works. now, let me compare this to the president's proposal to use ipad, the unelected unaccountable bureaucrat board of political appointees for current seniors. here is the president's budget and wrap he is proposing. this is law, by the way. this is the law that is in the affordable care act. what it proposing for medicare's growth rate. let me do that again. i think i can -- so this is the republican budget. what it proposes, here is what the affordable care act in current law does for growing medicare. see much difference there? yet my friends on the other side seem to complain that this is draconian cuts to seniors. how can that be if our trajectories are the same? let's talk about the main difference between our approach and the affordable care act. the president's new health care law. it's not the proposed spending,

you can see the paths are the sail. the difference is, who is in control. 15 bureaucrats or 50 million empowered seniors. that's the difference. now, look at what happens if th unlike cms, cbo thinks ipads will fail by the actuaries at cms tell us 40% of medicare providers under the affordable care act will go bankrupt and go out of business. providers will get paid 30 cents on the dollar, and go bankruptcy or stop taking medicare patients. that doesn't provide much access or affordability. here's what happens if we revert back to the status quo, the current law. medicare grows at unstainable rates that jeopardizes this program not just for future seniors but for current seen

years. if ipad ends up fail weg go to the red line. here is what that red line does to our budget deficit, more importantly to our debt. this is the debt over the last 40 years. this is the debt into the future. this is what cbo is estimating our debt becomes in the primary, major driver of our debt is medicare. and if ipad fails, if all those providers go bankrupt, if the price controls don't work and we relapse back to the status quo, we have a debt crisis on our hands. here is what our plan proposes. oops. i guess the next click, we pay this debt off. that's what we're proposing. so let me go back to it one more time. we're proposing to grow at this rate. the affordable care act grows at this rate. if we go up there -- sorry. doing it the wrong way. if we go up to the top we

bankrupt the country. we bankrupt medicare. so at the end of the day, the difference is this -- medicare in order to save medicare, in order to keep its guarantee, for current and future seniors, in order to prevent a debt crisis from ruining our country and giving our kids a diminished future must be reformed. the president's health care law, which is in law, does reform medicare. it says 15 political appointees will decide how that line is going to meet. they will decide how to cut medicare to providers which will lead to denied access for seniors. we are saying, let the seniors decide. empower 50 million sooniers to make choices. more to the point, force the insurers to compete against each other for business as a beneficiary and also give the choice of traditional medicare system, if she so wants to choose to do so. we think that's far more

rational, far more humane and more importantly, we do not want to subject her medicare benefits to the discretion and control of 15 political appointees. we want to put her in power and more to the point we think it's this -- wealthy people, because they're wealthy, can afford more out of pocket. low income people can't. so we distinguish. we say, cover that low income person with out of pockets. give people more money the less they have subpoena give people more support if they get sicker and require higher income individuals to pay more out of possibility, because they can afford it, doing it this way saves medicare, and with that i yield to my gentleman, the doctor from georgia, mr. price. >> thank you very much, mr. chairman, and i just want to say to my colleagues on the other side who have dubbed this amendment the end of medicare as we fwloe it amendment, the fact of the matter is as the chairman pointed out, that's what the president's health care bill that does. that's what, that's the bill you

all adopted which is removing $500 billion plus from the medicare program and putting in place this unelected bofrd 15 bureaucrats, which we understand and appreciate is necessary in their plan, in your plan, because you've got to control costs because you don't trust people. when bureaucrats choose, patients lose. when bureaucrats choose, patients lose. and that's the program that y'all have put in place. we believe that it's important to save and improve and strengthen medicare and the chairman ed consequently outlined how we propose to do that. i draw your attention to page 61 on the budget which goes through the four main points on the medicare program that is that those in and near retirement will see no changes whatsoever. for future genrations they are provided a guaranteed health coverage, line five. for those live ing from a home, guaranteed health coverage or page 61, line 5. in addition as the chairman says, those with higher health challenges receive more asimps.

those with lower income leave more assistant and puts medicare on a sustainable path which the president's proposal does not and your proposal does not. so i urge a rejection of the adoption of the underlined question. >> yield the remainder of our time and recognize the gent. lady, mr. schwartz 0 for one minutes for the purposes of closing. >> we're going to try to split this one and yield half a minute to mr. van hollen. >> if we could, could i put that chart back up? i think it's a very useful chart. a very useful chart. put that up, please, for the -- is it coming up? here. let me -- you want the whole thing? >> yeah. i do. all three lines. because i think this make as very useful point. thank you, mr. chairman. the first point it makes, d. s

despite everything we heard, the democrats didn't have a plan to contain medicare costs what it says is essentially the same in terms of medicare costs. the red line in temples of medicare savings, what the red line shows is the risk if things go wrong. and under your proposal, the risk for when things go wrong if this doesn't work is put on the seniors. the cost is put on the seniors and the reason that is very different than what we have for ourselves as members of congress and what federal employees is is that under the current plan for federal employees, you don't bear that entire risk. you will always get about 75% of whatever the increase in costs are picked up by the federal employees health benefit program. whereas under this proposal, the senior eats it all and that's why we do call it a voucher. premium support suggests that the support from medicare rises as health care rises. the way you do this is the risk is the opposite. and it's put on the senior.

>> and my time sup and i want to say there's a huge disagreement here. some of the assumptions on the other side were so inconsistent. there's a lot more discussion to have here. we're committed to keeping medicare, strengthening, continuing it, see it can be done, we're doing it. >> and we can keep this conversation going. the question is, on agreeing to the amendment offered by the gent gentle lady from pennsylvania. eyes, noss? >> opinion of the chair, the nos have it. a recorded vote is requested of the clerk will call the roll. >> mr. garrett? mr. simpson. mr. simpson? no. mr. campbell? mr. campbell, no. mr. calvert? no. mr. aiken? mr. aiken, no.

mr. cole? mr. cole, no. mr. price. mr. price, no. mr. mcclintock. mr. mcclintock no. mr. chaffetz? mr. setsman? mr. setsman, no. mr. lankford. ms. black? ms. black, no. mr. ribbal? mr. ribbal, no. mr. florez? mr. florez, no. mr. mulvaney? mr. mulvaney, no. mr. huescamp? no. mr. young? mr. young, no. mr. amarsh? mr. amarsh, no. mr. akita? mr. akita, no. mr. guinta? mr. guinta, no. mr. woodall? mr. woodall, no.

mr. van hollen -- >> yes. >> mr. van hollen -- aye. ms. schwartz? ms. schwartz, aye. mr. kaptur? aye? mr. bloomen nour, aye. mr. mccullum, mr. yarmouth. mr. pascrell? mr. honda? mr. honda, aye. mr. ryan of ohio. mr. ryan, aye. ms. wasserman schultz? ms. wasserman schultz, aye. ms. moore? ms. moore, aye. mr. caster? mr. caster, aye. mr. schueler? mr. schueler, aye. ms. bass. ms. bass, aye.

ms. bonamici? ms. bonamici, aye. mr. chairman? >> no. >> mr. chairman, no. mr. garrett? mr. garrett, no. >> are there any other members looking to vote tore change their vote? if not, the clerk sha report. >> mr. chairman on that vote, ayes 13, nos are 20. >> nos have it. the amendment is not agreed to. are there further amendments? it's, ms. kaefcastor, i think. isn't it? yeah, i do, but i just want to get -- yeah. go ahead and offer -- >> thank you, mr. chairman. >> so the amendment offered by ms. castor, amendment at the deck. >> i have an amendment at the desk.

gent. lady from florida? >> amendment offered by ms. castor relating to medicare. gentle lady is recognized nine minutes. >> thank you, mr. chairman. mr. chairman, in addition to the republican plan that breaks the promise of medicare and ends medicare as we know it, the republicans also propose to raise the cost of prescription drugs and slash the smart, new benefits and popular consumer reforms that have been in place for two years now, and are working very well. this is a real double whammy for our older neighbors all across america. so here's what my amendment does. it proposes to retain the closing of the doughnut hole and the money that's going back into the pockets of our older neighbors, parents and grandparents. proposes to retain those important new screenings, the mammograms and colonoscopies that are saving lives and proposes to retain that

important new wellness vis that has become very popular and actually is very smart policy. so first on the doughnut hole, under the affordable care act that has been in place for two years, what is currently happening is that cliff that many of our older neighbors were falling off of when it came to paying for their prescription drugs is now closing. right now senior, getting 50% discounts on brand name drugs, under medicare part d. that doughnut hole would be completely closed by 2020, and it has already helped over 3.5 million seniors with high drug costs on average, it saved -- saved the average medicare beneficiary over $600. in my district, florida district alone, over 6,000 seniors in my district have received prescription drug discounts, and it is predicted that through

2021, this will save our older neighbors $2,400 and our parents and grandparents will no long verify to struggle with those very expensive prescription drugs. unfortunately, in the republican budget, republicans propose to put these costs back on our seniors with high drug costs and have them make very difficult choices. secondly, the affordable care act also right now has provided an estimated 32.5 million seniors and disabled individuals with a preventative screening sump as a mammogram or colonoscopy because of the affordable care act in my florida district, over 70,000 of my older neighbors have received this preventative screening. without an additional co-payment that oftentimes kept them out of the doctor's office. the republican budget, unfortunately, will increase the

costs. they will now have to go back and pay additional co-payments if they want to go in for those screenings. and finally one of the most popular reforms under the affordable care act has been the new wellness visit. they get one annual wellness visit. in 2011, 2.3 million seniors in traditional medicare took advantage of this new benefit. through the republican budget, and repeal would take away this important tool that patients and their doctors realize is really saving lives. it is smart policy, and the republican budget shouldn't break the promise of medicare and they shouldn't roll back these important reforms that are making a difference in the lives of our older neighbors. at this time i will yield to -- to ms. schwartz to speak on the amendment. >> well, thank you, ms. castor and thank you very much for this amendment.

the republicans keep saying that their voucher plan, premium support plan they prefer to call it, would not change anything for current seniors. that is simply not true. it was just said again in response to the previous amendment. there would be no change. no shift in cost. only for future seniors but not current seniors. it is simply not true. by repeal of the affordable care act the fact that we are gradually closing that prescription drug gap, the coverage gap, means that more seniors will be paying more out of pocket right away, if the republicans get their way and repeal the affordable care act. that they would not be able to afford prescriptions, get sicker, risk their health and increase costs for us. so understand as ms. castor said, this is benefiting 3.5 million seniors now. they would lose this benefit. so you can no longer say, unless you vote for this amendment, that in fact you are protecting

current seniors from a cost shift. so i want to say this is extremely important to seniors in my district. i can't believe it isn't also important to seniors in everyone's district to make sure that we protect their health, their safety, their economic security and their health security sbi the future. we should actually continue to provide them with the benefits that they receive under the affordable care act that republicans seek to repeal and i yield back. >> to the ranking member, mr. van hollen. >> well, thank you, ms. castor. thank you for offering this amendment and just to first emphasize a point that's already been made, which is this budget does immediately, immediately, reduce benefits to medicare beneficiaries, because the affordable care act does close that doughnut hole. that provides that support for seniors in need, and this budget reopens the doughnut hole and. does it immediately. and so that's an immediate change for those seniors.

i think it also needs to be pointed out that when we did the affordable care act we used savings, for example, by ending the subsidies to some of the private insurance carriers that were way high. 140% subsidies were being paid. we used those savings for the purpose of providing these additional benefits. in other words, we used those medicare savings to provide this prescription drug benefit, and the budget we have before us from republicans takes those savings, even though, ads were run against people base and the savings. while you take those savings you don't plow any of them, none of them, back into medicare. you don't plow any of them back into preventative services and you don't plow any of them back into closing the prescription drug doughnut hole and that's why i think it's so important that we adopt this amendment.

>> are you okay -- >> i'd would like to yield to -- >> yeah. let's do it, since -- yeah. >> thank you. for many american families the first real affect of the affordable care act will be felt by them in a positive way in 2014. but for seniors, the affordable health care act is already producing measurable benefits and for all of us, all those who express concern about the long-term solvency and sustainability of the medicare system, by plowing the savings that we achieved at some political cost last year, into this plan we are extending the life and solvency of the medicare trust fund by over a decade.

seniors who face tremendous prescription drug cost and there's much more that needs to be done in this way, are already saving millions of dollars across the country on prescription drug costs. one of the focuses on encouraging cost control is prevention, as ms. castor has said, and there is an emphasis on prevention in this bill that i think will produce more savings. this amendment serves a valuable purpose in protecting our seniors the benefits that they're already getting, and i yield back. >> yeah. and i'll just take one minute to close quickly, and urge my colleagues, don't pass this budget and break the promise of medicare that allows all of our parents and grandparents and generations to come to live their retirement years in dignity, and don't pass a budget that will roll back these very important consumer protections and improved benefits under medicare. closure of the doughnut hole. these new screenings, and the

wellness visit. don't just take it from me, either. take it from the aarp who just sent a letter to congress. they said, this republican budget lacks -- >> you can conclude that and wrap up. we have a vote. i stick to the -- >> you'll get a minute at the end. i now recognize dr. price. ten minutes. hopefully it won't take all that and we can get to the floor with vote. >> with all due respect to my colleague proposing this amendment that says this is breaking the props to medicare to look in the mirror. look, the fact of the mat sir that the president's law, the law passed last congress, does in fact break the promise to seniors because it removes $500 billion from medicare and puts in place a 15-member unelected board of bureaucrats to designed whether or not payment to physicians to care for seniors will occur. look at our budget. page 61. lines 1 and 2. current medicare benefits are preserved for those in and near retirement without changes.

section 2 on page 61. a guaranteed health coverage for recipients they choose the plan that best suits their needs. the question is who's going to be in charge? is it going to be the federal government? this 15-member board or is it going to be patients? you've said, the other side has said that there will be changes in our budget is adopted and put into law. you're absolute right. we're end the raid on medicare and we will end the 15-member unelected board of bureaucrats to be able to decide what kind of care senior, able to get from their physicians to be paid for. this pacific amespecific amendm answer the doughnut hole. and that provision of the new law has the affect of increasing prices. the chairman in his wisdom asked the cbo to determine what the cost increase were. i'll quote from the letter available to all of us aesof "t increase in prices drug ben knits and the cost faceed by

some beneficiaries higher than in the absence of those provisions. the legislation impose as fee on manufacturers and importers of name drug. cbo expects this will increase purchased through medicare and newly introduced drugs purchased through medicaid and other drug proms." this will increed so the premiums paid by beneficiaries will increase. so the fact of the matter is, our budget saves, improves and strengthens medicare. the medicare plan that the seniors of this country already know is already being altered and will be changed significantly and adversely to their quality of care if we allow the current law to go forward. i'm pleased to yield for a minute or two to ms. black on this issue. >> thank you, mr. chairman. i'll be very brief. i think my colleague made those points very clearly that when we talk about changing medicare as we know it, that's already been done, the patient affordability

act, half a trillion dollars taken out of the medicare fund, and put into the exchanges, and so we already see that there's is a change in breaking the promise to our americans, that's already started by my colleagues on the other side, but i think that it is certainly been said very clearly by chairman price that we are going to give seniors an opportunity to have choice of their own. we're going to put it back to them to allow them to choose the plan that is best for them. some may find that a drug program is more important. others may find that they warrant a prevention, but that's the american way. it's to give choice. and why do we think our seniors just because they're seniors can't make those choices? they will make good choices, and they'll make choices to find the program that best suits their needs. so thank you, mr. chairman. >> i repeal the amendment. yield back the balance of time. >> wonderful. keep us on time.

the gentle lady from florida, one minute to close. >> thank you very much, mr. chairman. i would say to my colleague from georgia if you agree medicare benefits and older americans shouldn't be harmed then you should support my amendment, if you don't think the republican budget changes benefits, then i don't see what problem you would have. my amendment simply have says very clearly, we will retain the improvements that have been in place for two years, closing the doughnut hole, allowing those screenings without additional co-payments and that all-important annual wellness visit. you've also argued time and time again that the affordable care act took a half billion out of medicare. it didn't actually. it took it away from the insurance companies that were receiving large overpayments. medpac, medpac's recommendation, half a million dollars plowed back into these benefits in closing the doept doughnut hole of the screenings and wellness visit. i urge you again, don't break

the promise of medicare and don't take it from me. >> time is expired. >> the proposal lacks balance. jeopardizes let and economic security -- >> time expired. look, because of just this -- why i'm being tough on it. >> the -- >> gentle lady, come on. the question offered by the gent. lady from florida, all those in favor say aye. opposed say no. the nos have it. roll call vote requested. the clerk will call the roll. >> mr. garrett? mr. simpson? mr. simpson, no. mr. campbell? mr. campbell, no. mr. calvert? mr. calvert no. mr. aiken? mr. aiken, no. mr. cole? mr. cole, no. mr. price? mr. price, no. mr. mcclintock? mr. in clin tok, no? mr. president chafies? mr. sudsman. mr. sudsman, no. mr. lankford?

mr. lankford, no. ms. black? ms. black, no. mr. ribbal? mr. ribbal, no. mr. florez? mr. florez, no. mr. mulvaney? mr. mulvaney, no. mr. huescamp? no. mr. young? mr. young, no. mr. amosh? mr. amosh? no. mr. akita? mr. akita, no. mr. guinta? mr. guinta, no. mr. woodall? mr. woodall, no. mr. garrett? mr. garrett, no. mr. van hollen? mr. van hollen, aye. ms. schwartz? ms. schwartz, aye. mr. captor? mr. captor, aye. mr. doggett, mr. doggett, aye. mr. blumenauer? mr. blumenauer, aye. ms. mccallum? aye. mr. yarmouth?

aye. mr. pascrell? mr. honda, aye. mr. president ryan of ohio? mr. ryan, aye. ms. wasserman schultz? ms. moore? ms. moore, aye. ms. castor, aye. mr. schueler -- ms. beck -- mr. schueler, aye. ms. bass? ms. bass, aye. mr. bonamici, aye. mr. chairman. >> no. >> mr. chairman, no. >> are there any members looking to vote or change their vote? ms. wasserman schultz? >> mr. wa-- ms. wasser man schultz? aye. >> the clerk will report. >> mr. chairman on that vote, the ayes are 15 and the nos are 22. >> the nos have it. the amendment is not agreed to. since we have four votes, markup is recessed subject to the call of the chair.

so this house budget commit markup of chairman paul ryan the 2013 budget proposal is going into recess now. so members can vote on the house floor. this all got under way about 10:30 eastern and wouldn't be a surprise if it goes late into the evening as they work to finish this. we'll show you opening statements from earlier today as members get under way. it. >> the market for 2013 budget resolution, i'm proud to be here