and this is an expert that's worked additio -- that's made hg by deal with health care issues. he knows what happens with insurance companies. that's why what we did in this legislation, the consumer protections, no more -- no mor more -- no more preexisting conditions. no more dropping coverage. justin discriminate nently. no more caps on coverage. and no more gaming the community rating system. no more discrimination. that's what this legislation is all about. if you have insurance, you like what you have, you can keep it. absolutely. our bill guarantees that. you have consumer protections, plenty of people who are satisfied with their insurance get sick, find that their insurance is canceled. no more of that under this legislation. susan from central ohio, from franklin county writes, i'm in my mid 50's, unemployed for over a year looking for a job the entire time. living without health insurance the at this point is terrifying.

i'm 56, this woman is in her mid 50's will she been un-- she's been unemployed for a year. she sounds like she's healthy, but she's always thinking about it. always scared. my father was a physician in private pack in his columbus from the 1950's through the 1980's and the days when the physicians made the diagnosis and the health care providers trusted them to do so. please fix the health care system. make it possible for everyone to have access to good medical care. sighs ann is somebody -- susan is somebody that understands the health care from within as the daughter of a physician and understands that the terrifying -- her words, the terrifying living -- without health insurance at point in my life is terrifying. think about that, with all of the worries that someone has in their mid 50's and thinking about what happens if i get sick. liberty from franklin county, i need a followup ct is a scan for

liver cancer. i hope having to wait does not kill me, but i'm one of mancy. please fix our broken health care system. mr. president, we hear stories every day about health care denied, health care delayed really is health care denied and what happens to people when they have to -- when they have to delay. liberty from this letter it sounds to me like liberty is hoping -- hoping that we can move quickly so she can get insurance -- so she can have the followup ct scan for kidney cancer. claudia from franklin county in central ohio. my husband and i have owned our successful business for 2 years. our health insurance costs have escalated to point where we can barely pay the bill. with a $5,000 deductible per person, we're insuring only against catastrophic illness. little money is available for checkups, regular tests or

dental care. there no relief in sight. many self-employed people are discontinuing health care because of the cost. we need help. claudia and her husband are like self-employed people all over the country. they can no longer afford health insurance. even if they're a business of 30, 40, or 50 people. if two or three of those employees get very sick and they need remicade or they need herceptin or one of the biologic drugs that costs $10,000 costs $10,000, $20,000 or $50,000 or $100,000 a year, what happens to that small business if they have 20 or 30 employees, a couple of those employees end up with drug costs of $50,000 or $100,000, that may cause the employer to cancel insurance, because the insurance premiums go so high because of three or four or five sick

people. as chairman dodd points out, this legislation has specific provisions to help small business. it let's them go on the health exchange so they can spread out their costs among larger number of people than the 10 or 15 or 20 people or in the case of self-employed people like claudia from columbus and her husband not having any chance to get insurance. they know people with insurance and small business will no longer have to pay the cost of the uninsured, the extra $1,100 that they have to pay. they will get additional tax credits so they can insure themselves an their employees. almost everyone i know wants to insure his or her employees, so many can't afford it. this bill will make a difference for small business. it will make a difference with the consumer protections that will help those people who are happy with their insurance, but will always anxious about perhaps their insurance being

canceled or caps put on the -- caps put on their insurance. all of those issues that happen to people. that's why this legislation is so important. that's why these letters from individual people, whether they're from zanesville, mansfield or vena or youngstown. people all over my state are hurting. people all over the country are hurting, the people in the presiding officer's state, anywhere in colorado or connect, that's why this is why we need to take action. 14,000 americans are losing health insurance every day. i'm hearing from a lot of them. i'm hearing from those who can't find work and can't find insurance. it's time that we move forward, mr. president. i yield the floor. mr. dodd: can i just -- the presiding officer: the senator from connecticut. mr. dodd: i want to personally thank him. i mentioned earlier has done a tremendous job, as others have

as well, but sherrod brown brings a wealth of experience and talking about real people with these issues. there is a tendency of all of us to discuss these matters from about 30,000 feet using the language we're familiar with to describe what's going on. too on for people across the -- too often for people across the country, they wonder if anybody is talking about them. by reading letters from people from ohio and what they're wrestling with, brings us back down to a level that we need to think about more often when we debate these issues. every single day of those 14,000 who lose their health insurance, there are many who are in a health care case is and -- crisis. so i -- i appreciate immensely his contribution. not only during the long days that we spent day in and day out crafting the legislation now before us, a and we need to do

more talking about what is in the bill. from a small business perspective, the prevention, quality of care, workforce issues are all very significant contributions to our debate. the class act, which allows individual people at no expense to contribute to their long-term cares is one of the most innovative and creative ideas in the bill. that will provide not only substantial resources but the ability of people to live independent lives that have disabilities that might otherwise force them into living into more expensive care or tapping into medicare. in fact the projections under the congressional budget office is that we will save $2 billion in medicare costs by having the class act, that is, the long-term care provisions of our bill. i invite my colleagues to look at it, to read this by, to go through the briefings. i spent about an hour -- a little more than an hour today with our colleague from

california, dianne feinstein, that requested that i combine with her staff and went through the various sections of our bill and how it would work, how it would affect people in her state, how these various provisions worked. and i don't want to speak for her, but i think she was pleased to hear what we've done. there is more that needs to be done under the finance committee and i couldn't have answers for that because there's no bill yet out of the finance committee. on part of the effort that we've made, i think as our members an colleague look at what we've done, they'll be pleasantly pleased about the efforts we've made to assist the insured with preexisting conditions and the dhaips mentioned, the credits that we provide to small businesses to allow them to make that health care insurance available to their employees as many would like to be able to do at costs they can afford without crippling them because one employee ends up with a serious health condition, thus raising the cost of every other employee and the -- in the cost of overall health care, that's

gone, as a result of what we've written in our legislation. and i urge my colleagues to read the bill, to talk with us, to raise the questions you have, particularly over these weeks between now and the time we come back. i think you'll, again, be pleased at the effort that our colleagues have made to improve, certainly, vastly improve the status quo. i've contributed significantly to where we need to be going with regard to health care reform. i'm grateful to sherrod brown of ohio for his contribution. mr. president, i yield the floor and note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

mr. brown: mr. president? the presiding officer: the senator from ohio. mr. brown: i ask unanimous consent to dispense with the quorum call. the presiding officer: without objection. mr. brown: i ask unanimous consent that the judiciary committee be discharged from further consideration of s. res. 195, the senate proceed to its immediate consideration. the presiding officer: the clerk will report. the clerk: s. res. 195, recognizing bishop museum, the nation's premier showcase for hawaiian culture and his on the oh,ation of -- occasion of his 120th anniversary and so forth. the presiding officer: is there objection to proceeding to the measure? without objection, the committee is discharged. mr. brown: i ask unanimous consent the resolution be agreed

to, the preamble be agreed to, the motion to reconsider be laid on the table, and any statements related to the resolution be placed in the record at appropriate place as if read. the presiding officer: without objection. mr. brown: mr. president, i ask unanimous consent that s. res. 22 be star printed with the changes at the desk. the presiding officer: without objection. mr. brown: mr. president, i understand that s. 1552 introduced earlier today by senator lieberman is at the desk. i ask for its first reading. the presiding officer: the clerk will read the title of the bill. the clerk: s. sa 1552, to reauthorize the d.c. opportunity scholarship program and for other purposes. mr. brown: i ask for its second reading and object to my own request. the presiding officer: objection is heard. the bill will be receive its second reading on the next legislative day. mr. brown: i ask unanimous consent that when the senate completes its business today it adjourn until 9:30 a.m. tomorrow, friday, july 31, following the prayer and pledge,

the journal of proceedings the journal of proceedings, morning hour be deemed expired, the time for the two leaders be reserved for use later in the day the senate then resume consideration of calendar number 105, h.r. 2997, the agriculture appropriations bill. the presiding officer: without objection. mr. brown: mr. president, as previous hely announced there -- previously announced there will be no roll call votes during tomorrow's session of senate. if there is no further business to come before the senate, i ask that it adjourn under the previous order. the presiding officer: the senate stands

>> donations maybe? i have no idea. >> government? >>c-span gets its funding through taxes. >> sort of a public funding? >> maybe, i don't know. >> how is c-span funded? america's cable companies created c-span as a public service, no government mandate, no government money. >> we are going to take you live now to the house energy and commerce committee where members are continuing to work on health care legislation. this markup began at 10:00 a.m. eastern today. this is live coverage on c-span2. >> general surgery training, so they are well qualified physicians and certainly what mr. deal is suggesting i think makes great sense. these patients are not

abandoning the emergency room. they are triage, a determination is made that they are not, they should not really be in the emergency room. their situation is not an emergency and they have patients there that are waiting to why having heart attacks or maybe they are suffering a gunshot wound, a motor vehicle accident. a life-threatening condition and i think this is so important to free them of that liability of making a sound political decision of referring that patient to a community health center the next day and i would be glad to yield to my friend from iowa. >> reclaiming my time. i just want to make the point many states have good samaritan laws to encourage a doctor to stop at the scene of an accident and protect him for services he/she renders at the scene of an accident. mr. sutton made a point or mr. braley made the point that we cover doctors who provide care at a medical clinic created by the federal government. as well we should and there is the difference between those

doctors and the doctors in the emergency room at the federal health center. we are lease bang the salary of those doctors. in this situation we are forcing them by the law you must provide free care in that emergency room in that hospital. we won't pay them and we don't cover their liability. no wonder they don't want to show up and provide care. why would they? they have to give free care not have their liability coverage. it is wrong and i strongly urge my colleagues to support mr. d.o.'s amendment. >> the time is expired. are we ready for the vote? all those in favor say aye. oppose, no. no, we are going to go to a roll-call vote. >> mr. waxman. [roll call]

earl earl. [roll call]

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[roll call] [roll call] >> have all members responded to

the call of the role? any member wish to change his or her vote? the clerk will tally the votes. >> mr. chairman on that though there were 23 ayes and 35 no's. >> the amendment is not agreed to. we are going to open the bill up for amendments to tie-- title a or b but before we do that we are going to take a recess so that the clerks can put the amendments and and get them ready for consideration so we will take a ten-minute recess now. [inaudible conversations]

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[inaudible conversations] [inaudible conversations] [inaudible conversations] >> a short break, a ten-minute break in this markup of the house energy and commerce

committee marking up health care reform legislation. this is the final committee that meets during legislation before it can go to the house floor. that is expected to happen sometime in september. during the break we are going to see some of what the committee talked about earlier today. like rogers, a representative from michigan offered an amendment that will leave treatment decisions up to patients and their doctors. >> i think we can all agree that comparative effectiveness research can be a useful resource for doctors and their patients but it should not be used as a tool to limit or deny coverage of treatments. this bill creates an entire nuke that rovers team to conduct sea research. alarmingly the bill has no restrictions on how the federal government can use this research. this is a dangerous open-door policy that well, certainly leave-- lee to comparative effectiveness research being used to make coverage decisions.

hears what ce can teach us. what treatments are generally more effective, which preachers might work better for a particular disease or which drugs have a bigger impact on treating one disease over another. this is important. compared the effectiveness research is about general, averaged assumptions. it can determine anything about an individual patient with the knee condition looking for a unique treatment. we cannot allow the federal government to use a calculator or bureaucratic standard to get in the middle of patients and doctors. here are some examples of how they do it and other government-run systems. 823 a british woman was diagnosed with cervical cancer. she is corey pabst mer three times and was denied by the national institute for clinical excellent other version of comparative effectiveness research. at only provide service to women over the age of 25 and they do that for cost reasons, not because it is best for that

patient or respect the doctor patient relationship. 36-year-old woman and by the way that women did get cervical cancer at age 23. 36-year-old ontario woman was diagnosed with stage iv call on cancer. dr. suggested a cancer treatment that target cancer cells exclusively. unfortunately the canadian government would not cover that drug on the claim that the treatment when unproven even though that drug is a standard cancer treatment covered by insurance companies in the united states. 46-year-old montreal woman was denied access to the only cancer drug that would keep her life as she battled a very tough form of colon cancer. the drug is a standard treatment and the united states but candidate denied the treatment because it said quote we wanted to see a more prolonged survival rate. the government made a life-and-death decision on that patient and the reason they do it is because the only way that the government can control costs is by denying access or denying

treatments. these are tragic stories. these patients deserve better and i believe americans there better and shouldn't be subjected to governing, a government rationing health care. maya amendment is very simple. would prohibit the federal government from using comparative effectiveness research to deny or ration health care. it is common-sense protection that must be included in this bill. only doctors and patients should be making the decisions about what treatments are best, not a government bureaucrat. >> would the gentleman yield? >> mr. shimkus. >> thank you. this grade amendment, the history behind what happened in the british system is that it was established to calculate compared the effectiveness. with design for the same purposes as we are saying comparative effectiveness is designed to day to help us get better quality care. what nice has turned out to be

is a rationing program for the british government and there are horror stories on both sides but it is undeniable that the comparative effectiveness, the same arguments we hear today, was used to establish this federal bureaucracy or this national bureaucracy in the u.k., which rations care. this amendment says you cannot use these figures to ration care and i applaud the gentleman from michigan and the yield back my time to him. >> mr. chairman? >> this someone else see the recognition? >> with this amendment applied to also limit to private health insurance companies from doing the same thing based on this information? >> as it is drafted, takes care of the government plan and buy your built all plans must comply with the government plan. >> i noticed the language does say by the federal government. it seems anyone who would do the plain reading would assume you

are trying to exclude anyone-- >> again in your bill all bills must comply with the government so my answer is yes. >> so the private insurance company could not use this information either? >> correct. >> the gentleman yield back the balance of this time? >> mr. chairman? >> the gentleman yield back his time. >> mr. dingell. of words. >> the gentleman is recognized. >> i would like the attention of the author of the amendment because this is friendly comment but as always when we're considering amendments, the devil is in the details. now, the amendment would prevent the search by comparative effectiveness research being used to design or ration care. i appreciate the concerns of the gentleman and i don't want this

research misused and my feelings on that are the same as and i would like to give the gentleman a couple of concerns i think he should share with me. first, it was a comparative effectiveness studies showed the i accept we calls to heart attacks, more of them. now the question do we really want to limit that use of science? another study showed that the drug for weight loss caused heart valve damage. again, do we want to limit that kind of science and use of science? now, fortunately these kind of research findings are rare but if a study shows that a treatment is dangerous should we be denying ourselves the ability

to deny that treatment? so i understood what my good friend from michigan is trying to do, and i share his concerns, but i also am concerned that it is a bit too broad and i am wondering if my friend would be willing to strike the word to do my, which would enable us to support the amendment because it would say that research that says that an amendment, rather, that a particular treatment or particular kind of a pharmaceutical is in fact dangerous would probably be precluded under the amendment. >> as the gentleman yield? thank you for the time. i respect the gentleman greatly and couldn't disagree more with the language. the fda stepped in on those cases and this wouldn't prohibit that at all from happening, and more importantly it protect the doctor and patient relationship.

if a doctor knows it is a problem through comparative research they are not going to use that in the treatment the patient, and i wouldn't take my word for it, if you would yield to dr. gingrey he can give a perspective as well as the gentleman would be so inclined. >> i am sorry the gentleman and i disagree on the interpretation of his language, but i just think if the gentleman could accord with me on removing we could support the amendment otherwise i have to oppose it and i assure my colleagues on this side will join me in opposition. the amendment of the gentleman has a great deal of back if it has that changed i want to support as his friend and because i am convinced this is a sound amendment. >> will the chair emeritus yield? >> who seeks -- i am glad to yield to the gentleman of course. >> i thank the gentleman. my comment is this, you

mentioned in fact several drugs approved after market, after fda approval to be harmful to patients, and of course the fda moved pretty darn quickly to take those drugs of of the market and in fact the whole purpose of the fda to make sure that products that have been approved that are found to be harming patients and in fact in some cases even causing their deaths that these products are removed and the other thing of course you might say is self policing physicians, you know, every physician is practicing under the hypocritical in the first place do no harm and clearly is not going to be prescribing medication. >> i can't deal further to the

gentleman and with respect i simply observe positions are received just like everybody else and when we have researched this is certain practices are dangerous, or certain pharmaceuticals are dangerous, we ought to permit that research to be communicated to the doctors so they can put it to work and so that they can achieve of research because remember doctors major function is application of scientific research and new learning in the area of science with regard to the profession which they are very important and valuable part. i yield back the balance of my time. >> further discussion? ms. bald when -- baldwin. the chair will yield to himself. i've been listening to this discussion to see if we could come to terms of this.

mr. rogers? the examples mr. dingell pointed out were fda examples. door amendment says that the research could it be used by the federal government to deny or ration care and i think he was pointing out that there are sometimes informational where we ought to do nine carroll when we find it is harmful. so, one way to resolve is to strike the word diman and say be used by the federal government to ration care and then we won't have that problem. is that something you could accept? >> no, sir, it is a philosophical difference of fortunately we've run into because in the cases i gave you and the way that the united kingdom uses it is they use it to deny care. they denied a young lady paps mirrors when she now when we asked for them three different times. so what we are saying is a comparative effectiveness research can be made available and a doctor can take that in

the course of his or her practice that we want to have them but for the government to deny coverage based on the effectiveness research, you know, 19-year-old cancer coming to statistical you shouldn't get the treatment. we are not quinta do it. the debate in the united kingdom, canada -- philosophically i think we are not going to agree on this. >> i hear when you're singing and agree. you're saying we shouldn't do i care to rational or use as information in a way that would give care people need, but denied care when we find out a procedure is harmful is something that we would want the federal government to do. i don't think we have that philosophical difference -- >> that is the practice of good care. you don't do more harm to your patient. you wouldn't give a treatment you know is harmful to the patient -- >> if you do when you suggested

is being done elsewhere that is bad medicine as well. mr. wiener. >> let me take another stab, and what you described as rationing. they didn't say no papsmears for this person that they will give it to this person. i think what the offer being made by mr. dingell gets to where you want to go. it prevents them from making the decision they are not going to allow something that is harmful but still allows them to say, you know, that prevents them from singing you get it or don't. it gets there by rationing would then be left in which would say they can't do what you described. one more thrust to get their -- >> would the gentleman yield? why i disagree they were denied access because the research said statistical. it doesn't mean it won't happen but statistically it isn't likely therefore we are going to use the calculator and not the doctor determinations. >> but me reclaim my time.

>> i feel passionate about it as a cancer survivor myself. >> the chairman reclaims his time to give you another idea to look at. why don't we say government to do not care that may be harmful or rationed care? because you want to make sure we are not denying care that is beneficial. >> again mr. chairman i don't read the amendment the same way you do and as somebody who would fit the criteria to be denied care i feel extremely passionate about this. >> secure of interest in chongging -- >> no, sir. i apologize but somebody that's been in this vote and would fit the statistics i would have been denied care under a government system i passionately believe we better send a clear signal -- >> you would have been denied helpful care, not harmful care. anybody else wish to be recognized? dr. christiansen. >> mr. chairman, i object to the amendment based on the fact that

the comparative effectiveness research is designed on fauves treatments that are most effective and in no way dictates to physician or other providers, which treatment they should or should not use and the same way that is harmful treatment being made known to a provider would enable them to make the decision not to use the medicine favorable treatment, effective treatments being made known through comparative effectiveness research will allow the provider to use that information but there is no place in here that would cause denial or rationing and remember we are not operating under the british system, we are not creating a single-payer here.

it's an atmosphere people are free to choose their insurance coverage. we will be offering an amendment on cer that perhaps we would ask our colleagues to consider supporting, which may address some of his issues and i would yield to mr. wiener if he still wants to be recognized. >> the gentlelady e gentlelady yields to mr. sarbanes. >> i thank the gentlelady for yielding. i think our concern about this amendment is on its face it seems pretty straight forward and intuitive and in the context in which you placed it has some attraction i guess but i am concerned about the way it could be interpreted, and you have heard one expression or concern about the interpretation that could be made with respect to

this amendment and might prevent you from taking steps with respect to harmful care. i can envision a scenario -- >> debate from earlier today on amendment offered by mike rogers. we are back in the committee room life. we see chairman henry waxman getting the mark upstarted again. live coverage on c-span2. [inaudible conversations] >> without objection the amendment will be considered and the gentle lady from california is recognized. >> thank you mr. chairman. you know, i would prefer if it isn't to bring the abortion debate into the health reform

debate, but from years of experience and this body and committee it is too often that tactic used to play some good pieces of legislation. so, my colleagues and i have worked on a good compromise language to make sure we can put this issue to rest. and this amendment puts all options and the exchange level playing field which is one of our goals. no plan, neither private nor public will be required to cover abortion services. similarly, no plant will be prohibited from covering abortion services. furthermore this amendment is crafted to carefully preserved existing laws that ban federal funds from being used to pay for abortion with existing exceptions for cases of rape, incest or life of the mother. the amendment also ensures no physician or hospital is

required to participate in abortion services. for private plans in the exchange, the only funds that may be used to pay for abortion services have to come from policyholders and own premium subsidies, and it on a repeat public money is prohibited from being used cars are not allowed under the hi amendment. there is precedent for insurance companies being able to set up separate accounts funded with private funding. and as for the public plan, which allows the secretary discretion in covering abortion but also prohibits her or him from using public funds for these services. any cover abortion services would have to be paid for with private funds that are collected in premium payments. finally, we specifically spelled out no state law regarding abortion, parental notification

or consent are affected are pre-empted. we also cross reference the amendment to insure no law on conscience protection are affected by this amendment. in conclusion, i believe this to be a common sense solution for what is often a very difficult issue and i urge all of my colleagues to support this amendment and i would be happy to yield to my colleague mr. doyle from pennsylvania. >> i thank capps. this is a very, very emotional issue and there are strong feelings on both sides of this issue by all the members of this committee and by the congress. well we have tried to do here in this instance is preserve the status quo and a long-held principle i think all americans share whether they consider themselves pro-life or pro-choice and that is that we

not use federal tax dollars to pay for abortion. this amendment preserves the status quo. no federal funds can be used to pay for abortion except in the case of rape, incest, or the life of the woman. no pro-life doctor or hospital or even insurance plan can be required to participate in abortion services. no one, not the secretary, not the benefits committee and now the commissioner can make abortion a part of the minimum benefits package. private plans in the exchange can choose to provide coverage for abortion or not. it's their decision. no public funds may be used to pay for abortions not allowed under the hi amendment. the only funds that may be used to pay for other services are funds that come from the policies, policy holders own premiums. public money is specifically prohibited from being used for other abortions. the secretary may choose to

allow the public plan to cover abortion not allowed by hyde but if they do that they must be paid with private funds. no public fund can be used. no state laws are effective about abortion coverage funding. procedural requirements, parental notification or consent. we preempt no state law and no federal law affect on conscious protection or refusal to provide or pay for abortion. the weldon amendment is specifically cross referenced and moreover the weld and amendment is extended to cover private plans in the exchange. that is a protection beyond the current law. so mr. chairman, as i said, this is an emotional debate. this gives a common ground i think all americans can support and that is to make sure we have a policy that makes sure no federal tax dollars will be used on abortions and buying yield back the time.

>> the gentle lady's time is expired. >> mr. chairman. >> who seeks recognition? mr. pence. >> thank you, mr. chairman. this so-called compromise is an effort to try to get pro-life votes but this is and april life amendment. the pro-life caucus chairman will subsequently offer a pro-life amendment that will continue policy of not mandating or providing taxpayer funding for elective abortions. this amendment departs from a longstanding federal policy prohibiting funding for plans that include abortion. the longstanding federal policy is no federal funding for plans that include abortion and this policy has been applied to medicaid, federal employee health benefits program to the military, to the health system. the capps amendment stands and creates an accounting scheme by

which taxpayer subsidies called affordability credits if you will will go to plans that pay for elective abortion both public plan and private plans whether hyde and by continues in force. the amendment incorporates a two-step strategy that will result in funding abortion on demand through the public plan and subsidize private plans as long as the hyde america eckert of and you will hhs appropriations bill the capps earmarks secretary to cover elective abortion in the plan. clearly secretary sebelius would include abortion in the public plan. once the hyde amendment is adopted or changed or its removal was blocked by a veto threat federal medicaid will lead in fund elective abortion in the capps amendment mandates they do so as well. bye voting for this amendment the committee will be casting a vote in favor of abortion and

the government plan and subsidizing public and private plans that include elective abortion. the results, immediate federal subsidies for plans that cover elective abortion, and both public and private that choose to cover abortions. all pro-life groups have come out in opposition to this amendment. so i would urge the members to look at this, read this very carefully and oppose the amendment. >> would the gentleman yield? >> yes. >> i would like to ask a question of counsel. if the capps amendment is adopted what the secretary of health and human services be allowed to cover elective abortion in the public plan? >> yes, sir. >> said this is a sham? >> answer -- >> yes search? [laughter]

>> the cowles was supposed to only give guidance as to the law. [laughter] >> he answered correctly mr. chairman. i'm going to yield back to mr. pitts. >> can i ask the council something else? does the capps amendment cover partial birth -- partial birth abortion? >> the capps amendment doesn't describe procedures, it would allow any abortion procedure currently legal. >> okay. what the been under the capps amendment that partial birth abortion would be covered by tax payer dollars? >> no. under the capps amendment know are covered with taxpayer dollars except those allowed under the hyde amendment. >> okay. i think if mr. pitts had pointed out the capps amendment is opposed by the national right to life there is no one under al-sadr understands better than them. the conference of catholic

bishops, family resource counsel and every pro-life group in america doesn't support the capps amendment. in fact the national right to life, says, quote, the capps amendment is an assault on longstanding federal policy against tax funded abortion. a vote for the capps amendment is a vote for massive federal subsidies of elective abortion. couldn't be more clear. so i urge my colleagues to vote against the capps amendment. >> reclaiming my time. mr. chairman, the hyde amendment must be adopted annually when we adopt the labor hhs appropriations bill, and if it is not adopted, that is a different set of circumstances that occurs and i will yield at this time. >> thank you, joe. such three lines come on line through 12, clearly gives -- says nothing shall be constructed as preventing the public health insurance option from providing or prohibiting coverage, so just like you said,

secretary sebelius, with this administration, clearly will make that part of the public plan with one public plan the affordability credit. some will get 100%. some will only get a certain percentage of their paid premiums paid by these credits, but nonetheless whether it is 100% or 90% or 80% tax payer money will this is a faux separation. >> ms. degette. >> thank you mr. chairman. i want to respond to a couple of points. perhaps i should ask the council this question. in the capps amendment, the public plan, the administrators -- the secretaries allowed to either decide whether or not the public plan will cover abortion, but if she or he did decide to cover abortion would any portion of those abortions be paid for

by public dollars? >> no man. >> why is that? >> the capps amendment as drafted requires public plans and private plans eckert a sufficient amount from private policyholder dollars to pay for abortion coverage estimated to be required. >> thank you. so basically because the public plan the way we have set up in the bill is to compete with private plans. it will also be taking dollars from private insurance premiums. and the way this bill a set up, it says any plan whether public or private can offer abortions, but only with private dollars. no federal funds shelby used for abortion whether it is under the public or private plan that with federal dollars except for under the hyde provisions. and i just can't point that out

strongly enough. in addition, this bill still allows the state of laws to stand with respect to any kind of restrictions on abortion. it allows current conscious walls provisions to stand. basically what this is an attempt to do is say this bill is not abortion. this bill was providing health care to all americans and we should let the status quo stand. one last thing, we just passed the hyde amendment last week in the labor hhs appropriations bill. the president didn't threatened to veto and none of this vote against it. they are going to stay in current law and i yield to mr. doyle. >> i think that is well taken. many people are concerned because hyde isn't codified in this amendment that somehow this administration is going to strike hyde. this administration under president obama and speaker pelosi just had that bill on the floor and the hyde amendment

language was part of the bill and we all voted for it so there is no attempt to do anything here to hyde. i want to ask the council one question because this needs to be made crystal clear. under the capps amendment is there any way possible, any loophole, any way in this amendment a federal tax dollar can be used to pay for any abortion that is the result of rape, incest or the mother's life in danger. >> no, sir. >> not legally. >> not a single penny to pay for any abortion that isn't rape, incest or mother's life in danger? >> that is prohibited by the capps amendment. >> i yield back. >> i would like to yield from the gentleman of texas, mr. greene. >> ms. degette, i heard the debate, you and our colleague from pennsylvania said we voted for the labor age bill last week that included the hyde

amendment, and all of us voted for that. i was wondering how many members on the republican side voted for the bill that had the hyde amendment in there. that is the issue we need to look at. my only does this amendment protect the hyde amendment but it was in the bill a number of folks voted no on that last week. thank you. >> mr. chairman, i will yield back. >> [inaudible] >> i will yield to mr. sarbanes. >> i have a question for counsel. leaving aside the segregation of funds which would be i think the insurance to many people, if i read this correctly even if that wasn't enough of an assurance to you and you wanted to find a plan in the exchange that did not cover such services would there be a plan available that didn't even need to get into the

segregation issue? >> yes, sir, the capps amendment as drafted requires the commissioner of health and insurance exchange to ensure there is at least one plan in every premium area that doesn't cover abortion beyond the hyde amendment. >> so there's two levels of insurance to those that would be uncomfortable. one is you can use of the dollar's so there is no public dollars are going to support those kind of services, but second we if you didn't even want to be part of a plan where that was happening there would be at least one option available within the exchange then you could choose. >> yes, sir. >> i yield. >> time is expired. mr. barton. >> mr. chairman, i want to yield to mr. stupak. >> thank you, mr. barton for yielding. as this start off i was disappointed the author of the

amendment said some how we use this as a place in a spill. for 17 years even before the author ever came to congress i worked on these amendments. i never used it as a place in a spill. we've always based our legislation when i have worked with both sides on principles and bar ethics and morals may be. so it isn't a poison pill. secondly, early on this year in january, 180 members, democrats and republicans wrote to the speaker, to the head of the appropriations, wrote to the rules committee and said we've always had laureate to protect our interests, our beliefs. please let us have our work right terse on the amendments, excuse me the appropriations bills. we heard nothing and commerce state appropriation we lost the writer. financial service appropriation we lost the writer. yesterday or earlier this week

the senate actually took out the hyde amendment of federal employees health benefit package where it has always been. so we'd write a letter, 100 of loss and every time we go to the rules committee and say keep the writers in place to protect clinics and the debate we want we are shut down. we are shut down. in fact on this debate and this bill in particular before it got going 20 democrats said we want to see pro-life language. so here's what we have. there are two principles and most of us cannot and will not retreat from. principles we held before we came to congress and we will have after we leave conquer eckert abortion must be explicitly excluded from the scope of any authorities anywhere in this bill to the mandatory benefits package. second, we must preserve the longstanding principles that public funds do not pay for abortion procedures followed

through any plan that includes abortion. that is the policy that has long been applied by congress and until the senate action to even the federal employees health benefit package which most of you are covered under. the ban on subsidies for abortion coverage must cover the entire bill including the public option plan and any plans purchased with these federal subsidies. unfortunately, the capps amendment fails on these goals. when i take a look at this amendment it was just share with us if you start taking a look at it page two, second line abortion services federal funds appropriate for the department of health and human services is not permitted. so what are we going to do, go back to a brighter every year to get a writer? you will even give an amendment to the date on the floor so we are skeptical whether or not that really takes care of the language and then we have the six months before the beginning of the plan involved whatever

that means. and then if you go down to page four, the bottom of the page the commissioner sell estimates the basic royalty determined on average actuarial basis. so we are pulling people together putting them on the plan and as we spread the cost for services including abortion services we are now going to spread out the cost of the plans of that it's cheaper and more affordable? that's not a principle i can endorse. this bill -- this proposal doesn't take in the principles many of us believed in. we don't do it as poisonous pills. we do it because we believe it. mr. pitts and i have four amendments and have been up front. number one, no public funds for abortion. number two, abortion not provided in the public option and number three the conscience clause nobody should be forced to form an abortion or how postabortion and number four, no preemption of state law.

very simple. each one goes on less than one page. its language we've long lived with and i ask we defeat this amendment and let us bring our four amendments and have the clean votes that have been lost since about 1976 in this congress that's long been supported by both democrats and republicans. not ways and bills trying to destroy legislation but because those are principles we believe in and have to have our votes on. this amendment falls short. i ask a no vote on the amendment and he'll back to mr. barton. >> high-yield back the balance of my time and ask we go to the vote. >> the gentleman yields back the balance of his time and we proceed to the vote and the clerk will call the roll. [roll call]

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[roll call] [inaudible conversations] >> have all members responded to the call of the roll? any member wish -- mr. shimkus? >> mr. shimkus votes no. >> any member wish to change his or her vote? if not, the clerk will tell the the vote and report. >> on that god mr. chairman there were 30 ayes and 28 noes.

>> 30 ayes and 28 noes. the amendment is agreed to. >> mr. chairman, could i ask the clerk to gun-free count, not recall vote but recount the vote? because i have a different vote count and i am not saying you're wrong, i just would like you to recount, not retake, but just recount. you had more than that. you had six democrats voting on it. [inaudible conversations] >> mr. chairman, i still get 30 ayes and 28 noes. >> i thought you said 31.

>> 30 ayes and 28 noes. the amendment is agreed to. further amendments. mr. pitts. >> mr. chairman, i have an amendment at the desk. >> the clerk will report the amendment. >> it is pitts 001. >> [inaudible conversations] does the clerk -- >> could mr. pitts still with the division is to that amendment? >> it is division a. >> division a? okay.

>> pitts-stupak-blunt amendment. >> and substitute age of 32 by mr. pitts of pennsylvania mr. stupak of michigan and mr. blog of missouri. >> without objection the amendment is considered as read and the gentleman that pennsylvania is recognized five minutes. >> age or 3200 will require virtually every individual to have health care coverage that meets the minimum benefits standards. the bill that establishes a new government help work called health benefits advise rick mehdi to determine what qualifies as a minimum of the standard. this committee chaired by the surgeon general and in concert with secretary of health and human services will have the power to binding decrees on what type of health care coverage individuals must have and in players must provide. history has demonstrated on less abortion is explicitly excluded

administrative agencies and the courts will mandate for example, the federal medicaid statute was silent on the issue of abortion, but administration and quote abortion on demand to be mandated coverage. in the case of planned parenthood affiliates of michigan forces and were the sixth circuit court of appeals explained that, quote, abortion fits within many of the mandatory categories including family planning, outpatient services, and patient services and physician services. some of the same terms such as outpatient services come inpatient services and physician services are mandated under the bill. if the courts use such terms demanded coverage of abortion in the 1970's they will surely do it again. if the administration to private insurance coverage. in fact any employer who does not provide coverage that meets

the minimum benefit standards will pay up to 8% tax penalty and any individual who doesn't have a plan that meets these benefits standards will be forced to pay 2.5% tax penalty. this means americans who do not want a plan that please pays for abortion will be penalized. my amendment would simply clarify that nothing in this bill can be used to mean a coverage of abortion. under the current plan system, insurance companies can provide coverage for abortion if they choose and individuals can purchase plans that pay for abortion if they choose. my amendment would ensure this remains the case. i ask my colleagues to vote in favor of choice, vote in favor of allowing americans the opportunity to choose whether or not they want to participate in plans that pay for abortion without having to be penalized for that choice. i urge support for the amendment

at this time and yield to the gentleman of michigan mr. stupak. >> i thank the gentleman for yielding and again i would ask that we support the assignment -- amendment. the secretary of hhs advisory committee will determine the specific mandated services and as we've seen throughout since about 1973 that abortion included in the minimum benefits packages on less it is specifically excluded and unfortunate even the president has indicated that reproductive care is essential basic care so its at the heart or the center of part of the plan he is proposing and when you take a look at an national abortion federation the health care reform as a way to increase access to comprehensive reproduction health care including abortion care for all women so history has shown when we don't exclude it is included and that is why it is statutory explosions like the schip program and until the senate

acted on the federal employee health benefit package. so, this bill does ron on the current funding restrictions of the high amendment, so i would ask we support the pitts and mad -- >> reclaiming my time i yield to the gentleman of missouri, mr. blount. >> i thank the gentleman for yielding. i'm glad to join he and mr. stupak in the amendment and it clearly does the things that have already been well prescribed. it would prohibit services that have long been prohibited. there is nothing in this amendment would be a change of long established federal policy. it defines in specific and consistent way is what the essential benefits package could reflect and it's been well described it is one of two or three amendments coming up that

simply continue the current policy in this area. it has the provisions in lines 11 through 16 that should provide the protections that have been provided for these services if they do occur, and i urge the adoption of the amendment. >> the gentleman's time is expired. who seeks recognition? ms. degette. >> thank you. i rise in opposition to this amendment. on its face it might look attractive to say no provision of this act shall impose any requirement for provision of abortion but in fact when you look at a particularly in light of the capps compromise amendment just past, but this amendment does is create a broad restrictions against any recommendation that any plea in public or private should give anyone in any choice of abortion

services. this is beyond current law because under the current law which we have preserved the amendment we just passed the hyde amendment prohibits public funds for abortion except under limited circumstances, but under the current law and under the capps amendment, women could still use their own private funds to choose private insurance that would cover abortion services with private dollars. what this amendment would do is to apply the hyde amendment to insurance companies and women who purchase private insurance with private dollars. it would greatly expand this restriction to frankly what is still as last i heard a legal procedure in this country, and in a weird twist of fate, the other thing that it might do because it would require plans to include the hyde amendment is actually require some institutions who for religious

reasons wouldn't want to cover abortion to cover them, so it is not necessary and it goes far beyond current law and i am happy to yield -- >> i haven't spoken on this issue and i would like to weigh in on something. i would like to speak on two things. first out of humility and then out of constitutionality and first i want to speak out of humility. it is difficult on this issue knowing the great men and women on this body who each have intense personal view about the relative morality of a woman's right of choice and i agree humility understand the sincerity how powerfully people feel about their own morality and it seems to me in that moment of humility the only refuge we can have as a group is to follow the law. it is the only place we can be safe is to follow the law which is the only thing that can unite

us in our different interpretations of humanity so the second thing i want to speak of its constitutionality. the united states constitution guarantees a woman's right of choice and the united states constitution and it seems to me while that happens men and women ought to respect that constitutional right and i don't think it should be any less constitutional right than others we have. let me know what the right to bear arms. it seems to me a woman ought to have at least as much constitutional right that is now restricted by the supreme court to her own body as a man does to his firearms. and if we would think of these constitutional rights with dignity perhaps we would allow individuals to make those individual choices. this essentially would deny people the right to make their

individual choices with their bodies. and men who enjoy the right to bear arms which is a constitutional right and adequately and should be respected ought to respect a woman's right to protect pre-constitutional right of choice. and i think out of humility of recognizing this supremacy of law and the appropriateness of respecting a woman's individual dignity, this amendment of the linus and sere should not be adopted by this committee. >> i yield to the gentle lady from illinois. >> i thank the gentlelady for yielding. i want to respect the views of all of my colleagues here, all of us have our various believes that may come out of our work religious beliefs, our own set of moral values, and i just don't want to leave and

represented the views of millions and millions of people, not just women, but men across this country that believes the comprehensive health care does include reproductive health care, prenatal and maternity care, screening for breast, cervical and other cancers orestes, abortion, contraceptive services. if these are all basic health care for women that we have a right to bye virtue of our own reproductive organs and right to control a were own bodies. and i just want to say that polling was done and this is an issue people don't want to talk about hyde and i understand that, but you should just know voters overwhelmingly support the broad outlines of reform and requiring coverage of women's

reproductive health. 70% favor such a proposal. but if the reform eliminated current insurance coverage of reproductive health services like birth control or abortion the word was used in the whole opposition to health care reform jumps to three and five, 60% with 47% strongly opposing it and just 31% favoring at. this is mainstream to allow women to choose their own control of their own bodies including abortion services. >> the gentlelady's time is expired and the chair neglected to notice so we will give the other side sufficient limit. mr. barton. >> [inaudible conversations]

>> the only thing i want to respond to something mr. inslee said. if you look at the second amendment, it says the necessity of maintaining a well regulated militia the right to keep and bear arms shall not be infringed upon its explicit in the second amendment to the constitution, second only to freedom of speech. the roe versus wade decision was a five to four supreme court decision, which of those voting with the majority about one vote spoke of somewhere in the numbers of the constitution. you can't read the constitution of the united states and anywhere in it even find the word abortion or twice. so there is a supreme court decision that is a law of the land but that is not an explicit guarantee like the right to keep and bear arms. i yield to mr. shimkus. >> thank you. to the ranking member barton. we'll be street is evident all

men are created equal and endowed by their creator with certain inalienable rights that are among fees' life, liberty and the pursuit of happiness. now, this security of life granted in the declaration of independence is for the unborn. and for those to attack that that is what this debate is about. and it is a great time to go on record that if you support right life, here is the chance and if you support the declaration of independence that granted these any legal rights, this is the time. >> will the gentleman yield, please? >> i yield to the gentleman. >> thank you. i just want to respond to a couple of the points made. first the capps amendment has a loophole. if hyde goes on the abortion coverage will be mandated in the plan. secondly, nothing in this amendment says anything about disallowing voluntarily offered abortion coverage.

it simply says that the government can't mandate abortion coverage. if private plans want to cover abortion, this amendment doesn't stop that. but it stops is the mandate to force abortion in every insurance plan in the country. the question whether secretary or the advisory committee or commissioner can mandate that plan covers abortion. and if that is not the intent this amendment should pass unanimously. finally on this poll i have a copy of that. it was extraordinarily a skewed in favor of the pro-abortion view. all persons were left with an impression that the pro-life position would result in a lack of access to contraception, no miscarriage treatment, failure to even provide abortion to save a woman's life. completely unrealistic representation of the pro-life. there were other polls taken as well. i urge support for the amendment. >> mr. chairman, see no other members -- >> with the gentleman yield?

>> mr. terrie. i didn't see you mr. terrie. >> somebody else was asking to deal, mr. gingrey, but i was leading my hand. i thought it was interesting we keep hearing about the capps amendment as this compromise amendment. it must have been compromising of angst the pro-abortion because it's really the only thing that is changed is that the capps amendment mandates that at least one private plan under the publicly supported national insurance exchange has to have abortion services as part of it but then i guess al's the compromise amongst themselves said okay. in balance let's have one, not have abortion services. that isn't a compromise with true pro-life people in the room. i just want to clear that up. i don't think there is any one

that belongs to the pro-life caucus that would have been at the discussion and i yield back. >> dr. gingrey. >> i thank the gentleman for yielding. in reference to the capps amendment, the so-called compromise amendment, i just want but 28 of us on this side, and mr. stupak, it voted against the compromise, we are saying that we don't compromise. we don't compromise on our opposition to the use of taxpayer dollars to pay for the structure of human life unless it is to protect the life of the mother or in the case of rape or incest. nothing could be more clear. i commend the gentleman of pennsylvania, mr. pitts, the gentleman of michigan, mr. stupak of missouri, mr. blount and i commend all of those who are unwilling to compromise and i negative we

recommend that we pass this amendment and i yield back the time to the gentleman of pennsylvania. >> mr. chairman before i do yield back directly six democrats that voted and 22 republicans for life. so i want to let all six on the majority side know that we appreciate that and with that, i would see no more folks seeking recognition and i yield back to you mr. chairman and ask for a vote. >> the gentleman yields back his time. further recognition -- ms. eshoo for the last five minutes of debate. >> thank you. i didn't plan to speak on this but cast my vote but i do want to say a few things. first of all, passions are high and i understand that. and i respect that. and i respect that. i think what mr. inslee said has had the most impact on me

though. we are a nation of laws, and it seems to me that there is a law that is on the books that i would acknowledge has not been embraced 100% by the american people. there are a great tensions within that law and what it represents. from the safe side, i consider myself extremely devout, a devout catholic. some can't understand my of faith and some of my votes, but i am at peace about that. well i am especially struck with are the number of voices that leave out what women go through,

and how complex women's bodies are and the variety of services that are so necessary to address what conditions they may suffer from. i don't hear people raising their ways is about any of that. i think every time an abortion takes place in this country it means we have failed somehow, but i don't see a word in this amendment or in any other that says that any of these plans should allow for birth control. why on that? why is there any passion about that? to prevent unwanted pregnancies. so i see these things for the record. i don't think anyone is predicting a dimond about where they are. and what i say is not meant to change anyone's mind. i am not that naive, but i do

think it is important to say -- is someone asking for me to yield? i will yield. ..

on the last lion, of the amendment by mr. pitts and mr. stupak, the limitation, it includes simply forcible rape or and i want to ask counsel the hyde amendment, what language is there about rape? >> i believe the current hyde amendment, i did not like yesterday's vote but the hyde amendment as it is then for the last least ten years has always been-- >> statutory as well as forceful. perhaps i should ask about the restriction just to forcible rape. >> is there such thing as permissive break? >> tattoo tory. >> i beg your pardon? i beg your pardon. >> if that was a deliberate-- >> if the lady wishes, the word

forcible to me-- be stricken and what of-- i would agree. >> there was a question from kelso. >> i am claiming my time, and i think what i would like to do is just yield back at this point because i think people will hold their views. i respect that, but i appreciate mr. chairman especially your giving me the time to be able to say the things that i did today. thank you and i thank the others as well. >> the gentlelady yields back her time. >> could i ask unanimous consent to remove the word forcible? >> any objection? >> i object. >> objection is heard. we will now proceed to a vote on the pits amendment. the clerk will call the roll.

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[inaudible conversations] >> have all members responded to the vote? any member wish to change his or her vote? >> i am sorry, mr. chairman? >> i wish to change my vote from note to aye. >> mr. waxman is of the note and on aye. >> all members have responded. does any member wished to seek to change his or her vote? anybody want to parchute and that has not voted? if not, the clerk will tally the

vote. [inaudible conversations] [inaudible conversations] >> could we have the vote reported, please?

>> the clerk will report the vote. >> on that though it mr. chairman, the ayes were 31 and the nays were 37. >> 31 ayes, 37 knows, the amendment is agreed to. mr. markey. for what purpose to seek recognition? >> i have an amendment at the desk. it is marking number three. >> the clerk will report the amendment. >> the amendment to the amendment in the nature of the substitute offered by mr. markey of massachusetts and mr. burgess of texas. >> without objection the reading of the amendment will be dispensed of, dispense with and

the gentleman from massachusetts is recognized for five minutes. >> thank you mr. chairman very much and i am pleased to offer this important bipartisan amendment with dr. burgess. arra amendment is based upon legislation that i first introduced with chris smith last year, the independents at home act. our amendment is quoted by a wide range of stakeholders including the aarp, consumers union, the american academy of comcare physicians, intel and 30 other organizations. our amendment creates the independents at home pilot program in the 13 states with the highest medicare patient costs plus 13 additional states to be identified by the secretary to ensure geographical representation. and the district of columbia for a total of 26 states and the district of columbia. >> would the gentleman yield? we are prepared to accept the

amendment. you might want to let mr. burgess no briefly but we think it is a good amendment. >> i thank the gentleman and i will yield to the gentleman from texas. >> i thank the gentleman for yielding and i so appreciate him offering this amendment. this is one of the most important issues that our generation will face and hand off to the next generation so i applaud the gentleman for bringing the amendment forward. it is one of those areas where we are apt to achieve significant savings and significant breakthroughs. >> would the gentleman yield? this amendment creates the independents at home pilot program and i am pleased that this a bipartisan effort by you and mr. burgess. it pilots and other delivery system reform and it addresses a particular version of the medical home which is shown great promise especially for people with cognitive impairment in people who are homebound. i appreciate the work that has been done to produce this

language, and worked out with dms and ours staffs. this is a common-sense provision that will help to further bend the cost curve and i urge members to support it. >> if i may be clean my time. my mother died from alzheimer's and i learned a big lesson from that whole process, that i think it's something that we are all going to learn as well because 12 to 15 million baby boomers are going to have alzheimer's, which means in most instances one of the family members will have it with them. that is the family member that is trying to take care of them so that is 24 to 30 million americans in the baby boomer category who are going to have to deal with that issue. in addition to parkinson's, it ale s, all the chronic diseases and that is why we definitely have to increase the funding for nih research to try to cure these diseases, that is for sure but this program will authorize a program that will provide

coordinated care to medicare beneficiaries with multiple chronic conditions in their own homes by the interdisciplinary teams of health care professionals such as physicians, nurse practitioners, pharmacists, social workers and others. the project will run for three years. it can be extended if the secretary determines it should be, but it will deal principally with the those medicare beneficiaries with multiple chronic diseases such as alzheimer's, parkinson's, a l s., other diseases. 10% of the medicare population is all it represents but 60% of medicare spending so if we can interject a program like this with the goal of saving money while keeping people at home, which ultimately is the objective that dr. burgess and i have for the program, then i think we are beginning to put in place the kinds of programs that we are going to need for medical system if we are going to deal

with this tsunami of health care issues that are going to have the baby boomer generation. i thank everyone for their support and i yield back the balance of my time. >> we will now proceed to a book. all those in favor of the markey burgess amendment sayyed aye. opposed, no. the ayes have it and the amendment is agreed to. mr. burgess, you have an amendment at the desk. >> this is burgess number 28. >> the clerk will report the amendment. see the amendment offered by mr. burgess of taxes, strike the subtitle b of title to division a and conform to the context appropriately. in section-- >> without objection the amendment will be considered as read. the gentleman from texas is recognized. >> mr. chairman the recent article in the "dallas morning

news" that, highlighted the troubles that a young girl had who was covered by medicaid. she had difficulty finding a doctor to treat her stating due to the lack of medicaid doctors, medication patients often grow sicker. there are of course similar stories out there every day outlining the difficulties that patients with government health care phase on a day-by-day basis. this is not rhetoric. this is reality and it will be reality for millions more americans who inevitably will be pushed onto the rolls of government-run health care if the public plan is part of the health care reform bill. a government plan would not compete fairly with private plans. it is like the umpire being on the home team and it does not work. so, the amendment is fairly simple. it strikes all language pertaining to the public plan and specifies in the bill that no federal funds may be used to invest in, establish or operate a government-run health care

plan. now mr. chairman i'm committed to helping millions of americans who want coverage into lowering costs for everyone. i will not, however, allowed that coverage to come in a slow but inevitable takeover of our health care system and that is precisely what the creation of a public option, which is probably more properly referred to as government insurance, will do. let me be clear, i am not, i was not, i have not nor will i ever be an advocate on behalf of private health insurance companies. but i do believe the role of the government is to play that role of referee or umpire ensuring performance standards are met and that everyone is treated fairly but then it should get out of the way. and let american hard work in ingenuity and american know how do what it does best. that is why think it is so important for this amendment to pass.

we do not need more government involvement in health care. we do not need a government-run health care option. it is often quoted the american medical association's in is in favor of h.r. 3200. let me just say from the perspective of my physician colleagues in texas, this is not a popular notion, so i would encourage members to think of their physicians back home, think of their patients back home. let's do the right thing by creating the right kind of system and reject the public option. i will be happy to yield to my friend from michigan. >> thank you doctor. henry ford was a great industrialist there and he said you can have any color car you want as long as it is black and that is all he sold where black cars. this is exactly where you are going with this notion on a government-run plan and you know i thought the tirade from my friend from new york was entertaining but the more listen to him that maury really understood that that is the philosophy where we are going.

private plans are inherently bad and can't work for america and we should show everybody on to a government plan. as a matter that the lewin study over 100 million americans will lose the health care as they know it today, 100 million. as a matter of fact they said we are willing to use the weight of government to do great things to medicare, cut it $400 billion cut out of medicare. hospice, home nursing, hospitals , $400 billion. why? because that is the only way the government can control costs, by denying access or rationing care. that is it. look at candidate, look at the united kingdom. and systems that have it, that is the only way they can control costs and you are going to take all of these 100 million people come up with the monta a government plan that tells

doctors, we will not pay you what it costs to see that patients. if you don't think that is trouble brewing, look at the health systems in the european system. they are dying under the weight of their system and as a matter of fact the fastest-growing part of their system are people who are escaping it in getting their own private health care insurance. americans deserve better. people like the states of michigan who built the middle class, who built this notion that you could work really hard and by the way you get great health care is part of your employment is destroyed by this system. if you are a cancer survivor, look out. if you are somebody who has a serious ailment that takes very complicated treatment, look out because you are going to have to call up a bureaucrat in hope to god his calculator is more compassionate and smarter than your doctor and i would yield back my time. >> reclaiming my time and i thank the gentleman is fashion. our subcommittee on health, his

medicaid patient population grew to 70% of her practice, she was sparling from retirement fund to keep your doors open. >> the gentleman's time has expired. >> can i ask for an additional 15 seconds? >> without objection. >> if we take away the private sector the public sector cannot afford what it is going to be required to pay and doctors across the country are going to inevitably be borrowing for operational expenses and as the business model for those of you in the room who have run your own business you know that is not a model for survival. i urge an affirmative vote for this amendment and i would feel that the additional time and i thank the chairman for his indulgence. >> who seeks recognition? the gentleman from connecticut, mr. murphy. >> i thank the chairman. i understand the public plan has become the bogeyman in a lot of this conversation. i think it is a lot harder to

present the argument if you really are reading of this is laid out in the bill. there is nothing to be scared of here because this ultimately gets at the issue that a lot of republicans have run on and talked about on the house floor and that is choice. that his choice for our constituents, for our patience. the fact is, there is no one that is going to be forced into the public option. it is going to be every individual's choice as to whether they want to stay in private insurance or they want to choose public insurance. if you guys are right, and the government can't run an efficient product, can't put something competitive on the market then it is going to lose out because this bill requires the public option finance itself completely with its own premium so it can do a good job of running its own show, then no one is going to buy into. seconded is not going to eliminate private insurance. we have the cbo as much as those this clearly that not only are

there only by their estimate going to be 10 million people to take the public option which by my count is 3% of total patients across the country but we are actually going to see more people as a result of this bill, not let's go to private insurance, so contrary to the arguments we have heard those they are going to be about 3% of people in the public option, actually more people will be in private insurance, not less. lastly this methodology that is out there that people have a choice today is not rooted in fact. 50% of the states in this country have one ensure that controls more than 50% of the market. in some areas especially rural areas in this country, there is one ensure that controls 70% of the market. that is no choice for individuals who are trying to go out there to find a more affordable product. this bill with the public option gives people the choice and it is not just their choice. it is dr. choice as well. nil physician will be forced

into this. it will be their choice as to whether the rate is enough to bring them in, so i think this is the essential to try to inject competitiveness into the health care market by giving our constituents patience in the system of choice they have been longing for. >> would the gentleman yield? >> i would be happy to yield to ms. spaulding. >> i want to underscore a couple of things you said and expand on your point. a robust public option is essential to the success of what we are trying to do here and you have just heard the gentleman talked about the places where there were few choices to begin with selee public choice will make meaningful the idea of choice. i have also just have to name the obvious. our private options are for-profit. the public option will not have that motivating force. if you look good this ceo

salaries of the top seven private insurance, this is on average, $9.7 million that is an average. some are much higher. that is enough to cover 648 families with health insurance for a year. that is what that is. the ceo of a public plan is going to earn a high government salary, under $200,000 likely, maybe somewhere around $150,000. the last one i want to make, and i realize i have made this point many times before, is to draw your attention to the wisconsin example in medicare part d. in all your states, and all people have is private options. we happen to be fortunate in wisconsin as we have a public option. it is called senior care and it exists by waiver of the department of health and human services. this is a very successful

program, very popular among seniors. the cost per enrollee is one-third the cost of private plans. but for all of those of you who are out there saying that inserting a public option will stifle private competition, we have more private sector choices in medicare part d in wisconsin than most other states. this has been a singular success to have a public option competing side-by-side the private option and i will tell you that every member of our congressional delegation, a democrat and republican when that waiver was up wrote the secretary saying please, please give us our waiver to continue our public option and when jim sensenbrenner and i can agree on something, dino you have got a good thing. so, we have got to keep a public option. >> ides is one their constituents to have this choice. wonder constituents to be able to decide whether they want to stick with their private plan or they want something kind of like we have as members of congress.

i think that is okay to allow for our constituents to have that choice. i don't think there's so dumb as to not be able to figure out what is best for them and that is why i support. >> the gentleman's time has expired. >> mr. chairman? >> the gentleman will be recognized for five minutes for the last five minutes of debate on the republican side. i hope you won't take it and maybe go to the vote earlier. the gentleman is recognized. >> i won't make promises to take it because i think this is important. there is indeed a heated debate as to whether not a public plan will destroy private insurance. indeed there is debate in the minds of some members of congress because some members of congress have said flat out that the goal behind the public option is a single-payer care. indeed barney frank said that in a reported statement now being published all over the internet right now. he said the way we get to a single-payer system is to start with a public option.

let's talk about choice but the republicans desperately want choice. we believe in choice but what is stopping choice in america today is not the absence of a public option. what is stopping choice in america today is that tax code says if your employer visor health care he days before tax dollars but if you buy your health care you have to pay with after-tax dollars. that makes it impossible for the average american to go buy health care on their own so they have to take health care that is controlled by a third party. if you want to give choice to the american people, then let every single american buy their health care with pretax dollars. if they like their employer's plan, fine, take that plan but if they don't, let them buy it with their own money. republicans would give them a tax credit to do it and give them a refundable and danceable tax credit to do it. democrats say that a public option will set a level playing field.

it can't set a level playing field. n.t. there will be no property tax imposed on the federal government health care plan. there will be no financial solvency requirements. we were just told there would be no high salaries paid so we are favoring the public plan and the public plan will drive out of existence the private plans. it is just a matter of time. mr. frank is very blunt about saying there are members of this committee that it said that. talking little bit about what is the notion behind a robust option. do we need a robust public option for ottawa insurance? no we don't because we let people buy their own auto insurance on the same basis as businesses. do we have a public option, are you proposing a public option for life insurance? why should we be able to go to a public food vendor and get private competition and profit out of the food sales business? the reality is that a public option is not needed to promote competition. what is needed to promote

competition and bring down the cost of health care in america is to empower individual americans and let them buy their own care. take their employers, if they choose or go by their own care with money that we give to them if they can't otherwise afford care. that is real choice. that is the choice republicans have been talking about, not some government plan. as for the choice that is given in medicare part d i believe you are repealing that in this deal so i don't know how, if that is the great modeled you can also seek to repeal it in this bill. there will be no fair competition by the private sector if you have a public choice option. we will subsidize it like we currently subsidize other public health care. i would be happy to yield to the lady from tennessee. >> i thank the gentleman from arizona for yielding and i find it so interesting as we have this debate, what we have seen

in tennessee is what actually happens when you have a government plan, a government-run plan in competition with private insurance. our plan was put in place in 94. it was a test case for hillary clinton's health care plan. it was the public option plan that you can look at now with 15 years of data behind it and say, it did not work. look at what happened. when it comes to choice and individual choice, is limited and restricted that choice. people work for their private insurance plans onto a government plan and then to get cost back under control, guess what the governor had to do a couple of years ago? remove nearly 200,000 of them. guess what is getting ready to happen now? there are over 100,000 people there going to be removed. lack of competitiveness is what you see. you do not see more

competitiveness. it is a plan that does not work. it has been described in our state as a disaster. >> plan quadrupled and costs and consumes 36% of the state budget and it ended up restricting access and driving costs through the roof and the yield back to the gentleman from arizona. >> i thank the gentlelady. we have offered the idea of choice on this committee in the past. i propose legislation that would let you drive-- buy insurance that was qualified in a separate state. that would address the problem the gentleman spoke about which is there aren't enough plans offering insurance in the state's on the market. but a public plan will solve this problem. >> the gentleman's time has expired. do we need more debate or be ready for a vote? okay. the clerk will call the roll.

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>> any other members wish to record their votes? the clerk will report the tally. >> on that boat mr. chairman there were 25 ayes and 35 nays. >> and the amendment is defeated. >> hold on one second. i am sorry. i said it wrong. on that both mr. chairman there were 24 ayes, and 35 days. >> 24 ayes, 35 days in the amendment is defeated. mr. stearns? >> mr. chairman. >> mr. stupak? >> mr. chairman i have the amendment at the desk, 005. >> the clerk will report the

amendment. >> mr. stupak, could you repeat the number? >> 005. >> five? >> top right-hand corner, 005. >> could you say what the vision? is it a or b? >> a. >> it is a. >> the clerk will report the

amendment. >> amendment offered by mr. stupak of michigan, mr. pitts of pennsylvania and mr. terrie of nebraska. at the poor pcie please insert the following. >> i would ask unanimous consent that the amendment be considered as read. can i ask again that this is within the division and has been provided within the time, the two hours? >> yes, mr. chairman. >> thank you. mr. stupak is recognized. >> thank you mr. chairman. over the past 35 years congress has passed three laws, the church amendment, and the hyde amendment protecting the conscious writes for health workers is this the with regard to abortion. however the lenhardt feazel legislation we are considering here today does not contain conscious protections for health care workers. we do have on the capps and amendment that was accepted on page 6, we do have a reference to it on nine-- line 19 begin

our fear is that is going to be a yearly thing and we will have to fight it out every year to keep the conscience clause in there so we are offering this amendment. kant this is about choice. health care professionals should not be forced to engage in any actions that they see as taking a human life. no one should be forced to have an abortion and no one should be of force to assist in an abortion nor should any institution be told they must perform abortions in violation of their ethical, moral or religious convictions. health care workers as i said should not be forced to participate in abortion, euthanasia or any mercy killing. some state laws permit physician assistant suicide the contras protection provisions to assure federal funds cannot be used to force health care providers in the states to participate in violation of their conscience. federal funds directly to state and local governments are any health care plans treated or mandated by congress should not be used to pressure health care workers to engage in activities

they opposed. it should be left up to health care workers as to what does or does not violate their conscious, not up to the congress, not up to the secretary of health and human services. this is not an abortion issue. no other profession that i can think of is forced by the federal government to engage in practices or procedures they disagree with. the dedicated men and women who choose to enter into the medical profession do so to help people. their highly trained professionals and should have the latitude to determine which treatment to offer patients so let's not force their views on any one. i urge my colleagues to support this amendment. i would yield to mr. terrie for comments on this as a cosponsor of the legislation. >> thank you mr. stupak and i appreciate the opportunity to join with you. sense roe versus wade in 1973 congress has always provided steadfast for those who have had, have a conscience-- kant

changes the objection to the practice of abortion but who, due to the circumstances of their employment in their health care field may be required to assist in abortion procedures. this bill as currently drafted-- and with the capps amendment does harm to the 36 year president on protecting the conscience rights of these doctors, nurses and other employees employed in allied health professions and denying them the protections that have come to be expected in every other federal foray in the health care. in my district alone we have to catholic run charitable hospitals. one of them is a teaching hospital, and both have contacted me and basically said that if they are forced to have to subject their doctors and their physicians who work there

with the understanding that they won't have to perform abortions or assist in any thing that they feel violates their ethical or moral code, and that if they are put in that position they may just close down the hospital. in fact that was backed up by further up the chain in the archdiocese that without this we are actually going to deny access to hospitals in many communities and i yield back to mr. stupak. >> would the gentleman yield? beil to mr. barton? >> the minority has looked at your amendment and we are prepared to accept it. >> mr. pitts? >> thank you. this amendment would prevent discrimination against not only individuals, health care professionals but institutions like catholic hospitals and insurance companies, health

plans to refuse to provide abortions. health care provider to serve the protections for their legal right to practice without violating their religious beliefs or convictions, and on an issue as fundamental as live health care providers should not be forced to ban their moral convictions when they come to worst. i think this issue strikes to their nation's founding where individuals can be free to practice their religious faith unhindered. according to an april 8, 2009 poll, commissioned by the christian medical association conducted by the polling company, 87% of americans believe it is important to ensure health care professionals conscious rights are protected in this mr. stupak said, three laws have been adopted over the years, the church amendment, the hyde amendment to protect the conscience private health care workers. this bill does nothing satisfactorily to address that, all of those concerns.

under the bill, the secretary of hhs has numerous authorities to determine what health insurance must cover in plans but there is no conscious protection to cover, to ensure that health care workers or insurers wanting to participate in the exchange are not forced to participate in specific activities they find objectionable, so the need for health protection is very clear. a lawsuit in 97 against valley hospital association force this private community hospital in alaska to open its doors for late term abortions. the same thing happened in 2002 with a catholic operated hmo in new york. without these protections health care providers will be forced to choose between violating their beliefs and leaving their profession or refraining from entering their chosen field so i urge members to protect the right of conscience and support the amendment. >> the gentleman's time has expired.

okay, who would seek recognition mr. green. >> mr. chairman i would like to ask the author of the amendment the question if i could ask congressman stupak. i know under current procedures oftentimes when someone exercises their conscious decision, is there any requirement in your amendment? i could not find it or anywhere in a ball that would say if a woman the may have been raped shows up at a hospital or a clinic, is there any way that they could exercise their conscience clause and yet still refer that person to someplace that they could receive care? is that in your amendment? >> it does not stated specifically, no, but i mean we don't state incidents specifically but that is the chosen-- i have for catholic hospitals and they have said they just prefer them.

>> would the gentleman from texas yield? >> i would prefer having the language in the amendment and i would yield to the chairman. >> i was stunned by the language on page 2 that said nothing in this act shall be construed as forbidding a health plan or health insurance issue were to accommodate a conscientious objection of the purchaser or an individual or institutional health care provider when a procedure contrary to the religious beliefs our moral convictions of such purchaser or provider. perhaps we can have an explanation or some council on that point. that a provider could refuse to sell a contraception, contraceptive in a pharmacy? how far would that go? with that apply to family planning, if somebody wanted to get contraceptive services? maybe mr. westmoreland you can explain what the implications of

that section. >> the provision here is not related directly to abortion services. it is any item or service that a health care provider says is contrary to his or his or her moral convictions. it is not founded by abortionist the previous language has been. >> mr. chairman? i could not quite hear him. >> county your mic so everyone can hear. >> it is not on. >> as i read the language in subsection d it is not directly related to abortion services. it is about any health care service in this bill to which any provider has the religious or moral objection. and consequently it could be, if i interested mr. waxman's question, it could allow a provider to refrain from providing contraceptive services, which is the question

the chairman post to me. >> will the gentleman from texas deal further? i don't think that is necessary. i wonder if the gentleman from michigan would consider taking that-- >> you are talking about subsection d? >> yes. >> i agree, take it out. i would ask unanimous consent to take out section d. >> without objection. >> mr. chairman, again i ask my colleague from michigan, i would just feel more comfortable and i think, i should have my time. i only get one question. i will ask my question slowly. if there was something we could do that would place in their what is common practice is in your hospital and i was born in a catholic hospital, my children were born in a catholic hospital. i respect the right to do it but i also respect their right to refer someone for someone who does not have a conscious

concern. >> is there a problem with accepting that in your amendment? >> no, i mean i am open to it. why don't i withdraw this one for now let's get these concerns worked out for a few minutes. this thing has been around in these things are just coming at us. let's look at it closer. i withdraw from now. >> i yield back my time. >> mr. rushdie wanted to be recognized? >> mr. chairman i would like to call to the amendments and block, amendment number 13001 and 14001. >> the clerk will report the rush of amendments. >> it is our turn i believe mr. chairman. that was the stupack amendment.

[inaudible conversations] >> mr. chairman d. want me to report the amendment? >> report the amendments. >> amendment to the amendment 3200 provided by mr. rush of illinois. >> without objection for the two amendments will be considered a en bloc and further without objection they will be considered as read and the gentleman from illinois, mr. rush is recognized for five minutes.

>> thank you mr. chairman. mr. chairman and members of the committee, these amendments mandate better protections for children as early and periodic screening and diagnostic treatment services. it easier enrollment processes and cost sharing measures. i would like to enter into a colloquy with you mr. chairman regarding these amendments. >> i am sorry, the gentleman? >> i would like to enter into a colloquy with you. mr. chairman, i have major concerns. >> just a minute. with the gentleman suspend? i would like to ask the committee please be in order. if people want conversations they can go into the anterooms. mr. rush. >> mr. chairman i have major concerns with the bill's

provisions and protections that release children into the exchange and how they will be treated in relation to children who are currently enrolled in medicaid and chip. it is my concern, as well as the concern to over 65 children's hospitals and medical wards that children will be worse off under this bill than they are currently, then they currently are under current public programs particularly winschip expires in 2013. >> i truly understand your concerns, as i think we all would agree that your the amendment seek the best approach to protecting the health of children of low-income families. i am a strong advocate for children's benefits and their continued protection as well and i want to work with you to ensure that children will not suffer any detriment as a result of this bill. >> mr. chairman i appreciate

this effort should be the highest priority in our nation's most vulnerable children come who are poor children. we are-- we extremely regret, if we look back ten years from now and realize children were being treated worse under a newly reformed health care system than they are currently under a broken health care system. mr. chairman i ask for your commitment to continue to work with me to ensure better protection for children in this field-- this bill and to make easier for poor children to become enrolled in public benefit programs and to receive the same, if not better, benefits than they currently receive today particularly-- benefits and i also ask for your commitment to work to secure better cost-saving protections for families of these children. if these ideals are met-- if

these ideals are not met we will not have truly achieved a more affordable health choice for this particular act. >> if the gentleman would yield to me further? i strongly am sympathetic to what you are trying to do it. why share those goals and concerns. i will continue to work with you because we have the guts to do all we can to protect children in this country, especially low-income children, to get all the services that they need and i will continue to work with you. >> thank you mr. chairman and the yield back the balance of my time. i withdraw these amendments. >> the gentleman withdraws the amendments in yields back the balance of this time. mr. stearns, do you have an amendment? >> i have an amendment at the desk. i think it is stearns one or a more arcane name for it. >> the clerk will report the

stearns one or some other arcane number to it. >> amendments to the amendment in the nature the substitute h.r. 3200 from mr. stearns of florida. >> without objection, the amendment will be read. >> mr. chairman thank you very much in my amendment does to the heart of the debate of protecting consumers with keeping their private policy. now mr. shadegg of arizona mention the quote for mr. barney frank who indicated to hopefully have a one payer system but you know that is not what the president of the united states has talked about. in fact the president said and let me quote exactly what the president said, if you like your doctor you'll be able to keep your doctor and dor plan period. it you like your health care plan, he will be able to keep your health care plan, period.

so the president really does not agree with barney frank and i think this amendment goes to the heart of this whole policy position of this bill. there is, most of the people, almost all the people on this side of the aisle think that it is proper that individuals should be able to keep their current health care plan. in fact, poll numbers show that 83% of satisfied with their current health care coverage and that they do not, do not want to be forced into a government-run health care plan and in their opinion it could lower quality. it might cost less there will be long waiting lines. outlook of taxes to lifesaving technologies. so i think when the president says he wants to protect everybody in america by saying we should be able to keep our health care plan, my amendment simply does that by saying quote nothing in this act shall be construed to prevent or limit individuals from keeping their current health coverage.

that is pretty simple, and this is something that i think majority of people on both sides of the aisle should agree with except for those die-hards that agree with barney frank that they want to have a universal government-run program. obviously the president doesn't sell my amendment goes along with what the president said. i think the president was being sincere when he said he promised to americans and their families that they be able to keep their health care system, so my amendments is a simple statement that nothing in the action show prevent or limit individuals from keeping their current health coverage. ..

her health care plan. greater competition is not necessarily in tents, we argued on this side of legislation, and we feel that with this public policy people will slowly move into it either through mandates or pricing for all kinds of different contingencies into this public policy, and we are saying we don't want the government to put stipulations on the commercial, private insurance plans that would force americans to move into the public policy. so by creating a federal regulated health care system,

the government-run, competing with private health insurance, it won't be long if we are not careful everybody will be moving into the public policy. but if we put ourselves in the position that nothing in this health care plan would commit americans to move into the public policy by mandates, by the pricing of this public policy we are making a statement in agreement with the president indicated. we are actually saying positioning the government as the umpire pitcher and a health care game the government is setting the rules, calls the balls and strikes, control what kind of delivery is offered. so they have a lopsided vantage, and so we don't produce a level playing field. my amendment is following with the president promised, with 83% of american families have said when they say i want to keep the coverage i have come and it fulfills basically the promise

americans will be able to keep their health care plan, period. thank you, mr. sherman. >> the gentleman yields back the balance of his time. mr. pallone. >> thank you, mr. chairman. i just don't understand why this amendment is necessary because it says nothing in this bill will prevent or limit individuals from keeping their current health benefits plan. i mean, the fact of the matter is the bill already permits and on definite grandfather permission for individual health insurance policies, so that means if you like your individual policy, you can keep it as long as you like and as long as it continues to be offered. that doesn't mean that it's likely you're going to do that because frankly it means it may very well be that it doesn't have the essential minimum benefits we are going to provide. it may not have protection so it's not likely many people will continue those individual policies if they can get a better option and the whole

exchange but they are allowed to keep it indefinitely under this bill. with regard to existing and planned based group health plans, they are allowed to stay the same for a five-year period. the reason for that and for the shorter grandfather period for java based plans is because the choice of plans an employer makes affect all workers, not just the employer. and the fact of the matter is after five years we want to make sure the essential benefit package and all the other consumer protections that exist under this legislation, no discrimination for pre-existing conditions for example and other protections taken because otherwise an employer could decide i don't want to provide this basic benefits. i don't want to provide -- you know, i want to continue with discriminatory policies in definitely even though the employee decides he doesn't want to do that. i don't think that's fair so

there is a distinction if you will between individual policies and employer policies for that reason. bottomline is people should be able to have a choice if they want a better package and if they want these consumer protections. if they don't want them as an individual they don't have to do it. they can keep what they have but i don't think people who have employer sponsored plans should be forced into the situation if they can find -- they should be able to take advantage of better protections and the better benefit package that's being offered. i would like to yield to the gentleman from florida. >> thank you, mr. pallone, for yielding time. members, need to be careful with this amendment because what it does, it sounds very simple. it is a to line amendment but what it does is cut out three or four very important pages of the bill that introduce for the

first time very important consumer protections that american families have been clamoring for for many years. for the first time americans will not be discriminated against due to pre-existing conditions. insurance companies will be prohibited from refusing coverage because of your medical history. for the first time, note exhort attend out of pocket expenses, deductibles or copay. insurance companies have to abide by the year with caps on how much they can charge for out-of-pocket expenses. no cost sharing for preventive care. insurance companies must cover without charge regular checkups and tests that help to prevent illness such as mammograms or all i care and the exams for diabetics. they can't drop coverage if you're seriously ill. insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill. no gender based discrimination,

no annual or lifetime caps extended coverage for young adults, children will continue to be eligible for family coverage through the age of 26. this amendment says health care in america is working. you like the status quo. we need to vote this down because what is happening today is not acceptable for american families. this amendment continues to allow today's broken insurance market to flight discriminating against the elderly and sick. instead, our health reform bill creates a new health insurance market where people are no longer discriminated against because of their health status and pre-existing conditions and gender, where they work and a host of other reasons. so, though down this amendment and instead let's fix this broken health insurance market place where everyone, whether they are old or young or sick or healthy men or women can access quality health care.

>> mr. chairman -- >> i will yield the remaining time to mr. green. >> this is such a simple amendment and i concerned because this shouldn't permit or limit individuals from keeping their current plan. if you have a private health care plan from your company, adc, and abc decides to reduce benefits i wonder how all this very short amendment would in fact that and i know i've run out of time. thank you. >> that's the problem. mr. chairman? >> who seeks recognition? mr. martin. >> and i will yield to mr. shadegg. i want to read in section 102 of the pending bill what makes this amendment necessary is on page 16 at the bottom, line 20 it says greece period for current employer, and climate based health plans in general the commissioner shall establish a grace period whereby beginning after the end of the five-year period beginning with year juan

and employment based health plan in operation is the day before the first day of year one must meet the same requirements as applied to a qualified health benefits plan under section 101 including the essential benefit package requirement under section 121. so, if you like what you have and want to keep it the best that can be said under this bill is you might get to keep it for five years. >> would the gentleman yield? >> i'd be happy to yield. >> this is exactly my point, mr. barton, if you are an individual and decide you don't want the basic benefits package and are willing to do with less, that's fine, but an employer who decides beyond disgrace period that he's going to continue to offer a less than -- less benefits than the standard package -- >> will the gentleman yield? >> he shouldn't be allowed to do that to the employee?

>> i reclaim my time to read this grace per go gives five years and your current plan if you like it and it doesn't meet these requirements -- speed the individual doesn't have those options. >> i yield to mr. shadegg. >> what's read the language, it says nothing shall prevent or limit an individual from keeping. that means it is their choice to keep it but the language of the bill, mr. malone, doesn't do what you say. if you go to section one of two, page 15 and read is as health insurance is grandfathered. it's talking about individual health insurance but if you read down to line 20 it says it is grandfathered if but only if the following conditions are met and then you read line 2325 and those say it's grant valverde, the individual policies grandfathered if they don't sell any more coverage to anybody else. any plan out there in existence that you can never enroll anybody knew will go away.

you can't sustain a policy if you can't enroll new people but second you go to page 16 and look at line seven through 12, and it says you can make no changes in the plan. so if you have a plan right now under the language of this bill and the person offering the plan decides to give you more benefits they decide we have not covered breast implants in the past or this or that or the other item as soon as they make a change in the plan they've disqualified and you can no longer keep that plan. on top of which mr. barton is quite correct if you read further on to line 2325 of that page and picking up on line 17, every single employer based plan and the nation the of has to go away and five years and the benefits haven't been prescribed

in the law yet. the reality is when the president says if you like your plan you can keep it the specific language of the plans is no plan, individual or group will be able to be in existence five years from now. some of them will go away immediately, others will go away in five years. but no one, the berlin no one will be able to keep the plan more than five years and i would be happy to yield to the gentleman from tennessee. >> let's actually my time and i would be happy to yield to the gentleman of tennessee for about 30 seconds -- >> i think the gentleman for yielding and agree with everything said and i do support the amendment. a couple of points. when you have no cost sharing, guess what happens. you encourage overt use prescription rate in the country. the next thing, extended coverage to children 26 and

under, i really have questions about the wisdom of putting that has the upper age limit as what is considered a child and i yield to mr. barton for the purpose of yielding -- >> mr. burgess, very quickly. >> thank you for yielding. i would remind the chairman when we had our legislative hearing i asked secretary sebelius if i would be able to keep my high deductible savings account or if it would be deemed nonqualified and i would be penalized if i wanted to keep it -- you, mr. chairman, i trust the secretary and said the gentleman raised an important point and desert and answer and i will tell you today i haven't received an answer from the secretary and i will yield back. >> the time is expired. who seeks recognition? the chair recognizes himself in opposition to this amendment. today's individual health insurance market is completely dysfunctional. even america's health insurance plans have recognized insurance

market reforms are necessary. this amendment continues to allow today's broken insurance market to thrive, discriminating against the elderly and sick. the bill creates a new health insurance market where people are no longer allowed to be discriminated against and the bill would grandfather people in their current plans preserving the promise people can keep the coverage they have if they like. but new plants will need to follow the new entrance requirements. people can still enroll in new individual market plans, just ones that do not discriminate. allowing an individual market that doesn't meet the new reforms means insurers will continue to play games to get the healthiest individuals leaving the sickest and the reformed market. it's time to fix the broken marketplace where everyone, old, young, sick, healthy, men and women can access quality health

care and i urge members to vote against the stearns amendment. anyone else seek recognition? if not we will proceed to the vote. do you want a role call? we will proceed to a roll call vote. the clerk will call the roll. [roll call] [roll call] [roll call]

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[roll call] [roll call] [roll call] >> mr. rush wishes to be recognized. [roll call] >> have all members responded to the call of the roll?

any member wish to change his or her vote? the clerk will tally the votes. >> the clerk will announce the vote. >> mr. chairman on that vote there were 26 ayes and 32 noes. >> 26 ayes and 32 noes. the amendment is not agreed to. further amendments? >> mr. churn and if i could go back to the amendment we had before on the conscious walls -- >> before i recognize you -- [inaudible conversations] >> mr. chairman, going back to my amendment -- >> mr. stupak, if he would withhold for a moment. [inaudible conversations]

amol conversations >> mr. stupak, you are now recognized. >> before we worked this thing out, page two, line 8349 ask unanimous consent to strike that subsection d and i believe that was agreed to and after talking with members it looks like the amendment would now be acceptable to all sides. >> first foul was called the stupak amendment we put up a few moments ago. the clerk will report the amendment. >> amendment offered by mr. stupak -- >> it will be considered red. you wish to strike -- >> loranne 8314 section d.

>> any objection? is agreed to. if the gentleman will yield to me. i appreciate you making this change. i think this makes the amendment acceptable and i would urge members to support the amendment. >> i yield back. >> are weak ready for the vote? all of those in favor of the stupak amendment say ayes, a post, no. the ayes have it, the amendment is agreed to. mr. blood. >> i have an amendment at the desk. it is blunt-terry-gingrey, looking for a number here. ecr17-t. >> i raise a point of order. >> the lady from california reserves a point of order on the amendment. has the clerk unable to identify the amendment? the clerk will report the

amendment. >> amendment to the amendment the nature of a substitute teacher 3200 offered by mr. blunt of missouri, mr. terrie, mr. gingrey and mrs. myrick. >> without objection the amendment considered red and the gentleman of missouri is recognized for five minutes. >> also asked to be intended in the amendment and we didn't get that filed but i appreciate his and mr. upton's help. this amendment accepted in my opinion mr. chairman the reality that the public plan within a very short time becomes the only plan. i don't think the public, and i don't think the public plan can be a fair competitor and i think other plans go out of the system and this amendment says if there is a public plan the elected federal officials, the president, the vice president,

and members of congress would enroll would be enrolled in the public plan, and i think that is a leadership thing for us to do. every study you read on this indicates the other plants would survive the competition with the public plan. i felt the debate we had earlier about medicare itself further indicated the difficulty of any tax paying competitive plan competing for a long period of time probably need to think of a better analogy than this as a republican, but i sort of see the public competitor, the government competitor as an elephant in the room full of negative, and believe me the smart negative get out of the room as quickly as they can. the slow were mice get crossed by the elephant and at the end of the day there's only one competitive left and that competitor does provide the single-payer the chairman of the

finance committee said today he thought the public plan would lead to at least one member of this committee said publicly she was confident the public plan would lead to and based on my belief that we would shortly have only one option any way i think that federal elected officials should be required to go ahead and began to chart the course for what that plan would be like and i will yield to mr. terry. >> thank you, mr. blunt, i appreciate working with you on this amendment to the first fall, there is lots of questions about the public plan, the government-run plan, what's going to be in it, and frankly we've been challenged by many constituents to say, you know, if there is going to be this government plan don't you think you should be part of it, and i think in a way they may have

some qualms about how good of the plan will this be and would eventually be the plan that is, backed and all i agree with some of my constituents that say hey, if we are going to pass this plan we should put ourselves in. secondly, i believe the people that will be eventually end up in this plan because the scenario set forth by mr. blunt that i truly believe is accurate, the people that are in that plan i think will feel more secure with members of congress within this plan, perhaps that we would arrest the deterioration of that plan or the rationing that will likely occur so i think this is important for us as a committee to step up, proved this language, show that we are going to stand with the people in that public plan, and i will yield back to mr. blood. >> i yield to ms. myrick of

california. >> thank you. i want to speak in support of the amendment. it's very simple. it says members of congress, the president and vice president shall participate in this public land and if it is the right choice for all of the americans, you know, a lot of them are going to be losing the coverage they currently have now and if this is a good plan for them than it should be good enough for us as well and i yelled back to mr. blunt. >> i yield to mr. siegel and ease of indiana. >> i thank the member of missouri and i think it's very important. i strongly oppose the government takeover but for those people that support shall the amendment and it is very clear and i yield

back. >> i would like to yield to mr. gingrey of georgia. >> i thank the gentleman for yielding and i am proud to be a co-sponsor along with mr. blog and mr. terry and mr. scalise. as my colleagues have said what is good for the goose is good for the gander. i was on a local school board a number of years ago, and, a public school system, and it was pretty much expected every member of the local public school board should have their children and the public school system -- >> time has expired. >> mr. chairman sensorium a co-sponsor i ask unanimous consent for an additional minnick were you can come back to me. okay i yield back. >> mr. chairman. >> ms. capps. >> if i could speak please on a point of order i raised earlier. >> you wish to assert your point of order.