who ask questions, since this amendment was introduced, the at 8:00 this morning, mr. cantor and i and others on this side of the aisle heard from folks who offer hsas from physicians, who are involve with hsas and they believe, mr. becerra, the language in the bill would have a devastating impact on the offering of hsas. i know that is not your intent, i believe what you say today and i believe you are very sincere but i ask you, ask you to support the management but i don't think we'll have much luck in that but i ask you in two years, if this provision does become law, and the impact occurs -- mr. cantor believes, what i believe, what mr. camp believes and many on this side of the aisle believe will occur and that is, we will see a dive in the number of hsas throughout michigan. i hope that your sincerity today of what you have said, that you

will work with us, to implement the cantor amendment that you are probably going to vote against in a few minutes. i yield back. >> mr. chairman, thank you very much. very briefly, listen, you know, either you are going to allow the promise of the president to be fulfilled or not. more than 8 million people have hsas. and, with all due deference the gentleman from california, i don't think we are here to cast judgment against those who believe that an hsa is appropriate for them or their family. in fact, the increasing number of people purchasing hsas is reflective of the fact that they can have some backstop, that a cot strofk coverage is something that allows them some sense of health care security, and economic security. and to sit here and say we have

heard sea many stories of people being duped and buying things they thought they didn't know they were buying, that answer irrelevant point, mr. chairman. these individuals, either we're going to apply the law and trust the regulators and allow them to promulgated the proper regulation so there is transparency in these products and then allow the mark place to work -- marketplace to work, mr. chairman i urge adoption of this amendment. >> all in favor kate by saying aye. opposed. >> opposition -- the amendment fails. clerk call the role. >> mr. stark. >> no. >> stark votes no. >> mr. lefrp. >> no. >> mr. levin votes no. >> mr. mcdermott. >> mr. lewis. >> no. >> mr. lewis votes no. mr. neil no.

>> mr. tanner. mr. becerra, mr. becerra votes no. mr. pomeroy votes no, mr. thompson. votes no. mr. larson. mr. lumme in our. votes no. mr. kind. mr. kind votes no. mr. pass crowe. no. ms. berkeley. >> yes. >> votes yes. mr. crowley. votes no. mr. van hollen. mr. van hollen votes no. mr. meek. mr. meek votes no. ms. schwartz. votes no. mr. davis of alabama. votes no. mr. davis of illinois. mr. davis of oil now votes no. mr. ethridge. mr. ethridge votes no. ms. sanchez. votes no. mr. higgins. mr. higgins votes no.

mr. yarmouth, voetsdz no. mr. camp. mr. camp votes yes. mr. larson votes no. mr. herger. votes aye. mr. johnson. mr. johnson votes aye. mr. brady. mr. brady votes aye. mr. ryan, mr. ryan votes aye. mr. cantor, mr. cantor votes aye. mr. linder. mr. linder votes aye. mr. nunez, votes aye. mr. tea barry votes aye. ms. brown wait, votes aye. mr. davis of kentucky. mr. davis of kentucky votes aye. mr. reichert, votes aye. mr. buse taney. votes aye. mr. heller, votes aye. mr. ross cam, votes aye. mr. mcdermott, votes no.

mr. tanner. mr. tanner votes no. mr. chairman chairman votes no. 16 yeas. 25 nays. thank you mr. chairman the underlying bill allows for redistribution of unused slots for primary residents in medical education, increasing the total number of graduate, milled education slots by 15% is really, part of my amendment. it would direct these newly created slots as well, currently unfulfilled slots for training of primary care residents as in the underlying bill and includes pediatric service specialty

residents, pediatric medical, subspecialties, surgical specialties or pediatric psychiatric service. there is a columbus children's hospital in my drink and outside of the obvious need we have talked about in the committee for primary care, specialty services in pediatrics, is in short supply, throughout our country. i offset this, mr. chairman, by increased spend by reducing the low income subsidy for individuals being mandated to purchase insurance, the subsidy would be reduced from 400% of pomping to that which fully -- the gme slots which we believe would be over 300 thousand and to note my state legislator would qualify for low income subsidies under the currents language in the bill. mr. chairman, i would hope that those of you on the other side of the aisle, most notably, ms. schwartz, who i have worked

with on this issue, would be interested in working with me, as we move through the process on this issue which i believe is not just important to ohio, but to many of our states, and, with the commitment from either you or ms. schwartz i would be happy to withdraw my amendment. >> chair yields to mr. watson. >> -- ms. watson. >> i know i've worked on the issue and legislation on it and i'm very pleased with the progress we have made as you have mentioned in the legislation, to reassign, make sure we use all of the unused slots, but directed towards primary care because of the importance of -- and need for primary care physicians. i do agree with you, i think we need to increase the number of slots for residency programs including specialty residence programs and i know mr. crowley is also concerned about that and i would say i would be interested in working with you

as we move forward and see what we can do to make sure we have an adequate number of primary and specialty training slots, residency programs in the nation and i think that will take a little more work and not get done tonight but i look forward to be wonking in a bipartisan way to get that done. >> by unanimous consent the... [inaudible]. >> i thank the chairman. the amendment that will be districted momentarily would create a government health care trust fund, this trust fund would keep track of all of revenues and out lays that are associated with the provisions in this proposal that we have before us. dubbed the america's affordable health choices act. addition, this amendments ensures that the revenue that is raised by america's affordable health care choices act may only be spent on provisions in the

act. addition, the amendment requires the secretary of the fresh, secretary of health, and human services and the controller general to provide congress with an annual report detailing revenues and out lays associated with the trust fund. mr. chairman, i believe that the american public serves to know exactly how much this bill is going to cost taxpayers, and, subsequently how that money is spent. the amendment will ensure that it is being done in a most transparent manner. and i would reserve the balance of my time, for closing. >> thank you, mr. chairman. i think i understand what the gentlelady's intent is, i think we are all committed to make sure the bill is paid, but i

think the creation of another trust fund here is not necessarily the best way to go about this. first, how we're going to credit a medicaid or dollar -- dollar not spent, are we going to have automatic reductions, if there is any short fall, are people going to see their health blumenauer, medicare payments reduced if there is a temporary accounting imbalance and we already have one trust fund under medicare, that is responsible for part of this, trying to cycle back in another one, and i think, is -- sort of difficult to diagram, i don't know, administratively, how it would work. and, i do think that we would

have some unintended consequences in terms of, instability of making sure that people get the medical care that we are committing to. so i think, everybody wants to make sure this is in balance and well work on it, but creating nor trust fund element commingling the two, and having some automatic cuts is not the way to do it. i urge rejection. >> thank you very much, mr. blumenauer, if you are not crazy about this, let me tell you what i also wanted to put in, i also wanted to put in it any member of congress who voted to raid the trust fund would have to spend their franking money to explain to their constituents why they were raiding again another trust fund. i would ask for a -- i would ask for a voice voted on this amendment. and -- >> [inaudible].

>> aye. >> opposed. >> no. >> [inaudible]. >> thank you, mr. chairman. looking at amendment number 54. and thank you for the time. i just wanted to share with you, i have to believe that most people here in congress have principles they follow, and -- to determine how they vote and why they vote for a particular bill. i would like to share one, called the more, higher, less, more competition, higher quality, less cost and if a piece of legislation comes in front of me that meets those qualifications, more competition, higher quality, less cost, i'll vote for it and i think my votes today reflect those principles. like i said, i like to think everybody has certain principles, i wonder. but i have an amendment in front of you today i believe meets

these three principles, more competition, higher quality and less cost and provides a way to immediately incentivize fogsz care for uninsured patients not able to pay for treatment and as my colleagues are awas,y that often seek care in the emergency room because they know they will be treated regardless of their ability to pay. however, the emergency room is the most expensive place to receive care. the median cost of an emergency room visit is nearly five times the cost of a typical doctor's office visit. the more people we treat, out of the e.r., the lower cost of health care will be overall. my amendment would allow physicians to deducted the cost of treatment as a bad debt write off for federal tax purposes and the proposal would encourage more doctors to care for the uninsured and could provide many patients immediate access to a physician unlike the underlying

bill, which won't take effect for many years. i'd like to thank my colleague from texas, mack thornbury for offering the bill from which my amendment is modeled and grateful for his willingness to work with me on this important issue and urge support for my amendment, mr. chairman and yield back. >> recognized to respond. >> thank you, one-on-one here today, mr. heller and while i recognize mr. heller, what you are trying to do to provide the benefit to those doctors and serve the indigents i salute you for the amendment, i oppose it scanned my colleagues to do it, the current law provides physician that treat low income patients the ability to claim a deduct for the cost of treating those patients and they are business expenses, and the physicians can claim on his or her tax returns. rather, this amendment would allow doctors to duct the profit that would have been recognized by the physician for treating the low income patient and expand current laws today of

providing tax benefits to the value of services volunteered and under our tax law we do not provide charitable deduktsz for services, congress has long been concerned about such reductions. and the murkiness of them, and how will the value of services provided be estimated? who would provide these valuations, cms? i have heard arguments about the reimbursement methods used by cms and i highly doubt you would recommend them and how would the treasury department verify services were actually provided and the amendment would open the door to serious concerns, about waist waste, fraud an abuse and something that no one on the committee, regardless of side of the aisle wants to do, while we are discussing ways to eliminate fraud, this amendment, i believe, could expand fraud, in the tax system. and, finally on a grander point the amendment would end volunteerism as we know it in the gray by allowing people to take tax deductions for current volunteerism and people

volunteers, such as those doctors providing the services to better their community and help people, not to seek a tax break and where would it stop? should we then provide a tax deduction for all volunteer services or -- offered in the u.s. such as pro bono work of attorneys and for those who volunteer at soup kitchens and walk dogs for a local animal shelter? i don't know. i'm not saying the gentleman's amendment is an insult, but, rather, it is an end of the volunteerism spirit, i think, that has made america what it is today. and i urge my colleagues, recommend the no vote to them and yield back the balance of my time. >> mr. camp is recognized. >> thank you, mr. chairman, i'm sympathetic to what the gentleman from nevada is trying to get at in this bill but i would have to associate myself with the remarks of the gentleman from new york and urge a "no" vote on this amendment for the reasons stated. i think it is a policy that is not -- i think it would be an im advised approach, to this particular problem. and, for the reasons that the

gentleman from new york mentioned. i think would be a precedent that could be extended to many other areas, and potentially, cause a great deal of fraud and i urge a no voted, thank you, mr. chairman. >> mr. heller. >> thank you, mr. chairman. in closing, i'd like to go back to the original premise which i think is a very conscientious step and move forward, that this bill is something that causes more competition, by getting more physicians involved, with higher quality because we are moving these out of the e.r. room and people going to their physicians, and less cost, obviously, if you have more competition out there and we are talking 20% of the costs. i am somewhat concerned, or -- enjoy the back and forth about the fact we are worried, perhaps about what the costs would be,

and in the fact that the underlying bill itself, we don't care about the cost, all of a sudden we care about the cost of the amendment, and that is kind of an unusual tack for saying that this bill should not move forward and having said that, i would urge, again, support for my amendment and yield back. thank you. >>... [inaudible]. >> aye. >> those in opposition, indicate by saying no. >> no. >> the amendment fails, the chair -- >> i don't see enough hands, i don't see enough hands. >> all those who support roll call vote by indicate by raising their hand. not a sufficient number. mr. davis is recognized. of illinois. >> thank you very much, mr. chairman. and i have an amendment, at the desk. that i will withdraw. once i explain it. thanks so much. i do have a great deal of

concern about waste, fraud and abuse. and i want to caution us, because i represent a district that has more than 20 hospitals, four medical schools, 7 teaching hospitals and, of course, many of the individuals who make use of these facilities are low income. therefore, they would also be disproportionate share hospitals. the concern that i have is that we treat teaching institutions a little differently, not that i'm going to suggest that there isn't fraud, abuse and waste, but i'm also suggesting that we take a real hard look. the amendment really said let's not cut any more for medicare and medicaid from these institutions. but, what i'm really saying is that the cost of medical

education is extremely high. attention a great deal of resource to train individuals, residents and interns, and these institutions are trying to make sure that we have the primary care physicians that we all talk about needing, so i simply caution us to take a good, hard look at teaching hospitals as we deal with the medicaid, medicare problems and as we deal with the fraud and abuse, and with that, mr. chairman -- >> mr. chairman? mr. chairman? could i be recognized just as -- offer support to what mr. davis is attempting to do? mr. chairman, there continues to be a debate, as you know, about the role the teaching hospitals play and i want to assure members of the committee, if this is elevated to the next stage, i intend, and most

members of the committee, we have spoken with intend to bring it to the speaker's attention, and to stay with this issue. it is of most significance to many of us who represent urban areas and we have had this conversation and i intend to kind all the way to the rules committee if necessary into mr. lewis of georgia. >> mr. chairman i want to be identified with the concern of mr. davis, and mr. neal, i feel very strongly, about this issue, coming from an urban center like atlanta, where we have teaching facilities. >> mr. --? mr. chairman, i would be associated with the comments of my colleagues, we in north carolina are fortunate to have a number of outstanding teaching hospitals, and i think, they are -- expressed it very well and i associate myself with their comments, thank you, i yield back. >> mr. chairman, briefly i want to recognize, mr. davis, in his efforts, here, and i agree with

many a-- of the points he has made so far and look forward to working with mr. davis as well as mr. neal in the future to make sure the cuts don't go forward. >> and not to prolong it but, i, too, represent a sae an region that has great medical teaching hospitals, we're proud of and they do great service in providing not only health care but in also, training physicians for all -- from all over the country and we, too, are concerned about cuts that might be made, that would lead to a reduction in any kind of quality of the teaching hospitals that are so extraordinary in the kaye. >> and mr. chairman, speaking on behalf of mr. pascrell and myself in order to save time, we would like to associate ourselves with the amendment that is going to be withdrawn by mr. davis. >> i thank the chairman, by unanimous consent, this committee has a grave concern over the subject matter, and the chair and ranking member, we

will look into this. so -- you did pretty good for an amendment -- >> you are doing all right, thank you very much, mr. chairman. i certainly want to thank all of my colleagues, and i ask unanimous consent to withdraw the amendment, and i yield back the balance of my time. >> without objection, mr. brady is recognized for purpose of an amendment. >> i will drop one of them, because it was essentially addressed. this amendment is the -- the genesis of this comes from a lot of people in our district, who don't have high expectations of congress, but, a major -- on major bills like this they expect to us do two things, one to read and study the bill before we vote on it, and, then, give them time to be able to read and study the bill as well. what this amendment does, it just expresses the sense of congress, and this committee,

each number, prior to voting on this massive health care bill, each member will certify in the congressional record he or she has read the entire bill and that the bill be publicly available on-line for 72 hours prior to vote. this issue has come up, because, i think, the public has seen the stimulus bill, 700-some billion dollars rushed through again with almost no time to read it, less than 24 hours notice. the same thing occurred with the cap and tax bill, here, recently, and, now, we have evidence that the original bill for this health care was introduced less than 24 hours, ago, and the new bill was introduced at midnight, tonight, and virtually no one has had a chance to read it and we don't even know how much it costs and we're being asked to vote on it. and we can the not rush legislation of this complexity and cost through congress and

this amendment simply says we will read the bill and give the public 72 hours to read it as well before we voted on it and this sense of congress, i get you accept it and not do it. i would ask members that to not only vote for the bill but to have the integrity to actually follow it. to read this bill, and then to give the public the chance to do so as well. and i would urge -- it -- urge its passage. >> [inaudible]. >> mr. chairman. >> mr. john lewis. >> mr. chairman, i am pleased to respond. let me say to my friend, and brother from texas, mr. brady, i know it is getting late, very late, and -- but we're moving to a very interesting point in this

debate tonight. and -- in marking up this bill. it is my understanding that our leadership on our side plan to have this bill on-line, 48 hours before we vote on the bill. and this bill was introduced more than a month ago. and all of the changes will be described in the bill when it is placed on-line. i think this is a bad idea, you know, we're not children. we are not little boys and little girls. no one -- we shouldn't have to pass a resolution telling us what we should read and not read. in fact we should be smart enough to read the legislation and no one should force us -- no resolution we pass, something we

vote on, command that we read a bill. i think you should vote against the bill and ask for a "no" vote, mr. chairman. >> your suggestion is well taken. you want to voted on this. >> just a voice -- >> before the committee all in favor indicate by saying aye? aye. >> the no, say no. >> no. >> nos have it. mr. ryan has an amendment. >> mr. chairman, there are two directed score keeping provisions in the bill and first appears in section 164, the reinsurance program for retirees in the amount of $10 billion and the second in section 2002, public health investment fund in the amounted of $88.7 billion for a total of $98.7 billion. both sections contain the budgetary implication language which, basically, is a direct scoring provision that is what we call it, in the budget candidate, which effectively says don't count it.

taking it off budget. these two funds basically will not be counted in the budget act and will be taken off budget, i don't think this is the intention of the majority to do this with these funds, with these two programs, and, i urge adoption of the it and i will yield to the chairman. >> thank you, so much. thank the gentleman for bringing it to the gentleman's attention and it was included in the introduced bill and we agree that the provision should be taken out. however, the amendment raises jurisdictional issues, which is why we left it in for the block but plan to delete it. the second part is, the amendment to the public health service act, which is in division c and that division is not before us, and is within the jurisdiction of the committee of energy and commerce, but we will delete as suggested and we thank the gentleman for bringing it to the committee's attention. >> i thank the chairman for his indulgence and with that i ask

unanimous consented to withdraw the amendment. >> by unanimous consent and the chair recognizes ms. brown waite, to introduce amendments number 50. >> while the amendment is being tributed bile briefly explain what it is. it would strike the provision from the bill that bases payments to medicare advantage plans on medicare fee-for-service. as you may know medicare advantage plans provide benefits to seniors, that traditionally medicare does not. including dental, and vision coverage, and a buy-down of part b premiums. these plans have consistently grown in popularity, and seniors have become accustomed to the additional benefits they receive from these plans, the bill before us will reduce medicare advantage payments, thus, eradicating these additional benefits. even medpac sit is unlikely that

such a change will happen, without disrupting senior benefits. medicare advantage plans care predominantly for special needs, beneficiaries, minorities, and low income seniors. this committee should be aware of this before it votes to cut benefits to this group. i also have ascertained that the average amount that seniors will have to pay more for their benefits, if this is enacted is about $150, in my area, in mr. meek's area, in south florida it actually would be closer to $500, i only have the figures for florida, i don't have the figures for other states. but, i know that in many other states, particularly, in rural areas, these are very, very popular plans. and i'll reserve the balance of my time for close.

>> the chair would like to recognize the chairman of the health committee to respond, mr. stark. >> mr. chairman, this amendment would promote and keep the wasteful government spending that medpac has said would cost us 165 billion dollars, over ten years. paying medicare advantage 14% more, than we would pay for traditional medicare, and, there is no guarantee that beneficiaries receive any extra benefits. indeed, the plans may offer them, and, that would sort of be like offering the chairman and myself health care plans in a gym with high speed

chair-climbers or stair climbers. we might be -- they might be offered but we might not use them. there is very little evidence that these plans are providing benefits while they may have offered them. under hr-3200, efficient plans would still be able to offer extra benefits to their enrollees. it is also important to know that the higher medicare premiums or the overpayments, if you will, to the private plans, are paid for by all taxpayers and medicare enrollees. medicare enrollees are -- now have to pay $50 a year more in their premiums to support the current overpayments in the medicare advantage. medicare advantage overpayments encourage inefficient plans in the market, and, this would allow inefficient plans with

poor quality, to stay in the market, get a windfall for overpayments, and this treats every part of the country, the same way. it is important to note that there are 12 members of the committee, on our side of the aisle, who have a greater share of their seniors enrolled in medicare advantage than the district the gentlelady represents in florida. we know that overpayments to these plans hurt all medicare beneficiaries, because, they increased the medicare premiums, encouraged low quality and waste our medicare dollars. i urge the defeat of this amendment. >> mr. -- ms. braun brown money wa -- ms. brown-waite.

>> perhaps the gentleman is not aware they've already cut the plans 4 to 5% and is not the 14% over medicare, traditional medicare fee-for-service they are being paid. when you add up the dental, vision, and part b reimbursement, it is going to mean a couple of hundred dollars more that our seniors are going to be paying. and, while the gentlemen was quick to point out that there are members who have higher numbers of individuals who sign up for medicare, advantage plans, i would just encourage them to support this amendment. and with that, mr. chairman, i do close and encourage a voted in floort of this amendment. >> the brown-waite amendments is before the committee, all in favor indicate by saying yea. >> aye. >> oppose, say no. >> the nos prevail, the motion is not agreed to. ms. brown-waite do you have

another amendment. >> mr. chairman i do, and happily, i can tell you it is the last brown-waite amendment, sir. >> you are recognized for that purpose. >> thank you, mr. chairman. you know, in the bill there are some provisions that would cause un-- cause very serious harm to skilled nursing facilities. in order to stave off some of the cuts, and prevent any disruption to senior care, this amendment would do three things. first, it would spread the forecast error adjustment over a three year period giving nursing homes time to adapt to this regulatory change. second, the market basket and the productivity adjustment would not be changed in the house bill. this amendment would permit nursing homes to retain their market basket. the final component of the amendment would amend the

rehospitalization provision to give the secretary of hhs authority to utilize a trigger. if the provision does not yield the estimated savings, by the end of the ten-year period. the trigger would actually allow the secretary to reduce the market basket, by 1%, from fiscal years 2015 to 2019. mr. chairman, the reason why i put this amendment in, was to highlight the fact that one of the things that i learned very, very rapidly when i chaired the health committee in the florida senate, and had to deal with nursing homes, is, that unless there is adequate reimbursement, for nursing homes, you can have all of the regulations in the world, and they become snake pits. they become places that you would not want your loved one to be in. i am very concerned about the cuts in the bill, to nursing

homes. and, mr. chairman, i would like to work with you, and certainly, with mr. stark, so that we are not jeopardizing the health and safety of our seniors in nursing homes. i -- with such a commitment, i am not saying adopt this, i'm saying, we do need to be cognizant of the harm that these kind of cuts would do. i am willing to withdraw the amendment, but i would like some cooperation on this very important issue. >> i would like to assure the gentlelady that i would like to work with her. the center for medicare advocacy asked to us look into this. there are many things that we could do to -- i don't want to say regulate but improve the quality of long-term care in nursing home and skilled nursing facilities for our seniors, and i would look forward to working with this gentlelady on that

behalf. >> reclaiming my time, mr. chairman i certainly appreciate mr. stark's offer to do that. as i say, the one thing that i learned was, if you cut back on funding or don't provide adequate funding, you are not going to have quality care. one of the things that we did, and yes, it costs state dollars. we actually raised the minimum staffing levels above that which the federal government required. and what happened? there was better care, fewer lawsuits and a whole lot happier person and families of those in nursing homes. so -- mr. chairman i will with draw the amendment, and look forward to working on this issue. >> i thank the gentlelady and look forward to her continued cooperation in the matter. thank you. >> mr. chairman, i also would like to thank you for agreeing to work with those of us who have a serious issue with skilled nursing homes and i appreciate your sensitivity to this issue. >> thank the gentlelady for her

comment. >> mr. chairman. >> as chairman i would like to say you lovely ladies have really brought out the best in peter stark... [laughter]. >>... and so, this is a high note to wrap this up. >> one of the guys wants to get on board i think. >> who is that. >> mr. meek. >> all right, ms. schwartz. >> mr. meek. >> anyone else at this time wants to say something nice about mr. stark? [laughter]. >> let me say, something nice -- what is it? oh, yes we have -- mr. rosscam. >> thank you, mr. chairman. this is an amendment that is meant to refocus our attention on fraud, we have had a conversation earlier, when mr. camp offered his amendment, and, i want to try and describe this in another way, last week the miami herald, had an article where they described a man named

jose luis perez, who is i think figuratively laughing at us right now. mr. perez according to the authorities, ripped off medicare for $56 million. and he had an enterprizing partner. they were two 33-year-old guys, and, they completely hustled the system and mr. perez is gone, described by the fbi as an international traveller and now is at large, $56 million over several years, is gone. we have had a conversation this evening and throughout the day and i think all of us recognize that there is waste, fraud an abuse within the system. and, to be fair, i think the majority makes an attempt in their bill, to try and get at it and there is decent stuff and they are increasing some enforcement mechanisms and enhancing penalties but the problem is, that for people like

mr. perez, and his partner, these efforts don't get at those guys. in other words, the paradigm has to shift. in other words, we have got to get to the point of sale on medicare, and not have a pay now and chase later approach and that is exactly what the medicare system does. and even some of the other changes, frankly, that the majority has, you know, it is -- says the secretary may impose enhanced screenings and that is all fine and well and good. but, if we want to really get at this we have to do it a different way and what my amendment says is simply, it calls on the secretary of health and human services to establish a system to use technology for real time data review, to stop waste, fraud and abuse, at the point of sale. now, think about this. we have a credit card economy, that moves over 11 trillion

dollars a year. there are 700 million credit cards in place around the world. or in circulation around the world, and, yet, that industry is able to have their fraud number, at .047%. now, compare and contrast that -- we were sort of laughed off the stage, when mr. camp offered an amendment that said, we had to have as a goal of three or 3.5% and that was like you oh, you are completely unrealistic and yet with another industry, that is actually bigger, than medicare, their beating the living daylights outs of us in terms of efficiency and why is that? because they do point of sale. think about it. ups and fedex can track 23 million packages offered and customers can track it in real time. we can do this. but, it will take a paradigm

shift. i was told earlier, sort of these shuttle diplomacy, sort of staff discussions that there was some objection to this bill, based on cost. because i called -- it spends $50 million a year on this and i literally laughed out loud, that anyone would suggest cost as an objection to this. so i can't up even believe anybody will bring that up, because simply with one out lay of $50 million, we get mr. perez, and his partner. so, i think this is an idea whose time has come and i know it is late. but i think that it is a transformative idea, that can begin to put real serious teeth into ending this madness of allowing our constituents to be ripped off. i yield back. >> would you respond, please? >> mr. chairman?

is -- last amendments, is this the last amendment. >> i hope so -- >> i think it is a and, appropriate one toendz on, because after a long day of telling us how we care too much, and we'll spend too much to help people get out of the health care crisis, we are asked to spend another $250 million more, based on a newspaper story in -- and one sheet of paper delivered to our staff a couple of hours ago. it may be that this is a good idea. i -- it sounds like, rather specialized technology, and it certainly sounds like the kind of specialized technology that could be presented to the secretary, under the moneys we have already appropriate under the stimulus act. it may be the shining carriage that will carry us to resolve medicare fraud. but, i am inclined at this late hour to think it might be only a pumpkin and i ask for its rejection. >> close on this -- >> i would be delighted.

you know, the irony here is that for a majorities that is jamming through a bill, that has no idea what the cost is, i find it very sobering that somehow a good faith idea is simply a pumpkin. i think that we can do better. i appreciate the chairman's indulgence and urge its passage. >> the amendment is before the committee all in favor, indicate by saying aye. >> aye. >> all opposed. >> no. >> the nays have it, the roskam bill fails and let me say this, as we reach the conclusion of the amendment process, i seriously want to once again thank for bar bart hold for his endurance as well as the professional contribution that he has made to this.

all of the staff. the star members that testified as well as those that worked hard to bring us to this. i particularly want to tell the members how proud i am to have chaired this where the amendments, as many as they may have been, were of substance, and were responded for the most part, the sense of mutual -- in a sense of mutual respect and i do hope that this continues throughout the process, no matter which way the vote goes, because, ultimately, even without the vote, i am thoroughly convinced that the minority would want the best possible bill that we could create and bring to the floor. and i also would want to thank mr. camp, because of his efforts that create this atmosphere that makes it very easy for -- to do this and at this point in time, i would like to yield to him, before we end the amendment process. into just very briefly, because it is so late, mr. chairman, i

want to also thank you for working with me, as we identified these amendments and had the mark-up, thank you for that indulgence and members were able to offer the amendments that they very much wanted to offers i also want to thank the staffs on both sides, who i know worked incredibly hard and long hours, to get us ready for this moment. as well as mr. barthold, thank you for all of your efforts, in advising the committee on important tax issues. thanks again, mr. chairman and i want to thank all the e members as well. >> any other questions or amendments to the bill? if not, the chair will put the question on the amendment in the nature of a substitute, all those in favor indicate by saying aye. those opposed -- those opposed by saying nay. >> aye. >> no. >> in the opinion of the chair, the ayes have it, the amendment

is agreed to and the chair will be in receipt of a motion for mr. -- >> mr. chairman. i move that hr 3200 as amended be reported favorably to the house. >> all those in favor indicate by saying aye. >> aye. >> opposed, say no. >> no. >> the ayes have it and the motion is -- >> roll call vote. >> roll call is called, the clerk would call the roll. >> mr. stark. >> aye. >> mr. stark votes aye. mr. levin. >> aye. >> mr. levin votes aye. >> mr. mcdermott. >> mr. mcdermott votes aye. mr. lewis. mr. lewis votes aye. mr. neal. votes aye. mr. tanner. votes no. mr. becerra. votes aye. mr. dogett, votes aye. mr. pomeroy. votes no. mr. thompson.

votes aye. mr. larson. votes aye. mr. blumenauer, votes aye. mr. kind. mr. kind votes no. mr. pascrell. mr. pascrell votes aye. ms. berkeley. votes aye. mr. crowley. mr. crowley votes aye. mr. van hollen. votes aye. mr. meek. mr. meek votes aye. ms. schwartz. ms. schwartz votes aye. mr. davis of alabama. mr. davis of alabama votes aye. mr. davis of illinois. mr. dafrs of illinois votes aye. mr. ethridge. mr. ethridge votes aye. ms. sanchez. votes aye. mr. higgins. votes aye. mr. yarmouth. votes aye. mr. camp. mr. camp votes no. mr. haringer. votes no. mr. johnson. mr. johnson votes no.

mr. brady. mr. brady votes no. mr. ryan. mr. ryan votes no. mr. cantor. mr. cantor votes no. mr. linder. votes no. mr. nunness. votes no. mr. tae barry. mr. tea barry votes no. ms. brown-waite, votes no. mr. davis of kentucky. mr. davis of kentucky votes absolutely no. mr. reichert. mr. reichert votes no. mr. bustany, votes no. mr. heller. mr. heller votes no. mr. roskam, votes no. mr. chairman? >> absolutely yes. >> mr. chairman votes absolutely yes

>> 23 yeas, 18 nays. >> members, the bill is passed, all members have two days to file any additional materials for the record and without objection, staff is authorized to make any technical corrections, and the committee stands adjourned and, once again, thank you so much. >> charlie, congratulations. >> thank you. [inaudible conversations]

[inaudible conversations] [inaudible conversations]. >> an update on the progress of health care legislation, in congress. here's a capitol hill reporter with more. >> jilly rob ner of national public radio, lots of action this week on capitol hill

regarding health care legislation and let's start with what happened in the house this week. >> it has been a busy week and first the house unveiled its bill and that in itself was kind of remarkable and you had three committees basically agreeing on the same piece of legislation and that doesn't usually happen and committees are very competitive. then we had two of the three committees actually start and finish their mark-ups and we have the ways and means committee having reported its bill, the education and labor committee having reported its version of the bill, and both of them on party line votes and both of them it might be noted not all the democrats voting for it. three democrats who parted company, on each committee, possibly a harbinger of what key all the blue dogs and more conservative democrats, worried, really about cost, and particularly the long term costs of these bills. >> let's dig into the house bill, what are the key elements. >> guest: the key elements of the house bill are pretty much the key elements we are seeing in the senate, too. obviously there will be generous subsidies to help this uninsured

get insurance, they that have what they call shared responsibility, and the basis of this is that everybody, basically, pays what they can and the government pays for the people who can't pay. and, so, in essence people will be required to have insurance, and, if they dome have insurance they'll be required to pay a penalty and if you can't afford the insurance the government provides you with subsidies and employees will -- employers will be required to provide insurance to workers or will have to pay also a penalty. and, small employers, for whom obviously this is a very big, big efforts, and who can't generally afford it will be given tax credits to help them pay for their workers' insurance and very small employers will be excused from this, again, for the very small employers, those -- their workers will be given subsidies to help them buy insurance, and, again, that is what they call it shared responsibility, individuals will have a responsibility, and employers will have a respond, and, the government will have a responsibility. and there will be new, changes and places where people can go

and choose from a variety of plans, one of those options will be a public plan, and a plan that will be sponsored by the government, presumably run by the government, but, again, that will not be the only plan in these exchanges, there will be a number of private plans, that public plan will have to compete with the private plan and will pay in fact a little bit more than the pro veiling rates and according to the congressional budget office, not that many people will go into the private plan, because it will not be all that much cheaper. i mean -- i mean, excuse me, the public plan because it will not be all that much cheap than the private plan and a lot of the accusations, hundreds of millions of people will go on to the public plan at least the way it is devised in the how about according to the cbo, not going to happen. >> let's talk about the process and we understand e health committee approving the bill and what is this next step in the senate senate we are waiting for the senate finance committee, this is the committee that has considerably more jurisdiction

in the senate than the health committee and have jurisdiction over how to pay for it and this medicare and medicaid programs. so, when we talk about saving money, and raising money, those are the two things the finance committee has to do. and of course saving money in the health care system, when you are talking about the federal government, really comes from the two big health programs, medicare and medicaid and so the finance committee is going to figure out how to save the money and because it has jurisdiction over taxes, they have to figure out how to raise this money and have been meeting mostly behind closed doors and small groups and chairman of the committee over there, max baucus has been trying to do it on a bipartisan basis and it is tedious and has taken a long time and they of have broken for the weekend and will come back next week and they counted say we are making good progress and have good ideas but i think one of the things they were moving close to a bill, one of the ways they were going to finance this was using money that they would raise from starting to tax health care benefits for highly paid workers for people who had

generous health care benefits, the president has made very clear he really strenuously opposes that and there are a bunch of polls that show the public opposes that. and the senate majority leader, harry reid, urged baucus to take it off the table and left a $320 billion hole in the bill. and they have been struggling to try to fill the financing hole ever since and i think that is the main reason we have not seen a bill out of the finance committee. >> i'll speed you up, what are the cost estimates for the proposals and how do lawmakers plan to pay for them. >> they vary a lot but they are trying to keep these to around a trillion dollars and there are a couple of aspect to the cost estimates and over ten years, they would cost a trillion dollars, they would be paid for by a combination of reducing spending within the health care system, mostly medicare and medicaid, and, some of these tax changes, over the long term, though, that want to try and make some changes to the health care system so this would not only pay for itself but start to lower health care costs, and that is a different issue and it is a harder issue, not something

the congressional budget office scores, they are two different debates and you have to be careful not to get those two debates mix u. as you watch this. >> is there a timeframe forgetting the bills approved and on the president's desk. >> yes. the timeframe for that is the year, the timeframe for getting 3m through the house and senate so they can get to conference and try and put them together was supposed to be the august recess, looks like the house is going to make that, and looks like the senate probably isn't. >> and, how about president obama? how involved is he in helping get these measures through congress. >> well, he is the head cheerleader and has been coming out more and more emphatic and in fact only just now offered up a proposal that would give the independent medicare payment advisory commission some more teeth to basically, you know, urge their recommendations for cutting medicare and medicaid costs, and make coverage, and vote on those every year and basically make them take an up-or-down vote on those every year and would be a way to inject cost cutting into these profiles, which the congressional budget office says

doesn't -- proposals which the congressional budget office says they don't have any jurisdiction over and the question is what will happen over the long term. >> host: you can hear julie rovner on national public radio. thanks for your time, julie. >> you are very welcome. :