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tv   Energy and Commerce Committee Markup of Affordable Care Act Replacement...  CSPAN  March 9, 2017 9:57am-2:11pm EST

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we will continue with our live coverage of the health care coverage markup of the committee. the committee began the work on the markup yesterday at 10:30 and continued through the night. live c-span coverage. >> it's showing. i think we all need to take a very deep breath. i think you have done right thing by apologizing for what he said. i'm equally proud this committee
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has had two of its strongest members, one on the republican side, the chair, the republican congressional campaign committee. the other on our side. but we're talking about a health care bill. and we all worship at the altar of our veterans. but i worship at the altar of all of the american people as well. they are in service to our country. the debate about health care and how this legislation is going to affect them has been the debate for 24 hours. so, you know, i -- it seems to me that -- i wish there were more that felt the sense of
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rawness over what might become of people with a per capita cap, at least in my view. let's just take a deep breath and be respectful of one another. all right? let's not let this leave this room with a bitterness or bitter cloud hanging over it. we're better than that. i'd be happy to yield the rest of my time to mr. luhan. >> thank you. i very much respect the words of mr. mullins and mr. schimkis. i do not have the words and courage to put on the uniform like millions of others, like my grandfather who served in world war ii and others. i know that. i'm also a representative that
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also believes like you we should fight for our veterans and we should give to that commitment. i apologize i did not submit it respectfully earlier in the day. you are absolutely correct, sir. it was submitted two hours ago. may have been longer. it is not a long read. you are absolutely correct. if you read the proper investigati provision of the legislation, it doesn't take effect that this result in reduced access and care for veterans. that is all it says. and so, again, i apologize if i insulted my colleagues who have served. that's not what this is about. i have the floor at this time. i will in just a second, sir. again, i respect the words of my colleagues here. i certainly hope none of us take away another responsibility to stand up and fight for veterans
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who i clearly know freedom is not free and ultimate price is often paid in many ways. >> can i reclaim my time? >> i will yield back. >> i would like to add something else to this that i just thought of. for the last 24 hours, we have been going amendment by amendment and we have spoken of on both sides of the aisle about particular populations in our country. we talked about women that are pregnant. we talked about the disabled. we talked about the elderly. we talked about those that are in long-term care or may need some day to go into long-term care. we talked about those that need mental health services. in this case, veterans. so, i think that, you know, that is the community of america.
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and there are special needs in each one of those communities of interest for a variety of reasons. the health services that one group really needs, another group needs another type of service. so, i hope that we can keep that in mind and let's stay on a very respectful plane. with that, i will yield back my nine seconds. >> the lady yields back. the chair recognizes the gentleman from pennsylvania. mr. murphy. going in seniority. >> i would like to strike the last word. i will yield to my veterans. i want to associate myself with the words of colonel schimkis.
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a lot is being said and done here, but more is said than done in the committee. i agree with him. when things like this are put out, i do not believe it is done in earnest to say let's help veterans. that is why we have a veterans administration. but the whole purpose of much of this despite what people said, let's work together. there is the affordable care act. i have not seen an amendment to say let's fix it. i have seen let's stick it to the other side. i am offended to use veterans this way. i did not join until a member of congress. i did it because i felt the navy needed psychologists. one of the things for people serving appreciate is simply being quietly appreciated to make sure they have service available.
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they don't appreciate people using them for political purposes. i know you apologized for some of the mood he had, but he didn't apologize for what he said. that is important. i would like to yield now to -- i guess i'll go to mr. olson and mr. kensinger. >> i thank my friend pennsylvania. what my colleague from new mexico to know he didn't just hurt veterans. he hurt veterans' families. >> mr. chairman? >> i deployed six months out of hawaii. the second time, i left my new bride at home after seven months of being married. i left for six months. i could not call. no internet at that time. 1994. she was alone. she just moved there. i left her for seven months.
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while i was flying in the persian gulf, we had fire control radar telling us they are tracking us and could shoot us down. i came home safely. i was home less than two weeks. they sent me to d.c. right before christmas. my wife who hadn't seen me for seven months had to more our family and furniture all by herself. all across the pacific. all across the country to washington, d.c. families make such sacrifices for veterans. men and women. your comments today hurt not just me, my wife and every veteran and every family members. we do this because we love our country. not because we want to claim some health care benefits. we love america so much we want to defend her. my friend, i accept your apology, but it was wrong what
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you said. i would like to yield to mr. kensinger. >> thank you. although you are navy, i'm proud to follow you. >> that hurt. >> i get it. let's be honest. this is a messaging amendment. i think we all probably have done something similar and messaging amendment. let's protect baby formula. if you vote against it, you are against baby formula. whatever that is. being a veteran doesn't necessarily make you right in every opinion. nobody argues. veterans on the other side of the aisle on our side of the aisle. i think both sides love veterans. that's a fact. democrats love veterans and republicans do. we respect the service. the only thing i would caution against and i'm not particularly angry about this, but i would caution against saying whenever you throw veterans into something like this, it can be seen as using them as a tool.
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look, these are folks who sacrificed a lot for the country. i would not just in this case, but frankly the next 19 months going forward to the election, there may be legitimate issues veterans use if it is a department of defense or v.a. bill. on messaging things like, this i would discourage both sides of the aisle from using this in the future. with that, i yield back. >> i would just suggest for the sake of comedy and mood in the committee, i would request the gentleman withdraw the amendment. i field bacyield back. >> just a second. i was with governor scott. i apologize for not being here. >> i have a point of order. >> you know, kids, i'm gone for five minutes. w whose time? >> i have a point of order, mr.
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chairman. >> i believe it's mr. murphy's time which has now run out. you seek a point of order. >> yes, sir. under rule 17 of the house rules. it is against the rules to characterize a member's motives or intentions. the last two speakers both questioned mr. lujan's motives for bringing up the amendment. i've got to say, i would move to take their words down, but it has been now almost 24 hours. i don't think that's a very good use of our time. i would caution the members of this and i would ask them to please apologize to mr. lujan and keep their comments toward the substance of his amendment. both of the last two speakers said he was doing this for political reasons. >> all right. if i could respond to the point.
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i appreciate. if we can have -- settle down. i appreciate. i did not hear any of it. let me start with that. i appreciate -- i know that. i appreciate the fact we have been here now almost 24 hours. tempers are fraying a little. we're all a little tired. so the extent of which we can move on from here and i believe mr. lujan is not asking for an apology if i read. if he is okay with that and we'll try and -- all of us take a breath -- >> i will tell you if someone else on your side does that, i will move to take their words down. they are questioning his motives. i think you can argue with the amendment just like you did all the other ones. i'm serious here. >> i know the seriousness of the members. i appreciate that. all right. i think we're on this side.
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have you been recognized, frank? i'll go to the ranking member. mr. palone. you are recognized for five minutes on the amendment. >> thank you, mr. chairman. i would hope that the gentleman would not withdraw his amendment because i think it is an important amendment. i don't question his motives. look, the bottom line is as we know although this committee doesn't have jurisdiction over the v.a. or v.a. hospitals, the fact of the matter is there are many veterans because they are not service connected or the v.a. hospital is not close by cannot take advantage of the v.a. health care system. so they go to, you know, they take advantage of medicaid if they are eligible. they may go on the exchange and buy insurance through the exchange. all the things that we're discussing with the affordable care act apply to veterans given
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the circumstance as well as spouses. i think it is very important to have the amendment in order because we want to make sure that veterans like any other group or any other particular group are not impacted by changes that might be made to the aca that are detrimental to them or detrimental to the larger population. i heard mr. murphy say the democrats aren't talking about how to fix it. the fact of the matter is, we think the aca is working. we think it has actually covered tremendous amount of people. up to 95% of the people. has health insurance. we think it has resulted in affordable premiums because of the subsidies in place. we think it has provided better benefits and health care. we are not saying it should be fixed. you are the ones with the legislation are suggesting and the president has suggested that all kinds of wonderful things
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are going to happen to improve the aca because of the legislation. i think we spent the last 24 hours clearly saying we don't agree. we think fewer people will be insured and we think premiums will go up and insurance is less affordable. we think benefits will be reduced. we see all terrible things happening with the legislation put forward. don't suggest it is our obligation to fix it. we feel the affordable care act has done a good job. with regard to the veterans, they are subject to the same problems if their insurance premiums go up because of the legislation before us. if they are not eligible for medicaid expansion because of the legislation that's before us, if they become uninsured because of the legislation before us, mr. lujan is saying we don't want them to be negatively impacted. i don't know why that is different from what most of what
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we have been saying for the last 24 hours. we feel this legislation is going to be very destructive to a lot of americans and veterans, hopefully not. i think his amendment is very much in order. i would hope he would pursue it. i urge my colleagues to support it. >> would the gentleman yield for a question? >> yes. >> i will ask the ranking member or author. in the opening statement, the author of the amendment said potentially 66,000 veterans and 35,000 spouses that might be covered. do you have any idea actually would be impacted? as mr. palone pointed out, you have to be a veteran who was not employed after he got out and not service connected and not eligible for medicare, but low income and you were eligible for medicaid. out of that potential pool, do you have any data on how many
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people actually? >> i do have this information with regard to the non expansion states which would include texas. in the non expansion states, 66,000 veterans and 35,000 spouses with incomes between 100% and 138% of the poverty line who qualify for insurance through the marketplace if they don't have access to affordable employer-sponsored insurance. you don't have a cbo score here. we have been asking for 24 hours we should not proceed. you don't have a cbo score. as a result, the cbo hasn't indicated -- >> what is the source of the data you did use? >> the source of the data i gave you is the -- let's see. it looks like a document by jennifer haley called infante
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shou uninsured veterans and families members. >> who might those stellar individuals be? >> all mr. lujan is saying is veterans may be impacted. we have been saying for last 24 hours, a lot of people may be impacted. we are concerned what you are doing for veterans and seniors and children. there is nothing new here about what we're saying. i know you think you are doing a great thing, but you're not. that's the point. >> pardon me. the gentleman's time has expired. are there other members seeking recognition on this amendment? mr. butterfield. recognized. strike the last word on the amendment. >> thank you, mr. chairman. i won't take the full five minutes. i thank you, mr. kesinger for your remarks. there is not a single person who doesn't support our veterans. the sad part about it is in the
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non expansion states such as south carolina and texas, these states have failed to expand the medicaid program. our veterans who fought our country have been left on the sidelines and not able to get health insurance in the expansion states. mr. palone is correct. in the non expansion states, there are 66,000 veterans and 35,000 spouses with incomes between 100% and 138% of the federal poverty line who qualify to purchase through the marketplace if they don't have access to employer-sponsored insurance. only qualify if their stayed were to expand. another stat. 2/3 of veteran spouses have incomes below 100% of the federal poverty line. they are only eligible if their
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state expands medicaid. colleagues, if we are really concerned about veterans, let's join in a bipartisan way and expand medicaid to benefit from the coverage. thank you. i yield back. >> other members seeking recogniti recognition? seeing none, the clerk will call the roll. i'm sorry. who is seeking recognition? mr. greene. has he already spoken? he has not. gentleman is recognized for five minutes. he yields to mr. lujan. >> chairman, thank you. thank you, mr. greene. look, i know when i go home, i'll be able to look the veterans that i represent in the eye and tell them i used every tool i could as well. on the committees that i represent in communities like new mexico. mr. chairman, i respectfully
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take heart to what dr. murphy said with asking me to withdraw that amendment. if i did that, i could not go home and look my veterans in the eye. i wanted to explain. >> will the gentleman yield for one second? veterans don't like to be used. i yield back. he allowed me the time. i'm not screaming. i'm just saying. >> the gentleman has yield ld back his time. >> mr. chairman? if you really need -- wait. we'll recognize you in regular order. the gentleman seeks five minutes to speak. strike the last word and speak on the amendment. >> i would like to yield if he would like the time. >> no, i'm done. >> i yield back.
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>> gentleman yields back. the ranking member asks for a roll call. clerk will call the roll. >> mr. barton. mr. upton. mr. schimkiss. mr. murphy. mr. burgess. mrs. blackburn. mr. scalis. mr. lauda. mrs. morris rogers. mr. harper. mr. lance. mr. guthrie. mr. olsen. mr. mckinley. mr. kinsinger. mr. griffith.
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mr. bilarakis. mr. johnson. mr. long. mr. buchand. mr. flores. mrs. brooks. mr. mullen. mr. hudsen. mr. collins. mr. kreimer. mr. walberg. mrs. walters. mr. costello. mr. carter. mr. palone. mr. palone votes aye. mrs. eschoo.
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votes aye. mr. doyle. mr. doyle votes aye. mr. butterfield. mr. butterfield votes aye. mr. sarbanes. mr. mcnerney. mr. lujan. mr. lujan votes aye. mr. tonka. mr. tonka votes aye. mr. kennedy. mr. kennedy votes aye. mr. cardenas. mr. cardenas votes aye. mr. peters. mr. peters votes aye.
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chairman? >> i vote no. are there members who are not recorded who wish to be recorded? >> mr. mcnerney? votes aye. >> any other members? is mr. engel on his way? mr. welsh? >> he is repocorded. >> mr. engel. perfect. >> mr. engel votes aye. >> okay. now the clerk will report the tally. >> mr. chairman, on that vote, 23 ayes and 29 nos. >> 23-29. the amendment is not adopted.
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are there further amendments for consideration? the gentleman from texas seeks recognition. for what purpose? >> strike the last word. amendment at the desk. number 128. >> number 128. let's let the clerks find the amendments so we're all on the same page. the clerk will report the amendment. >> amendment to the amendment to the sub nature. >> dispensed with reading. the chair recognizes his friend from texas to speak on his amendment for five minutes. >> thank you, mr. chairman and members. this amendment i heard for the last this hourhours. i'm asking for flexibility. this would he ceffectively end
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medicaid expansion. you offered to low income adult was incomes up to 138% of federal poverty level. 31 states and district of columbia expanded medicaid programs, but a number of states, including texas, has not. almost 50,000 of my constituents who would otherwise have medicaid remain uninsured. for states that took up the option, the federal government covered 100% of the cost for the first three years. the house plan would end me medicaid expansion in 2020. this means the americans who gain access to medicaid through aca would lose it. this strikes the medicaid expansion and replace with the billy introduced in congress and allow states to have yet to expand medicaid get three years of the federal match. so, the states that didn't join,
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texas, florida, north carolina would have a chance to do that. mr. chairman, i'll be glad to yield to my colleague from north carolina. >> thank you. thank you for offering this an men amendment. under this legislation, colleagues, we must ensure states are able to continue mead kad program and enable states to receive the full amount of federal funding for the expansion that we passed seven years ago. under the harmful bill, medicaid expansion would be curbed and new states would not expand after the year 2020. my constituents support north carolina governor cooper to expand medicaid. i represent one of the poorest districts in the country where nearly 1 in 4 live in poverty.
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my constituents would greatly benefit from medicaid. representative greene's amendment would preserve medicaid expansion and provide full funding in the aca for new states that choose to expand. north carolina already receives this through taxes and should be able to receive medicaid. this amendment would enable my governor and other governors to continue to pursue medicaid expansion. thank you for your timely amendment. i support it. i ask colleagues to vote aye. i yield back. >> to continue on my time, mr. chairman. these states that didn't do it may not do it. it will give the governors and state legislation and in texas in session right now, to see if they want to cover these folks. like the other 31 jurisdiction did.
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that's all we're asking. the flexibility for the states who did not make the decision. give them time to realize like in my case, almost 50,000 of my constituents would get medicaid if expanded. with that, i'll be glad to yield back my time and ask for a yes vote. >> the gentleman yields back his time. the chair recognizes another gentleman from texas. the chair of the sub committee on health. dr. burgess. >> i thank the chairman for yieldi yielding. mr. chairman, the balance that the sub committee is -- or full committee is striking with expansion and non expansion states gives both expansion and non expansion states the tools they need to manage their health care markets. the current proposal would grandfather all medicaid
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enrollees enrolled in the expansion population as of december 31st, 2019. those people would stay in the program. after that date, expansion states could continue to keep the enhanced map under current law for those grandfathered enrollees as long as these individuals remain on the program. this is a significant improvement for non expansion states from the reconciliation bill passed in december of 2015. if a state keep s an expansion program beyond 2020, they will receive the federal matching rate for new expansion enrollee determined eligible and enrolled in the program on or after the date. this is fiscally responsible and fair. ensuring the proposal does not suddenly discontinue anyone
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while also ending the obamacare expansion that unfairly prioritizes able-bodied working adults over the most vulnerable. when the aca passed in 2010, current law, the aca passed in 2010 and it repeals payments from share hospitals because, of course, everyone at the time felt medicaid expansion would meet the needs of every hospital. we know the medicaid expansion was deemed unconstitutional. in comparison, we line up the restoration with the kutsz for expansion states at the same time that the grandfathering policy begins. january 1st, 2020. ensuring party between expansion and non ex-pans states. also expansion states just likes non expansion will be given the
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state flexibility fund. before the aca were program specific limiting the local officials to meet the unique needs of diverse communities. this fund will help repair states damaged by the aca. again, under current, in non expansion states, the share funds are scheduled to be reduced on october 1st of this year of 2017. in non expansion states, a restoration of those disproportionate funds so those ki cuts will not occur in the states that did not expand medicaid. for all the talk of helping patients, i have not heard articulation why the other side thinks it is fair for the federal government to pay 90% for the cost of care for low
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income able bodied adults above the poverty line while paying a fraction of that for traditional medicaid populations. the medicaid expansion is unfair prioritizes able bodied adults over those for whom medicaid was designed in the first place. the base bill would write disparity by allowing states to maintain medicaid for low income adults, but do so in an equitable manner. i'll be happy to yield. >> gentleman yields back the balance of his time. i recognize the ranking member mr. palone for five minutes. strike the last word. >> thank you, mr. chairman. the medicaid expansion has been overwhelming success providing insurance to 13 million people in 31 states and district of columbia who could not afford
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coverage and remained uninsured. those individuals who have enrolled have been overwhelmingly satisfied with coverage with 86% of new enrollees optimistic about the health insurance ability to help them access the care they need. expansion has also been a benefit to the health care system in generals le leading t $1,000 per person reduction in dead a debt and reducing the care by $10,000 for hospitals. rolling back medicaid expansion would do great harm to patients and hospitals and budgets. states expanding medicaid generate savings and revenue to use to finance other state initiatives. those same states have benefitted from the increase of jobs in the health care sector. for all these reasons that i support the amendment offered by mr. greene which would repeal the rollback of medicaid
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expansion in the gop bill today and incentivize to expand medicaid program. when we passed the aca, the idea is expand every state with medicaid. that hasn't been the case. it is something we like to do. a lot of talk about what can be done to improve the aca. this incentive program that mr. greene proposing is one way to do that. contrary to all the concerns we have about the republican bill here and republican replacement bill. this is something we know will increase the number of people insured. we are up to 95% insured because of the forwaaffordable care act. i think there are still 4 million individuals who could gain access to health care coverage if the additional 19 states used the incentive to expand medicaid.
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i want to take this home to dr. burgess. he may remember we went to the commonwealth fund seminar for a couple days in houston. i took a break from that one day and mr. greene and sheila jackson lee took us to the children's texas hospital at the texas medical center. we be monmoaned the fact of the texas children's hospital next to the emergency room. there were so many people waiting in line at the emergency room. many on cots and different things in the lobby of the beautiful facility waiting in the emergency room. we know a lot of those people would be eligible for medicaid expansion if only the state of texas would do what it should do and expand medicaid. the way to do that is to provide some sort of incentive. that's exactly what mr. greene is trying to do here. it is my hope that my republican
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colleagues, probably not support it, but i would urge the democrats to do so because we need to make the point that medicaid expansion is one way to incentivize is one way to make sure the goal -- i'd like to see 100% coverage. to add another 4 million people will make a difference in adding more people who are insured and eliminating a lot of people uninsured. i would urge passage of the amendment, mr. chairman. i don't know if anybody wants my time. mr. greene. >> thank you for yielding. for the next two years, these states, 19 of them, would have the opportunity to say we know that we could cover more people and they would be in the program just like the 31 who did accept it. now there is an issue because this bill actually requires states now to do six months
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re-signing people on medicaid. in texas, we have six months. congress member bartlett and i are trying to change that to a year. this does the six-month renewal. it gives the states who didn't do do it realize those could be covered. children and disabled and veterans. we have veterans in houston to get that coverage from the medicaid expansion. i thank my colleague. >> i yield back. >> gentleman yields back. chairman recognizes himself for five minutes. i was going to make the same point, mr. greene, that you just did. the states that did not expand still have the ability and right to do that. just as michigan expanded medicaid by passing through legislation through the statehouse and signed by the governor. michigan is now one of those 31
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states. the states that did not take advantage of that still have the ability to do it before january 1st, 2020. that is my understanding. is that correct? >> mr. chairman, if you yield. >> yield. >> i think we need actually allow -- >> couldn't taxes in a state still pass a bill? >> my goal with this is that -- tell the governor the door is closing. for the next three years, we could expand and fit in with everyone else. >> i think the governor knew the door was closing down to 90% anyway. it is not something new. they still have the ability to do that. let's face it. they are not probably likely to do that under the current. >> i don't think any state as you continue to yield. i don't think any state likes to leave money on the table. >> that, in fact, is what is
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happening. knowing they could pursue the same course that michigan did. what we have done in this bill, i think, has been a careful balance. we provided aperiod to allow the insurance companies who are no longer eligible under the 138% number. we are able to hold harmless those on there until they are off for whatever reason. whether they get a job or move to a different state. they are held harmless. and we reward the states like texas and florida and the other states that did not choose to expand by reversing and not allowing the cuts that would come into play which provides some balance and equity in that and therefore, because it is the right balance, my sense is that
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majority on this side of the aisle would oppose that provision. appreciate your interest. let me yield to my friend from colorado. >> thank you so much, mr. chairman. so, of course, what the greene amendment is addressing is the phase-out of the medicaid expansion in 2020. right now, the medicaid expansion covers 11 million people in 32 states and district of columbia. when you phase it out. what this repeal bill will do is it will break that commitment to our states. you might want to reset the clock. >> it's still my time. you asked me to yield. >> i asked to strike. >> it's still my time. >> okay. >> all right. i'll take back my time that i yielded to you. are there members on my side
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that would like to speak? with that, i yield back the balance of my time. strike the last word. >> sorry about that. it's been a long day. i won't, however, repeat what i just said. let me just say that my state of colorado is a good example. my state of colorado, people who are in the medicaid program will be in very bad shape if the repeal bill becomes law because we expanded medicaid in 2014. one of the original states to do it. since then, nearly 588,000 coloradoans have enrolled. after 2020, hundreds of thousands muthousand s of people will not have medicaid unless colorado comes up with the money. what the bill does it shifts $253 billion on to states under the provisions that gut the
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expansion alone. so to continue covering the expansion population, states are going to have to pay three to five times more than they do under the affordable care act. in colorado, our federal payment rate will drop by 40% for the expansion population. federal payments will be slashed to a similar extent. in california, new york, new jersey, illinois, pennsylvania, washington and other states. these are draconian cuts that our states cannot handle. that's why the governors are pleading with congress to keep the commitments on the expansion. for example, on january 24th, the national governors association wrote, quote, in considering changes to medicaid financing, it is kricritical th congress maintain a meaningful federal role in the partnership and does not shift costs on to states. if we gut the medicaid expansion, this also places extreme burden on hospitals.
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especially those in rural areas. this is one of many reasons why the american hospital association and virtually all of the major hospital groups have come out in opposition to the bill. so, you know, republicans in the senate are already figuring this out. my senator gardner, republican of colorado, joins senators portman in a letter to republican leadership opposing this approach. they said, quote, the draft proposal from the house does not meet the test of stability for individuals currently enrolled in the program. senator gardner knows that colorado is not going to be able to make up the difference. i want to talk about one more issue that dr. burgess talked about. the dish issue. the dish is not going to fix
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this. what this manager's amendment says for the non expansion states, they will get their dish restor restored. that is all well and good. also in section 115 of the manager's amendment. it gives safety net funding. it rewards those states that didn't take the medicaid expansion, but then for the states that did take the medicaid expansion, 39 of them, what it says is that the dish restoration will have a two-year delay. you are actually punishing states that have taken the medicaid expansion and that's not going to be acceptable. i'll yield to the vice ranking member the balance of my time. >> i want to thank miss degette on two things. the goal is for coverage for families across america.
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when you don't expand medicaid in some states, you are really missing out. then to build back to very inefficient system where you know you are always going to have some safety net funding. and disproportionate shares a wobbly formula. that is a very expensive inefficient system. the goal for everyone across the country is to have coverage. that's why a lot of the discussion has been about in committee. because of what is happening in the individual market doesn't serve families. the goal is coverage. not access. it's very expensive to provide health care to our folks who show up to the emergency room. those costs are shifts back on to people's employer-based health insurance. you think you might not be paying, but you are picking up a larger cost. i yield back. >> i yield back.
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>> mr. chairman. >> gentle lady yields back. i recognize mr. lance. strike the last word for five minutes. >> thank you. mr. chairman, i move to strike the last word. when the legislation went before the supreme court as everyone on committee knows, it was not to clear constitution under the commerce clause. there was the thought by the administration and by the solicitor general that it was constitutional based on the commerce clause. obviously this is the commerce committee. in the alternative, the solicitor general argued that it was constitution under the tax clause. that is why the law stood. but at the same time, the supreme court said as committee knows that the forced expansion of medicaid was
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unconstitutional. i thought at the time when the supreme court ruled that it was an internal tension and dichotomy that somehow eventually would result in the very fine discussion we're having today. i bet a friend of mine it would be declared unconstitutional under the commerce clause and we would rewrite. president obama said it was not a tax. that was the only way it was declared constitutional. as you know, it was a 5-4 vote. it seems to me it is unrealistic to think the states that did not expand medicaid would be willing ultimately to permit the rest of us, including new jersey, which expanded right away. i wish every state had done it. it is unrealistic to think that
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those states that did not expand would ultimately permit a 90% match. i think that is unfortunate. i wish every state expanded. including the great states of texas and florida and north carolina and the others. but the supreme court in an anomolous decision ruled it unconstitutional. ruled several paragraphs later that the forced expansion was unconstitutional. that is a dichotomy and tension that results in what we are trying to do today. we are obviously trying to be fair to both classification of states. in a perfect world, i would continue to see continued 90% payment to those states that expanded. including new jersey with a republican governor and democratic legislature. these are matters discussed in the senate by senator gardner
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and others. i believed as an attorney then and i believe this tension exists based on the inconsistent decision by the supreme court. not ruling under the commerce clause and saying states are not forced to expand. thank you. >> will the gentleman yield? >> yes, of course. >> i want to make the point that all of us look at this issue and there was a report today in roll call this morning. there are a number of republicans on obviously my side of the aisle that think, in fact, the provision in the underlining generous. they are looking to scale it back. that is why a number of us like the balance that's there and not only a period of transition grandfathering those that are on until they are naturally off and providing some assistance to
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states that in fact did not move forward on expanding medicaid. >> reclaiming my time. i am not one of those republicans. >> i know that. i'm saying there are a number of folks that would like to whittle this further down. we may have that vote at some point. maybe on this committee. maybe on the house floor. maybe in wherever. i yield back. >> i yield to mrs. eschoo. >> i thank the gentleman from new jersey. i thank him for his remarks that we just all paid close attention to. intelligent remarks. i just want to say one thing about the underlining bill. to actually penalize a state that has expanded by what disallowing the dish for two
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years. i think that states that expanded are part of the honor roll in the country because they're providing such such marvelous services to people across the country. so i object to that, and i don't believe it is a bragging point of the most frankly of the bill that is being consider ed and i thank the gentleman for yielding to me. i yield back. >> the gentleman's time is now expired and i will go to this side of the aisle. anyone who wants to strike the last word. if not, i recognize the gentleman from georgia. for five minutes. >> mr. gentleman, to strike the last word, but i want to point out that i keep hearing that they are saying that the dirks and restoring the dish cuts for the next two years is penalizing the expansion states, and that is not what it is doing at all.
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in fact, what it is doing is to reward those that did not expand, like my state of georgia to, make them whole. that is exactly, and this is a three-tiered program. the medicaid safety supplemental funding that is going to be $10 billion over the next five years, and depending upon the ratio of the people in the between 100 and 138% is depending how much you get of that and the patient state stability fund which again has modifiers in that, but the dish payme payments and not suspending them for the nonexpansion states is a reward to help to bring them up and make them whole with the expansion states. >> will the gentleman yield? >> i yield. >> that is not what we are saying. what we are saying is that you are giving the states that did not do the medicaid expansion the dish plus an additional fund under section 115. the safety net funding.
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but then what you are doing to the states that did expand the 39 states, you're penalizing them, because once they phase out in 2020, it is a two-year delay to get their dish funds, and this is what we are saying. >> that is exactly right, and reclaiming my time, and this is exactly right, and the reason for that is to get it even for the nonexpansion states like the state of georgia. >> again, if the gentleman will kweeld, what will happen though is that because of the two-year delay, all toefx pangs states are going the fall off of the cliff and their hospitals are not going to be able to get the dish funds for two years. >> arereclaiming my time, and what the lady noutz understand -- >> don't you call me the lady. >> and you are now able to cover the adults who are not covered in the medicaid expansion. >> will you yield? >> i will yield. >> i want to ask the kocouncil
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can question. if you a nonexpansion state under current law and you are watching this state, and your governor and legislature has a lightbulb going on and say, hey, i want to expand under current law, is that automatic or do they have to petition hhs and get approval from either the secretary or cms? if the governor for texas sent in an e-mail today saying that we have changed our mind and we want to expand, would they be l allowed to automatically, or would there be an approval process? >> the state could expand medicaid under current law. >> and so it is not subject to approval or disapproval and it is automatic? >> they could do it under the waiver, but they don't have to do it under a waiver. >> that doesn't make sense. they could do it under a waiver,
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but they don't have to do it under a waiver. >> they could expand the medicaid under current law or do it under a waiver as well under different terms. >> so essentially a state could join the parade late without having to get approval from the trump administration? >> that is right. they could expand without approval. >> and reclaim iing my time. staff, isn't that why we have this formula here is to try to get them whole as whole as we coul could? >> for the nonexpansion states, there are essentially three benefits included with the underlying -- >> exact ly. >> the first is the safety net supplemental addressed for medicaid providers and the second benefit is the aca medicaid dish cut s ths that ar
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immediately repealed for the nonexpansion states. >> right. >> or the expansion states where those dish cuts are restored two years later. >> right. right. >> and mr. carter, as you have mentioned earlier, there is additional funding through the patient and state's stability program which is a modifier to help nonexpansion states. >> right. i yield to mr. griffin -- >> i am sorry, we had a clock issue, and the clock has expired. >> i yield. >> h and the gentle lady from florida, the ranking vice chair is recognized for 5:00. >> thank you. on the section 115 that relate s to the safety net payments, this new safety net fund that is going to go to nonexpansion states, i notice that in the subsection a, it used the word may. so, this appears to send down
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some funds to a nonexpansion state, but not have a requirement that it actually goes to safety net providers. why aren't there, why aren't there direct -- why isn't there direct language that says, yes, we are sending this safety net funding, but it a has to go to the safety net providersk because sometimes what the states do, they do a little shell game, and the feds send them money, a it is going into the state budget, and the state general revenue. >> can you restate your question so we are clear on that. >> yes. so in section 115 a, safety net funding for nonexpansion state, it provides a new fund is created to send money to
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nonexpansion states and the assume is that the general intent is going to the hospitals and the providers that serve the uninsured and that we are not covered by medicaid through the expansion. but it appears to be too permissive. so, money would be sent to the stat state, but it is no, and using the word may would appear that there is no real requirement that it goes to the safety net providers that are providing uncompensated care. >> so the may is to let them not take the money if they don't want. >> and where in the language, and -- of course they are going to take the money, right? where in the language does it are require that it goes to the safety net providers and not just town the general revenue of
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a state budget? >> so on page 23, there is limitation language that would limit the funds to not exceed the provide er's costs for furnerring health care -- >> can you speak up, please. >> yes, ma'am, on page 23, language similar to how there is -- >> order. >> can you read that language so that everyone can hear it. >> limitation on payment adjustment amount for the individual providers and the amount of the payment under section a for an eligible provider may not incur the costs adds determined by the secretary and the net payments of this title other than under this section by uninsured that individuals -- >> that doesn't say that it has to go to the provider, but it
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just says that the payment adjustment may not exceed the provider's costs. >> that is what that language says. >> so, it is permissive, and it is not clear. >> ms. castor, it is clear that the state does not have to take the money and to the extent -- >> they will take the money, but what we want to see is that it is going to the providers and the hospitals and others that are providing uncompensated care. >> and so it has to go to the provider for the state to get the incentive that is on page 22 related to the match. so if you are taking a look at -- >> can you read that language, please. >> page 22, line three. provides an additional match for the states. >> can you read that explicitly, because i --b. >> sure. >> i'm on page 22. >> it starts on page 21. >> okay. >> so it reads increase in ap
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plik able f-mat. >> can you speak up, please. >> notwithstanding section 19501-b, the applicable expenditures attributable to the payment adjustment under subsection a for which payment is permitted under subsection c shall be equal to paragraph one, and 100% for the calendar quarters in calendar yoos 2018, 2019, 2020, 2021 and 2021 and paragraph two, for calendar year years and quarters 2022. >> that language, again, it does not are require that the money e that comes from the safety net, this new safety net actually going to the providers, and maybe we can work on an amendment, ale though that i e
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know that we want to bring it in for a landing, but you have another clarification? >> yes, ma'am. we have been advised by the legislative council that the may is for states to accept the money, and in subsection b, the if they receive the money then the rules apply on the top of page 22 which payment is permitted under subsection c may be equal to and you is the amount or the march, the amount, the formula and then the limitation on the providers. so the mechanics is that it is a state option to take the money, and if the state takes it, this is the formula for the spend, the match and the parameters for that funding. >> so, is it clear to the committee that -- >> if we were awake we might b but some of us are still half asleep. >> the gentle lady's time has expired. >> well, in san is is an issue >> and the time has expired and mr. barton. >> i would like to ask council
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under the current law, and the enrollees of the able-bodied adults, what is the approximate cost per year of the federal government per year for that expansion population? my back of the envelope is about $80 billion a year, but i could be off by as much as cbo will be. >> mr. chairman, that is sounding right. >> it is multiple billions and somewhere between 50 and $80 multi billion? >> yes. >> and it is a big number. a big number. and now, we have been having a little bit of a kumbaya moment here where everybody who is for the expansion on both sides of the aisle, and there are some republicans who support it have been almost hugging each other about what a great thing it is.
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keep in mind that it is able bodied adults, most of whom are under the age of 40. these are not the sick frail elderly. now, some of us don't share that enthusiasm, and all of those manila folders down there, and two of them have my name on them. and at the appropriate time when chairman walden gives me the green light, and i won't do anything until he says it is approapriate to do so i am goin to offer an amendment to tweak the bill in a different direction than mr. green does. my amendment would say that the states that have expanded, or maybe some states that haven't, but want to can keep expanding for this calendar year, not for three more years, but for this
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year. one more year. then, because the current bill as it is currently drafted does not ever definitively end this 90% match, although this year it is 95, but it does go to 90, and that is theoretically going into perpetuity with ms. blackburn and mr. hudson, i will offer a second amendment to end that super match by date certain to my amendment is 2023. if you take $80 billion a year and start to multiply it out, and we don't change the program, friends, that is a lot of money. and republican study committeeing a e grees with myself and ms. plaqueburn and mr. hudson who just officially supported our amendments, and the steering committee supports it, and the trump administration
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is open to it, so as chairman upton has pointed out, at some point in time, we will have a come to jesus moment and see whether we might not can short en that expansion period and put some definitive certainty to when it is going to end, and then the majority will rule, and we will find out whether we have the votes to tweak it a little bit or whether we don't. so with that, mr. chairman, i than k your courtesy and yield back. >> will the gentleman kweeld? >> mr. carter and mr. griffith. >> i thank the gentleman for yielding, but mr. chairman, i want to point out that georgia is one of the states that did not expand the medicaid, and if you are looking at obamacare, it should have been called obamacaide. of the lives covered 14 million
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of them went on the expansion of medicaid and able bodied aduls s went into a safety net program that was never intended to be for the able bodied adult and it is for the aged, the blind and the disable and children and i'm glad that georgia did not expand that program, and i think that we ought to be treated fairly and i will do everything that we should be treated fairly just like the expansion states and i yield back. >> mr. griffith. >> thank you. i appreciate that. and two things. one that mr. lance did a great job to explaining the balance. i thought that he did a nice job on, that and then mr. barton said earlier that he asked the council if the governor sent an e-mail, could they expand, and the council answered correctly the state could expand, but it depends upon the laws of each individual state, and in my home state the commonwealth of virginia which still retains some of the sovereign ti, the legislature has to go along with
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it, and it is not just the governor, but the governor and the legislature and i want toed be clear that nobody thought that the governor of virginia could put us somewhere we don't want to be. >> and the same thing in texas. >> i yield back. >> and any other interest to speak on the amendment? seeing none, the roll call has been requested and the debate has ended, and those in favor of the amendment offered by the gentleman from texas mr. green will vote aye and no, and the clerk will call the roll. mr. barton. mr. barton votes no. mr. upton. mr. upton votes no. mr. shim kus? mr. murphy. mr. murphy votes no. mr. burgess. mr. burgess votes no. ms. blackburn. ms. blackburn votes no. mr. scalise votes no.
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mr. latta votes no. ms. mcmorris rodgers. ms. mcmorris rodgers votes no. mr. harper. mr. harpert votes no. mr. lance. mr. lance votes no. mr. guthrie votes no. mr. olson votes no. mr. mckinley. mr. mckinley votes no. mr. kinzinger votes no. mr. griffith. mr. griffith votes no. mr. bilirakis. mr. bilirakis votes no. mr. johnson? mr. johnson votes no. mr. long. mr. long vote nos. mr. bucshon vote nos. mr. flores votes no. ms. brooks. ms. brooks votes no. mr. mullin. mr. mullin votes no.
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mr. hudson. mr. collins. mr. collins votes no. mr. cramer. mr. cramer vote nos. mr. wahlberg. mr. wahlberg votes no. ms. walters. ms. walters votes no. mr. costello. mr. costello votes no. mr. carter? mr. carter e votes no. mr. palone. he votes aye. mr. rush? mr. eshoo? ms. eshoo votes yes. mr. engle. mr. green. mr. green votes aye. mr. degette votes yes. mr. doyle, mr. doyle votes aye. ms. schakowsky votes aye. mr. butlerfield votes aye.
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mr. matsui ms. matsui votes aye. mr. castor. mr. castor votes aye. mr. sar bans? mr. sar bans votes aye. mr. mcnerney votes aye. mr. welch votes aye. mr. lujan votes aye. and mr. tonko votes aye. and ms. clarke. ms. clarke votes aye. mr. lobe sac votes aye. mr. kennedy, mr. kennedy votes aye. mr. cardenas votes aye. mr. ruiz votes aye. mr. peters votes aye. ms. dingle votes aye. chairman walden votes no. >> and members wishing to cast a vote. mr. shimkus? >> mr. shimkus votes no. >> mr. hudson votes no. >> mr. engle votes aye.
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mr. mcnerney votes aye. other members wishing to cast a vote? seeing none, clerk will report the tally. >> mr. chairman on that vote, 23 ayes and 31 noes. >> 23 ayes and 31 noes, and the amendment is not agreed to. are there further amendments to the bill? the gechair recognizing the gentleman from vermont to offer an amendment. do you have the amendment? >> thank you, mr. chairman. i to have an amendment at the desk. amendment number 166. >> and can you help us? >> this amendment is about making certain that nothing in the law will aggravate the problem of higher prescription drug prices.
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found it. >> the amendment is going to be considered as read and the staff will distribute the amendment, and the gentleman is recognized as -- >> there are two 166. the one that is written on tr clean version? it is the clean version. >> the clean version. >> okay. >> sorry. >> and in that case, amendment to the nature of a substitute offered by mr. welch. >> the clerk has reported the title of the amendment to be considered as read, and the gentleman from vermont is recognized for 5:00 in support of the amendment. >> mr. chairman, when mr. walden was here, he was indicating an appreciation of the urgency of attempting to address the cost of health care, and something that he said that we would do down the line. and there's a number of colleagues on your side who are working hard on that, and mr. griffith is working with me, and dr. bucshon has been a leader on
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this bill. and we do nothing but to address the costs, and, in fact, that is where the money is. if we start to bring down the cost, it is going to be making things much more possible for us to get health care delivered to the people who need it. one of the areas where where cost is totally, ploeding is farm suitle cal drugs. just think about it. suvalde to treat hepatitis c is $12,000 for a 12-week treatment course. and touring pharmaceuticals, because they bought a company that had a drug selling for $15, it ended up being sold right after the company bought it for $1,500. epipen where parents in vermont contacted me, and this is about providing the what a child needs
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when they are going into shock. that is sold for $600 and 400% more than just four years ago, and that company that is head kwart quarter ed in the netherl and u.s. company mylan sells the same eitem in the netherlands fr $100. we are getting ripped off. now, the costs that what we are spending on, and what we are spending on farm suitle cal d - pharmaceutical drugs almost 3/4 of the -- mr. chairman, the committee is not in order. committee is not in order. mr. chairman. >> gentleman is correct. the committee is not in order. >> what was that? >> gentleman, proceed. >> mr. chairman or mr. chairman, according to the aarp report,
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the annual retail price of drugs was over $11,000 in 2013 for a patient who had prescriptions for a chronic illness which is almost 3/4 of the average social security retirement benefit of $15,526 and nearly half of the median income of someone on $23,500 and this this amendment is about makings certain that nothing in this legislation is going toing the already excessive burden of the -- going to aggravate the already excessive burden of the prescription drugs. president trump spoke about the prescription drugs and talked about what a bad deal the american consumer was getting with the high cost of prescription drugs, and that we were getting ripped off. yesterday, the president trump met with congressman elijah cummings and me, and reiterated, and restated the support to act
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promptly to address this prescription drug price crisis. this is an opportunity for us to at least begin focusing on health care costs and prescription drugs is the area where the costs are rising the fastest. mr. chairman, i urge this committee to adopt this amendment and begin the process of reign ining in the excessive costs of prescriptions mentment. i yield back my time. >> and the remained over the time is going to be yielded to the gentleman from missouri. >> the cost of prescriptions is too high, and spending
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represents over 10% of all health care spending, but instead of exercising greater government control, congress could opt and should opt for less focusing instead on the efficiency, innovation and competition. we have spoken about the three phases that the republicans will pursue on rescuing people from the harms of the affordable care act and there are things that after we finish the reconciliation, there are things that can be done administratively, but we also have to user fee agreements within the fda to reauthorize, and the subcommittee is actively engaged in that and we had the first hearing in fact last week. the fda does take too long to approve the generic application, and there are literally 1,500 applications that have been pending at the agency for year, and that needs to improve, and it needs more competition. we also have the problem when
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with the time that it takes to review innovative drug, and costs nearly $2 billion and costs 14 years to bring the new drug to market. and of course, the chairman worked on this diligently with the 21st scentury cures bilks ad the committee got the work done, and it ran through two or three congresses, and it was a milestone effort when it was achieved, but the work there is not done, and the oversight of the implementation of the 23rd century cures act is going to be part of the ongoing process in the subcommittee. working on legislation over the next few months to reauthorize the fda user fee process will, could improve the fda processes so that people can see real competition in the prescription drug market. my opinion, and it has been the opinion of others that the federal government should not ration drugs and decide which drugs are available to seniors
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under medicare, and ultimate ily leading to price controls, and reduction of the types of the products that are available. congress should retool entitlement programs to encourage the greater competition among the providers and insurers, because the private negotiation as we have seen in the part d program, the private negotiation does work. in the part d, program, it continues to come in below the cost projection, and keeping the cost costs steady for the beneficiaries from year to year, and premiums have remained stable over the course of the prom gram, and now half of what -- of the program, and half of what was originally projected by the congressional budget a office when this committee marked up the moerndization act in 2004. 2005. the program that was implemented in 2006 has been a success story, and it has put the powers of choice and competition and em
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pow erred seniors. i would note that the committee and the staff continues to work in a bipartisan manner to advance the hr-749 and the lower costs of drugs through the kom come pe tigs act by representative schraeder and bilirakis and we look forward to continuing our efforts in this way. and there is no activity occurring in the subcommittee process and the reg ular proces that will continue through the balance of the year, and likely -- >> will the gentleman yield? >> yes. >> mr. chairman, i thank the gentleman for yielding and i want to assure the gentleman from vermont that he has no better ally than myself because we co-chaired the pharmacy caucus and i appreciate the interest in this, and there are a number of things that we can do and in fact, if you will look
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at the bloomberg today, there is an article about the pbms how they are the primary reasons that drug prices are increasing, and in fact, gilead has said that pbms like that keep the prices high so that the pbms get a higher rebate. this is one of the problems that we v and you are are right, that the president said that anybody on the other side of the r&d needs to be aware and we are after them and the pbms because they are a primary problem here. again, i want thoong you for this, but i am not sure that as dr. burgess has said, it is not the right time to do it as the speaker has explained this is a three-bucket approach that we are trying to get at through health care. this is the first bucket. we have still got the two buckets to go, and at that time, i hope that we can indeed address this. thank you, mr. chairman. i yield back. >> the gentleelman's time has expired.
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>> and the gentle lady of california and strike the last word. >> thank you, mr. chairman. i move to strike the last word. very interesting to listen to chairman of the health subcommittee. i hope that everyone was listening, because it was long and winding, and you had to listen hard, but there is one message that kcomes out of it. it seems as if our colleagues on this side of the aisle are not in sync with the president of the united states. that is what is more than obvious to me about bringing down the cost of drugs. i'll yield to welch, mr. welch. >> thank you very much. and mr. carter, i am so delighted that you are on this committee with the extensive experience on pharma and i will listen to you, and we will lis on you, but let me express some frustration, these drug prices have been rising constantly, and the pharmaceutical companies which we all note do some very
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good things. they create life extending and pain relieving medications. in my first wife was the beneficiary of that and i get it, and they need research and development, but you know what, if they are going to hide behind the assertion that it is research and development that justifies these prices that are starting to kill the patients who can't get access to what they need, show us the books. you know, there has to be some transparency here. i'm all for letting folks get the price they need in order to do the research for the new breakthrough drug, but there has never been any transparency, and the other thing is that the cost is unbelievable. i mean, we are going to be up to $500 billion soon in the whole fapharmaceutical expend can chu -- expenditure between the government and others. and so the house is burning, and we can have a rhetorical
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argument here, and we have a situation that needs attention, and the frustration that i have is that we go round and round and we have not made concrete progress. price negotiation, for instance, and that is a bill that we were, mr. cummings and i were talking to the president about, and i mean, i do not to get u wwhy we don't use the free market principles that the buyer and the seller is going to negotiate, and the buyer is trying to get the low price, and the sell ser ter is trying to g higher price. and that is the way it works and you bargain with the power that you have, and medicare is the biggest purchaser of drugs in the world. and you know what we do? it is astonishinging, we buy wholesale and pay retail and you know why? because congress said that is what we have to do and the noninterference clause, and this is like upside down capitalism. we don't do it in the v.a., and
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we don't do it in the medicaid and we are getting the prices 60% less. so my question is, how can any of us claim that we are fiscally responsible when we are not willing to bargain to get a better price. now, bargaining is not setting price, it is bargaining. and president trump gets that. if he is going to get 1,000 mirrors for one of the buildings is he going to be paying the per unit cost of 1,000 as he would for one? i doubt it. he didn't get to where where he is by making that bad deal. i implore the colleagues because we have is a lot of knowledge here on both sides of the aisle and we have to do something about it. it will help the taxpayer and the consumer, and it is going to help our employers who are trying to keep the costs down to continue to provide the good health care coverage to the workers. i yield back. >> would the gentleman yield. >> i yield back. >> and last week, the health
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subxhut tee hsu subcommittee had a hearing, and excellent witnesses and the subject matter was really how much generics have brought down costs, and how that market has grown and how many people are a part of it, but there was a statistic that one of the witnesses stated when i asked the question if there's, the generic market has grown so muc much, and we have so many people participating in it, why do we have such a problem with the high cost of drugs? and he said 11% of drugs account for 63% of drug costs. that is amazing. 11%. so it is a a realreally a handf products. i yield back. >> and the gentlelady yields back, and now over to the
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gentleman from florida mr. bilirakis. >> and we have a bill with represe representative slader, a bipartisan bill to address this issue, and we had a hear og on it last week, and we intend to mark it up. i understand that, mr. chairman, by the hopefully the end of the month house bill 749 and aiming to incentivize more generic drug competition where it is needed the most. and since this bill, we have encouraged more competition, and working on the bipartisan basis to consider these options around and the bill is going to increase the generic competition to come from reauthorizing and improved je eer innic drug user fee. and again, this is an issue that we are address iing. i appreciate mr. welch bringing the issue up, because we have to low lower the drug prices through
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competition. and i don't know whether mr. shraider wants time or anybody else want time? >> i do. i do. can you give me some time. >> i yield to mr. schraeder. >> thank you very much. i appreciate it. i think that this is timely. and representative welch had been a long time advocate to trying to rein in the explosive costs of the pharmaceuticals and i appreciate working with the gentleman from florida to get to the bi-partisan basis and it is not all acrimony here, and we do get along to try to solve the problem a and it is not a huge step, but it is a first step to get somewhere down the line. it serves notice that this committee and the congress is interested in rein manage the costs wren ever and wherever we c can. and that bill goes that way, and representative welch has some interesting work on the mitigation studies that we could get behind, and that would be great legislation. so i urge ugs to continue to work along the line, and hopefully do what we do best
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which is to get together and solve the problems for the american people. that what they are looking for us to do right here, right now. >> i could not agree more. anybody else? >> mr. carter wants some time. >> oh, yes. okay. very good. i yield to mr. carter. >> i thank the gentleman for yieldi yielding. i want to reiterate to representative welch and everyone, that i am as committed as anyone for this, and i am not taking up for the pharmaceutical manufacturers and they need to the pay the price and be responsible for this, but it is much more than just that. again, this is a phased process, and i have been told by the leadership not to use bucket, but phased now. evidently it is too pedestrian, but evidently this is not the right phase to be doing this, and representative welch, i am not supporting the amendment, but i am supporting the underlying effort to rein in the drug prices. i yield back.
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>> and that is the goal. and now, i recognize the gentleman from new jersey mr. pallone. >> i was hoping with all of the happ happy republican faces that we could support mr. welch's bill, and maybe we can get some of u you. but the prescription drug prices as we see it are rising at a an alarming pace. and the annual drug spending in the u.s. is estimated to reach more than $500 billion by 2018 and in 2014 spending grew by 12%, and faster than any year since 2002. this increase is having a very real impact on american families with 11 of 5 american s aged 19-64 unable to afford their prescriptions. there is bipartisan support for lowering the costs of prescription drugs and make the treatments more affordable for the families. the president said that he does not like what he is going on
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with drug price, and he has said in fact, i am going to bring down the drug prices, end quote. and yet despite this, the republican appeal plan does nothing to address the drug prices, and continues to give the breaks to the pharmaceutical companies that our president believes is getting away with murder by repealing the brand name prescription drugs that the pharmaceutical drug companies agreed to under the affordable care act. this is another one of the pay fors for the affordable care act that is repealed in the republican bill, and again, and give away in this case to corporate interests. the vast ma jjority of the democrat and the republican voters agree that the highest pri priority for the congress is to make prescription drugs affordable for those who need them. and ranking a close second, and also with the bipartisan agreement is for the government the take action to lower drug prices. so if we believe the president's latest tweet, e he says that a
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new system where there is competition in the drug industry is coming, and end quote, pricing for the american people is going come way down. and however, while we wait for t the republican's next plan to be revealed i would urge my colleagues to support this amendment and delay the implementation of the american health care act until it can be certified for the secretary to the lower the costs of the consumers and soy urge the colleagues on both sides of the aisle and thank mr. welch. anybody would like some of my time? okay. i yield back, mr. chairman. >> and the gentleman yields back. nibbles wishing to speak. i see none -- the gentle lady from illinois is recognized for 5: 5:00. >> i move to strike the last word. i support congressman's welch's last amendment, because the families are struggling to afford the prescription drug, and we talked about how president trump has said that big job corporations are quote getting away with murder, unquote. and just yesterday after meeting
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with congressman welch and congressman cummings, the tweet was, i am work on a new system where there will be competition in the drug industry, and pricing for the american people will come way down. that is a tweet. and i have to say that this may be one of the issues that if he is serious that we are going to to be able to work with him. you know, i was here when medicare part d passed. a lot of us have been having a lot of talk about this, and i remember big pharma putting in the one sentence that really changed everything, and that was that medicare is prohibited from negotiating for lower drug prices with medicare. and that has plagued us, really, ever since. the price, and the cost of drugs nearly doubled from $62 billion in 2007 to $121 billion in 2014.
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in medicare part d when medicare pricing doubled from $11 billion to 2007 to 2015 and by the way, we rereintroducing a bill that will add transparency and we want to know how much they really spend on the research. in medicaid, spending on the prescription drugs per en role lee grew 13% between 2013 and '14 and a 2016 aarp study of widely used brand name drugs found that 97% had price increases that exceeded inflation. out of the pocket costs for americans are rising with to a average american paying over $1,300 out of pocket in medical, pences, including the prescription drugs before their health care coverage kicks in, and that is a sharp increase from the average deduction of
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$584 a decade ago. as a result, too often the patients and the families have to make real decisions about what they can afford every month, and we have talked about the tradeoffs and do you pay the electric bill or the grocery bill or the prescription drug bill. and according to the aarp survey, 50% of the adults over age 50 decided not the fill a prescription because of the cost, and one-third said that cost is the main reason, unquote, for not filling the prescription. skipping doses or prescriptions can have serious implications for the patients and the health care system. estimated 125,000 deaths and 10 to 20% of hospital and nursinging home admissions each year are the direct result of nonadherence to medication. the problems are not limited to
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the people taking the prescription drugs, because the price increases affect employers, private insurers and the taxpayer-funded programs like medicare or medicaid by increasing the premiums and the cost of the public programs, and so this is a systemic problem that requires a an aggressive and comprehensive solution. the american people totally agree with this. aarp's survey on the prescription drugs found that 87% of the americans age 50 and older support the efforts to control prescription drug costs, and similarly, a poll done by the kaiser family foundation found that 77% of americans believe that the price of drugs are unreasonable. people are demanding action, and it is time for congress to the act. one way to el help address the issue is to limit what patients pay out of pocket for the prescription drugs in a month.
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so for all of the costs of the republicans to reduce the costs, the repeal bill does nothing to address the skyrocketing drug price, and those who want to work on that with us, i suggest that this is a great place to start. why don't you vote for the welch amendment right now, and we can roll up our sleeves, and we get to work, and guess what, maybe we can work with the president on this as well, and i yield back. >> the chair thanks the gentle lady, and yielding back. anybody seeking recognition? seeing none. further discussion on the democratic side? for purposes of recognition, the gentleman from new york. >> mr. chairman, i move to strike the last word. >> you are recognized for five minutes. >> and i am in support of this, and reining in the costs of prescription drugs should be nu number one priority for this committee for addressing health care. it is the key to unlocking the overall health costs.
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a poll found that democratic, and republican voters agreed to make it the number one priority for congress, and make it happen for the american people. and addressing drug costs would help the individuals in my district, and people like tracy from troy new york who needs multiple drug prescriptions to treat pre-existing conditions, including diabetes. the affordable care act has made it possible for tracy to get health coverage for herself and the family, and without the aca, tracy could not pay the doctors drug company, and still, we can do more, much more to help tracy manage the costs. prescription drug costs are spiraling out of control. here are the facts from a "money magazine" article. double digit drug pricing increases have taken place in each of the last three years. prices for 30 common e prescription drugs increased as eight times the pace of inflation between 2010 and 2014. 16.7% of all health care spending wentdrugs compared to
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15% in 1990s. the annual price increase of drugs was over $11,000. and the price of deraprin made famous by martin ska really was jacked up overnight. this situation must be fix and we can take a good first step with this amendment and i strongly urge my colleagues to support this amendment, and with that, mr. chairman, i yield back. >> the chair asks if anybody else wishes to speak on the welch amendment. seeing none, the question that occurs on the welch amendment, the gentleman from new jersey had previous ly asked for a rol call vote, and the clerk will call the roll. >> mr. barton? mr. upton. mr. shimkus.
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mr. shimkus votes no. mr. murphy? mr. burgess? mr. burgess votes no. ms. blackburn. mrs. blackburn votes no. mr. ka lease. mr. ska lease votes no. mr. latta. mr. lat ta votes no. ms. mcmorris rodgers votes no. mr. harper. mr. harper vote nos. mr. lance. mr. lance votes no. mr. guthrie. mr. guthrie votes no. mr. olson. mr. olson votes no. mr. mckinley. mr. mckinley votes no. mr. kinzinger. mr. kinz iinger votes no. mr. griffith. mr. griffith votes no. mr. bilirakis votes no.
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mr. johnson. mr. johnson votes no. mr. long. mr. long votes no. mr. bucshon. mr. bucshon votes no. mr. flores? mr. flores votes no. ms. brooks. ms. brooks votes no. mr. mullin. mr. mullin votes no. mr. hudson. mr. collins. mr. collins votes no. mr. cramer. mr. wahlberg. mr. wahlberg votes no. ms. walters. ms. walters votes no. mr. costello votes no. mr. carter. mr. carter votes no. mr. pallone. mr. pallone votes aye. mr. rush. ms. eshoo votes aye.
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mr. engle. mr. engle votes aye. mr. green. mr. green votes aye. mr. degette votes aye. mr. doyle. mr. doyle votes aye. mr. schakowsky votes aye. mr. butterfield votes aye. mr. matsui. mr. mat sueway votes aye. mr. castor. mr. kcastor votes aye. mr. sar bans votes aye. mr. mcnerney votes aye. mr. welch votes aye. and mr. lieujan e votes aye. mr. tonko votes aye. ms. clarke votes aye. mr. loeb sac votes aye. mr. schraeder votes aye. mr. kennedy votes aye. mr. cardenas. mr. ruiz. mr. ruiz votes aye. mr. peters. ms. dingell votes aye.
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chairman walden. chairman walden votes no. mr. barton. mr. barton votes no. mr. upton. mr. upton votes no. mr. murphy. mr. murphy votes no. mr. hudson. mr. cramer votes no. mr. engle? mr. engle votes aye.
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>> the clerk will report. >> mr. chairman on that vote, 21 ayes and 30 noes. >> 21 ayes and 30 nos, and the amendment is not agreed to. is there members seeking recognition? for what purpose does the gentle l lady from new york seek recognition? >> mr. chairman, i have an amendment at the desk. >> the clerk will report. >> number 86. >> amendment to the amendment in the nature of a substitute offed by ms. clarke. >> without objection, the reading of the amendment is dispensed with, and the gentle lady is recognized for 5:00 on her amendment. >> thank you, mr. chairman.
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my sense of congress amendment would prevent the prevepgs of public health fund. this is critical to addressing health disparities and preventing infectious diseases in underserved populations. african-american women are particularly vulnerable and benefit greatly from the programs support ed by this fun. as i have always maintained, access to quality affordable health care is and should be a basic human right. having access to health care not only improves and sustains one's quality of life, but it also helps to bend the health care cost curve. however, i nknow that firsthand there are significant barrier ares to accessing quality in affordable health care which in turn xexacerbates racial and gender health disparities. according to the center of
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disease control and prevention, african-american women are twice as likely to sufficient from heart disease as a result of the high rates of the chronic health conditions such as obesity, elevated cholesterol, and the high blood pressure, and diabetes, and when it comes to blood cancer, the rates and the severity of the disease are even more alarming. african-american women are twice as likely to be diagnosed with aggressive subtypes of breast cancer including -- >> and if you will suspend so that the committee will come to order. gentle, la lady, you may procee. >> thank you, mr. chairman. african-american women are twice as likely to be diagnosed with the aggressive subtypes of breast kacancer including the triple negative breast cancer which disproportionately affects young african-american women. african-american women are 43% more likely to die from breast cancer than their white
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counterparts. the five-year survival rate for white breast kacancer survivorss 89% whereas the five-year survival rate for african-american with women is just 79%. you may be asking yourself, why breast kacancer is so important and personal for me. the answer is simple. my staffer gail , dell degail. she was die diagnosed with a precursor, but dell was not able to get high quality medical follow-up, and as a result, dell's condition worsened, and like many other african-american women, when she did eventually receive health care, her disease was in an advanced age. thankfully, dell survived. because of dell, and countless other women like her, i will continue to work towards the
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decreasing health disparities, and in doing so to improve the quality of life and longevity of all women of color, and soy urge my colleagues this morning to support my amendment to prevent the elimination of the prevention and public health fund. mr. chairman, i yield back the ba balance of my time. >> the gentle lady yields back. >> chair recognizes the gentleman from pennsylvania, and for what purposes? >> strike the last word. >> the gentleman is recognized for 5:00. >> thank you, mr. chairman. i want to point out some things about the prevention and public health fund and how it is used. again, it sounds good and with the good intents here, but there are a number of thing as that have happened without the proper oversight over this in temperatures of how the money is spent. so before, this is the fiscal year 2014 when congress began to allocate funds through the appropriation, and the grants to some of the following grantees, the city of nashville, $17.5
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million with the community prevention work grant for free pet spaying and neutering. the city of boston got $1 million for urban gardening. pitt county, north carolina, got signage to promote bike lanes in public parks. the cascade bicycle education club got money for approving the walking and biking environment. and also money that went into the kickboxing and zumba and kayaking and paddleboarding classes in waco, texas. and king county, washington, got $12 million for changing the zoning policies to locate the fast food retailers farther from the schools, and the list goes on. i know that some people are saying that this some of the cuts are coming to the cdc and we have always fund ed the cdc and we recognize that there is value in that and that it is going to go through the regular order of processes through the appropriations committee, but part of it is that we wanted to
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make sure when congress began to take a closer look at this and kcon troll the spending since 2014 is that the prevention of the public health fund was not used for that. we face similar problems in the past when we have found out that substance abuse and mental health administration, good name, and does many good things, was also using the money for websites for children's sing-along songs. the website for people in boston helped them with snow anxiety, including -- >> will the gentleman yield for a question? >> so it's always appropriate -- >> would the gentleman yield? >> not yet. for a number of things. we want to make sure things are used right, and certainly the nice thing about our bill is we have $100 billion over ten years to go towards things that states can use for true innovation, for things to really control better ideas with health care, and we'll have a lot of over sight
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of that to make sure things are not misused. and certainly, i yield to my friend if you want a question. >> i just had a question because i'm just trying to figure out what about the items that you just mentioned does not fit into the intention of the fund? it's about prevention and public health. i'm trying -- you went down a list of things. and from what you have described, they're promepromoti fitness, wellness in eating properly. you went down a list. and i'm trying to figure out what it was that you found to be objectionable. >> i thank the gentle lady. let me try to address it this way. certainly, fitness is important. weight control and lack of smoking is important. the question is, how federal funds are used in a situation like this and how best to coordinate it. when we're talking about so many areas of health care and cost,
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looking at these as areas such -- i guess i don't quite understand how urban gardening is part of that or signs. >> because just to answer your question, sir, many urban areas are food deserts. when you establish a garden in those communities, now they have access -- >> i hear you. >> to fresh vegetables. i'm trying to figure out perhaps if we have a conversation, i can interpret some of that for you in a way in which you may have not seen it before, but these are very important initiatives, and many communities across the nation. >> let me reclaim my time so i can conclude on that. the initiatives i really want to make sure we're taking care of are so many things we don't have enough provider. we don't have enough services, enough hospital beds for people with mental illness. states are not coordinating care for people under medicaid to properly integrate and coordinate care. and so it is tough when we see that we're working on pet spaying and neutering and
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gardening and signs for where their local parks are. if local communities and states and counties want to put money into that, great. but we're trying to use precious dollar to promote so many other things with health care. i want to make sure we're doing that. i have great deal of respect for you. and i would be glad to talk with you off line about some of these things and how we can look at different ways to promote fitness and healthy living, et cetera, but in terms of this, i think we have a number of high priorities on how we're going to address that. i yield back. >> the gentleman yields back. for what purposes the gentleman from new jersey seeks recognition? gentleman is recognized for five minutes. >> thank you, mr. chairman. this amendment obviously would prevent the elimination of the prevent and public health fund that's in the republican repeal bill. we haven't spent much time in the last 25 hours or so discussing how the aca encourages innovation, improves
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the quality, and aids the quality of health care and aids in prevention, but it was around important part of the bill that many hours were spent on, and fortunately, most of those or a lot of those things have not been repealed as part of the -- as part of the republican effort here. one of the most important things was, is the prevention fund. and i do, you know, i'm going to be critical of mr. murphy because the fact of the matter is he's picking out a few things which don't add up to a lot in terms of the overall prevention fund, and one could argue even the things he's bicked out like the gardening, the bicycle, trying to protect kids from eating fast foods. even those i would argue make sense. but what he doesn't mention is that a huge amount of the prevention fund goes toward
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major things like tobacco cessation, disease outbreaks, bioterrorism, preventing bioterrorism. obesity, diabetes. things that most people i think would agree are very important in terms of prevention. bottom line is it's very hard to score prevention because usually the cbo won't score it. and you know, it's hard to calculate over a period of time what it actually means in terms of saving health dollars. preventing people from getting sicker. but it's crucial. because today in america, chronic preventable disease such as heart disease, diabetes, and cancer are among the nation's most costly and preventable health problems and unsurprisingly, spending on chronic disease alone accounts for roughly 86% of all health care expenditures in the united states. and despite the harms caused by chronic disease, only a small percentage of government health expenditures are spent in
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preventing the dediseases before they happen. when we passed the aca, we knew protecting the health of the nation depends on access to affordable, high quality health insurance. we recognized it made little sense to provide broader access to treatment services while continuing to neglect access to prevention services that help americans avoid developing costly chronic conditions. now, i also wanted to mention that many times i have mentioned my meeting last week or so with the national governors association. both governors from the republican and democratic party. more actually from the republican party. this was a major issue there. there were governors who said, please, whatever you do in changing the affordable care act or replacing parts of the affordable care act, do not neglect prevention. do not neglect innovation. do not neglect improving good quality of health care. because that is very important to us. and so i guess i'm a little shocked that we're here today considering eliminating the prevention fund in the name of
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saving money on other things because frankly, if mr. murphy or others feel that there are problems with it, i don't see them. >> will the gentleman yield? >> i don't have a lot of time. >> you referenced me and i would like to respond. >> i'm not being critical. >> i think you questioned my motives. >> i do not question your motives. i'm saying simply if there are problems with it, we can exercise the oversight, we can have some better oversight, something of the nature, but the problem is this is eliminating the fund all together. and what i'm suggesting to my colleague is that just because there's some problems, i don't think there are, but even if you think there are, that doesn't think we should eliminate the whole thing because this is one of the few ways that we have to actually do some good things on prevention, which is often neglected. i think, you know, you know that you have been the chairman of the oversight subcommittee for some time. we have had a lot of hearings on
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things that can be preventable. i'm simply asking, you know, i don't know what the expression is, but just don't throw everything out. the baby with the bath water, thank you. don't throw everything out just because you see some problems. you know, you can exercise the oversight if you want to have some additional hearings on this. and then we can figure out a way to continue with the fund without actually saying that it shouldn't exist at all. because i don't really think eliminating the fund makes sense given what's already been stated today. so i yield back the balance of my time, mr. speaker. >> mr. chairman. >> mr. speaker sounds better. >> i promoting you but not to president. >> the gentleman yields back his time. the gentleman recognizes himself for five minutes. and i would like to yield to the gentleman from pennsylvania, mr. murphy. >> i thank you. on this, i certainly know that my friend from new jersey is
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also holds in high esteem the importance of preventative health. if states are going to ask for money for road signs and neutering and other things, they ought to be able to produce data for us to show what impact it had upon it. i know when we asked the gao to give us a report on samson, some things are funded with regard to account of mental health problems, they said 20% of grants have people reporting back where it went. i think you're right, if we had more oversight and accountability for the prevention programs and were able to see what works and doesn't work and what is the way of states to say we can have something pay for something and not. now, this being said, this fund came out to be about a billion dollars a year, then $2 billion a year after that. is the alternative in this piece of legislation today, we put $100 billion in there for states to do innovative things to work on prevention and intervention
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and lowering health care costs and a wide range of things. actually, there's a lot more mp money available to us and we can work together to make sure accountability is there for the programs and i know under our oversight committee we will have hearings on how to do this better. this is making reference to that. >> would the gentleman -- >> it's the chairman's time. >> sorry. >> the chairman controls the time. i actually do want to speak on this, so if there's time left over, i'll come back to you. you know, it was always the advance appropriation nature of this, and let me just say, and the gentleman from new jersey remembers this. there were a number included in the affordable care act. there are a number of them that i would love to visit about. but that will be done under the regular order, part of our committee's activity, the center for medicare and medicaid, the
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comparative effectiveness branch. but this is one that because of the advance appropriation nature of this, and it was entirely up to the discretion or it is entirely up to the discretion of the secretary, how those dollars are spent -- >> excuse me, mr. chairman -- >> it is the obligation of this committee to have oversight over how those dollars are spent. >> mr. chairman -- >> i will not. i'm using this time to concur with dr. murphy that it is the requirement of the oversight committee that dha do have oversight. look, it's no great surprise to anyone that never in his wildest dreams did president obama think that thomas price would be secretary of health and human services, so i'm happy about that. but even with that development, our committee, our investigative
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subcommittee, our oversight subcommittee does have the obligation, the constitutional obligation to have oversight over those funds. i have been concerned a number of times. we have had public health emergencies, things that are just up in the windshield all of a sudden. and it is when i have asked could the prevention and public health funds be used for immediate response to these occurrences, i was always told by the previous administration, no. we need that for other things. we've got these other things we're funding. when these other public health emergencies seemed so much more critical, and the true nature of a prevention and public health fund, is in my opinion, when something happens that you weren't expecting, that you'll be able to respond with some agility. because of the subscription of the funds for some of the activities that dr. murphy has already outlined, it became very difficult to do that. i think this is a reasonable
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approach, that congress should have the oversight over this activity. even with dr. price over at the head or the secretary of health and human services, i still want our oversight subcommittee to have -- to exercise its oversight authority. and i think, again, that is our obligation of the committee, that's our constitutional obligation. the -- the fact of the matter is the advanced appropriation occurs so these funds, yes, it started out with a billion dollars a year, but sometimes in 2020 or 2025, it increases to $2 billion a year. then in purpitutety, and honestly, the committee simply cannot not exercise the oversight. i'll yield the remaining seconds to gentle lady from new york if she would like. >> so i will yield back my time.
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>> mr. chairman. >> gentle lady is recognized for five minutes. >> thank you, mr. chairman. move to strike the last word. so i'm listening very hard to what you're saying. this is, what, about $15 billion over ten years? but the use for these dollars is not identified but has to be in the bill, so it's -- i guess this is what my kids would call a slush fund. and that's what you're referring to in terms of oversight? am i correct that it's about $15 bhl over the next ten years? >> she's talking about the one you're proposing? >> the patient stability and safety fund? >> the bill. >> the innovation fund. >> right. the other one. >> prevention fund. >> that's what the amendment is
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about. the prevention fund. >> you're right. let me ask -- let me ask and then i'll yield to the author of the amendment. is it -- how much is in this fund? and over what period of time? and is there any identification of use for the funds? >> the funds have been authorized at $1 billion for each of fy '12 through fy '17. $900 immediately for '19 and '20. >> what's the total over how many years? >> you're talking about the prevention and public health fund, correct? >> yes.
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>> once you get to 2025, it's roughly $2 billion indefinitely. it ramps up prior to that. >> that's annually. so what is it total over how many years? >> it's mandatory spending. >> how much is it total? >> indefinite. >> for the next ten years? >> indefinitely. >> it just never ends? wow. the whole purpose of our, what, 26 hours and 7 minutes has been to just absolutely squeeze the hell out of medicaid. and now, we've come to this. this is a ton of money that's
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set aside. does it have any identification? is there any specificity for the application of the funds? >> it's for purposes, prevention purposes and public health purposes under the public health service act. >> and this is -- mr. chairman, did you say this was the secretary that would direct it? that's the other fund? no? but it's not so. okay. all right. thank you. i'll yield the rest of the time to the gentle woman from new york. >> thank you very much. thank you very much. i wanted to ask counsel, could you inform us how are these funds actually appropriated since fy 2015?
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>> that would be through the labor hhs appropriations subcommittee. >> that is through the congress, not the secretary? >> it's trance forauthority, so the committee on appropriations made provide for the transfer of funds to eligible activities, subject -- >> could you really say that, state that clearly? because i think my colleagues were under the wrong impression. they were under the impression that it was coming directly from hhs under the authority of the secretary. would you state explicitly how these funds are appropriated because we're attributing certain behaviors and oversight to the secretary when indeed it is already in our purview to provide that. if i understand that correctly. >> so the appropriations could
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be made transfer funds if the secretary does not direct the funds. >> i'm sorry. >> in the instance that the funds are not transferred -- >> what has happened since fy 2014. what has happened since 2014? >> what happened or what happens? >> isn't it true that congress has appropriated every dollar? since fy 2014? >> that's correct. >> that's what i thought. that's what i thought. so then it's not true about the secretary, which has been the premise by which this argument has been taking place this whole time. >> the secretary previously allocated funds, before fiscal year 2014. >> previously. we're in 2017, right? >> before fiscal year '14. >> right. right. so i just wanted to be clear, because my colleagues were making statements that made it sound as though we had no role to play in this. and we can shape this if our
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goal is indeed to bring down health care disparities, to make sure that we're modifying behaviors for preventative health. this is an avenue in which we can do that. and i yield back to the chairman. actually, who -- >> your time has expired. >> okay. i yield back the balance of my time. i just want us to be -- >> time has expired. >> i want us to be clear. >> time has expired. are there other members seeking recognition on this amendment? so we'll go to ms. matsui for five minutes to strike the last word. >> thank you, mr. chairman. i move to strike the last word. the mental health crisis in this country is very personal to me. and i have been fighting for patients and their loved ones for many years. there is a lot we can do better to stop or slow down the hurt and pain that patients and
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families feel when mental health is left unaddressed. the aca took giant strides forward for the mental health community by expanding medicaid, which cover s mental health and substance abuse services. covering people with pre-existing conditions, expanding access to preventative services like depression screening and further requiring parity between medical and physician health services. we spent years in this committee working on legislation to further improve our nation's broken mental health system. one of the things we worked on together was reauthorizing the garrett lee smith memorial act to fund youth suicide prevention. nothing could be more heartbreaking than when a young person takes their own life before they've had a chance to live it to the fullest. one of my constituents, mike, comes from sacramento to my office in d.c. every year to advocate on behalf of those who can no longer speak for
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themselves. mike lost his 19-year-old daughter suzy to suicide in 2003. he now advocates to increase awareness and funding for suicide prevention programs, especially for our young people. mike understands the importance of making sure that the pain he and his family have suffered is prevented from happening to other families across the country. the republican aca repeal bill before us today would be devastating to our efforts to reduce teen suicide in our communities. it cuts the public health and prevention fund, which has provided $12 million to the garrett lee smith youth suicide prevention program thus far. that accounts for nearly one third of the total funding that the program has received. by passing this aca repeal bill, republicans are taking away funding for important programs like these that save people's lives. these programs work.
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prevention training programs have led to significantly lower suicide rates among young people. preventing thousands of suicide attempts. repealing the prevention fund would be turning our backs on millions of young people at risk of suicide every year. our mental health system remains under constant financial strain. the system and the patients and their families who need it cannot afford any cuts. that is why i'm offering this amendment to protect mr. clark's amendment to protect the garrett lee smith yooyouth suicide prevention program from any cuts. mike speaks for suzy and all of those still alive today because of investments in mental health services and suicide prevention programs. we need to listen. i urge my colleagues to vote in favor of this amendment. thank you. i yield to ms. dingle. >> thank you, ms. matsui.
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i just want to add to her story and say that there's another very important project that is funded through this prevention and public health fund that we cannot lose. it does fund a number of diseases like alzheimer's and diabetes and mental illness, which we all care about, and the zika virus, but the cdc's childhood lead poisoning prevention program is funded exclusively through the prevention and public health fund. and the prevention fund has been the backbone of america's fight against lead poisoning. and we have to keep that funding in place until the cdc can certify that children in this country are free of lead poisoning. as we all know too well, our children remain at risk for lead poisoning, as has been sadly documented in flint. a study in the american journal of public health found nearly 5% of children in flint under the age of 5 had elevated lead
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levels and now we had another study, a recent analysis that says there's almost 3,000 neighborhoods who have recorded childhood lead poisoning rate at double those in flint during the peak of the city's contamination. these cut are putting our nation's public health at risk. we cannot sacrifice long-term savings in exchange for a quick buck and i also support my colleague's very important amendment. i yield back. >> and the gentle lady-year-o y back. are there other seeking recognition to speak on this amendment. the gentleman from maryland, mr. sarbanes, is recognized for five minutes. strike the last word. >> thank you, mr. chairman. i appreciate it. i want to support my colleague's amendment. i think the public health and prevention fund is a critical
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resource, if we're going to begin to turn our health care system towards prevention, with all of the savings that that can produce for our health care system, then we have to maintain these investments. i'm nervous about sort of conflating this with the state stability fund or whatever the name of it is, the $100 billion, because we heard in connection with earlier amendments that that fund is going to certain purposes at the state level, and so i don't think one services to replace the other. it's an apples and oranges thing. i think we have to preserve the integrity of this fund and the supports it can provide. i'm proud of having authored something called the no child left inside act, which we introduced for five straight congresses. finally got it passed. which encourages schools around the country to build outdoor education into their curriculum
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to get young people outdoors. which encourages their interest in science and other pursuits in the environment, environmental literacy, but also helps to promote fitness. that has a wonderful impact in terms of prevention. there's a program here in the district of columbia called park rx, where physicians will actually prescribe fitness activities for young people and families that they see. pediatricians will say i'm writing you a prescription to go walk in the park. you know, once a day. walk a mile and they're seeing an impact in terms of reducing childhood obesity. i know a program called health leads, which operates in baltimore and boston and around the country. they do an assessment when people come into a health clinic to determine what social determinants are at work. for example, somebody has asthma, if you don't account for
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where they live and what mold and other irritants might be in the home, then you're really not going to solve their problem from a prevention standpoint. these are the kinds of initiatives that can be supported by this fund. and i want to echo what was said about the childhood lead poisoning issue and the need to address that. and i'll just close and then i'll yield some time to congresswoman castor. in australia, there's actually a portion of the health care dollar that goes to support their national parks system because they understand that getting people out into public spaces, into parks, into nature, is all part of fitness. it's all part of prevention. it reduces cost for the health care system over time. it's a smart investment, just the way this public health and prevention fund is a smart investment. i support congresswoman clarke's amendment and i'll yield the
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blabs of my time to congresswoman castor. >> i thank my colleague and i thank ms. clarke for introducing this amendment. is it less expensive to prevent diabetes or to treat diabetes? is it less expensive to prevent heart disease or to treat it in later stages? of course, it's less expensive to prevent disease. and in america, where we spend so much money, especially in later years in medicaid and medicare, the intent behind the prevention fund was to try to shift some of the dynamics there. this is smart public policy. unfortunately, if this is repealed, my home state of florida is going to lose maybe $100 million. this is money that we use very wisely for things like chronic disease prevention, including diabetes, heart disease, and
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stroke and tobacco cessation. we use it for infectious disease prevejz. think about what happened with zika over the past two years. it sure would be more efficient and a better use of tax dollars to prevent the spread of the zika virus than having to come to congress and ask for hundreds of millions of dollars on the back side. so i support the amendment and i urge my colleagues to do so as well. and i yield back to mr mr. sarbanes. >> i yield back. >> gentleman yields back. chair recognizes the gentleman from kentucky, mr. guthrie, to speak on this matter for five minutes. >> thanks. i just want to say, we find these things important as well. as we talked earlier, the $100 billion fund, which rolls up the prevention funds, on page 47 of the draft i have in front of me, paragraph 8, preventing access to preventative services,
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providing payments. there are several things listed here. ymg not sure that fitting in, and i understand the food desert issue. i'm not sure if that would fit in what we're moving forward, but the diabetes education, spoking cessation, dealing with addiction disorders, individuals with mental or substance abuse disorders or any combination of such services. so i'm not going to say that the herb garden in new york, which i understand the food desert issue would apply here, but certainly a lot of things that we listed would. >> would the gentleman yield? >> i sure would. >> it's about sound nutrition, right? >> i understand that. i'm not sure if it would apply, but i do think it's clear that some of the stuff that my friend from florida just listed would be. i'm not saying that's not unporptd. >> i'm just saying it's not a big leap when you recognize that sound nutrition, you're able to maintain better health than you understand why we urban gardens
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have become so very important. >> i'm not disagreeing with you at all. the prevention fund is big. not the prevention fund, but the stability fund, $100 billion over ten, and it allows with high risk pools, helping people buy down their premiums. states can have their own exchanges and move forward. as we talk about the freeze and the freeze ending and just having the tax credits going through the ways and means, this is also an opportunity for states to do that and move forward. just want to point that out, that you still can use prevention funds. >> will the gentleman yield? >> then i want -- i need to give him time, but yes, ma'am. >> i just wanted to ask whether what you're referring to mandates prevention, that the funds be used for prevention? it's my understanding in that particular section of this bill, there is no mandate for prevention. so if others set another priority, then prevention will never become a priority in the
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lives of the people that we're trying to -- we're trying to help with their health care. >> it is state allocated but -- >> it's not mandated? it's optional? >> it's permissible. >> it's optional. >> as i read that, i agree with you. i need to yield to the chairman. >> i thank the gentleman for-year-olding. i think we all care about these issues, and to ms. clarke on nutrition, i was, i think it was last friday, it's hard to keep track at this hour, and they're doing some amazing research on nutrition as the relates to diabetes, heart disease, in the mother and grandmother. and what carries on through. so these are issues, i would like our community to get into in depth to look at what it means 100 years from now, based on what you read now. it's really interesting research that they have pioneered. we'll work on that. >> yeah, i think so.
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and i just want to make the point, too, just so we're all on the same page. that the fund is not phased out until the end of fiscal year 2018 in our legislation. and that gives the appropriators time. we have a whole appropriations committee. they can come in and fund these programs if they so choose. so it gets the congress back into the say on this in terms of the appropriations process, and that check and balance on how the money is spent. we'll actually have a say in it going forward on programs that are federal. the states would have and their elected officials, some say in how this state stability and patient fund would be used. and in the meantime, these programs are funded through the end of fiscal year '18. so we're really thought this through, i think, in a very responsible way because a lot of these programs are very important to our health, to our
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nutrition, to public safety. all of the things that matter in prevention. i yield back. >> my other friend from oregon raised your hand for time, did you? >> if i may, thank you very much. >> happy to yield. >> just a question about the stability fund. i'm worried it's being used for everything. if i'm a health insurer and looking at a fund that i want for, you know, as a risk pool primarily and that's what most of this refers to, i'm getting worried that it's getting killed off into a prevention fund. the prevention fund before was actually about developing innovative strategies that a risk pool could then apply. it's a different entity all together, as mr. sarbanes said. i thank you for the time. >> thank you. >> and i yield back. >> the gentleman yields back. mr. tonko is recognized for five minutes to debate this matter. >> thank you, mr. chair. i move to strike the last word. the reconciliation instructions under consideration today could move us to the verge of public
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health disaster. why try to fix something that isn't broken? since fiscal year 2014, congress has allocated all of the funding from the prevention and public health fund through the regular appropriations process. and the centers for disease control and prevention have received much of that funding to support prevention and health promotion programs in every state. i know new york has benefitted tromthis program. for example, more than $890 million of cdc's budget comes from the prevention fund. that means that the republicans' proposal to eliminate the prevungz fund would result in the immediate cut of 12% from cdc's annual budget. that cut eliminates funding for the preventive health and health services block grant that provides $160 million in funding to all 50 states, the district of columbia, two american indian tribes and eight u.s.
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territories. the block grant is used to address their public health needs, respond rapidly to emerging public health issues and fill funding gaps in programs that deal with leading causes of death and disability. the need for these services could not be clearer. for example, recently, the national center for health statistics reported the first decline in the united states life expectancy since 1993. and an increase in death rates for eight of the top ten leading causes of death in the united states. such data made clear that increasing investments in population wide public health intervngzs are critical to promoting and protecting the health of americans. repealing the prevention fund cuts all of the funding for cdc's childhood lead poisoning prevention program. that program helped states and cities identify high risk areas for lead poisoning and deploy evidence-based preventative measures. the ongoing water crisis in flint, michigan, as well as the
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almost 3,000 neighborhoods recording lead poisoning grades at least double those in flint prove this is critical to protecting the health of our nation's children. the proposal cuts $40 million from the epidemiologist and laboratory capacity program that enhances state, local, and territorial capacity for detecting and responding to infectious disease and other public health threats. and finally, the recent ebola and zika crises show that investments in strengthening our public health surveillance system is as important as ever. these examples make it so clear that we would not be cutting what republicans want you to believe is a slush fund. instead, we would be crippling cdc and the state and local partners' ability to promote and protect the health of all americans. so with that, i yield back, but strongly support the amendment
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by my colleague from new york. >> gentleman yields back the balance of his time. other members seeking recognition or can we go on to the vote? we a rot of amendments to get through. we'll have a roll call vote. all those in fave, vote aye, those opposed vote no. >> mr. barton? mr. upton. no. >> mr. uppen votes no. mr. shimkiss. mr. murphy. mr. murphy votes no. mr. burgess. mr. burgess votes no. mrs. blackburn. mrs. blackburn votes no. mr. sculeze. mr. scalise votes no. mr. latta. mr. latta vote no. mrs. mcmorris rodgers. mrs. mcmorris rodgers votes no. mr. harper. mr. harper votes no. mr. lance. mr. lance votes no. mr. guthrie.
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mr. guthrie votes no. mr. olson. mr. olson votes no. mr. mckinley. plk mckinley votes no. mr. kininger. mr. griffith. mr. bilirakis. mr. bilirakis votes no. mr. johnson. mr. johnson votes no. mr. long. mr. long votes no. mr. bushaun. mr. bushaun votes no. mr. flores. mr. flores votes no. mrs. brooks. mrs. brooks votes no. mr. mullein. mr. mullein votes no. mr. hudson. mr. hudson votes no. mr. collins. mr. kramer. mr. kramer votes no. mr. wahlberg. mr. wahlberg votes no.
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mrs. walters votes no. mr. costello. mr. costello votes no. mr. carter. mr. carter votes no. mr. pallone. mr. pallone votes aye. mr. rush. ms. eschew. she votes aye. mr. ingle. mr. ingle votes aye. mr. green. mr. green votes aye. ms. degette votes aye. mr. doyle votes aye. ms. schakowsky votes aye. mr. butterfield votes aye. ms. matsui votes aye. ms. castor votes aye. mr. sarbanes votes aye. mr. mcnerney votes aye. mr. welch. mr. welch votes aye. mr. lujan. mr. lujan votes aye.
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mr. tonko votes aye. ms. clarke votes aye. mr. lobesack votes aye. mr. charader votes aye. mr. kennedy. mr. kennedy vote aye. mr. cardenas. mr. cardenas votes aye. mr. ruiz votes aye. mr. peters votes aye. ms. ding l votes aye. chairman walden. >> walden votes no. >> chairman walden votes no. >> are there members we should be recorded? gentleman from illinois, mr. shimkiss? >> votes no. >> gentleman from new york, mr. collins. >> votes no. >> gentleman from illinois. >> mr. kin singer votes no. >> gentleman from virginia, mr. griffith. >> mr. griffith votes no. >> members on this side that are not recorded? do we know of any other members making their way here on either
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side? okay. i think the clerk can report the result. >> mr. chairman, on that vote, there were 23 ayes and 30 noes. >> 23 ayes, 30 noes, and the amendment is defeated. chair recognizes for what purpose is the gentle lady from colorado seeking recognition. >> i have an amendment after the desk, amendment 60. >> amendment 60. >> on acchaeral requirements. >> number 6-0. the clerk will report the amendment. >> amendment to the amendment in the nature of a substitute. to the committee print offered by ms. degette. >> it's dispensed with and the gentle lady from colorado is
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recognized for five minutes to speak on her amendment. >> thank you very much. >> let me get order though because it seems noisy in here. do our members and staff if we can hold it down just a bit. so we can all hear the gentle lady from colorado. please proceed. >> thank you, mr. chairman. one of the biggest complaints that i hear about the affordable care act mainly from the other side of the aisle is high deductibles. and i just want to mention, for example, a few of the many times president trump has complained about the deductibles being too high. in february, he said, quote, your dedoubleables have been so high you can never use it. obamacare doesn't work. it's become totally unaffordable. and then he said, quote, the health care can't even be used because the deductibles are so high. it's not -- mr. chairman, i'm so sorry. it's so loud, i can't even hear myself. >> i agree.
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please take your conversations outside of the committee room so that we can conduct our business. >> thank you. >> the jettal lady may provide. >> thank you, mr. chairman. even members of this committee have talked a lot about the high deductibles that people are paying. i won't shame people by name, but let me give people a couple quotes from colleagues on the other side of the aisle. one of the colleagues said in november 2016, quote, people have crappy insurance now. they have high costs, they have high deductibles. it's like they don't have insurance. someone else has no less than three press releases from the past year on her website with complaints about deductibles. and they say things like, quote, obamacare is taking us back to the day of old major medical policies with high deductibles. i think you get the gist.
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clearly, those on the other side of the aisle have identified high deductibles as a major problem. and high deductibles were a problem before we passed the affordable care act, which was one reason why we did the affordable care act. i completely agree that as we look at trying to improve the affordable care act, high deductibles is something that we should look at. unfortunately, though, this bill eliminates vital affordable care act protections known as actuarial enactments that shifts insurance companies from shifting more costs onto consumers in the form of out of pocket payments like deductibles and co-pays. ironically, by eliminating the aca protections, the managers amendment will actually make deductibles sky rocket. so it turns control back over to
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the insurance companies to push as many costs as they can back onto the consumers. but the problem doesn't stop there. the repeal bill also eliminates an important part of the affordable care act called cost share reduction or csr payments that help families who make less than $60,000 a year afford their deductible. so not only does the bill raise the deductible, it also then rips away the support under current law that makes deductibles affordable for more people. in 2016, 7 million people received help with cost sharing under this aca program, including 29,000 people in colorado. and this made a big difference for people. deductibles and plans with csr payments were around $246 on average. compared to over $3,000 in plans where the assistance was not available. if we really want to help more
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people with their deductibles, we should expand this program and not end it. and so frankly, my colleagues, if you think your deductible is bad under the aca, you just wait to see how high it's going to go under this new bill. the american people were promised lower costs and they were specifically promised lower deductibles. repeatedly. this amendment gives our republican colleagues a chance to make good on their promises. it strikes the provision in this bill that will allow insures to push more costs onto the american people in the ford of out of pocket payments. i urge everybody to get together on this because truly, if we're going to make insurance affordable and better for everybody, we're going to have to work to reduce deductibles, not let them go out of control. i yield back. >> gentle lady yields back. are there other members seeking recognition on this amendment?
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the chair recognizes the gentleman from indiana, dr. bushaun, for five minutes. >> thank you, mr. chairman. currently, the affordable care act requires insurers label their plans by metal tiers. they're determined by their actuarial value. although they sound pretty, they limit choices. they're rigid and do not allow insurers to develop flexible plans to meet the needs of individuals in certain regions of the country. we have seen this with insurers weighed down by the tiers thus leading to plans too expensive for most americans. the lack of flexible plans is very real. it is the very reason why we're seeing the individual market in a death spiral, and those aren't my words. they're from a ceo. insurance is too expensive for most americans, and when it is affordable, it does not cover the services that individuals
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need. the affordable care act has crippled our insurance markets in repealing the values imposed by this law on insures is the first step we can take to stabilize markets and return security to americans. of course, there is still more we will have to do beyond repealing the actuarial values to stabilize the markets. this has to be met -- this has to be met coupled with relaxing the age band to 5 to 1 in providing states with grants through the patient and state stability fund so that the states can make meaningful reforms to their individual markets. i'll yield to any republican member that wants to speak. i yield to mr. scalise. >> thank you, doctor. and you know, this amendment gets to, i guess, the heart of that question that we've been talking about for a while. that's freedom. because if you look at the driver of cost under obamacare,
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over the last -- over the last six years, as you see double digit increases. let's look at some facts. 25% is the average increase in premiums this year on the obamacare healthcare.gov exchange. 25% increases. and it's because there's all these mandates telling you what you need to buy as opposed to letting individuals choose what they want to buy. that's the heart of the question. and so again, what is freedom? freedom to me is not under this amendment, government's telling you what you have to buy, even if it's things that don't work for your family. it jacks up the cost of your health care because you're buying stuff you don't need. but they're making you buy that stuff under this amendment. why not let the families choose that? do you fear american families
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making their own choices? picking their own plans? going through and saying that's something that i want for my family, that's something that i don't want, and if government's not telling me all these things have to be in my plan, i actually get a lower cost. i actually get a lower deductible. these deductibles are through the roof. i know we have done this over the last few days, but i think we need to go back to it because maybe people forget what real families are dealing with. i'll go back to pamela. my premium went up from $986 per month, 57 years old, and her husband who is 56, to $1346 per month, with a $4,500 deductible each. it's required to have maternity and pediatric care for a 57 and 56-year-old. i'm so frustrated, i just can't afford this anymore. this is as much as my mortgage
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payment. but you're going to tell pamela she still has to keep buying it, even if she doesn't want it and it doesn't even work for her. but because you want to figure out in washington what somebody else needs to buy, then you don't care that they can't afford their own health care anymore because of all this. let's let families make these choices. i think we should be able to trust them a lot more than somebody up in washington who thinks they know best for everybody because a one size doesn't fit all. every family is different. and you know what. i trust that a family can make it a lot better than somebody in washington who doesn't know their name. you may not know pamela, you may not know jeff who is paying a deductible of $12,500 per year. for his health care. that's something he can't afford. let him buy what he wants.
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he's a whole lot smarter in knowing what is good for his family than somebody up here in washington. so let's give people freedom. let's trust them to make their own decisions and let them afford plans that work for their family. defeat this amendment. i'll yield back. >> i urge my colleagues to vote against this amendment. i yield back. >> mr. green from texas. >> i would like to yield my time to me colleague from denver. >> in closing, i just want to say, pamela and jeff are going to be really shocked if this bill passes and they get their insurance bill and they see the deductible that they're going to have because what we're talking about is the percentage that they're going to have to pay. right now, under the affordable care act, it's a 70% to 90% ratio. under this managers' amendment, there's no level. that means theoretically,
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insurers could set any level of deductible they want. and the thing that our constituents are mad about is not, aside from the insurance costs, they're mad because they buy an insurance plan, they buy one of these bare-bones plans and then they get in a car accident and they're mad because they have this big deductible. under this bill, it's going to be even worse. and i'm here to tell you guys, if this is the problem that you're trying to address, and we don't fix it, and this bill somehow becomes law, then they are going to be at your doorstep, and they're going to be mad. i yield back. and i ask for a yes vote. i yield back to gene. >> i just want to know from congressman scalise, is this the budde rose or the thibodeaus. >> it's more than hem, and they
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make a lot more than crawfish. they don't want someone in washington telling them what to buy. they can do better on their own. >> i thank the gentleman for yielding. i was noticing last night, republicans were telling a whole set of stories ay we were telli whole set of stories and the difference was republican stories were all about people's frustration with the premiums and the costs of the plans. our stories were all about the benefit of the aca when people actually had to use the coverage that they had purchased. and if you're just looking at it in terms of the front end of the equation, sort of what it's costing, and you don't yet know whether the coverage that you have bought is actually going to do the job for you, you're missing half the picture. so we're concerned about what happens when people actually have to access this coverage and whether it's sufficient, whether the, you know, whether all the
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protections are in place. whether it's actuarialy sound and so forth, but even if we were only concerned with the issue of the premium side, the cost side, without even getting to the use of the coverage, we would still want to reject this repeal proposal because it's actually putting an extra burden on when you look at the fact that these supports to reduce the cost of deductibles and co-payments, that that is being pulled away. when you look at the fact that the credits being offered are significantly downgraded from the credits offered now. when you look at the fact tt the age rating guard rails are going away. even just by the analysis of what's good on the front end in terms of the cost, the out of pocket costs for people, the repeal being proposed doesn't
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solve that problem for them. but just as importantly, the coverage that they can actually access when they do get sick and need it is a critical focus. and that's why we've got to look at the actuarial soundness of these plans. i yield back. >> mr. chairman, i yield. >> thank the gentleman. the gentleman has yielded back. do we have anybody on this side who wishes to speak? mr. cardenas. the gentleman from california. >> thank you, mr. chairman. i think it's important that people soak in what congressman sarbanes just mentioned a minute ago. we have been here for over 24 hours, far beyond that. but i think it's important for people to understand and listen that americans or human beings never to want to pay for something they're not going to
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use at that moment. nobody wants to pay car insurance. nobody wants to pay homeowners insurance. nobody wants to pay health care insurance. my daughter, for example, she got married, and her and her husband were going to get health care because they both decided to leave their jobs and venture into doing other things, opening his own business and things of that nature. they had to buy their insurance where before they always got it from their employer. my daughter is like, oh, my god. it's so expensive. when she told me the amount, i was like, are you kidding me? that's not much at all. so they got nar insurance, like they're supposed to, and they stopped complaining. but a couple years later, they're blessed to have a child, proud to say that i'm a grandfather, but let me tell you, when i looked in her eyes after we got over the glow of the few days together, and i said, how do you feel about that
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insurance now? no complaints whatsoever. not one. not one. just like when somebody gets in a car accident. everybody is complaining about writing that check every month, but ifever, heaven forbid, have to use that insurance after they get into a car accident, my gosh, there aren't words to describe how grateful, how grateful they are. and one of the things that congressman sarbanes just pointed out and i'm glad he did. it's like a tale of two cities here. the democrats have been talking about how people are so grateful and glad once they realize that after their daughter had a catastrophic illness that that insurance actually helped their daughter, got her daughter to be healthy, but at the same time they weren't thrown out on the streets, having to pay the deductibles that were in existence and legally allowed by the insurance companies -- for the insurance companies to charge before the aca.
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i'll mention again, a gentleman came to my town -- my forum in my district a couple weeks ago and he started off by complaining that his -- he's paying 25% more today for his insurance than he used to. but then he also mentioned that he had four hospital stays and three surgeries and i said, well, sir, can you describe to me if that would have happened maybe ten years ago or what have you, what would the insurance company have done? how much would you have had to pay in deductibles? he stopped me mid sentence and he said, oh my god, they would have taken away my house. so basically, what we've been trying to explain here is for the first time in the united states of america, we have health care geared toward making sure that if you ever need your insurance, you're not going to be thrown out on the streets or you're going to have to pay for the bills for the rest of your life. for the rest of your life.
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don't forget, ladies and gentlemen, in the old days before the affordable care act, if you had to go to the hospital like this gentleman did, you'd have $100,000 or $200,000 or $300,000, maybe blow through the million dollar cap and all of a sudden the second million's on you. that is not allowed anymore. and if i'm wrong, i would love for anybody on this dais to correct me. that is not allowed anymore. >> will the gentleman yield? >> sure. >> i'll be glad to give you some examples. it might not be million dollars but to people that live in appalachia and ohio, $20,000 is like a million dollars. when you get a $20,000 hospital bill when you were expecting to be able to keep your insurance and your doctor. >> thank you very much for that example. you just remined me to remind all of us. if that person in appalachia had to pay $20,000 and thank god they still have their life to speak of but at the same time, they could still get insurance
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the next day. back in the good old days before the affordable care act, when that person had that catastrophic injury, they couldn't find insurance. $20,000 wouldn't be enough to pay for their insurance, just for one year, heaven forbid they would ever need it again. again, families couldn't even get insurance because one of their children actually had asthma. people -- americans don't believe that's a prooeeexisting condition. it is. it is. so, yes, there's a lot of reasons why many of us are against this bill that's before us today, because it's taking us backwards, not to the good old days but the catastrophic days. i yield back. >> i thank the gentleman. any further members seeking recognition? if no further members seeking recognition, the question occurs on the amendment and there's been a request for a recorded vote so the clerk will call the role. >> mr. barton. >> mr. upton. mr. upton votes no.
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mr. shimkis votes no. mr. murphy. mr. burgess. mrs. blackburn votes no. mr. scalese votes no. mr. lata votes no. mrs. mcmorris-rogers votes no. mr. harper. mr. harper votes no. mr. lance votes no. mr. guthrie votes no. mr. olsen? mr. mckinley votes no. mr. kinsinger votes no. mr. griffith votes no. mr. vilarocas votes no. mr. johnson votes no.
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mr. long votes no. mr. bouchon votes no. mr. flores votes no. mrs. brooks votes no. mr. mullen votes no. mr. hudson votes no. mr. collins votes no. mr. kramer votes no. mr. wahlberg votes no. mrs. walters votes no. mr. costello votes no. mr. carter votes no. mr. polon votes aye. mr. rush. ms. escew votes aye. mr. ingle votes aye. mr. green votes aye. ms. degette votes aye.
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mr. doyle votes aye. ms. shikowski votes aye. mr. gutterfield votes aye. ms. matsui votes aye. ms. castor votes aye. mr. sarbanes votes aye. mr. mcnernny votes aye. mr. welch. mr. luhan votes aye. mr. tonko votes aye. ms. clark. mr. lobesac votes aye. mr. schrader votes aye. mr. kennedy votes aye. mr. cardenas votes aye. mr. ruiz. mr. peters votes aye. ms. dingal votes aye.
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chairman walden votes no. >> are there other members wishing to be recorded? chair recognizes the gentleman from pennsylvania. >> mr. murphy votes no. >> the gentleman from texas, mr. burgess. >> mr. burgess votes no. >> the gentleman from texas, mr. olsen. >> mr. olsen votes no. >> okay. the -- are there any other members wishing to be recorded? anybody -- do you have any other members or like four -- mr. butterfield, you are recorded, right, sir? okay. any others? all right. the clerk will report the tally. >> mr. chairman, on that vote, there were 20 ayes and 30 nos. >> i'm sorry, what was the tally? >> 20 ayes and 30 nos. >> wait a minute. just in time.
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ms. clark. i don't believe you're recorded and i think you're a yes. >> ms. clark votes aye. >> now what's the total? >> mr. chairman, on that vote, there were 21 ayes and 30 nays. >> 21-30. the amendment is not adopted. are there other members seeking to offer amendment? chair recognizes his friend from new york, mr. ingle for what purpose. >> i have an amendment at the desk. it's amendment number 159. >> 159. now serving amendment 159. >> okay. clerk will report the amendment. we'll make sure it's the right one because we're -- do we have the right amendment? what's it on, mr. elliot. >> hospitals. >> hospitals. okay. clerk will report the amendment.
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>> amendment to the amendment in the nature of a substitute to the committee print offered by mr. ingle. >> we'll dispense with further reading of the amendment and i recognize the gentleman from new york, mr. ingle, for five minutes to speak on his amendment. >> thank you, mr. chairman. my amendment would require cms to perform an independent assessment of how this bill's medicaid policy changes would affect local hospitals prior to implementation. cms would need to demonstrate that republicans medicaid changes will not force hospitals into the red or to close their doors. there is nothing unreasonable about such an assessment. every single member on this committee should want to know beyond a shadow of a doubt that this bill won't threaten the hospitals that their constituents depend on. there's only one possible outcome when you take away people's insurance coverage, newly uninsured americans will turn to hospital emergency rooms and when hospitals treat these newly uninsured americans, they take a financial hit. where will americans go if their
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local hospital has to fold? to one that's less convenient. i'm from new york city and i think that's outrageous. just imagine how americans in rural areas will feel if they're forced to travel even further during an emergency. and hurting our hospitals doesn't just hurt the patients who rely on them. it hurts the economy. in new york, our hospital and health systems generate more than $24 billion annually. they were also responsible for hundreds of thousands of jobs. if we push hospitals into the red, or force them to close altogether, we're shutting down major economic engines on top of harming patients. with respect to the republican repeal bill, which won't maintain current levels of insurance coverage, the american hospital association said this, and i quote them, resources need to be returned to hospitals and health systems in order to provide services to what will likely be an increased number of uninsured americans.
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let me read an excerpt from america's essential hospital statement on this bill. could we have some water, mr. chairman? let me read an excerpt from america's essential hospital statement on this bill and i quote them. this legislation could place a heavy burden on the safety net by reducing federal support for medicaid expansion over time and imposing per capita caps on the program. i'm still quoting. these changes alone could result in deep funding cuts for essential hospitals which now operate with little or no margin. continuing the quote, our hospitals could not sustain such reductions without scaling back services or eliminating jobs. this bill delivers a serious blow to safety net hospitals' finances and that in turn is a blow to the communities who rely on them. there is no reason that any member should oppose this amendment to make sure that doesn't happen so i urge my
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colleagues to support this amendment and i'll yield back if nobody wants my time. >> mr. chairman -- mr. engel -- i just wanted to urge support for your amendment. i think you -- most of us know that the hospitals have been a very big supporters of the affordable care act because they have managed -- because of the fact that with so many people now being insured, whether it's through the marketplace and the subsidies or with the -- through medicaid expansion, they have major infusion of funds through these payments that they would not normally get and they've been able to reduce the number of people in the emergency room and use the money that they've gained for a lot of things that are -- you know, that have made health care better quality and new technologies.
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i mean, i could just see that in my own district in the hospitals that i represent and so i think it makes sense that they're very concerned about the republican bill that's before us today, because as we have said many times, the problem is a lot of people will now become uninsured again because they lose their subsidy, they're in the individual market or they eventually lose medicaid as medicaid expansion starts to disappear. they do not want to see an increase in the uncompensated care and a return to the emergency room. it's not good for the patients and it's certainly not good for their bottom line. so i think it's very important that we support this amendment because we know the negative impact that the bill before us, the republican repeal bill will have on the health care system in general and on all the things that we're concerned about in terms of people losing their insurance, higher premiums, and loss of funding that is so
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crucial to the hospitals. i yield back. >> chair would ask of the gentleman from new york if -- >> yes, i yield back. >> well, did you have a unanimous consent request that we missed during the changing of the guard? had you made a unanimous -- i thought i heard a unanimous consent request. no. okay. very well. gentleman yields back. the chair thanks the gentleman. chair recognizes the gentleman from west virginia, mr. mckinley or for what purpose does the gentleman from west virginia seek recognition. >> speak in opposition. >> does the gentleman move to strike the requisite number of words. >> yes. >> gentleman is recognized for five minutes. >> mr. chairman, the -- i think the premise here is trusting the cms on what they've done or how they would make the projections, but we also have to put things in context. back with the aca.
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and i've pulled up an article that was put up by national rural health association, representing the rural hospitals across america. and one of the -- they made several statements here that i thought were worth consideration, given the situation we're dealing with. and it says that to some of the regulations were implemented are actually -- actually harming rural america and not fulfilling the ultimate goals of the aca. then it goes on to say that despite the well intentions of the aca, have really fallen short and may actually be exacerbating the hospital closure crisis. so, having said that with their articles, we -- i think we all understand the role of the hospitals play in a community. for those of us in rural america. i get a kick out of when i hear the speaker talk about janzville like it's just a little tiny town. janesville is twice the size of
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any community i have in my district. it's 60-some thousand people so we understand the role of hospitals, but we also have to understand the role -- how cms has made the predictions of how this was going to help out years ago when the aca was put in place. so, i'm having some suspicion, some doubts about that. i think something can be worked out. but we have to understand, first, these -- with the aca as an example, i know of a 250-bed hospital in my district, 250-bed hospital that the aca has failed so miserably that they now still have an $8 million uncompensated care. and because of the changes in the dish payments back under obamacare, they have to write off $8 million in uncompensated care and all they get in exchange is $350,000 in d.i.s.h.
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payments. that doesn't seem like a very -- that just shows why our rural hospitals are in trouble. so, we're -- and i could go on statistically with it that we know that rural hospitals all across, primarily because of the aca, are closing in the last seven years, they've been closing at a rate of one a month. and at the rate they're going, we're going to have 10% of our hospitals closed or 25% of our rural hospitals are going to close within ten years so we have an option. we have this option of this new way because whatever has been done under the aca, it did not work. and it exacerbated the problem. more and more hospitals are closing. so we've got to have an option and so we have is this. this one -- the bill that we have is one is primarily based around free market principles. we think that people, if they can use -- if we can double their hsa ability, that you're
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going to be able to have more funds available for that. the refundable tax credits are going to be available for people. the high-risk pools, all this is going to come into place where i think -- when i've talked to the rural hospitals, they're excited about an option because they see the aca has failed. and they're -- so, mr. chairman, i would hope that we will defeat this amendment and move on. i yield back. >> gentleman yields back. for what purpose does the gentleman from new jersey seek recognition. >> strike the last word on the amendment, mr. chairman. >> gentleman is recognized for five minutes. >> and i would yield time to mr. engel. >> thank you. let me say to the gentleman, mr. mckinley, if you think that rural hospitals are closing
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quickly, just pass this bill and have it become law without my amendment and i guarantee you they'll close even more quickly. uncompensated care refers to the amount of care hospitals provide for which they receive no payment either from a patient or an insurer. a study by the georgetown university health policy institute found that, and i quote it, compared to nonexpansion states, states that have expanded medicaid have seen major reductions in uncompensated care delivered by safety net institutions, significant drops in the number of uninsured residents and budget savings for hospitals and community health clinics. we also know at the republican repeal bill, slowly but surely kills the medicaid expansion that helps states reduce their uninsured rates. in new york, for example, that rate was cut in half. we know that the 2.2 million new yorkers who enrolled in medicaid under the aca's expansion now stand to lose coverage and we
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know where these newly uninsured americans will turn, to our hospitals who will afford each and every person the best care possible but will do so at a tremendous loss. so, i think it's quite evident that without this amendment, hospitals are going to close. people are going to go to them, to the emergency rooms, and go in them for help and there will be less and less help. people have to travel further and further all because we don't do anything to help these hospitals under this bill. >> anybody like some time? >> mr. butterfield. which one? do you want -- yeah. >> thank you very much, mr. engel for yielding time and thank you for this amendment. i'm pleased to speak in support of your amendment. that would require that the medicaid provisions in this bill do not negatively impact hospitals like the one in my congressional district in belhaven, north carolina, that was forced to close because my state's then-republican governor
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and legislature did not expand medicaid. this bill blocked new states from expanding their medicaid programs beyond the year 2020, converts medicaid into a per capita cap funding structure that will inevitably result in the rationing of care. the bill also eliminates medicaid expansion that has helped millions of americans to gain affordable korchl. the bill removes the man david that medicaid cover all essential expenses and covers a 30% reinsurance penalty that goes straight into the okts of the insurers. may i have some water, please. all right. let me try that one again. imposes a 30% reinsurance penalty that goes straight into the pockets of the insurers for individuals who for any reason are unable to maintain coverage. colleagues since the year 2010, 80 rural hospitals have closed throughout the country.
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and in my district, it closed because of the refusal of the state to expand medicaid. 75% of those hospitals are located in states where medicaid was not expanded through the aca. one of those hospitals, as i mentioned, was located in my district. the closure of the hospital has left a large void in eastern north carolina. there is now a 130-mile gap between hospitals in northeastern beaufort counties and hyde counties. people in the region no longer have access to emergency room care in times of need. on july 7, 2014, portia gibbs from hyde county lost her life just five days earlier. the hospital in belhaven had just closed. had it remained open, she could have reached care quickly, possibly could have been saved. because of the closure, first responders tried to transport her by way of helicopter to a
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hospital in greenville 75 miles away. she did not make it. people in eastern north carolina deserve to have health care when they are in need. since the closure, the belhaven community has advocated for a new hospital to provide emergency room services. in fact, the mayor of belhaven has twice walked here to washington, d.c., 300 miles, and he's a republican, to advocate for medicaid expansion. too many lives are lost unnecessarily because of the lack of health options. the expansion of medicaid under the aca has helped stem the tide of the closure of rural hospitals. let's keep these rural hospitals open. let's expand medicaid to give them that opportunity. thank you, and i yield back. >> chair thanks the gentleman. gentleman yields back. does anyone on the republican side for what purpose does the gentleman from oklahoma seek recognition? >> move to strike the last word. >> gentleman is recognized for five minutes. >> it's not too often that my
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colleague from north carolina and i agree on something, but we do agree on keeping our rural hospitals open. i have 36 rural hospitals in my district. and 41% of rural hospitals right now are operating at a loss. now, where we and my colleague from north carolina disagree on is he takes the position that it's because they didn't expand -- open an exchange in their state. well, the fact is -- >> no, they didn't expand medicaid, sir. >> the fact is, it was forced upon them by obamacare. what's forcing them to take a loss is the lack of the d.i.s.h. fund reimbursements. what's drove up the rates and the disproportionate amount of individuals in rural parts of the country to go to them is they've been forced on medicaid because their insurance plan is no longer available for them to have. so, now these hospitals are in a
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situation to where they're taking a loss because 80% to 90% of the people walking inside there are on medicaid. 41%, 41% of rural hospitals right now are operating at a loss. 80, as my colleague from north carolina stated, have already closed. what we're trying to do is fix that. and that's what we do through this plan. we increase the d.i.s.h. funds. we allow those hospitals in rural parts of the country to stabilize. we're here to make it better. and that's what we're trying to do and i look forward to working with my colleague from north carolina if that's what his intentions are because it sounds like we both represent rural districts but this is moving in the right direction. >> would you yield? we have that in common and i would like to work with you on that because when this hospital, vieden hospital acquired this hospital, they were assuming that medicaid was going to expand but then we got the
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supreme court decision that made it optional for the states, and the state did not expand and the business model fell apart. >> well, my colleague, i think we just found something that maybe you and i can talk about because it's about getting it right for the american people. >> thank you, sir. >> would you yield to me? please. >> just because i like you, dave. >> thank you so much, mark. i appreciate that. that's why i asked. thanks. thank you so much. yeah, i -- we're going to have -- we do have a fundamental disagreement about what would happen if this -- if this bill were to be passed to these rural hospitals. i didn't plan to speak on this, i don't have prepared remarks. all i can say is that in iowa, we have over 80 rural hospitals and medicaid has been very, very important for them. the charity care was already mentioned, the importance of reducing charity care, noncompensated care. i mentioned yesterday that i had visited three of my rural hospitals. i have 24 counties, and every
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one of them has almost every one of them has not quite as many as yours but almost every one of them has a rural hospital, a critical access hospital. and in every single case, these folks, the administrators have told me that if the affordable care act is repealed, that that's going to put a tremendous amount of budgetary pressure on them and they're not sure that they can keep their doors open and we know what that's going to do for patient access, obviously. >> reclaiming my time. i am talking to the same hospital directors, and they're saying just the opposite. if we don't do something about these d.i.s.h. funds, that they're going to be forced to close. remember, they've right now 41% of rural hospitals are operating at a loss. they're closing at an alarming rate and that's been increasing since obamacare was enacted. i will yield back. >> chair thanks the gentleman. for what purpose does the gentleman from california seek
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recognition? gentleman is recognized for five minutes. >> thank you, mr. chairman. i just want to make an observation, and it is the following. the california hospital association, cha, has come to d.c. to meet with all members of the california congressional delegation and while most members may not realize it, we have many, many rural areas in california. and -- but the cha, california hospital association, has been urging members of the delegation, republicans and democrats, to continue to support the affordable care act because of the salutary affect it has had on hospitals throughout california.
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so, you know, there's a mix on the take. now, we didn't ask them to come. they came on their own. and have instructed us. in fact, they've given us all the figures for hospitals, both before and after the affordable care act. so, i think that since this amendment is about hospitals, we are the -- we're a nation state, the largest state, the most populus state in the union, and that california hospital association is recommendation, i think, is really a weighty one. so, i want to thank the gentleman for the amendment that he's offering, and i also placed in the record earlier in our mark-up an article that was written by the ceo of the stanford medical center.
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that is stanford university medical center. and it -- i placed it in the record because i think that it was a -- it is worth the read as to why there is far more stability in terms of what was uncompensated care and how that has changed and changed dramatically for hospitals, readmission rates, and really all of the issues that we are all familiar with, especially from the health subcommittee or as members. you don't have to be on the health subcommittee to know it from our hospitals. so, i just wanted to offer that in terms of testimony and how important it is to, i believe, to support the amendment and i yield the remainder of my time to mr. engel. >> thank you. i just wanted to add one fact, because as we were having this
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debate, i want to say that according to beckers hospital review, 21 hospitals closed in 2016. 18 of them were in nonexpansion states where they wouldn't expand medicaid. 16, i'm sorry. 16 of them were in nonexpansion states out of the 21. so, i think it has a little bit to do with the expansion of lack of expansion. >> it has a lot to do with it. >> i yield to ms. caster. >> colleagues, if you want to protect hospitals across america, the last thing that you want to do is vote for the republican bill. and i find the arguments that the affordable care act has weakened hospitals to be very untrue in my experience back in florida. all of the hospitals were enthusiastic partners in trying to get our neighbors covered with health insurance. because the last thing a hospital wants is a patient to
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come in the door that's uninsured. of course the care providers there are going to provide the top quality care. but when it goes to the accountants, if they're not covered with insurance, they don't have insurance, they're going to -- we're going to end up with bad debt on the hospital's bottom line, which will be passed along to everyone who has insurance. it's interesting because like you all, i've heard from hospitals back home. they're not shy. here are the few -- a few of the points they said as we go into the republican repeal effort. they said, what you have to do, we recommend strongly, maintain coverage. so, the bill rips coverage away from so many of our neighbors because you undermine, you take away the tax credits, you don't provide the support that our families need. they say, provide support for premiums. provide adequate financial assistance to help those in need.
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that is critical. and yet, this bill, we had a debate hours ago about how our older neighbors are going to really suffer, the folks that are age 50 to 664, it was discovered, during debate, the age rating in the bill actually isn't the 5 to 1 that's printed there. it's unlimited when it goes back to states. so it looks like our older neighbors are really going to get hammered. they also said, please do not reduce an already underfunded medicaid system. well, this is the most radical rewrite to medicaid that we've seen in decades. changing to a per capita cap that doesn't grow over time in an adequate way to provide the support that our families, our children, folks with disabilities, i think about my childrens hospitals back home
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that are taking care of children with the most complex medical needs, if you want to support our hospitals, i strongly recommend you support mr. engel's amendment and you vote no on the republican bill. >> seeing no one else seeking recognition, i'm told we're going to go to a vote in accordance with an agreement with the -- >> sorry. >> okay. i recognize the gentleman from vermont. >> i'll be very brief, but mark wayne mullen talked about rural hospitals in his state, and we have the same thing in vermont. mr. engel has the same thing even in an urban district. the hospital ceos that i spoke to said that if we basically change the health care bill as it's being proposed now, it would be a big spike in
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uncompensated care. one of the big benefits to our rural hospitals has been that the free care that they were given, they now get medicaid reimbursement. it's low reimbursement but it's better than zero and it literally has made the difference between black ink and red ink for our hospitals. now, with mr. mullen's situation, what it suggests is it's not working for them, and this is the strangle hold we've put ourselves in by not taking time to try to figure out how to have a bill that's going to work for the small hospitals in his community and mr. engel's community and mine. i yield back. >> thank the gentleman. gentleman yields back. the question now arises on approval of the amendment. the clerk -- those in favor will vote aye. those opposed nay and the clerk will call the role. >> mr. barton votes no. mr. upton. mr. shimkis votes no.
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mr. murphy votes no. mr. burgess votes no. mrs. black burn votes no. mr. scalese votes no. mr. lotta votes no. mrs. mcmorris-rogers votes no. mr. harper votes no. mr. lance. mr. guthrie votes no. mr. olsen votes no. mr. mckinley votes no. mr. kinsinger votes no. mr. griffith votes no. mr. bilaroces votes no. mr. johnson votes no. mr. long votes no. mr. buchon votes no.
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mr. flores votes no. mrs. brooks votes no. mr. mullen votes no. mr. hudson votes no. mr. collins votes no. mr. kramer votes no. mr. wallberg votes no. mrs. walters votes no. mr. costello votes no. mr. carter votes no. mr. pallone votes aye. mr. rush. ms. eshoo votes aye. mr. engel votes aye. mr. green votes aye. ms. degette votes aye. mr. doyle votes aye. ms. shikowski votes aye. mr. butterfield votes aye. ms. castor votes aye.
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mr. sarbanes votes aye. mr. mcerny votes aye. mr. welch votes aye. mr. luhan votes ie aye. mr. tonko votes aye. ms. clark votes aye. mr. loebsack votes aye. mr. schrader votes aye. mr. kennedy votes aye. mr. cardenas votes aye. mr. ruiz votes aye. mr. peters votes aye. ms. dingal votes aye. chairman walden. chairman walden votes no. >> the gentleman from michigan, mr. upton. >> mr. upton votes no. >> gentleman from new jersey, mr. lance. >> mr. lance votes no. >> are there other members wishing to be recorded on this amendment? clerk will report the tally. >> mr. chairman, on that vote, there were 23 ayes and 31 nos.
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>> 23 ayes, 31 nos, the amendment fails. the chair now recognizes the gentleman from texas, the vice-chair of the full committee for unanimous consent request. >> yes, sir. yes, sir. but before i do that, mr. chairman, i want to commend you for your handling of your first major markup. >> thank you. thank you. >> this has literally been a baptism of fire and you have handled it with grace and humor. >> you're kind, thank you. >> and style and it bodes well for your tenure as chairman of what i think is the best committee in the house of representatives. >> i think it also set a record 27 hours nonstop, so congratulations to all of you and to our staff. >> don't give them something to shoot for, mr. chairman.
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>> now i'd recognize the gentleman for a uc request. >> i have -- i have two amendments at the desk, mr. chairman. i think they're barton 1 and barton 2. i would ask unanimous consent that we consider them both at one time, which i think the technical term is enbloc. >> the clerk will report the amendments. >> in en bloc amendment the committee print offered by mr. barton. >> i ask unanimous consent that be considered as read, mr. chairman. >> we'll dispense with the readings of the amendments. i now turn to my friend from texas, mr. barton, to speak on his amendments. >> i appreciate that, mr. chairman. these are the barton, blackburn, hudson amendments. we have three sponsors, and they're very straightforward. the bill as ks currently configured allows the states that expanded their medicaid population to healthy adults to continue that expansion until
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december 31, 2019 for all practical purposes, that's three years. this -- these amendments ends that ability to expand at the end of this year, january 1, 2018. so, instead of a three-year expansion continuation, my amendment would cut that by two years to just one year. the bill is currently drafted, has no date certain, that the super medicaid match goes back to the normal medicaid match. super medicaid match right now is 95%. it does go down to 2020 by 90% and then it continues in perpetuity at 90%. the second part or the second amendment, which is being considered en bloc, says by january 1, 2023, that super
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match goes to the normal state match, whatever that state's match is. so, that's the two amendments. now, my friends on the minority side have been asking for cbo scores all last night and this morning. i don't have a cbo score, mr. chairman, but i do have a bbo score. the barton budget office score. this is the back of an envelope score, but if you assume that there's 14 million eligibles or current enrollees in the expanded medicaid population, and instead of letting that continue and perhaps expand for three years, you stop it after one year, those two years that you have stopped that expansion, according to my calculations, is somewhere between $82 billion
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and over $100 billion in real savings. mr. chairman, that's real money, and it would start saving in calendar year 2018, not in calendar year 2020. so that's the amendment. we basically take the model in the pending bill, we end the continuation of the expansion two years earlier, and we put a date certain on when you go back to the medicaid normal match of 2023 which is what the committee staff estimates the attrition would result in going back to the medicaid match. with that, i want to yield to mr. hudson for his comments on our joint amendment. >> well, i thank mr. barton. thank you, chairman, for your work on this markup. mr. barton, thank you for your leadership on this amendment. our debt and deficit are out of control. our debt currently stands at $15 trillion, 77% of gdp.
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our deficit is at half a trillion dollars today. this amendment begins the important process of reigning in our federal spending two years earlier than the bill in its current form. we all agree we should take care of our most vulnerable citizens but medicaid is on an unsustainable path. solutions like the attempt we're putting forth today will ensure we can provide sustainable coverage to our most vulnerable. i look forward to working with my colleagues to advance this legislation and i yield back to mr. barton. >> let me say, mr. chairman, i believe mrs. blackburn is going to seek her own time or -- i yield to the gentle lady from tennessee. >> thank you, mr. chairman. mr. barton has explained the amendment. i want to thank the chairman and i want to thank the whip for working with us on this. we do think it is important to find a date certain to end the expansion and to do that this year, and then we also think it is important to have a date
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certain to return to that normal medicaid match. it is the right step for our country. it is the right step as we look at the affordable care act repeal and replacement and with that, mr. barton, i'm going to yield back the balance of my time to you to close. >> we've got 18 seconds left. let me say, mr. chairman, that the amendment -- that the two amendments i've just discussed have been endorsed by the republican study committee. they've been endorsed by the freedom caucus. in the days ahead, they're going to be endorsed, i'm sure, by a large number of conservative groups. white house is considering it. they're open to it. they're looking at it. they have not yet come out in support of it. but in private discussions, i have received quite a bit of positive feedback. with that, mr. chairman, to honor the agreement you've made with the minority, i am going to
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withdraw the amendment. >> if the gentleman -- yes. >> i'm not going to withdraw the amendment. >> no, no. >> great. >> but i know -- mr. pallone wanted to be able to speak on it. so if you could yield back. >> i yield back. >> then i'll recognize m mr. pallone and then you can withdraw. >> my hopes were soaring, mr. chairman. >> i know they were. few others were soaring and others were -- >> yeah. >> okay. so with that -- >> i yield back the negative balance of my time. >> i'll recognize the gentleman from new jersey to speak on the amendment. >> thank you, mr. chairman. i understand that mr. barton is going to withdraw the amendment. i do want to speak in opposition. the underlying bill freezes the medicaid expansion population for which states can receive enhanced federal funding. this would effectively end the medicaid expansion in 2020. the amendment also changes the date of this freeze from 2020 to 2018 and ends the availability for any enhanced match for the previously eligible medicaid
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expansion population in 2023. the amendment would end the expansion in 2018 and eliminate states enhanced funding for previously enrolled beneficiaries in 2023. of course i urge my colleagues to oppose this amendment to protect the 11 million people who are covered by the medicaid expansion. and i yield back. >> gentleman yields back. chair now recognizes the gentleman from texas for what purpose? >> mr. chairman, i seek recognition to withdraw my amendment. >> the gentleman seeks to withdraw his amendment. his amendment is withdrawn. and we now move to -- for what purpose the gentleman from new jersey seek recognition. do you want me to do -- >> mr. chairman, i just want to make some comments -- final remarks and thank the staff before we move to the final vote on the substitute. i think it's clear -- would rip
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health care away from millions of americans, raise costs for working families and seniors and lead to the rationing of care for 76 million americans who receive medicaid. while i appreciate the debate we had here in committee, this is not been a transparent process. we did not go through regular order. the bill was posted less than two days before markup. no hearings were held and we don't have a cbo score. this is not the way this process should work. and this repealed bill should be defeated. but i want to thank the staff on the committee for all their hard work. the staff and personal offices for all their hard work. members for this engagement and especially the clerks on both sides of the aisle. i yield back.
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>> i would thank the -- my colleague from new jersey. i recognize myself for five minutes. i too want to thank our staffs on both sides of the aisle. they conduct themselves with incredible professionalism, integrity, thoughtfulness, even in the heat of battle. they can exchange messages in a most cordial way. and so i -- i especially want to thank our health team, paul, josh, jp, buk, kristen, caleb, and our clerks, the people who have kept us fed and watered and distributed the amendments and really the people that make all this work. you know, we go back and forth. we agree, we disagree, we do it in the best spirit that our tempers and time of day will allow, and we get to an end product and none of it works without all of the people involved.
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and especially i want to thank and cspan too, that makes this all public. i think they've -- i think they've endured even more. because they get to listen and not participate much, so anyway, and i want to thank my leads too with our comps team and certainly karen and mike and ray balm and our whole team and our personal staffs as well and to our colleagues, thank you very much. you've done a marvelous job on a really historic moment, whether you're for it or against it, you have to admit this was a pretty big deal we just did. and i want to -- i also want to thank our house legislative counsel. i think they drafted a few amendments that i'm sorry you didn't get to. they certainly worked with us.
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they've been terrific. frankly, as much as we go back and forth about cbo and others, we -- oh no, we've been invaded by the former ways and means committee chairman, the speaker of the house we want to recognize here in our midst as well. so mr. speaker, i guess you finally get to see the real a committee you couldn't get on so you went to ways and means. we have more work to do. we got it done. we got it done. so, i just want to say thanks to everybody. with that, i think i have to do something official here to -- if there's no further discussion, there's no further discussion, the vote occurs on the amendment in the nature of a substitute as amended. all those in favor -- and i'll call the role or have the clerk call the role so shall signify by saying aye, all those opposed no, the clerk will call the role. >> mr. barton.
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mr. barton votes aye. mr. upton votes aye. mr. shim kis votes aye. >> mr. murphy votes aye. >> mr. burgess votes aye. mrs. black burn votes aye. mr. scales votes aye. mr. l oo tta votes aye. mr. harper votes aye. mr. lance votes aye. mr. guthrie votes aye. mr. olsen votes aye. mr. mckinley votes aye. mr. kinsinger votes aye. mr. griffith votes aye. mr. bilarocas votes aye. mr. johnson votes aye. mr. long votes aye. mr. buclon votes aye. mr. flores votes aye.
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mrs. brooks votes aye. mr. mullen votes aye, mr. hudson votes aye, mr. collins votes aye, mr. kramer votes aye, mr. wallberg votes aye, mrs. walters votes aye, mr. kos tell hello votes aye, mr. carter votes aye, mr. pallone votes no. mr. rush. ms. eshoo votes no, mr. engel votes no, mr. green votes no, ms. degette votes no, mr. doyle votes no, ms. she cow skooe votes no, mr. butterfield votes no, ms. matsui votes no, ms. castor votes no, mr. sarbanes votes no, mr. mcerny votes no, mr. welch
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votes no, mr. luhan votes no, mr. tonko votes no, ms. clark votes no, mr. loebsack votes no, mr. schrader votes no, mr. kennedy votes no, m mr. cardenas votes no, mr. ruiz votes no, mr. peters votes no, ms. dingal votes no, chairman walden. >> walden votes aye. >> chairman walden votes aye. >> clerk will report the tally when ready. >> mr. chairman, on that vote, there were 31 ayes and 23 nos. >> 31 ayes and 23 nos. the amendment in the nature of a substitute as amended is approved. i move that the committee do now approve and transmit the
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recommendation -- i move that the committee do now approve and transmit the recommendations to this committee and all appropriate material including supplemental dissenting views to the house committee on the budget. all those in favor will vote aye and the clerk will call the role. >> mr. barton. mr. barton votes aye, mr. upton votes aye, mr. shim kis votes aye, mr. murphy votes aye, mr. burgess votes aye, mrs. black burn votes aye, mr. scalese votes aye, mr. lotta votes aye, mrs. mcmorris rogers votes aye, mr. harper votes aye, mr. lance votes aye, mr. guthrie
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votes aye, mr. olsen votes aye, mr. mckinley votes aye, mr. kinsinger votes aye, mr. griffith votes aye, mr. bill roks votes aye, mr. johnson votes aye, mr. long votes aye, mr. buchon votes aye, mr. flores votes aye, mrs. brooks votes aye, mr. mullen votes aye, mr. hudson votes aye, mr. collins votes aye, mr. kramer votes aye, mr. wallberg votes aye, mrs. walters votes aye, m mr. costello votes aye, mr. carter votes aye. mr. pallone votes no. mr. rush. ms. eshoo votes no, mr. engel votes no, mr. green votes no,
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ms. degette votes no, mr. doyle votes no, ms. she cow skooe votes no, mr. butterfield votes no, ms. matsui votes no, ms. castor votes no, mr. sarbanes votes no, mr. mcerny votes no, mr. welch votes no, mr. luhan votes no, mr. tonko votes no, ms. clark votes no, mr. loebsack votes no, mr. schrader votes no, mr. kennedy votes no, m mr. cardenas votes no, mr. ruiz votes no, mr. peters votes no, ms. dingal votes no, chairman walden. >> walden votes aye. >> chairman walden votes aye. >> the clerk will report the tally. >> mr. chairman, on that vote,
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there were 31 ayes and 23 nays. >> 31 ayes, 23 nays. the ayes appear to have it. the ayes have it and the motion to transmit is agreed to. now, we have one more piece of business to deal with as per our notice. so, at this point, the chair calls up h-res 154 and asks the clerk to report. >> hres 154 of inquiry requesting the president of the united states in directing the sktd of health and human services to transmit certain information to the house of representatives relating to plans to repeal or replace the patient protection and affordable care act and the health related measures of the health care and education reconciliation act of 2010. >> without objection, the reading of the resolution is dispensed with and the chair recognizes mr. kennedy for five minutes. >> thank you, mr. chairman. i'm conscious of the fact that i'm bringing up this resolution after 27 hours of being this
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this room is probably not the most popular thing at the moment. however, i would not do it if i did not believe it was very important and i appreciate the recognition. this committee just finished marking up half of this bill, obviously, ways and means finished it before it however that is only the first step in a very long process and i have strong concerns that this committee and particularly our democratic caucus has not been afforded all the information that is necessary for us to understand the details of the bill and where this is going forward in the days and weeks ahead. just today, the president of the united states tweeted out that, quote, despite what you hear in the press, health care is coming along great, we are talking to many groups and it will end in a beautiful picture. yesterday, he expressed openness to expanding the rollback to 2018 contrary to the bill that we just marked up, delaying the changes in the insurance markets until 2018 and 2020.
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on tuesday, the president took to twitter again when he wrote up, don't worry, getting rid of state lines which will promote competition and will be will bee 2 and phase 3 of the health care rollout. that was obviously news to many of us that there was in fact a phase 2 and phase 3. he continued on twitter that i am working on a new system that will be competition in the drug industry. pricing for the american people will come way down. mr. chairman, after in the of nondisclosure agreements between judiciary and white house personnel, we have requested information as to whether documents, notes, e-mails, correspondents between white house transition officials and this committee if they exist about the roll back of -- potential roll back of the affordable care act so we can
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have an idea of what this process would entail. we obviously haven't gotten that yet. we talked about it several weeks ago. we then filed this resolution of inquiry with the hope of obtaining that series of correspondence if any exists so this committee and the american people and democratic caucus, democratic members of this committee, can be certain that we understand what is taking place and what plans are as we debate the biggest policy -- or biggest policy portfolio for this administration, as least for this congress. i would respectfully that this is not -- look, it was successful, you guys got the vote, it passed. but as we all know this is the first step to the pros senproce and phase 2 and phase 3 that i didn't know about until i read about it on twitter. i would respectfully request that the committee divulge
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whatever correspondents exists between the white house and this committee so that we, as members of the committee, can have an accurate representation and reflection of what is coming next and what is the true ambition of the health care policy rollout for this caucus. with that, i will yield back and -- or yield to any other member of the democratic caucus here, or democratic committee that want it. i repeat that this bill, i know on the republican side of the aisle, you have very strong feelings here as well. and i'm not so warm and fuzzy as you are at this point. i yield back. >> gentleman yields back the balance of his time. chairman recognizes himself for five minutes. from the investigations, under chairman upton, the committee on energy and commerce has a long history of conducting robust oversight of the executive
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branch. we will continue to carry out this important constitutional obligation under my -- never went to this statement of inquiry. quite frankly, i think this is premature and i would urge my colleagues to reject this. >> mr. chairman, just to respond to that for 30 seconds, if i
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may. >> sure. i would yield to the gentleman. >> and i understand that perspective. and i do, sir. i would bring up that this is, this resolution, resolution of inquiry has been performed by actually this committee, by republicans, when we were actually negotiating passage of the affordable care act. just to be clear, i did ask about correspondents informally between committee and committee staff and the white house before filing this resolution hoping that we wouldn't have to get there. so i understand your position. i would respectfully say this wasn't the first step. this was second or third down the line. i yield back. >> i appreciate that. reclaiming my time, again, when i believe that a member of our committee did pursue documents first. they did go through the steps i just outlined then they went to the resolution of inquiry. so that was kind of the process i was laying out. is kind of traditionally how the
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committee is operating under democrats and republicans. you go through a request process. you try and get an administration to comply. quite frankly, most administrations sort of slow lock things. they just do. and so, then you turn the heat up and then you do oversight hearings and maybe a number of steps. this kind of the nuclear option, if you will, at end when they completely don't comply. >> nuclear didn't work so well. >> well, i'm just saying. so with that, i would yield to the gentleman -- i would yield to the gentle lady for what purpose of my time? >> to strike the last word on the resolution. you can't do that. >> i thought we were just doing the two of us. >> can i ask a question? >> can i just yield on my time? i thought that was our agreement. >> sure. >> the gentle lady. i would yield to her.
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>> i want to thank mr. kennedy for the resolution and what i would like to ask you, mr. chairman, what are the steps? and what's the timetable for them so that the end result is the procurement of the materials that are in the privileged resolution. >> yes. so i think i outlined them. but basically you would have an inquiry of the agency. you would have a written inquiry. ask for certain documents. we would work through that. you know in our o & i role we do that often in bipartisan way. i've signed a lot of letters to this administration asking for documents. we have pursued that already. in various areas. some of those are follow-up. from document request that overlap administrations, that frankly administrations that -- >> let me ask this, have any requests been made from the administration for materials yet? >> i don't know about these
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specific materials, no. >> and mr. chairman, if i may -- >> i would yield. >> thank you. again, just so the committee is clear, this was done in a committee hearing. done followed up in writing. there was no response given. this was -- as you outline, if i can -- i would love to work with you and your committee staff to advance this process, if you can get a commitment from you. or clear idea as to what steps are necessary so we can get this. but we tried once verbally, we tried again on paper. no response. no response. my nuclear option isn't so nuclear. but i understand your response. this is important to members, and i would like to figure out what to do. >> reclaiming my time. i thank the gentleman. i'm happy to have discussions along the way on these and other issues. but my time is expired. the question now occurs on reporting hres 154 to the house unfavorably. all those in favor, shall
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signify by saying aye. those opposed, nay. and the clerk will call the roll. mr. barton. that's a good -- maybe i should clarify that. it is a double negative. so everyone wants the correct vote. so the recommendation for all would be to vote aye on the motion to report unfavorably although my friends on this side might want to disagree with me on that. did that make it clear? i think mr. barton wants it vote aye. that's what i thought. >> mr. barton votes aye. mr. upton? mr. upton votes aye. mr. shim kiss? mr. shim kiss votes aye. mr. murphy?
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mr. murphy votes aye. mr. burgess? mr. burgess votes aye. mrs. blackburn? mr. blackburn votes aye. mrs. rogers? mrs. mcmorris rogers votes aye. mr. harper? mr. harper votes aye. mr. lance? mr. lance votes aye. mr. guthrie? mr. guthrie votes aye. mr. olson? mr. olson votes aye. mr. mckinley? mr. carol costel mr. mckinley votes aye. mr. griffith? mr. griffith votes aye. >> ladies and gentlemen, if we could -- the clerk will have trouble coulding rodoing the ro hearing us. mr. johnson votes aye. mr. long? mr. long votes aye. mr. bourbon? mr. bourbon votes aye. und
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mr. ploeres? mr. floeres votes aye. mr. hudson votes aye. mr. collins voets aye. mr. claimeramer? mr. cramer votes aye. mr. wahlberg? mr. wahlberg votes aye. mr. costello? mr. costello votes aye. mr. carter? mr. carter votes aye. mr. rush. ms. eshoo. no. mr. green? mr. doyle? mr. doyle votes no. ms. she could you ski? she could you ski votes no. mr. butterfield? mr. butterfield? mr. butterfield votes no. ms. met suey? ms. met sooi votes no. ms. caster? ms. caster votes no. mr. sarbanes? mr. sarbanes votes no. mr. mcnerny?
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mr. mcnerny votes no. mr. welch? mr. welch votes no. mr. lou han? mr. lou han votes no. mr. tonko? mr. tonko votes no. mr. love sack? mr. love sack votes no. mr. slader? mr. slader votes no. mr. kennedy? mr. kennedy votes no. mr. cardenas? mr. cardenas votes no. mr. ruiz? mr. ruiz votes no. mr. peters? mr. peters votes no. ms. ding el? ms. ding el votes no. chairman waldon? chairman waldon votes aye. >> are there any members not recorded that wish to be recorded? if not, the clerk will report the tally. >> mr. chairman, on that vote, 31 ayes, and 22 nays. >> 31 ayes -- >> 22 nayets.
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>> 22 nays. ayes have it and resolution is recorded unfavorfully. without objection staff can make conforming changes to matters considered by the committee over the last 27 1/2 hours. so ordered without objection this committee stands adjourned. [ applause ]
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house energy and commerce wrapping up. more than 24 hours of work on amendments to republican health care law replacement. 31-23. earlier also another committee met, house ways and means committee. they spent more than 17 hours debating different parts of the bill and they wrapped up their work this morning at 4:00 a.m. eastern time. now that both committees have finished marking up the measure, the house budget committee will be taking it up, possibly next week and vote on final passage in the house likely by the end of the month. if you missed any of the process, you can find all 40 plus hours on-line. we've got that up at c-span.org in the video libraries. just type ways and means or energy and commerce committee into the search bar. also could be hearing shortly from house speaker paul ryan. he made an appearance in the
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committee room a short time ago and he is expected to hold a briefing shortly. in the meantime, a look at some of the hearing and markup. part of the markup this morning began with a bit of humor from joe barton of texas who offered to treat the full committee to breakfast if they would vote on the amendments all together or on block. democrats turned that offer down. >> the chair would point out that if the minority would be willing to move all their ame amendments in block and out on a voice vote and if the majority would accept the blackburn/hudson amendment, we can end this and i will buy waffle house for everyone in the committee. >> can't do it. >> can't do it. worth a shot. are there other members that wish to offer amendments? ge

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