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[roll call] mr. chairman on that boat the ayes are 11 and the nose are 22. >> the no's have it. the amendment is is not agreed to. i believe we are down to one more imminent. >> thank you very much mr. chair. >> amendment at the desk. >> trying to speed it up. an amendment offered by ms. mccallum. eliminates sequester for fy2013, paid for rate reductions in oil and gas subsidies. >> an example of the distributed copies. ms. collins is recognized for 25 minutes. >> thank you mr. chair.

last august the house, the senate passed the budget control act and president obama signed it. it wasn't an ideal solution but it share the burden of deficit. defense spending tickets necessary sheriff cuts are going fortunately, the version we marked up today changes the rules of sequester. it chooses military hardware over american seniors. right here. pentagon triumphs over property program. latest cuts frame long-term budget choices, budget choices while the choice was wrong. what i'm doing here with this amendment will protect access to vital health care services, for seniors and people with disabilities. it will ensure that physicians, nurses, home health care aides, hospitals, clinics and many other health care professionals will be able to continue to provide critical services to these vulnerable populations. they pay for -- to pay for --

excuse me, took pay for preventing the sequester cuts to medicare for one when you come my amendment closes wasteful unnecessary tax breaks for oil and gas companies. i have been here all day with all of you and so i just thought i would share something i found out. we first passed oil and gas subsidies in 1960 and i figured out my 104-year-old grandmother was a very young girl at that time. it was the right thing to do. it was a very risky venture. we wanted to grow our own energy. we needed to figure out ways to transport it and how to refine it. it was the right thing to do but in doing my research i also found out the reagan administration in the 1980s saw to pursue what was believed to be a more neutral and less discretionary energy tax policy. the administration oppose using tax laws to promote oil and gas development, energy efficiency,

renewable energy sources or unconventional renewable fuels. a belief that high oil prices along with the enough to spur the economic level of investment it went on to say in the crs report that congress is being consistent with a free-market approach allows the number of the tax energy provisions enacted to expire. the reagan administration did successfully reduce the number of tax energy provisions but it did not accomplish all of their goals. so with that spirit in mind, i think we can look at what we have done with oil and gas revenues. in fact just today, just today it came out that exxonmobil tops fortune 500 top list. and you can see right there, the five biggest oil companies record profits were more than $1 trillion over the past

decade. in fact exxon's profits were up 35%. that is good. in 2011, from 2010 totaling that 35%. $41.1 billion. chevron and conocophillips and other oil companies were number three and four but they have had a good year. at the same time these oil companies are raking in record profits, home care health organizations are on a financial brink because of medicare's low reimbursement. be no medicare does not pay the cost of the service that is provided. home health care aides are nervous because the cuts from the sequester may push their organizations off a financial cliff. they will find themselves out of work. when they in the states are out of work they are not providing care to seniors to keep them healthy and stay in their homes and stay active. ultimately these health care organizations that they could no longer hire or pay personnel to provide quality health care due

to the cuts that are going to take place today here, many seniors who will be transferred into nursing homes and more costly settings. and that is going to cost taxpayers more money. when the choice for me is keeping unnecessary tax breaks for oil companies at the top fortune 500 companies or ensuring our seniors have access to the care they need, i know much my choice is going to be. it's going to be for helping seniors stay in their homes, helping seniors stay healthy. this amendment is about choices. it's about the choice we are going to make today. are we going to work to protect seniors to provide access for services or are we going to protect petroleum profits? so i would ask people to seriously consider this amendment in preventing unnecessary cuts to our seniors health care, which will lead to fewer services being provided to coast providers will be crowded out. they won't be able to afford it. with that i would like to yield

five minutes to mr. ryan of ohio. >> i thank the gentlelady. i won't say we have a lot of members who want to speak on this so i won't take the entire five minutes but i think it ordinance we talk about the medicare program to recognize that it's not a real simple solution to say we are going to make all of these cuts to medicare without recognizing the complexities of the health care system. and seeing how these cuts would play out, and i think if it sounds too good to be true, it usually is. and so the simple solution of just making cuts is going to fix the entire medicare program i think sounds too good to be true and it is, because the issue we have with medicare is very complex and part of it has to do with a lot of people in the old rust belt states like ohio and pennsylvania and michigan and wisconsin and other states, where you have people lose their job and their health insurance when they are 55 or 60 years old and don't have any health insurance at all or can't afford

it. they end up waiting until they get into the medicare system and then they cost the medicare system a lot more money than they would have if we had accessible and affordable health care to those people who may have lost their jobs or underemployed or have just work and don't have health insurance. so those costs are borne into the medicare system. the medicare system needs to bear the brunt of those costs are go what we tried to do in the affordable care act is say those people should have access to affordable health care even if we have to help them with this, because then we will be able to get to problems that they have sooner so that they don't get as expensive into the medicare program. that is just one way of doing it, and making sure they get access to preventative care. is a little more complicated. it takes a little bit more activity on our part to try to deal with that but if not it's going to cost the medicare program a lot more money.

and the idea that has been presented here in congress for us to give these folks a voucher and i know the chairman will say no, it's premium support but it's not remy him support like our premium support that we get as members of congress which is 75% of the cost of health care that we have every year, whether it goes up or down. it's still 75% and the medicare reform that is being proposed on the other side is a percentage, it doesn't go up or down with health care costs and so over time as we continue to see high health higher health care costs, that premium support becomes worth less and less. and so we are going to send our seniors to swim with the sharks in the insurance market, health insurance market with a voucher that is going to be worth less and less. the issue of medicaid came up here earlier. one of the things is, well there are no-docs who want to take medicaid patients. one of the reasons is they don't

get paid very much and we tried to fix that in the affordable care act. i'm sure with all the savings that you are proposing on the medicaid side, one third cut to the medicaid program, i am sure that money is not going to go to increase the fees for the doctors and if it does that would be terrific. cuts to graduate medical education. when we have more and more people that will need access to health care we are cutting graduate medical education. that is not going to hurt the harvard's of the world. that's going to hurt the young ohio's of the world because of that debt burden. this meat axe approach sounds good and a very concise message but it doesn't reflect the complexities of the problems we are trying to deal with and i hope that this amendment is one way of us going about it, is to say hey let's ask those folks who are doing really well, clearly making profits, and the oil up on the chart there, or

doing well. we need to ask him to help us a little bit here to help soften the blow to some of these cuts so we don't have to make these dramatic cuts that otherwise will be made. i don't think that is too much to ask and the american people when you look at the polling say yes, it needs to be a be a dollar revenue, two, four or $5 in cuts or $3 in cuts but when we have a presidential candidate leading the party when you say there's not even one in 10, that is unreasonable. that is an unreasonable position to have it would we have such complicated process is so i've appreciate what the gentlelady has done with this amendment and i supported and i ask others, especially those on the other side of the aisle, to open up their minds and give the spill some consideration. i yield back. >> i yield to four minutes to the congressman from pennsylvania, ms. schwartz. >> thank you and i want to thank ms. collins for this important amendment and again for giving this committee a choice because we are talking about choices. republicans have chosen, could

have chosen i'm sorry, to protect medicare from sequester. they chose not to. instead the republicans chose an even more destructive path and the budget choice that you see when you made the choice to and medicare guarantees by turning medicare into a voucher program. and shifting current and increasing cost to our seniors. we have had that debate and even tonight, not only is the republicans budget and medicare as we know it for future seniors, but they have decided in the reconciliation language to cut medicare providers now, risking access to doctors and hospitals and nursing homes, all providers, for our current seniors. as a result of the republican legislation to replace sequesters, medicare providers will experience billions of dollars at a cost of medicare

cuts. this republican action will result in $6 billion in cuts to medicare in 2013 along. while seniors are protected from direct cuts to benefits under this action, the impact of cuts to medicare providers is a clear threat to beneficiaries access to care and i have heard that said by republicans and at this budget hearing and of course on the floor as well. so to be concerned about those cuts to providers is what we are talking about tonight. it means cuts to hospitals, who are already experiencing care under medicare or medicaid. the medicaid sequester that they have chosen, republicans have chosen to keep in place is expected to hit the hospitals artist. 61% of hospitals already lose money on medicare. instead of cutting provider reimbursements and risking seniors access to care, again

republican democrats myself included have talked about are concerned about that. we should instead be supporting our providers, doctors and hospitals, nursing homes and so many providers in their efforts to reduce health care costs the right way to increase efficiency and value in medicare. so this sequester was not intended to sound fiscal policy. as an incentive for lawmakers to find a better way. we can protect medicare from arbitrary cuts by repealing wasteful subsidies to the big oil and gas companies which we have talked about quite a bit. in fact many of them said they don't need those subsidies. and is that what we should do is work together to reduce costs and and of medicare delivery and payment reforms that reward quality, efficiency and improve healthy outcomes. so i urge my colleagues to support this amendment, reject the across-the-board cuts to medicare providers and to work together to make sure that

seniors have access to medicare today and into the future and i yield back. >> thank you and i yield to mr. van hollen. >> thank you ms. mccallum and thank you for offering this important amendment. at the beginning of the hearing we said we thought there was a meeting of the minds on the question about whether a sequester across-the-board approach was wise or made sense. the thought that there was an agreement that kind of meat axe approach in dealing with budgets was not the way to go, that we should look for specific policies that would replace the sequester. the republican reconciliation bill has policies which we strongly disagree with and we have dated those. we believe we should replace the entire sequester with a balanced approach but it turns out that the republican bill and this

accompanying provision, the bill bill to modify the sequester, leaves in place, leaves in place that made ask across-the-board cut when it comes to medicare. a to 2% across-the-board cut to all providers, whether they are providing care efficiently or not, again, just a blind across-the-board cut. and so we believe that instead of doing that, once again, you should ask the oil and gas companies whose chairmen have testified under oath that they don't need these big subsidies in order to encourage them to produce more, that we should instead cut those and it's a little puzzling that we would have a sequester, a provision that would eliminate for example the sequester on defense cuts and other things but we would for some reason want to leave the across-the-board cuts on

medicare in place. we have had a lot of testimony in this committee from various experts and i thought there was general consensus that just cutting providers who are already stretched doesn't make sense, and yet that is exactly what the republican bill would do, and with this amendment offered via ms. mccallum is designed to avoid. so i want to thank you for the time and i yield back. >> thank you. earlier today we heard, show the results, show the results. minnesota ranks number one, number one in quality, number one in outcome and number one in providing the best value for your dollar. the report was just released a couple of weeks at go. rochester in a couple of other cities in minnesota were all in the top 10. you hear the term geographic

disparity. medicaid and medicare reimbursements are intertwined. mr. ryan, i come from a state where our doctors, nurses and their hospitals, there are several of us around the table, they are not paid for the value of what they do. my state gives -- gets reimbursed at a much lower-quality for providing much better outcome for seniors. and so across-the-board cuts to providers? do you want to talk about fairness? do you want to talk about looking at what is going on in this country? that is not right. it's not fair. $62.4 million to minnesota hospitals that already are reimbursed at the lowest was the best outcome.

we could lose our health care providers. when a doctor or a nurse graduates from college, their student loan debt is the same, whether they are providing health care in texas or new york or minnesota or wisconsin. they have choices that they can make on where the reimbursements are. personal health care attendance, many of them get snap because they are paid so poorly. these are the cuts that i'm trying to say we don't need to do this. this is a choice we don't have to make. we can do so much better. mr. chair, with that i will yield back. >> who seeks time in opposition? >> you are recognized for 30 minutes. >> thank you mr. chairman and i guess i -- i begin my comments

by saying i'm somewhat confused by my friends on the other side, who have multiple opportunities during the sgr, the sustainable growth rate discussion we had over the previous four years but they let it lapse repeatedly and had to inject all sorts of incredible uncertainty into the lives of those providing care for patients. so i am somewhat confused or maybe amused by the newfound concern that they demonstrate that i'm more confused mr. chairman bayh this, this report that i have here from the white house. just talking now about the woeful situation that has just been described by medicare beneficiaries but the president himself, the white house, says on a fact sheet regarding the

sequester, that in a number of different places but i will quote two of them. quote protect social security and medicare beneficiaries and in other spots enforcement protects medicare beneficiaries so i'm somewhat confused by the hyperbole and the discussion on the other side but be that as it may, let me talk a little bit about the issue of health care, because it is important. as a physician i talk a lot about health care. i have talked to a lot of folks who deal with health care, those providing the care and also the patients, young and old. and what i hear everywhere i go is that the status quo is absolutely unacceptable. the status quo in health care is absolutely unacceptable. we talked about that before this committee. if you are new medicare patient, and your physician doesn't see medicare patients or isn't seeing any new medicare patients, and almost any community across this country, if you have defined a new

medicare patient, a doctor who is taking new medicare patients it's virtually impossible to do so, virtually impossible and if you are medicare or medicaid, one of the dual eligibles, it is even more difficult. so the status quo is absolutely unacceptable. i will tell you however and my friends talk about it and they put a slide up there on the nursing homes and other suppliers and the like, i have talked to more than a few individuals in the nursing home community and long-term care community, medical supplier community who will testify if asked, that the reason that they are having difficulty making ends meet, a bigger reason they are having difficulty making ends meet in addition to reimbursement is all of the rules and burdensome regulations coming out of this administration stifling their ability to just do their job, not to the benefit of the

quality of any senior out there but just because this administration and our friends who were in charge or the previous four years believe washington knows best about how to make these rules. it just is really befuddling to them because they have been working for decades and decades for patients out there. with that, the medicare actuary, chief actuary, we all know these numbers well. the medicare program runs out of money and becomes bankrupt or however you want to define it in 2024. so there are real challenges that we have, there is no doubt about it. the question is how are we going to address it? which leads me to a couple of different ways to handle it. one, you can fix prices and that has been done by both republicans and democrats alike and i think it's probably not a wise idea and we are working to try to correct that. took up the good move in the direction of the the president's

bill. the president's bill has been cited by a number of high colleagues and friends on the other side. in fact the way that it saves money, the way that it handles medicare is to remove $500 million, $500 billion from the medicare program. significantly reducing the ability for medicare advantage patients to utilize medicare advantage, something that many of them liked to a great degree. and the $500 billion, the largest portion of the $500 billion is found by empowering the independent payment advisory board, group of 15 individuals appointed by the president. curiously when i talked to my friends in the health care arena, curiously these 50 members come you can't have a majority of folks who have actually cared for patients. you can't have a majority of individuals who actually know what it means to take care of a patient on this board i lot,

bylaw that our friends -- and buy why you can't have any actively practicing physician on this board so it befuddles us as to how you're going to figure out what they ought to be doing if they were truly concerned about the quality of health care for seniors. the fact of the matter is they are only charged to save money, to be the final arbiter of how you get that $500 billion out of the medicare probe ram. >> what the gentleman yield for a question? >> i will when i'm finished. so, what are they going to do? some folks have said it's the rationing board. i don't call it a rationing board because i think that actually gives them a different kind of power than they have. they don't have power to ration but what they do have is a power to decide payment for service. when i mention that two to groups that come the kind of chuckled because they no denying payment for services means those

services won't be provided so the independent payment advisory board, remember not physicians, not actively practicing physicians not a majority who have ever cared for patients. the ones they are charged with pulling 500 billion or the balance of $500 billion out of the program. denied payment for care for seniors and at the same time, at the same time that law that was supposed to address all these wonderful things didn't do a thing, not a thing to address the compensation of payment for physician services that supposedly is the highlight of this amendment. so how else do you solve this challenge? there they were wonderful ways to do it in a positive way that we call patient-centered health care, which is by short-term definition the patience of families and doctors are making medical decisions and not washington so we can improve medicare. that is our take-home message is that yes you can do this without denying payment for services and

you can do it without limiting the choices and options available to seniors. we'd have described this twice in our budget. how do we do that? we do a couple of things that are important to mention because they have been distorted oftentimes by our friends on the other side. versed is the current seniors see no change whatsoever in the medicare program. the good news is we can do that right now. if we wait much longer we won't be able to do it. current seniors will be significantly affected if we don't address these challenges that we have right now that medicare actuaries have clearly laid out for us. second, we preserve the medicare guaranteed. we preserve the medicare guaranteed. we believe that the promise, the agreement, the pact packed if you will that has been made by the federal government and seniors in this country is sacrosanct and we preserve the medicare guaranteed. third, we preserve the option of

the medicare program as a choice for seniors, and that is incredibly important because our friends on the other side oftentimes have distorted as i mentioned, our proposal but one of the things they did over the last year following the first budget we passed through this committee last year was to significantly inject fear and seniors minds about what would be available. the fact of the matter is we preserve the option for medicare for seniors. and then finally, those near their retirement will see no significant changes whatsoever. so what we do is save and improve and strengthen medicare. let me just mention about the sgr, the sustainable growth rate because it is incredibly important. as a physician i hear about it from my colleagues and my former physician colleagues all the time. the clip that -- the cliff that

we are approaching at the end of this year, january 1, is upwards of 30%. i've worked with folks on both sides of the aisle to try to address this in a positive way and we will be continuing that work and look forward to continuing that work and i'm hopeful that some of the comments that i have heard in this discussion so far will lead into a more positive and fruitful discussion as we move forward toward the end of this year to truly solve the sustainable growth rate dilemma and challenge that we have because we can't continue, we cannot continue to have the positions out there who are working as hard as they can to care for patients across this country have the uncertainty of not knowing exactly what's going to happen from a growth rate stamp on. the status quo does not work. it's clear that the president's bill doesn't work. health care law does not work. doesn't work with patients, doesn't work with