support of this legislation that is going to provide an additional $2 billion for the cars act, a bill that i sponsored, sometimes referred to as cash for clunkers. but by any name, this bill has been thus far a tremendous success. it has helped consumers purchase cars that they couldn't have purchased in this downturn, but which they need. it is going to give them fuel savings for a long time to come. it is helping our auto companies and dealers, all of the jobs associated with that very vital and important industry in this country to maintain itself, to continue and give it the chance to grow and store. the program is good for our environment pa because it is taking the less fuel efficient cars and getting them off the road and replacing them with more fuel efficient cars. this is an unprecedented success, and we must make sure that it works throughout the

entire process. but we are well on our way, and i appreciate the leadership of the chairman of the appropriations committee, secretary lahood, the administration who i have been working closely with to make sure that we build on the success which is stimulating our economy, keeping people working, helping our environment, and helping our consumers when they really, really need it. i yield back. . the gentleman from california. mr. lewis: mr. speaker, i'd like to say to the gentlelady who has offered this floor, she has more -- i'm proud to yield two minutes to the gentleman from california, mr. campbell. the speaker pro tempore: the gentleman from california is recognized for two minutes. mr. campbell: thank you, mr. speaker. and i thank the gentleman for yielding. you know, mr. speaker, cash for

clunkers program was inartfully clunkers program was inartfully drafted, i than come bersome than it needs to be -- come bersome than it needs -- cumbersome than it needs to be. the administration of it has not gone on well but it has worked. and, mr. speaker, we have passed a number of things in this congress this year intended to stimulate the economy. the vast majority of them have not had that effect. but this one has. and it has clearly worked. for the initial billion dollars to be exhausted, that means that roughly 250,000 new vehicles must have been sold in just the last week or two in order to exhaust all of that money. that is clearing inventories in car dealerships which means car dealers will be ordering more cars. when they order more cars, plants will begin to run again. plants will open up. they will be producing more cars, and people will go back to work. there will be suppliers that will produce supplies, various parts for those cars, steel mills will be produced for those cars, and those people will go back to work. there will be trucks and trains that deliver those cars and

those people will go back to work. and, mr. speaker, the $2 billion for this is coming out of the existing funding, so it is not increasing the debt or the deficit any more than what has already been there. mr. speaker, i support this bill. i support this effort. there is -- it is the one thing we have done in this congress that is absolutely working. it is stimulating the economy. it is creating jobs and we want it to create more. i yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from wisconsin. mr. obey: i yield a minute and a half to the distinguished gentleman from massachusetts, mr. markey. the speaker pro tempore: the gentleman from massachusetts is recognized for a minute and a half. mr. markey: i thank the gentleman very much and i appreciate your hard work in extending this program. this program is a win for consumers who are trading in old gas guzzlers for hybrids, a win for our economy and a win for energy independence and the environment as the new vehicles are averaging 60% more fuel

efficiency than the junkers being taken off the road. however, i am concerned that we are taking funding from the renewable energy loan guarantee program and would express my strong belief that we must find a way of replenishing those funds as soon as possible. mr. chairman, could you work with me and other members to ensure that the funds for this program will be replenished? mr. obey: if will the gentleman yield? i share the gentleman's view that the renewable energy loan guarantee program is of vital importance to creating a new green economy. we have talked with the white house. we've talked with the speaker. and i want to assure you that all of us certainly have every intention of restoring these funds. mr. markey: i thank the chairman very much. i know that this has always been the highest priority for yourself, for speaker pelosi and for the obama administration. and i look forward to working with you in the future in order to make sure that we have a win-win here for renewable energy and for fuel-efficient

vehicles. thank you. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from california. mr. lewis: mr. speaker, i yield two minutes to the gentleman from arizona, mr. flake. the speaker pro tempore: the gentleman from arizona is recognized for two minutes. mr. flake: i won't take two minutes. i have to say i thought i had heard it all until i came to the floor today. somebody said earlier, this bill is a success. ford motor company loves it. i think that that's self-evident. but i think that there are taxpayers around the country who are wondering why we're taking $2 billion more from them to decide which industry here is going to get a break. we decided to give out free money and now we're surprised when people take advantage of it and love the program. i mean, that's the nature of human nature. if you're given free money, you like it and you want more. and that's what this program is. why are we deciding to aid this sector and not another? if you're mr. or mrs. businessman across the country,

you've got to be wondering if we have lost our minds here by saying we're going to continue to give out more money just for this industry but not help the others. i just -- i don't understand this process and how we can bring this up this quickly but an appropriations committee that can bring a defense bill to the floor in 18 minutes for a markup that has more than 1,100 earmarks, i guess, has no problem doing this. with that i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from wisconsin. mr. obey: mr. chairman, i yield myself 20 seconds. the speaker pro tempore: the gentleman is recognized. mr. obey: i just want to say, mr. chairman -- mr. speaker, that we've heard several times here today about this action are complaints from the people who helped wreck america's economy and are now complaining because of the way this president and this congress is trying to pull the country out of the ditch and restore economic growth. we've come to expect that, but that doesn't make it any more pleasant.

with that i yield a minute to the distinguished speaker of the house. the speaker pro tempore: the speaker of the house is recognized. the speaker: thank you very much, mr. speaker. i thank the gentleman for yielding and i thank him for his very important and swift action to address the opportunity that was given to us this week. as you know, my colleagues, as part of the supplemental earlier this year the cash for clunkers provision was provided in it. many people had worked very, very hard on that for a long time and we were able to have it passed on a bill that was going to be signed by the president. i want to acknowledge congresswoman sutton for her enthusiastic support and leadership, congressman inslee, congressman israel, steve israel of new york, all worked very hard on this. certainly the chairman emeritus, mr. dingell, the current chairman of the -- the current chairman, mr. waxman, mr.

markey, for his leadership on this issue for a long period of time. i mention all of them because this brings together so many elements of what we want to do to grow our economy, to help our workers, to protect our environment and to do so in a very focused way that works. and that's what is interesting about this week and about -- week. in about six days it's estimated that 250,000 cars were sold. on both sides of the aisle people acknowledge the effectiveness of this initiative. and that is why yesterday, as we were seeing what was happening this week, the obama administration asked us to help consumers who have yet to have the opportunity to take advantage of trading in their old cars for new energy efficient models. when they do that, again, they strengthen the auto industry, strengthen our economy at large and help preserve our

environment. what's interesting about it and the point that is made by many speakers already is just -- that was made by many speakers already is just that everything has performed beyond the requirements of the bill. the cars that have been purchased are much more fuel efficient and the emission standard much better than the bill even required and that's good news. i do share the concern that has been put forth by mr. markey and, i don't know if mr. inslee has yet but he will, about the source of the revenue and that is the innovative technology's loan guarantee program. the recovery package in january, we voted for a $6 billion initiative. it was very important to have it at that level and it's very important in terms of our renewables program. $6 billion.

the administration has just released a solicitation for about half of that money, $3 billion, in loans for renewable energy. the rest of the money would not be released until next year, until after january. so that gave us an opportunity for the time being to use $2 billion of that for this cash for clunkers expansion. and i, again, am concerned about the fact that that money is taken from that account but the not taken -- it has not made any opportunity costs for the program because the timing is that that money would be spent next year. i do hope that whether it's in the continuing resolution or some other step along the way, that those funds will be restored because it's not appropriate for us to take money to do one thing for fuel efficiency out of an account that is designed to do just that looking into the future with further inovation.

so i share the concerns expressed by mr. markey and appreciate the comments made by mr. obey in the colloquy that they had about restoring those funds. but again i think this is pretty exciting -- this is a pretty exciting day. as i said, we got the word just as this news was unfolding this week, yesterday it was determined that we could go forward. the rules committee under congresswoman slaughter responded very positively, the chairman of the appropriations committee, mr. obey, just trying to find solutions for us and the leadership of the republican party very cooperative in how we could bring the billed to floor. so this is a very positive, bipartisan initiative to help our auto industry, to help consumers, to grow our economy, to do it in an environmentally sound way. i think it's the perfect message for us to take home for august. thank you all for your leadership in making this possible. with that i yield back the balance of my time.

the speaker pro tempore: the gentlewoman yields back the balance of her time. the gentleman from california. mr. lewis: mr. speaker, the time remaining on each side? the speaker pro tempore: the gentleman from california has four minutes remaining and the gentleman from wisconsin has 7 3/4 minutes remaining. mr. lewis: thank you, mr. speaker. i yield one minute to dr. broun. the speaker pro tempore: the gentleman is recognized for one minute. mr. broun: i thank my friend from california for yielding. cash for clunkers has serious problems that are administrative problems. i have dealers in my district in northeast georgia that probably are going to go bankrupt because of these problems and i hope as we go forward that we'll fix these administrative snafus that are in this problem. we're throwing money into another government program that has serious, very serious problems where dealers can't get their money. i have one dealer that has paid out of his pocket for 50 cars and has only gotten money back for one.

now that dealer, if he doesn't get paid back, is going to have very severe financial problems and his employees are going to be put out of work if we don't fix these. certainly we've sold a lot of cars because this program but just throwing money into a program that has tremendous administrative red tape problems and other problems is not going to be the long-term answer. i hope that the administration will straighten out these administration snafus and will get this program the money to dealers that they desperately need. i yield back. the speaker pro tempore: the gentleman's time has expired. the gentleman from wisconsin. mr. obey: i yield one minute to the distinguished gentleman from new york, mr. maffei. the speaker pro tempore: the gentleman from new york is recognized for one minute. without objection. mr. maffei: mr. speaker, today we are faced with a rare problem. we have a program that is proven to be working and all with we

need to do is keep it working. getting gas guzzling vehicles off the road replaced by new fuel efficient vehicles is helping our environment, it is putting money directly into the pockets of middle income families, it is a ray of hope for auto dealers in this country, a ray of hope for the u.s. auto industry and a ray of hope for our economy. finally we have a bailout not for the big businesses, not for wall street, but a bailout for main street. as the lead sponsor of a bill to help protect the legal rights of auto dealers, i can tell you, this is a god send for the auto dealers in my district. don't stall what's working. give it a fillup and let's get cash for clunkers back on the road. i yield back the balance of my time. the speaker pro tempore: the >> we will talk to the press reporter about the cash for

clunkers program. the heritage foundation posted david mason will discuss a bill to put limits on executive pay. joe madison will debate the state of race relations in america. washington journal is like each morning at 7:00 eastern on c- span. >> george signed the declaration of independence. he was also murdered. father bruce chadwick on "i am murdered." at 8:00 p.m. eastern on c-span. >> now the house energy and commerce committee pose a market of health care legislation. they discuss republican joe barton's amendment to take the public plan out to the bill and replace it with reimbursement programs. this is two hours and 25 minutes.

this meeting will please come to order. we're still considering amendments to titles "a" and "b." mr. barton, i believe you have an amendment you wish to offer at this time. >> mr. chairman, could we have a colloquy first before we go to that? >> certainly. >> i was not privy to the fan club meeting out in the hallway. could you brief the committee on what you told the world? >> we have tried to bring the democrats together.

and we wish we could bring you with us. perhaps we will. >> part "a" first before you go to part "b." >> perhaps we will. we're going to have a series of amendments. they will be shared and must be available for two hours in advance that will include the blue dog amendment and several other amendments. we hope members will look kindly on these commitments. >> hope springs eternal. perhaps some of them will be kindly looked upon. i hope so. could you educate the committee on your timetable for concluding for today? >> i would like to conclude the markup by 2:00 this afternoon. i know that's a very tight tame frame and there are lots of amendments, but i think we ought to set that as a goal and try to

stick to it. i would hope we could therefore we strict the time of debate -- we were doing ten minutes on each side yesterday. five on each side would be better. i've discussed this with you privately. you think we shouldn't go to five on each side officially, but encourage all members to stay within five minutes. >> we will try to adhere to that, mr. chairman. with some exceptions. i think that will work. can we now amend the bill at any point? >> we're still on "a" and "b." >> i have a transparency amendment in "c" that i think may be accepted. also an amendment for "c" we

think can be accepted. >> we are going to get to all of these amendments. prioritize your amendments so that we can conclude our deliberations in the afternoon. but all amendments will be considered. >> thank you, there chairman. with that understand iing -- >> all amendments considered within the time limits that we have. >> we are appreciative of the way you conducted this markup. we do hope on the republican side that it has a happy conclusion for all. >> thank you. >> with that, mr. chairman, i do have an amendment at the desk. >> clerk will report the amendment. >> without objection the amendment will be considered as read. recognized for five minutes. >> mr. chairman, one of the most controversial and contentious points in the pending

legislation is the public plan. the public plan is put into the legislation to provide coverage or insurance coverage for all americans who currently do not have it for whatever reason. the problem with that is it's very expensive. it's very controversial. it's very difficult to figure out how to put it together. there is an easier way. this amendment is not the only easier way but it is an easier way. a subtitle to division "a" that related to the public health insurance options. we take that out and put in a guarantee. that we would help set up in each state, we call a qualified

state reinsurance program. and/or a qualifying high risk pool. we would totally fund it with federal dollars so that every individual in that particular state has the option to go into this reinsurance program or high-risk pool and get the insurance that they wish. it's that simple. webl that the score on this over a ten-year period would be in the neighborhood of $16 llion. so it is certainly less than a trillion. it is simple. it is straight forward. we have every indication that it would work. there's no need for a massive bureaucracy. you could use the existing state infrastructure that exists for the medicaid and the s-chip program if that's what you wish.

or the state could set up a separate system if they wish to do that. so it's a two-page amendment -- or a three-page amendment. the state high-risk pool has to offer assistance for low-income individuals. it has to offer a variety of covered options. it must be funded with a stable funding source. it has to cover all preexisting conditions. it's pretty straight forward. i would hope that you might look favorably upon it. >> gentleman yields back the balance of his time. >> i'm opposed to the amendment. i do want to point out that he has been a champion for individuals harmed by abusive practices like the rescission practices that have been looked

into quite a bit by the oversight and investigations committee. i think you don't believe in what's so great about what we've done with this bill. i'm so proud of this bill. i'm so proud of president obama. he's managed to get the insurance companies to come in and say that they'll support health care reform. and eliminate discriminatory practices based on gender or whatever. the exchange itself gives the people a choice of a new coverage option that does not have the track record of discriminatory behavior that many private insurers have showed. we talk about it being the

american plan. it's not the british plan. it's not the french plan. it's not the canadian plan. it's the american plan. what it says is that if you have insurance through your employer or medicare or medicaid or the va or whatever you have, you can keep it. but we know a lot of people don't have insurance. we know a lot of people go out and look for individual policies. often times they can't get them because of preconditions or they're so expensive. small group plans that are too expensive and have all these discriminatory practices. we're setting up this exchange with both public and private insurers competing against each other that has eliminated these practices and provide affordability for several reasons. now there's a large exchange. all the the people participated in it are acting like a large group plan. they bring prices down. then you have the competition between the public option and

the other private insurers. it brings prices down more. then you have a sub su di for a lot of people that brings prices down even more. so for a lot of reasons, and the public plan is an important part of it, we're really eliminating discrimination. and the public plan is a very important part of that. not the only part of it. so what you're proposing simply isn't necessary. there's no reason to set up these high risk pools or the other things that you're talking about and putting that burden on the state. because the exchange accomplishes everything that you're seeking to accomplish. >> would you yield? >> i yield to the gentlewoman. >> thank you very much. i've been pretty kwooiquiet, bue been taking it all in. i'm a blue dog. but i call myself the unblue dog for purposes of health care. like mr. barton and many others on the committee and both sides i strongly believe in the ability of markets to deliver

the best health care. that is why i support a robust public option. it can create pooled purchasing power to lowered prices. multistate drug purchasing pools. there are examples of how well this kind of thing can work. this flexibility. incentives to innovate and competition. the public plan will at the max have 30 million people. many estimates are far smaller. so it won't be the dominant exclusive provider of health care. right now we have a market failure. we have one insurance plan in 50% of the markets in the united states. 94% my abled colleague corrects me. that is obviously worse. i wanted to name it something

else. i have always thought that sounds a bit scary. but that's its name. and what it is is a way to drive competition, get prices down, and quality up, and that's what we're all about in trying to report this bill today. thank you for yielding. >> mr. chairman, the problem is you're such a pessimist. you have a notion that what we have out there is doomed to failure. therefore you've got to set up these high-risk insurance pools. this bill is the most optimistic wonderful thing we could possibly achieve. don't take it down with this pessimistic attitude of this amendment. i yield back. >> gentleman yields back his time. >> very briefly, mr. chairman. contrary to what my friend from new jersey says i'm an optimist. but i look at the cbo score in the current bill and i see a trillion. it's not all because of the

public plan, but a big chunk of it is. i look at this ternd and i see $2 billion a year. if we can get the same bang for the buck, it would seem to me we would want to go with the less expensive alternative. but i'm very optimistic. the market, transparency, through the state, infrastructure, it saves a lot of money in overhead. it's much prefer to something that in the public opinion polls less than half the country says they won't. with that i yield back. >> the vote comes on the barton amendment. i believe we're going to go to a role call vote. the clerk will call the role.

>> mr. waxman. >> no. >> mr. waxman, no. >> mr. dingle. >> mr. dingle no. mr. marqui. mr. bouchr. mr. palone. mr. palone, no. mr. gordon. mr. gordon, no. no. mr. engle. mr. engle no. >> mr. green, mr. green, no.

@@@@@@@@@ @ @ @ @ @ @ @ @ @ @ [roll call vote] [roll call vote]

mrs. christianson. mrs. caster. mrs. caster, no. mr. sarbane, no. mr. murphy of connecticut. mr. murphy, no. mr. space, no. mr. mcnerny. mr. mcnerny, no. mrs. sutton. mrs. sutton, no. mr. welch. mr. welch, no. mr. barton. mr. barton, aye. mr. upton, aye. mr. stern. mr. diehl, aye. mr. whitfield, aye.

mr. blunt. mr. blunt. mr. blunt, aye. mr. boyer. mr. boyer, aye. mr. pitts. mr. pitts, aye. mr. terry. mr. terry, aye. >> mr. rogers. mr. rogers, aye. mr. sullivan. mr. sullivan, aye. mr. murphy of pennsylvania. mr. murphy, aye. mr. burgess. mrs. blackburn. mrs. blackburn, aye.

mrs. scolise, aye. mrs. christianson votes no. mr. rusch, no. mr. stupack, no. mr. doyle, mr. doyle, no. mr. marqui, no. mr. mathison. mr. mathison votes no. mr. stern, aye. mr. ross. mr. ross votes no.

>> have all members responded to the call of the role? this is an opportunity if anyone wishes to change his or her vot vote. >> clerk will vote report the votes. >> 22 ayes, 32 noes. the amendment is not agreed to. you have an amendment at the desk. >> thank you, mr. chairman. i have an amendment at the desk. 06 069. >> may we get the decision on that amendment? it's either "a" or "b." it's to "b." >> to "b"? thank you.

>> clerk will report the amendment. >> young lady is recognized for five minutes. >> thank you, mr. chairman. my colleague is a clarification of medicaid coverage for citizens of freely associated states. which most of you may not be familiar with. i'll just spend about a minute. over the years the federal government has made treaty agreements with the islands and to allow citizens to enter the

united states without a visa or health certification. they're called compact migrants. in exchange the u.s. operates military bases on the islands. they tested bombs on the islands, which had detrimental health effects to people living there. including their children, and their children's children. they're allowed to arrive and live in any of the 50 states. that state is required to pay for them with no federal assistance whatsoever. the federal government stop contributing medicaid dollars towards compact migrant health care. while states are not required to cover compact immigrants, there are serious public health ramifications for not doing so. this amendment addresses that gap, and i'm pleased to offer it i think it's a worthy amendment. i can hardly hear myself speak.

i don't think the committee is in order, mr. chairman. >> young lady is correct. committee will please come to order. >> thank you for calling me young lady. i caught that. nice way to start the day. at any rate, hawaii has the highest number of compact migrants. due to its proximity. that state alone is spending hundreds of millions dollars in medicaid alone. i would like to yield to mr. engle. i thank the chairman for allowing us to offer this amendment. it makes sense. it's practical. it's fair. it makes sense. especially since tts united states entered into an agreement with them. >> the young lady yielding to me, we'll say it twice.

i'm pleased to put forward in amendment to her with our friend mr. abecrombie from hawaii. these are agreements made by the united states. we talk a lot about unfunded mandates on the states. this is an unfunded mandate if i ever saw one. we have treaty agreements with these countries. people come over here to work. the united states, the federal government, signs these agreements then the states are left to pay for this. this isn't right at all. this should be pads for by the federal government. compact migrants are allowed to come to the united states. the state must absorb their cost. that isn't right at all. so this amendment simply makes compact migrants eligible for medicaid, with federal matching dollars to help pay for them. that is something that's very

important now we have treaty agreements with the islands. and the people come over. it's not simply they're people come over here. we are getting something in return. we have bases on these islands. this is something that's important to the united states' national security. and all we're saying is the state should not be left holding the bag if this is a federal agreement then the federal government needs to be responsible. we will yield back the balance of our time. >> time has been yielded. >> yield back. >> mr. barton. >> i'm going to insist on mr.

scolice's point of order. this bill has not been referred to the interior committee. therefore this amendment is not germane. for the same reason one of the amendments we offered last night was not germane. >> without objection while we check with the parliamentary, may we set aside this issue. we do want to get a definitive ruling. >> sure. >> without objection the amendment will be put aside. the pend iing matter before us which is the point of order. we'll return to it as soon as -- >> just an objection here p mr. chairman. i just want a clarification. we have indicated a point of

order. mr. barton indicated a reason. it's almost identical to last night. >> rather than telling me how identical it is, let me find out what his view is. because we do rely heavily on the parliamentarian's views. i want to put aside the debate on the issue. >> you seem to be able to make the decision last night pretty quickly. i don't understand why we have to put this aside. it's absolutely identical. we wanted to make sure the members of congress had the same policy health care as the rest of americans. we asked for a vote on it. you would not allow the vote because you said it was not germane because it had to be referred to government administration. you made a decision on the spotd. i don't understand. this is absolutely identical. why can't we use a parallel? >> gentleman yield to me? >> sure. >> last night when that issue

came up, we called the parliamentarian to get the ruling. that's the way to operate. we have to follow the rules. >> i understand the rules. but once the rule has been set, then you just follow the rule. i think you established the rule last night. so let's just follow the rule. >> we would like to see if the same rule applies. >> it might be a different rule today. identical. we were slightly offended we couldn't offer this. >> will you yield to me? >> oh, sure. >> i don't know why you should be offended. we're trying to follow the rules. i would think you would be offended if you didn't follow the rules. >> it's not the question of following the rules. a precedent was set. you made a decision.

this is an identical precedent. if you're talking in terms of legality. you already set a precedence. i don't understand what the big discussion is. >> some time you may be chairman of the committee. although i doubt you'll ever be on the supreme court. let's wait. some people think he should be on the supreme court? >> mr. chairman, parliamentary inquiry? >> let's not waste time. >> how long you going to take on this? is it going to be half hour? ten minutes? a day? >> you want to stop work while we're -- >> not necessarily. it seems to me it's so blatantly obvious this is not germane. >> is the chairman bound by the ruling of the parliamentarian? >> it's a strong indication of

what the interpretation of the rules. >> where is this parliamentari n parliamentarian? >> i'm going to recognize you to speak on the point of order. you have your views. we'll have some debate. then i'll make a ruling based on the parliamentarian's advice. >> i don't want you to get upset. >> i don't want you to be upset. all i want to do is follow the rules. >> isn't the parliamentarian right behind you? >> no, no, no. we have a house parliamentarian? >> did you consult last night? >> yes. >> it seems like you made that decision pretty promptly. that decision was made within three or four minutes. it seems like this is very simple to do. i guess the question for you. what is the difference between this and last night that you can't rule without the

parliamentarian? that would be the key question for you to answer. >> the question is whether i need a parliamentarian's view or not? >> based upon@@@@"$4 do not you think it is unclear that the chairmen on his desire to get an interpretation? is that unreasonable to give him a few minutes to get in interpretations of economic and informed decision? >> i need this fundamentally unfair to go forward. this amendment -- a preston has been set. new have a precedent, you follow that precedent. >> and do not know exactly why you have the time. [laughter] the issue is this, it does depend on what committee a bill

was referred to when it was introduced. depend on what committee a bill was referred to when it was introduced. and i want to find out if that rule pertains in this particular case, last night's ruling, was a fact that the amendment which i supported was not in order under the rules because the bill had -- had not be referred to the committee on house administration and therefore, we would be legislationing in that committee's jurisdiction, now the inference from that, had the bill originally sent to the house administration committee, it might have been germane. i don't know if this bill was originally referred to the interior committee. and what the parliamentarian's view would be of that matter.

if you want to play strictly by the rules, and you don't want us to do anything else than talk about this issue, i'll ask the lady to withdraw her amendment and we'll come back to it. >> thank you, mr. chairman. for the record, i just think especially mr. stearns should know that the bill was introduced last year, to reinstate these federal benefits and we went through the story of what happens in the agreements and why we think that this is a good, sensible case to be made and it was -- it was exactly like this amendment, that legislation. and it did not -- it was never isn't to or had to go the interior committee. so, i just ask you to consider that if, if the chairman thinks that we should withdraw and this

will be -- you got a ruling in. >> mr. chairman? >> i'm ready -- >> mr. chairman? >> do you want to withdraw it? >> what's the ruling? >> mr. chairman, mr. chairman. >> committee will come to order. committee will come to order. let's -- i have just now had an interpretation from the parliamentarian, now, i request not to withdraw your amendment. point of order has been recognized. mr. scalise or mr. barton, if you would like to elaborate. the parliamentarian has given me an interpretation. >> i'll yield to the ranking member. >> i think i said what i wanted to say. i might ask the gentle lady from california, when her bill was introduced, was it refer to any

other committee last year? >> thank you. to my understanding, it was not. no referral to interior. >> we're told that it was referred also to the ag committee last year. not the resources committee, not the interior committee. anyway, we're ready to hear your ruling. >> we have been informed by the parliamentarian that this particular amendment doesn't invoke the resources of the resurss committee or any other committ committee, but this committee. the point of order will not be sustain. further debate on the eshoo amendment. mr. chairman. mr. barton. >> i'll recognize your five minutes. >> to oppose the eshoo amendment. i want to make one comment on the ruling. based on the ruling you just

ga gave, will it be -- i'll ask that later. we understand what the gentle lady from california and the gentleman from new york are attempting to do, but it does call into question, this would be an expansion of medicaid, it would waive certain rules that citizens of the united states. there should be another way to help these folks without in essence, waiving current federal law. we would oppose it on policy grounds. >> gentleman opposes the amendment. >> who seeks recognition? >> mr. hall. >> i yield my time to chairman stearns. >> i yield my time to you if i

have the time. >> you have the time. >> i rise in opposition of this. i don't think many people know what payload is, it's a very small country, the country only has about 600 people in it, a huge number of islands that stretch out, supposedly 17 of the terrorists from gitmo, guantanamo bay are going to be sent there. we're going to $200 million so they'll take these terrorists. their all gdp is about $64 million. is a huge surplus. for the united states to say we're going to include in medicaid, to bypass the five-year waiting period, under. personal responsibility and the work reconciliation act, seems a little over the top. i'm not sure we need to do that.

mr. engel mentioned that we have a military base there. so, i really think this is a huge amount of money we're gi giving to these folks and i just impose an amendment on the basis on why not let them wait five years under the waiting period for the law. i just think, mr. chairman, that we should defeat the amendment. >> will the gentleman yield? >> sure. >> thank you. right now, these people are getting what they need. it's just paid for by the states as an unfunded mandate. i know my friend, because we have talked for many years is opposed to unfunded mandates. it's a matter of who will pay for it. the question is, if the united states government entered into

an agreement with these people, we may not like the agreement, but they entered into an agreement, shouldn't the united states federal government pay for it. it affects five states, hawaii, california, oregon, washington state and arkansas. so, it doesn't affect my home state. but i think it's fair that the federal government pay for something that they entered into and not put an unfunded mandate on the state. >> we got unfunded mandates across the board here everywhere. i'm sure california w the budget crisis, has unfunded mandates, too, is there any reason, mr. n engel, why they couldn't wait? >> well, because these agreements have been in effect for many, many years. and the states are forced to, to

pay for this. so, if we wait five years, it's just five years of the states paying for an unfunded mandate. >> just with the economy here in the united states, so dishefled and such high employment across the country, should we go into palau, that has such low gdp. isn't there some point where we follow the year? >> if the gentleman would yield? >> just one last question, how much is this going to cost the united states government? what's the total cost? >> i'm told it's $200 million over ten years. scored by cbo. i want to say it's the federal government signed the agreements, allowing these people to enter the u.s. without

ve vi visas. >> gentleman, yield. >> gentleman's time has expired. we have consumed five minutes on each side. i would like to ask that we allow the gentle lady from the virgin islands to have two minutes. >> thank you, mr. chairman. i'm in strong support of the eshoo/engel amendment. the freely associated states, former residents of trust territories of the united states and in some instances, the marshall islands, they have been on the receiving end on many of our nuclear tests and have remain loyal -- loyal to this country throughout. there is a compact agreement between the united states and these freely associated states and i think the fact they were

trust territories of the united states, these are not immigrants from a totally foreign country, they have always -- they historically been part of this country as residents of truster the toirs. the compact being in place, assistance to these freely associated states. supports this amtdment and providing medicaid to the freely associated states who are allowed freely migrate to the united states and placing an undue burden on the states where they decide. >> are we saying palau, is that an island in the south pacific? where it was bypassed already. but a general wanted to take it.

>> palau -- >> one of the most beautiful islands in the pacific. >> yes. >> how can there be over 500, 600 people there? >> a lot of people who migrated to hawaii or arkansas, are not from palau but from the marshall islands, some of the poorest islands in micronesia, and who have suffered because of the activities, the nuclear activities that we have done in those islands. >> all time is expired. >> will the gentlewoman yield? it's over? >> we got a lot of amendments before us. >> these people pay taxes in the united states. >> all those in favor of the

eshoo amendment. say aye. mr. chairman, an amendment at the desk. >> mr. chairman, can i reserve a pint of order? >> gentleman from new jersey, reserves a point of order. clerk will report the order. >> the amendment offered by shadegg of arizona. >> thank you, mr. chairman. this amendment is to a stealth provision of the bill, a provision of the bill that no one has talked about in the press and no one has talked in this room. it's a provision i'm betting, that no one knows it's in the bill. under current law, if. an union plan negligently or

even willfully and in bad faith denies coverage to an employee, and that employee is either injured or killed by the denial of coverage, that employee can recover nothing for their injuries, nothing, even if there's a wrongful death. now, one would think that's the kind of injustice that congress would want to correct. no one, in america should be left to suffer a loss like that from the wrongful denial of coverage and recover nothing. but this bill, not only doesn't fix this problem it literally preserves it and extends it. this injustice is a case, late in her pregnancy florence cochran was ordered hospitalized, either she would die or her baby would die. but united health care refused

to cover her hospital stay. they would only offer home nursing services. tragically mr. corcoran's treating physician wdpdpéé/>m÷ united health care's outrageous conduct, mrs. corcoran and her husband could recover nothing

for the death of their child, absolutely nothing. why? because the united states security court had ruled under section 514 the corcorans could recover nothing for their injury. in this bill, we do not fix the injustice of corcoran versus united health care, we preserve and protect section 514. don't believe me? open the bill to page 49. and look at lines 19 through 22. we apply section 514 to future plans. this committee has defeated amtdment after amendment to provide medical doctors with some slight form of liability protection. but in this bill, we extend and preserve immunity for government plans, an injustice which leaves

people like the corcorans with no remedies. there are unions across the country that support this bill. i wonder if they know they're exposing union members to this kind of an injury? i know that the american medical association has come out in support of this bill and say they think it's a good idea. it makes doctors liable, but other plans immune. i wonder my colleagues on the other side of the aisle that they're voting for immunity for plans that not only negligently refused to provide coverage but willfully and in bad faith refuse to provide coverage. my amendment simply removes this injustice and provides that no plan should be able to immune. with that, i'll be happy to yield to my partner, mr. terry. >> this is a good amendment, at the heart of a long-running debate about the responsibility

of the administrators of plans, this fixes what the courts have dimed an immunity for these plans caused by the language within the arisa law. so, this protect patients. this is consumer-or not d. it fixes a long-running problem. and, because the bill opens up arisa, of course you can't do any federal exchange without discussing arisa, because this in essence this replaces arisa. >> mr. burgess. >> i would like to point out, this is a huge, huge problem. but more importantly, there's also an arisa exemption that allows some people access to the white house, specifically members of congress.

i yield back to the gentleman. >> mr. chairman, having read the amendment, having problems in the past because i represented distri district, a great number of employers fall under arisa. i have some concerns about jurisdiction. >> that is a problem, mr. shadegg, that this particular amendment says specifically, that we're referring to the arisa law and that is not within the jurisdiction of this committee. i would -- i am support your amendment, i feel badly that we can't take it up. but we have jurisdictional elements. i don't know if you want to withdraw it. >> i understand, if i can be heard on point, mr. chairman. >> okay. >> mr. chairman, i didn't raise a point. >> mr. pallone did raise a point

of order. he's asserting the point of order. i would like to recognize you on the point. >> let's hear what the point of order is. we would like to hear what it is. >> the point of order, if i might speak for you mr. pallone, it's not within the jurisdiction of this committee and not germane to this bill. it amends the arisa statute. that's not within our jurisdiction. >> shadegg? >> if barton wants to finish. >> i would like to recognize -- >> i do want to be recognized. i'll let you go first, mr. chairman. >> here's, you know, this is an unusual situation, mr. chairman. last night, we had an amendment by mr. blunt on covering whatever the public plan is that members of congress had to be

included in that plan, you were eloquent that you supported it but you were constrained because of a point of order that you can't accept it. mr. shadegg put up an amendment that you're very supportive of. if the majority doesn't make a point of order, we can do whatever we want to do. the point of order is only valid if it's insisted upon. if you're for this, i would suggest that you ask mr. pallone to remove his point of order. let's have a debate on the policy and see where the votes are. because this is acceptable under the rules. >> why don't you yield to mr. shadegg. >> thank you gentlemen for yielding. quite frankly a couple of comments on the substance. i'm stunned that this provision is there. i think there are questions to be asked about this language -- >> the matter before us is the

point of or order. >> it's immense dollar values to insurance plans. they're getting an individual mandate. and they're willing to accept for an individual mandate, a requirement that we have guaranteed issue and community rating. i wonder if they're getting is a immunity? i wonder if they're being candidate wid america? opinions from judges all over the country have called for congress to fix this. now when we have a chance to fix it, we're not fixing it. we're giving those insurance companies immunity. i think it's a little odd to allow insurance plans, under arisa, immunity.

but we can't give doctors any protection. quite frankly, mr. chairman, i think you're correct. this isn't in the jurisdiction of the committee. i would like to know what deal is behind it. i would like to make sure that the american people know that someone slips something in here in the dark of night, it's really important to slow down and look at these provisions. because i think mr. and mrs. corcoran got a raw deal. >> mr. chairman, on the point of order. >> who seeks recognition. >> clarification, when we appeal to the house parliamentarian, it's under my understanding that it's advisory to you and it's the chair's right to rule as the chair sees fit? is that the rules?

>> the charl makes the ruling. >> mr. chairman? i would like to speak. >> may i answer your question? >> you did. i . >> mr. boyer, on to point of order. >> yes, sir. >> gentleman, recognized. >> chairman, i respect the discretion of the chair. the challenge you have had here, that all committee of the house obtain jurisdiction of the bill. there have been amendments presented, good in protecting amendments, you would also like to adopt. the challenge will have, is how you go to the rules committee and combine these bills that come out of three committees. what we have here, mr. chairman, i'll be bringing amendments from

the veterans committee. when we come to this, my appeal to you, mr. chairman, i believe in you and your sincerity that this is a problem that you would like to work on but you're restrained by the parliamentarian. keep a side list of amendments that we would like to work with you as we go the rules committee to protect bill. mr. chairman. >> mr. chairman, i want to add, if you rule this as not germane, it's the correct ruling. i would urge my colleagues on the other side if you vote for this kind of language, don't be shocked when you get home in the august break and you're asked why are you voting to extend immunity to plans that for example, can injure or kill people when they deny coverage. in particular, people in union plans.

>> will the gentleman yield? >> who seeks recognition? >> mr. greene. >> mr. chairman, i do think that it's not the correct jurisdiction. but i understand the need, we have multistate employees. it needs to be corrected. i would love to work with my colleagues on the other side. who would be sensitive to that. but, i don't know if we have much choice but to carry that immunity forward since we don't have jurisdiction. >> could we move on? because we have a lot of work to do today. the chair is prepared to rule on the point of order. the chair has to follow the rules. i know without objection, without a point of order, legislation late in any other committee's jurisdiction, that's contrary to what the house of representatives and the committee system is all about.

i wouldn't want other committees legislationing in our jurisdiction if they do it by some sort of collusion. the rules are the rules. this chair rules that this rule is not germane because it legislation lates in areas that aren't within the jurisdiction. we're entertaining mandates. >> all i want to say, if people want copies of corcoran versus united health care, i would be happy to give them copies. >> mr. green, you have an amendment. >> thank you, mr. chairman. . >> the clerk will report the

amendment. . >> this is an in-block amendment that was actually submitted as one amendment within the time frame and i think the clerk will confirm that. >> can i ask the clerk if the amend system in order with within division "a" or "b" and filed within the two hours? >> yes, mr. chairman. >> thank you. >> mr. chairman, may i proceed?

>> has the clerk, amendment considered as read? >> gentlemen. >> thank you, mr. chairman. i'll try to be as brief as i can. the first provision deals with abdominal neuestical aneurism, a study, to date the utilization of the triple a screening in medicare is very low, to medicare beneficiaries owner to get a medicare exam. as a result, less than 10,000 beneficiaries look to take advantage of it since 2007. the amendment request -- >> will the gentleman yield. >> we're prepared to accept all three amendments.

>> actually four. >> i only have three. >> amendment number five is a quality msh@@báhb rszik sutton. >> let's make sure we understand what we're voting on and

agreeing on here. we got an amendment -- green 3200. section 1192. insert impairment after outcomes. we have green 001 xml, dealing with a report to congress on barriers to preventive services. >> mr. chairman, i can't hear. >> the committee is not in order. if the gentleman will suspend. >> can i ask the clerk the review the three amendments we're considering now? >> yes, mr. chairman, we're now passing out the sutton amendment 10, which was not passed out with if other three green amendments. we had green 5 underscore 0015. >> 4, 5 and 10. >> exactly.

>> are you in support of the sutton amendment as well? >> we have seen the sutton amendment and staff tells me, we're okay with that. >> can we consider those together at this time? >> all four considered in bloc and be accepted? >> any further debate on this since they have been agreed to on both sides? okay. without further debate, we'll call to question, all those in favor say aye. all those opposed say no and the amendments are adopted. we'll next go to the minority side. mr. whitfield. >> i have an amendment at the desk. >> the clerk will report the amendment. >> one moment, mr. chairman.

>> and i'll ask again, if the amendment is within the divisions and timely with the two-hour notice? >> it is, mr. chairman. >> the clerk will report the amendment. >> amendment to the amendment -- >> without objection the amendment will be considered as read. >> mr. whitfield, you're recognized for five minute and thank you very much. mr. chairman,chronic pain continues to be an issue, and procedures to deal with chronic pain are primarily done in ambulatory surgical centers and/or hospital outpatient clinics. it's made a decision that they are going to reduce the

reimbursements to pain management physicians in ten of their most 11 most prevalent procedures. in fact n 2009, they're going to receive a reduction of about 27%. and over the next five years, accumulative total of a little over 100%. now, the issue here is that gao has determined that it's more expensive to do these procedures in hospital outpatient clinics than it is in ambulatory surgical centers. so, we feel that if -- >> i can hardly hear. i would ask members to either sit down or go to the coat room so we can continue. >> if these procedures, reduce

procedures, which will increase the overall cost of health care. it provides a more toirm on these reductions until additional studies to be conducted. i will yield to the gentleman from penalty mrichlt. >> mr. stupak. >> he's right that ambulatory centers, those who deal with pain intervention, is facing 135% cut over the next five years. this year, it's about a 27% cut. as we trite to straighten this health care dilemma, i don't think one area or one certain group should take significant cuts in the reimbursement rate. we do have public option which is medicare reimbursement and physicians, but when you start cutting 27% out of one area, it's little much.

the other thing that i would point out, these are pain management specialists. if they're going to go specialists, they're going to be going to emergency rooms. people can still get the relief and still reimburse at a fair rate of reimbursement. i yield back. >> mr. whitfield. >> thank you. >> i yield back. >> yield back. >> mr. whitfield yields back. does anyone else wish to comment on the whitfield/stupak amendment. we'll call into question of the amendment. all those in favor say aye. those opposed. the ayes have it and the amendment is adopted. an amendment on the majority side. >> mr. chairman, i have three amendments at the desk.

engoal 6, engel 5. >> asked that they be considered together? >> yes. >> the clerk will report the amendments. >> amendment to the amendment in the nature offered by mr. engel of new york and mr. schakowsky of illinois. >> mr. engel is recognized for five minutes. >> thank you, mr. chairman. today i'm offering two amendments. the first is with my good fri d

friend, ms. capps of california. child-bearing women and newborns and uncovered adults, as we look to improve value, in cost containment in the underlying bill. our amendment will help us with these important goals. medicaid now pays for 43% of births in the country. 25% of hospital charges to medicaid are for child-bearing women and newborns. in fact, material newborn care is the most expensive medicaid hospital condition. we want to make sure we're spending our federal funds wisely on care. second, i have worked closer with my good friends mr. schakowsky and mr. hall, that's

supported by the american optometric association, our amendment requires medicaid coverage of the medical services furnished by an optometrist. it doesn't expand provider's scope of practice. i'm a strong spotter of the quality that the opt met reis in my district do. we need to provide quality health care services. i would urge my colleagues to support these amendments combined. and i yield to my good friend,

schakowsky of illinois. >> i'm glad we're able to work on a bipartisan way that was agreeable to all parties. i want to thank my colleague, representative hall for co-sponsoring the original bill and this amend wmt us. i want to thank representative sullivan for joining us on this amendment. we know providing access to comprehensive eye exams is the based way to diagnose eye and vision problems. we identify problems early and give children and adults the care they need. to ensure the people have access -- >> will the gentle lady of illinois yield? >> the minority's prepared to accept these amendments. >> i yield back. >> will the gentle lady yield first? >> i yield to representative hall. >> i want to thank you and thank you the american academy for

opthalmology. it's a good amendment. if you would yield to congressman sullivan for one minute for his comments. i yield back my time. >> thank you, congressman hall. mr. chairman, i support the engell/hall/schakowsky amendment. it's always been defined in the state, never at the federal level. it should be limited to provider's scope of practice as defined by state law. this amendment mandates provider status under medicaid program provided by optometrist. it leads these important decisions to the states. while we want to make sure that americans have access to vision care services, we want to make

sure that the federal legislation requiring state programs to reimburse optometrists for their services. this amendment strikes this balance. i encourage adoption of this amendment and i yield back. >> i thank gentleman. ms. capps. >> thank you. to my colleague, mr. chairman, this will also ensure the quality of maternity care is measured in c.h.i.p. program. when it comes to maternal mortality rates ranked around the world, we're tied with the country of belarus, we're 41st. we lack well-coordinated data. by including maternity care measures, we can do a better job of ensuring that a provider,

collecting necessary information and ensuring that companies are follow. >> gentleman's time has expired. >> mr. barton. >> i have unanimous consent request. we have a new member on the republican side that's joined us, mr. boehner. i asked that he be added on the minority side. for the remainder of the markup with full voting privileges. is there an objection to that? >> i have heard one. from mr. boehner. >> we're glad to have our leader here. >> we welcome the republican leader to our committee. >> the vote now comes on the engel/capps amendment. the ayes have it and the amendment is greed to.

. >> mr. chairman, two amendments i'll offer in block. to the relief of the committee, they have nothing to do with biomaz. >> let's not move on. two amendments. >> walden 3 and walden 2. will offer them in block. >> mr. chairman, we don't have walden 3. i mean -- >> we have walden 3. they're looking for walden 3.

>> one is division "b." >> one is division "b." and one is to division@@@@" > makeup where this health commission would be practitioners practice in the

rural areas so they have a voice of what it is like to practice in rural areas. i believe welch is a co-sponsor. mr. chairman -- >> will the gentleman yield? >> it already has a requirement like this. section 1805 of the social security act mandates that medpac has broad representation. adding this new requirement would be redundant. but i'm also open to accepting this and looking into it further. also, i support a balanced and robust benefits advisory committee. but we don't want this committee to become ineffectual. i support this amendment. we'll have to take a look at it as we move forward.

>> it has two rural commissioners. i believe one of them is actually a practitioner. they had issues that one practitioner wasn't there. when she finally was able to weigh in, they just missed the whole thing they were working on once they got her input. we're trying to get some balance. on page 31 of the legislation there's a long list of requirements for participation in the commission, dealing with all kinds of specific areas. we're looking for that rural voice. of the unique nature of delivering health care in rural areas. >> thank the gentleman for the amendment. all those in favor of the amendment. the ayes have it and the amendment is agreed to. >> mrs. capps. >> thank you, mr. chairman. an amendment at the desk. number 40002.

>> the clerk will report the amendment. >> an amendment to an amendment. >> without objection, the amendment will be considered. >> thank you, mr. chairman, this is the waxman/welch/capps, can combined amendment as we make a move toward wellness-based health care, we're insent vising people to seek care.

for the most effective and proven preventive clinical services we'll save money and lives. these services include cervical cancer screening for women, blood pressure screening for adults 18 years and older. these measures are not only common sense, they're prove on the work in preventing diseases which are extremely expensive to treat. one example that every parents knows about the advantage of screening young children for their vision, as they prepare to enter school, if we can ensure there are no financial barriers for these services, more americans will take advantage of them. i urge colleaguings to support this amendment and ensure that we don't stand in the way of individuals seeking preventive care. i'm happy to yield to the gentleman from vermont, mr. welch. >> thank you very much. this amendment is very important

to the state of vermont. because vermont entered into a very unusual arrangement with the federal government, instead of having our medicaid payments being totally tied to the number of people on medicaid, we entered into a long-term, five-year stable agreement, where vermont took on some risk, it might be eligible for some more money, in exchange received flexibility from the federal government in the ability to manage our program locally and it actually worked out. an arrangement entered into between a democrat legislature and a republican governor. if we had flexibility at the local level to administer this program we would be able to develop some efficiencies and provide benefits to folks without sacrificing act ssz and we have been successful doing it. this amendment essentially

allows us to maintain a federal state partnership. within vermont, our program has been a partnership between private and public insurer and mr. chairman, we haven't received all of this amendment. the little b bit that we have gotten, is okay. >> gentleman, yield. you make a good point. it looks like we had the wrong amendment distributed. we'll have the correct one distributed forthwith. >> do you want me to stop? >> let's continue the debate. >> essentially the amendment is respectful of arrangements that have been made by states who have taken some steps to provide access to health care to their citizens and it allows the implementation of the bill that's under consideration to be implemented without providing some ineffect penalty of those

states that are taking positive and constructive steps in trying to address the health care needs of their citizens. and i will yield back to mrs. capps. >> i'll yield now to the mr. chairman waxman. >> can we told, can you read the identifier on the amendment. we got two different amendments and we don't know which one you're all talking abt. >> clerk will inform us as to what's pending. >> mr. chairman, my understanding was that mrs. capps had mentioned -- well, she mentioned the 40002 amendment which we distributed. then we understood that the second amendment of capps with mr. welch and ms. sutton was also to be include zbld the amendment that i have in my hand

s says capps/sutton/welch? >> so, they have both been distributed now. >> does the gentleman from texas -- i want you to look at them. we would like to consider them in block. if you would like to divide them, we'll divide them. because of the fact they were not distributed in the same time. >> i'm going to ask for division. i want to divide the capps 40002. consider it separately and accept that. >> we're going to vote on that particular amendment, without objection, we'll divide the question of the two amendments. all those in favor of capps 40002. the ayes have it and the amendment's agreed to.

the secondment amendment, ms. capps you spoke in favor of it. >> the second one is mr. welch. >> he spoke in favor of it. is there further debate on that measure? >> i would like to ask mr. welch on this amendment, is your amendment for a direct negotiating for drug prices under medicare part d? >> it is not. don't be disappointed because it's come zblg which one do-- >> we had a waiver, mr. blunt from the federal government that was negotiating by our republican governor. and what that waiver did, was set a cap the obligation over a five-year period, we were a state that took the burden of risk, that in the event, our

medicare eligible population increased, the cost of that would be bourn by the vermont t taxpayer. the reason that we did that, it was a democratic legislature and a republican governor, is that we got some flexibility on our medicare program. >> on medicaid. >> on page 4, line 7, does this talk about medicaid or medicare? page 4, line 7. >> is that yours? >> maybe you don't have the same amendment that we have. >> i do. >> page 4, line 7, section 1186. >> we have in vermont, a price -- we have -- >> what i'm looking at, mr.

welch, negotiating of lower covered part d drug prices on the part of medicare beneficiaries. is that in your amendment? >> yes, it is. >> does that do what the title says? >> that actually might inaccurately state medicaid than medicare. >> counsel, does that section directly amend on medicare part d? >> turn on your mike. >> it amends part d of the medicare program. >> the answer is, yes. the description of the amendment and the amendment don't seem to me to be the same thing. i oppose the amendment.

or do you want to withdraw the amendment and come back with an amendment that meets your amendment? >> while you're referring to counsel, he was asked this question specifically the other day by the majority, direct negotiation on medicare part d save money and he said no, it would not save money. there are many people in the medicare part d program that already eligible to get veterans drugs that aren't negotiated. but they can't get the drugs that their doctor says they need. approaching somewhere in the neighborhood of 40%, people who have access to that negotiated

program have chosen instead to get the drugs they want by finding a company that offers them in medicare part d and i'll oppose that amendment. >> will the gentleman yield? down here. >> let me yield to mr. welch. >> let's see if we have the amendment we want. i believe this is the wrong amendment distributed. >> okay, without objection the amendment will be withdrawn, without prejudice to the gentleman offering the other amendment. >> the wrong one has been distributed. >> i'll be glad to oppose the wrong one when it's distributed at the right one. >> and i'll be glad to give you the opportunity. >> the amendment being distributed is the amendment that you intended to offer. >> apparently not, mr. chairman. >> let's withdraw it. are you ready to have the correct amendment distributed and debated at this time?

or do you want did zblsh i want to consult to see what happened here. >> let's move on to another amendment and then we'll come back. >> mr. buyer you have an amendment. >> at the desk, buyer 2. title of programs of health promotion or disease prevention. >> mr. pallone do you reserve a point of order? >> mr. chairman, i would reserve a point of order. >> the clerk have the amendment? be sure we have the right amendment and distribute the right amendment.

>> the clerk will report the amendment. >> amendment offed by mr. buyer of indiana. hivision a,@@@@@@@@@ @ @ @ @ @ s his support for these programs in any health reform package. with greater flexibility, employees will be able to draw more people into their programs

and improve the the health of m americans and decrees health care costs. employers today are providing the most innovative tools of improving the health of our population and decreasing health costs. regarding the bending of the cost curve, these employers showed providing employees with incentives to i improve their health, they're able to improve the health of their employees and save money. this is an idea that we should be embracing. it follows common sense that if you provide individuals with financial incentives they're more likely to work to improve their health care. it's one of the reasons that years ago we created the health savings accounts. trying to bring more personal responsibility back into the equation. the amendment expands upon the success of employer-sponsored wellness programs and provides

greater employee participation programs. it aloes discounts of up to 50% of the toe that's cost of an employee's health care coverage, instead of 20% allowed under current hipa regulations. the amendment with quantify existing wellness program regulations and expand existing regulations to allow the programs to grow. the amendment does not change current law regarding hipa regulations. they will stand in place to protect individuals' health information. additionally a wealth of other federal and state laws that wellness programs remain in place. ill like to read a quote from president obama he stated in a statement before the american medical association on june 15th, 2009. the president stated building a health care system that promotes prevention rather than just managing diseases will require all of us to do our part.

and safeway, which is rewarding workers for taking better care of their health while reducing health care cost miss the process. if you're one of the 3/4 of safeway workers enrolled in the program, you can get screened for problems like high blood pressure. >> the committee is not in order. i cannot hear the gentleman. >> gentleman is correct. committee will please come to order. >> it's a program that has helped safeway cut health care costs by over 13%. we are open to doing more to help employers adopt and expand programs like this. this is president obama's comment. with regards to the theme i'll reiterate on helping or -- strike the word helping. healthy people cost less. if 75% of health care costs come from four major conditions, cardiovascular disease, cancer, diabetes and obesity, if we can

have an impact upon human behavior, we can prevent some of these conditions. that's, in fact, what this amendment is all about. with that i will yield back my time. who seeks recognition? >> thank you, mr. chairman. i rise in opposition to the boyer amendment. to start i would like to ask unanimous consent that we include in the record and pass out a letter from 60 organizations that oppose the amendment. mr. chairman, i think we all -- >> mr.chairman, i want to reserve the right to object. we have not seen the letter. i would like to see it before we just give unanimous consent. >> all right. then i'll go ahead as they pass it down. >> no unanimous consent has been agreed to. the gentle lady asked it o be put in the record.

was that question? >> yes, and passed out. >> let's have it passed out. >> colleagues, i know we agree in employers playing a better role. well designed initiatives improve health outcomes, increase productivity and lower health care costs overall. these are covered by hipa. the health insurance affordability and accountability act prohibits them from treating them differently. this makes an accommodation for employer-sponsored wellness initiatives. but the wellness initiative must be structured in a

nondiscriminatory way. the eeoc has expressed concern over wellness concerns that are punitive. such as those that require employees to complete a mandatory health risk assessment of programs that require or use monetary penalties, use mandatory million exams and test i ing, employee inquiries. the boyer amendment unfortunately takes this task. if he could withdraw it we could work on a better structured amendment. appropriate wellness amendments improve access to preventive service and encourage healthy lifestyles through positive incentives. that encourage individuals to be actively engaged in their health care that pursue recommended reenings and maintain an

improved -- the employees' health through physical activity, good diet, good nutrition. unfortunately, the provisions in the boyer amendment give employers authority to raise premiums based on health status. in the current form it promotes the discriminatory programs that could compromise an employee's right to privacy in the workplace. >> would the gentle lady yield? >> i'm almost done. >> i'm afraid this amendment would undermine our overriding goal of health reform which is to provide access to affordable health care in a nondiscriminatory way. we are joined by the american association of people with disabilities, the american cancer society, the american heart association, the american stroke association, the american lung association, the epilepsy foundation, and since he came in

second in the tour de france, i'll mention the lance armstrong foundation. the administration also opposes this amendment. >> gentle lady has the time. >> gentle lady yield? >> yes, i'll go ahead and yield. >> i want to say briefly a lot of time was spent in sub committee hearings on the issue. the general consensus, and this is why i oppose the amendment is that this was something that is very difficult to figure out the balance so we don't start discrimination. it was suggested this be left it

would continue with the discriminatory practices. i would oppose it at this time. >> would you be willing to withdraw and we can work on an amendment that is -- that avoids the diskrim na tocriminatory ta keeps the general idea in place? i know we all agree that the on sight wellness and prevention programs are vital to keeping people healthy. i'll yield to the gentleman. >> i thank the gentlewoman for yielding to me. you made a comment in your statement, ma'am, that this amendment would allow employers to raise premiums. that's false. there's nothing that would affect existing laws. all we're doing is an amendment that was adopted in the senate

is very similar. and they go to 30%. i go to 50%. obviously we're going to talk about this at conference. i would prefer to remain with this. i'm doing what the senate is tals doing. >> i thank him. i respectfully disagree and would ask unanimous consent again that the letter with the 60 organizations in opposition be included in the record. >> without objection? now we've done five minutes on each side. i want to recognize mr. boyer, do you want to control the time for another five minute round? >> thank you, mr. chairman. >> the gentle lady from florida, i respectfully disagree how is it punitive or discriminatory

when you're not raising the premiums for those who don't choose to participate in a wellness program? what his amendment says we we ought to encourage this kind of activity, not discourage it. companies like safe way and others that have shown tremendous savings berewa -- by rewarding. that's what this should be all about. you would think other people are being discriminated. what's discriminatory about them paying the standard rate, the standard group rate for the health insurance policy but rewarding others who lower the cost? >> i reclaim my time. yield one minute. >> i want to thank my colleague. this is exactly the reason we fear the public option, which we

believe is the gateway drug is going to drive care to the lowest denominator. wellness is bad. let's penalize it. let's drive it down to the lowest denominator so we don't make wellness a part of the program. this is exactly why we're going the wrong direction. >> the language of opposition in here, frankly, i think the groups are just wrong. the gentle lady from florida says that charging individuals different premiums is wrong. everybody has to pay the same. everything is going to be equal. we need to look at healthy models. we talk about it in this committee. when we want to incent healthy behavior, we can't. everybody has to be treated the same. we rrnt punishing those morbidly obese and refuse to change their

behavior. smoke too much and drink too much. we're going to force those healthy to subsidize those. that's just a bad policy. >> thank you. this is a voluntary program. we should be promoting the personal responsibility of wellness. healthy people cost less. safe way saved $52 million between 2005 and 2009. it was based e ed on 22,500 employees. we can createer better incentives. it's something we should be doing. we have this in the automobile

sector. if we give to our children you get a discount. we incentivize. >> if a person has a good driving record, no accidents, no tickets, their rates for their auto insurance would be less than a person with multiple duis. multiple collisions, multiple speeding tickets? >> that's correct. yet, we are not permitted to do this in the ball with regard to someone who may voluntarily smoke or not take care of themselves versus those who would voluntarily do all they can to keep up their health, see a doctor regularly and not smoke. >> reclaim my time. the protections under current law are not affected by this

amendment. the hippa regulations remain in place.@@@@g sitting next to someone who does smoke who doesn't take care of themselves and the person realizing that the other person's taxes pay for them.

that would be an interesting conversation. >> gentleman's time has expired. you wish to be recognized. we're entitled to five minutes. if you can take less. lit be appreciated. >> i will move quickly. just begin by saying that autoinsurance is not the same as health insurance. a driver can choose not to speed. a person can't change her dna, heredity. it's easy to figure out who has had an accident or not and discourage that in the future with premiums. it's different in health care. completely different. so the gentle lady from florida has an amendment that's going to come up in a little while that deals with this issue in a way

that doesn't act in such a coercive way to say to people that the price you have to pay in order to receive lower premiums is that you have to give away your privacy. here's a form that one company gives to people, employees, is this something you want people to have to answer? i am planning on becoming pregnant in the next six months. i am not currently pregnant. i'm not planning on becoming pregnant in the next six months. these are the kinds of questions that you have to answer in order to get a discount. huh? well, if you're in a wellness program. if you're working to improve your overall well being that should be the condition for receiving the benefit.

as the price to enter a wellness program. and i think if we wet for the set of balanced amendments that the gentle lady from florida has. to present in these companies, a ten-person company that somehow or another all of the most intimate secrets of family and the medical history is not going to be compromised is to really hope for something that might exist in another world no. the world we live in. let's not allowed that to be conditioned. i would like to yield one more time to the gentle lady from florida so she can have another opportunity to expand upon how her proposal will differ, but still achieve the same.

>> we all agree that prevent and wellness programs are very important cost savers for companies and also great for employees and their families. i would hope we would work together moving the forward to ensure that we're structuring it correctly in a nondiscriminatory way that provides all the benefits necessary. i'll yield back. >> i yield back to you, mr. chairman. >> all time is expired. we will exceed to the vote on the boyer amendment. let's go to a role call vote. >> mr. waxman. >> no. >> mr. waxman, no. >> mr. dingle.

no. mr. boucher? mr. palone? mr. palone, no. mr. gordon? mr. rusch? miss eshue, no. mrs. supack, no. mr. engle. mr. green. mr. green, no. no. mrs. caps. mrs. caps, no. mr. doyle. mr. doyle, no. miss harmon. miss harmon, no. mr. gonzalez. mr. insley. mr. insley, no.

miss baldwin. miss baldwin, no. mr. wayner, no. mr. mathison. mr. butterfield. mr. butterfield, no. mr. hill. mrs. christianson. mrs. christianson, no. mrs. caster. mrs. caster, no. mr. murphy of connecticut. mr. murphy, no. mr. mcnerny. mr. mcnerny, aye. mrs. sutton. mrs. sutton, no. mr. braley. mr. braley, aye.

i'm sorry. no. mr. welch, no. mr. hall, aye. mr. upon tton, aye. mr. whitfield. mr. whitfield, aye. mr. shimkus, aye. mr. blunt. aye. mr. boyer, mr. baoyer, aye. mr. pitts, mr. pitts, aye.

mr. walden, mr. walden, aye. mr. terry. mr. terry, aye. mr. rogers. mr. rogers, aye. mr. sullivan, aye. mr. murphy of pennsylvania. mr. murphy, aye. mr. burgess. mr. burgess, aye. mrs. scolise, aye. mr. engle. mr. engle votes no. mr. rusch. mr. rusch votes no. mr. green.

i'm sorry. no. miss matsui. i'm sorry. miss matsui votes no. mr. boucher votes no. mrs. meyerick is aye. >> have all members responded? anyone wish to change his or her vote? if not the clerk will tally the vote. hold it. we have something else coming. i don't believe you are recorded. gentlemen wish to vote?

votes no. mr. hill votes no. mr. space. mr. mathison. mr. mathison, no. mr. gordon, no. >> anyone else? clerk. >> no. mr. ross. mr. ross, no. miss baldwin is recorded as voting no. >> clerk will tally the vote.

mr. rusch? mr. rusch is recorded as no. have all members responded to the role? clerk will report the vote. >> on that vote, mr. chairman, there were 24 ayes and 34 noes. >> the amendment is not agreed to. who do we go to now? mr. welch. >> do you have your amendment? >> i do. >> could the clerk report the

amendment and pass out the amendment as well. >> an amendment to the amendment offered. by mr. welch of vermont. in -- >> without objection the amendment will considered as read. the clerk and gentleman from vermont is recognized for five minutes. have we had it distributed? >> it is being distributed. we have now distributed the correct amendment. as i was explaining earlier, this addresses medicaid waiver that the state of vermont negotiated with the federal government where the state took on the burden of risk of increasing medicare experiences

through enrollment. they showed significant flexibility. what this amendment would do is say that in the event that the health care legislation and the underlying bill is passed into law vermont would not be penalized by the current eligibility standards, and instead would get to be treated like any other state with respect to who is eligible for medicaid and how the federal government would participate in that financial implication financially of that. this is being presented at the request of our governor in legislature. governor douglas, who was the governor at the time this medicaid waiver was negotiated with the bush administration. the bottom line here is it would allow vermont to be treated the

same as any other state in the event that the underlying legislation is passed into law. there plr chairman. i yield back. >> can i have some time? >> mr. blunt is recognized. >> a couple of questions of council. it's my sunsing that the underlying bill would prohibit this kind of agreement being made in the future. is that correct? i don't see any other reason for the amendment if that's not correct. >> the underlying bill has a maintenance of eligibility requirement that applies to all states. >> yes. for their medicaid population and their child health insurance populations. mr. welsh's state has a unique

characteristic but otherwise applies the same eligibility requirement to vermont as it tr@ @ @ @ @ @ @ @ @ @ h @ @) r makes no sense. this allows the secretary in the state of vermont to address that

specific situation. >> if you said in case of a state waiver under section 1115 and left out the words in effect on june 16th, 2009, that permits them to be eligible, any state could do this? without the effective date? why are we doing this? >> the effective date is the base for the maintenance of eligibility. the maintenance of eligibility requirement is tied to eligibility standards, methods and procedures. in effect on june 16th, 2009. >> that's six weeks ago. >> that's in the base bill. yes, sir. >> that's in the base bill? >> yes, sir. >> that would become the base for everybody except for

vermont. because they have a waiver. the rules vermont had in effect on june 16th, 2009, were under its waiver. >> but no other state in the future could get the same waiver that vermont has? >> any other state that had a waiver that permits individuals to be eligible solely to receive a premium for individual or group health insurance. >> i think there diehl has unanimous consent request. let's go to him. we're talking here. can you tell us how many 1115

waivers there are across the country? >> i don't have the answer to that on the top of my head. >> i've been told it's in the neighborhood of 650 waivers granted to states in various fashions. we were singling out only one 1115 waiver in the amendment to grant an exemption from the underlying bill. is that correct? >> when vermont in its waiver, which is unique because what we did mr. diehl, was take on as a state the risk of rising eligibility in medicaid without and gave up our right to federal higher reimbursement in exchange for flexibility, we use that to make more people in the state eligible for medicaid this will

say that vermont can rewrite with the federal government that portion of its commitment to eligibility for people above who will be covered under this bill. so ooel be held financially harmless. >> i understand, the gentleman. as i read your amendment it says you can continue as a state of vermont to allow premium assistance for individuals who are medicaid eligible and allow assistance for them to buy into their employer plan. >> that's correct. >> yesterday i offered an amendment that would have extended that opportunity to every state in the country. how did you vote on my amendment yesterday? >> i can't remember. but i wouldn't be surprised if i voted against it. >> so you're asking us to extend to vermont what you were not able to extend yesterday? >> will the gentleman yield to me. >> yes.

>> we have the ability to do what, i believe this to be the case. your amendment would have mandated it. why then are we having to eamd and give one state an exclusion from section 1703 of the underlying bill, which puts prohibitions on future 1115 waivers except for in this case. >> i would yield to the gentleman. >> i don't think you are, mr. diehl. this deals with a practical problem. vermont took on the financial burden of providing benefits to folks on its own tab. that was a financial burden it took on because it felt that we would be able to accrue savings

and then return those to citizens in the form of benefit benefits. >> vermont wants the same treatment as every other state. this legislation is intended to do very simply is allow the state and federal government to rewrite a waiver. na waiver has stringent obligations. we want to rewrite that to conform vermont and the eligibility section for every other state. it's a fix for a problem that vermont uniquely has. that is correct. it doesn't change any of the rules for any other state. it doesn't confer on vermont. >> reclaiming the time. the underlying portion of the bill you want to change, that

provision states as a condition of the state plan under this title and as a condition for receiving any federal financial assistance, a state shall not have an effect of eligibility standards or procedures, including waivers urnds section 1115 that are more restrictive than the standards reflected under the base plan. other states would not have the ability to restrict our plans. we're excludeing vermont. given the authority to do that. >> is that correct? >> i believe it's not correct. >> i was asking council. >> i'm sorry. >> for the class of individuals covered under the labor that are eligible solely to receive a premium the answer to your

question is yes. >> let's proceed to the vote. all those in favor say aye. opposed no. >> the ayes have it. the amendment is agreed to. mr. barton, you have an amendment. >> i have an amendment at the desk. it's cr 440m1. dealing with physicians in hospitals. >> without objection the amendment will be considered as read. gentleman is recognized for five minutes. >> thank the chairman who are is a gentleman. i intend to discuss this and in all probability withdraw it. but i feel very strongly about this. section 156 of the pending bill beginning on page 318 and going

through page 384 basically outlaws a physician to own specialty hospitals. this amendment would strike the section in its entirety. most hospitals or clinics established in the united states up until about 100 years ago or maybe 50 years ago were owned by physicians. it is the heart of the american practice of medicine. the most famous hospitals in america. either started out or still are physician-owned. like the mayo clinic, john hopkins in baltimore. in my state, md anderson. not every state allows physicians to have an interest, an equity/ownership interest in

hospitals. in those states that do they have the highest quality rating, patient satisfaction ratings. i am blessed in my congressional district to have a number of physician-owned hospitals. i have been treated in the hospitals. i have gone to the emergency rooms in the hospitals. my mother has been in one of these. without exception. the experience has been as good as it can be given the situation that resulted in it. the pending bill for some reason is punitive. on these types of facilities. would at a minimum prevent their expansion. in all probability cause a number of them to close. if you read the language that my amendment strikes it is punitive

and nature and very restrictive. some limited exceptions where you can appeal to the secretary of hhs. if we're going to have a robust health care system you have to give the providers and practitioners of the health care some opportunity where it is allowed by state law to participate in owning and having an equity in the facilities in which they perform their health care services. my amendment does nothing but obtain the status quo. if it's adopted we will go back to where we are today, where each state makes a decision whether to allow this type of owner ship interest. if they do, under what terms and conditions it's allowed.

they have more satisfied patient rates. they are an example of how health care should be run. we can look at perverse incentives. to ban them outright is just wrong. i support the amendment. >> i'm going to yield to mr. boyer, mr. terry, and mr. burgess. i want to thank the gentleman. i hope you don't withdraw it. competition occurs if we're going to wipe out specialty hospitals, hospitals around the country will enjoy monopoly status. it will begin a stagnation as to quality. that's not good. i yield.

there is a partially physician-owned hospital being dealt in an underserved area -- about 60,000, 70,000 people who live in the area. it is 80% filth. they will not be eligible to take medicare or medicaid because they did not receive their medicare authorization as of the date. i support and want this amendment to pass. yield back. >> i encourage the gentleman to not withdraw his amendment. this is an extremely important topic. the retroactive nature of the language in the base bill is unnecessarily punitive. i can not imagine how in america we can restrict unlawful business just based from the standpoint of someone's professional degree.

there's nothing like the pride of owner ship. when you own something you want it to be the best. i thank you, gentleman. >> my time is expired. >> thank you, mr. chairman. i reluctantly oppose it for the following reasons. we have two almost extremes. those who don't recognize the abuses and short comings of doctor-owned hospitals, which do exist. and those others who would simply say let's allow business as usual. i will tell you that i attended a meeting hosted by mr. wrangle. i wasn't very happy with the at

tult of physician-owned hospitals. this is what they said. they don't take medicare patients. there's no emergency room@@@@@å

health rate. it exceeded the 90 percentile on overall patient satisfaction. it outperforms larger competitors on many of the key processes. and charges actually less than the general hospital. the problem with the provision as we presently find it is it doesn't reck mognize the efficiencies of hospitals that are physician-owned. we can close our eyes to some of the abuses and shortcomings as i earlier stated. why aren't we working with some

sort of measurement that will allow for physician-owned hospitals that perform within certain guidelines and do it well? to protect us from certain abuses that are out there in today's operations. >> will the gentleman yield? >> only if you agree with me. >> i do agree. >> i'm being facetious. >> i go gree with what you said. you talked about the good and bad actors. the underlying bill accomplishes that i was there several times at 2:00 in the morning listening to the texas guys talk about this. the underlying bill accomplishes the goal. it says hospitals with medicare provider agreements in effect on

january first this year where it doesn't require restructuring for currently operating hospital. >> i have to reclaim my time. yes, we have provisions. it really stops any future endeavors that may mimic the outstand i outstanding it's going to stop it in its tracks. which i disagree with. i think there's away to addressing, as i've said, the inherent problems that we have tout there without doing away

the notion of physician-owned hospitals. >> i want to point out the way this is structured in the underlying bill, it does allow for those that exist now to continue. i want to make the point clear. a lot of time was spent in trying to deal with this in a way that is fair for those that currently exist. >> we're fixed where we are today i will still oppose this amendment. it doesn't make the distinction. i yield back to the chairman. >> gentleman yields back his time. mr. barton. >> this is one of the ones i'm going to use ten minutes on. it's really, really important.

when he started his comments i interrupted and i apologize. i strongly disagreed. but he was saying that as a predicate to say what he said about the hospital in his district, which is one of the outstanding physician-owned hospitals. there are many states for whatever reasons that don't want to allow them at all we're not trying to allow a physician-owned hospital where the state doesn't allow it. but where the states do allow it webl in the overwhelming majority these hospitals rank at the top in every category. in terms of quality,

performance, cost, outcomes, you name it. however you evaluate a hospital. these hospitals are at the top. there may be a few problem physician-owned hospitals. those are the exception. not the rule. this bans exception. it has a limited exception for somewhere between five and ten hospitals. which is very arbitrary. when mr. gonlez says he wants to fix the problem. i don't hear him say he wants to ban them. i am more than willing to work with mr. gonzalez and anybody on the committee if they are truly problem if we need to put

special parameters, let's do it. let's don't outlaw one of the mechanisms for innovation and quality that exists. i feel very, very strongly. this is the only amendment we've had in four days that i've felt strongly enough to speak twice of. this is if not the future of health care in america, it's a pathway to better health care in america. the pending bill stops it in its tracks. there are there any of you that want to work and identify the problems? and if there are problems fix them in a bipartisan way? do we have any interest at all?

>> this is a very important conversation. i think that we're all aware of individuals that have sought that place out. it's been life saving. >> md anderson is not physician-owned today. it started out that way. >> i don't want to kill gooses and golden eggs and all that. as i understand the issue and what is troubling to me about physician-owned facilities it really is an exchange of taking money out of one pocket and putting it in the other in the same pair of pants. there's the tendency or motivation for the physician to

to oversubscribe, to overutilize, et cetera. i don't know what you have built into what your suggestion is that would address that. we have to watch costs. we have to cut costs. these practices are bending the curve in a negative way. that's my question. >> thank you for yielding to me. i reck reck needs the problem. if we didn't have physicians the large nonprofits will not move in the neighborhood. i have hospitals that have been there since the '60s. i was born in a catholic hospital thats no a

physician-owned hospital in houston. now we're trying to find somebody to take it over in central city, houston. so we need to look hat this. >> do i have the assurances that you'll work with tus to try to find a middle ground on this? >> if you yield to me, i'll be pleased to work with you and see if we can reach an accommodation? the other committee. we have joint jurisdictions with ways and means. i know that they were involved with putting this together. that's the caveat. we have to consult with them as well. >> chairman wrangle has agreed

to meet with the him. i don't want to let something that is as good and as important as this. i have spoke within the leadership. they are more than willing to come to the table and whatever the real problems are to address them in a forthright fashion. i am withdrawing the amendment. >> gentleman withdraws his amendment. we're going to have votes on the house floor shortly. i also understand the staffs are going to try to go through the amendments, prioritize them, bundle them together to move faster this afternoon. it's my hope can't give any guarantee. it's my hope we can conclude the markup by 4:00 or 5:00 at the latest nest the afternoon.

whatever time it takes we're going to complete the bill today. >> mr. chairman -- >> if i can finish. >> ask members to come back. >> as i understand, there's one amendment, my amendment that you folks -- we could do that now. >> we'll put all the amendments we're going to accept together. >> i've already agreed privately with what you said, that we have a brief recess in which we try to have the staffs coordinate. i would like your assurances, which you've given me privately, that the key amendments, whatever the blue dog compromise is that it will be made available for two hours. >> that's a reasonable request. we will make the amendments that we're going to have available to

you two hours before the vote. >> some priority amendments. >> there are a number of amendments. we're going to try to meet everybody's priorities. >> with that understanding, we're more than willing to work with you to expedite to the extent it's possible we understand how hard you worked on this. we would like to see it concluded today. we also want to make sure that all the issues that need to be addressed are addressed in a forthright fashion. >> i think that's a reasonable question. we'll work together to accomplish it. we'll stand in recess until after the last vote on the floor. on

payments to the characteristic are you ready with the sentiment? >> i am ready. >> i would like the clerk to report the amendment. >> this is amendment 21? >> yes, sir. >> the amended to the nature of a substitute to h.r. 3200 offered by mrs. christianson of the virgin islands. >> without objection the amendment will be considered as red and the gentleman is recognized for five minutes. >> thank you, mr. chairman. while this amendment is far from the parity or state like treatment of medicaid that we would have wanted and which we want to continue to work with this committee to achieve, we thank you, mr. chairman, and we

thank the ranking member for providing a meaningful increase in medicaid funding to begin to put us on the road to get to where we really want to be. this amendment does three things. one, it keeps the funding provided in the amendment in the nature of a substitute at the same@@@@rz

benefits of health care reform to your fellow americans in those territories, this is a substantial first step, and i ask for everyone's support. >> the gentleman yield to me? >> s. >> i want to express my support for this amendment in which we could do more than miss a minute because people living in our territories are u.s. citizens. and we got to be up to provide them the full health care rights we give to all americans. i want to continue working with you as we try to figure out how to accomplish that goal. this is a major step forward, and i am pleased that we are able to take that step. >> thank you, mr. chairman. yes, it is a very, very big step forward, and we truly appreciate the work of un your staff on this amendment. >> with the gentle lady deal for

a question? >> yes, i would be happy to yield. >> if i heard you correctly, you indicated in your statement in support of the amendment that it didn't have any increased funding, minority staff seems to think that it does increase the funding. and the total -- do you just redistribute funding? >> absolutely. just redistribute it in a way that all of us sat down and figured it out, and it totals the same amount that is in the substitute him in. >> if the gentle lady would permit, i am told we have the wrong amendment before us. so there seems to be some confusion about it. >> we made some revisions working with your staff, especially on the match area. yesterday. >> is your amendment reflect the agreement with our staff? >> yes. the amendment that i have here reflects the agreement with the

staff. the only thing that was change was in the match area. and that has to be worked out so that it still stays within the same amount that's in the mm and the nature -- >> the nascar council, medicaid expert. >> this is a big increase. it says right here. >> have you had a chance to review the amended? is to see a minute that was worked out? do we have the wrong amendment? i think the minute that was distributed might not be the correct amendment that the member intended because it does not reflect -- >> at the gentle lady would withdraw the imminent temporarily. we will get to it. >> reserving the right to object,. >> there is no yield at this i'm. >> but the mm that we haven't says additional increase for fiscal years 2011 through 2009. additional increase. >> mr. ranking member, i believe

that that means that the increase does not start until that time, because in arra were given increases for two years, and so the amount, the total amount that is in the amendment in the nature of eight substitute starts to be used after -- in 2011. >> we just need -- obviously you can offer anything you wish, but if it is just a redistribution we are fine with that, but if you are increasing above the baseline, that is something we would like to know how much. >> we were very, very careful in ensuring that it did not increase above the baseline. >> just pull it back temporarily, if you would, because there shouldn't be any confusion. >> i will pull back temporary until we can clarify. >> mr. kerry, you have been a minute? >> mr. chairman, i have an amendment at the desk. it is as the hbp 003.

>> de klerk will identify the amendment. >> do you have the amendment? >> mr. chairman, can i reserve a point of order? >> the gentleman from new jersey preserves a point of order. does the clerk had the amendment? >> could we hear the number? >> . .

[inaudible conversations]

with [inaudible conversations] the amendment has been located, the clerk will report them and. >> and the nature of substitution of hi3200 and offered by mr. terry. a strike subtitle a nba of title two of division eight and answer the following: subtitle a congressional health care for all. iraqi rating. >> section 201, congressional health care available to all. in general. notwithstanding any other provisions of law beginning with your wine, and the individual who it would be a u.s. citizen in the united states and to is not enrolled in a group health plan and health insurance coverage offered in connection with a group health plan and

shelby entitles to enroll in a qualified health benefits plan having the same terms they cover conditions as the health benefit plan under chapter 89 of thai live in that the states could. >> of this time i ask unanimous consent to waive reading. >> may i begin, mr. chairman? >> without objection, the rating of the amendment will be dispensed with and the gentleman is recognized for a five minutes. >> as a clerk read, this is to provide those without insurance or frankly anyone that needs a certain level of insurance to opt into a system, to enroll into a system exactly what we have as members of congress and all federal employees. the federal employees health benefit plan that is determined

by much of the public in many of our colleagues in the house of representatives has the gold standard for health care. it matches what many of us on both sides of the aisle wish and think is best of the american public. if provides coverage at an affordable rate because of this plane can have as many as 47 million or more people in a group to drive down the costs. and they have joyce. between different plans like we have in the federal employees health benefits -- health benefits were as the market's entity is competing against each other, to get someone to enroll in their plan so we have got competition, we have got affordability. we have that choice. those are all things that i want and i think most of the

republicans want for our constituents of this country, it just so happens that this is private sector not government-run plan. let me read you from a recent floor statement. this is a quote from one of our committee members, the fact of the matter is that some of the republican party don't want these problems fixed and accessibility because they are already doing just fine. they've got choice. they've got that federal plan. that's what i have by the way. the government run plan. well, and the democratic party we are seeing something else, we want the american people to get at least as good as my friends in the republican party have. we wanted least the benefits that we have in congress, a choice of portability, lower costs, and lower taxes for all

americans. i cannot agree with you more, that is exactly what we are doing here today isn't doing what you have asked us and to challenge us to do. i cannot only wish they would be a co-sponsor of this with mr. gingrey and mr. bond and i. this is the right thing to do with the people of americans to divide them into the federal health care plan or they say similar type of system until another committee can have a role on that part but that's not what this bill does, it allows the light to be traded so that a in a. of portability and choice at this time i'd like to yield to mr. bonds. >> i think the gentleman for yielding and deal to mr. gaidar and his seconds. numerous times and the last campaign the senator obama said that the american people should have exactly the same kind of insurance had. he did not point as to whether important things, one was that test. ingle federal

. . federal employees quite a bit and some at the how the savings accounts don't cost very much. he also did and point out there was no government-run option. if anybody knows they don't want a government-run health-insurance plan it's a bunch of federal employees who clearly now that the federal government can barely run the government let alone also run health care. there are federal employees in every ste. this would be part of our overall plan that we want more choice, more competition, even if you have insurance at work be fine with me if you also have insurance access to this plan but certainly if you don't like to have every american have this as well as every american regardless of pre-existing conditions have access to health coverage, that was of a big part of the problem here that i yield to our other cosponsor,

mr. gingrey. >> i think the gentleman, i'm sure all my colleagues have had experience either on a town hall meeting in or live in town hall meeting, we my democratic friends have experience somebody outrageous lot of opinions in regard to this, but people will say to us why can't we have the same thing you guys have? that they assume they get it for free. obviously we don't, we pay for is, but the federal employee health benefit plan is a good plan. it is a gold standard in that we ought to give in this opportunity to everybody in this country and also led the supplement to supply those who are low and, they should have the same opportunity we do and, of course, of this eminence we get rid of a government-run plan and get rid of exchange -- we don't need that to commend the gentleman's time has expired. >> i strongly recommend this to both sides of the aisle.

>> mr. villone. >> mr. chairman, i insist on my point of order that specifically mentions in the bell the health benefit plans under chapter eight of title five which is under the jurisdiction of the government reform committee. this is outside of our jurisdiction. we do not have jurisdiction. >> mr. chairman, point of order. >> i am sure we have checked this with the parliamentarian and we believe it does me the standard of the committee and we are going to insist on a road two. >> we are going to refer to the chairman to allow us to have a road two. >> let me say to it my friend from azeri and my colleagues we just ran our savages read this amendment to the parliamentarian and of parliamentarians said this is solely within the jurisdiction of the oversight house oversight committee and not within our jurisdiction. >> will do yield? >> we need to call the parliamentarian, mr. chairman

because we've drafted this in because we've drafted this in conjunction with a@@@@@@@ @ @ á

amendment. [inaudible conversations] this doesn't come to have an amendment? >> i do, it is eminence slauson underscore of 39. it is sutton's sarbanes actually appear in [inaudible conversations]

the clerk will report the amendment to recommend an opera by ms. sutton of ohio and that mr. sarbanes of maryland, and a sometime socci of title one. >> without objection will be considered as read and the gentle lady from ohio is recognized for five minutes to that reserve a point of order mr. chairman. >> mr. sculley is reserves a point of order. >> thank you mr. chairman and i am very pleased to offer this amendment in conjunction with my distinguished colleagues from maryland, mr. sarbanes. this amendment deals with pre-existing conditions and as we now they america's affordable health choices and will prohibit pre-existing condition exclusions and insurance markets but this section will not take the bank until 2013. end of the americas with pre-existing conditions cannot wait until 2013. so this is intended to remedy that situation currently uninsured can deny coverage for in the absence of have a

pre-existing condition for up to 12 months period in individual has had a continuous coverage defined as coverage with no lapses 73 days or more, then this 12 month time can be reduced based on the number of months of rebel coverage. in determining whether an individual has a pre-existing condition insurers are able to look back at an individual's medical history for six months with this amendment simply reduces the pre-existing medical condition limitations from time to 12 months to have to three months. this amendment also reduces the look back from six months to 30 days. for group health plans, these changes would apply to plan years beginning six months after enactment. for how their insurance coverage and the individual markets in these changes would apply six months after enactment. this amendment makes these changes to the public health service act which falls of this committee's jurisdiction.

my friend and distinguished joe courtney from connecticut offered a companion amendment during the education and labor committee markup regarding this issue and his eminence made identical changes to private employers provide health care and the employee retirement income security act, his amendment mr. chairman was approved by the education and labor committee by a voice votes obviously widespread support in the mr. chairman is my sincere hope that our commitment to they can also passed by voice vote and at this point i like to yield to my distinguished colleague from maryland, mr. sarbanes for his remarks. >> thank you, i think the gentle lady from ohio. i want to commend her on this amendment, i'm very pleased to join in offering its. i would imagine that there isn't anyone in this drama certainly no one on the committee as they move around their districts who has not heard stories heart

wrenching story is told to them where somebody thought that they would be covered for a particular achievement and then when they went to try to access that treatment they were confronted with this pre-existing condition exclusion from their coverage. is the most debilitating game of gotcha and you can imagine and, of course, it comes at a point in time when at the last thing people need to be worried about is whether coverage is fine to be there. as was indicated, this is designed to further modify the health insurance portability and accountability act which put in place provisions and that would limit this kind of exclusion for pre-existing conditions. and their recognizes that the total elimination of this kind

of exclusion is not going to occur at the base spell until the year to has an 13, but there is such high expectation on the part of the public that this particular issue will be address that we thought it was critical to try to do something during the transition. and as congressman sutton indicated the education labor committee already took action in a unanimous fashion to enter as of this with respect to employer sponsored plans. we do is pick up the rest of the universe and now limit that lookbacks to 30 days instead of six months and reduce an exclusion from 12 months to three months. we think this is of the right thing to do whether many people out there that have borne the burden of this exclusion coverage based on pre-existing

conditions and we would hope that this is noncontroversial and would be supportive by our colleagues on both sides of the aisle. without i yield back. >> the gentle lady yields back, mr. barton. >> mr. chairman, i'm going to oppose the amendment. i offered to read before the break the national pool that covered all pre-existing conditions at the same level. and i believe every member of the majority of those in that. of now we have a proposal where it if i endorse it correctly, you can be diagnosed with some catastrophic condition, wait a month and apply to insurance and i have to cover you. i do say that i totally understand the to the extent i

do understand this is a disincentive to have a health insurance until you know you needed to which would tend to be kind of counter-productive to the whole point of insurance and the others place. >> for the gentleman yield? >> at i'd be happy to command it wouldn't permit this in error you're talking about, the 63 day lapse of coverage provision still applies, in other words, if you have gone more than 63 days or more without being coverage than your not going to get the benefit of what they call this creditable coverage as to carry forth from the time in which you were covered. so it is really address in this situation that they both have some coverage for one reason or another lost are needed to change their job, had elapsed time that was less than 63 days and then when they went together your insurance coverage they're able to carry over creditable

coverage from before. with a means to the is if you have six months of coverage from before under current law if you carry that foreign you is still high exposure because you only get credit of six months against a 12-month time in now because we are reducing the 12 months down to three months, the kerry huron mean you would experience no time of exposure in terms of your coverage so i don't think it is, this does not create an opportunity for people that want to gain the system. it really just tries to enhance and strengthen the portability element that was part of the original hipaa and to energize to adjust during this interim time and leaving at two the implementation. >> with the gentleman yield? >> i have another question for mr. sarbanes, the ranking

members bill earlier, we want to cover everybody regardless in the existing conditions established risk pooling mechanism where insurance companies would have summer to collectively go with patients that charlie had is a generic cost rather than passing those costs onto all of their other customers, i wonder is there anything like that in this bill, which expects to trade them on their own and i guess why weren't we able to get that done earlier since we both have the same goal? high-yield. >> i appreciate that, my reason for voting against the earlier proposal is that i think recently in vesicular there has been too much emphasis on this notion that you can solve these insurance questions by creating these opt out opportunities. the strong this kind of insurance models are the ones that have the most people in the same pool. those who are well, those who are not so well, those who are

young and old so that you completely distribute the rest across the pool. >> reclaiming my time, i thank the gentleman. i think i would tend to agree with that except you are now talking about putting people who are already sick into the pool as opposed to some other way to assure you cover people with pre-existing conditions, that would be my problem and i yield back. >> dr. burgess and then mr. stern's. >> and thank the gentleman for yielding, between these two proposals offered by the ranking member, this proposal mr. chairman is a shame we did not serve from this .4 months ago. there is a broad consensus and would have delivered a product that would have solved a problem for a million which is the real problem they're asking us to solve, they don't want us to turn over 17 percent of the nation's economy to some program they don't trust the they do want us to fix this problem and as you can see from this discussion there are good ideas on both sides to have to get

this down. i yield back mr. vartan met mr. stern's. >> quickly, council appears to me that the offensive did this start six months after enactment but there is a clause on page three special rule for collective bargaining agreements and the question i have reviewed is this of this, the more these collective bargaining agreements and special exemption. the bill starts by six months after enactment of a site into this bill that three years after enactment who are these people collective bargaining agreements are set up for so they get a waiver of three years? >> what entities are we talking about blacks. >> collective bargaining agreements? and its use they usually are? >> why do we have a special exemption for one group -- >> without objection, gentleman from texas will be given additional minutes to complete.

>> said the council can ask a question, we don't need additional time to adjust an answer from the question. >> collective bargaining agreements are usually between unions and employers i believe in giving so in this case the unions get an exemption for three years but all the insurance companies in this bill would apply six months after enactment? >> normally enters contracts are written on a one-year basis so when insurance contract is a review of an individual they can do that changed within a year or as the collective bargaining agreements are multi-year contracts so is about not to serve in the contracts. >> the last question i have for you is six months after enactment of the bill all insurance companies in america must comply with this, is that correct? in other words, the bill as written is 2013 but with this bill passing this pre-existing condition will apply six months after enactment? command that is the way they buy today is written.

>> all time is expired, will now proceed to a vote on the sutton that sarbanes and an income of those in favor will say ayes. opposed nos. the ayes have in the amendment is agreed to. mr. rogers. >> thank you mr. chairman, i have an amendment at the desk. i believe it is a degree 10 on the list. [inaudible conversations] the clerk have the eminence? >> mr. gingrey, but it should be -- >> matheson, gingrey, rogers or

one of those. and. >> scores 00 to appear in at the top@ )í@@@@ @ @ @ @ @ @ @ @ @ @> >> i have at the end of section. >> will be considered as read. >> thank you, mr. chairman, i would hope that this would be an amendment the order would set. one of the particular trends is there's been a lot of misleading comments. that if you like the health plan you have, you can keep it, unless you are one of the 11 million seniors or the 8 million americans which have health

saveings accounts, which is growing by 30% each year or the 40% on arisa plan that will loose their plan after five years. this is an important amendment that provides information and catastrophic coverage. >> will the gentleman yield to me? >> yes, sir. discrimination by anybody who are representing planned. would you be willing to work with us to allow people the choice of age as a way but not a plan that exempts them from

these issues of consumer detections? >> if you are saying it has a mirror of a government plan mr. chairman. >> i'm not saying, it has to mirror a planned test. >> mightier reclaim my time is the more difficult to remain these things to be successful the last opportunity people have to participate and one of the reasons these are so successful and growing so quickly is we've made it very easy for people to get involved in this program and employers to get involved in the program, some 30 percent of everybody has on never had health insurance to their employer before so it tells me it's the one thing working, the one innovation as working to get people connected to health care. mr. chairman, my argument would be i went to anything to stop the progress and by the way by the time the exchange of your bills passes this new government and exchange 20 million americans will be on age as a day, why we would want to screw that up is beyond me so i would

respectfully dashers by flea decline and hope we would take to protect the people who have opted to get connected to health insurance through has. >> will the gentleman yield further? your eminence would excuse has high deductible plans, other requirements apply to all other qualified health benefit plans. over example the has eligible health plans that don't cover the benefits such as maternity care or prescription drugs. just like other health insurance policies these high deductible plans will eventually add to the grandfather have to cover all the minimum benefits as drafted in the amendment would also excuse has eligible plans from other requirements for example, a high deductible health plan would deny coverage for pre-existing conditions allowing insurers to charge cancer patients more for insurance and rely on inadequate provided

networks will the two have prompted requirements and more. >> i would hope to give a little i should have two our hopes as you been arguing on our time mr. chairman. here is the point, if you really believe it has all of you have said that you want choice which of this bill by the way does not provide, then let them have the joyce. of the people who have been chosen of savings accounts keep them if they like them. he may find those and i disagree with your assumption that those will happen, i completely disagree with that but was just consider the set of arguments say it was if they wanted to make this choice they will and if that is true believe me it will be a viable option in your new federal government mandate run exchange. so let's all this says is if your employer you should have the right to be able to provide this, if you are an insurance provider you should have the right to be able to sell this and by the way if your individual american up losing choice two have the right to build to buy one. is really all it does and i would feel some time to

mr. gingrey. >> mr. chairman, may i ask unanimous consent for an additional minute? thank you, again going back to the president said, if you like to have you can keep it. until you can't. and when you can't is 2013. and mr. chairman with all due respect i thank you pretty much made a case when you said then that may be held savings accounts with high deductibles low premium insurance policies that young people many of whom are in that 47 million today that don't have health insurance, these other kinds of plans and they would choose and certainly our great fear on this side and i think most people would agree that after 2013 as secretary in her infinite wisdom or whomever the secretary is an hhs could determine that any

employer plan not just the high deductible low premium affiliated with combined age essay, by any standard plan that not meet the requirements was not credible and all of a cent would be disallowed and that's where the 110 million that are now in shared by employers with more of into the government's public auction so-called public auction. clearly we don't want to deny a million people the opportunity to have these plans. we would just be contributing more to the percentage of when members of the uninsured. so this is a straight toward amendment, i would hope that members on both sides of the aisle was supportive and i yield back. >> gentleman yields back his time. of the chair recognizes himself. i made a simple request of the gentleman from michigan -- i wanted to support his idea of the hsa but wanted to be treated like all other insurance plans

competing. and i don't think it ought to have a separate special treatment, i don't want hsa saying they don't have to cover benefits like maternity care, prescription drugs, i don't want hsa to say that they could deny coverage for people with pre-existing medical conditions. were allowed insurers to charge cancer patients more for this insurance. this is a form of insurance by should not be treated as an of insurance that is so special that they can do all the things we're trying to stop insurance companies from doing. now offered to take your eminence if you work with me in new to nine the willingness to even more for me, i can support your amendments. >> the difference between working with us and completely changing the locus of the amendments to man quick changes of this of the amendments.

>> i am asking a question, would a change of the lotus of your amendments to allow hsa plans and not allow them when they compete to be was to discriminate when we are not allowing the other insurance plans to discriminate? >> mr. chairman, if you yield that is not what you're doing. which you say is right but your intent in the language is wrong he has actually the premiums what you've done about 70 percent just by -- >> i have asked you to work with me to make sure we accomplish these goals. >> with the chairman neil? , the gentleman from texas. >> i think we might having on intercepting conversation here. i think both of you are right. i think mr. rogers is right. the intent of the house savings account is to put cash money each month into an account in most cases the build of tax-free and the most of savings accounts

have in this forest -- requirement to have a catastrophic policy. but within the discretionary part you can spend that money on anything, many of the things you are talking about would be covered by cash and the discretionary part of the account. >> levied reclaim my time. let's look at the amendment. says in the case of a health benefits plan offered in conjunction with a health savings account so in the flag to the health benefit plan under the legislation in conjunction with the health savings account would not have to meet these requirements? >> i may be missing something but i would think mr. chairman the joys of it -- if you believe in choice we should allow this to go forward command i don't believe in the choice of insurance companies to exclude people. >> there is an individual choice to be allowed to be part of the government exchange. >> wouldn't the catastrophic part of -- that's what i think you're both right, the cash and

other parts of the hsa and have to read the requirements that chairman waxman is talking about but that cash discretionary part of the account that mr. rogers p.o.t.u.s. -- focused on is available for whatever the patient and that the health care provider wanted to be is the way i would interpret it so you both of which you want. >> and just try to make sure that high deductible plans have the same requirements as in the and the insurance plan. entrée to dictate how the cash would be used rather, it's a high deductible plan we know that. but that ought not to be able to discriminate, on not to be able to ignore all of the things we have in the consumer protections no cost-sharing, no dropping of coverage for seriously ill, no gender discrimination, no annual or lifetime caps on coverage. guaranteed insurance renewal.

the gentleman from michigan with not like to allow that? do rich and those kinds of provisions? >> again it is a trojan horse, mr. chairman. >> i oppose the gentleman's amendment and recommended that other members to some. we will try to work out something on a hsa health savings accounts that require them to be the same as others and not allow this discrimination. are you ready for the question press all those in favor of the rogers and evans say ayes, opposed nos. the nos have a, the amendment is not agreed to a man can we have a [roll call] can we have a roll-call vote, mr. chairman? >> [roll call]

>> [roll call] >> [roll call] >> [roll call] >> [roll call] >> [roll call]

>> [roll call] >> [roll call] >> [roll call]

>> [roll call] >> [roll call] >> [roll call] >> [roll call]

>> [roll call] >> [roll call]@@@q@d@dag@g@g@g@@ >> [roll call]

>> [roll call] roll call jo roll call q!ll have all members respond to the call the roll blacks [inaudible conversations] mr. gordon? to mr. gordon votes now. any member wish to change his or her vote?

the clerk will tally the votes to. >> [inaudible conversations] >> [inaudible conversations] >> [inaudible conversations]

the clerk ready to announce a the? >> mr. chairman, there are 26 ayes and 33 nos. >> the amendment is not agreed to. mr. space, you have an amendment? >> thank you mr. chairman, i do have an amendment at the desk. >> mr. chairman, while we are getting that is the bill of entombment at any point plaques to have not yet but will be sent to mad. c-span: >> you don't have a whole lot of time left. the clerk will report the amendment. >> amendment to the amendment in the nature of the age of 3200 and offered by mr. space of a high of. at the end of some tile h of

title seven of division b add the following concessions 1783. prohibitions on federal to ask that we dispense with reading. >> without objection the amendment will be considered as read and the gentleman from ohio is recognized. >> a point of order, mr. chairman. >> mr. sculley is observes a point of order. >> mr. space command thank you mr. chairman. this amendment is very simple. it ensures that this legislation does nothing to bring people in this country illegally -- medicaid services. reaffirms and provides assurances both to members of congress and the american public's that and removes all doubt frankly that this bill has somehow or another would afford benefits to those who are here

illegally or in an undocumented vashon. i asked and urge my colleagues on both sides of the aisle to adopt this straightforward amendment to the legislation and would yield some of my time to my colleague from california, congressman mack and rene. >> of like to commend my colleague from ohio for his work on this amendment which as a common-sense clarification to the bill to ban medicaid into payments from being made on behalf of illegal immigrants. federal prohibits illegal immigrants from enrolling medicaid in schip, this amendment simply ensures that those prohibitions and maintain. the amendment is a message to maintain the integrity of our laws and ask our colleagues to support it. this i would yield to my colleague from indiana. so i will turn back over to my

colleagues from ohio. >> mr. chairman, i would deal the back. >> with the gentleman from ohio il to lee brice. >> by all means. >> i think the gentleman for yielding cummings says on live forever your eminence, nothing in this title shall change current prohibitions against federal medicaid in payments under the title. what verification system do you have to make sure that these individuals are lawfully present in the united states? document this amendment does not provide any new verification system, is simply applies the existing verification system. >> what is that existing irrigation system? >> i would refer your question to castle. >> search if you refer the question to me, counsel i do ask that question. what is the existing verification? under this h.r. 3200? >> under current law not of the bill before you, and the crown

on already in place in the medicare gramm is a citizenship documentation requirement and that was recently extended to the legislation that passed this year. >> -- counsel for that and in regard to the language in this bill would be the verification blacks meant there is no new verification system in this bill >> there is no verification. >> there is an existing law to this citizenship requirement both and medicated and the chip. there is an existing law verification system call citizenship documentation. >> another question for council. does this require a photo identification verification system drugs under current law to match the amendment before you does not, the bill does not, the current law does. the current law the citizenship

documentation requirements requires documentation of citizenship and identity. an entity requirements include peanuts among other things presentation of the photographic evidence. so that is just current law. this amendment with the bill makes any change in the front of citizenship documentation requirements. you have to prove citizenship and establish identity. mack well, i ask my colleague and from ohio does this amendment included current law verification for the legal presence in the united states by virtue of an indication system but no? >> i think the gentleman from georgia, this legislation. terms existing law and specifically to iraq's nothing in this section of legislation

changes to existing law when it comes to determine eligibility for medicaid and chip provisions. >> if this doesn't change existing law the why are you offering the amendment comics can't because there seems to be some misunderstanding or concern that the legislation at hand will provide some kind of benefits to undocumented aliens. this legislation is being offered to provide assurance those members of congress to question that as well as the general public that it is not and i benefit to those who are undocumented aliens. i think generating this sufficient confidence to the american public in this legislation is a very important step in the process and i think this is one of the steps we should be making. >> who wishes to be recognized? mr. chairman mr. deal, you're recognized for five minutes. >> mr. chairman i like to ask counsel isn't it true that the underlying bill has a provision

that says that in certain conditions namely in medicaid that individuals and family units will be automatically enrolled in the medicaid program and that a state may not put any other interference in front of the automatic and roman? >> the only provision that comes to mind i have to look back at is requirement for automatic enrollment of newborns who do not have any other source of acceptable coverage. >> what about those individuals who are up to the 150 percent of poverty will be automatically enrolled now in medicate? >> the bill requires the coverage of asserting and 2013 of individuals under 133% of the federal poverty level. >> automatically enrolled? >> if they needed the current

eligibility requirements to make an automatic enrollment to mad include the citizenship documentation requirements. >> there is no reference in the automatic alignment to verification of citizenship and is there? >> the bill requires states to cover people under 133% in the medicaid programs and leaves his testing procedures and methods and standards in place. one of the procedures in citizenship documentation. that applies to all people be enrolled under medicaid of these eligibility levels. >> descanso recall when we reauthorize the schip program as to what was done to the language that requires verification amanda that is a reduction act? did not, in fact, in the schip reauthorization made this an option that states could elect not to verify? >> states don't have an option with respect to whether they need the documentation requirements. i have an option as to how they

do appear in. >> right. >> with the gentleman yield? >> is council aware of the situation that existed in this area prior to the death was a reduction in 2005 in which 46 days and the district of columbia and existing laws that mr. space is referring to which says you not allowed illegals to enroll in these programs, 46 days in the district of columbia used self revocation of just signing an affidavit? >> that is not in a proper question to ask of counsel, counsel can tell us with a lot is and what the bill says that the tax r. >> mr. chairman, question for council? >> i will not ask counsel that question, i will tell this body that that's exactly the reason the 2005 provision was put in. now, if you really wanted verification you would have

voted for them and that loss by one vote yesterday. i recognize that this is political cover. but i want to tell you is a spin as a fast machine, it will provide you know cover on this issue and the reason being is that verification is the key to making this provision workable. and you have rejected the provision that was offered yesterday that would have provided very clear language about in the verification requirements that should exist here. >> i yield to my colleague from illinois. >> i think my colleague, this is the debate we had last night, this is a see why a amendment because my colleague is correct, the laws were changed to allow states to make a determination without federal intensification prove. we all know there are states that allow illegal immigrants to get driver's licenses and they can then use those to this day

many kids to summer to enroll and to sign an affidavit that they are citizens. so don't try to cover up for the failure of last night, this bill will allow illegal immigrants access to federal funded in taxpayer dollars and if that is what you want that is fine, but don't hide it. just be up front. and i yield back to my colleagues to read the yield to the gentle lady from tennessee. >> i think the gentleman from georgia. and i think him for his good work on this issue and i do oppose this amendment. i have talked a lot about the experience in tennessee, what we saw with this is with the state verification mechanism drivers license which have been in a properly obtained, they could use a utility bill, they could use a rental receipts, they could use all sorts of mechanisms to enroll in the public option plan, taxpayer

funded and we held that the bill hearing in tennessee on enrollment with illegal immigrants and 10 percent of the growth every year was attributed not by us but by 10 carries off to illegal@@@@e&@ @ @ @ @ @ @ @r certificate. for some proof of their citizenship. the reason that amendment was

rejected is because it hurt more americans than anybody who tried to skirt the requirements that they be undocumented aliens from of the ones who are being disadvantaged. american citizens are being disadvantaged. now, this amendment would say that new eligibles will be subject to the same citizenship documentation requirements that apply to existing beneficiaries. there will have to document their citizenship for a passport or verse certificate, half that documented their identity to a valid driver's license with a loa id, that is in order to ensure that undocumented aliens and not eligible. this basement makes clear that the current prohibitions against federal medicaid payments for services of undocumented immigrants will be made in place and that this title does nothing

to change these prohibitions. so i don't understand this argument with some of his argument for argument's sake. and i almost think we ought to have a recorded vote to see if republicans want to vote against this amendment. i can't believe that they would any more than bonds to against medicare. which they chose not to do whether it was offered by mr. wiener and speaking of mr. wiener, he asked me to yield to him and i will do so can i briefly mr. chairman i think my colleagues and the other side to some degree inherent in this space eminence think there is a conversation going on that we have to continue in this congress about how we deal with 11 million undocumented people in this country. but we tried real idea, and it was a failure, if you verify we can't seem to figure out a way to get up and running. this is not just in health care. my colleagues are correct, there are problems in figuring out both employers and government and everyone tries to figure out how the undocumented, how we

figure out a way to bring them out of the shadows of horse a lot to get preventing terrorists and i just want to remind all of us, another is almost an irresistible urge to demagogue and it comes to immigration matters. just remind everyone that when you are talking about young children who are sick, who are trying to find care led to the likes of which that might be in your examples here of. those children who are sick have committed no crime. they are too young, they're just children and to some degree we need to have a health care system that figures out how we make people well, how we don't think fred, how we have a system that makes sense. we don't have that now and so with to have his young children being kept on because parents are fearful of bringing them to a doctor. going into hospital emergency rooms and getting care that is not been paid for by the bill berry, it will be by all of us. so i know there is this desire

to be to the rostrum about immigration and his courage to use this of language about people being illegal, the suns i commend to children are what we're talking about and i hope we can keep that in mind that made a mistake i agree with many of my colleagues. how is that we solve these immigration problems and how it is that we saw the idea and identify. >> notwithstanding a powerful argument the amendment before us with proof of its federal medicaid in check payment for undocumented aliens, even given vitamins they think that to be covered are not but the space amendment says that they will not be entitled to those coverage. >> i would ask a question of counsel and i'm a human mr. radanovich, i yield to you. >> repressing council, in the law where it is a required the health care choices commission and to require where they were acquired and all want to apply

citizenship of their vacation under 1903x of the the social security act? >> search in my response before i was referring just to that for the medicaid law and just the the current jupon not speaking to the health choices administration can agree planning my time i yield back and ask for the question, all those in favor of the space amendment say hi. all those opposed say now. the the ayes have it, the amendment is agreed to. kingman mr. chairman, i want to ask unanimous consent to amend the lending greets harry blount eminent. that we withdrew because of question about chimineas. and i want to bring that back up and then i was to ask unanimous consent to strike line 13 on page one whether to on page

two. ..

>> i can't argue with you. you are right about my being right, you are right. [laughter] >> if you agree, or if every member will agree to the unanimous consent that we strike that portion that i have identified, then we are told, and i hope you were told, that the remainder is germane. >> the gentleman is correct. however, that doesn't make it without controversy. >> it makes it jermaine. >> but let's bring it before as. without objection, the amendment offered by mr. gingrich, mr. blonde, mr. terry, on congressional health care for all, will be put before the committee again. and by unanimous consent, everything after line 10, -- everything from line 13 through

line two on page two will be stricken. and mr. pallone reserves a point of order in case we can find something else that is not jermaine. >> i believe there is one, mr. pallone. >> and i would yield to the author's -- >> the amendment is now under consideration. the gentleman is recognized. >> we have already spoken on our five minutes. >> mr. terry, do you wish to control the five minutes? >> we say we the proponents have spoken. we would certainly let the opponents have five minutes and then have a vote on the amendment. >> i will recognize myself than in opposition to the amendment. the amendment seeks to require that all citizens may go into a

plan for insurance that would be under the same terms and conditions as a health benefit under chapter 89 of title five, and if so, it is like the -- it strikes the public plan completely. in fact, would substitute something else. and we argue that it would substitute something like that federal employees benefit plan but not that plan but i think that is not what we intended in underlying legislation. we intend a market competition with a public plan, and i would have to oppose this amendment because it strikes the public plan and does not give that as an option to any american who might choose it.

>> mr. chairman? >> i would be happy for further debate. mr. starr bains, and then we will come back. >> thank you, mr. chairman for yielding. i would echo what you just said. the biggest problem with this is that it does strike not just the public plan. it strikes the whole exchange. the purpose of the exchange is to begin to bring innovation and choice into insurance markets all across the country that right now are captive of a handful insurers with predictable consequences for costs and innovation, which means often high-cost and a little innovation. and so i can't understand why the other side would want to remove an opportunity to

generate more options and more choice to explore -- to test the opposition really to add more actors into the mix, choices into the mix that you might get to a better health care system. so my primary concern about the amendment as proposed is the fact that it would completely wipe away what is a prime mechanism in this bill to get to the kind of choice and options and competitiveness and exploration of reducing costs that have to be central to this reform effort. and so for that reason i would urge us to reject the proposed amendment. i yield back my tight. >> mr. pallone? >> mr. chairman, this goes back to what i basically was saying before. we have set up a really great proposal here under this underlying bill, and i think mr.

sarbanes and you describe this to some extent, whereby people now who are in an individual market or small group market or have no insurance can enroll in an exchange that offers them a benefit package, consumer protection, and all kinds of ways of reducing costs, because it is a sort of like a group plan because it has the competition between the public and private insurance because it has subsidies. you know, just assuming that somehow letting people enroll in something like that federal employees plan is somehow going to be better, i think is a false assumption. >> this is not a federal employees health plan. it is something like something like that, or something like something that is like that. it is very vague. and we shouldn't -- >> with the chairman yield on that? >> yes. >> the reason it is like that is

for germane purposes. honestly, we couldn't say the febp plan because that would not have been germane. >> i understand what he did. >> that's what we had to do to make it jermaine. >> it is germane, and now that it is germane to say congressional health care for all. but we don't have congressional health care. we are federal employees. and you make it sound like it's for the same thing as we are getting, but it is no certainty of that at all, and you strike in this amendment an option for a public plan. so we are objecting to it -- we would like to proceed to a vote that we have a lot of amendment. mr. barr says he is willing to vote let's go to the. all of those in favor of the amendment say imac. opposed. let's go to a roll call vote.

[roll call] [roll call] [roll call]