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tv   Energy and Commerce Committee Markup of Affordable Care Act Replacement...  CSPAN  March 9, 2017 5:07pm-8:01pm EST

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73% to the aged, blind and disabled. we're just trying to get back to where we take care of most of those in need first. that's what this is about. flexibility to the states. and then fix this broken insurance market. the young people have fled from 19.2 million people, 45% of which are -- can we have order, please? meeting come to order. 45% of which whom are under 35 years of age. so when you look at the death spiral of the individual market, it's because young people said i'll pay the irs penalty forced on me or i'll get a waiver. twice those did that as signed up. we're trying to get people back into the insurance market with affordable insurance, more choices, better rates, and help for those who really need it. with that, i yield back the balance of my time. >> in that case, amendment in the nature of a substitute offered by mr. welch.
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>> the amendment will be considered as read. the gentleman from vermont is recognized for five minutes. >> mr. chairman, when mr. walden was here, he was indicating an appreciation of the urgency of attempting to address the cost of health care. something that he said we would do down the line. and there's a number of colleagues on your side who are working on that. mr. griffin is working with me. dr. butchon i think has been a leader on this. there's an immense amount of interest on our side. but here's the deal, we do nothing in this bill to address costs. and in fact, that's where the money is. if we start bringing down the cost, it's going to make things much more possible for us to get health care delivered to the people who need it. one of the areas where cost is totally exploding is
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pharmaceutical drugs. just think about it. solvavi, to treat hepatitis c, $22,000 for a 12-week course. 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. this is about providing the child's needs when they go into shock. that is sold for $600. 400% more than it was just a few years ago. by the way, that company that is headquartered in the netherlands, u.s. company, sells that same item in the netherlands for $100. we are getting ripped off.
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now, the costs -- what we're spending on pharmaceutical drugs, a total of almost three-quarter of the average of -- mr. chairman, the committee's not in order. the committee's not in order. mr. chairman? >> the gentleman is correct, the committee is not in order. the gentleman will proceed. >> mr. president -- or mr. chairman, according to the aarp report, the average annual retail price of drugs was over $11,000 in 2013 for a patient who had prescriptions for a chronic illness. that's almost three-quarters of the average social security retirement of $15,526, and nearly half the median income of somebody on $23,500. this amendment is about making certain that nothing in this legislation is going to
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aggravate the already excessive burden with the cost of prescription medication. i'd like to remind the committee that mr. -- president trump spoke about prescription drugs, and what a bad deal the american consumer was getting with the high cost of prescription drugs, and that we were getting ripped off. yesterday president trump met with congressman elijah cummings and me and reiterated, restated his support to act promptly to address this prescription drug price crisis. this is an opportunity for us to at least begin focusing on health care cost, and prescription drugs is the area where the costs are rising the fastest.
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mr. chairman, i urge this committee to adopt this amendment, and begin the process of reining in the out-of-control costs of prescription medication. i yield back the balance of my time. >> the gentleman yields back. the chair recognizes the chairman of the health committee, dr. burgess. >> mr. chairman, the cost of drugs is a problem for too many patients. and we need to find solutions. spending on prescription drugs represents 10% of overall health care spending. however, instead of exercising greater government control, congress could opt and should opt for less, focusing instead on efficiency, innovation and competition. we've spoken about the three phases that republicans will pursue on rescuing people from the harms of the affordable care act. and there are things, after we
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finished the reconciliation, there are things that can be done obviously administratively. but we also have the user fee agreements within the fda to reauthorize. and we had our first hearing last week. the fda does take too long to approve generic applications. there are literally 1,500 applications that have been pending at the agency for years. that needs to improve, and that needs more competition. we also have a problem with the time it takes to develop and review innovative drugs. it costs nearly $2 billion and takes 14 years to bring a new drug to market. of course, the chairman worked on this very diligently with the 21st century cures bill. it ran two or three congresses and it was a milestone effort, but it was achieved. but our work here is not done. and of course, the oversight of
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the implementation of the 21st century cures act will be part of the ongoing regular order process in the subcommittee. working on legislation over the next few months to reauthorize the user fee process will -- could improve the fda processes, so 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 under medicare. ultimately, that leads to price controls, and reduction of the types of products that are available. congress should retool entitlement programs to encourage greater competition among providers and insurers, because private negotiation, as we've seen in the part d program, private negotiation does work. in the part d program, it continues to come in below cost
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projections, keeping costs steady for beneficiaries from year to year. premiums have remained stable over the course of the program, and are now half of what was originally projected by the congressional budget office when this committee marked up the medicare modernization act in 2004. 2005. the program that was implemented in 2006 has been a success story. and has put the powers of choice and competition and empowered seniors. i would note the committee and the staff continues to work in a bipartisan manner to advance hr-749, to lower drugs cost competition act, by representative schrader and bill raucous which aims to enhance generic competition. we look forward to continuing our progress in this effort. mr. chairman, there is no shortage of activity that is occurring in the subcommittee
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level, through the regular order process, and that will continue through the balance of this year. and -- >> will the gentleman yield? >> yes. >> mr. chairman, i thank the gentleman for yielding. i want to assure the gentleman from vermont he has no greater ally working on drug prescription prices than myself. he and i together co-chaired the pharmacy caucus. i appreciate his interest in this. there are a number of things that we can do. in fact, if you will look in the bloomberg today, there is an article about pbms, and why they are the primary reasons drug prices are increasing. in fact, gilead said pbms keep prices high. they do this through keeping the prices high so the pbms get a higher rebate. this is one of the problems we have. you're right, the president has made it clear that anyone who's on the other side of r & d needs
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to be aware, because we're after them, and we're after the pbms, because they are the primary problem here. again, i want to thank you for this. but i'm not sure as dr. burgess has said, i'm not sure this is the right time for us to do it. as the speaker has explained, this is a three-bucket approach that we're trying to get at through health care. this is the first bucket. we've still got those two buckets to go. and at that time, i hope that we can indeed address this. thank you, mr. chairman. i yield back. >> the gentleman's time is expired. the gentle lady from california strikes the last word. >> thank you, mr. chairman. move to strike the last word. very interesting to listen to the chairman of the health subcommittee. and i hope everyone was listening. it was long and winding. you haven't listened hard. but there's one message that comes out of it. it seems as if our colleagues on this side of the aisle are not
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in sync with the president of the united states. that's what's more than obvious to me about bringing down the cost of drugs. i'll yield to mr. welch. >> thank you very much. i am so delighted you're on this committee with your very extensive experience in pharma. i'm going to listen to 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 good things. they create life-extending, and pain-relieving medications. my first wife was the beneficiary of that. i get it. they need research and development. but you know what, if they're going to hide behind the assertion that it's 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.
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you know, there's got to be some transparency here. i'm all for letting folks get the price they need in order to keep doing the research for new break-through drugs. but there's never been any transparency. the other thing, the cost is unbelievable. we're going to be up to $500 billion, assumed, in the whole pharmaceutical expenditure between the government and between others. it's like a house is burning with these expenses. and we can have these rhetorical arguments and line up on with one side or the other, but we've got a situation here that needs attention. the frustration i have is that we go round and round and have not made concrete progress. price negotiation, for instance, which is a bill that we were -- mr. cummings and i were talking to the president about, i mean, i do not get why we don't use free market principles which says that if a buyer and seller
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negotiate. and a buyer tries to get a high price, a buyer tries to get a low price, a seller tries to get a higher price. that's the way it works. medicare is the biggest purchaser of drugs in the world. you know what we do? it's astonishing. we buy wholesale, and pay retail. you know why we do it? because congress said that's what we had to do. the noninterference clause. this is like upside down capitalism. so we don't do it in the va, we don't do it in medicaid, and we get prices that are about 60% less. so my question is, how can any of us claim that we're fiscally responsible when we're not willing to bargain to get a better price. now, bargaining is not setting price. it's bargaining. and president trump gets that. if he's going to get a thousand
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mirrors for one of his buildings, is he going to pay a per-unit cost on a thousand that he would get for one? i doubt it. he didn't get to where he is by making that kind of bad deal. i implore my colleagues. we've got a lot of knowledge here on both sides of the aisle. we've got to do something about it. it will help the taxpayer, it will help the consumer, it will help our employers who are trying to keep costs down so they can continue to provide good health care coverage to their workers. i yield back. i yield back to -- yeah. >> last week the health subcommittee had a hearing, and excellent witnesses. and they were -- the subject matter was really how much generics have brought down costs, how that market has grown, how many people are a part of it. but there was a statistic that one of the witnesses stated when
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i asked the question, if the generic market has grown so 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's amazing. 11%. so it's really a handful of products. i'll yield back. >> the gentle lady yields back. the chairman recognizes the gentleman from florida. >> mr. chairman, thank you very much. mr. welch, we have a bill with representative shrader, bipartisan bill to address this issue. as a matter of fact, we had a hearing on this last week. and we intend to mark it up. i understand, mr. chairman, hopefully by the end of the month. it's house bill 749. and it aims to incentivize more
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generic drug xu tegs where it is needed the most. we're addressing this issue. since introducing this bill, we've heard a number of additional ways to encourage the competition. we're working on a bipartisan basis to consider these options. the bill will supplement the increased generic competition that will come from reauthorizing and improve drug user fees. so again, this is an issue that we're addressing. i appreciate, mr. welch, bringing this issue up. we've got to lower the drug prices through competition. and i don't know whether mr. shrader wants time. anybody want some time? >> i do. do you yield back? >> i yield to mr. shrader. >> thank you very much. i appreciate it. i think this is timely. i think representative welch has been a longtime advocate for trying to rein in explosive costs of pharmaceutical, and appreciate working with the gentleman from florida on a bipartisan basis to get at that.
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it's not all acrimony here, occasionally we do get along and solve a few problems. it's a first step, it's not huge. but you've got to take those first steps to get somewhere down the line. i think it serves notice that this committee, and this congress, is interested in reining in health care costs wherever and whenever we can. the bill goes that way, representative welch also has some interesting work on mitigation studies that we could get behind, i think. that would also be great legislation. so urge us to continue to work along these lines, and hopefully do what we do best, which is get together and solve the problems for the american people. i think that's what they're looking for us to do right here, right now. >> i couldn't agree more. anyone else? >> i yield to mr. carter. >> i thank the gentleman for yielding. i want to reiterate to representative welch, and to everyone, i'm as committed as anyone to this. i am not taking up for the
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pharmaceutical manufacturers. they need to pay the price, too. they need to be responsible for this. but it's much more than just that. and again, this is a phased process i've just been told by leadership not to use bucket anymore, use phase now. evidently it's too pedestrian. but nevertheless, this is not the right phase for us to be doing it, so representative welch, i will not be sup borting your amendment, but i'm supporting your underlying effort to rein in drug prices. >> that's the goal. does the gentleman from florida yield back his time? >> i yield back. >> the gentleman from new jersey. >> thank you. i was hoping with all these happy faces on the republican side we could get the support of mr. welch's bill. maybe we can still get some of you. i just want to say that, prescription drug prices, as we know, is rising at an alarming pace. annual drug spending in the u.s.
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is estimated to reach more than $500 million by 2018. and in 2014, spending grew by 12%. faster than any year since 2002. and this increase is having a very real impact on american families with one out of five americans age 19 to 64 unable to afford the cost of their prescriptions. throughout the country, and even from our president, as has been mentioned, there's bipartisan support for actions to lower the cost of prescription drugs and make treatments for affordable for patients and their families. the president has said he doesn't like what's going on with drug prices, and in fact he said, and i quote, i'm going to bring down drug prices. yet despite this commitment from the president, the republican repeal plan does nothing to address drug prices, and instead continues to give breaks to pharmaceutical companies that our president believes are getting away with murder by repealing the fee on brand name prescription drugs that pharmaceutical companies agreed to under the affordable care act. so this is another one of the
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pay-fors for the affordable care act as repealed in the republican bill, and again, is a giveaway. in this case, to corporate interests. the vast majority of republican and democratic voters agree that the most important health care priority for a new president and congress is making prescription drugs affordable for those that need them. also with bipartisan agreement is the need for government to take action to lower drug prices. so if we're going to believe the president's latest tweet, he says, quote, a new system, where there will be competition in the drug industry is coming, and pricing for the american people will come way down. however, while we wait for the republicans' next plan to be revealed, i would usual my colleagues to support this amendment and delay implementation of the american health care act until it can be certified by the secretary, that it will lower drug costs for consumers. so i urge my colleagues on both sides of the aisle to vote in favor of this amendment. i thank mr. welch.
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would anybody like some of my time? i yield back, mr. chair. >> the gentleman yields back. other members wishing to speak? the gentle lady from illinois is recognized for five minutes. >> move to strike the last word. i support congressman welch's amendment. because families across the country are struggling to afford their prescription drugs. we talked about how president trump has said that big drug corporations are, quote, getting away with murder. unquote. just yesterday, after meeting with congressman welch and congressman cummings, the tweet was, i'm working on a new system where there will be competition in the drug industry. pricing for the american people will come way down. naes a tweet. and i have to say, this may be one of the issues, if he's serious, that we're going to be able to work with him. you know, i was here when
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immediate i card part d passed. 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 cost of drugs nearly doubled from $62 billion in 2007 to $121 billion in 2014. medicare part b prescription drug pricing doubled from $11 billion to $22 billion between 2007 and 2015. and by the way, i'm reintroducing a bill that will add transparency. we want to know, how much do they really spend on research. in medicaid, spending on the prescription drugs per enrollee
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also agree by over 13% between 2013 and '14. and in 2016, aarp study of widely used brand name drugs found that 97% had price increases that exceeded inflation. out-of-pocket costs for americans are rising with the average american paying over $1,300 out of pocket in medical expenses, including their prescription drugs, before their health care coverage kicks in. and that is a sharp increase from an average deduction of $584 a decade ago. as a result, too often patients and their families have to make very real decisions about what they can afford every month. and we've all talked about the tradeoffs, do you pay your electric bill, your grocery bill, or your prescription drug bill. and according to aarp survey, 55% of adults over the age of 50
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decided not to refill a prescription in part because of the cost. nearly one-third said cost was, quote, the main reason, unquote, for not refilling the prescription. skipping doses or prescriptions can have serious implications for patients and our health care system. an estimated 125,000 deaths, and 10% to 20% of hospital and nursing home admissions each year are the direct result of non-adherence to immediate i indication. medication. the problems created by prescription drug prices are not limited to people who are actually taking prescription drugs. these price increases also affect employers, private insurers, and taxpayer funded programs. like medicare or medicaid, by increasing premiums and the cost of public programs. this is a systemic problem that requires an aggressive and comprehensive solution. the american people totally agree with this.
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aarp's survey on prescription drugs found that 87% of americans, ages 50 and older, need control for prescription drug costs. the kaiser family foundation found # 77% of americans feel the price of drugs is unreasonable. people are demanding action, and it really is time for congress to act. one way to help address this issue is to limit what patients pay out of pocket for the prescription drugs in a month. so for all the talk from republicans on reducing health care costs, the repeal bill does nothing to address skyrocketing prescription drug prices, and those who want to work on that with us, i would suggest this is a great place to start. why don't you vote for the welch amendment right now. we can roll up our sleeves, we can get to work, and guess what, maybe we can work with the president on this as well. and i yield back.
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>> the gentle lady yields back. does anyone on the republican side seek recognition? seeing none, is there further discussion on the democratic side? the gentleman from new york is recognized. >> chair, move to strike the last word. >> gentleman is recognized for five minutes. >> thank you, mr. chair. i rise in support of this amendment, reining in out-of-control prescription drug costs should be the number one priority for this committee in addressing health care. lowering drug prices is the key to unlocking lower overall health care costs. a recent poll found both republican and democratic voters agree in making this the number one priority for congress. let's make it happen for the american people. addressing drug costs would help individuals in my district, people like tracy from troy, new york, who needs multiple drug prescriptions to treat preexisting conditions, including diabetes. the affordable care act has made it possible for tracy to get health coverage for herself and
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her family. without the aca, tracy would not be able to pay her doctors or the drug companies. still, we could do more, much more to help tracy manage her costs. prescription drug costs are spiraling out of control. here are the facts from a money magazine article. drug price increases have taken place in each of the past three years. prices for 30 common prescription drugs increased at eight times the pace of inflation, between 2010 and 2014. 16.7% of all health care spending went toward prescription drugs compared to roughly 7% in the 1990s. the average annual retail price of drugs was over $11,000 in 2013. the price made infamous by martin sh relly was jacked up 5,000% overnight. this situation must be fixed. we can take a good first step with this amendment and i
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strongly urge my colleagues to support this amendment. with that, mr. chair, i yield back. >> the gentleman yields back. the chair thanks the gentleman. does any other member seek to be heard on the welch amendment? seeing none, the question then occurs on the welch amendment. the gentleman from new jersey had previously asked for a roll call vote. so the clerk will call roll. >> mr. barton? mr. upton? mr. shimcuss? >> no. >> mr. murphy? mr. burgess? >> no. >> mrs. blackburn? >> no. >> mr. scalise? >> no. >> mr. latta? >> no.
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>> mrs. rogers? >> mrs. rogers votes no. >> mr. harper? >> no. >> mr. lance? >> no. >> mr. guthrie? >> no. >> mr. olson? >> no. >> mr. mckinley? >> no. >> mr. kinsinger? >> no. >> mr. griffith? >> no. >> mr. billrackas? >> no. >> mr. johnson? >> no. >> mr. long? >> no. >> mr. butchon? >> no. >> mr. flores? >> no. >> mrs. brooks? >> no. >> mr. mullen? >> no. >> mr. hudson?
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mr. collins? >> no. >> mr. kramer? mr. walberg? >> no. >> mrs. walters? >> no. >> mr. costello? >> no. >> mr. carter? >> no. >> mr. pallone? >> aye. >> mr. rush? miss eschu? >> aye. >> mr. engel? mr. green? >> aye. >> miss byget? >> aye. >> mr. doyle? >> aye. >> miss shecowski? >> aye. >> mr. butterfield? >> aye. >> miss matsui? >> aye. >> miss caster? >> aye. >> mr. sarbanes?
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>> aye. >> mr. mcinerney? >> aye. >> mr. welch? >> aye. >> mr. louhan? >> aye. >> mr. tonko? >> aye. >> miss clark? >> aye. >> mr. loadsack? >> aye. >> mr. shrader? >> aye. >> mr. kennedy? >> aye. >> mr. cardana? mr. ruiz? >> aye. >> mr. peters? miss dingle? >> aye. >> chairman walden? chairman walden votes no. mr. barton? >> no. >> mr. upton? >> no. >> mr. murphy? >> no. >> mr. hudson? mr. kramer? >> no.
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>> mr. engle? >> aye. >> okay. >> the clerk will report. >> mr. chairman, on that vote, there are 21 ayes and 30 nos. >> 21 ayes and 30 knows. the amendment is not agreed to.
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is there members seeking recognition? what purpose does the gentle lady 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 offered by miss clark. >> without objection, the amendment is dispensed with. the gentle lady is recognized for five minutes on her amendment. >> thank you, mr. chairman. my sense of congress amendment will prevent the elimination of the prevention of public health fund. the prevention of public health fund 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 supported by this fund.
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as i've 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 also helps bend the health care cost curve. however, i note firsthand that there are significant barriers to accessing quality health care, which in turn exacerbates racial and gender health disparities. according to the centers for disease control and prevention, african-american women are twice as likely to suffer from heart disease as a result of high rates of chronic health conditions, such as obesity, elevated cholesterol, high blood pressure and diabetes. and when it comes to breast cancer, the rate and severity of the disease are even more alarming. african-american women are twice as likely to be diagnosed with
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aggressive types of -- >> the committee will come to order. gentle lady may proceed. >> thank you, mr. chairman. african-american women are twice as likely to be diagnosed with aggressive types of cancer, including triple negative breast cancer that disproportionately affects young african-american women. african-american women also are 43% more likely to die from breast cancer than their white counterparts. the five-year survival rate for white breast cancer survivors is 89%, whereas the five-year survival rate for african-american women is just 79%. you may be asking yourself, why breast cancer is so important and personal for me. the answer is simple. my staffer, gail was diagnosed
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with lcis, and acknowledged precursor to breast cancer. unfortunately, gail was unable to receive high quality medical follow-up, and as a result, gail's condition worsened. like many of the african-american women, when gail eventually did receive health care, her disease was in an advanced stage. thankfully gail survived. because of gail, and countless other women like her, i will continue to work towards decreasing health disparities, in doing so improve the quality of life and longevity for all women of color. so i urge my colleagues this morning to support my amendment, to prevent the elimination of the prevention in public health fund. mr. chairman, i yield back the balance of my time. >> the gentle lady yields back. the chair recognizes the gentleman from pennsylvania -- for what purpose?
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>> strike the last word. >> the gentleman is recognized for five minutes. >> thank you, mr. chairman. i just want to point out some things about the prevention in the public health fund and that is how it is used. again, it sounds good, and with good intents here, but there are a number of things that happened without proper oversight over this in how the money is spent. so before this year 2014 when congress started directing the allocation of funds through appropriations, here are some of the following grantees. nashville received -- putting prevention work grant for a free pet spaying and neutering. boston got $1 million for urban gardening. north carolina got money for signage from low recreational destination for public parks, bike lanes. the cascade bicycle education club got money for approved walking and biking environment.
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there was also money that went into a kickboxing, zumba, and kayaking, and peddle boarding classes. king county washington got $12 million for changes in zoning policies to locate fast-food retailers farther from schools. and the list goes on. i know some people are saying that some of this is -- we've always funded cdc. we recognize their value. that will go to the regular order of process in terms of the appropriation committee. but part of this is we wanted to make sure as we've also said when congress began to take a closer look at this, and control more of the spending since 2014, is that the prevention of public health fund was not often used for that. we face similar problems in the past with samsa was also using the money for websites, for children's sing-along songs that
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cost several thousand dollars. a website for people in boston to help them with snow anxiety. >> would the gentleman yield for a question? >> it's always -- >> would the gentleman -- >> not yet, please. i will. but anyway, for a number of things here. we want to make sure funds 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 that really control better ideas for health care, and a lot of oversight of that to make sure some things are not misused. i certainly would yield to my friend if you have a question. >> i just had a question. because i'm just trying to figure out about the i tempts you just mentioned does not fit into the intention of the fund? it's about prevention and public health. you went down a list of things. and from what you've described,
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they are promoting fitness, they're promoting 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 for her question. certainly fitness is important. weight control and lack of smoking, it's important. the question is, how federal funds are used in a situation and how best to coordinate it. that when we're talking about so many areas of health care and costs, looking at these as areas -- i guess i don't quite understand how urban gardening is part of that. or -- >> because urban -- just to answer your question, sir, many urban areas are food deserts. >> i understand. >> when you establish a garden in those communities, now they have access -- >> i hear you. >> -- to vegetables. perhaps if we have a
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conversation, i can interpret some of that for you in a way which you had not seen it before. but these are very important initiatives, in many communities across the country. >> let me reclaim my time on that. the niinitiatives are -- we don have enough providers, we don't have enough hospital beds for people with mental illness, states are still not using, or not coordinating care under medicaid to properly coordinate care. it is tough when we see that we're working on pet spaying and neutering and gardening and signs for where the local parks are. if local communities and states and counties want to put money into that, great. but while we're trying to use precious dollars to promote so many other things in health care, i want to make sure we're doing it. i recognize my friend represents an urban area. i would be glad to talk with you offline to look at other ways to promote fitness and healthy
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living, et cetera. but in terms of this, i think we have a number of high priorities that would address that. i yield back. >> the gentleman yields back. for what purpose does the gentle woman from new jersey seek recognition? >> the gentleman is recognized for five minutes. >> thank you, mr. chairman. this amendment would obviously eliminate the 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 the quality and -- the quality of health care and aids prevention. many hours were spent on it, and fortunately, a lot of those things have not been repealed as part of the republican effort here. but one of the most important things is the prevention fund.
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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 fund, and one could argue even the things he's picked 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 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
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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 common 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 directed at preventing these diseases before they happen. so when we passed the aca, we knew that protecting the health of the nation depends upon 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, you know, many times i
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mentioned my meeting last week with the national governors association. both governors from the republican and democratic party. more actually from the republican party. and 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 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? for a moment. >> i don't have a lot of time. >> you referenced me and i'd like to respond. >> i'm not being critical. >> i think you questioned my motives. i'd like to respond. >> no, no, i'm not questioning your motives.
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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, you know, 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 mean 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've been the charnl chairman of the oversight subcommittee for some time. we've had a lot of hearings on 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, miss eshoo. 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
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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 promoted you but not to president. >> the gentleman yields back his time. chair thanks the gentleman. gentleman recognizes himself for five minutes and i'd like to yield to the gentleman from pennsylvania, mr. murphy, for his response. >> i thank you. on this, i certainly know that my friend from new jersey is also holds in high esteem the importance of preventative health. my point is this. with regards to this, if states are going to ask for money for road signs and neutering and other things, you ought to be able to produce some data for us so show what impact that's had upon it. i know when we asked the gao to give us a report on samson, some things are funded through this with regard to account of mental
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health problems, they said only 20% of grants had people reporting back to 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 someone 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. as 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 and lowering health care costs and a wide range of things. actually, there was a lot more 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 continue to have hearings on ways we can do this better. i want to look at alternative models for medicaid and -- >> would the gentleman -- >> it's the chairman's time. i yield back.
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>> sorry. >> the chairman controls the time. and i actually do want to speak on this, so if there's time left over, i'll come back do 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 of acronyms that were included in the affordable care act and 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, medicaid innovation, the 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
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how those dollars are spent. >> mr. chairman -- >> no, i will not. i'm using this time to concur with dr. murphy that it is the requirement of the oversight committee that they do have oversight of the activities of the secretary. 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 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
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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 prevention of 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, very difficult to do that. i think this is a reasonable approach, that congress should have the oversight over this activity. even with dr. price over as the head of 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.
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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 sometime in 2020 or 2025, it increases to $2 billion a year. then in perpetuity, and honestly, the committee simply cannot not exercise the oversight. i'll yield the remaining seconds to the gentlelady from new york if she would like. so i will yield back my time for what purposes the gentle lady seeks recognition. >> mr. chairman. >> gentlelady 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.
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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 billion over the next ten years? >> she's talking about the one you're proposing? >> the patient stability and safety fund? >> about the bill. >> the innovation fund. >> the other one. >> prevention fund. >> that's what the amendment is 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?
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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. >> what's the total over how many years? >> you're talking about the prevention and public health fund, correct? >> yes. >> 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?
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>> indefinitely. >> it just never ends? wow. the people for -- 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 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?
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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 gentlewoman 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? >> that would be through the labor hhs appropriations subcommittee. >> that is through the congress, not the secretary? >> it's transfer of authority, so the committee on appropriations may provide for the transfer of funds to eligible activities subject to -- >> could you really say that, state that clearly? because i think my colleagues
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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 committee may 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 actually happened since 2014? >> what happened or what happens? >> isn't it true that congress has appropriated every dollar?
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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 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.
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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 miss matsu 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 families feel when mental health is left unaddressed. the aca took giant strides forward for the mental health community by expanding medicaid, which covers 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
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physical health services. mr. chairman, we spent years on 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 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
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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. 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.
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that is why i'm offering this amendment to protect miss clarke's amendment to protect the garrett lee smith youth 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. and i yield to ms. dingell. >> thank you, miss matsu. 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
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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 levels and now we had another study, a recent reuters analysis that says there are almost 3,000 neighborhoods who have recorded childhood lead poisoning rates at double those in flint during the peak of the city's contamination. these cuts 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
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amendment. i yield back. >> and the gentlelady yields back. gentlelady leads back and all time has expired. 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 resource, if we're going to begin to turn our health care system toward 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
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with earlier amendments that that fund is going to certain purposes at the state level, and so i don't think one serves to replace the other. it's an apples and oranges thing. i think we have to preserve the integrity of this particular 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 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
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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 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 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
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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. so i definitely support congresswoman clarke's amendment and i'll yield the balance of my time to congresswoman castor. >> well, 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
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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 stroke and tobacco cessation. we use it for infectious disease prevention. 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
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well. and i yield back to 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, promoting access to preventative services. providing payments. there are several things listed here. i'm 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
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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 unimportant. >> no, i was just saying it's not a big leap when you recognize that with sound nutrition, you're able to maintain better health than -- then you understand why urban gardens have become so very important. >> i'm not disagreeing with you at all. the prevention fund is big. not the prevention fund, the stability fund, $100 billion over 10, 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
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on through ways & 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. >> would the gentleman yield? >> i need to give him time, but yes, ma'am. >> yeah, 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 lives of the people that we're trying to -- we're trying to help with their health care. >> it is state allocated and it is -- >> it's not mandated. it's optional. rig right. >> 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 yielding. i appreciate the discussion. i think we all care about these issues, and to ms. clarke on
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nutrition, i was at a university on i think last friday, it's hard to keep track at this hour, and they're doing amazing research on nutrition as it relates to diabetes, heart disease, in the mother and grandmother. and what carries on through. so these are issues, i would like our committee to get into in-depth to look at what it means 100 years from now based on what you eat now. so it's really interesting research that they've pioneered. we'll work on that. >> yeah, i think so. 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. remember, 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
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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've 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 nutrition, to public safety. all of the things that matter in prevention. so i yield back. >> my other friend from oregon i think raised your hand for some 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
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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. >> gentleman yields back. are there other members? 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 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
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from this 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 prevention 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, 2 american indian tribes and 8 u.s. 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
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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 interventions 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 preventive measures. the ongoing water crisis in flint, michigan, as well as the almost 3,000 neighborhoods recording lead poisoning grades at least double those in flint prove that this program 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
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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 -- >> gentleman yields. >> -- support the amendment 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? i know we have a lot of amendments to get through. we'll have a roll call vote. all those in favor, vote aye, those opposed, no. the clerk will call the role. >> mr. barton? mr. upton? mr. upton votes no.
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mr. shimkus? mr. murphy. mr. murphy votes no. mr. burgess. mr. burgess votes no. mrs. blackburn? mrs. blackburn votes no. mr. scalise? 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. mr. guthrie votes no. mr. olson? mr. olson votes no. mr. mckinley? mr. mckinley votes no. mr. kinzinger? mr. griffith? mr. bilirakis? mr. bilirakis votes no.
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mr. johnson? mr. johnson votes no. mr. long? mr. long votes no. mr. bueshon? mr. bueshon votes no. mr. flores? mr. flores votes no. mrs. brooks? mrs. brooks votes no. mr. mullen? mr. mullen votes no. mr. hudson? mr. hudson votes no. mr. collins? mr. kramer? mr. kramer votes no. mr. walberg? mr. walberg votes no. mrs. walters? mrs. walters votes no. mr. costello? mr. costello votes no. mr. carter? mr. carter votes no. mr. pallone? mr. pallone votes aye. mr. rush? miss eshoo? miss eshoo votes aye. mr. engel?
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mr. engel votes aye. mr. green? mr. green votes aye. ms. degette votes aye. mr. doyle votes aye. ms. schakowsky votes aye. mr. butterfield? mr. butterfield votes aye. miss matsui? miss matsu votes aye. miss castor? miss castor votes aye. mr. sarbanes votes aye. mr. mcnerney votes aye. mr. welcwelch? mr. welch votes aye. mr. lujan? mr. lujan votes aye. mr. tonko? mr. tonko votes aye. miss clarke? ms. clarke votes aye. mr. lobesack votes aye. mr. schrader? mr. schrader votes aye. mr. kennedy? mr. kennedy vote aye. mr. cardenas? mr. cardenas votes aye. mr. ruiz? mr. ruiz votes aye. mr. peters? mr. peters votes aye.
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miss dingell. ms. dingell votes aye. chairman walden? >> walden votes no. >> chairman walden votes no. >> are there members we should be recorded? gentleman from illinois, mr. shimkus? >> votes no. >> gentleman from new york, mr. collins. >> votes no. >> gentleman from illinois. >> mr. kinzinger votes no. >> gentleman from virginia, mr. griffith. >> mr. griffith votes no. >> members on this side that aren't recorded? do we know of any other members making their way here on either side? okay. i think the clerk can report the result. >> mr. chairman, on that vote, there were 23 ayes and 30 nos. >> 23 ayes, 30 nos and the amendment is defeated. chair recognizes for what purpose does the gentlelady from colorado seek recognition?
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>> mr. chairman, i have an amendment at the desk, amendment 60. >> amendment 60. >> on actuarial value requirements. >> actuarial value requirements, amendment number 60. the clerk will report the amendment. >> amendment to the amendment in the nature of a substitute. to the committee print offered by ms. degette. >> the amendment is dispensed with and the gentlelady from colorado is recognized for five minutes to speak on her amendment. >> thank you very much. >> let me get order, though, because it seems a little noisy in here. our members and staff, if we can hold it down just a bit so we can all hear the gentlelady 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.
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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, "your deductibles have gone so high you can never use it. obamacare doesn't work. it's become totally unaffordable." and then he said, "the health care can't even be used because the deductibles are so high." and it's not -- mr. chairman, i'm so sorry. it's so loud, i can't even hear myself. >> i agree. please take your conversations outside of the committee room so that we can conduct our business. >> thank you. >> the gentlelady may proceed. >> 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
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quotes from our colleagues on the other side of the aisle. one of the colleagues said in november 2016, "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, "obamacare is taking us back to the day of old major medical policies with high deductibles. i think you get the gist." 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 is one reason why we did the affordable care act. and i completely agree that as we look at trying to improve the affordable care act, high deductibles is something that we should look at.
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unfortunately, though, this bill eliminates vital affordable care act protections known as actuarial value requirements that actually prevent insurance companies from shifting more costs on to consumers in the form of out of pocket payments like deductibles and co-pays. and so ironically, by eliminating these aca protections, the managers' amendment will actually make deductibd deductibles skyrocket. so it turns control back over to 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.
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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 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.
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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 form 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. >> gentlelady yields back. are there other members seeking recognition on this amendment? the chair recognizes the gentleman from indiana, mr. bueshon, 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, these plans limit choices.
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they're rigid and do not allow insurers to develop flexible plans to meet the needs of individuals in specific regions of the country. we've seen this in particular with insurers who have been weighed down by demands of the higher tiers thus leading to plans that are too expensive for most americans. lack of flexible plans to accommodate the needs of america 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 need. the affordable care act has crippled our insurance markets in repealing the values imposed by this law on insurers 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
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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, dr. bucshon. this amendment gets to i guess the heart of that question that we've been talking about for a while, and that's freedom. because if you look at the driver of cost under obamacare, 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
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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 doesn'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 making their own choices? picking their own plans? going through and saying that's something that i want for my family, that's something 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've done this over the last few days, but i think we
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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's 56 to $1,346 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 payment. but you're going to tell pamela she's still got to keep buying it even if she doesn't want it and it doesn't even work for her. but because, you know, 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
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thinks they know best for everybody because a one size doesn't fit all. every family is different. you know what, i trust that a family can make that most personal choice a whole lot better than somebody up here in washington who doesn't even know their name. you may not know pamela, you may not know jeff from slydell who's 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. 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 yield back. >> mr. chairman, i urge my colleagues to vote against this amendment. >> i yield back. >> mr. green from texas.
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>> i would like to yield my time to my colleague from -- >> 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, 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 barebones 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
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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 are 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 beaudreaus or the thibodeaus? >> it's a whole lot more than the boudreaus and thibodeaus. they 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 and were were telling a whole set of stories and the difference between them was republican stories were all about peep's frustration with premiums and the costs of the plans.
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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 protections are in place. whether it's actuarially 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
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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 that are being offered now. when you look at the fact that the age rating guardrails 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 that's being proposed doesn't 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 got to look at the actuarial soundness of these plans. and 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?
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mr. cardenas. the gentleman from california. has the floor. >> 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 that they're not going to 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
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that nature. so they had to go out and buy their insurance, whereas 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 their 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, i said, how do you feel about that 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 if they ever, 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. one of the things mr. --
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congressman sarbanes just pointed out, i'm glad he did, we've been -- 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 deducti e deductibles that were in existence, legally allowed for the insurance companies to charge before the aca. i'll mention, again, a gentleman came to my town -- my forum inthy distriin my district a couple weeks ago and he started off by complaining that, you knows, 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.
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and i said, well, sir, can you describe to me if that would have happened maybe ten years ago, what have you, what would the insurance company have done, how much would you have to pay in deduct bls? he stopped me mid-sentence and said, my god, they would have taken away my house. 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 going to have to pay for the bills for the rest of your life. for the rest of your life. 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, $200,000, $300,000, maybe you'd 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.
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>> i'll be glad to give you some examples. it might not be million dollars but to people that live in appalachia, ohio, $20,000 is like $1 million. when you get a $20,000 hospital bill when you were expecting to be able to keep your insurance and keep your doctor, that's just as bad. >> i reclaim my time. thank you very much for that example. so you just reminded me to remind all of us about another thing. 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 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 that's a precondition. it is. it is.
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so, yes, there's a lot of reasons why many of us are against this bill that's before us today because it's taken 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. mr. shimkus? mr. shimkus votes no. mr. murphy? mr. burgess? mrs. blackburn? mrs. blackburn votes no. mr. scalise. mr. scalise votes no. mr. latta. mr. latta votes no. mrs. mcmorris rogers.
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mrs. mcmorris rogers votes no. mr. harper? mr. harper votes no. mr. lance? mr. lance votes no. mr. guthrie? mr. guthrie votes no. mr. olson. 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 votes no. mr. bouchon. mr. bucshon votes no. mr. flores. mr. flores votes no. mrs. brooks. mrs. brookss votes no. mr. mullin. mr. mullin votes no. mr. hudson. mr. hudson votes no. mr. collins. mr. collins votes no.
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mr. cramer. mr. cramer votes no. mr. walberg. mr. walberg votes no. mrs. walters. mrs. walters vote noz. mr. costello. mr. costello votes no. mr. carter. mr. carter votes no. mr. pallone. mr. pallone votes aye. mr. rush. miss eschoo. miss eshoo votes aye. mr. engel. mr. engel votes is aye. mr. green. mr. green votes aye. miss deget. miss degette votes yi. mr. doyle votes aye. miss shaskowski votes aye. mr. butterfield. mr. butterfield votes is aye. miss matsui votes aye. miss castor. miss castor votes aye. mr. sarbanes. mr. sarbanes votes aye. mr. mcenerny votes aye.
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pulp welsh. mr. lew han. mr. lew han votes yi. mr. tang covotes aye. miss clarke. mr. loebsack. mr. loebsack votes aye. mr. schrader mr. schrader votes aye. mr. kennedy. mr. kennedy votes aye. mr. cardenas. mr. cardenas votes aye. mr. ruiz. mr. peters. mr. parties voteses aye. police dingell votes aye. chairman walden votes no. >> are there other members wishing to be recorded. the chair recognizes the gentleman from pennsylvania. >> mr. murphy votes no. >> the gentleman from terms mr. burgess. >> votes note. >> mr. olson from texas. >> mr. olson votes no. >> okay. are there any other members
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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 noes. >> i'm sorry, what was the tally? >> 20 yis and 30 noes. >> wait a minute. just in time. miss clarke. i don't believe you're recorded and i think you're a yes. >> miss clarke 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
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new york, mr. engel. >> thank you, mr. chairman. i have an amendment to the desk. it's an amendment number 159. >> 159. now being amendment 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. elliott? >> hospitals. >> hospitals. okay. clerk will report the amendment. >> amendment to the amendment in the nature of a substitute to the committee print offered bid mr. engel. >> we'll dispense with further reading of the amendment. i recognize the gentleman from the new york mr. engel to speak on his amendment. >> thank you, mr. chairman. my amendment would require cm sr to perform an independent assessment of how this bill's medicaid policy changes would affect local hospitals prior to implementation.
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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 stair opportunities 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 local hospital has to fold? to one that's less convenient? i'm from new york city and i think that's outrageous. imagine how americans in rural areas will feel if 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
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than $24 billion annually. they're also responsible for hundreds of thousands of jobs. if we push hospitals into the red, or force them to close all together, 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. let me read an excerpt from america's essential hospital statement. could we have some water, mr. chairman? so let me read an excerpt from america's essential hospital statement on this bill and i quote them. this legislation cog place a heavy burden on the safety net by reducing federal support for medicaid expansion over time and
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imposing per capita caps on the program. i'm still quote packaging. these changes an loan could result in deep funding cuts for essential hospitals which now operate with little or no marge. continuing the quote, our hospitals could not sustain such reductions without scaling back services or eliminating jobs. there 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 colleagues to support this amendment and i'll yield back if nobody wants my time. >> mr. chairman. >> mr. pallone. >> i just wanted to urge support for your amendment. i think you most of us know that the hospitals have been very big supporters of the affordable care act.
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because they very -- 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 plakd 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 have made health care better quality and new technologies. i could see that in my own district in the hospitals that i represent. so i think it makes sense that there's 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. the individual market or they eventually lose medicaid as medicaid expansion starts to
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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 crucial to the hospitals. i yield back. >> chair would ask of the gentleman from new york to -- >> yes, i yield back. >> did you have a 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. >> very well. the gentleman yields back. chair recognizes zwramt from the
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west virginia, mr. mckinley. for what purpose does the gentleman from west virginia seek recognition. >> i speak in opposition. >> the gentleman is recognized. does the gentleman move to strike the requisite number of words? >> yes. >> 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. i've pulled up an article that was put out by national rural health association, representing the rural hospitals across america. and one -- they've made several statements here that i thought were the worth consideration given the situation we're dealing with. and it says some of the regulations were implemented are actually harming url america and
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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, 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 janesville like it's just a little tiny town. janesville is twice is the size of any community i have in my district. it's 60 some thousand people. we will understand the role of hospitals. but we also have to understand how cms has made the predictions 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.
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but we have to 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 exchanging is 3g $50,000 in dish payments. that doesn't seem like a very -- that just shows why we are our rural hospitals are in trouble. 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're closing at a rate of one a month. at the rate they're going, we're
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going to have 10% of our hospitals close 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. andton exacerbated the problem. more and more hospitals are closing. so we've got to have an option and so what we have is this. the bill that we have is one that's primarily based around free market principles. we think people if we can double their hsa ability, that you're going to be able to have more funds available for that. the refundable tax credits will be available for people. the high risk pools, all there is going to come into place where you think when i've talked to the rural hospitals they're excited about an option because they see the aca has failed. and so mr. speaker, or
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mr. chairman, i would hope that we will defeat this amendment and move on. i yield back. >> the gentleman yields back. for what purpose does the gentleman from new jersey an seek recognition. >>. >> strike the last word on the amendment, mr. chairman. >> the 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 quickly, just pass this is 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 in 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
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the have expanded medicaid have had 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 that it the republican repeal bill slowly but surely kills the medicaid expansion and 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 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 to them for help and there will be
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less and less supreme 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 mr. butterfield. >> thank you very much, mr. engel, for yielding time and thank you for this amendment. i'm pleased to speak in support of it 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 belle haven, north carolina, that was forced forced to close because my states then republican governor and legislature did not expand medicaid. this bill blocks 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 coverage. the bill removes the plan date
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that medicaid cover all essential health benefits and imposes a 30% reinsurance penalty that goes straight into the pockets of insurers. may i have some water, please? 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. 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 hospital as i mentioned was located in my district, the closure of the hospital has left a large void in eastern north carolina. there's now a 130 mile gap
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between hospitals in northeastern bow for the county and hyde counties. more than 15,000 people in the region no longer have access to emergency room care in times of need. on july 7th, of 2014, pore shars gibbs from hyde county lost her life just five days earlier, the hospital in belle haven 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 hospital 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 belle haven community has advocated for a new hospital to provide emergency room service. in fact the mayor of belle haven has twice walked here to washington, d.c. 300 miles to and he's a republican, tox
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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 s.t.e.m. the tied of the closure of rural hospitals. let's keep these rural hospitals open. let's expand medicaid to give them that will opportunity. thank you, and i yield back >> chair thanks the gentleman. the gentleman yields back. does anyone on the republican side? for what purpose does the gentleman from oklahoma sec rec fligs. >> move to strike the last word snir it's now the toot often that my 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, were we and my colleague from north carolina disagree on is he takes the position that
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it's because they didn't open an exchange in their state. well, the fact is. >> they didn't expand medicaid. >> they didn't expand medicaid. the fact is, it was forced upon them by obamacare. what's forcing them to take a loss is the lack of the dish fund reimbursements. what 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 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 rights now are operating at a loss. 80 as my colleague from north carolina stated have already closes. what we're trying to do is fix that. and that's what we do through
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this plan. we increase the dish funds. we allow those hospitals in rural parts of the country to stabilize. we're here to make it better. that's what we're trying to do. i'd like 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? i would like to work with you on that because when they hospital acquired this hospital, they were assuming that medicaid was going to expand. but then we got the 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, think we just found something that maybe you and i can talk about. it's about getting it right for the american people. >> would you yield to me? please? >> just because i like you, dave. >> thank you so much. i appreciate that. that's why i asked.
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thank you so much. yeah, we're going to -- we do have fundamental disagreement what would happen if your -- if this bill were to be passed to these rural hospitals. i didn't plan to speak on this. i didn't prepare remarks. all i can say 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 visited three of my rural hospitals. i have 24 counties and every 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
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know what that's going to do for patient access obviously. >> reclaiming my time. i am talking the same hospital directors and they're saying just the opposite. if we don't do something about these dish funds, they're going to be forced to close. remember they have right now 41% of rural hospitals are operating at a loss. they're closing at an alarming rate and that's been increasing sfins obamacare was enacted. i will yield back. >> the gentleman yields back. chair for what purpose does the gentleman from california seek rec anything? 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
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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 sal utory effect it has had on hospitals throughout california. 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
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amendment is about hospitals, we are the -- we're a nation state, the largest state, the most populace state in the union and that california hospital association's 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 markup an article that was written by the ceo of the stanford medical center, 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
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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 system 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 debate, i want to say that according to becker's 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 or lack
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of expansion. i yield to miss castor. >> 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 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
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you all, i've heard from hospitals back home. they're not shy. here are 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 credit is. you don't provide the support that our families need. they say provide support for the premiums. provide adequate financial assistance to help those in need. 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 64, it was discovered during debate the age rating in the bill actually isn't the 5-1 that's printed there. it's unlimited when it goes back to states. so it looks like our older
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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 was disabilities, i think about my children's hospitals back home 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
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going to go to a vote in accord wince an agreement with the -- >> sorry. >> okay. i recognize the gentleman from vermont. >> i'll be very brief. but mark wayne mull been 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, there would be a big spike in 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. it has made the difference between black ink and red ink for our hospitals. now, with mr. mullins' situation, what it suggests is it's not working for them.
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and this is the stranglehold 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 in mr. engel's community and mine. i yield back. >> thank the vamt. gentleman yields back. the question now arises on approval of the amendment. the clerk, those in favor will vote aye. those opposed nay. the clerk will call the roll. >> mr. barton, mr. barton votes no. mr. upton. mr. shim kiss. mr. shim kiss votes no. mr. murphy. mr. murphy vote noz. mr. burgess. mr. burgess votes no. mrs. blackburn, mrs. blackburn vote noz. mr. scalise. mr. scalise votes no. mr. latta. mr. latta votes no. mrs. mcmorris rodgers. mr. harper. mrs. mcmorris rodgers votes no. mr. harper.
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mr. harper votes no. mr. lance mr. guthrie. mr. guthrie vote noz. mr. olson. mr. olson votes no. mr. mckinley. mr. mckinley votes no. almost kinzinger. mr. kinzinger votes no. mr. griffith. mr. griffith vote noz. mr. bilirakis. mr. bilirakis vote noz. mr. johnson. mr. johnson vote noz. mr. long. mr. long vote noz. mr. bucshon. mr. bucshon votes no. mr. flores votes no. mrs. brooks. mrs. brooks vote noz. mr. mullin. mr. mullin votes no. mr. hudson. mr. hudson votes no. mr. collins. mr. collins vote noz. mr. cramer. mr. cramer votes no. mr. wahlberg. mr. wahlberg votes no. mrs. walters. mrs. walters votes no. mr. costello vote noz. mr. carter.
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mr. carter vote noz. mr. pallone. mr. pallone votes aye. mr. rush. miss eshoo. miss eshoo votes aye. mr. engel votes aye. mr. green. mr. green votes aye. miss degette votes aye. mr. doyle. mr. doyle votes aye. miss schakowsky votes aye. mr. butterfield. mr. butterfield votes aye. miss matsui votes yi. miss castor votes aye. mr. sar banes. mr. sarbanes votes aye. mr. mcenerny votes aye. mr. welsh. mr. welsh votes aye. mr. lew han votes aye. mr. ton co. mr.ton covotes aye. miss clarke. miss clarke votes aye. mr. loebsack votes aye. mr. schrader votes aye. mr. kennedy, mr. kennedy votes aye.
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mr. cardenas votes aye. mr. ru riz votes aye. mr. peters. mr. peters votes aye. miss ding counsel votes aye. chairman, walt done. >> walden votes no. are there members not recorded? the gentleman from the michigan. mr. upton. >> mr. upton votes no. >> the gentleman from the new jersey, mrs. 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 ayes and 31 noes. 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.
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[ applause ] >> thank you. this is literally been a baptism of fire. and you have handled it with grace and humor. >> thank you. >> and style tan bodes well for your tenure as chairman of what i there is the best committee in the house. >> here here. >> 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. >> now i'd recognize the gentleman for uc requests. >> i have two amendments at the desk, mr. chairman. i think they're barton one and two. i would ask unanimous consent that we consider them both at one time which i think the technical term is en banc. >> without objection, so ordered. the clerk will report the amendments. en banc amendment. >> in en banc amendment to the
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committee print offered by mr. barton. >> i ask unanimous concept they be considered as read. we'll dispense with the reading of the amendments. i now turn to my friend from texas, mr. barton, to speak on his amendments. >> i appreciates that, mr. chairman. these are the barton blackburn-hudson amendments that we will very three sponsors. and they're very freight forward. the bill as it's currently configured allows the states that expanded their medicaid population to healthy adults to continue that expansion until december 31st, 2019 for all practical purposes, that's three years. these amendments ends that ability to expand at the end of this year, december -- january 1st, 201. so instead of a three-year expansion continuation, my
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amendment would cut that by two years to just one year. the bill as 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 1st, 20th 23, that super 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.
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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 and over $100 billion in real savings. and 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
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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. >> 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. the debt currently stands at $15 trillion, 77% of gdp. 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 amendment we're putting forward today will ensure we can provide sustainable physically responsible and affordable coverage to our most vulnerable.
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i look forward to working with my colleagues to advance there is legislation and i yield back to mr. barton. >> let me say, mr. chairman, i believe mrs. blackburn is going to seek her own time. then 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 attorney end the expansion. and to do that this year and then we also think it is important to have a date 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
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the two amendments that i've just discussed have been endorsed by the republican study committee. they've been endorsed by the freedom caucus. and the days ahead, they're going to be endorsed i'm sure by 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 withdraw the amendment. >> if the gentleman, yes. >> not going to withdraw? >> no, no, no. but mr. pallone wanted to be able to speak on it. >> sure. >> if you could yield back. >> i yield back. >> then i'll recognize mr. pal loan, then you can withdraw. i think that works better in terms of our process. >> my hopes were soaring, mr. chairman. >> i know they were. a few others were soaring.
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> another way. >> okay. >> so with that, the gentleman's time. >> i yield back the negative balance of my time. >> there we go. i'll recognize the gentleman from the new jersey to speak on the amendment. >> thank you. i understand na mr. barton is going to withdraw the amendment. i do want to speak in opposition. the underlying bill freeze 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 20,00018 and ends the availibility fo any enhanced match for the previously eligible medicaid expansion populationing in 2023. the amend would end the expansion in 2018 and eliminate state's 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. claire now recognizes the gentleman from texas for what
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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 are purpose the gentleman from new jersey seek -- >> mr. chairman, i just want to make some final remarks and thank the staff before we move to the final vote on the substitute. i think it's clear based on the robust debate that has taken place over the last i guess it's 27 hours now, that committee democrats have serious problems with the republican repeal bill. this bill would rip 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, has not been a transparent process. we did not go through regular order. the bill was posted less than two days before markup.
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no hearings were held and we don't have a cbo score. this is not the way this process should work and this repeal 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. [ applause ] >> i would thank 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.
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and so i especially want to thank our health team, paul, josh, j.p., buck, kristin, 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 the an end product. but none of it works without all of the people involved. and especially i want to thank and c-span too, we want to thank c-span that makes this all public. [ applause ] 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 to with our comps team
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and certainly karen and mike and raybaum 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 also want to thank our house legislative council. i think they drafted a few amendments that i'm sorry you didn't get to. they certainly worked with us. [ applause ] 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. [ applause ] so mr. speaker, i guess you probably get to see the real a an committee you couldn't get
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on. so you went to ways and means. yeah, yeah. that's because 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 amendments in the nature of a substitute as amended, all those in favor, and i'll have the clerk call the roll. shall signify by saying aye, all those opposed no the clerk will call the roll. >> mr. barton. mr. barton votes aye. mr. upton. mr. upton votes aye. almost shim kiss. mr. shin kiss votes aye. mr. murphy votes aye. mr. burgess votes aye. mrs. blackburn. mrs. blackburn votes aye. mr. scalise. mr. scalise votes aye. mr. latta, mrs. latta votes aye.
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mrs. mcmorris rodgers votes aye. mr. harper votes aye. mr. lance. plts lance votes aye. mr. guthrie. mr. guthrie votes aye. mr. olson. mr. olson votes aye. mr. mckinley votes aye. mr. kinzinger votes aye. pulp griffith. mr. griffith votes aye. mr. bilirakis. mr. bilirakis votes aye. mr. johnson. mr. johnson votes aye. mr. long. mr. long votes aye. mr. bucshon votes aye. mr. for fles votes aye. mrs. brooks votes aye. mr. mullin. mr. mullin votes aye. mr. hudson. mr. hudson votes yi. mr. collins votes aye. mr. kramer. mr. cramer votes aye. mr. walberg votes aye. mrs. walters votes aye. mr. costello votes aye. mr. carter. mr. carter joets aye. mr. pallone.
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mr. pallone votes no. mr. rush. miss eschoo votes no. mr. engel. mr. engel votes no. mr. green. mr. green votes no. miss deget votes no. mr. doyle. mr. doyle votes no. miss schakowsky. miss schakowsky votes no. mr. beautierfield votes no. miss matsui votes no. miss castor votes no. mr. sarbanes. mr. sarbanes votes no. mr. mcnearny votes no. mr. welsh votes no. mr. lew hon votes no. mr. tomko votes no. miss clarke. miss clarke votes no. mr. bobby sack votes no. mr. schrader. mr. schrader votes no. mr. kennedy. mr. kennedy votes no. mr. cardenas. mr. cardenas votes no. mr. ruiz. mr. ruiz votes no. mr. beaters votes no.
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miss ding did votes no. chairman wall done. chairman wal done votes aye. >> the clerk will report the tally when ready. >> mr. chairman, on that vote, there were 31 ayes and 23 noz. >> 32 ayes, 23 noz. the amendment in the nature of a substitute as amended is approved. i move that the committee do now approve and transmit the -- i move that the committee do now approve and transmit the recommendations of this committee and all appropriate accompanying material including additional supplemental or dissenting views to the house committee on the budget. all those in and i'll have a roll call vote. all in favor vote aye. those opposed no. the clerk will call the roll. mr. barton. >> final.
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>> mr. barton votes aye. mr. upton. >> mr. upton votes aye. mr. shim kiss. mr. shim kiss votes aye. mr. murphy. mr. murphy votes aye. mr. burgess. mr. burgess votes aye. an mrs. blackburn votes aye. mr. scalise. mr. scalise votes aye. mr. latta. mr. latta votes aye. mrs. mcmorris rodgers votes aye. mr. harper. mr. harper votes aye. mr. lance. mr. lance votes aye. mr. guthrie. mr. guthrie votes aye. mr. olson. mr. so on votes aye. mr. mckinley votes aye. mr. kinzinger votes aye. mr. griffith. mr. griffith votes aye. mr. bilirakis. mr. bilirakis votes aye. mr. johnson votes aye. mr. long. mr. long votes aye. mr. bucshon. mr. bucshon votes aye. mr. flores votes aye.
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mrs. brooks. mrs. brooks votes aye. mr. mullin. mr. mullin votes aye. mr. hudson. mr. hudson votes aye. mr. collins. mr. collins votes aye. mr. cramer. mr. cramer votes aye. mr. walberg. mr. walberg votes aye. mrs. walters votes aye. mr. costello votes aye. mr. carry the. mr. carter votes aye. mr. pallone. mr. pallone votes no. mr. rush. miss eschoo. miss eschoo votes no. mr. engel. mr. engel votes no. mr. green. mr. green votes no. miss deget votes no. mr. doyle. mr. doyle votes no. miss schakowsky votes no. mr. butterfield votes no. miss matsui. miss matsui votes no. miss castor votes no. mr. sarbanes. mr. sarbanes votes no. mr. mcnorthern nil votes no. mr. welch votes no.
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mr. lew han votes no. mr. ton covotes no. miss clarke. miss clarke votes no. mr. loebsack votes no. mr. schrader. mr. schrader votes no. mr. kennedy votes no. mr. cardenas. mr. cardenas votes no. mr. ruse is votes no. mr. parties votes no. miss dingell votes no. chairman wal done. >> wal done votes aye. >> chairman wall done votes aye. >> the clerk will report the tally. >> mr. chairman, on that vote, there were 31 ayes and 23 nays. >> 31 ayes, 23 nays. the ayes appear to have it. the eyes 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.res154 and asks the
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clerk to report. >> h res 154 of inkirry requesting the president of the united states and detecting the secretary of health and human services to transmit certain information to the house of representatives relating to plans to repeal and replace the patient protection and affordable care act and the health care measures 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 bringing up this resolution after 27 hours of being in 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. i appreciate the recognition. some committee just inned marking up half of this bill, obviously ways and means finished before. that is the first step in a very long process and i have strong concerns that this committee and
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particularly our democratic caucus has not been afforded all the information that is necessary for to us understand the details of the bill and where this is going forward and the days and weeks ahead. just today, the president of the united states tweeted out that "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. delaying the changes in the insurance markets till 201 and 2020. on tuesday, the president took to twitter again and he wrote up don't worry, getting rid of state lines which will promote competition and will be in phase two and phase three of the health care rollout. that was obviously news to many of us that there was in fact a phase two and a phase three. he continued on twitter that i am working on a new system where there will be competition in the
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drug industry pricing for the american people will come way down. mr. chairman, after notice of nondisclosure agreements between committee staff and judiciary and white house personnel, we had requested information as to whether documents or notes e-mails correspondence between the white house transition officials and this committee if it exists about the rollback of potential roll back of the affordable care act so that we could have an idea as to what this process would entail. we obviously have not got than yet and we talked about it i think you'll recall several weeks ago and the committee process. we then filed this resolution of inquiry with the hope of obtaining that series of correspondence if any exists so that this committee and the american people and the drawing caucus, democratic members of this committee, can be certain that we understand what is
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taking place and what plans are as we debate the biggest policy im, or the biggest policy portfolio for in administration at least for this congress. and i would respectfullysk request that is not -- this markup was just successful. you guys got the votes. it passed. but as we all know, this is the first step through a process and apparently a face two and face three way i didn't know the about it till finding out about it on twitter. i would respectfully request that the committee be able to divulge whatever correspondence exists between the white house and this committee so the that we as members of this committee could have an accurate reflection and an accurate representation as to what is coming next and what is the true ambition of the health care policy rollout for in caucus. with that, i will yield back and or yield to any other member of the democratic caucus here or democratic committee that wants
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it. i repeat that this bill i know you've got very strong feelings on the republican side of the aisle. you've got very strong feelings here, as well. we've and not -- i'm not so warm and fuzzy as some of you guys are at this point. i'll yield back. >> gentleman yields back the balance of his time. chair recognizes himself for five minutes. from chairman dingell's work to the solyndra and aca investigations to name a few under chairman upton the committee on energy and commerce has a long history of conducting robust oversight of the executive branch. we will continue to carry out this important constitutional obligation under my leadership. but there is a process by which we do this work. we typically begin by asking account executive branch to comply voluntarily with our requests. we send document requests and ask questions. we utilize subpoenas when necessary. which create a legal obligation to comply.
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last congress, chairman upton issued five subpoenas after obama administration officials refused to come apply with our requests. what we don't do is begin with a resolution of inquiry like is before us today. but even in the face of the situation with the obama administration, chairman upton never went to this statement of inquiry. quite frankly, i think this is premature and i would urge mile colleagues to reject there. >> mr. chairman, if i could just to respond to that for 30 seconds if i may. >> sure. >> i would yield to the gentleman. >> thank you. 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 the passage of the affordable care act and just to be clear, i did ask
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about correspondence informally between committee and committee staff and the white house before filing resolution hoping that we wouldn't have to get there. so i understand your opposition. i would respect flit respectful wasn't the first step, second or third down the line. >> i appreciate that. >> reclaiming my time. when a member of our committee did go through the documents and the steps i just outlined and went through the inquiry, traditionally how the white house has worked under republicans and democrats. they stall a lot of things and turn the heat up and an oversight hearing and a number of steps. this is the nuclear option when
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they don't completely don't comply. >> nuclear didn't work so well. >> i'm just saying. with that, i yield to the gentle lady for my time. >> to strike the last word or ask a resolution? >> i thought we were just doing the two of us. >> can i ask a question? >> can i yield on my time? the gentle lady. >> i want to thank mr. kennedy for the resolution. i want to ask you, mr. chairman, what are the steps and what's the timetable for them so that the end result is the procu procurement of the materials that are in the privileges resolution. >> so i think i outlined them. basically, you'd have an inquiry of the agency. you'd have a written inquiry,
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ask for certain documents, we would work through that. you know in our o&i roll we do that oftentimes in a bipartisan way. i already signed a lot of let r letters to this administration asking for documents. we have pursued that already in various letters. some of those are follow-up from document requests that overlap administrati administrations, frankly administrati administrations -- >> let me ask this, have any requests been made of the administration for these materials yet? >> i don't know about these specific materials, no. >> mr. chairman, if i may. >> i would yield. >> so the committee is clear, it was done in a committee hearing and in writing and no response given. this was, as you outlined, i would love to work with you and your committee staff to try to advance this process if i can get a commitment to you or idea
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what steps are necessary to get this. we tried once verbally and on paper and no response and no response. my nuclear option isn't so nuclear. i understand your response and i'd like to figure out what we can do. >> reclaiming my time. i thank the gentleman, happy to have some discussions along the way on these and other issues. but my time is expired. hr154, reporting unfavorably. always those for say aye and those opposed, nay, and the clerk will call the roll. >> mr. barton. >> maybe i should clarify that. it is kind of a double negative. anybody that wants to make the correct vote, i think the
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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. prepareton wants to vote aye -- mr. barton wants to vote aye. that's what i thought. >> mr. barton votes aye. >> mr. upton. >> mr. upton votes aye. >> mr. shimkus. mr. shimkus votes aye. mr. murphy. mr. murphy votes aye. mr. burgess. mrs. blackburn. mrs. blackburn votes aye. >> mr. scalise, mr. scalise votes aye. mrs. mcmorris-rodgers votes aye. mr. harper. mr. harper votes aye. mr. lance votes aye. mr. guthrie votes aye. mr. olson.
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mr. olson votes aye. mr. mckinley votes aye. mr. kins linger votes aye. mr. griffin votes aye. -- >> ladies and gentlemen, if we can -- the clerk is going to have trouble doing the roll and hearing us. if we could. >> mr. johnson votes aye. mr. long. mr. long votes aye. mr. bucshon votes aye. mr. flores votes aye, mrs. brooks votes aye. mr. mullen votes aye. mr. hudson votes aye. mr. collins votes aye, mr. cramer votes aye. mr. wahlberg votes aye. mrs. walters votes aye. mr. costello votes aye. mr. carter votes aye. mr. pallone votes no. mr. rush -- miss erb es you
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votes no. mr. engle votes no. mr. green. votes no, mr. doyle, mr. doyle votes no. mr. butterfield. mr. butterfield votes no. miss met suey votes no. miss castor votes no. mr. sarbanes votes no. mr. mcnerney votes no. mr. well much votes no. mr. lu hon votes no. mr. tonko votes no. miss clark votes no. mr. lo zack votes no. mr. schrader. mr. schrader votes no. mr. kennedy votes no.
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card cardines. votes no. mr. louse votes no. mr. peters votes no. miss dingell votes no. chairman wall don votes aye. >> are there any members not recorded who wish to be recorded? if not, the clerk will report the tally. >> mr. chairman, on that vote, there are 31 ayes and 22 nays. >> 31 ayes, 20 -- >> 22 nays. >> the ayes have it and the reszlutires resolution is reported unfav unfavorably. without objection staff is authorized to make technical changes on matters presented to the committee over the last 27 1/2 hours, so ordered, without objection, this committee stands adjourned. [ applause ]
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