all that they are looking at is what current law, how will this affect? now, i understand completely that this side of the dais is completely trying to repeal the president's health care law. i fully appreciate, that and i'm hoping the supreme court beats us to it, but in reality what cbo reporting is what only cbo can do. this is not 300,000 people are thrown in the streets. they are saying if this was done with current law, this would happen then. it would make that that sift so i understand it sounds good to give the illusion that 300,000 people are thrown on the streets. cbo reporting does not line up that w that, and so while i understand the dynamics of this of trying to give flexibility back to the states and to be able to allow the states to be able to make some decisions on this and to take us back to where we were just three years ago on how he handled medicaid, i do not see a draconian cut on it and throwing people into the streets with that. with that i yield back.

>> thank you. i'd like to yield five minutes to mr. hillscamp. >> thank you, i appreciate the time and the comments and my colleagues. i'm from a place that many of us on this committee have and that's working on our state legislatures before we arrived here, and i must note my constituents do ask do you drink different water in washington, d.c.? what happens when you go up there? the discussions we have here is much different than the bipartisan discussion we've had back in kansas. indeed, if you look across many current folks in the current administration, in president obama's administration, they i think would agree with our comments about flexibility, and regulatory overload, about the need for a medicaid system that's not a one-size-fits-all but is based on what the individual state's needs are.

if we look across the budgets, the majority of our states, including my state of kansas, spend more of their budgets on medicaid than they do on k-12 education, and the idea somehow if they could just spend some more money that's geronimo gil to alleviate or enhance the ability to meet those needs doesn't match the reality, and it doesn't match the reality when hhs secretary kathleen sebelius was the governor of the state, and when she was the governor she said every governor in this country is trying to grapple with this rapidly growing part of the budget. ask former governor, current senator mark warner. he said medicaid is on a road to a meltdown and will bankrupt the states. current senator joe manchin, former governor as well. i know there's never enough. we desperately need to get this program under control. these are folks serving in

washington, things they said back in the state capital when they were faced with the grim reality of cutting education in order to put money in medicaid. this is a dual program. some money from washington, some money from the states, all the money from the taxpayers and all the regulations from washington, and what this proposal does in our budget is actually puts the responsibility on the folks closest to the people. it's about what you thrust. if you were kathleen sebelius and you were governor, you didn't trust washington. you asked for a waiver. actually our current governor has put in almost the identical same waiver that then governor kathleen sebelius requested. it would be interesting to see if she approves the actual waiver that she requested. we see this again and again, the idea in the medicaid program is somehow that washington knows best. in the state of kansas, for example, medicaid costs have gone up by 50% between 2003 and 2009. i served at that time, governor

kathleen sebelius did as well. we found out that despite the mandates there are times when you can actually improve care and do a better job and not have to spend more money. that's called regulatory flexibility. it does occur. the reality is there is waste and fraud and abuse and there's a better way of doing thing than the centers of medicare and medicaid suggest. she said at the time there's a war between medicaid services and states around the country. there's a war. this is coming from the current hhs secretary when she was governor, and all i ask here is pass the rhetoric. let's get down to the reality of what occurs. medicaid is a program that should be administered and run by the states, by people that are closest to those in need, and that's what this program will do for us with the changes in this budget. we don't need 50 different -- 50 -- we have 50 different states. we have 50 different education policies and transportation policies, but somehow we have to

have the same policy for medicaid, and i think in doing that, we can agree with these governors and a couple others though, current ag secretary, talking about they just put mandates after mandates upon us. hhs, dhs secretary. we need more support from the federal government, more flexibility and go through these things. sometimes i wonder if it's the water in washington or the politics or rhetoric, because i think we all agree as the chairman mentioned this is about enhancing and improving care, and what we found out is throwing more money at the problem hasn't solved it. if it is, we should be able to cap it. that's not the case here. we can actually keep the funding flat, keep it steady, reduce the regulation, reduce the man tastes and hold local folks accountable. i think we can definitely improve the system. we actually did that in the state of kansas and we're doing that right now again if indeed the obama administration would give us that flexibility, and with that i yield back the

balance of my time. >> thank you. i'd like to yield five minutes to the gentleman from texas, mr. flores. >> thank you, mr. rokita. >> i would like to back up. when this motion was introduced by miss castor she talked about rhetoric from our side of the aisle, and i'd like to come back and go to the 50,000-foot level, and that is what is it that americans want? i mean, why are we in the position that we're in today where we have to worry about government funding for welfare programs? and it's because the economy is in bad shape. from january 2007 when the democrats took control of congress till january 2011 we lost 7 billion jobs and we spent about $4 trillion in deficit spending. the american people are rightfully concerned about the direction of the federal government. they don't trust the federal government. they don't trust federal government programs. i've got a list of them here. they know the gsa will party with their money.

the tsa is going to grope grandmothers and babies. the epa wants to crucify a particular industry. the secret service goes off and has their fun. the department of labor wants to regulate youth labor on farms. the department of energy wants to spend money on failed projects like solyndra. the department of interior has been subpoenaed because it won't provide information that congress has requested. parts of the department of justice will be held in contempt for too long because they won't provide money for fast and furious. we wasted $800 billion on a stimulus program, and yet the other side of the aisle wants to propose that all good answers come from washington. you talk about priorities. your priorities seem to be that you want to provide more washington dollars to provide to waste more money. what we'd like to provide are paychecks. a paycheck is the best social program ever designed by man. it's where you feed a family, you house a family, you educate

a family. you provide medical care for that family, including their children. it's where you grow a local tax base so that your schools can be healthy and provide the right kind of environment, the right kind of education to those children, and it's also where you grow a vibrant middle class. the same middle class that's been destroyed by the last four years of the economic policies, either from the democratic congress or from the white house, the same ones where over half the middle class is either in low income levels or poverty now, where more people have fewer -- have no health care coverage and are more dependant on the federal government than ever before, where gasoline prices are twice what they were before. it's also -- we talk about values. deficit spending is not a value, ladies and gentlemen. deficit spending is what's going to bankrupt the future for the children that you say you care so much about. what we need is a balanced

approach, i agree, but what is the balance? the balance is part from revenues and part from spending cuts. the question is how do you grow the revenues? the answer is you grow it because -- through economic growth, not from trying to raise taxes on folks. let's say that you took the list of the companies and the profits that mr. yarmuth talked about a little ago. let's tax 100% of the $81 billion in profits that he talked about. that will save about 6% of our annual deficit, and yet you basically have taken these companies off the map. these companies hire people. these companies think like economic, just like everybody else does. these companies can redomicile themselves in foreign countries, and is that what we want? is that what we want by demagoguing this business? why don't we go after apple? apple made $37 billion. it has four times the profit margin of an exon.

i mean, there's a great article in sunday's "new york times" about how apple hides its earnings. why don't you talk about them? it's just because it's easier to demonize a particular industry. this is not what we want to do as we move forward, so, again, yeah, i think we need a balanced approach, but let's focus on economic activity and that's what comes from the path to prosperity budget that we post and that's what reconciliation does by right sizing the federal government. i yield back the balance of my time. >> thank you. i think the gentleman said it well. i yield back. >> the gentle laid freflorida is recognized for five minutes to close. >> thank you very much, mr. chairman. colleagues, if we want to reduce the deficit in a manner consistent with our values as americans we would not be heaping the burden on children, on older americans, on disabled americans by the republican budget targeting the children's

health insurance program and medicaid so that's what my motion proposes to do is to in just one small part take the burden off of kids across america who need to go see the doctor and need to get immunized and ask the big oil companies to pay a little bit. like i said, if we didn't have such looming deficits or maybe we would have the luxury of being able to debate whether it's a good idea or not for the most profitable corporations in america to continue to get taxpayer subsidies while you're cutting children's health care but we don't have that luxury and we've got to make choices, and i'm really trying to help you out as you have independent commentators now calling -- calling the republican party so extreme and ideologically driven that they are a problem in functional government in america. by the way, when we're talking about medicaid, you know,

medicaid is administered and run by the states, it is, and medicaid overwhelmingly doesn't go to able-bodied people that can work. remember, it's seniors in nursing homes with dementia, with parkinson's, with cancer, with heart disease. it is -- these are our disabled neighbors. a lot of children who need specialized care. these are children who have nowhere else to go. their parents are working. they probably don't have health care, but our values as americans and past congresses we've said on -- said in a bipartisan way we believe those kids should be able to see a doctor. you know what? it's smart. it's cost effective as well. also medicaid is flexible. republicans simply like to call for flexibility when their actions finally speak in the reconciliation process.

flexibility to them means cut. it means fewer doctor visit for children. it means families with disabled kids or family members are going to have -- are probably going to fall out of the middle class because those medical bills are so burdensome to those families. it means those families with a parent in a nursing home now will -- without that support that medicaid provides, they are going to have trouble staying in the middle class as well. medicaid is also cost effective. it's not perfect. there's plenty of fraud we can work together to root out, but to say that certain -- because there's certain problems, that's the justification to do away with that safety net. no. medicaid is cost effective. the cost growth in medicaid is lower than private health insurance. the administrative costs in medicaid are lower than private

health insurance, but just like medicaid and private health insurance it's not immune to the rapidly rising costs of the entire u.s. health system and then we try to tackle that through the affordable care act, and we provided a good start, so now the double whammy, and it's no wonder you have commentators calling this -- the republican party extreme and reverse robinhood and destructive, and this amendment, this motion would give us an opportunity to say big oil companies, republicans, you're not going to look for one penny in tax loopholes. instead, you're going to look at 300,000 kids and say you can't have -- you can't go see the doctor. i think it's very telling and you're playing right into the hands of those -- if you disagree with these commentators, take this vote today and show them, you know what, we heard that message. we're not that far out of the mainstream. try to get back into the mainstream consistent with our values as americans, and i'll yield the remaining balance of the time to mr. van hollen.

>> i want to thank miss castor for her motion, and i do think it's important, mr. chairman, that we have a fact-based conversation in this committee. the congressional budget office has said the impact of these cuts means 300,000 kids will not get coverage. we heard from your own analysis that you have no reason to dispute that fact. i know it makes people feel better to pretend that these cuts don't have real consequences, but the reality is that they do. we heard about the kids going down the exchanges, another part of this very reconciliation package cuts the exchanges. this is about choices. we all agree we've got to reduce the deficit. miss castor's motion is very clear. let's not do it on the backs. kids. let's do it by saying to the oil companies who themselves have said they don't need those subsidies as an incentive to drill more, that they should help share responsibility. don't put it on the kids. thank you, mr. chairman. >> all time having expired, the question is agreeing to the amendment proposed from the

gentle lady from florida. all those in favor, say aye? >> a roll call vote is questioned. >> mr. garrett? >> mr. simpson. >> mr. simpson no. >> mr. campbell. >> mr. campbell, no. >> mr. calvert. >> no. >> mr. calvert, no. mr. akin? mr. cole? >> no. >> mr. cole, no. mr. price? >> no. >> mr. price, no. mr. mcclintock. >> no. >> mr. mcclinton, no. >> mr. chaifetz. >> no. >> mr. stutzman. >> no. >> mr. stutzman, no. >> mr. lankford. >> no. >> mr. lankford no. >> miss black. >> no. >> miss back, no. >> mr. ripple. >> no. >> mr. ribel no. >> mr. floor es? >> no. >> mr. flores, no. mr. mulvaney. >> no. >> mr. huls camp? >> no. >> mr. young?

>> no. >> mr. young, no. >> mr. amosh? >> no. >> mr. amosh, no. >> mr. rokita. >> no. >> mr. giunta? >> no. >> mr. giunta no. >> mr. woodall? >> no. >> mr. woodall, no. >> mr. van hollen, yes. >> miss sxharts. >> yay? >> miss captor? >> aye. >> miss captor, aye. >> mr. doggett? >> mr. bloomenhauer. miss mccallum? >> aye. >> miss mccallum, aye. mr. yarmuth? >> aye. mr. honda? mr. ryan? >> aye. >> mr. ryan, yay. miss wasserman schultz? >> aye. >> miss moore? miss castor? >> aye. >> miss castor aye. >> mr. schuler. >> aye. >> mr. schuler, aye.

>> miss bass? aye. >> miss bonimic sydney. >> aye. >> mr. chairman? >> no. >> mr. chairman, no. mr. chairman, on that vote the ayes are 12, the nos are 21. >> the nos have it. the motion it not agreed to. are there any other motions? miss had schwartz? >> i have a motion at desk. >> the clerk will call -- the clerk will designate. >> a motion offered by mischwar and miss wasserman-schultz. >> the staff will distribute the motion. >> miss schwartz is recognized for 25 minutes. >> to continue the discussion about the choices that with remaking and in fact there are choices being made by the republicans, this one again i think is quite stark. the republican budget sacrifices the health of millions of women

and children in this country in order to preserve tax breaks for companies that ship jobs overseas. again, this is a choice. how do we make sure that we reduce the deficit, how do we tackle some of the fiscal issues in our nation? we believe they are really important to tackle the deficit. we believe they ought to be done in a balanced approach and certainly should not be done on the backs of millions of women and children. of the more than $1.7 trillion in health care spending nationally every year in this country, less than four cents of every dollar of production is spent in public health. republican reconciliation language eliminates the entire $11.9 billion in funding for prevention efforts and public health efforts over the next ten years. investing in prevention and public health will offer a nation the opportunity to not only improve the health status of americans but also to control health care spending. the republican reconciliation, again, eliminates almost $12

billion in prevention of public health funds, including funding for immunizations, screenings for birth defects, developmental disabilities loss in children. the fund has been used to expand immunization for underserved children and adults. it all although indicates $72 million for vaccines to prevent childhood diseases like measles, and for seniors who need flu vaccines and other at-risk populations who need immunization efforts. according to the cdc, every dollar decrease -- every million-dollar decrease in this funding would lead to state and local entities having 30,000 fewer doses of life-saving vaccines. again, the repealing this fund, the republicans jeopardize the funding for 12 states conducting autism surveillance. we know the statistics on autism are justin incredible. early diagnosis and intervention makes a world of difference in

the success of children with autism. the republican language would have 52 states in territorielial departments now conducting hearing loss screening for infants would lose their funding. eliminating access to basic prevention services now virtually ensures we'll be paying more for costly treatments down the road. we should be testing best practices, and we should share what works. and we should be doing this on the local and state level. we just heard that from the other side of the aisle. that's the only way they would consider these efforts. that's exactly what this fund does. it actually funds local, private, nonprofit efforts and state efforts. my own governor has applied. republican has applied for these funds, because he knows what a different difference it can make in helping to make sure we save money in the long-term. this approach is short-sighted in terms of budgeting, it's certainly shortsighted in terms of the impact on the health and safety of our women, children and families. let me mention several of the ways that eliminating this

funding would have an impact on real americans. this republican language specifically targets women by eliminating funding from important screening and prevention efforts for women, including for cancer and heart disease. i know some of my colleagues will speak to this effort, as well. it -- there is already dedicated money in the president's budget, $143 million for prevention fund for breast and cervical cancer screening in all 50 states. this means that 326,000 fewer women will be screened if it republicans are successful, 326,000 fewer women will be screened for breast cancer. 284,000 fewer women will get cervical cancer screenings each year. it will result in an estimated 10,300 more cases of breast and cervical cancer being diagnosed in the later stages. an estimated 6,800 invasive cancers being diagnosed at the later stages.

by supporting my motion, you'll be restoring funding for these vital preventative services that protect women's health. on chronic diseases, chronic disease accounts for 70% of all health care deaths and costs in our nation. approximately $1.8 trillion each year in lost productivity, and health care expenditures. more than 60% of adult americans are overweight or obese. and this epidemic costs the united states $147 billion annually. obesity increases the risk of health conditions like coronary heart disease, stroke, high blood pressure, diabetes and cancer. we hear about this time and time again. people who are obese have health costs that are $1,429,000 higher than people with normal body weight. and this prevention fund that the republicans are going to vote to eliminate would reduce health care costs by -- it would actually increase health care

costs for these families and for the government, because they would eliminate the cdc's obesity biometrics grant, all these state and local efforts. six communities received announcement of dollars, including philadelphia. $9 million -- $9.3 million to support obesity reduction efforts in our local communities. there are local variables. there are different ways that we might be able to be successful. we should test those different ways, and we should, in fact, make sure that we eliminate what doesn't work, we use the evaluation efforts to identify the most effective and promising obesity strategies, using dollars wisely, helping to make sure that people are not sick and get sicker. one other thing i'll mention and then i'm going to turn it over to my colleagues. the prevention fund the republicans will eliminate if we don't stop them today would stop some of the most important efforts in training our primary care professionals.

we have all understood and talked about how important it is to make sure that women, children, families, seniors, get the most effective preventative services, particularly those with chronic diseases, and i'm talking about primary access -- access to primary care professionals. we know that with 10,000 baby boomers becoming seniors every day, that we need more primary care professionals, doctors, nurse practitioners, physicians assistants. and by what you're going to do today, the effort we're going to stop the republicans from doing is to actually -- we want to make sure we continue to train our physicians in primary care. $168 million for training 500 new primary care physicians by 2015, supporting physician assistance programs for $32 million. i just talked to a young woman today in my district who has just gotten into a physician assistant school next year, and is applying for one of these grants, can make a difference in her working with the most vulnerable populations, which is

what she wants to do. increasing the number of nurse practitione practitioners, $30 million, train 600 new nurse practitioners in establishing new nurse practitioner-led clinics. i could go on. but these dollars are so important in making sure that we have the kinds of dollars that are the best practices in how we can make sure that americans don't get sicker if they have chronic diseases, and prevent getting those chronic diseases in the first place, potentially saving millions if not billions of dollars in the future, in the very best way possible. not by slashing funding for important services, but, in fact, by showing what works and making sure that americans are healthier and that we save money in the right way. so in support of this motion, i want to yield five minutes to my colleague from florida, deb wasserman schultz. >> thank you very much congresswoman schwartz, and i'm glad we could work together on this motion.

and thank you also for your career-long leadership in the area of public health. this was an unprecedented investment, particularly the health of america's women and children. by providing fubltding for vital cancer and infection screenings, modernizing vaccine systems and the fight against endemocratics like obesity and diabetes, this fund truly invests in our nation's health. and it will provide savings down the line by helping to catch afflictions early. yet once again, republicans are playing politics with our health. while democrats have repeatedly voted for painful spending cuts, cuts we would normally oppose, because we understand that we need a common sense balanced approach to deficit reduction. by seeking to undermine the affordable care act, the republican bill would eliminate funding for hundreds of thousands, if not millions of life-saving screenings, all to score political points with their extreme base. mr. chairman, when i was 41 years old, i know many of the members know that i was

diagnosed with breast cancer after finding a lump in my own breast. it was confirmed to be cancer after a series of screenings, including a clinical screening, just like the ones that this fund provides. these screenings saved my life. but it bears repeating that this bill would prevent 326,000 women from having access to the same life-saving screenings that i did. it will prevent an estimated 10,300 women from being diagnosed with breast and cervical cancer in its early stages. which is why i'm still here today. because my breast cancer was caught early. thanks to these screenings. we can't afford legislation that attempts to pay our nation's bills by placing at risk the health of our nation's women. furthermore, this bill slashes funding for screening for birth defects, developmental disabilities and hearing loss in children. last year, the republican majority slashed funding for wik, for s.n.a.p. and maternal and child health block grants and now they are at it again. how can any of us in good

conscious cut funding by cutting investments in our children's health. frankly, i really don't know what else to say here, because i think it's just common sense you don't pay down a deficit on the backs of our children who didn't create that deficit in the first place. and compromise their health and their future. these republican cuts are not a balanced approach to reducing the deficit or replacing the sequester. they are reflective of the obsession of republicans to repeal the affordable care act. if our republican friends put such effort into a balanced approach to deficit reduction as they do in denying americans quality emotional health care, we would get the deficit reduced in no time. mr. chairman, this deficit hole was not dug by women and children, and we cannot climb out of it on their backs. instead, we have an opportunity with this motion to close the loophole that incentivizes american companies to ship our jobs overseas. but republicans are once again trying to protect their special interest friends by letting everyday americans pay the price. this isn't what americans are looking for. we need common sense, balanced solutions, and this bill does