr. GENE GREEN of Texas. Will the gentleman yield?
  Mr. BILBRAY. I will yield to the gentleman.
  Mr. GENE GREEN of Texas. I thank the gentleman for yielding.
  Again, this is not a medical malpractice bill, but I would be glad to 
offer you to be a cosponsor. We passed the bill out of this House twice 
and sent it to the Senate which would allow volunteers to go into 
community-based health centers and be covered under the Federal Tort 
Claims Act. Congressman Murphy from Pennsylvania is a lead sponsor of 
this Congress. I've been the lead sponsor when Democrats have been in 
control because we need to do that. If I could do it under this bill, I 
would do it. But this came out of your conference that you want to 
repeal mandatory spending to try and train primary care doctors to 
serve in primary care clinics or whatever.
  Mr. BILBRAY. Reclaiming my time, look, the fact is these physicians 
are being held with a liability that is inappropriate, way over the 
head, and it is not justifiable----
  The Acting CHAIR (Mr. Fortenberry). The time of the gentleman has 
expired.
  Mr. GUTHRIE. I yield the gentleman 1 additional minute.
  Mr. BILBRAY. We're talking about the fact that those who want to 
stand up and say we'll spend Federal funds to create an environment to 
provide health care but then are not willing to say, not just the fact 
that we find special tort coverage--and I know that the gentleman from 
Texas knows because I was at a county level providing those services. 
We have Federal programs that protect those in the community clinic. 
But we're not just talking about the little bit of protection we get 
with our Federal protection. We're talking about the whole tort 
exposure needs to be considered.
  And if you want to talk about access and stand up here and have the 
moral high ground on access, you've got to be willing to take on the 
big guy, the powerful trial lawyers, and say, look, physicians are 
going to be held harmless from your lawsuits. We're going to find a 
reason to encourage young people to go to school not just by providing 
Federal subsidies to their tuition, but also telling them, once you get 
your degree, you'll be able to go into a field where you'll be able to 
practice your art of medicine without having somebody who has never had 
to make a life-and-death decision drag you before a judge and a jury 
and attack you for your decisions.
  Mr. GENE GREEN of Texas. Mr. Chairman, my colleague from California 
again is confused. We have H.R. 5 that the majority has to federalize 
medical malpractice insurance in our country. Some States have taken 
care of it. The State of Texas has done it by constitutional amendment. 
And that debate may come up if the majority brings up their H.R. 5.
  With that, Mr. Chairman, I yield 2 minutes to my colleague from New 
York, Congressman Tonko.
  Mr. TONKO. Mr. Chair, the underlying legislation guts funding for 
vital teaching health centers across the country. Teaching health 
centers are residency programs for primary care physicians. They 
provide community-based training for doctors who will go on to work in 
rural and our underserved areas.
  Mr. Chair, my amendment is very simple. It requires that we find out 
exactly how many primary care physicians we will lose if Republicans 
succeed in cutting teaching health centers across the country. My 
amendment commissions the Government Accountability Office to report on 
these findings so that the American people can see how drastically 
these cuts will eliminate jobs and hurt the quality, access, and 
affordability of primary care health options.
  I'm interested to know, Mr. Chair, if some of my Republican 
colleagues are aware that if H.R. 1216 is adopted, there will be fewer 
primary care doctors working in their communities. For example, this 
bill guts funding for 23 physicians at the teaching health center in 
the heart of Scranton, Pennsylvania. These 23 individuals are being 
trained to provide basic health care for constituents in the greater 
Scranton area. If my Republican colleague from the Scranton area joins 
the Republican leadership in eliminating this program, his community 
will lose training for 23 new primary care physicians. That's 23 jobs, 
jobs that they support, and 23 individuals who help serve constituents 
with their health care needs.

[[Page H3366]]

  Again, Mr. Chair, my amendment is a matter of effective oversight. It 
asks that we find out from a nonpartisan source exactly how many 
primary care physicians we will lose if the Republican leadership moves 
forward to cut teaching health centers across the country.
  Mr. GUTHRIE. Mr. Chair, I yield myself as much time as I may consume.
  I want to point out, as we went through, what we're talking about 
doing is graduate medical education in teaching health centers will be 
identical to the graduate medical education in hospitals and children's 
hospitals.
  And I remember, I was not on the Energy and Commerce Committee but in 
Education and Labor. We worked on the health care bill. And the 
description that we went in through the night and went through the bill 
line by line is absolutely true. I think we were 24 or 25 hours direct 
on that. And I wasn't on Energy and Commerce when you went, but they 
went through the night, as well, Mr. Chairman. And when this bill 
passed out of the House of Representatives, the teaching health centers 
were authorized subject to appropriation.

                              {time}  1520

  The change was made in the Senate. So working late into the night and 
going through the bill, we are just asking and what we are proposing is 
to treat teaching health centers as the House-passed version of the 
health care bill did, which is exactly the same as hospitals and 
children's hospitals and many of the other programs, nurse training and 
other things as well.
  I reserve the balance of my time.
  Mr. GENE GREEN of Texas. Mr. Chairman, I yield myself such time as I 
may consume.
  I have no problem with including children's hospitals , and I think 
we could probably pass it on the suspension calendar if we had 
legislation that would expand that mandatory funding for teaching 
hospitals, and particularly children's hospitals, but that is not what 
this legislation does today. It takes away that help we are providing 
to train more primary care physicians in our country. That is what this 
bill does: It takes away the mandatory funding.
  Now there have been examples all through history of mandatory 
funding. We realized during the Affordable Care Act that we need more 
primary care physicians. We need a lot more health care providers. We 
need more nurses. We need everything. In fact, it is a great job growth 
area. But we know we need primary health care providers because we know 
when somebody needs a doctor, they will see that primary care doctor. 
They may need a specialist, but they still need to go to that primary 
care doctor. That is why this mandatory funding is so important, and 
that is why this bill is the wrong way to deal with it. That is why it 
shouldn't be considered today. I would hope everybody would realize 
that if you support health care and primary care physicians, you would 
want that mandatory training so we can get those physicians out in the 
community where they are really needed.
  Numbers show that if we have a program like this where primary care 
physicians will go into a community based health care center, they will 
go into that area as part of their residency program, they are more 
likely to come back to that community. That is why that was part of the 
Health Care Act. We have people who their primary care physicians now 
are the emergency rooms in hospitals in my district. I would much 
rather they be able to go see a doctor down the street for their sinus 
infection than showing up at midnight in an emergency room where we are 
going to end up having to pay for it, even at a public hospital, where 
the local taxpayers are paying for it. That is why this mandatory 
spending is so important. And that is why I think it is so the wrong 
way to go in health care, to take away mandatory spending for primary 
care physicians. That is something that is so important in our country, 
it should be mandatory.
  I reserve the balance of my time.
  Mr. GUTHRIE. Mr. Chairman, I want to point out again, the mandatory 
spending was not in the House version of the health care bill that was 
passed. Teaching health centers were treated exactly like general 
pediatric and primary care physicians are in hospital settings and in 
children's hospital settings--general hospitals and children's 
hospitals. We are saying we are going back to the way it was 
established in the Affordable Care Act as it was passed out of the 
House of Representatives.
  We are talking about primary care physicians as well. I agree we need 
more primary care physicians. Their training at children's hospitals 
and hospitals is in geriatric, pediatric, internal medicine, all the 
primary care physician specialties that we know. We are just saying one 
shouldn't be treated differently than the other. They are important, 
and we should go through the annual appropriations process and present 
the validity of programs and let the appropriations process determine 
the level of funding.
  Mr. Chairman, I yield 4 minutes to the gentleman from Georgia (Mr. 
Gingrey).
  Mr. GINGREY of Georgia. I thank the gentleman from Kentucky for 
yielding me this time.
  As everyone knows, the financial health of this Nation is in a very 
precarious State. Unfortunately, it was made worse by the spending 
decisions and actions of this last Congress. Today, the Federal 
Government borrows 41 cents of every dollar it spends. We are facing a 
$1.6 trillion deficit for this fiscal year, the third straight year of 
trillion-dollar deficits, an all-time record in nominal terms and a new 
post-World War II record as a share of the economy.
  The reckless spending of the last Congress has only exacerbated this 
problem. The so-called stimulus bill--that didn't stimulate much 
besides a lot of wasteful spending--and ObamaCare, the Patient 
Protection and I think un-Affordable Care Act, are two such examples of 
legislation that spent recklessly.
  Mr. Chairman, among the 2,400 pages of ObamaCare, the last Congress 
created $105 billion in secret slush funds that can be used to advance 
the political goals of President Obama and his administration without 
our oversight, congressional oversight.
  At a time when our country is facing financial ruin, my concern is 
how much damage to our national budget the White House can do with 
these funding streams. The time for blank checks is over. The time for 
leadership is now.
  Section 5508 of ObamaCare provides a $230 million direct 
appropriation for teaching health centers residency programs. H.R. 1216 
would simply convert the direct appropriations into an authorization of 
appropriations. The legislation allows for teaching health centers to 
receive funding through the normal appropriations process with proper 
Congressional oversight.
  Mr. Chairman, many Members of this Congress have supported medical 
education--I certainly count myself among them--including graduate 
medical education for children's hospital programs. However, in her 
testimony before the House Energy and Commerce Health Subcommittee 
earlier this year, HHS Secretary Sebelius stated that the President's 
fiscal year 2012 budget eliminates children's hospital graduate medical 
education programs because they duplicate the teaching center funds in 
ObamaCare.
  Mr. Chairman, is this the future of medical education that we want 
for our children? Teaching our medical professionals in clinics that 
might not be equipped to properly train them to handle emergency 
situations versus in hospitals regarded as centers of excellence like 
Children's Healthcare of Atlanta in my own home State of Georgia. This 
is why the appropriations process is so important--we need 
congressional oversight to help decide what the priorities of tomorrow 
should be.
  This Congress, the 112th Congress--is focused on reining in spending 
and reducing our deficit. We cannot do the job of the American people 
and make the spending cuts necessary unless the legislative branch has 
oversight over Federal spending. If this is truly the people's House, 
give back what the last Congress gave away--control over the budget. If 
this body is sincere in its wishes to restore fiscal sanity in this 
country, I see no reason why this body should not be voting in a 
bipartisan manner to prevent this President--or any President, for that 
matter--from spending our Nation into insolvency.

[[Page H3367]]

  So I urge all of my colleagues to support H.R. 1216. I thank the 
gentleman from Kentucky for his bill and for yielding me this time.
  Mr. GENE GREEN of Texas. Mr. Chairman, I yield myself such time as I 
may consume.
  Let me correct some of the statements that have been made. We have 
had mandatory hospital training residency programs since 1965. By 
taking away direct or mandatory spending for community-based residency 
programs, it is a direct attack on community-based programs. Let me 
list for you the teaching hospital programs that are under mandatory 
that was part of the Affordable Care Act. I joked on the floor one 
night to my colleague from Georgia, I wish they would name it the Green 
Act, GreenCare instead of ObamaCare, because I am so proud of that law.
  The teaching hospital program supports the training of individuals 
who practice in family medicine, internal medicine, pediatrics, 
internal medicine pediatrics, obstetrics, gynecology, psychiatry, 
general dentistry, pediatric dentistry, or geriatrics. These are 
disciplines where we are experiencing significant physician shortages. 
That is why we need the mandatory spending. It does cover children.

                              {time}  1530

  Now, we have had mandatory spending for hospital training, again, 
since 1965. All this bill would do would be to take it away from 
community-based health centers where we know there is a shortage. The 
statistics show, if you have doctors who do their residencies or 
residency programs through community-based centers, they are more 
likely to go back there and practice, whether they be pediatricians, 
whether they be in family practice, whether they be in internal 
medicine. That's where we need the growth and to have primary care 
physicians. This is a direct attack on health care in our own country.
  Why wouldn't we want it mandatory for community-based facilities if 
it's already mandatory for hospital-trained physicians? We need 
physicians in the community, not just in the hospitals.
  Mr. Chairman, I yield back the balance of my time.
  Mr. GUTHRIE. Again, Mr. Chairman, it is important that we have an 
adequate supply of primary care physicians, and it is important public 
policy for this country. It is important that we also have oversight 
and control over the budget in the way the money is spent, and we do 
that through the appropriations process.
  I just want to point out, in the last Congress, there was great 
effort in putting together the health care bill. When we passed out of 
this Congress the House-passed version, this was an authorized 
``subject to appropriations'' section of the bill. I know it has been 
described as being against health care throughout the country, but that 
was the way, through much debate, it passed out of this House of 
Representatives. It treats it similarly to hospital-based education in 
primary care and to children's hospital-based. It puts it on an equal 
footing with nurses' programs, nurse practitioner programs and other 
programs, which we all agree have shortages. We need more people in 
those fields.
  I just want to reiterate that this does not eliminate the program. It 
authorizes it. It changes it from a direct appropriation to an 
authorized appropriation through the regular appropriations process.
  Mr. DINGELL. Mr. Chair, I rise today in strong opposition to H.R. 
1216. As a declining number of physicians in our Nation are entering 
into primary care fields, my colleagues on the other side of the aisle 
are working to pass legislation that will irresponsibly impede critical 
training of the next generation of primary care physicians.
  A primary care physician shortage is a very real and alarming problem 
looming before us. The Association of American Medical College's Center 
for Workforce Studies anticipates a shortage of 45,000 primary care 
physicians and a shortage of 46,000 surgeons and medical specialists in 
the next decade.
  Since 1965, the Medicare Graduate Medical Education program, which 
has been supported by mandatory funding, has trained the majority of 
resident trainees across the country in a hospital-based setting. The 
Teaching Health Center program is the first medical graduate program of 
its kind to allow future physicians in primary care fields to train in 
the actual setting they will be practicing in--community-based health 
centers.
  My colleagues claim that converting the Teaching Health Center 
program from a mandatory appropriation to an authorization--subject to 
the annual appropriations process--will not endanger the program. We 
saw during the debate on the fiscal year 2011 budget that could not be 
further from the truth.
  During that dreadful debate it became painstakingly clear that my 
colleagues know the cost of everything, but the value of nothing.
  Subjecting this program to the annual appropriations process will not 
allow for a predictable and stable funding stream needed to assist 
community-based health centers and resident trainees in planning and 
preparing for this training.
  We all recognize and agree with the need to reduce federal government 
spending, but making the Teaching Health Center program a pawn in the 
appropriations game is foolish at best.
  Further, I find it ironic that during debate in the Energy and 
Commerce Committee my colleagues expounded on their desires for more 
investment in our health workforce, yet at the first opportunity they 
are placing the Teaching Health Center program in the vulnerable 
position of future funding reductions.
  Mr. Chair, H.R. 1216 is another plan in the Republicans' repeal 
health reform platform. Passing this legislation will jeopardize 
funding for the Teaching Health Center program, further delaying the 
fundamental training needed for our primary care physicians.
  I urge my colleagues to stand up for the training of our primary care 
physicians and vote no against this reckless piece of legislation.
  Mrs. CHRISTENSEN. Mr. Chair, I rise today, fully disappointed that my 
colleagues on the other side of the aisle are trying to move forward 
with this bill. This bill has no merit; in fact, it is little more than 
a part of a larger, ill-conceived strategy to undermine the progress we 
have made and will likely continue to make as a result of the historic 
health care reform bill that was enacted last year.
  While on its face it seems harmless, we all know the reality of what 
this bill will do. And, it is crucial that the very individuals who 
elected us to represent them--the large majority of whom will be 
directly and indirectly affected by this and in a very negative way--
also know that this bill does nothing to ensure fiscal responsibility 
or improve the medical education system in health centers, and does 
even less to ensure that there are trained and qualified health care 
providers in their communities to serve their communities.
  In fact, it jeopardizes ongoing and forthcoming efforts to ensure 
that there are highly-trained and qualified health care providers 
practicing in every community--especially those that suffer due to a 
shortage of health care providers--across the country.
  If this bill were to pass and become law, then the already-planned 
primary care training programs that will be operated by community-based 
entities, like community health centers, will not likely continue 
beyond their first planned year because turning this program into a 
discretionary one offers no guarantee of future funding. Further, 
making this program discretionary will serve as a disincentive to other 
community-based entities that are considering launching similar 
graduate medical education programs for the same reasons.
  The unfortunate element in all of this is this: These programs train 
individuals who will practice in family medicine, internal medicine, 
pediatrics, obstetrics and gynecology, general dentistry and 
geriatrics--the very areas of medical care where the provider shortages 
are the greatest.
  Further, the individuals trained by these programs are very likely to 
serve most underserved communities--a disproportionate number of which 
are rural, low-income and/or racial and ethnic minority--across the 
Nation.
  Why, I must ask, would we want to end these programs, when provider 
shortages are not issues that affect only our side of the aisle; it is 
a public health crisis that touches every district across the Nation. 
In fact, during the health care reform debates, my friends on the other 
side of the aisle continually argued that there are not enough 
physicians in the country to meet our current primary health care needs 
and to address our current primary health care challenges. So, it seems 
counterintuitive to, then, seek to compromise and put an end to the 
very programs that were designed and funded to address this very 
problem.
  We have had and continue to have very serious health care challenges 
in this country, and our primary care workforce shortages fall into 
that category. All of these serious health care challenges warrant even 
more serious solutions--many of which are being implemented thanks to 
the Patient Protection and Affordable Care Act.
  However, this bill--H.R. 1216--is not a serious solution and, if 
passed, will only become a serious part of a serious problem.

[[Page H3368]]

  I, therefore, urge my colleagues to vote, ``no'' on this bill. And, 
in doing so, you will be voting yes for the improved and strengthened 
primary health care workforce across the Nation.
  Mr. BLUMENAUER. Mr. Chair, I rise in opposition to H.R. 1216, which 
rescinds funding for graduate medical education in qualified teaching 
health centers. The Affordable Care Act provides funding for the 
training of medical residents in qualifying health centers, which will 
strengthen the health care workforce and support an increased number of 
primary care medical residents trained in community-based settings 
across the country. This bill undermines that key objective and in so 
doing, undermines public health efforts, limits access to doctors in 
communities around the country, and weakens our medical workforce.
  Teaching health centers are community-based patient care centers that 
operate primary care residency programs, such as family medicine, 
internal medicine, pediatrics, and general and pediatric dentistry. 
Physicians trained in health centers are more than three times as 
likely to work in a health center and more than twice as likely to work 
in an underserved area than are those not trained at health centers.
  Oregon's community health centers--29 clinics offer care at more than 
150 delivery sites--provide high-quality, comprehensive health care to 
more than a quarter-million people across my state. Services range from 
medical and dental care to prescription medications to behavioral 
health care. Many centers also provide such support services as 
transportation and translation to ensure that everyone who needs 
healthcare can access it. This legislation, however, would undermine 
the ability of these centers to attract doctors and other health 
professionals so vital to providing community-based care.
  The Institute of Medicine reports that already there is a need for 
more than 16,000 new physicians in currently underserved areas. Unless 
we invest in medical education that closes this shortfall, it will 
worsen in future years. The Association of American Medical Colleges 
estimates that, by 2024, we will need 46,000 additional primary care 
physicians. This legislation makes it more difficult to close this gap.
  A recent study by Dartmouth investigators published in the Journal of 
the American Medical Association found that beneficiaries living in 
areas with better access to primary care physicians had lower mortality 
and fewer hospitalizations. By eliminating funding to train doctors in 
community-based settings, this legislation makes it less likely that 
patients in underserved areas will be able to see a doctor or to get 
the care that they need. This legislation will worsen health outcomes 
in underserved areas.
  Rather than making refinements to improve the Affordable Care Act, 
H.R. 1216 merely eliminates funding. It fails to advance the key 
objectives of the law to improve healthcare while lowering costs and it 
fails to offer alternative solutions to meet these important 
objectives. I oppose this legislation.
  Mr. GUTHRIE. I yield back the balance of my time.
  The Acting CHAIR. All time for general debate has expired.
  Pursuant to the rule, the bill shall be considered read for amendment 
under the 5-minute rule.
  The text of the bill is as follows:

                               H.R. 1216

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

     SECTION 1. CONVERTING FUNDING FOR GRADUATE MEDICAL EDUCATION 
                   IN QUALIFIED TEACHING HEALTH CENTERS FROM 
                   DIRECT APPROPRIATIONS TO AN AUTHORIZATION OF 
                   APPROPRIATIONS.

       (a) In General.--Section 340H of the Public Health Service 
     Act (42 U.S.C. 256h), as added by section 5508(c) of the 
     Patient Protection and Affordable Care Act (Public Law 111-
     148), is amended--
       (1) in subsection (b)(2)(A), by striking ``under subsection 
     (g)'' each place it appears and inserting ``pursuant to 
     subsection (g)'';
       (2) in subsection (d)(2)(B), by striking ``in subsection 
     (g)'' and inserting ``pursuant to subsection (g)''; and
       (3) by amending subsection (g) to read as follows:
       ``(g) Authorization of Appropriations.--To carry out this 
     section, there are authorized to be appropriated $46,000,000 
     for each of fiscal years 2012 through 2015.''.
       (b) Rescission of Unobligated Funds.--Of the amounts made 
     available by such section 340H (42 U.S.C. 256h), the 
     unobligated balance is rescinded.
       (c) Technical Correction.--The second subpart XI of part D 
     of title III of the Public Health Service Act (42 U.S.C. 
     256i), as added by section 10333 of the Patient Protection 
     and Affordable Care Act (Public Law 111-148), is amended--
       (1) by redesignating subpart XI as subpart XII; and
       (2) by redesignating section 340H of the Public Health 
     Service Act (42 U.S.C. 256i) as section 340I.

  The Acting CHAIR. No amendment to the bill shall be in order except 
those received for printing in the portion of the Congressional Record 
designated for that purpose in a daily issue dated May 23, 2011, and 
except pro forma amendments for the purpose of debate. Each amendment 
so received may be offered only by the Member who caused it to be 
printed or a designee and shall be considered read.


                  Amendment No. 2 Offered by Mr. Tonko

  Mr. TONKO. Mr. Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 4, after line 12, add the following:
       (d) GAO Study on Impact on Number of Primary Care 
     Physicians to Be Trained.--The Comptroller General of the 
     United States shall conduct a study to determine--
       (1) the impacts that expanding existing and establishing 
     new approved graduate medical residency training programs 
     under section 340H of the Public Health Service Act (42 
     U.S.C. 256h), using the funding appropriated by subsection 
     (g) of such section, as in effect on the day before the date 
     of the enactment of this Act, would have on the number of 
     primary care physicians that would be trained if such funding 
     were not repealed, rescinded, and made subject to the 
     availability of subsequent appropriations by subsections (a) 
     and (b) of this section; and
       (2) the amount by which such number of primary care 
     physicians that would be trained will decrease as a result of 
     the enactment of subsections (a) and (b).

  The Acting CHAIR. The gentleman from New York is recognized for 5 
minutes.
  Mr. TONKO. Mr. Chair, my friends on the other side of the aisle seem 
steadfast and determined in their attack on access to affordable, 
quality health care. Couple that with their plan to end Medicare, and 
our Nation's seniors are put in quite a bind. Meanwhile, they want to 
place our health in the hands of Wall Street and Big Insurance, not 
between doctors and their patients. The seniors in my district and 
across the country know that vouchers will not cover their health care 
needs. They see the tax breaks for millionaires and billionaires and 
handouts for Big Oil, and are vehemently opposed to this plan.
  Today, we have yet another assault on affordable access to health 
care. My Republican colleagues have found their next boogeyman: family 
practice physicians. This is surprising as we have a dire shortage of 
primary care physicians in our country.
  The American Association of Medical Colleges has estimated that an 
additional 45,000 primary care physicians are required by 2020 just to 
meet America's health care needs. A few short months ago, both sides of 
the aisle agreed on the need to build our Nation's primary care 
workforce. This is a proven way to bend the health care cost curve by 
decreasing health spending through prevention and early, simple 
treatment.
  Unfortunately, Republicans have since changed their tune. They have 
declared that the problem is not that we have a shortage of these 
crucial doctors. Instead, they must believe we have too many primary 
care physicians, and so we face this call to eliminate training for 
those on the front lines of the fight for quality care.
  The underlying legislation guts funding for vital teaching health 
centers across our country. Teaching health centers are residency 
programs for primary care physicians, providing community-based 
training for doctors who will go on to work in rural and in our 
underserved areas. From Medicare to high gas prices to tax rates, my 
friends on the other side have proposed time and time again policies 
that put middle class Americans on the line and let Wall Street, Big 
Oil and Big Insurance take over and earn big. The constituents in my 
home district, in the Capital Region of New York State, need a break. 
They are looking at the price of gas, at the price of food and at the 
price of prescription drugs, and are just wondering how they will make 
it through the month.
  Do we need to balance the budget? Yes. Do we need to balance the 
budget on the backs of hardworking Americans who play by the rules? 
Absolutely not.
  Mr. Chair, my amendment is very simple. It requires that we find out 
exactly how many primary care physicians we will lose if Republicans 
succeed in cutting teaching health centers

[[Page H3369]]

across the country. My amendment commissions the Government 
Accountability Office to report on these findings so that the American 
people can see how drastically these cuts will eliminate jobs and will 
hurt the quality, access and affordability of primary care health 
options.
  I am interested to know, Mr. Chair, if some of my Republican 
colleagues are aware that, if H.R. 1216 is adopted, there will be fewer 
primary care doctors working in their communities. For example, this 
bill cuts funding for 23 physicians at the teaching health center in 
the heart of Scranton, Pennsylvania. These 23 individuals are being 
trained to provide basic health care for constituents in the greater 
Scranton area.
  If my Republican colleague from the Scranton area joins the 
Republican leadership in eliminating this program, his community will 
lose training for 23 new primary care physicians. That's 23 jobs, the 
many jobs they support and 23 individuals who will serve constituents 
in need.
  Mr. Chair, if my colleague from Pennsylvania would like to come to 
the floor to defend the rights of the teaching health center in 
Scranton against this shortsighted and unjust attack by the Republican 
leadership, I would gladly yield him time.
  The same challenge is faced by my colleague from the Billings, 
Montana, area, whose district will lose funding to train seven primary 
care physicians specifically for the health care needs of rural 
Montanans. In Idaho, Illinois, Texas, and Washington, it's the same 
story. All of these communities are seeing good American jobs put at 
risk--and for what?--to fund handouts to insurance and oil companies? 
to pay for even more tax breaks to millionaires, billionaires and some 
of the wealthiest corporations on Earth?
  I would gladly yield my Republican colleagues from these districts 
time to defend their constituents.
  Again, Mr. Chair, my amendment is a matter of effective oversight. It 
asks that we find out from a nonpartisan source exactly how many 
primary care physicians we will lose if the Republican leadership moves 
forward to cut teaching health centers across our country.
  When it comes to ensuring our constituents have access to basic 
primary health care, when it comes to protecting Medicare and Social 
Security for our seniors and to ensuring they have healthy and 
comfortable retirements, there should be no disagreement.
  Please join me in supporting this amendment and in standing with 
middle class Americans across the country.
  With that, I yield back the balance of my time.
  Mr. GUTHRIE. Mr. Chairman, I rise in opposition to the amendment.
  The Acting CHAIR (Mr. Campbell). The gentleman from Kentucky is 
recognized for 5 minutes.
  Mr. GUTHRIE. Mr. Chairman, first, I want to point out the list that 
was read of teaching health centers.
  The text of the bill is very clear: that we only rescind unobligated 
funding. If the funding has been obligated, then it continues to move 
forward. So, as to the list that was read, those will be funded.
  The amendment before us directs the GAO to determine the number of 
physicians who will be trained by this program if funds are not kept 
mandatory. I oppose the general premise that a program must have 
mandatory funding in order to be effective. This type of thinking has 
led us to massive budget deficits as far as the eye can see.
  During the debate on the continuing resolution, I can remember more 
than a few Members complaining that reductions in discretionary 
spending would have little impact on the deficit. There is some truth 
to the fact that discretionary spending which Congress has more control 
over comprises an increasingly smaller share of the Federal budget.

                              {time}  1540

  It seems to me that some people's solutions to reining in the 
discretionary ledger of our Federal budget is to simply shift programs 
from discretionary to mandatory and let the spending cruise on auto 
pilot. That is not responsible governing. In a time of $1.5 trillion 
annual deficits, we must make spending priorities. However, setting 
priorities involves tough choices. The people that oppose this bill do 
so because they are unwilling to make the tough choices on what 
programs the Federal Government should fund and what they should not.
  So let's review what happened. Certain programs for training were 
made mandatory in the health care act and others were subject to future 
appropriations. Listening to the debate today, it is apparent that some 
believe any provision in the health care act that authorized a program 
subject to appropriations is essentially meaningless and did nothing at 
all. I have heard Members extol the virtues of dental education 
programs or training for nurse education contained in the health care 
act, but they are subject to further appropriations.
  Where was the amendment to the health reform bill that asked GAO to 
look into how the lack of mandatory spending in section 5305 of the 
health care act would affect geriatric education? There wasn't one, and 
not a single Member of the other side brought the issue up. The reason 
the other side didn't bring it up is because the programs were 
constructed in a way to go through the normal authorization and 
appropriations process. The underlying bill simply puts teaching health 
centers on equal footing with a myriad of other programs.
  I also oppose the amendment because it is a waste of Federal 
resources. We are asking the GAO to conduct a study that is almost 
impossible for it to complete. The GAO cannot determine the number of 
physicians that will be trained because so much of the program is under 
the discretion of the Secretary. In fact, the contours of the program 
have not yet even been set. The Health Resources and Services 
Administration does not even anticipate issuing a Notice of Proposed 
Rulemaking on the Teaching Health Center Graduate Medical Education 
Program until December.
  Under my bill, supporters of the program will continue to be able to 
make the case on an annual basis that the program is not duplicative, 
it is effective, and warrants continued funding over other programs 
like children's hospitals which the President's budget zeroed out.
  I urge my colleagues to vote ``no.''
  I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from New York (Mr. Tonko).
  The question was taken; and the Acting Chair announced that the noes 
appeared to have it.
  Mr. TONKO. Mr. Chairman, I demand a recorded vote.
  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further 
proceedings on the amendment offered by the gentleman from New York 
will be postponed.


                 Amendment No. 9 Offered by Mr. Cardoza

  Mr. CARDOZA. Mr. Chairman, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 4, after line 12, add the following:
       (d) GAO Study and Report on Physician Shortage.--The 
     Comptroller General of the United States shall conduct a 
     study to determine--
       (1) the impact that expanding existing and establishing new 
     approved graduate medical residency training programs under 
     section 340H of the Public Health Service Act (42 U.S.C. 
     256h), using the funding appropriated by subsection (g) of 
     such section, as in effect on the day before the date of the 
     enactment of this Act, would have on the number of physicians 
     that would be trained if such funding were not rescinded and 
     made subject to the availability of subsequent appropriations 
     by subsections (a) and (b) of this section; and
       (2) the impact that the enactment of subsections (a) and 
     (b) will have on the number of physicians who will be trained 
     under approved graduate medical residency training programs 
     pursuant to such section 340H.

  The Acting CHAIR. The gentleman from California is recognized for 5 
minutes.
  Mr. CARDOZA. Mr. Chairman, I rise today to offer an amendment that 
would require the GAO to conduct a study that highlights the impact 
that elimination of funding would have on the number of physicians that 
would be trained if this program were allowed to continue as intended.
  Countless studies have demonstrated a serious and growing shortage of 
health professionals facing the United States--most critically a 
shortage of primary care physicians and dentists. However, where I come 
from, there is a

[[Page H3370]]

shortage of specialties as well. With an existing shortage well 
established and an aging population increasing, our country desperately 
needs investments in the health care workforce, not rescissions.
  In my home State of California alone there are 567 designated health 
professional shortage areas, which include a population of more than 
3.8 million medically underserved individuals. In California's San 
Joaquin Valley, there are already fewer than 87 primary care physicians 
for 100,000 patients of population. The doctor/patient ratio in my 
region is not getting better; it is getting significantly worse. That 
is why I have consistently advocated for the need to improve access to 
care and address this vital shortage.
  All eight counties in the San Joaquin Valley have been designated as 
medically underserved by the Department of Health and Human Services, 
including Merced, Stanislaus, San Joaquin, Madera, and Fresno Counties. 
At one point a few years ago, we were down to one pediatrician for the 
entire county of Merced. With the passage of the Affordable Care Act, 
we were able to include additional funding for these medical residency 
programs to help address the mounting health care profession shortage 
in already established underserved areas.
  The new Teaching Health Centers Graduate Medical Education Program is 
intended to be an investment that helps struggling underserved 
communities deal with the reality of increasing demands on an already 
strained health care system. Studies have shown that the most effective 
way to attract and retain new doctors in underserved areas is to allow 
medical students to complete their medical residency programs in the 
communities that are in need. Graduating physicians most often practice 
in the communities where they have completed their residency training, 
which is why this program is uniquely important. My wife is a perfect 
case in point, a primary care physician who stayed in our community and 
practiced for 18 years after she finished the program.
  Without these critical investments, the lack of care will most 
certainly have a costly price on the health and well-being of many 
rural underserved communities, including those I represent.
  Mr. Chairman, I yield back the balance of my time.
  Mr. GUTHRIE. Mr. Chairman, I move to strike the last word.
  The Acting CHAIR. The gentleman from Kentucky is recognized for 5 
minutes.
  Mr. GUTHRIE. Mr. Chairman, this amendment is very similar to the 
previous amendment we discussed, so I will be brief.
  One, as I said before, it is difficult for the Government 
Accountability Office--almost impossible for them--to perform this 
study moving forward because there is so much discretion that is given 
to the Health and Human Services Secretary. And as I said before, the 
Health Resources and Service Administration does not even anticipate 
issuing a Notice of Proposed Rulemaking on teaching health graduate 
centers until December.
  And then again, as a lot of the comments today, I don't think that 
moving an authorized and mandatory spending program to an authorized 
and discretionary spending program renders that program meaningless. If 
it does do that, then all the other programs that I have listed earlier 
in the debate--training in general hospitals, training in children's 
hospitals, training in behavioral education and health, training in 
nurse retention, training in nurse practitioners--that means that those 
programs that were in the health care act would not have as much 
strength as well. And so the comment that by moving this from one part 
of the budget to the other makes it meaningless, to me, is just not 
accurate.
  And, second, I also want to stress again that the language of the 
bill is clear: we do not rescind obligated funds; it is only 
unobligated funds. So again, it wasn't my friend from California, but 
someone earlier mentioned that there were programs that have already 
been in place that would be hurt by that. If the funds have been 
obligated, those programs move forward.
  Mr. Chairman, I yield back the balance of my time.
  Mr. GENE GREEN of Texas. Mr. Chairman, I move to strike the last 
word.
  The Acting CHAIR. The gentleman is recognized for 5 minutes.
  Mr. GENE GREEN of Texas. Mr. Chairman and Members, I know there has 
been talk only about obligated money. I would like to introduce into 
the Record a press release issued on January 25 of this year from 
Health and Human Services announcing the new Teaching Health Center 
Graduate Medical Education Program. And of those programs, it lists the 
ones; and that money is obligated, but there will be no future funding 
for them. So you get a few months of funding, but you don't get any 
more funding.
  These centers--six of them are in Republican districts, five in 
Democratic districts--will get a very short 3 months' worth of funding 
if this bill becomes law. And it doesn't do any good. The graduate 
medical education pays for the training of that physician. These 
community centers will only receive a short term funding. So it may 
only be talking about that obligated money, but they won't get any more 
after this year if this bill becomes law. That's why it is so important 
that this bill be defeated or that we adopt an amendment similar to our 
colleague from California.

 HHS Announces New Teaching Health Centers Graduate Medical Education 
                                Program


    Eleven centers will support primary care residency training in 
                        community-based settings

       HHS Secretary Kathleen Sebelius today announced the 
     designation of 11 new Teaching Health Centers in the Teaching 
     Health Center Graduate Medical Education program, a 5-year 
     program that will support an increased number of primary care 
     medical and dental residents trained in community-based 
     settings across the country. These Teaching Health Centers 
     will be supported by funds made available through the 
     Affordable Care Act and will help address the need to train 
     primary care physicians and dentists in our nation's 
     communities.
       With the funds, these Teaching Health Centers can seek 
     additional primary care residents through the National 
     Resident Matching program this month and will train 50 
     additional resident full-time equivalents beginning in July 
     2011. While 3 months of funding totaling $1,900,000 is being 
     awarded this first program year, in future years the annual 
     funding will increase to cover the full-year costs, as well 
     as additional residents. These investments provide an 
     important platform for expanding the primary care workforce 
     and creating more opportunities to prepare physicians to 
     practice primary care in community-based settings, while 
     ensuring primary care services are available to our nation's 
     most underserved communities.
       ``The Teaching Health Center program is an integral part of 
     our mission to strengthen the nation's primary care workforce 
     and ensure that all Americans have adequate access to care,'' 
     said Secretary Sebelius.
       The new Teaching Health Centers are distributed around the 
     nation and will train residents in family medicine, internal 
     medicine, and general dentistry. Teaching Health Centers will 
     receive up to 5 years of ongoing support for the costs 
     associated with training primary care physicians and 
     dentists. HHS' Health Resources and Services Administration 
     (HRSA) will administer the program.
       ``Participating in this program not only provides top-notch 
     training to primary care medical and dental residents, but 
     also motivates them to practice in underserved areas after 
     graduation,'' said HRSA Administrator Mary Wakefield, Ph.D., 
     R.N.
       Eligible Teaching Health Centers are community-based 
     ambulatory patient care centers that operate a primary care 
     residency program, including federally-qualified health 
     centers; community mental health centers; rural health 
     clinics; health centers operated by the Indian Health 
     Service, an Indian tribe or tribal organization; and entities 
     receiving funds under Title X of the Public Health Service 
     Act.
       For additional information, visit Teaching Health Centers.

                                           2011 TEACHING HEALTH CENTERS
----------------------------------------------------------------------------------------------------------------
               Organization                            City                        State                Award
----------------------------------------------------------------------------------------------------------------
Valley Consortium for Medical Education..  Modesto....................  Calif......................     $625,000
Family Residency of Idaho................  Boise......................  Idaho......................       37,500
Northwestern McGaw Erie Family Health      Chicago....................  III........................      300,000
 Center.

[[Page H3371]]

 
Penobscot Community Health Center........  Bangor.....................  Maine......................      150,000
Greater Lawrence Family Health Center....  Lawrence...................  Mass.......................      112,500
Montana Family Medicine Residency........  Billings...................  Mont.......................       37,500
Institute for Family Health..............  New York...................  N.Y........................      150,000
Wright Center for Graduate Medical         Scranton...................  Pa.........................      225,000
 Education.
Lone Star Community Health Center........  Conroe.....................  Texas......................       37,500
Community Health of Central Washington...  Yakima.....................  Wash.......................       75,000
Community Health Systems.................  Beckley....................  W. Va......................      150,000
                                          ----------------------------------------------------------------------
    Total................................  ...........................  ...........................    1,900,000
----------------------------------------------------------------------------------------------------------------

  Mr. ELLISON. Mr. Chairman, I move to strike the last word.
  The Acting CHAIR. The gentleman from Minnesota is recognized for 5 
minutes.
  Mr. ELLISON. Mr. Chairman, I rise in opposition to this underlying 
bill.
  As the Senate votes this week on the Republican scheme to end 
Medicare, I am standing up to protect health care for our seniors. Our 
seniors, they blazed the trail for all of us. They fought the wars, 
they've earned the money, they've come and made America a great place; 
and we have inherited what they've done. We have inherited what our 
senior citizens have made for us. And now we see our Republican 
colleagues want to end Medicare for these same seniors. To spend nearly 
$1 trillion on handouts to millionaires not only harms American 
seniors, but threatens our economic future.

                              {time}  1550

  Medicare guarantees a healthy and secure retirement for Americans who 
pay into it their whole lives, Mr. Chairman. It represents the basic 
American values of fairness, decency and respect for our seniors that 
all Americans should cherish.
  Last month, our Republican colleagues voted to end Medicare as we 
know it. According to the Congressional Budget Office--and, Mr. 
Chairman, that's the office that is bipartisan and calls it straight as 
they see it--this plan, this Republican plan, would raise seniors' 
health care costs by more than $6,000 a year--that's a lot of money, 
Mr. Chairman--more than doubling their costs. Instead of fulfilling a 
promise to our seniors, a promise that the people who gave everything 
for us would have something in their golden years, the plan would bring 
about a corporate takeover of our health care. Insurance company 
bureaucrats would be able to deny seniors care that they had paid into 
for their entire lives. The GOP plan no longer guarantees seniors the 
same level of benefits and choice of a doctor that they have today 
under Medicare.
  Mr. Chairman, this debate is not about the deficit. Only if it were. 
This debate is about something else, and it is about whether we are 
going to meet the promises of our seniors, of our children, of our 
students, of our public employees, or not. It's a choice of whether 
we're going to put America to work or not. It's a basic choice about 
how we're going to live together.
  Mr. Chairman, this debate is not about a deficit. And as my fellow 
colleagues pound on this idea that we're broke, we're not broke. What 
we are is unwilling to do the basics for people who have given America 
so much. This debate is not about a deficit, because we can reduce the 
deficit by putting America back to work. Two-thirds of American 
corporations don't pay any taxes, including General Electric, Bank of 
America, and others. If we ask people to just do their fair share, 
America's not broke.
  By siding with insurance industry lobbyists to raise Medicare costs 
only increases the burden on our seniors while doing nothing to address 
the deficit. As I said, this is not about the deficit.
  Raising taxes for 95 percent of Americans to pay for a trillion-
dollar tax cut for CEOs who ship American jobs overseas sides with the 
rich at the expense of the middle class.
  Spending billions on handouts for corporate special interests, 
including $40 billion on Big Oil, only drives up prices at the pump for 
families who are already hurting the most.
  The Progressive Caucus, Mr. Chair, has a plan that puts people's 
priorities first. Our budget, which we call ``The People's Budget,'' 
strengthens Medicare and Social Security. It lets Medicare negotiate 
cheaper drug prices so insurance company bureaucrats can't deny you the 
medication you need. And it creates jobs by eliminating the deficit by 
2021. That's right. The Progressive Caucus eliminates the deficit. That 
is the fiscally responsible budget. That's a budget that Americans can 
get behind. Not some budget that rewards the rich at the expense of 
everybody else and doesn't do anything to end the deficit.
  I'll not stand for a vision of America that throws American seniors 
under the bus. We have a vision of honoring our seniors, honoring those 
people, the Greatest Generation, the generation that brought us civil 
rights, women's rights, human rights, the generation that brought us 
Medicare. We are in a generational fight, Mr. Chairman, and generations 
in the future will look back on us and ask us why did we let the 
Republican Caucus take away the basic promises of America, and we will 
be able to stand now and say, We didn't. We fought them back and we 
fought for America where everybody does better because everybody does 
better, including our seniors.
  I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from California (Mr. Cardoza).
  The question was taken; and the Acting Chair announced that the noes 
appeared to have it.
  Mr. CARDOZA. Mr. Chairman, I demand a recorded vote.
  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further 
proceedings on the amendment offered by the gentleman from California 
will be postponed.


                  Amendment No. 7 Offered by Ms. Foxx

  Ms. FOXX. Mr. Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 4, after line 12, add the following:
       (d) Prohibition Against Abortion.--Section 340H of the 
     Public Health Service Act (42 U.S.C. 256h) is amended by 
     adding at the end the following new subsection:
       ``(k) Prohibition Against Abortion.--
       ``(1) None of the funds made available pursuant to 
     subsection (g) shall be used to provide any abortion or 
     training in the provision of abortions.
       ``(2) Paragraph (1) shall not apply to an abortion--
       ``(A) if the pregnancy is the result of an act of rape or 
     incest; or
       ``(B) in the case where a woman suffers from a physical 
     disorder, physical injury, or physical illness, that would, 
     as certified by a physician, place the woman in danger of 
     death unless an abortion is performed including a life 
     endangering physical condition caused by or arising from the 
     pregnancy itself.
       ``(3) None of the funds made available pursuant to 
     subsection (g) may be provided to a qualified teaching health 
     center if such center subjects any institutional or 
     individual health care entity to discrimination on the basis 
     that the health care entity does not provide, pay for, 
     provide coverage of, or refer for abortions.
       ``(4) In this subsection, the term `health care entity' 
     includes an individual physician or other health care 
     professional, a hospital, a provider-sponsored organization, 
     a health maintenance organization, a health insurance plan, 
     or any other kind of health care facility, organization, or 
     plan.''.

  The Acting CHAIR. The gentlewoman from North Carolina is recognized 
for 5 minutes.
  Ms. FOXX. Thank you, Mr. Chairman.
  My amendment is designed to protect life and the livelihood of those 
who defend it.
  Since 1973, approximately 50 million children have been aborted in 
the United States. This is a tragedy. According to a CNN poll last 
month, more than 60 percent of Americans oppose taxpayer funding for 
abortion. This number includes many of my constituents and is 
consistent with my strong

[[Page H3372]]

pro-life convictions. I am offering my amendment today to ensure that 
their hard-earned money will not be used to pay for elective abortions 
or given to organizations that discriminate against pro-life health 
care providers.
  Earlier this month, the House passed H.R. 3, the No Taxpayer Funding 
for Abortion Act, which codifies many longstanding pro-life provisions 
and ensures that taxpayer money is not being used to perform elective 
abortions. H.R. 3 is now awaiting consideration in the Senate, but I 
will not cease to fight to protect the unborn children in America at 
every turn.
  This amendment ensures that the grants being provided to teaching 
health centers are not being used to perform elective abortions and 
makes it crystal clear that taxpayer money is not being used to train 
health care providers to perform abortion procedures.
  Mr. Chair, when the liberal Democrats rammed through their government 
takeover of health care, in an unprecedented fashion, they refused to 
include longstanding pro-life provisions. With this bill, House 
Republicans are seeking to restore a grant program for residency 
programs to the regular appropriations process, and my amendment 
explicitly and permanently ensures that should the appropriations 
committee fund this program, taxpayer money will not be used to pay for 
elective abortions or train abortion providers.
  In addition to the need for a permanent prohibition of taxpayer 
funding for elective abortions, it is also important that scarce 
resources are allocated to the most worthy applicants. An applicant 
that demands that individuals and institutions provide or refer for 
abortions is simply not the kind of applicant that should be funded 
under this program. Numerous doctors, nurses and other health care 
providers refuse to perform or participate in abortions because they 
believe it is wrong to kill a child. Congress should ensure that these 
individuals are not discriminated against because of their beliefs. Any 
form of discrimination is abhorrent, and individuals should not be 
forced to act against their convictions. This amendment is similar to 
previous efforts to protect pro-life health care providers and is 
consistent with these efforts.
  To be eligible for funding under this grant program, centers have to 
agree that they will not discriminate against pro-life health care 
providers.
  My colleagues across the aisle may argue that we already have the 
Hyde amendment that prohibits taxpayer funding for elective abortion 
for programs that are included in the Labor, Health and Human Services 
and Education appropriations legislation. However, this amendment must 
be included every year. My amendment ends the uncertainty for this 
program by providing a permanent prohibition on taxpayer funded 
elective abortions and protects pro-life health care providers. Until 
we have a permanent prohibition on taxpayer funding of elective 
abortion and protections for health care providers who cherish life, I 
will continue to offer and support efforts to support taxpayers, 
families and children from the scourge of abortion.
  The unborn are the most innocent and vulnerable members of our 
society and their right to life must be protected. Therefore, I urge my 
colleagues to vote in favor of this amendment.
  Mr. Chairman, I yield back the balance of my time.
  Ms. DeGETTE. Mr. Chairman, I rise in opposition to the amendment.
  The Acting CHAIR. The gentlewoman from Colorado is recognized for 5 
minutes.
  Ms. DeGETTE. Thank you, Mr. Chairman.
  Well, here we are again, forced to stand up again to protecting 
women's health care against an extreme agenda. I disagree with the 
whole underlying bill, Mr. Chairman, but even so, even so, how one 
could tie restricting a woman's right to choose to graduate medical 
education is sort of beyond me.

                              {time}  1600

  Let me explain why this is just an extreme and direct attack on 
women's health.
  What it would mean is that across the country residents would be 
barred from learning how to perform even a basic medical procedure 
required for women's health. This amendment would jeopardize both 
education and women's health care by obliterating funding for a 
necessary full range of medical training by health care professionals.
  And here's the thing. The Hyde amendment is the law of the land right 
now. I don't like the Hyde amendment. I would repeal the Hyde 
amendment. But frankly, the Hyde amendment has been in place for over 
30 years, and it's not going away. And what it says is no Federal funds 
shall be used for abortions except in the case of rape, incest, or the 
life of the mother.
  Now, there is nothing in the Hyde amendment about restricting medical 
doctors' training to legal medical procedures. There's nothing about 
graduate medical education in the Hyde amendment whatsoever. And if we 
pass this amendment, we will not allow basic medical training that 
would even allow doctors to provide the procedures that are allowed 
under the Hyde amendment--life, rape, or incest.
  And let me talk about why this is so incredibly dangerous for women's 
health.
  Ensuring that doctors and nurses are fully trained in abortion 
procedures is essential to ensuring that they can be providing 
lifesaving care when abortion is a medically necessary procedure to 
save the life of a pregnant woman.
  Now, most pregnancies, thank goodness, progress safely. But sometimes 
there's an emergency. And sometimes a medical abortion is necessary to 
protect a woman's health or life. For example, Mr. Chairman, in cases 
of preeclampsia, hemorrhage, and severe pulmonary hypertension, or 
bleeding placenta previa, which can be fatal if left untreated, an 
abortion is a life-saving procedure. In addition, in managing a 
miscarriage, sometimes an abortion procedure is essential to saving the 
woman's life.
  Now, under this amendment, virtually any type of health care facility 
could face the loss of funding if they needed to provide abortion care 
in an emergency situation. And moreover, Mr. Chairman, residents need 
to be trained in how to handle these very complicated conditions that 
could necessitate an abortion.
  I'm afraid to say these examples are tragically real. The case 
involving a woman experiencing severe hypertension that threatened her 
life at St. Joseph's Hospital made the news when a nun, Sister McBride, 
was excommunicated last year for allowing the woman's life to be saved 
through an abortion.
  The Foxx amendment would also greatly expand the reasons why health 
care entities should give in to refusing care.
  So, Mr. Chairman, here's the thing. Maybe we don't like abortions, 
and all of us wish abortions would be rare. But sadly, even in the case 
of a wanted child with a loving home and everything else, even in the 
case of an exception under the Hyde amendment, sometimes abortions are 
necessary. And if we say we are not going to train doctors how to 
provide a range of women's health care services, then we are basically 
allowing women to bleed to death in the emergency rooms of this 
country. And I don't think that's what this Congress is about. It is 
certainly not what the medical profession is about.
  I would urge just for reasons of mercy for this House to reject this 
amendment. It's mean-spirited and it's far, far beyond current law.
  With that, Mr. Chairman, I yield back the balance of my time.
  Mr. GARAMENDI. Mr. Chair, I move to strike the last word.
  The Acting CHAIR. The gentleman from California is recognized for 5 
minutes.
  Mr. GARAMENDI. Mr. Chairman, I find myself in opposition to the 
underlying bill and the amendment.
  You just heard a very cogent argument. I don't understand why we 
ought to have ignorant doctors. It doesn't make any sense to me. 
Abortions are sometimes necessary for saving the life of a pregnant 
woman. And to have a medical system in which the doctors don't know 
about that procedure is really stupid. I won't say this amendment is 
that, but it's really not wise to have ignorant physicians. And it's 
really not wise not to have physicians at all.
  What in the world are we thinking here? What's the purpose of this

[[Page H3373]]

amendment and this particular resolution? To deny American men, women, 
and children the opportunity to go to a doctor? We know all across this 
Nation that there is a shortage of primary care physicians. In most 
every community of California, there is a shortage of primary care 
physicians. Plenty of dermatologists, but not primary care physicians.
  So what are we going to do here? Eliminate the funding to train 
primary care physicians.
  Now, that in itself is bad enough. But this is just one piece of a 
much larger plan to dismantle health care in America. The repeal of the 
Affordable Health Care Act will increase the cost of medical services 
all across this Nation and particularly increase the cost to 
government. Not my projection. The independent Congressional Budget 
Office said clearly that the Affordable Health Care Act will reduce the 
cost of Medicare and Medicaid.
  So repeal it. Increase the deficit. Huh? Is that what this is all 
about? I don't get it guys and women. Makes no sense to me.
  And now in your budget, the Republicans go after Medicare and 
terminate Medicare for every American who is not yet over 55 years of 
age? Terminate it. And turn it over to the rapacious, greedy, profit-
before-people health insurance industry, an industry that I know a 
great deal about. I was the insurance commissioner in California for 8 
years, and I know those characters. It is about profit. It's not about 
caring for people.
  And when you say the government shouldn't make decisions, the 
government does not make decisions in Medicare. The physicians make 
decisions. But if you turn Medicare over to the insurance companies, it 
will be the insurance companies that make decisions about medical 
services.
  And by the way, you also voted to repeal those sections of the 
Affordable Health Care Act that protect all of us from the 
rapaciousness of the health insurance industry. Eliminating a law which 
eliminates such things as preexisting conditions, age, sex 
discrimination, and the rest. So you repeal that and give back to the 
insurance companies the opportunity to discriminate. And now you want 
to throw tomorrow's seniors into that same pool of sharks.
  I don't get it. It makes no sense whatsoever. It perhaps is the worst 
idea I've heard in the 35 years I have been involved in public health 
and in public policy. It makes no sense whatsoever.
  And this bill on top of it? Come on. We're not going to train primary 
care physicians? What in the world are you thinking? I don't get it. I 
don't get the whole strategy. It is a strategy that will put America's 
health at risk. It is a strategy that will deny benefits. It is a 
strategy that will provide us, with this latest amendment, doctors that 
are ignorant about basic women's health. And it is a strategy that will 
deny us the necessary primary care physicians.
  What in the world are my Republican colleagues doing here about the 
deficit? Come on now. What you're doing is going to increase the 
deficit. You're going to increase the deficit. If there are not primary 
care physicians, then you'll go to the emergency room. And everybody 
knows that the emergency room is more expensive than a doctor's office.
  What are you doing? I don't get it, guys. I don't understand. You're 
worried about the deficit; yet you take action that increases the 
deficit? It makes no sense to me.
  Madam Chair, I yield back the balance of my time.
  Mr. GENE GREEN of Texas. Madam Chair, I move to strike the last word.
  The Acting CHAIR (Mrs. Capito). The gentleman is recognized for 5 
minutes.
  Mr. GENE GREEN of Texas. First of all, I have utmost respect for 
Congresswoman Foxx of North Carolina. But her amendment is a solution 
in search of a problem. Graduate medical education does not do 
abortions.

                              {time}  1610

  The teaching hospital center program funds training for primary care 
residents. There is no payment for services in the law. It's about 
salaries, benefits, and paying faculty. Teaching health centers will 
pay for abortions no more than Medicare Graduate Medical Education has 
paid for abortions for the last 45 years.
  The President signed the executive order to make all the provisions 
subject to the Hyde amendment, all the provisions of the Affordable 
Care Act subject to the Hyde amendment. The executive order establishes 
a set of policies for all provisions of the Affordable Care Act to 
``ensure Federal funds are not used for abortion services'' consistent 
with the Hyde amendment. The Presidential order reinforces what we all 
agree on. No one is here claiming that we should use Federal funds for 
abortion, except in very limited circumstances, whether they are under 
this program or elsewhere.
  There is another layer of protection codified in permanent law under 
section 245 of the Public Health Service Act. The Coats amendment 
clearly prohibits the Federal Government from discriminating against 
any physician, post-graduate physician training program, or participant 
in a program of training in the health care professions because the 
entity refuses to participate in abortion training. That's not an 
appropriations vehicle; it's not an executive order. It's the law of 
the land.
  That's why I say this amendment is a solution in search of a problem. 
There is not a problem with Graduate Medical Education, whether they be 
teaching hospitals, whether they be community-based centers that this 
bill is subject to.
  I yield back the balance of my time.
  Mrs. CAPPS. Madam Chair, I move to strike the last word.
  The Acting CHAIR. The gentlewoman from California is recognized for 5 
minutes.
  Mrs. CAPPS. I rise in strong opposition to this dangerous amendment.
  Last month, the Republican majority brought us to the brink of 
government shutdown over its disapproval of Planned Parenthood. But 
here we are again, a new week, but the same obsession with reopening 
the culture wars. This time, instead of saying that Congress knows 
better than a woman and her family about her reproductive health care, 
this amendment takes one step further. It says that Congress knows 
better than our medical doctors and medical educators about what our 
medical training curricula should look like. This is an unprecedented 
restriction, one that goes against the Accreditation Council for 
Graduate Medical Education's guidance and against medical ethics 
themselves.
  Medical education is supposed to prepare our future doctors for 
whatever they may come across in their practice. This includes women 
whose lives are in danger due to their pregnancy, for whom terminating 
a pregnancy is the only way that woman will stay alive. Keeping future 
providers from learning these procedures--and it is an option that they 
may choose only if they choose to learn it--puts these women at risk. 
Regardless of what one's views are on women's reproductive rights, I 
think we can all agree that our future medical providers should be 
trained and ready for any medical emergency that they might encounter. 
To play politics with their education and the lives of women is an 
embarrassment.
  Madam Chair, it is time for this Congress to learn to trust the 
American people, to trust our doctors, to trust our families, and to 
trust women.

                                          The American Congress of


                              Obstetricians and Gynecologists,

                                     Washington, DC, May 24, 2011.

              ACOG Opposes the Foxx Amendment to H.R. 1216

       The American Congress of Obstetricians and Gynecologists 
     (ACOG), representing 55,000 ob-gyns and partners in women's 
     health, opposes the Foxx amendment to H.R. 1216, an amendment 
     to the Public Health Service Act.
       The Foxx amendment would disallow GME funding for abortion 
     training, part of ob-gyn educational curricula in accredited 
     medical residency programs, and unnecessarily duplicate 
     already recognized protections for medical students and 
     teaching hospitals who choose to not participate in abortion 
     training.
       Residency education standards are set by the universally 
     recognized Accreditation Council for Graduate Medical 
     Education (ACGME) whose Residency Review Committees (RRCs) 
     accredit residency programs. These standards, supported by 
     the American College of Obstetricians and Gynecologists, 
     require that ``experience with induced abortion must be part 
     of residency training.''
       These standards already fully accommodate institutions, 
     programs, and individuals

[[Page H3374]]

     who choose not to participate in abortions or abortion 
     training. Every ob-gyn residency program may opt out of 
     providing in-house training, and is required only to offer 
     their residents an opportunity for abortion training at an 
     outside facility. Similarly, residents with religious or 
     moral objections may opt out of receiving abortion training, 
     and are required only to be trained in management of abortion 
     complications--not the provision of abortion, but the care of 
     potential consequent medical complications.
       Training in abortion, for those institutions, programs, and 
     individuals who choose to participate, is important to 
     women's health. Federal funds may be used for abortions in 
     cases of rape, incest, or when a woman's life is endangered. 
     Girls and women who are victims of rape or incest, or whose 
     lives are endangered by their pregnancies, must have 
     continued access to this surgical procedure, and this care 
     must be safely provided by trained medical specialists.
       The Nation's women's health physicians urge a no-vote on 
     the Foxx amendment. Should you have any questions, please 
     contact Nevena Minor, ACOG Government Affairs Manager, at 
     nminor@acog.org or 202-314-2322.

  I yield back the balance of my time.
  Mr. TONKO. Madam Chair, I move to strike the last word.
  The Acting CHAIR. The gentleman from New York is recognized for 5 
minutes.
  Mr. TONKO. Madam Chair, I rise in opposition to H.R. 1216, the 
underlying bill. As a resident of upstate New York, where much 
attention has been given to today's special election for a 
congressional seat, people are saying loud and clear, Hands off my 
Medicare.
  Republicans are determined again to put us on the road to ruin with 
their plans to end Medicare. Despite outcries from their constituents, 
they are pushing forward to end a program that 46 million seniors and 
disabled individuals depend on for their health care. This gross 
injustice is made immeasurably more egregious and offensive by the fact 
that this is being done not to balance the budget, but to expand and 
permanently guarantee even bigger tax cuts for millionaires and 
billionaires, and to give new tax breaks to some of the world's most 
profitable companies, including oil.
  I have heard a lot of talk in the last few months about the need to 
make tough choices these days. The average senior on Medicare earns 
just over $19,000 a year. About one quarter of Medicare beneficiaries 
suffer from a cognitive or mental impairment, and most have at least 
one or more chronic medical conditions. So I ask my Republican 
colleagues, what exactly is it about stripping these Americans bare of 
their health and economic security that qualifies as tough? There is 
nothing tough about stealing from the poor or the weak to give to the 
rich.
  Our seniors, on the other hand, know all about tough choices: Do I 
buy groceries, or do I buy prescriptions? Do I pay rent, or do I pay 
medical bills? It hurts, but how much will it cost? These are those 
tough choices. These are life and death choices. With the passage of 
Medicare in 1965, we entered into a covenant with each and every 
American citizen.
  The Republican voucher plan ends Medicare. Instead, seniors will be 
on their own with a measly voucher and forced to buy insurance in the 
private market, where all decisions will be profit-driven. More profits 
for insurance companies on the backs of seniors. Sounds like a 
Republican plan to me. This new voucher program amounts to a ration 
card. The value of the voucher is not linked to increases in health 
care costs in the private market, yet the costs of private health 
insurance have risen over 5,000 percent since the creation of 
Medicare--5,000 percent.
  The analysis of the nonpartisan Congressional Budget Office has 
estimated that in less than 20 years these vouchers would pay just 32 
cents on every dollar that a senior would spend on health care 
premiums. Now, the Republican leadership has repeatedly stated that 
this budget gives seniors the same coverage as Members of Congress. 
Well, as a Member of Congress myself, I know that our health plans pay 
for about 72 cents on every dollar of health coverage, not 32 cents.
  America knows that legislation in Congress carries a statement of 
priorities and values, not purely dollars and cents. And what sense 
does it make to cut funding for training primary care physicians who 
are on the front lines not only of keeping our constituents and 
communities healthy, but also of lowering health care costs with early, 
simple treatments?
  I urge my colleagues to stand with our seniors and stand up for 
middle class priorities. Let's defend our middle class. Let's defend 
our working families. I urge my colleagues to oppose this bill.
  Madam Chair, I yield back the balance of my time.
  Ms. TSONGAS. Madam Chair, I move to strike the last word.
  The Acting CHAIR. The gentlewoman from Massachusetts is recognized 
for 5 minutes.
  Ms. TSONGAS. Madam Chair, I rise in opposition to the underlying 
bill, H.R. 1216, and to the ongoing efforts by my colleagues across the 
aisle to undermine our constituents' access to affordable health care.
  I recently heard from my constituent from Haverhill, Massachusetts, 
named Phil Gelinas, who relies on Medicare for his health coverage. His 
wife's diabetes treatment and prescription drugs are also covered 
through Medicare, and they have both paid into Medicare all their lives 
through payroll deductions. He remarked to my office that there was no 
way that they could meet the cost of health care today without 
Medicare.
  He and his wife are not alone. Each day, thousands of seniors like 
the Gelinases use Medicare to cover the costs of doctors' appointments, 
prescription drugs, as well as routine tests and treatments.
  Under the budget that House Republicans passed in April and that the 
Senate is set to consider this week, the Medicare program that seniors 
have relied on for more than 50 years to meet their medical needs and 
expenses would be eliminated. In its place would be a voucher system 
that pays a small lump sum to private insurers to cover seniors. Any 
costs not covered by that payment would fall to seniors to pay or 
forego coverage.
  My colleagues on the other side of the aisle argue that elimination 
of Medicare is needed to help reduce the deficit, and that the same 
benefits that seniors now enjoy under Medicare will be replicated in 
the private insurance market. Not so. In reality, their plan will 
result in a far lower standard of care for seniors, while trillions of 
dollars continue to be added to the national debt. Rather than taking 
steps to reduce the underlying increases in health care costs, which in 
turn drive up the cost of Medicare, their plan simply shifts those 
costs to seniors.
  The value of the vouchers that would replace Medicare would not keep 
pace with rising health care costs, so seniors will be increasingly 
required to make up the difference. Just 8 years after the program 
starts, a voucher will cover less than one-third of the cost of a 
private health insurance package with the same benefits as Medicare 
currently provides, leaving seniors to cover the rest.

                              {time}  1620

  According to the nonpartisan Congressional Budget Office, the average 
senior will end up spending nearly twice as much of their income on 
health care than under the current Medicare system. That is why AARP 
released a statement warning that the budget ``would result in a large 
cost shift to future and current retirees. The Republican proposal, 
rather than tackling skyrocketing health care costs, would simply shift 
those costs onto the backs of people in Medicare.''
  Instead of focusing on cost control measures that would bring down 
the cost of Medicare, the budget claims cost savings but only by 
passing those costs directly on to our seniors.
  Furthermore, because costs have typically grown faster in the private 
market than in Medicare, the costs faced by seniors under the 
Republican plan will be much higher than the costs faced by the Federal 
Government now.
  My colleagues have argued that seniors won't be affected by these 
costs for years to come, but this is simply not true. For example, the 
House budget immediately reopens the prescription drug doughnut hole 
for current seniors that was fixed with passage of last year's health 
reform law. It also significantly increases costs for seniors now 
residing in nursing homes and for their adult children who may not be 
able to afford their parents' care.
  Despite being presented as a solution for our deficits, the budget 
proposal

[[Page H3375]]

would still add $8 trillion to the national debt over the next 10 
years. These new debts are incurred in part because their budget 
proposal also slashes taxes for the wealthiest Americans while 
continuing to provide billions in tax breaks for oil companies and 
other preferred industries.
  Real deficit reduction will require a blend of spending reductions, 
new revenue, and additional reforms to control rising health care 
costs. But simply shifting those costs onto seniors by eliminating 
Medicare will prove as unsustainable for our Nation's well-being as the 
current budget crisis we face.
  Mr. DAVIS of Illinois. Madam Chair, I move to strike the last word.
  The Acting CHAIR. The gentleman is recognized for 5 minutes.
  Mr. DAVIS of Illinois. Madam Chairman, I rise in opposition to the 
Foxx amendment and to the underlying bill, H.R. 1216, to amend the 
Public Health Service Act, to convert funding for graduate medical 
education in qualified teaching health centers from direct 
appropriations to an authorization of appropriations.
  This bill would eliminate mandatory funding that establishes new or 
expanding programs for medical residents in teaching health centers and 
unobligated funds previously appropriated to the grant program.
  Under policies currently being considered by some in the House 
majority, academic medical centers and teaching hospitals face as much 
as $60 billion in cuts over the next 10 years to Medicare funding for 
indirect medical education and direct graduate medical education. These 
cuts would reduce indirect medical education payments by 60 percent 
from the current level of 5.5 percent to 2.2 percent, capping direct 
graduate medical education payments at 120 percent of the national 
average salary paid to residents.
  It would reduce Federal funding for medical residency training, as 
wrong public policy. Given our present situation with the shortage of 
primary care and family practice physicians, and the expected future 
growth of our population, it makes no sense for the Republicans to end 
the present structure of Medicare. In 2010, 47.5 million people were 
covered by Medicare. We have 39.6 million at the age of 65 and older 
and 7.9 million disabled.
  The Republican budget plan is a voucher plan that would raise health 
care costs and would immediately create higher costs for prescription 
drugs for our seniors and disabled. This plan would end Medicare's 
entitlement of guaranteed benefits and promote rationing by private 
insurance companies, who would make decisions on approving or 
disapproving treatments for our seniors and the disabled.
  The Medicare program is efficiently managed, devoting less than 2 
percent of its funding to administrative expenses. Medicare has 
dramatically improved the quality of life for seniors and the disabled. 
It is the largest source of health coverage in the Nation. Democrats 
are committed to strengthening Medicare, not tearing it down.
  Under the guise of reform, Republicans desire to end Medicare as we 
know it today.
  Last year, the Republicans promised the American people that jobs 
would be their number one priority. Well, I ask, where are the jobs? 
But, instead, they want to make draconian cuts to programs to help 
seniors and the disabled, the middle class, the poor and the needy, and 
yet provide tax cuts of over $1 trillion to millionaires and 
billionaires.
  And so we ask, where are the jobs and where are the opportunities? 
The estimated 1-year impact of anticipated graduate medical education 
cuts for Illinois is $144 million for indirect medical education and 
$39 million for graduate and medical education, which totals $183 
million. If there are no doctors, there can be no medical care.
  I urge that we vote against these measures.
  Ms. WATERS. Madam Chair, I move to strike the last word.
  The Acting CHAIR. The gentlewoman from California is recognized for 5 
minutes.
  Ms. WATERS. I rise in opposition to the underlying bill, H.R. 1216, 
which would undermine the teaching health centers program, which trains 
primary care physicians.
  Madam Chairman and members, this is just one more trick by 
Republicans to dismantle health care reform. They are going after the 
training of primary doctors. We need more primary doctors, even if 
there was no health care reform. There are many communities throughout 
this country that have no primary health care physicians.
  Our Nation is facing a serious shortage of primary care physicians. 
Primary care physicians are an essential part of a successful health 
care system. They are the first point of contact for people of all ages 
who need basic health care services, whether they are working people 
with the employer-provided health insurance, low-income children on 
Medicaid, or seniors on Medicare.
  The Republicans have made it clear that they are not concerned about 
access to basic health care services. The Republican budget for fiscal 
year 2012 turns Medicare into a voucher program, slashes Medicaid by 
more than $700 billion over the next decade, and cancels the expansion 
of health insurance coverage, which was included in the The Affordable 
Care Act last year.
  The Republican budget cuts to Medicare are especially detrimental to 
current and future Medicare recipients. Under the Republican budget, 
individuals who are 54 and younger will not get government-paid 
Medicare benefits like their parents and grandparents. Instead, they 
will receive a voucher-like payment to purchase health insurance from a 
private insurance company.
  There will be no oversight to these private programs. We will not be 
able to contain the cost. We will not be able to mandate what the basic 
services should be. As a matter of fact, we know the stories about the 
HMOs and the fact that they had accountants who determined what care 
you could get, not physicians who had the knowledge and the ability to 
determine what you need.
  When the first of these seniors retire in 2022, they will receive an 
average of $8,000 to buy a private insurance plan. That is much less 
than the amount of the subsidy Members of Congress receive for our 
health plans today.
  The coverage gap in the Medicare prescription drug program will 
continue indefinitely. Under the Affordable Care Act, this so-called 
doughnut hole is scheduled to be phased out. The Republican budget will 
allow seniors to continue to pay exorbitant prices for their 
prescriptions when they reach the doughnut hole. The Republican budget 
also gradually increases the age of eligibility for Medicare from 65 to 
67 years of age.
  Madam Chairman, the Republican budget is also detrimental to 
Americans who depend again on Medicaid, including low-income children, 
disabled Americans, and seniors in nursing homes. The budget converts 
Medicaid into a block grant program and allows States to reduce 
benefits, cut payments to doctors, even freeze enrollment. Medicaid 
funding is slashed by more than $700 billion over the next decade.

                              {time}  1630

  That is over one-third of the program's funding.
  Meanwhile, the Republican budget extends the Bush-era tax cuts beyond 
their expiration in 2012 and cuts the top individual tax rate down to 
25 percent from 35 percent. According to the Center for Tax Justice, 
the Republican budget cuts taxes for the richest 1 percent of Americans 
by 15 percent while raising taxes for the lowest income 20 percent of 
Americans by 12 percent.
  The national shortage of primary care doctors is not a problem for 
multimillionaires. They will always be able to find a doctor who will 
treat them and pay them whatever they ask for. But most American 
seniors need well-trained primary care physicians and Medicare benefits 
that they can rely on.
  I urge my colleagues to oppose the underlying bill, oppose the 
drastic cuts to Medicaid, and oppose the Republican plan to dismantle 
Medicare. They're trying to dismantle health care reform piece by 
piece, inch by inch. Today it's an attack on training needed by primary 
care physicians. What is it tomorrow?
  We know that they have a strategy that includes hundreds of bills 
that would dismantle, again, piece by piece Medicare reform. It's not 
fair, Madam Chair and Members. Health care reform

[[Page H3376]]

so that all Americans are covered is something that we should all 
support.
  Ms. WOOLSEY. Madam Chair, I move to strike the last word.
  The Acting CHAIR. The gentlewoman from California is recognized for 5 
minutes.
  Ms. WOOLSEY. Madam Chair, I rise in opposition to this amendment and 
the underlying bill, H.R. 1216.
  This is just the last attempt, the latest and newest attempt, by the 
majority to stall health care reform and undermine the health security 
of the American people. We had barely taken our oaths in January when 
they voted to repeal the Affordable Care Act; now trying to eliminate 
title X funding that provides critical primary care for women, and last 
month they went after the funding for the health care exchanges, and 
they voted to cut grants for school-based health centers that served 
young children.
  But worst of all is the Republican budget resolution that was passed 
last month. It rips the heart out of Medicare, eviscerates and 
disfigures a program that would no longer be recognized. It's one of 
the more radical proposals I've seen during 18 years in Congress. They 
want to strip guaranteed benefits and break the Medicare promise that 
has served our seniors so well for nearly half a century.
  And what do they replace it with? A voucher. A voucher that won't be 
able to keep up with soaring health care costs, a voucher that will 
give seniors no leverage in the health care marketplace, a voucher that 
will put older Americans at the mercy of the insurance companies.
  Madam Chairwoman, the CBO has concluded that the Republican proposal 
will double health care costs for seniors. So if you are 54 years old 
today, you will need to save an additional $182,000 to make up for the 
Medicare benefits you will lose under the Republican plan.
  And they are not content to destroy Medicare. Medicaid comes in for 
brutal treatment as well. By converting it to a block grant, they would 
be throwing as many as 44 million Americans off the insurance rolls, 
eliminating coverage for the poorest people, most nursing home 
residents and people with disabilities.
  My friends on the other side of the aisle who say we have to do this 
to balance the budget, they know they're wrong. I say they're dead 
wrong. We do not need to put seniors and low-income Americans on an 
austerity program in order to rein in the deficit. We do not need to 
shred the social safety net or to squeeze the middle class in order to 
get our fiscal house in order. In fact, we can save taxpayers $68 
billion over 7 years and expand the menu of health care choices by 
instituting a public option. If you ask the American people, they would 
rather see some shared sacrifice than cutting spending. They would 
rather see us eliminate tax breaks for CEOs who have no idea what it's 
like to choose between taking their medication or eating their next 
meal.
  Madam Chairwoman, I will vote ``no'' on H.R. 1216. It's just another 
example of Republican negligence and callousness on health care. They 
clearly prefer the broken system that leaves millions uninsured, 
imposing crippling costs that bankrupt families and bankrupt small 
businesses. The majority doesn't want to solve the health care crisis. 
They want to exacerbate it.
  Ms. RICHARDSON. Madam Chair, I move to strike the last word.
  The Acting CHAIR. The gentlewoman from California is recognized for 5 
minutes.
  Ms. RICHARDSON. I rise to speak in opposition to H.R. 1216.
  Under the guise of deficit reduction, Republicans, through H.R. 1216, 
are attempting to attack our Nation's vital support system for our 
seniors. The Republican budget would deny seniors, and those who are 
coming forward after those that are currently taking advantage of these 
benefits, health care, long-term care, and the Social Security benefits 
that these seniors have earned.
  Sunday evening, I just got back from my district where I had an 
opportunity to have our annual senior briefing, and there were over 900 
seniors who were there and they were concerned. I spoke with several of 
my seniors in my district, and they're worried about how they and even 
some of their parents who are in their nineties today will be able to 
get by once RyanCare--which is what I'm going to call it, the attack on 
Medicare--destroys something we all need. By following RyanCare and 
turning Medicare into a voucher program, Republicans would gradually 
eliminate the peace of mind that many of our seniors have grown to be 
able to count on.
  We don't want to go back to the old days of calling seniors ``poor'' 
and not having an opportunity to live in dignity in the last years. 
These fixed value vouchers, which are being suggested in RyanCare, 
would not only not keep up with the rising costs of health care, but it 
would cost seniors an additional $7,000 more per year by 2020.
  In California alone, which is where I'm from, under the Republican 
budget, seniors would pay $214 million more on prescription drugs in 
2012 alone. That's next year.
  The Republican budget would return our country to a time when being 
old was something that people would be afraid of, not look forward to.
  The Republican budget would also turn Medicaid into a block grant 
system. Haven't we seen what that's done with community development 
block grants? It wouldn't work. Under a block grant system, Medicaid 
would no longer be able to support the elderly. By converting the 
current Medicaid system into a block grant index to inflation and 
population growth, Congress would shift the burdens of rising health 
care costs and aging populations to the States. All you have to do is 
look at the Los Angeles Times to see what's happening to my State, and 
I don't think we'd be able to help the seniors.
  The deficit must be addressed. In fact, I've supported many bills and 
amendments that have been brought forward on the other side. But it 
should be done in a fair way. We should not balance the budget on the 
backs of our Nation's seniors, not after Wall Street and our car 
manufacturers got a bailout.
  I will, and Democrats will, continue to work to protect, strengthen, 
and save Social Security, Medicare, and Medicaid.
  Ms. EDWARDS. Madam Chair, I move to strike the last word.
  The Acting CHAIR. The gentlewoman from Maryland is recognized for 5 
minutes.
  Ms. EDWARDS. I rise in opposition to the underlying bill.
  Madam Chair, Republicans have returned to the Hill after a hard week 
at work in our districts really trying to explain away the plan to 
dismantle Medicare to their constituents. But I want to tell it to you 
really straight, Madam Chair, and that is that the reason that it's 
hard to explain is because there really is no explanation. The plan 
that Republicans have under consideration would indeed end Medicare as 
we know it. It would end Medicare, and it's just that simple. The plan 
would turn Medicare into a voucher system that would leave seniors 
paying more and more out of their pockets for health care.
  I was out at a town hall meeting at a senior center in my 
congressional district. It's one where people have gone--they come from 
every level of the private sector and business--to enjoy their 
retirement. And they receive Medicare benefits. And I asked them, who 
in this room, a room of about 100 or so seniors, how many of you would 
like to go into negotiations with an insurance company about how much 
you're going to pay for your health care? And no surprise, not a single 
one of those seniors stood up. But that's exactly what the Ryan plan, 
the Medicare dismantling plan, would do for seniors. It would say to 
seniors, we want you to go on your own and negotiate with the big 
insurance companies.

                              {time}  1640

  Well, we know that that can happen for those of us who are younger, 
but it certainly cannot happen for our seniors. It would shift the 
burden on to retirees to make the system much less efficient and 
increase administrative costs that are eventually passed on to all 
consumers.
  According to the Congressional Budget Office, the Republican plan 
would raise the eligibility age for beneficiaries from 65 to 67. And it 
repeals provisions of the Affordable Care Act that are actually 
designed to make the system even more efficient. This just

[[Page H3377]]

doesn't make sense. I think seniors have caught on. In fact, I think 
all Americans have caught on.
  The thing about Medicare is it is not just about our seniors, Madam 
Chair. It is also about the contract that each of us, one generation, 
makes to the next generation. It is the contract that I have made with 
my mother and my son makes with me, and it is to make sure that we are 
taken care of in our old age because we have paid into it and we have 
paid for it.
  According to the Center for Economic and Policy Research, a 54-year-
old worker would need to save an additional $182,000 to pay for the 
higher cost of private insurance with the government elimination of 
Medicare; $182,000, let's just absorb that for all of those 54 year 
olds. How long is it going to take you to get to age 65 and save 
$182,000 to pay for your health care costs? Well, we know that that 
would be an impossibility.
  I want to tell you what is happening in Maryland because it will 
happen all across this country. It is that our seniors are recognizing 
that the GOP plan would require seniors to pay an additional $6,800 out 
of their own pockets for expenses for health care, and that is not 
including the fact that they will have to negotiate and probably pay 
even more than that.
  So at a time when our seniors are vulnerable and they are struggling 
and they have seen a depletion in their savings, it is really not fair 
to threaten them and to threaten their quality of life by ensuring that 
they are going to have to pay these out-of-pocket costs.
  So I would ask us, Madam Chair, to really examine what it is that we 
are asking the American people to absorb.
  I was up with a group of seniors in New Hampshire, and throughout my 
congressional district; and our seniors are saying to us, It is not 
just about us, and don't count on us supporting this plan just because 
we happen to be over age 55. We support Medicare because we understand 
what it means for future generations.
  So this is a link, a bond between the young people in this country 
who are working, our seniors and our retirees, to protect Medicare and 
to protect the benefits that come with it.
  I would ask us on this underlying bill--I think some of my colleagues 
have spoken to this--we need more primary care. Already we are seeing 
what is happening in our system where 26 year olds, up to 26 year olds, 
can be covered on their parents' health insurance. Do you know what 
that is doing? It is actually bringing down the cost. It is making sure 
that we have more resources to absorb the care that people need as they 
get older.
  And so let's not stomach a dismantling of the Medicare protection 
that we have known for 46 years in this country, this contract from one 
generation to the next generation, to ensure that our seniors who have 
worked so hard are able to enjoy their retirement without sacrificing 
everything that they have to pay the cost for additional benefits while 
health insurance companies walk away with record profits, and certainly 
while oil and gas companies walk away with theirs.
  Mr. GUTHRIE. Madam Chair, I move to strike the last word.
  The Acting CHAIR. The gentleman from Kentucky is recognized for 5 
minutes.
  Mr. GUTHRIE. I rise in support of the Foxx amendment. We have been 
debating the bill throughout the day, and I support the bill.
  I just want to comment, I was also back home last week, and I went to 
a 100th birthday party for a group of people in northern Kentucky in 
the Louisville area and part of my district who were turning 100 years 
old. There was a lady there who was 103. She was born during Teddy 
Roosevelt's Presidency. I went there to thank them. I am one who is a 
big believer in what the Greatest Generation has done for us. I am a 
member of the baby boom generation. I was born in 1964. I am 47 years 
old. From 1946 to 1964, if you were born in 1946, you are in Medicare 
this year; you are 65 years old. I wanted to thank them and let them 
know that what we are doing is making a sustained and secure Medicare 
system for them.
  We all know as of the end of last week that 2024 is the date put out 
that Medicare goes bankrupt. So what we have put together is a real 
proposal for 10 years to allow people the opportunity to adjust that 
are 54 and younger because there is not a member of the Greatest 
Generation--and if anybody says different they are wrong--there is not 
a member of the Greatest Generation that is affected. As a matter of 
fact, half the baby boomers are covered, are not affected by the 
changes that we have to make to make a secure and better future.
  I am 47 years old. This means a lot to me because my daughter is 17. 
And you ask a lot of people my age: Do we have a better life-style than 
our parents had? Well, the Greatest Generation gave us a better life-
style than they had because they wanted us to have a better life-style 
than they had. You ask a lot of people my age: Do we think our children 
will have a better life-style? It is amazing and it is disappointing to 
think how many people think that our children are not going to have the 
same quality of life that we had.
  I didn't come to Washington, D.C. to be part of a government that 
doesn't address the fact that we want our children to have a better 
future than we had. In 30 years when my daughter is my age--she 
graduates from high school in 2 weeks--we can pay off the national 
debt.
  So think about it. I am 47 years old. We have got a $14.3 trillion 
debt. You ask a lot of people my age: Do you think our children will 
have a better future? A lot of people say ``no'' because they say we 
keep piling on debt and deficits as far as the eye can see.
  Madam Chair, if you ask me now if I thought my daughter at 47 years 
old is living in a country with zero national debt, do you think my 
children, grandchildren and her grandchildren will have a better 
future, they will. That is what we are talking about. We are talking 
about saving and securing Medicare for the Greatest Generation. We are 
talking about saving and securing it for people as they become older 
and more mature.
  So anybody that says the Greatest Generation is affected by this is 
just not saying what was passed out of the House of Representatives. If 
anybody is saying that seniors are affected by this, they are not 
saying what was passed out of the House of Representatives. To say that 
we have to reform the program to make it stronger and better for them, 
that is accurate. And making it stronger and better for those who come 
forward, that is what we are talking about doing. That is what the 
facts are.
  People deserve the facts. People are tired of hearing rhetoric. They 
want facts. And the facts are that we are sustaining and securing it 
for the Greatest Generation, and reforming it so it will be there as 
our children mature. And if we pass the budget, if the Senate would 
pass the budget that we passed out of the House, when my daughter is my 
age, we will have zero national debt, and we will have a better future. 
And then ask her if she thinks her children will have a better future 
than she did, and I guarantee you that she will say that.
  Mr. MILLER of North Carolina. Madam Chair, I move to strike the last 
word.
  The Acting CHAIR. The gentleman from North Carolina is recognized for 
5 minutes.
  Mr. MILLER of North Carolina. I rise to oppose the nonsensical 
pending amendment and the underlying bill, although the underlying bill 
doesn't really do all that, but most of all to disagree with the 
remarks of the gentleman from Kentucky just now, and from other remarks 
like that, that what the Republicans have done is not going to affect 
the people on Medicare now or the people who are older than 55, 55 and 
older.
  What it does, in fact, is shift more and more of the cost of health 
care to people who cannot afford it so that the richest Americans will 
not have to pay taxes. They will cut taxes for the richest Americans by 
even more, and they will protect insurance company profits and the 
profits of everyone else in the health care field who are making vulgar 
profits that are causing American health care to be twice as expensive 
as health care anywhere else in the developed world.
  The arguments and what the Republican Congress has done in these last 
few months have made very clear how cynically dishonest everything 
Republicans said about health care in the last 2 years really was, 
especially about Medicare.

[[Page H3378]]

  When Democrats really did find a way to get control of costs without 
affecting the quality, the availability of care, the access to care, 
the quality of care, all Republicans would say, even when it was 
specifically and narrowly targeted at fraud, they said that we were 
cutting Medicare. Now we see what they really think about Medicare. Now 
we see how little they really do understand how important Medicare is 
to the financial security of older Americans, of Americans in 
retirement.
  They say it will not affect you if you are over 55; if you are 55 or 
older. Well, I just turned 58. It is nice to know that Republicans care 
that much about me; but let me tell you, that is not the way it is 
going to work.

                              {time}  1650

  Well, when I turn 65, I'll qualify for Medicare. Presumably, I'll get 
Medicare. My 96-year-old mother, who I also did visit this weekend, 
will get Medicare. I feel pretty confident she'll get Medicare for the 
rest of her life and that, when I turn 65, I'll get Medicare. For the 
guy who is 53 now, which is just 5 years younger than I am, at 60 he'll 
be paying taxes for my Medicare, and he won't be getting it. He'll 
never get it. What he will get instead is a coupon, a voucher. He'll 
get an allowance to go buy private insurance, and private insurance is 
simply not going to pay for what Medicare pays for. It's going to be 
far more expensive.
  The Congressional Budget Office estimates that in just 10 years those 
folks will have to pay 60 percent of their own health care costs if 
this plan goes through, what they call a ``path to prosperity,'' which 
should be called the ``path to insurance company profits.'' In 20 
years, it will be two-thirds of their health care costs. They'll be 
paying for it. They'll also be paying taxes. Working Americans, people 
who are still in the workforce, will be paying taxes so that I get 
Medicare, and they know that's not the deal they're getting. The deal 
they'll be getting is that little voucher, that puny little voucher, 
that puts them at the mercy of insurance companies.
  Now, Republicans thrive on resentment. All of Republican politics 
seems to be built around resentment. I don't want to have a Nation so 
filled with resentment between generations. Ms. Edwards spoke just a 
moment ago about the contract between generations, that just as our 
parents took care of us in our childhoods, we will take care of our 
parents and their generation when they retire. We'll take care of them 
with our Social Security taxes and our Medicare taxes. They will get 
those benefits. Yet under the Republican plan, the path to insurance 
company profits, they won't get Medicare. They'll get that little 
voucher.
  How long is that going to go on before that resentment builds up? How 
long is that going to go on before the people who are paying the taxes 
for it and who know they'll never get it are going to say, No, no more 
of this. We have got to change this?
  Madam Chair, what we want is for all Americans to get the same deal. 
We want the people who are 65 and the people who are 96 to get the same 
deal, the people who are 70 to get the same deal, the people who are 58 
to get the same deal, the people who are 50 and 30 to get the same 
deal. If this Congress is willing to control costs, even though that 
means limiting the profits of some of the people who are getting really 
rich from our dysfunctional health care system, we can do that.
  I yield back the balance of my time.
  Mr. CICILLINE. I move to strike the last word.
  The Acting CHAIR. The gentleman from Rhode Island is recognized for 5 
minutes.
  Mr. CICILLINE. I rise in opposition to the amendment and in defense 
of our Nation's seniors, who are really under attack.
  Why is that? Because the current Republican budget proposal passed by 
this House and up for Senate consideration pulls the rug out from 
underneath our seniors. It ends Medicare by making huge cuts in 
benefits and by putting insurance companies in charge of our seniors' 
health care, letting insurers decide what treatment and what tests our 
seniors will receive.
  Under the Republican plan, Medicare will end. It will not only impact 
our seniors; it will impact the family members of our seniors, who will 
now have those responsibilities. It will reopen the doughnut hole, 
making it more expensive for our seniors to get their prescriptions, 
the prescriptions they need to keep them healthy; and under their plan, 
they will slash support for seniors in nursing homes while continuing 
to give subsidies in the billions of dollars to big oil companies.
  And what else? More than 170,000 Rhode Islanders, which is my home 
State, rely on Medicare; and they will literally be paying to give 
additional tax breaks to the wealthiest Americans in our country. To 
make matters worse, the nonpartisan Congressional Budget Office 
determined that this budget actually adds $8 trillion to the national 
debt over the next decade because its cuts in spending are outpaced by 
the gigantic tax cuts for the richest Americans.
  Our seniors cannot afford this Republican budget. It would deny them 
health care, long-term care, and the benefits that they have earned. 
The Republicans' choice to end Medicare by cutting benefits and by 
turning power over to the insurance companies for the important health 
care decisions of our seniors will result in reduced coverage and an 
exposure to greater financial risk for Medicare recipients, costing 
seniors an estimated $6,000 more each year for their care.
  The Congressional Budget Office determined that, under this 
Republican budget, seniors' out-of-pocket expenses for health care 
would more than double and could almost triple. They concluded: ``Most 
elderly people would pay more for their health care under the 
Republican plan than they would pay under the current Medicare 
system.''
  To put that into context, the CBO found that, in 2030, seniors would 
pay 68 percent of premiums and out-of-pocket costs under the Republican 
plan compared to only 25 percent under current law; and it found that 
the Republican plan means seniors will pay more for their prescription 
drugs because it reopens the doughnut hole, costing each of the 4 
million seniors who fall into that coverage gap up to $9,300 by 2020.
  The conservative Wall Street Journal concluded that this plan ``would 
essentially end Medicare, which now pays for 48 million elderly and 
disabled Americans, as a program that directly pays those bills.''
  Under the guise of deficit reduction, this Republican plan is 
recklessly attacking vital support systems for our seniors. We all 
agree that we have to address the deficit. The issue isn't whether we 
should reduce it but, rather, how we do it. Let's repeal subsidies to 
Big Oil. Let's eliminate fraud and waste. Let's end the wars that are 
costing us more than $2 billion a week. We should not be balancing the 
budget on the backs of our Nation's seniors.
  The Federal budget is about more than just dollars and cents. It is a 
statement of our values and our priorities as a country. The Republican 
budget reflects the wrong priorities. It would rather cut benefits to 
our seniors than cut subsidies to Big Oil or corporations that ship our 
jobs overseas.
  By ending Medicare, this Republican budget breaks the promise we made 
to our seniors to protect them in their golden years. We must do better 
for our seniors. Medicare has met the health care needs of seniors 
while providing them with financial stability for more than 40 years. 
Ending Medicare would pull the rug out from underneath the feet of our 
seniors during their golden years.
  So I ask my colleagues, if we can't protect our Greatest Generation, 
what's next?
  I yield back the balance of my time.
  Mr. McHENRY. I move to strike the last word.
  The Acting CHAIR. The gentleman from North Carolina is recognized for 
5 minutes.
  Mr. McHENRY. Madam Chair, I've heard my colleagues give volumes of 
words here today, but I've seen little action. In the 4 years they 
controlled the U.S. House, they proposed nothing in the way of 
meaningful entitlement reform: nothing to preserve Social Security, 
nothing to preserve Medicare, nothing to improve Medicaid and ensure 
that it's there.
  Madam Chair, I ask, where is the plan of these House Democrats who 
are speaking today? Where is their plan for entitlement reform?

[[Page H3379]]

  Mr. ANDREWS. Will the gentleman yield?
  Mr. McHENRY. I yield to the gentleman from New Jersey.
  Madam Chair, I would ask my colleague, where is his plan on 
entitlement reform?
  Mr. ANDREWS. Does the gentleman favor permitting Medicare to 
negotiate the price of prescription drugs, the way the VA does, and 
save $25 billion a year?
  Mr. McHENRY. In reclaiming my time, I would ask, does the gentleman 
favor the Medicare part D prescription drug benefit, which has a lower 
cost basis than what your colleagues proposed at the time of enactment?
  Mr. ANDREWS. Will the gentleman yield?
  Mr. McHENRY. I'm going to finish up here, my friend.
  Madam Chair, in this discussion, there are lots of questions but 
little substantive action--no policy proposals--to make sure that 
Medicare is there for the next generation, much less for the end of the 
Greatest Generation.
  I would ask my colleagues to come forward with a substantive plan, 
not just to take up time here on the U.S. House floor, not to take away 
time from these important amendments that we have under this open rule 
here on the House floor. I would ask my colleagues to do something real 
and substantive rather than to push us to a debt crisis, which their 
policies and their spending are pushing us towards.
  I yield back the balance of my time.
  Mr. ANDREWS. Madam Chair, I move to strike the last word.
  The Acting CHAIR. The gentleman from New Jersey is recognized for 5 
minutes.
  (Mr. ANDREWS asked and was given permission to revise and extend his 
remarks.)
  Mr. ANDREWS. My friend who just spoke asked us where the plan is to 
reduce the debt and deficit. If he is here, I would be happy to yield 
to him, but I would ask him to consider these ideas.

                              {time}  1700

  One, Medicare pays more than twice as much for a Coumadin pill than 
the Veterans Administration does because we have a law that the 
majority supported that says that Medicare can't negotiate prescription 
drug prices. I favor repealing that law and saving at least $25 billion 
a year. I would ask my friend if he supports that, and I would yield if 
he would like to answer.
  Mr. McHENRY. Will the gentleman yield?
  Mr. ANDREWS. Does the gentleman support that idea?
  I yield to the gentleman from North Carolina.
  Mr. McHENRY. Why didn't the gentleman do it when he was in the 
majority? And I would be happy to yield back the balance of my time. 
Why is this not in ObamaCare? It's just everything else.
  Mr. ANDREWS. Reclaiming my time, we did not do so because we couldn't 
get two Republican Senators to support it on the other side. We would 
have done it over here.
  Second thing; does the gentleman support stopping the spending of 
$110 billion a year to occupy Iraq and Afghanistan and instead spend 
that money here in the United States? Does the gentleman support that? 
I would ask him if he would like to answer that question.
  Mr. McHENRY. I'm sorry, I didn't hear the question.
  Mr. ANDREWS. I'll repeat it. We are spending about $110 billion a 
year to help finance the Government of Iraq and Afghanistan. I would 
rather see that $110 billion a year reduce our deficit. Would the 
gentleman support that?
  Mr. McHENRY. Does the gentleman support the President's war on Libya?
  Mr. ANDREWS. I, frankly, do not. But reclaiming my time, I especially 
don't support paying the bills for Baghdad and Kabul that we could be 
using to reduce our deficit here at home.
  Third, we're going to spend at least $60 billion over the next 10 
years to give tax breaks to oil companies that made record profits--$44 
billion last year alone--as our constituents are paying over $4 a 
gallon at the pump. I support repealing those giveaways to the oil 
industry and putting that money toward the deficit. I don't see the 
gentleman anymore, I'm not sure how he stands on it, but we support 
that.
  Four, I support the idea that people who make more than $1 million a 
year might be asked to contribute just a little more in taxes to help 
reduce this deficit. Now I know the other side is going to say, well, 
this will hurt the job creators in America. There is an echo in this 
Chamber. In 1993, President Clinton proposed a modest increase on the 
highest earning Americans to help reduce the deficit. The former 
Speaker at the time, or Mr. Gingrich--he wasn't the Speaker at the 
time, he became the Speaker--said this would cause the worst recession 
in American history. He was wrong. The gentleman who became the 
majority leader, Mr. Armey, said that this was a recipe for economic 
collapse. He was wrong.
  When we followed the supply-side trickle down the last 8 years under 
George W. Bush, the economy created 1 million net new jobs. But when we 
asked the wealthiest Americans to pay just a little more to reduce the 
deficit in the 1990s, the economy created 23 million new jobs.
  So when they ask, where is the plan, here is the plan: Don't abolish 
Medicare the way they plan to; negotiate prescription drug prices; stop 
paying the bills for Iraq and Afghanistan; stop the giveaways to oil 
companies that make record profits; and ask the wealthiest in this 
country to pay just a bit more to reduce our deficit. Let's put that 
plan on the floor and reduce the deficit that way.
  Madam Chair, I yield back the balance of my time.
  Ms. LEE. Madam Chair, I move to strike the last word.
  The Acting CHAIR. The gentlewoman from California is recognized for 5 
minutes.
  Ms. LEE. Madam Chair, I rise in strong opposition to the underlying, 
very reckless bill, H.R. 1216.
  Republicans, and we've heard this over and over again, want to 
destroy and to deny seniors long-term affordable health care by 
eliminating programs that are training the future health workforce of 
our country.
  This legislation is really part of an ongoing Republican attack on 
Medicare under the guise of deficit reduction and fiscal 
responsibility. It really is about privatizing Medicare, and of course 
that means that there will be some winners and there will be some 
losers. The Republican plan to end Medicare threatens the healthy and 
secure retirement that we promised American seniors. In fact, an end to 
Medicare is an end to a lifeline that millions of seniors rely on. 
Medicare gives peace of mind to millions of Americans who pay into it 
all their lives.
  The Republicans want to give aging Americans a voucher, mind you, 
that will not come close to covering the cost of health care instead of 
maintaining and improving Medicare. Sure, waste, fraud and abuse must 
be addressed wherever we find it, including the Pentagon, but we 
disagree with the Republican agenda that the program must be killed. 
The Republicans want to end this program when millions of Medicare 
beneficiaries are struggling to make ends meet, and when we know that 
Medicare-eligible beneficiaries will double over the next 20 years.
  Republicans have the wrong priorities--focused on letting the rich 
get richer on the backs of the middle class and the most vulnerable in 
our Nation. Under the guise of reform, Republicans would increase costs 
for seniors and cut benefits while giving tax cuts to millionaires, 
subsidies to oil companies, and sending desperately needed jobs 
overseas.
  If the Republicans get their way, millions of seniors would 
immediately begin paying higher costs for prescription drugs. The 
impact of killing Medicare will be the most severe on vulnerable and 
underserved populations, including our seniors of color, while 
negatively impacting all seniors who rely on Medicare to protect their 
health and economic security. An end to Medicare is really an end to a 
lifeline that millions of seniors rely on.
  If Republicans have their way, millionaires will continue to get big 
bonuses while millions of Americans fall deeper into poverty. Madam 
Chair, approximately 43.5 million Americans were living in poverty in 
2009, but did you know that nearly 4 million of

[[Page H3380]]

those are seniors? Given our challenged economy, we can't expect these 
numbers to have improved since 2009.
  Medicare is part of a promise made to hardworking Americans to ensure 
that they would not lack the security of having health care. And so 
rather than stand silently while Republicans destroy a program that 
protects vulnerable populations, we are here to speak up and stand up 
for our mothers and our fathers, our grandmothers and our grandfathers, 
our aunts and our uncles, and yes, our young people and our children, 
to be their voice in the House of Representatives. We are here to 
declare that Medicare should be protected and improved to protect our 
Nation's seniors and most vulnerable populations, and we are here to 
say that we want to secure it for future generations.
  Ending Medicare really does end this promise and the security for 
millions of Americans today and in the future. So we are here today to 
defend Medicare and the support that it gives to our seniors. We must 
ensure that those who have worked hard their entire lives strengthening 
our Nation have the health security that they need and deserve in their 
later years.
  Mr. SESSIONS. Madam Chair, I move to strike the last word.
  The Acting CHAIR. The gentleman from Texas is recognized for 5 
minutes.
  Mr. SESSIONS. Madam Chairman, I have seen shameless acts on this 
floor before, and we are watching another one with the last few 
speakers that we have seen here today.
  The facts of the case are--and people know this--we passed a budget 
resolution which is a construct to ask this House of Representatives to 
consider a plan so that we do not bankrupt Medicare--which is exactly 
what anyone who voted for the health care plan on March 21 or 22 1 year 
ago did. The plan which President Obama and Speaker Pelosi at that time 
supported took $500 billion out of Medicare to support a plan--which 
could not be sustained either--which cost $2 trillion for health care. 
So this year, Republicans have a plan to sustain Medicare that is a 
market-based plan. It's not a voucher program. Not one person who is 
presently on Medicare today nor anybody that is 55 years old or older 
today would be impacted by this plan. It is a plan that says we should 
challenge the Congress of the United States--including the 
administration also--to come up with a plan about how we can sustain 
Medicare, as we do see a doubling over the next 15 years of people who 
will be expected to participate in that plan.
  So that we get this right for once, let me say this: It is not a 
voucher program. It does not impact anyone that is presently on 
Medicare. So the shameless things we've heard today about everyone's 
grandmother and everybody's grandfather and all these people that will 
be thrown off Medicare, they will be unaffected.
  Here's what the plan calls for: It calls for the United States 
Congress to begin a process with hearings that would allow people who 
would be on Medicare, instead of a one-size-fits-all plan of Medicare, 
to have a plan that looks just like what government employees would 
have, a realistic opportunity for them to choose among several plans, 
whether they want a basic plan all the way up to a plan in which they 
could fully participate themselves.

                              {time}  1710

  Today, Medicare is a closed, one-size-fits-all process, just like we 
heard Mr. Miller, ``We're going to treat everybody the same way.'' It 
does not work, because not everybody has the same needs as each other. 
We will have a plan which is market-based, which does not bankrupt this 
country nor the system, which will allow the individual an opportunity 
to come into a process and have their own health care just like 
somebody who works for the Federal Government. It would allow people 
who were in that program to take money out of their own pocket, to 
choose their own doctor if they chose to, and to be allowed to 
supplement those payments. We would probably set a mark, a bar, that 
said if you make above a certain amount of money, that's not determined 
yet, but if you had the ability to pay for yourself, you shouldn't rely 
upon the government. That is another way to make sure that we support 
the system, because if people have the ability to pay for their own 
health care, we should allow them to do that and encourage them to do 
that.
  Then we look at how doctors are paid. Doctors today have not only 
been mistreated by both sides, but in particular as we see doctors not 
being compensated, they are not available, and it means seniors are 
being denied coverage because physicians are not being reimbursed 
properly. It allows us to have a great system, where doctors would want 
to serve seniors, a great and better system that is market-based 
whereby the ability that a person has to pay, if they do, then they 
would pay their own physician and their own way with the minimum 
support from the government.
  The bottom line is, the gentleman from North Carolina asked a 
relevant question, and the answer that came back was, when he said, 
what is your plan, the answer that came back was, what about the war 
and what about oil companies? Well, the facts of the case are, we're 
talking about Medicare here today, a system that is draining this 
country from not only its ability to provide outstanding and excellent 
health care but also a system that takes away choices from seniors.
  I yield back the balance of my time.


                    Announcement by the Acting Chair

  The Acting CHAIR. Members are reminded not to traffic the well when 
other Members are under recognition.
  Mr. RYAN of Ohio. I move to strike the last word.
  The Acting CHAIR. The gentleman is recognized for 5 minutes.
  Mr. RYAN of Ohio. Madam Chair, I rise in opposition to the underlying 
bill, and I think it's important for us to go back, as we hear about 
market-based solutions, to why Medicare was started in the first place. 
There is no market to provide health care for older people, because 
there's no money to be made. Insurance companies can't make money off 
of covering old people who get sick, really, really sick.
  What this plan does, Madam Chair, and the analysis was, well, it's 
just going to be like the Federal employee plan, where Members of 
Congress and Federal employees get a premium support. Well, the premium 
support that Federal employees get is about 70 some percent of the 
health care costs, and that number goes up and down with inflation for 
health care. So no matter what the health care costs are, the Federal 
employee has 70 some percent of that covered.
  The problem with the Republican plan is that the voucher, or the 
premium support, is hooked to the CPI, the Consumer Price Index, which 
is 2\1/2\ percent, maybe, so the voucher is going to go up at CPI, say, 
2\1/2\ percent, while health care costs are usually a percent or two 
above GDP growth, so say we have 4 percent growth, then health care 
costs are going to go up at 5 percent, maybe 6 percent. So your premium 
support, or your voucher, is going to increase every year by 2\1/2\ 
percent, while health care costs are going up at 5\1/2\ percent. It 
doesn't take rocket science to figure out that over the course of 
several years, that voucher becomes worthless, and it will only 
probably cover 30 percent, maybe, of the cost of the health care that 
these seniors are going to get.
  So let's not sit here and pretend like the senior citizens in the 
Medicare program are going to somehow be living large and getting some 
kind of great health care. This dismantles the Medicare program. 
Period. Done. At least have the courage to come out and say, we want to 
dismantle the Medicare program.
  If you want to look at how far to the right that the Republican Party 
has gotten on this issue, I've never seen former Speaker Gingrich do a 
faster or more complete Potomac two-step in my entire life than when he 
even insinuated that this may not be good for seniors, because the goal 
now of the Republican Party, Madam Chair, is to dismantle the Medicare 
program.
  They tried years ago to try to privatize Social Security. This is no 
surprise. And so my question is, Madam Chair, if you're a 55-year-old 
guy in Youngstown, Ohio, who statistically, over the last 30 years, 
your wages have been stagnant with no increase in real wages over the 
last 30 years, now you're saying to them that they've got to come up 
with another $182,000 to be able to pay for their health care.
  You can nod your head ``no'' all you want, Madam Chair. These are the 
facts. The Congressional Budget Office

[[Page H3381]]

says, neutral third party, that the average person going into this 
Medicare proposal will pay $6,000 more a year. That's not the 
Democratic study committee or our policy wonk saying it, it's CBO. Six 
thousand more a year. While the guy's wages have been stagnant for the 
last 30 years?
  And that's where the issue of the oil companies does come in, because 
we're giving huge breaks to oil companies. We'll take more arrows to 
protect, on the other side, to protect even thinking about possibly 
asking the wealthiest 1 percent to pay just a little bit more to help 
us address this issue. The sky is falling. The world's ending. It's so 
bad that we can't even muster up the courage to ask Bill Gates and 
Warren Buffett to just help us out a little bit while we have all these 
problems and three wars going on at the same time? I mean, come on, 
Madam Chair, this is not right. This is not right.
  So, at the end of the day, the Democratic plan is for Medicare. We 
keep it to cover senior citizens and their health care when they get 
older, and if we've got to make adjustments, we make adjustments. But 
you don't dismantle the entire plan, and you don't at the same time 
give tax breaks to the oil companies.
  The Acting CHAIR. The time of the gentleman has expired.
  Mr. RYAN of Ohio. Don't dismantle Medicare, Madam Chair. Don't do it.
  Mr. BURGESS. Madam Chairman, I move to strike the last year.
  The Acting CHAIR. The gentleman from Texas is recognized for 5 
minutes.
  Mr. BURGESS. I thank the Chair for the recognition.
  You know, if we're going to tell stories here, let's start out with 
``once upon a time'' and maybe we can end with ``and they lived happily 
ever after.''
  Whose budgetary plan puts Medicare at the most risk? Is it the 
responsible Republican plan that was debated on this floor for hours 
over a month ago? This was a plan that for the first time we had laid 
out for us a road map, a pathway, for how to save Medicare for people 
who are going to enter into the program in 20 years', 30 years' time.
  Now what is the plan on the other side? Well, there was no plan from 
House Democrats. There is no plan from the Senate Democrats. There is a 
plan from the President. The President laid out his aspirational 
budget, just as the Republicans laid out their aspirational program 
which was their budget, and the President's aspirational document laid 
out a very clear path. The President believes in 15 people, not elected 
by anyone but appointed by him, and their ability to control costs in 
the Medicare system. It was written into a bill called the Patient 
Protection and Affordable Care Act. You may remember it.
  I have a great deal of sympathy with those on the other side who do 
not like the Independent Payment Advisory Board. In fact, one of their 
number wrote an editorial for USA Today yesterday decrying the nature 
of the Independent Payment Advisory Board, but the sad fact of the 
matter is, this is the Democratic alternative to the Republican plan to 
save Medicare into the next 50 years.

                              {time}  1720

  That plan, the Democrats' plan, the President's plan, with the 
Independent Payment Advisory Board, says 15 people are going to be 
picked, they will be paid well, they will then decide where are the 
cuts going to occur in Medicare.
  Now, true enough, Congress gets an opportunity. This 15-member board 
will come back to the United States Congress and say, ``Here is the 
menu of cuts that we believe are necessary to have this year in order 
to keep Medicare solvent.'' By law, they have to come up with a certain 
dollar number of cuts. But as the President himself said in his speech 
to Georgetown here earlier this year, that's a floor, not a ceiling. If 
we need to save more money, we can go back to the Independent Payment 
Advisory Board and save more money.
  Now, Congress looks at the cuts that are brought to them by this 
unelected independent board and says, We don't like those cuts. Some of 
those cuts are going to be very damaging to poor seniors on Medicare. 
Do we have a choice? Yes. We can vote it up or down. If we vote it 
down, we have to come up with our own menu of cuts to then deliver to 
the Secretary of Health and Human Services. What if Congress can't 
agree? I know. When has that ever happened before? But what if we can't 
agree amongst ourselves? Do we get to do something like the doc fix 
that we do every year? No, we do not. That's the whole purpose of the 
Independent Payment Advisory Board. We cannot intervene on behalf of 
America's patients because the President's board has spoken.
  So Congress can't agree on what these cuts should be.
  So what do we do? We continue to fight. But guess what happens? April 
15 of the next year, the Secretary of Health and Human Services, 
whoever he or she may be at that time, gets to institute those cuts 
that were brought to you by the Independent Payment Advisory Board. 
Now, is that a good idea?
  And I've heard discussion here on the floor today about $6,000. You 
know what? If you don't fix that sustainable growth rate formula, guess 
what's going to happen to every senior, rich and poor, who is on the 
Medicare program? Either they're not going to be able to find a doctor 
to care for them when they require care, or they're going to have to 
pay more money. How much money are they likely to pay? About $6,000 per 
senior.
  But look. The Independent Payment Advisory Board, something like that 
has never happened in this country. In a free society, we've got now an 
unelected board who is going to tell us what kind of medical care we 
can get, when we can get it, where we can get it, and most importantly, 
when you have had enough. And when they say you've had enough, that's 
it. No more. Dialysis, insulin. It doesn't matter. You're full. You've 
had your share. That is the problem with the Independent Payment 
Advisory Board.
  And Congress then becomes powerless because frequently we do disagree 
with each other, and if we can't come to a consensus, the Secretary 
makes that decision for us. And then the next year starts all over 
again.
  I've got a great deal of sympathy with my friends on the other side 
of the aisle because they did not include this language in their bill. 
And we all remember a year ago the very bad process that brought us the 
Patient Protection Affordable Care Act. And what was that process? It 
was the Senate on Christmas Eve that passed a House-passed bill that 
then came back over to the United States House and will the House now 
agree to the Senate amendment to H.R. 3590? You all remember 3590. It 
was a housing bill when you passed it in the summer of 2009. It was a 
health care bill when it came back to the House.
  You did not include the Independent Payment Advisory Board in H.R. 
3200 for a very good reason. The reason is it's un-American, and you 
know it, but now you're left to defend it.
  I yield back the balance of my time.
  Mr. MARKEY. I move to strike the last word.
  The Acting CHAIR. The gentleman from Massachusetts is recognized for 
5 minutes.
  Mr. MARKEY. You know, this is a crazy debate that we're having here 
right now because the Republicans, they keep saying to the Democrats, 
Well, what's the plan? So we say to the Republicans, Well, what's your 
plan? Your plan just seems to be saying to Grandma and Grandpa that 
they're taking too much. That they really--they're taking America for a 
ride, and we have to cut Medicare. Their health care is too good. And 
Grandma and Grandpa, they didn't do enough for America.
  So the Democrats, we turn around and say, Hey, how about looking at 
it this way: How about before you go after Grandma and her Medicare 
card and how about you say to Warren Buffet, Hey, how about not taking 
those extra tax breaks?
  And the Republicans say, We can't take away any tax breaks from 
Warren Buffet and all of the other multi-multimillionaires and 
billionaires. Because they've contributed so much to America, we don't 
want to touch their money, even though that would give us hundreds of 
billions of dollars.
  And then we say to them, Well, how about prescription drugs? How 
about we negotiate the price for prescription drugs, for Medicare, the 
way we do

[[Page H3382]]

with the VA? That would save about a quarter of a trillion dollars over 
a 10-year period. They say, That would be unfair to the drug companies. 
We can't touch them either.
  Then we say to them, Well, you know, the war in Iraq, the war in 
Afghanistan, it's winding down now. Maybe we could look into the 
defense budget and save a few billion dollars there before we ask 
Grandma to sacrifice on the health care that she gets from Medicare? 
And the Republicans say, We can't do that either. We can't look at any 
cuts in the defense budget. That would be much too hard on those 
defense contractors.
  So then we say to them, How about the oil industry? At least the oil 
industry, the $40 billion in tax breaks which they're going to get over 
the next 10 years? I mean, does anyone in America really believe that 
they need tax breaks in order to have an incentive to go out and drill 
for oil when people are paying $3, $3.50, $4 a gallon at the pump?
  But the Republicans say, No. You can't touch the oil companies 
either. You've got to give big tax breaks to the oil industry as well, 
even as they're tipping Grandma and Grandpa upside down at the pump 
when they're coming in to put in their unleaded $4 a gallon gasoline--
self-serve, by the way--at the pump.
  So what do they do instead? What they do is they put an oil rig on 
top of the Medicare card so that the oil industry can drill into 
Grandma's Medicare and pull out the funding in order to provide the tax 
breaks for Big Oil, for Warren Buffet, for the prescription drug 
industry, for the wars in Iraq and Afghanistan. It's all off of 
Grandma. She's the one. We've targeted the person responsible for all 
of the wasteful spending in the United States. It's all Grandma's 
fault. Let's cut Medicare. She didn't do enough to build our country 
through the 1930s, the 1940s, the 1950s, and the 1960s. It's all on 
Grandma.
  So this drill rig that they are building into the pocketbooks of 
Grandma in order to find that funding, that's what their plan is all 
about. It's an oil pipeline into the pocketbooks of the seniors. They 
want to cut checkups for Grandma while they cut checks for the oil 
companies. They want to cut health care to Grandma and give wealth care 
to big oil companies and to billionaires and to prescription drug 
companies.
  Their plan is big tax breaks for Big Oil and tough breaks for Grandma 
and for the seniors in our country.
  And the CEO of Chevron? He says it's un-American to think about 
increasing taxes on the oil industry. You know what I say to him? It's 
unbelievable that you could make that argument. But even more 
unbelievable that the Republican Party would accept that argument and 
cut Medicare for Grandma. To privatize it, to hand it over to the 
insurance industry, to increase the cost by $6,000 per year for their 
costs even as they say to Warren Buffet, the oil companies, the big 
drug companies, the arms contractors, Don't worry. We're going to 
protect your programs. It's just Grandma that's on the cutting block.
  So, ladies and gentlemen, this is a debate of historical dimensions. 
And until the Republicans come forward with a plan--which they don't 
have in order to make Medicare solvent--by raising the revenues out of 
these other areas from millionaires, from the oil industry, and from 
others, do not expect us to say to Grandma it's her fault. It's not her 
fault. She built this country. She deserves this benefit. And we should 
not be cutting it.
  This Republican plan to end Medicare is just something that wants to 
turn it over to the insurance industry. Vote ``no'' on the Republican 
plan.
  Mr. COURTNEY. I move to strike the last word.
  The Acting CHAIR. The gentleman from Connecticut is recognized for 5 
minutes.
  Mr. COURTNEY. I rise in opposition to the underlying bill, which, by 
the way, is a bill that would repeal a provision of the Affordable Care 
Act that was aimed at trying to strengthen the primary care 
infrastructure of this country, which is in fact a huge challenge for 
the Medicare program, but for some reason over the last couple of 
months or so, Medicare just seems to be the target.
  I think it's important for people to remember that in 1965 when 
Medicare was passed and signed into law on Harry Truman's front porch, 
only half of America's seniors had health insurance.

                              {time}  1730

  Part of it was because of the cost, but part of it was because the 
insurance companies would not insure that demographic. It was just 
simply too high a risk to write insurance policies by individual 
companies for people who, again, because of nature carried the highest 
degree of risk in terms of illness and disease. Over time, the genius 
of Medicare, which was to pool risk, to create a guaranteed benefit, to 
fund it through payroll taxes, to fund it through Medicare part B 
premiums, demonstrated that we could raise the dignity and quality of 
life for people over age 65 and in fact extend life expectancy.
  But the Republican Party has been targeting this program over and 
over again. In the 1990s, they came out with Medicare part C, Medicare 
Plus Choice, which was again giving insurance companies a set payment 
who promised to provide a more efficient, lower cost product for 
seniors. And what happened? Insurance companies enrolled millions of 
seniors in Medicare Plus Choice products. And realizing in a short 
space of time that they did not in fact have the funds to create a 
sustainable product, they canceled coverage for seniors all across the 
country.
  I was at hearings in Norwich, Connecticut, in 1998, where seniors who 
had signed up for these programs suddenly got notification in mid-
policy year that the insurance companies changed their minds, and they 
dropped them like a hot potato. In many instances, seniors who were in 
the middle of cancer treatments and chronic disease treatments were 
left high and dry without coverage. So that program failed.
  Later, we had Medicare Advantage. Medicare Advantage was sold on, 
again, the premise that it would provide coverage for seniors cheaper 
than regular Medicare. And what in fact happened? The Department of 
Health and Human Services had to offer insurance companies 120 percent 
of the baseline costs for Medicare in order to entice insurance 
companies to participate in the Medicare Advantage program; a 
ridiculous overpayment, treating unfairly seniors who were in 
traditional Medicare and paying for Medicare supplemental insurance.
  Last year we did something about that unfairness by equalizing the 
payments to seniors on traditional Medicare and Medicare Advantage. And 
today what we have is the Ryan Republican plan, which says you get an 
$8,000 voucher if you are under age 55, and good luck in terms of 
trying to find coverage, again, in a market that is going to be very, 
very careful about not extending actual coverage because of the risk 
that's attached to it.
  Now, the rank unfairness of saying that we are going to create a two-
tiered system for people over the age of 55 and people under the age of 
55 is obvious even in my own family. I am 58 years old. My wife Audrey, 
who is a pediatric nurse practitioner, is 51. I get one version of 
Medicare; she gets stuck with the loser version of Medicare under this 
proposal. Again, the unfairness of it is so obvious to all families 
across America. And again, it is one that is why I think the public is 
turning so quickly against the Republican agenda.
  And we are told and we are asked: What's your alternative? Well, look 
at the trustees' report that came out last week. Look at it. What it 
said was that the Affordable Care Act in fact extended solvency for the 
Medicare program by 8 years. We did suffer some reductions, but that 
was because of the economy. Read the trustees' language. The smart 
efficiencies which were introduced into the Medicare program through 
the Affordable Care Act in fact have made the Medicare program 
healthier.
  And if you look at the Ryan Republican budget plan, they took every 
nickel of those savings from the Affordable Care Act. Even though that 
caucus demagogued all across the country, campaigning about so-called 
Medicare cuts in the Affordable Care Act, well, the Ryan Republican 
plan incorporated every single one of those changes in the Affordable 
Care Act.

[[Page H3383]]

But at the same time, it took away all the benefits of the Affordable 
Care Act in terms of helping seniors with prescription drug coverage, 
annual checkups, cancer screenings, smoking cessation, all of the smart 
changes which the Affordable Care Act made to provide a better, 
smarter, more efficient Medicare benefit for seniors.
  The fact of the matter is that the Democrats do have an alternative. 
We have a program which we passed last year which, for the first time 
in decades, extended the solvency of the Medicare program.
  Let's not abandon it. Let's preserve the guaranteed benefit for 
seniors. Let's reject the Ryan Republican Medicare plan.
  Mr. McDERMOTT. Madam Chairman, I move to strike the last word.
  The Acting CHAIR. The gentleman from Washington is recognized for 5 
minutes.
  Mr. McDERMOTT. Madam Chairman, I rise in opposition to this 
underlying bill.
  It reminds me, as I listen to this debate, of debates around the 
Vietnam War. I remember a village that was napalmed by a military unit, 
and the officer who had them do it, he was asked why he did it. He 
said, well, I destroyed it to save it. Now that's the argument we are 
hearing today on Medicare. We have to destroy it to save it.
  Now ask yourself--and there are a lot of people watching, Madam 
Chairman. If I were sitting at home trying to figure out what's this 
all about, well, why would Representative Ryan suggest that a voucher 
system is the way to save Medicare because of the rising costs? 
Everyone knows that the costs of Medicare and medication and health 
care in this country are totally out of control.
  Now, President Obama came up with a plan which he brought out here. 
It wasn't like he created something that nobody had ever thought about 
before in the whole United States. He looked at the State of 
Massachusetts. It's been a place where a lot of great things have come 
from. And he saw what Governor Romney, a Republican, a Republican 
thought that we ought to have a universal plan for Massachusetts, and 
so they passed the law and they covered everybody in Massachusetts.
  Now, then came the question: Once you have got access for everybody, 
how do you control the costs? Well, then the problems developed. And 
the problem was they found in Massachusetts they didn't have enough 
primary care physicians. Now, what does that have to do with it? That's 
what this bill is about. This bill is about the training of primary 
care physicians.
  What everybody in this country needs is a physician that knows them 
and is a medical home. When they get sick, they go to that person. The 
doctor knows them. If they need some preventive care, the doctor takes 
care of it. The doctor does it in a very cost efficient way, before the 
catastrophes.
  Now, for the many people in this country who don't have a primary 
care physician, they sit at home and say, well, I've got to wait until 
I am really, really sick, and then they go to the emergency room. Now, 
if you have your blood pressure monitored and you take medication, you 
can live a long life; but if you don't, you are very likely to wind up 
with a stroke.
  Now, we spend millions of dollars in hospitals on stroke victims that 
could have been prevented by good primary care. And we say to 
ourselves, well, why don't we have more primary care physicians? Well, 
because the health care system is designed to take care of people after 
the big event. After they have got the cancer, we will spend millions 
of dollars on cancer treatment. We will spend millions of dollars on 
heart problems, on all these things where prevention could have 
prevented it all and cost less. That's what every industrialized 
country in the world has done.
  It's why the Swiss are able to provide universal coverage to 
everybody in Switzerland for a little over one half of what we spend in 
the United States. Because they provide good preventive care in the 
form of general practice, general medicine. That's true in England, in 
Norway, in Canada, in every other country except the United States, 
where we are dominated by specialists.
  Now, in this country, if you get sick or you have a pain, if you 
don't have a primary care physician, a doctor who knows you, you call 
up your friends and you say, I've got a pain in my leg. What should I 
do? And they say, well, I saw an orthopedic surgeon, and his name is 
such, and so you go to a specialist. And that specialist looks at your 
leg. He doesn't look at all the rest of you. He doesn't know what's 
going on with you. He doesn't know your whole history.
  When I started in medical school, the maxim we were taught at the 
very beginning was: Listen to the patient. He is telling you what's the 
matter with him. And everybody knows that doctors are running on a 
conveyor belt today, one right after another, no time to listen because 
we have not invested in primary care physicians.

                              {time}  1740

  Now, the average kid going to medical school would like to take care 
of people; but when he comes out, or she comes out, they are $250,000 
in debt. This bill is making that problem worse and, therefore, is bad 
for Grandma and everybody else.
  Mr. GINGREY of Georgia. Madam Chairman, I move to strike the last 
word.
  The Acting CHAIR. The gentleman is recognized for 5 minutes.
  Mr. GINGREY of Georgia. Madam Chairman, sitting in my office and 
listening to this debate, and I can't help but feel that this is 
nothing but a bunch of demagoguery on the part of our colleagues on the 
Democratic side of the aisle.
  I take this opportunity to oppose the amendment, but, more 
importantly, to ask my colleagues to stop this demagoguery in regard to 
throwing Grandma under the bus in reference to the Medicare program and 
what our side of the aisle has proposed in the Republican budget.
  You know, the average age of this body is 58 years old. Almost all of 
us are Grandma and Grandpa, and you are running these ads all across 
the Nation, I guess, particularly in New York 26, showing a reasonable 
facsimile of our fantastic chairman of the Budget Committee pushing 
Grandma in a wheelchair off the cliff.
  Look, New York 26 is over. You don't need any more votes. Stop all 
this demagoguery.
  You have done nothing in regard to the Medicare program. What is 
there in the 2012 budget, in the Obama budget, that does anything 
toward trying to solve the Medicare program, which will be bankrupt in 
2024 if nothing is done? That is the total irresponsibility and the 
hypocrisy of this side of the aisle, Madam Chairman.
  And the responsible side of the aisle is the Republican side of the 
aisle which says, look, let's save this program for our children and 
our grandchildren, guarantee, protect and strengthen it for Grandma and 
Grandpa, our current seniors, and not only the current seniors who are 
65 and those who are disabled and already on the Medicare program, but 
anybody who will come into the Medicare program within the next 10 
years.
  And, you know, Madam Chairman, at that point, in 2022, you will have 
about 65 million people on the Medicare program as we know it, 
traditional Medicare; and they will be on that program until their 
natural death and many of them, thank God, because of our great health 
care system in this country, will live to be 90 years old.
  So this idea of killing Medicare is an absolute misinterpretation, 
and you know it. You are misleading the American people.
  This program that we are proposing, and it's a proposal, it's 
something that we can work together on both sides of the aisle, we can 
negotiate, you know, it's not set in stone--but what we say, what 
Speaker Boehner says, what Chairman Ryan says is, look, let's try this 
program in 2022 where people who are coming into Medicare at age 65, 
many of whom are working and in excellent health, we will simply give 
them a premium support, but not a voucher in their hands, but to send 
to the insurance company of their choice. Let them get their medical 
care where Members of Congress get their medical care. Let them have 
the same options to choose from, Madam Chairman.
  That's what's this is about. And the average, if it is $8,000, it 
will be adjusted every year for inflation and that average 8,000 will 
be higher for an individual who comes into the Medicare

[[Page H3384]]

program at age 65 that is already sick, that already has heart disease 
or diabetes or is on dialysis. It's somebody, as they get older, that 
premium support will increase.
  This is the way we save the Medicare program; and, oh, yes, by the 
way, folks like us, like members of the subcommittee, our premium 
support will be significantly less because we are not Warren Buffett, 
but we can afford to pay more, and we should pay more. If that's $4,000 
a year more, so be it. We save the program for those who need it the 
most, those who are middle- and low-income seniors, and that is the 
compassionate thing to do.
  So, colleagues, stop this demagoguery. Let's get together, let's work 
together and solve this problem once and for all.
  I yield back the balance of my time.


                    Announcement by the Acting Chair

  The Acting CHAIR. Members are reminded to address their comments to 
the Chair.
  Ms. SCHAKOWSKY. I move to strike the last word.
  The Acting CHAIR. The gentlewoman from Illinois is recognized for 5 
minutes.
  Ms. SCHAKOWSKY. I am getting a real kick out of this debate. I really 
am. You know, we hear one after another of my Republican colleagues 
coming up here and self-righteously talking about ending the 
demagoguery and we should end the TV ads.
  And I just want to remind you that through the 2010 elections, the 
Republicans went on television and, yes, how about demagogued, the 
issue of Medicare, saying that Democrats wanted to cut $500 billion 
from Medicare.
  Well, let's talk about the truth. We were challenged, just a little 
while ago: What is your plan? Well, here was our plan to save Medicare 
and that was to say in The Affordable Care Act, yes, we are going to 
cut subsidies to the insurance companies that meant that we were 
bilking the government and the taxpayers, and we were having to overpay 
them, and, yes, we are going to cut waste and fraud from the Medicare 
program.
  And that's how we are going to save $500 billion. But not only would 
we not cut a single penny from benefits, but we were actually able to 
increase benefits while trimming Medicare.
  We, you know--so you scared the heck out of seniors but never 
mentioned, of course, at the same time we reduced the cost of Medicare.
  We improved Medicare by adding to its solvency; we closed the 
doughnut hole, making prescription drugs more affordable; and we 
provided a wellness exam every year at no cost; and we provided 
preventive services with no cost sharing. But nevertheless, on 
television, those ads warned against those Democrats who didn't cut one 
thing from Medicare and improve it. And now you are saying, well, we 
are not going to do anything to people 55 and under. To me that sounds 
like 55 and under, you better look out.
  Now, the ads in New York are working because people love their 
Medicare. And what they don't want to see, you know, all but four 
Republicans voted to literally end Medicare.
  You can call it something else, but you can't call it Medicare 
because those guaranteed benefits are gone. It makes huge cuts in 
Medicare benefits. Seniors that fall under the new plan would have to 
pay about $6,000 more a year. That's what the Congressional Budget 
Office says, $6,000 more a year out of pocket for their health care, 
and it would put insurance company bureaucrats in charge of seniors' 
health care, letting insurers decide what tests and what treatment that 
seniors get, throwing seniors back into the arms of the insurance 
companies who have shown no love to them.
  And so let's look at what the American people think about Medicare. 
Well, if you are 65 years and older, 93 percent of Americans say the 
Medicare program as it is right now is very important or somewhat 
important to them, actually 83 percent very important.
  If they are 55 to 64, 91 percent say Medicare is very important; and 
if you are 40 to 54, we have got 79 percent of Americans who say the 
Medicare program is very or somewhat important; and if you are 18 to 
39, 75 percent.

                              {time}  1750

  People get it. Medicare works. Medicare is efficient. Medicare is 
good for our country, for people with disabilities and for the seniors. 
And if we are looking to save Medicare, we do have a plan. We know how 
to make that more efficient. We have done it in the Affordable Care 
Act. And we are willing to sit down and talk about how we make Medicare 
more efficient, but not by ruining, destroying and getting rid of 
Medicare to the point that you've got to find another name. It won't be 
Medicare anymore.
  And so they've admitted, it seems to me, that people 55 and younger, 
you better look out. Because that program that will allow our seniors 
to live perhaps to 90 years old, people who are going to be eligible 
for Medicare as it is right now will no longer be in place. And we are 
not talking about rich people----
  The Acting CHAIR. The time of the gentlewoman has expired.
  Ms. SCHAKOWSKY. We're talking about poor seniors and middle class 
people.
  Don't support this plan.


                    Announcement by the Acting Chair

  The Acting CHAIR. Members are reminded to refrain from trafficking 
the well while another Member is under recognition.
  Mr. WOODALL. Madam Chair, I move to strike the last word.
  The Acting CHAIR. The gentleman from Georgia is recognized for 5 
minutes.
  Mr. WOODALL. Madam Chair, like my colleague from Georgia, I too was 
sitting back in my office. I saw the debate break out on the floor of 
the House on the Medicare proposal, the proposal to rescue Medicare 
from certain bankruptcy. And I wondered, because I sit on the Rules 
Committee, and the Rules Committee has one of the great pleasures of 
deciding what comes to the floor, how it comes to the floor and what 
goes on, and I knew that this wasn't Medicare reform day. This was the 
amendment by my colleague from North Carolina (Ms. Foxx) to protect 
life. It was an amendment to a bill brought to the floor by my 
colleague, Mr. Guthrie, which restores congressional oversight and 
regular order through the appropriations process, those things that I 
ran for Congress to do. And I rise in strong support both of the Foxx 
amendment and of Mr. Guthrie's underlying bill.
  But when I heard this talk about Medicare and all the games and what 
has happened in the past, I have to say, I have only been here--this 
is, what, month number 5 for me. I'm still brand new, and I'm still 
optimistic enough to believe that it doesn't have to all be about sound 
bites, that it really can be about solutions.
  And I want to say to my colleagues on the Democratic side of the 
aisle, when you say that you came up with a proposal in the President's 
health care bill last year to deal with Medicare, I believe you. I take 
you at your word. I read through that, too. I saw that Medicare 
Advantage was removed as an option for seniors. That distressed me. I 
saw that new benefits, as Ms. Castor just referenced, had been added, 
Madam Chair, added to a program that's already going bankrupt. I saw 
that that is one direction that you can take the Medicare program.
  Now I'm a proud member of the House Budget Committee, the House 
Budget Committee that worked hard and long to produce the Medicare 
reform proposal that we're talking about, oddly enough, here today. And 
it's a program that saves Medicare for everybody 55 years of age and 
under and provides them with choice.
  I just want to tell a personal story. I don't consume a lot of health 
care. I've been very blessed in that regard. But I had to go in for a 
chest CT the other day. I have a medical savings account, so I'm 
responsible for the first couple of thousand dollars of my health care 
bill. So the first health care I consumed was my chest CT. I got on the 
Internet and started shopping around. It turns out that the difference 
between the cheapest chest CT and the most expensive chest CT in my 
part of Georgia is four times--four times. I got in the car. I drove 
across town and spent my $4 a gallon for gas to go get the cheap one. 
It turns out the really expensive one was right next door. I could have 
walked right next door.
  Folks, when we talk about how we, we the United States Congress, we 
the U.S. House of Representatives voted to

[[Page H3385]]

save Medicare in the 2012 budget proposal, we talked about saving it by 
providing choice. Again, my colleagues are exactly right. We did that 
in 1997. That was the debate, can we save Medicare in 1997 by providing 
more choice? Well, we succeeded with adding Medicare Advantage, but we 
didn't get much further than that. This is that next step. This is that 
next step because we know that choice matters. We know that choice 
matters.
  The gentleman who held my seat and has been retired used to tell the 
story of his mother in upstate Minnesota, and every Tuesday she would 
go to the doctor with a group of friends just to make sure everything 
was okay, just to get checked out. She was on Medicare. One day, there 
was a terrible snowstorm in Minnesota. The winds were blowing and the 
snow was piling up. They all got together on Tuesday, and Edna wasn't 
there, and they began to get worried. They called around and they asked 
around. It turned out Edna just wasn't feeling well. She couldn't be 
there that day.
  You make different choices when you're not responsible for the bills. 
And we do that over and over and over again. This isn't just a Medicare 
issue. This is a philosophical difference between these two sides of 
the aisle about what kind of an America we are going to live in going 
forward. Are we going to live in one where folks take care of you but 
they tell you the manner they're going to do it? Or do we live in one 
where we help you along but you get to make those fundamental choices 
for you?
  It's clear to me why my constituents sent me to Washington as a 
first-time elected official this year. It's clear to me where the 2012 
budget proposal takes this House and takes this country.
  I implore my colleagues, we can absolutely argue about your plan as 
it was introduced in the President's health care bill and our plan as 
it was introduced in the fiscal year 2012 budget proposal, but let's 
not, let's not make it anything other than what it is. It's a 
difference in two visions. Yours saves Medicare for 6 years. Ours saves 
Medicare for a lifetime. And, Madam Chair, I think we owe the voters no 
less.
  Mr. PERLMUTTER. Madam Chair, I move to strike the last word.
  The Acting CHAIR. The gentleman from Colorado is recognized for 5 
minutes.
  Mr. PERLMUTTER. I just say to my friend from Georgia, who really is 
my friend, that this isn't about demagoguery, sir. And what I would 
say, Madam Chair, the issue before us is: What got our country into a 
financial pickle? The Republicans want to pick on Medicare, but 
Americans know.
  I had a Government in the Grocery this weekend, and an older 
gentleman came up to me. He said, Why is there such a focus on 
Medicare, something that has been working for 50 years? It's helping 
seniors have healthier, longer lives. What's the big deal? He said that 
10 years ago this country was running a surplus, running a surplus, 
revenues exceeded expenses. Under Bill Clinton, revenues were exceeding 
expenses. But then there was a decision under the Bush administration 
to cut taxes. Okay. If revenues are exceeding expenses, then maybe 
that's okay. That cost us $1 trillion over the next 10 years. Then came 
the decision to prosecute two wars. He said to me that two wars cost us 
about $1 trillion, too, didn't it, Mr. Congressman? I said, Yeah. He 
said, Okay. Medicare 10 years ago was fine, revenues exceed expenses. 
Now we've got tax cuts for millionaires and billionaires, $1 trillion 
dollars; two wars, $1 trillion; and then there was this big crash on 
Wall Street where we lost revenues and we had bigger expenses. That was 
a couple trillion dollars, wasn't it, sir? I said, Yeah, that's about 
right. And he said, So why--that turned our budget upside down. So now 
why are we focusing on Medicare? Why blame Medicare for $4 trillion of 
losses to the United States? It wasn't Medicare that is harming the 
financial success of this country. So why all the blame when this 
program really has been working for seniors for so long?
  So I would say to my friends on the Republican side of the aisle, 
this is a program that my friends haven't liked since its inception. 
This is a program that Republicans haven't liked from its inception.
  So to turn the target into Medicare and not say to have tax cuts for 
millionaires and billionaires, that that should be part of the whole 
equation of balancing our budget, or taking away the incentives and all 
of the tax benefits for oil companies at $100 a barrel but say, no, 
we're going to focus on Medicare, in my opinion, that's just wrong.
  Mr. GINGREY of Georgia. Will the gentleman yield?
  Mr. PERLMUTTER. I yield to the gentleman from Georgia.
  Mr. GINGREY of Georgia. I appreciate the gentleman from Colorado, my 
good friend, for yielding.
  I would just rhetorically ask, and maybe he would like to 
definitively answer, how much of the windfall profit taxes, if you 
will, against Big Oil, Big Pharma, big anything, are you going to put 
back into the Medicare program? And, by the way, how much of the 
Medicare Advantage cuts that came from ObamaCare are actually going 
back into the Medicare program as we know it?
  Mr. PERLMUTTER. Reclaiming my time, I would say to my friend from 
Georgia, do you know what? If those tax benefits are taken away at $100 
a barrel, we can put them into Medicare. We can use them to balance the 
budget. But I heard my other friend from Georgia say, well, this is 
what's causing the bankruptcy.

                              {time}  1800

  That is just not true. This country was running a surplus, for 
goodness sake, and Americans understand that. They know what got us 
into trouble financially, and it wasn't Medicare. So now to take it out 
of Medicare and just take it out of our senior citizens where a program 
is actually working, the goal of that program is so Americans could 
live longer, healthier lives in their senior years. It's working. But 
no, let's go blame that instead of the tax cuts for millionaires and 
billionaires. Let's forget about those wars and the cost to the 
country, and let's forget about the fact that we had a crash on Wall 
Street.
  My friends on the Republican side of the aisle say: Hey, this is a 
perfect time to go after Medicare. We didn't like it before, we still 
don't like it; let's get it.
  With that, I yield back the balance of my time.
  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, proceedings 
will now resume on those amendments----


                             Point of Order

  Mr. WEINER. Madam Chair, I rise to a point of order.
  The Acting CHAIR. The gentleman will state his point of order.
  Mr. WEINER. Madam Chair, under the rule, Members are entitled to 5 
minutes to speak to the matter at hand. Members are waiting; 
principally among them is myself waiting at the microphone to be 
recognized for that purpose. And now it sounds like you are proceeding 
to shut down debate. I say that it is in violation of the order of the 
House, as decided by the Rules Committee, to permit Members to speak 
for 5 minutes on this matter. It is early in the evening, and many 
Members are waiting to speak.
  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, the Chair may 
resume proceedings on a postponed question at any time, even while 
another amendment is pending.


                         Parliamentary Inquiry

  Mr. WEINER. Madam Chair, point of parliamentary inquiry.
  The Acting CHAIR. The gentleman will state his parliamentary inquiry.
  Mr. WEINER. So the Chair is deciding, notwithstanding the fact that a 
Member is standing here to speak about the plan to end Medicare, not to 
mention Members are here seeking to be recognized, I believe of both 
parties, the Chair is choosing at this moment that this is the 
propitious moment to cut off debate, early in the evening when we have 
plenty of work to do and Members seek to speak and offer amendments?
  Is the Chair deciding arbitrarily, or was she given guidance to do 
this by the Republican leadership who don't want to hear any more 
critique of their plans to end Medicare?
  The Acting CHAIR. The Chair is exercising her discretion to resume 
proceedings on a postponed question at any time.
  Pursuant to clause 6----
  Mr. WEINER. * * *
  The Acting CHAIR. The gentleman is not recognized.

[[Page H3386]]

  Pursuant to clause 6 of rule XVIII, proceedings will now resume on 
those amendments printed in the Congressional Record on which further 
proceedings----


                             Motion to Rise

  Mr. WEINER. Madam Chair, I move that the Committee do now rise.
  The Acting CHAIR. The question is on the motion to rise.
  The question was taken; and the Acting Chair announced that the noes 
appeared to have it.


                             Recorded Vote

  Mr. WEINER. Madam Chair, I demand a recorded vote.
  A recorded vote was ordered.
  The Acting CHAIR. Following this 15-minute vote, proceedings will 
resume on those amendments printed in the Congressional Record on which 
further proceedings were postponed, in the following order:
  Amendment No. 2 by Mr. Tonko of New York.
  Amendment No. 9 by Mr. Cardoza of California.
  The Chair will reduce to 5 minutes the minimum time for any 
electronic vote after the first vote in this series.
  The vote was taken by electronic device, and there were--ayes 14, 
noes 397, not voting 20, as follows:

                             [Roll No. 335]

                                AYES--14

     Capuano
     Cleaver
     Conyers
     Frank (MA)
     Green, Gene
     Johnson (IL)
     Kucinich
     Lee (CA)
     Miller, George
     Payne
     Schakowsky
     Watt
     Waxman
     Weiner

                               NOES--397

     Ackerman
     Adams
     Aderholt
     Akin
     Alexander
     Altmire
     Amash
     Andrews
     Austria
     Baca
     Bachmann
     Bachus
     Baldwin
     Barletta
     Barrow
     Bartlett
     Barton (TX)
     Bass (CA)
     Bass (NH)
     Becerra
     Benishek
     Berg
     Berkley
     Berman
     Biggert
     Bilbray
     Bilirakis
     Bishop (GA)
     Bishop (NY)
     Bishop (UT)
     Black
     Blackburn
     Blumenauer
     Bonner
     Bono Mack
     Boren
     Boswell
     Boustany
     Brady (PA)
     Brady (TX)
     Brooks
     Broun (GA)
     Brown (FL)
     Buchanan
     Bucshon
     Buerkle
     Burgess
     Burton (IN)
     Butterfield
     Calvert
     Camp
     Campbell
     Canseco
     Cantor
     Capito
     Capps
     Cardoza
     Carnahan
     Carney
     Carson (IN)
     Carter
     Cassidy
     Castor (FL)
     Chabot
     Chaffetz
     Chandler
     Chu
     Cicilline
     Clarke (MI)
     Clarke (NY)
     Clay
     Clyburn
     Coble
     Coffman (CO)
     Cohen
     Cole
     Conaway
     Connolly (VA)
     Cooper
     Costa
     Costello
     Courtney
     Cravaack
     Crawford
     Crenshaw
     Critz
     Crowley
     Cuellar
     Culberson
     Cummings
     Davis (CA)
     Davis (IL)
     Davis (KY)
     DeFazio
     DeGette
     DeLauro
     Denham
     Dent
     DesJarlais
     Deutch
     Diaz-Balart
     Dicks
     Dingell
     Doggett
     Dold
     Donnelly (IN)
     Doyle
     Dreier
     Duffy
     Duncan (SC)
     Duncan (TN)
     Edwards
     Ellison
     Ellmers
     Emerson
     Engel
     Eshoo
     Farenthold
     Farr
     Fattah
     Fincher
     Fitzpatrick
     Flake
     Fleischmann
     Fleming
     Flores
     Forbes
     Fortenberry
     Foxx
     Franks (AZ)
     Fudge
     Gallegly
     Garamendi
     Gardner
     Garrett
     Gerlach
     Gibbs
     Gibson
     Gingrey (GA)
     Gohmert
     Gonzalez
     Goodlatte
     Gosar
     Gowdy
     Granger
     Graves (GA)
     Graves (MO)
     Green, Al
     Griffin (AR)
     Griffith (VA)
     Grijalva
     Grimm
     Guinta
     Guthrie
     Gutierrez
     Hall
     Hanna
     Harper
     Harris
     Hartzler
     Hastings (FL)
     Hayworth
     Heck
     Heinrich
     Hensarling
     Herger
     Herrera Beutler
     Higgins
     Himes
     Hinchey
     Hinojosa
     Holden
     Holt
     Honda
     Hoyer
     Huelskamp
     Huizenga (MI)
     Hultgren
     Hunter
     Hurt
     Inslee
     Israel
     Issa
     Jackson Lee (TX)
     Jenkins
     Johnson (GA)
     Johnson (OH)
     Johnson, E. B.
     Johnson, Sam
     Jones
     Jordan
     Kaptur
     Keating
     Kelly
     Kildee
     Kind
     King (IA)
     King (NY)
     Kingston
     Kinzinger (IL)
     Kissell
     Kline
     Labrador
     Lamborn
     Lance
     Landry
     Lankford
     Larsen (WA)
     Larson (CT)
     Latham
     LaTourette
     Latta
     Levin
     Lewis (CA)
     Lewis (GA)
     Lipinski
     LoBiondo
     Loebsack
     Lofgren, Zoe
     Lowey
     Lucas
     Luetkemeyer
     Lujan
     Lummis
     Lungren, Daniel E.
     Lynch
     Mack
     Maloney
     Manzullo
     Marchant
     Marino
     Matheson
     Matsui
     McCarthy (CA)
     McCaul
     McClintock
     McCollum
     McCotter
     McDermott
     McGovern
     McHenry
     McIntyre
     McKeon
     McKinley
     McNerney
     Meehan
     Meeks
     Mica
     Michaud
     Miller (FL)
     Miller (MI)
     Miller (NC)
     Miller, Gary
     Moran
     Mulvaney
     Murphy (CT)
     Murphy (PA)
     Myrick
     Nadler
     Napolitano
     Neal
     Neugebauer
     Noem
     Nugent
     Nunes
     Nunnelee
     Olver
     Owens
     Palazzo
     Pallone
     Pascrell
     Paul
     Paulsen
     Pearce
     Pelosi
     Pence
     Perlmutter
     Peters
     Peterson
     Petri
     Pitts
     Platts
     Poe (TX)
     Polis
     Pompeo
     Posey
     Price (GA)
     Price (NC)
     Quayle
     Quigley
     Rahall
     Rangel
     Reed
     Rehberg
     Reichert
     Renacci
     Reyes
     Ribble
     Richardson
     Richmond
     Rigell
     Rivera
     Roby
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Rokita
     Rooney
     Ros-Lehtinen
     Roskam
     Ross (AR)
     Ross (FL)
     Rothman (NJ)
     Roybal-Allard
     Royce
     Runyan
     Ruppersberger
     Rush
     Ryan (OH)
     Ryan (WI)
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Scalise
     Schiff
     Schilling
     Schmidt
     Schock
     Schrader
     Schwartz
     Schweikert
     Scott (SC)
     Scott (VA)
     Scott, Austin
     Scott, David
     Sensenbrenner
     Serrano
     Sessions
     Sherman
     Shimkus
     Shuler
     Shuster
     Simpson
     Sires
     Slaughter
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Smith (WA)
     Southerland
     Speier
     Stark
     Stearns
     Stivers
     Stutzman
     Sullivan
     Terry
     Thompson (CA)
     Thompson (MS)
     Thompson (PA)
     Thornberry
     Tiberi
     Tierney
     Tipton
     Tonko
     Towns
     Tsongas
     Turner
     Upton
     Velazquez
     Visclosky
     Walberg
     Walden
     Walsh (IL)
     Walz (MN)
     Wasserman Schultz
     Waters
     Webster
     Welch
     West
     Westmoreland
     Whitfield
     Wilson (FL)
     Wilson (SC)
     Wittman
     Wolf
     Womack
     Woodall
     Woolsey
     Wu
     Yarmuth
     Yoder
     Young (AK)
     Young (FL)
     Young (IN)

                             NOT VOTING--20

     Braley (IA)
     Filner
     Frelinghuysen
     Giffords
     Hanabusa
     Hastings (WA)
     Hirono
     Jackson (IL)
     Langevin
     Long
     Markey
     McCarthy (NY)
     McMorris Rodgers
     Moore
     Olson
     Pastor (AZ)
     Pingree (ME)
     Sewell
     Sutton
     Van Hollen

                              {time}  1830

  Messrs. PERLMUTTER, GOHMERT, ACKERMAN and LEWIS of Georgia, Mrs. 
HARTZLER, Ms. HERRERA BEUTLER, Ms. GRANGER and Ms. SLAUGHTER changed 
their vote from ``aye'' to ``no.''
  So the motion to rise was rejected.
  The result of the vote was announced as above recorded.
  Stated against:
  Mr. FILNER. Madam Chair, on rollcall 335, I was away from the Capitol 
region attendng the Civil Rights Freedom Riders' 50th Anniversary 
Celebration. Had I been present, I would have voted ``no.''


                  Amendment No. 2 Offered by Mr. Tonko

  The Acting CHAIR. The unfinished business is the demand for a 
recorded vote on the amendment offered by the gentleman from New York 
(Mr. Tonko) on which further proceedings were postponed and on which 
the noes prevailed by voice vote.
  The Clerk will redesignate the amendment.
  The Clerk redesignated the amendment.


                             Recorded Vote

  The Acting CHAIR. A recorded vote has been demanded.
  A recorded vote was ordered.
  The Acting CHAIR. This will be a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 186, 
noes 231, not voting 14, as follows:

                             [Roll No. 336]

                               AYES--186

     Ackerman
     Andrews
     Baca
     Baldwin
     Barrow
     Bass (CA)
     Becerra
     Berkley
     Berman
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Boren
     Boswell
     Brady (PA)
     Brown (FL)
     Butterfield
     Capps
     Capuano
     Cardoza
     Carney
     Carson (IN)
     Castor (FL)
     Chandler
     Chu
     Cicilline
     Clarke (MI)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly (VA)
     Conyers
     Costa
     Costello
     Courtney
     Critz
     Crowley
     Cuellar
     Cummings
     Davis (CA)
     Davis (IL)
     DeFazio
     DeGette
     DeLauro
     Deutch
     Dicks
     Dingell
     Doggett
     Donnelly (IN)
     Doyle
     Edwards
     Ellison
     Engel
     Eshoo
     Farr
     Fattah
     Frank (MA)
     Fudge
     Garamendi
     Gibson
     Gonzalez
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hanna
     Harris
     Hastings (FL)
     Heinrich
     Higgins
     Himes
     Hinchey
     Hinojosa
     Hirono
     Holden
     Holt
     Honda
     Hoyer
     Inslee
     Israel
     Jackson Lee (TX)
     Johnson (GA)
     Johnson, E. B.
     Jones
     Kaptur
     Keating
     Kildee
     Kind
     Kissell
     Kucinich
     Langevin
     Larsen (WA)
     Larson (CT)
     Lee (CA)
     Levin
     Lewis (GA)
     Lipinski
     Loebsack
     Lofgren, Zoe
     Lowey
     Lujan
     Lynch
     Maloney
     Markey
     Matheson
     Matsui
     McCollum
     McDermott
     McGovern
     McIntyre
     McNerney
     Meeks
     Michaud
     Miller (MI)
     Miller (NC)
     Miller, George
     Moore
     Moran
     Murphy (CT)
     Nadler
     Napolitano
     Neal
     Olver
     Owens
     Pallone
     Pascrell
     Payne
     Pelosi
     Perlmutter
     Peters
     Peterson
     Polis
     Price (NC)
     Quigley
     Rahall
     Rangel
     Reyes
     Richardson

[[Page H3387]]


     Richmond
     Ross (AR)
     Rothman (NJ)
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schiff
     Schrader
     Schwartz
     Scott (VA)
     Scott, David
     Serrano
     Sewell
     Sherman
     Shuler
     Sires
     Slaughter
     Smith (WA)
     Speier
     Stark
     Sutton
     Thompson (CA)
     Thompson (MS)
     Tierney
     Tonko
     Towns
     Tsongas
     Van Hollen
     Velazquez
     Visclosky
     Walz (MN)
     Wasserman Schultz
     Waters
     Watt
     Waxman
     Weiner
     Welch
     Wilson (FL)
     Woolsey
     Wu
     Yarmuth

                               NOES--231

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

                             NOT VOTING--14

     Braley (IA)
     Carnahan
     Filner
     Frelinghuysen
     Giffords
     Hanabusa
     Hastings (WA)
     Jackson (IL)
     Long
     McCarthy (NY)
     Pastor (AZ)
     Pingree (ME)
     Smith (NJ)
     Webster


                    Announcement by the Acting Chair

  The Acting CHAIR (during the vote). There are 2 minutes remaining in 
this vote.

                              {time}  1838

  So the amendment was rejected.
  The result of the vote was announced as above recorded.
  Stated for:
  Mr. FILNER. Madam Chair, on rollcall 336, I was away from the Capitol 
region attending the Civil Rights Freedom Riders' 50th Anniversary 
Celebration. Had I been present, I would have voted ``aye.''


                 Amendment No. 9 Offered by Mr. Cardoza

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


                             Recorded Vote

  The Acting CHAIR. A recorded vote has been demanded.
  A recorded vote was ordered.
  The Acting CHAIR. This will be a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 182, 
noes 232, not voting 17, as follows:

                             [Roll No. 337]

                               AYES--182

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

                               NOES--232

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

[[Page H3388]]



                             NOT VOTING--17

     Braley (IA)
     Duncan (TN)
     Filner
     Frelinghuysen
     Giffords
     Hanabusa
     Hastings (WA)
     Israel
     Jackson (IL)
     Johnson, Sam
     Jones
     Long
     McCarthy (NY)
     Pastor (AZ)
     Pingree (ME)
     Turner
     Whitfield


                    Announcement by the Acting Chair

  The Acting CHAIR (during the vote). There are 2 minutes remaining in 
this vote.

                              {time}  1845

  So the amendment was rejected.
  The result of the vote was announced as above recorded.
  Stated for:
  Mr. FILNER. Madam Chair, on rollcall 337, I was away from the Capitol 
region attending the Civil Rights Freedom Riders' 50th Anniversary 
Celebration. Had I been present, I would have voted ``aye.''
  Stated against:
  Mr. TURNER. Madam Chair, on rollcall No. 337, I was unavoidably 
detained and did not vote. Had I been present, I would have voted 
``no.''
  Mr. GUTHRIE. Madam Chairman, I move that the Committee do now rise.
  The motion was agreed to.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Womack) having assumed the chair, Mrs. Capito, 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. 1216) to 
amend the Public Health Service Act to convert funding for graduate 
medical education in qualified teaching health centers from direct 
appropriations to an authorization of appropriations, had come to no 
resolution thereon.

                          ____________________